Help me get my facts straight before I dump my doctor
Posted: 10 June 2012 02:13 AM   [ Ignore ]
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I have fibromyalgia, so I always have to be careful with doctors. There are those that, despite the literature and consensus of professional organizations, believe that it’s not real or psychosomatic. Thankfully I’ve only run into two of those. There’s also those that either think woo will work or, realizing they don’t have anything more they can do for me, think they should recommend it in the hope that the placebo effect will kick in.

I’m seeing one of the latter at the moment. I’m in the process of switching PCPs, but I want to make sure I have my science straight before I go to see my new one and explain why I switched.

The two main reasons are that she continually pushed me to take multivitamins and use accupuncture. Those I’m confident on the science. The last straw was that she wanted to get me off of muscle relaxants because she doesn’t like the side effects (which I’ve never complained about, and in fact don’t have much of a problem with) and use magnesium citrate supplements instead.

I’m pretty sure that’s bunk since none of the reputable websites about fibromyalgia mention it, but I want to be absolutely sure before I talk to my new doctor so I don’t look like a crank. I’ve looked through PubMed and Google Scholar, but does anyone know about any studies that might have led my previous doctor to believe that Mg supplementation might help fibromyalgia-related muscle spasms? Or was it just that standard woo argument that since magnesium deficiency causes muscle spasms, muscle spasms of any cause can be treated by magnesium supplements?

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Posted: 10 June 2012 04:30 AM   [ Ignore ]   [ # 1 ]
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I can’t answer your question, and at any rate am not a doctor, but I do know that some muscle relaxants are habit-forming, and should not be taken for extended periods of time. If that’s the case with what you were taking, then at least in that regard your doctor was doing you a favor by trying to get you off of them.

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Posted: 10 June 2012 05:15 AM   [ Ignore ]   [ # 2 ]
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I know that. While the ones I’m on have a small risk of dependency, for the last seven years my doctors have helped me manage that risk, in part by limiting their use, and in part by switching to a different prescription when I start developing tolerance to them, which has worked pretty well and from what I understand is pretty standard practice.

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Posted: 10 June 2012 05:48 AM   [ Ignore ]   [ # 3 ]
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Fibromyalgia is a difficult disorder to both diagnose and treat for several reasons. The lack of any definitive test for fibromyalgia means that doctors have to rely on a symptom cluster to make their diagnosis. As a result people are often given this diagnosis when in fact they may have depression, chronic fatigue syndrome or any of a long list of other disorders. The overlap with these other conditions has created doubt in many physicians minds as to whether fibromyalgia is truly a distinct and separate disorder. Most experts in the field believe that it is.

Because any group of patients being treated most likely includes people with a hodge podge of conditions it can be difficult to get solid results about what works and what doesn’t. The fact that we don’t know the underlying cause or mechanism of the disorder makes it even harder to really come up with a rational way to treat it so treatment is often directed at the symptoms. Doctors have tried dozens of different treatments over the years from antidepressants, to muscle relaxants, and anti-seizure medications.

I’ve said it before ad I will repeat it here. Not all doctors are good scientists. Some of them have been been sucked into the CAM/woo movement just like Dr. Oz. Sometimes this allows them to build a practice treating patients who have tried everything else and are frustrated with traditional treatments. Some doctors use CAM in these situations out of sheer frustration. The patient has chronic debilitating symptoms and nothing else has helped so they figure “whats the harm” and because of the nature of the symptoms the placebo affect can be strong.

Regarding the muscle relaxants Doug makes a good point. They can be habit forming and that may be why your doctor is concerned. As far as I am aware though there is no true physical addiction that occurs with most muscle relaxants. Patients dont usually go through physical withdrawal when they stop using these drugs after prolonged use and they dont require higher and higher doses to get the same benefit over time. You might want to ask your physician to explain more precisely what her concerns are and see if you can work out a compromise. On a side note, the authorities have been watching physicians more closely over the past year or two to weed out doctors who over prescribe certain drugs because prescription drug abuse has become a huge problem in this country. I’m not saying that is the reason for her reluctance to prescribe this drug (Its not actually a controlled substance) to you but having too many patients who need monthly prescriptions for certain drugs can increase a doctors numbers and may make them pop up on the government’s radar.

As far as the magnesium is concerned, magnesium does play a role in muscle contraction and in the body’s ability to maintain proper potassium levels which also is important to muscle contraction. I am not an expert on the treatment of fibromyalgia but a PubMed search brought up a number of articles addressing magnesium in the treatment of this disorder.

http://www.ncbi.nlm.nih.gov/pubmed?term=fibromyalgia magnesium

[ Edited: 10 June 2012 05:51 AM by macgyver ]
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Posted: 10 June 2012 08:47 AM   [ Ignore ]   [ # 4 ]
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Why would the doctor have you take Mg citrate? That makes an effective purge, not sure what it would do for your muscle pain. On the other hand, magnesium is a muscle relaxant, and taken in large doses can cause muscle weakness, nausea and vomiting as well as respiratory depression. Just because it is a ‘natural mineral’ doesn’t mean it is free of harmful effects.

