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From Dr. Rodger Murphree -
NSAIDs
Nonsteroidal anti-inflammatory drugs (NSAIDs) can be helpful, especially when used for inflammation that comes from traumatic injuries (sprains, strains, accidents, etc.). They can also be effective in relieving pain and inflammation associated with chronic pain syndromes including all forms of arthritis and even some cases of FMS. However, long-term use of these medications can cause a host of unwanted side effects, and NSAIDs do not actually correct the cause of pain. In fact, they can accelerate joint destruction and cause intestinal permeability, which leads to more inflammation.
You might have heard of how drug company Merck pulled its NSAID Vioxx off the market. They were responding to the results of a long-term (18-month) clinical trial that revealed that some patients developed serious heart problems while taking the drug. The data that ultimately persuaded the company to withdraw the drug indicated 15 cases of heart attack, stroke, or blood clots per thousand people each year over three years, compared with 7.5 such events per thousand patients taking a placebo.
One of the FDA’s own scientists, Dr. David Graham, estimated that Vioxx has been associated with more than 27,000 heart attacks or deaths linked to cardiac problems. There is disagreement within the FDA over these findings, but they are still staggering to consider.
Potential side effects of drugs like Vioxx: Vioxx is what doctors call a “COX-2 inhibitor.” These drugs were developed to reduce pain and inflammation without the risk of ulcers and other–potentially deadly–gastrointestinal side effects posed by aspirin and similar medications. But in solving one serious problem, COX-2 inhibitors might be causing another. By blocking COX-2 enzymes, Vioxx reduced the risk of internal bleeding but also kept COX-2 enzymes from doing the important work of counteracting COX-1 enzymes, which narrow the blood vessels. The blood vessels were then remaining too narrow, increasing the chances of a dangerous blood clot forming.
Other COX-2 inhibitors, including Celebrex and Bextra, are being linked to an increased risk of heart attack and stroke. It may be a matter of time before all COX-2 inhibitor drugs are pulled from the market.
And the really sad news is that although Vioxx did apparently protect the stomach as intended, other COX-2 inhibitors do not. Celebrex and Bextra have turned out to be no safer to the stomach than older NSAIDs. And studies show that neither drug alleviates pain any better than the older medicines.
Plus, the COX-2 inhibitors cost close to $3.00 per pill. Over-the-counter pain relievers, in contrast, cost pennies a dose. Other NSAIDs are safer than COX-2 inhibitors. These include Mobic (meloxicam), Motrin (ibuprofen), Daypro (oxaprozin), and Naprosyn (naproxen). But still, unless nothing else works to control your pain, NSAIDs shouldn’t be used for any extended period of time.
Potential side effects of other NSAIDS: A person taking NSAIDs is seven times more likely to be hospitalized for gastrointestinal adverse effects. The FDA estimates that 200,000 cases of gastric bleeding occur annually and that this leads to 10,000 to 20,000 deaths each year. NSAIDs more than double a person’s risk of developing high blood pressure, possibly leading to more medication. In one study, 41% of those who had recently started on medication to lower their blood pressure were also taking an NSAID.
Narcotic Anelgesics
These pain-relieving medications, which act on the central nervous system, are extremely effective in relieving acute and chronic pain. Unfortunately, they eventually lose their effectiveness as your body becomes “tolerant” of them. If these analgesics worked long-term, I’d be recommending them. However, the person taking these medications finds that she has to take an ever-increasing dose to get any relief. Before she knows it, her body is addicted to a potentially life-threatening drug. Typically, another drug or additional drugs are then tried, and the process continues until the person becomes zapped of her vitality, living hour to hour in accordance with her medication schedule.
Narcotic analgesics include Ultram (tramadol), Lortab (hydrocodone), Darvocet (propoxyphene and acetaminophen), the Duragesic patch (fentanyl), Percocet (oxycodone and acetaminophen), Vicodin (hydrocodone and acetaminophen), Zerlor (dihydrocodeine, acetaminophen, and caffeine), and others. Ultram, which is less addictive, has been considered the best choice for those with FMS if a narcotic pain medication is truly necessary. However, many are not recommending Ultram due to its risk for causing seizures. Taking Ultram along with SSRI antidepressants increases the risk.27
Other side effects include cold, clammy skin; severe confusion; convulsions; diarrhea; severe dizziness; severe drowsiness; increased sweating; low blood pressure; nausea or vomiting; severe nervousness or restlessness; pinpoint pupils in the eyes; difficulty breathing; slow heartbeat; stomach cramps or pain; and severe weakness. These can happen to either you or any baby you are breastfeeding. More rare side effects include hallucinations, severe swelling in the face, and unusual bruising and/or bleeding.
Withdrawing from these medications can be a traumatic experience in itself, especially after your body has begun to build up a tolerance and expects to keep getting the drug. When the drug treatment stops, you could experience body aches; diarrhea; a fast heartbeat; a fever, runny nose, or sneezing; nausea or vomiting, nervousness or irritability; shivering or trembling; stomach cramps; trouble sleeping; or weakness, among other symptoms.
