Fibromyalgia Syndrome and Heavy Metal Toxicity

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Fibromyalgia Syndrome and Heavy Metal Toxicity

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Dietrich Klinghardt, MD, Ph.D.

Introduction:

Fibromyalgia has found its firm place in the spectrum of pain disorders in

the mid 1980s after Goldenberg1 established the major criteria for diagnosis,

which subsequently were further refined by the American College of

Rheumatology2. These include:

1. At least 11 of 18 specific tender points (in the absence of tenderness of

other randomly chosen points) in 3 out of 5 possible body regions: 1. Left

side of body 2. Right side 3. Above waist 4. Below waist 5. Axial skeleton -

often combined with morning stiffness (78%)

2. Mild depression

3. Disturbed sleep (73%)

4. Fatigue (85%)

5. Increased inability to cope with life’s normal chores

6. Absence of elevation of sedimentation rate

7. Absence of other demonstrable pathology

An estimated three to six million patients in the US are affected by FMS3

The goal of treatment has been to establish normal sleep cycles through the

use of low dose sleeping medication to boost the body's level of serotonin,

and reducing pain through either NSAIDS or complimentary modalities such as

exercise, physical therapy, relaxation techniques, massage, and biofeedback3.

In recent years it has been more and more obvious that fibromyalgia is a

syndrome, not a disease, with many possible underlying and/or contributing

causes. Based on new concepts of the illness other names were suggested such as

“

Dysregulation Spectrum Syndrome†(DSS). 4

Amongst the causal factors discussed currently are the following:

1. Hormonal abnormalities - most common5:

a) Subclinical adrenal failure

b) Subclinical hypothyroidism

2. Nutritional causes (magnesium deficiency, deficiency of

aminoacid-neuropeptide precursors etc.) 6

3. Systemic toxicity7 (petrochemicals, organophosphates and chlorines,

heavy metals)

4. Psycho-emotional problems8 (unresolved conflicts, post-traumatic stress)

5. Structural problems (whiplash injury, craniosacral dysfunction, “

osteopathic lesionsâ€)

6. Environmental stress9 (underground water lines, electro-smog)

7. Idiopathic/genetic10

Heavy Metal Toxicity:

In most of today’s toxicological literature the term “heavy metal†is

used

interchangeably with the term “toxic metalâ€. In this paper we will discuss

heavy metal toxicity as a common co-factor in FMS. The experience shared here

was gained in running a multidisciplinary pain clinic from 1984 - 1996

(author D.K.). In addition to the standard intake interview and exam, careful

attention was given to historical data suggesting toxic exposure in the past.

Since the major source of mercury body burden (in patients that did not have

professional exposure or extreme exposure from eating contaminated fish such as

in Minamata, Japan) is from dental amalgam fillings11, 12, we also used a

dental questionnaire and dental evaluation in the standard work-up of our

chronic pain population. The average amalgam filling contains 50% metallic

mercury,

which gradually is released from the filling over many years16. We also

utilized dental panorama x-rays in every patient, assessing the number of root

filled teeth, the number and size of radiolucent jawbone areas (infections or

NICO lesions13 and the number and quality of dental fillings, onlays, crowns

and bridges. It soon became clear, that there was a direct relationship

between chronic pain syndromes and poor dental status. Recently a high

correlation

has been found between poor dental status and coronary heart disease in a

study of 9760 US veterans14. Research at the University of Kentucky showed

clearly that jaw bone infections and devitalized teeth contain toxins that are

more noxious then hydrogen sulfide (H2S) and lead to the destruction of at

least

5 essential enzymes in the CNS15. Silver amalgam fillings give off

substantial amounts of mercury vapor from the moment they are placed, which is

absorbed to over 80 % by the mucous membranes of the oral cavity and lungs15.

Mercury is lipophilic and has long been recognized as a potent neurotoxin17. It

has

been suggested as a possible cofactor in chronic pain syndromes for many

years. From these reports it appeared reasonable to suspect, that some cases of

FMS are caused by either infections in the oral cavity and/or by mercury

toxicity. Other metals are also known as neurotoxins, amongst them lead,

cadmium

and aluminum.