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Posted: 10 June 2012 05:18 PM   [ Ignore ]   [ # 5 ]
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macgyver - 10 June 2012 05:48 AM

Regarding the muscle relaxants Doug makes a good point. They can be habit forming and that may be why your doctor is concerned. As far as I am aware though there is no true physical addiction that occurs with most muscle relaxants. Patients dont usually go through physical withdrawal when they stop using these drugs after prolonged use and they dont require higher and higher doses to get the same benefit over time. You might want to ask your physician to explain more precisely what her concerns are and see if you can work out a compromise. On a side note, the authorities have been watching physicians more closely over the past year or two to weed out doctors who over prescribe certain drugs because prescription drug abuse has become a huge problem in this country.

Yeah, she was fairly specific that it was the fact that “muscle relaxants act centrally” (and Mg, if it worked, wouldn’t?) and she doesn’t like the side effects. I use two different kinds and switch off when they start to lose efficacy (like most drugs do, after a point) to avoid any risk of dependency, and the risk of dependency for these particular ones are really low even if I didn’t switch. I have a family history of addiction, and kicked a caffeine addiction in college, so I’m very careful about dependence. If she had been concerned about addiction potential, I’d have listened to her. She convinced me to go off of my “emergency” muscle relaxant, Soma, because of that risk. But that’s not what she was worried about this time.

And like I said, I’m already switching doctors. I’d already become too uncomfortable with her recommending woo, whether out of gullibility or paternalism; this was just what convinced me to switch now rather than later.

macgyver - 10 June 2012 05:48 AM

As far as the magnesium is concerned, magnesium does play a role in muscle contraction and in the body’s ability to maintain proper potassium levels which also is important to muscle contraction. I am not an expert on the treatment of fibromyalgia but a PubMed search brought up a number of articles addressing magnesium in the treatment of this disorder.

http://www.ncbi.nlm.nih.gov/pubmed?term=fibromyalgia magnesium

Yeah, I ran that exact search, actually, along with a bunch of others. The problem is that basically all of the studies are basic science and not transferable to medical practice, and the couple that aren’t are crap. I was hoping someone might know of others.

asanta - 10 June 2012 08:47 AM

Why would the doctor have you take Mg citrate? That makes an effective purge, not sure what it would do for your muscle pain. On the other hand, magnesium is a muscle relaxant, and taken in large doses can cause muscle weakness, nausea and vomiting as well as respiratory depression. Just because it is a ‘natural mineral’ doesn’t mean it is free of harmful effects.

Yeah, the best part is that, in the same email conversation, I mentioned I was having constipation and asked if she had a recommendation of laxatives, since I’m on a fair number of prescriptions and didn’t want to take one that might interfere with absorption. She recommended PEG for constipation and Mg citrate for muscles in the same email, without even mentioning Mg salts’ laxative effects.

Do you have a source for Mg being a muscle relaxant? Because that’s what I’ve been looking for.

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Posted: 10 June 2012 07:15 PM   [ Ignore ]   [ # 6 ]
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We use it to stop preterm labor because it is a smooth muscle relaxer, but it will also slow peristalsis and make it difficult to digest food, and cause muscle weakness. You have to be careful with the dosing.
Here is an article describing how we use it (we put it directly in the veins in controlled dosing) The antidote is calcium.

http://www.webmd.com/baby/magnesium-sulfate-for-preterm-labor

Discuss it further with your doctor. Have her address your concerns and questions.

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Posted: 10 June 2012 07:23 PM   [ Ignore ]   [ # 7 ]
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I too found nothing other than in vitro and animal model studies on the muscle relaxant effects of magnesium. Most seemed to refer to smooth muscle, which is a bit different from skeletal muscle. If there really aren’t any other studies on the subject, I would probably put it in the “plausible but unproven” category. Not necessarily woo unless it is presented with unjustified certainty, but I think asking for the evidentiary basis your doctor is using is reasonable. My guess is she won’t have any more (or as much as) you have found. It sounds like you have enough reason to jump ship anyway, regardless of this issue.

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Posted: 10 June 2012 09:55 PM   [ Ignore ]   [ # 8 ]
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mckenzievmd - 10 June 2012 07:23 PM

I too found nothing other than in vitro and animal model studies on the muscle relaxant effects of magnesium. Most seemed to refer to smooth muscle, which is a bit different from skeletal muscle. If there really aren’t any other studies on the subject, I would probably put it in the “plausible but unproven” category. Not necessarily woo unless it is presented with unjustified certainty, but I think asking for the evidentiary basis your doctor is using is reasonable. My guess is she won’t have any more (or as much as) you have found. It sounds like you have enough reason to jump ship anyway, regardless of this issue.

Yes, it is a smooth muscle relaxant, but in OB patients on it for an extended amount of time they tend to feel weak and complain of nausea. We are able to introduce it directly into the bloodstream. I don’t know what the studies of oral magnesium shows.

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