Sleep Aids
Ambien (zolpidem) has been a very popular prescription medications in the United States. Lunesta (eszopiclone) is a similar sleep aid. Both are short-acting, designed to last four-six hours. If a patient takes a half-dose before bed, then he can take an additional half-dose if needed in the middle of the night. The newer Ambien CR tries to avoid this midnight redosing, however, by including a slower-release layer designed to last all night. Even though the literature on Ambien suggests that most patients don’t build up a tolerance, many do. But other patients do well on Ambien, and it does promote deep restorative sleep.
Potential side effects of sleep aids: short-term memory loss, fuzzy thinking, sedation, next-day hangover, mood disorders (anxiety and depression), flu-like symptoms, muscle aches, in-coordination, dizziness, diarrhea, and others. Long-term use can lead to other symptoms, including upset stomach, joint pain, upper respiratory-tract infection, sore throat, urinary infection, and heart palpitations. Don’t these symptoms sound a lot like those of FMS/CFS? If you do choose a sleep aid, familiarize yourself with its side effects, as they might show up later and appear at first to be unrelated.
Antidepressants
Selective serotonin re-uptake inhibitors (SSRIs), such as Zoloft (sertraline), Paxil (paroxetine HCl), Celexa (citalopram), Prozac (fluoxetine), and Luvox (fluvoxamine), work by increasing the brain’s use of the neurotransmitter serotonin. (Serotonin deficiency is linked to anxiety, depression, lowered pain tolerance, poor sleep, and mental fatigue.)
Potential side effects of antidepressants: Upset stomach, constipation, headache, heartburn, diarrhea, rash, muscle pain, mental confusion, hostility, swelling in the arms or legs, dizziness, nightmares, drowsiness, fatigue, chest pain, anxiety, nervousness, sleeplessness, weakness, changes in sex drive, impotence, tremors, difficulty in urinating, sensitivity to light, dry mouth, loss of appetite, nausea, itching, weight gain, hair loss, dry skin, bronchitis, abnormal heart rate, twitching, anemia, low blood sugar, low thyroid function, blurry vision, and early-morning hangover.
Harvard Medical School’s Dr. Joseph Glenmullen recently reported on the many dreadful side effects associated with conventional antidepressant medications. His report included neurological disorders, sexual dysfunction (in up to 60% of users), debilitating withdrawal symptoms (including hallucinations, electric shock-like sensations, dizziness, nausea, and anxiety), and decreased effectiveness in about 35% of long-term users.
Benzodiazepines
These medications are usually used as anti-anxiety medication, and they include Xanax (alprazolam), Klonopin (clonazepam), Ativan (lorazepam), Restoril (temazepam), BuSpar (buspirone hydrochloride), Tranxene (clorazepate dipotassium), Serax (oxazepam), Librium (chlordiazepoxide), Tegretol (carbamazepine), Valium (diazepam), Trileptal (oxcarbazepine), Seroquel (quetiapine), Risperdal (risperidone), and Symbyax (olanzapine and fluoxetine HCl).
Benzodiazepines are addictive, and patients build up a tolerance so that the drugs eventually lose effectiveness as a sleep aid. Addiction may occur in as little as two weeks.
The big problem with these medications, though, are the side effects, many of which mirror the symptoms of fibromyalgia and CFS. And they don’t promote deep, restorative sleep, so they are definitely not worth the risk.
Benzodiazepines should be weaned off, starting as soon as possible. Be sure to work with a medical doctor as you wean off, and take it slow to avoid terrible withdrawal symptoms.
Potential side effects of benzodiazepines: Poor sleep; seizures; mania; depression and suicidal thoughts; tinnitus (ringing in the ears); transient amnesia; dizziness; agitation; disorientation; low blood pressure; nausea or vomiting; fluid retention; muscular incoordination and tremors; sexual dysfunction; prolonged drowsiness or a trance-like state; fatigue; headaches; body aches and pains; chills; runny nose; cough; congestion; difficulty breathing; feelings of discouragement, sadness, or emptiness; diarrhea; difficulty swallowing; vision and voice changes; and a host of others.
The crippling side effects and addictive nature of these drugs have been known for at least 40 years, yet doctors continue to prescribe them at an ever-increasing rate, especially for seniors. Surveys show that over 5.6 million adults over the age of 65 are now taking benzodiazepines. A mouth-dropping 50% of all women 60 and older will be prescribed a benzodiazepine drug.
And since addiction often occurs within four weeks of starting these drugs, the majority of these folks are now dependent on them.
Tolerance to the hypnotic (sleep) effects of these drugs may occur within one week. Symptoms of tolerance are identical to drug-withdrawal symptoms and may include anxiety, panic, severe insomnia, muscle pain and stiffness, depression, suicidal thoughts, rage, heart and lung problems, and agoraphobia (extreme fear of public or crowded spaces).