Diagnosis:

Lead toxicity can be diagnosed with a simple inexpensive test (hair

analysis). Therefore it has been given more attention by researchers worldwide

then

the equally important toxicity from other metals. Aluminum, cadmium and

mercury toxicity is clinically diagnosed today by using a “challenge testâ€:

an

appropriate complexing or chelating agent is given orally or injected

intravenously followed by a 6 or 24 hour urine collection. The specimen is then

examined in the laboratory for the presence of the metal in question18.

In the years 1990-1991 we examined 10 consecutive FMS patients. The

diagnosis of FMS was made prior to referral to our clinic by physicians in the

orthopedic/rheumatology community and confirmed by us using the criteria

outlined

above. We excluded hypothyroidism by using the following lab tests: free T3,

free T4 and TSH. Hypoadrenia was ruled out by obtaining a 24-hour urine

hormone panel or saliva panel. Patients with a significant motor vehicle

accident

or trauma history were excluded. 7 patients were women, 3 were men (average

age of 44.2 years).

Method:

Initially each patient received an injection with DMPS

(Di-Methyl-Sulfonyl-Methane), 3 mg/kg slow iv., followed by a 24-hour urine

collection and

analysis for toxic metals. DMPS is currently the safest complexing agent

available

with the widest range of applications. It is most effective for copper, zinc,

arsenic, mercury, lead and cadmium. If the test showed high levels of a

toxic metal, the same injection was given once a month and the progress

monitored

with a simple pain drawing and self rating of the patients condition: no

improvement - moderate improvement - good improvement and resolution of pain

condition.

DMPS was first introduced in Russia in the late 1960s as a further chemical

development from BAL (British Anti Lewisite) and is used today in all Western

countries (except the US, where no agent is listed in the PDR for this

purpose) as the preferred agent to stimulate the excretion of mercury and lead.

It

is quite ineffective for aluminum toxicity. DMPS is FDA approved as a

compounding agent to be used by custom compounding pharmacists for the use of

individual patients in need for it.

We discontinued the injections, when

1. The patient had complete resolution of their FMS symptoms

2. With consecutive injections there was no further clinical improvement

3. All metals in the urinalysis dropped to normal levels.

Since normal levels for mercury were not known at the time, we established

our limit at 4 micrograms of mercury per gram of urinary creatinine based on

our clinical experience (we would often see clinical improvement, when levels

dropped from above to below 4 micrograms of Hg/gram of creatinine. We rarely

saw a clinical improvement when treating a patient who on consecutive

injections had a level of 4 or less micrograms of mercury/gram of creatinine).

By comparing the results of the urine test with the information from the

intake exam we tried to establish the possible source(s) of exposure to the

metal(s) found.

To trace the exposure to toxic metals was not always easy: a zirconium toxic

patient was working as a sales clerk in a suede-clothing store. Suede

leather is made by exposing the leather to zirconium (in the old days mercury

was

used for this purpose) which starts to evaporate when the clothes are hung in

a store or at home in the closet. The patient had to stop working in the

store before her urine-levels began started to drop. The cadmium exposures we

discovered were clearly linked to smoking and automobile exhaust. The aluminum

toxicity was from the tap water the affected patient was drinking.

Following the basic rule of toxicology “remove the source of exposure†each

patient was asked to act on the findings and avoid further toxic exposure,

no matter how difficult, expensive and inconvenient this may be.

If the patient had amalgam fillings a dentist skilled in the removal

procedure removed them. The fillings were replaced by biocompatible metal free

fillings and/or metal-free crown and bridgework.

Findings:

· Average number of root canal filled teeth/per patient: 2.4 (0-8)

· Average number of suspected jaw bone lesions (infections, NICO

lesions, sclerosis): 4.3 (2-10)

· Average number of “silver fillingsâ€: 7.6 (0-16). 2 patients had

no

silver fillings at the time of our intake exam, but had them for many years

before they were removed. However, both showed extremely high levels of

mercury in the initial test.

