The Guaifenesin Protocol for the Treatment of Fibromyalgia
by R. Paul St. Amand, M.D.

     Fibromyalgia is a legitimate and common entity. It is a cyclic and progressive illness manifested by multiple symptoms that may last only a few days in the early stages but later are present continuously. The disease eventually affects multiple areas and bodily systems until patients simply cycle from bad to worse. There are no diagnostic laboratory tests for fibromyalgia.

     Patients parade from one doctor to another and are often told that they have chronic fatigue, systemic candidiasis, myofascial pain, irritable bowel or vulvar pain syndrome. Physicians focus on symptoms germane to their specialty and often fail to perceive the much larger problem. Grouping a few symptoms while ignoring others leads to a medical dead end and incorrect diagnoses. The above-listed entities are actually symptoms of a much larger problem.

    The American Academy of Rheumatology recommends searching for tender points from eighteen predetermined sites on the body to make a definitive diagnosis of fibromyalgia. So-called “chronic-fatigue” patients simply have higher pain thresholds. For this reason they do not complain of body aches or stiffness but focus mainly on their fatigue and cognitive impairments. Since pain perception varies greatly, we urge physicians to seek objective evidence instead of the purely subjective response to variably tender points. The confirmation of fibromyalgia is far more secure when using our method of palpation that we call mapping (see below).

     Fibromyalgia has no set symptoms and many combinations from the following list are interwoven:

Central Nervous System: Fatigue, irritability, nervousness, depression, apathy, listlessness, impaired memory and concentration, anxieties and suicidal thoughts. Insomnia and frequent awakening due to pain result in non restorative sleep.
Musculoskeletal: Pain and generalized morning stiffness could arise from muscles, tendons, ligaments and fascia of the shoulders, neck, entire back, hips, thighs, knees, ankles, feet, inner and outer elbows, wrists, fingers, and chest. Injured or old operative sites are commonly affected. Though fibromyalgia is described as a “non-articular” disease many know better: Joint pains with or without swelling, redness and heat are frequent. The litany includes foot or calf cramps, numbness and tingling of the face or extremities.
Irritable Bowel: (Often called leaky gut, spastic colon or mucous colitis). Symptoms include nausea (often brief, repetitive waves), indigestion, gas, bloating, pain, cramps, constipation alternating with diarrhea and sometimes mucous stools.
Genitourinary: Common are pungent urine, frequent urination, bladder spasms, burning urination (dysuria) with or without repeated bladder infections and interstitial cystitis. Vulvodynia (vulvar pain syndrome) includes vaginal spasms, irritation of the vaginal lips (vulvitis) or opening (vestibulitis) and painful intercourse (dyspareunia). It typically mimics a yeast infection but without the cottage-cheese discharge. Intense PMS and uterine cramping are common. Symptoms of fibromyalgia are worse premenstrually.
Dermatological: Various rashes may appear with or without itching: Hives, red blotches, itchy bumps or blisters, eczema, seborrheic or neurodermatitis, and rosacea. Nails are often brittle and of poor quality and hair falls out prematurely. Strange sensations are common such as cold, heat (especially palms, soles and thighs), crawling, electric vibrations, prickling, super-sensitivity to touch, and flushing that is sometimes accompanied by sweating.
Head, Eye, Ear, Nose, and Throat: Headaches (migraines), dizziness, vertigo (spinning) or imbalance; dry eyes as well as itching and burning with or without sticky or crusty discharge upon awakening; blurred vision; nasal congestion and post-nasal drip; painful, burning tongue, mouth and abnormal tastes (scalded, bad or metallic); ringing in the ears (tinnitus) or lower-pitched sounds; ear and eyeball pain; sensitivity to light, sounds and odors.
Miscellaneous Symptoms: Weight gain; low grade fever; lowered immunity to infections; morning eyelid and hand swelling from fluid retention that gravitates to the lower extremities by evening where it stretches tissues causing the restless leg syndrome.
Hypoglycemia Syndrome: This is a separate entity. Thirty percent of female and twenty percent of male fibromyalgics suffer both conditions (fibroglycemia). Symptoms greatly overlap those of fibromyalgia, but sugar craving accompanied by tremors, sweating, anxiety, panic attacks, heart pounding, faintness, and frontal headaches, especially if hunger induced, are solid clues to the diagnosis. Hypoglycemics must follow a prescribed diet or recovery will not be complete even with the reversal of fibromyalgia. (See Hypoglycemia for more information.)

     Trauma, infection or stress can aggravate or tip susceptible individuals into fibromyalgia but are not the basic causes. It is generally accepted now as an inherited disease. We have treated family members that spanned three generations including four two-year-olds as well as patients who became symptomatic only in their seventies. This age spread strongly suggests a multi-genetic disease in various combinations. Boys and girls suffer equally in the pre-puberty but females predominate (85% to 15%) thereafter. Though some gene-carrying men have few or no symptoms, inheritance is possible from either parent. The cyclic accumulation of symptoms begins earlier than patients suspect but can be elicited with a careful history. Forty percent of our patients, for example, recall "growing pains" in childhood that disappeared during the true growth spurt of puberty. Untreated fibromyalgia ultimately leads to a "tartar of joints" that we recognize as osteoarthritis.

     Forty-six years ago, a patient taking a gout medication showed me that he could peel tartar (calcium phosphate) off his teeth with his fingernail. This observation indirectly led me to study an unrecognized systemic problem being reflected by deposits from the disturbed saliva. We now postulate that a defective metabolism, possibly a kidney enzyme, forces retention of phosphate, which gradually accumulates to detrimental levels in many tissues. This excess induces inadequate energy formation (ATP), cellular fatigue and malfunctions that explain all the symptoms of fibromyalgia. Our paper for interested professionals defends that theory.