Tragically, only 10%-30% of people are able to successfully stop taking these drugs. The rest are addicted for life.
Anticonvulsant Drugs
GABA inhibitors such as Gabitril (tiagabine HCl) and Neurontin (gabapentin) are anticonvulsant medications originally used to control seizures. They are now being used to block nerve-related pain (neuralgia), including pain caused by herpes zoster. These medications are also prescribed with some success for chronic headaches.
Pfizer’s anticonvulsant Lyrica, the first FDA-approved drug for the treatment of fibromyalgia, is very similar to Neurontin. The two compounds share similar mechanisms of action, but Lyrica is supposed to be as effective as Neurontin but at lower doses, which hopefully means lower side effects. Still, Lyrica is associated with all the same side effects as Neurontin.
Some say the Lyrica doesn’t work well enough to have warranted FDA approval. In 2004, reviewers recommended against approving the drug, citing its side effects. But the FDA approved it anyway. Pfizer then asked the FDA to expand the approved uses of Lyrica to include the treatment of fibromyalgia, and the agency did so in June 2007.
Is Lyrica effective? According to clinical trials, patients taking Lyrica reported that their pain fell, on average, about two points on a 10-point scale, compared with one point for patients taking a placebo. Not a big effect, to say the least.
Topamax (topiramate) is used primarily for adjunctive therapy for tonic-clonic seizures. It is also used to treat anxiety disorders.
Potential side effects of anticonvulsant drugs: prolonged drowsiness or a trance-like state; dizziness; weakness; blurry or double vision; fluid retention; muscular incoordination, balance changes, clumsiness, and accidental injury; long-term ophthalmic problems (abnormal eyeball movements and disorders); tremors; rapid weight gain or severe weight loss; severe back pain; constipation and painful, uncontrollable, or difficult urination; muscle aches; memory loss; weakness; depression, confusion, dementia, and delusions; difficulty breathing or speaking; itching; involuntary muscle twitching; serious rash; runny nose; swelling; stabbing or tingling pain; seizures; and even rarely, coma.
Topamax can also cause “serious eye damage and/or blindness.” This is a quote from the manufacturers themselves. They go on: “As of August 17, 2001 there have been 23 reported cases: 22 in adults and one in pediatric patients. It is generally recognized that post-marketing data are subject to substantial under-reporting.”
Beta-Blockers
Beta-blockers, such as Inderal (propranolol); Lorpressor or Torprol (metoprolol); and Tenormin (atenolol) are used for long-term management of angina (chest pain), mitral valve prolapse (MVP), irregular heartbeat, and high blood pressure. I’m always amazed at how many of my patients are taking these drugs for MVP, even with their very serious side effects.
These drugs slow the heart rate, which reduces cardiac output and leads to low blood pressure and fatigue. The brain and muscles then aren’t getting enough blood and oxygen, and this can lead to fuzzy thinking, poor memory, depression, anxiety, and fatigue.
Potential side effects of beta-blockers: According to Mark Houston, MD, associate clinical professor of medicine at Vanderbilt School of Medicine, side effects associated with beta-blockers include congestive heart failure, reduced cardiac output, fatigue, heart block, dizziness, depression, decreased heartbeat and function, cold extremities, paresthesia (a feeling of “pins and needles”), shortness of breath, drowsiness, lethargy, insomnia, headaches, poor memory, nausea, diarrhea, constipation, colitis, wheezing, bronchospasm, Raynaud’s syndrome (burning, tingling, pain, numbness, or poor circulation in the hands and feet), claudication, muscle cramps, muscle fatigue, lowered libido, impotence, postural hypotension, raised triglycerides, lowered HDL, raised LDL, and high blood sugar.
In my experience, the best way to stop the symptoms associated with heart irregularities, including MVP, is to correct magnesium deficiency. Magnesium is a natural sedative that relaxes muscles, and the heart is, of course, mostly muscle. The smooth muscle contained in the blood vessel lining is also dependent on magnesium.
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About Dr. Rodger Murphree
Dr. Murphree is a board-certified nutritional specialist and chiropractic physician who has been in private practice since 1990. He is the founder and past clinic director for a large integrated medical practice located on the campus of Brookwood Hospital in Birmingham, Alabama. The clinic, which combined prescription and natural medicines for acute and chronic illnesses, was staffed with medical doctors, chiropractors, acupuncturists, nutritionists, and massage therapists. Dr. Murphree is the author of five books, including , , and .
Dr. Murphree has appeared on numerous radio and television programs including Fox, NBC, ABC, and CBS. He is a regular contributor for several public and peer reviewed journals and magazines including Nutra-News, The Townsend Letter for Doctors and Patients, and The American Chiropractor.
In 2003, Dr. Murphree sold his integrative medical practice. He now maintains a busy solo private practice in Birmingham, Alabama, and conducts one- and two-day medical continuing education seminars. His website is .
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