· Elevated urine levels for one (or more) toxic metal after initial

challenge injection: 9 of 10 patients ( some patients showed more then one

toxic metal)

· Mercury: 7 of 10 (15-2900 micrograms of Hg/ gram of creatinine)

· Lead: 3 of 10

· Cadmium: 1 of 10

· Aluminum: 1 of 10

· Zirconium: 1 of 10

The one patient that did not have elevated metal levels decided to continue

on the once/month DMPS regime, since she felt better after the first

injection. On her 3rd treatment, she started to show significantly elevated

mercury

levels, which did not drop until after the 6th treatment.

Clinical results:

· All but one of the patients with FMS improved.

· Within 6 months 5 patients experienced complete disappearance of

their symptoms.

· Three patients had “good“ improvement. Two of these patients had

complete disappearance of their symptoms after removal of the root filled

teeth, which was done between four and nine months after begin of treatment.

· One patient stayed completely unchanged during the initial

observation period of six months but improved dramatically with continuation of

the

injections. Another patient felt quite ill after each DMPS injection (nausea,

G.I. upset) and was switched to another complexing agent (DMSA, 10 mg /kg

body weight in three divided doses, three days on, 11 days off). With this

regime the patient had no significant side effects and improved to “good

improvement†within seven months.

· One patient showed initially only elevated aluminum levels. He was

treated with Desferal (500 mg, given once/month s.c.) for 4 months, before

urinary mercury levels became elevated. At that time we switched to DMPS,

which resolved the FMS symptoms within 5 months

· Average number of treatments to “good improvementâ€: seven.

· Average number of treatments for entire course: 11 (4-23).

Conclusion:

This small subgroup of FMS patients had a dramatic response to minimizing

their exposure to toxic metals and reducing their toxic metal body burden.

Since there is no healthy control group the results could not be compared

statistically. This pilot study suggests however, that heavy metal toxicity

should

be considered as a possible cause or co-factor in fibromyalgia syndrome.

Outlook:

We suspected, that FMS in these patients is a reflection of heavy metal

contamination of the limbic system and that FMS is a limbic system disorder, as

suggested by other researchers 19. However, when we performed trigger point

injections in selected patients in an unpublished follow-up study using a mix

of DMPS and procaine, we found clearly elevated levels of urinary metal

excretion in the triggerpoint injected group as compared to the group only

injected

intravenously.

This suggests that in FMS not only the limbic system but also the muscle and

connective tissue itself is toxic, and further research should be directed

to this issue.

Many years have gone by since these early observations; hundreds of FMS

patients have been treated with our approach. The results and conclusions

presented in this paper have held up over time. Our approach has been modified

however. Today we use autonomic response testing (ART) as a diagnostic

procedure

developed by one of the authors (D.K), which helps to predict non-invasively

where in the body which metals are stored and which detoxifying agent would be

most suitable for a particular patient or problem20. We found that

physical21 and/or emotional scars22 can be a significant handicap to

detoxification.

We also found that any degree of heavy metal contamination of connective

tissue and the intracellular environment fosters the growth of microorganisms -

viruses, bacteria, mycoplasms and fungi. Simultaneous treatment of the

infection results in faster and more complete metal detoxification and more

rapid

and complete resolution of symptoms 23,24.

References:

1. DL Goldenberg: “Fibromyalgia Syndrome a Decade Later: What have we

Learned?†Archives of Internal Medicine: (1960), 1999, 159 (8) 777-785

2. Michael Wolk: The Diagnosis and Treatment of Fibromyalgia (May 1999)

[internet URL: http://ohr2.systoc.com/CMEcourses/wolk/index.htm]

3. “Fibromyalgia syndromeâ€. The Nursing Clinics of North-America J , 1998,

33 (4) vii, 653-669

4. FMS Monograph: “An Overview of the Fundamental Features of Fibromyalgia

Syndrome†(1999 Edition). Fibromyalgia Association of Greater Washington,

Inc., 13203 Valley Drive, Woodbridge, VA 22191. Website: www.fmagw.org. [web

URL:

http://www.abcjb.com/fm/features_of_fibromyalgia_syndrom.htm]

5. Joseph Teitelbaum: “The Treatment of Fibromyalgia Syndrome†Lecture at

American College for Advancement in Medicine, Reno, NV, October 1999.