     We no longer prescribe gout drugs (uricosurics). We now use guaifenesin for fibromyalgia because it has no side effects and is even safe for children. It is marketed for respiratory mucus problems and is available without prescription in various strengths, though some brands may not be effective for fibromyalgia. Currently, we can only advocate three products: the long-acting 600 mg tablets ‘Mucinex’ and one compounded for the Marina del Rey Pharmacy as well as a 400 mg tablet that is free of contaminants from Pro Health. (see Web site: fibromyalgiatreatment.com) We begin patients with 300 milligrams twice a day for one week. Feeling distinctly worse suggests adequate dosage and patients may remain on that amount. This suffices for only 20 percent of patients; if symptoms do not worsen, we increase to 600 mg. twice daily. Reversal begins for 80 percent of patients at one of these two levels leaving 20 percent who will need more. During reversal, symptoms are usually intensified and new ones may be experienced. These are not side effects, but signal that reversal is underway. Better hours eventually cluster into days and finally weeks. During this subjective roller coaster ride, lumps and bumps soften, fragment and gradually clear. Recovery is more rapid than the time it took to develop the illness. Even genetically-slow responders, clear at least one year of metabolic debris every two months. Longer endured disease requires more time to restore. Newer lesions clear first and the oldest ones last.

     The original description of fibromyalgia as “rheumatism with hard and tender places” has certainly been forgotten. Tender-point examination limited to a few preordained parts of the body has less value than our totally objective body mapping. We use our finger pads as though we were trying to iron out underlying tissue and thereby find the swollen places within muscles, tendons and ligaments. We record their location, size and degree of hardness on a body caricature that becomes a baseline for future comparisons. Unless swollen, the purely subjective tender spots are excluded in mapping. Subsequent examinations and patient inputs readily determine drug dosages and sequential disease regression. We hide previous maps until we complete the examination and only then compare them to confirm progress. The most important site for confirming the diagnosis and assuring future success is the left thigh. The outside of the quadriceps muscle (Vastus lateralis) and the front part (Rectus femoris) are involved in 100% of adults and clear within the first month upon attaining adequate dosages.

     Ignoring the following will guarantee treatment failure. All salicylates including aspirin completely block the benefits of guaifenesin for fibromyalgia. This occurs at a kidney site—something well documented with uricosuric gout medications. Salicylates are often found in pain medications. Less appreciated is the fact that all plants manufacture them in quantities that vary with genus and from crop to crop. They are stored in bark, leaves, roots, and seeds where they serve to repair damage or as weapons against soil bacteria and fungi. Salicylates are readily absorbed through the skin and intestine when introduced from botanicals in cosmetics, herb derivatives in medications and supplements, sap or oil from plants, gels and extracts. Individual genetics determine ease of blocking but all patients should assume a high level of susceptibility and take no risks. New or replacement products should be carefully inspected for changes made by manufacturers. Items on Salicylate-free lists should be double checked for accuracy.

     The following is a partial guide to natural and synthetic salicylates that must be avoided:

Medications: (1) Pain products containing salicylate or salicylic acid, for example, aspirin, Salflex, Anacin, Excedrin, Disalcid. (2) Herbal medications such as St. John’s Wort, gingko biloba, saw palmetto, blue-green algae, Echinacea, or nonni juice; vitamin supplements with alfalfa, parsley, rose hips or bioflavonoids. (3) Wart or callus removers, many acne products and dandruff shampoos contain salicylic acid. (4) Pain creams, balms and lotions such as Ben Gay, Myoflex, Zostrix, Capsaicin or capsicum. (6) Medications such as Pepto Bismol, Asacol, Alka Seltzer or Urised.
Cosmetic and Topical Products: (1) Skin cleansers or exfoliants that use salicylic/ betahydroxy acid(s). (2) Hair shampoos, conditioners or sprays with plant derivatives. (3) Bubble baths and lotions with essential oils or plants such as aloe, ginseng, lavender; almond or grape seed oils etc. (5) Sun screens or tanning lotions with aloe, octisalate, homosalate, or meradimate. (6) Lipsticks or balms, Chapsticks or sunscreens with aloe, camphor, menthol, or castor oil. (7) Deodorants with castor oil. (8) Sticky plant juices or saps adhere to the skin while gardening or weeding (Patients should wear canvas gloves and avoid barefoot contact with grass). (8)Beware of tissues, toilet paper and baby wipes with aloe.
Shaving Aids: (1) Shaving creams with aloe, mint, menthol or mentholatum will block. (2) Razors with aloe strips adjacent to the cutting edge deliver salicylates through microscopic cuts. Vitamin E, lanolin, and baby Oil are all acceptable.
Oral Agents: (1) Most mouth washes contain mint, wintergreen or salicylate (Listerine, Scope). (2) Toothpastes contain salicylates, as well as fresh or artificial mint, often unlisted. Use Grace FibroSmile toothpastes, Personal Basics by Andrea Rose or the non-mint ones made by Tom’s of Maine. Baking soda and/or peroxide provide good cleansing and whitening. The non-mint pre-brushing rinses are acceptable as are the Grace Fibrosmile Mouthwashes. (3) Use no lozenges, dental floss, breath fresheners or chewing gums with any mint flavor, including menthol, wintergreen, peppermint or spearmint. (Fruit/Cinnamon flavors may mask mint hidden by the stronger flavors.).
The word active ingredients should alert one to scrutinize inactive ones as well.