6. RM Bennett: “Emerging Concepts in the Neurobiology of Chronic Pain:

Evidence of Abnormal Sensory Processing in Fibromyalgia†Journal: Mayo Clinic

Proceedings, 1999, 74 (4) 385-398

7. D. Klinghardt: “Chronic Fatigue, Fibromyalgia & Environmental Illnessâ€.

Pp. 200-205. Future Medicine Publishing, Inc., Tiburon, CA. 1998.

8. D. Klinghardt: “Lehrbuch der Psychokinesiologie†Verlag Hermann Bauer,

Freiburg, Germany, 1996.

9. D. Aschoff, MD, Ph.D.: “Biophysical and Geopathic Stress and Chronic Pain

Syndromes†Lecture at Medicine Week, Baden-Baden, Nov.1992.

10. LM Breau et al: “Review of Juvenile Primary Fibromyalgia and Chronic

Fatigue Syndrome/ Pediatric Pain: New Directions from a Developmental

Perspective

†Canadian Journal of Developmental and Behavioral Pediatrics, 1999, 20 (4)

11.U.S.Department of Health and Human Services: “Toxicological Profile for

Mercuryâ€, Aug.1997, Atlanta

12. F. Lorscheider, M. Vimy, A. Summers: “Mercury Exposure from “Silverâ€

Tooth Fillings: Emerging Evidence Questions a Traditional Dental Paradigmâ€

FASEB J.9, 504-508 (1995)

13. JE Bouquot, A Roberts, P Person, J Christian: “NICO (Neuralgia-Inducing

Cavitational Osteonecrosis): Osteomyelitis in 224 Jawbone Samples from

Patients with Facial Neuralgiasâ€. Oral Surg Oral Med Oral Pathol 1992,

73:307-319

14. W Loesche, A Schork, M Terpenning et al: “Assessing the Relationship

Between Dental Disease and Coronary Heart Disease in Elderly U.S. Veteransâ€

JADA, Vol.129, March 1998

15. B Haley: “Jaw Infections, Root Filled Teeth and Tubulin Destructionâ€

Lecture at the Annual Meeting of the Australiasian Society of Oral Medicine and

Toxicology, Sydney, Australia, Sept. 1998. Contact ALT, Univ. of Kentucky

tel.: 606-257 2300 ext.291

16. Vimy, J.M, and F.E. Lorscheider: “Intra-Oral Air Mercury Released From

Dental Amalgamâ€. J. Dent. Research 64,8, 1069-1071 (1985)

17. Pendergass and Haley: “Mercury and its Effects on Effects on

Environment and Biology†In: Metal Ions in Biological Systems V, 34, pp.

661-478, 1997.

Marcel Dekker, Inc, NY, NY

18. Aposhian, HV et al: “Human Studies with the Chelating Agents DMPS and

DMSAâ€. J Toxicol Clin Toxicol (1992) 30 (4): 503-28

19. J Goldstein “ Chronic Fatigue Syndromes: The Limbic Hypothesisâ€

Haworth Medical Press, N.Y.(1993)

20. D. Klinghardt: “Using the Bi-Digital O-Ring Test to Detect Dysfunction

in the Autonomic Nervous System†Lecture at Columbia University at the 14th

International Symposium on Acupuncture and Electro-Therapeutics Oct 22, 1998

21 D Klinghardt: “Neural Therapy†J Neurol Orthop Surg (1993) 14: 109-114

22 D. Klinghardt: “Psychological Factors in Chronic Pain: An Introduction to

Psychosomatic Pain Managementâ€: Lecture Syllabus/ Annual Meeting of the Am

Acad of Orthop Med, Feb.1997, Orlando, Fl (reprints available at 206-721

3231)

23 D Klinghardt: “Amalgam/Mercury Detox as a Treatment for Chronic Viral,

Bacterial and Fungal Illnesses†J Explore! Vol 8, Number 3, 1997, Mt Vernon,

WA

(reprints: 206-721 3231)24 D Klinghardt: “Heavy Metals and Chronic

Diseasesâ€

J Explore! Article accepted for publication 1/00, to be published spring 00

(reprints: 206-721 3231)