Muscle and bone symptoms

  • muscle loss see weight loss

Further information

issues in pain management

“The first thing they told us in medical school is that no one has ever died from pain but plenty of physicians have had their careers destroyed trying to help people who are in pain.” Comment from an emergency room physician requesting anonymity (2001)

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Notes and comments

replaced out of order in out of view section Family Practice.com. New realities in pain management issues. Available at: http://www.familypractice.com/lectures/pain2/lecture_ mccarberg_text_frame.htm\Familypractice. Accessed on April 21, 2003. Family Practice.com. New realities in pain management issues. Available at: http://www.familypractice.com/ lectures/pain2/lecture_marcus_text_frame.htm\Familypractice. Accessed on April 21, 2003. Medscape. Barriers to effective pain management. Available at: http://www.medscape.com/viewarticle/405853_3\Medscape. Accessed on April 21, 2003. Pain and Policies Study Group, University of Wisconsin. Regulatory systems and pain management. Available at: http://www.medsch.wisc.edu/painpolicy/eguide2000/text_version/appendix_b.html\Medsch. Accessed on April 21, 2003. Pain and Policies Study Group, University of Wisconsin. Are intractable pain treatment acts what we need? Available at: http://www.medsch.wisc.edu/ painpolicy/eguide2000/text_version/ appendix_d.html\Medsch. Accessed on April 21, 2003. DrugTopics.com. Pain management regulation. Available at: http://www.drugtopics.com/be_core/ content/ journals/d/data/2003/0407/show_article.jsp?filename=dce04a2003.html\Drugtopics. Accessed on April 21, 2003. RxList. Description of diclofenac and misoprostol. Available at: http://www.rxlist.com/cgi/generic2/ arthrotec.htm\Rxlist. Accessed on April 21, 2003. Doctor’s Guide. FDA approves once-daily Avinza (extended release morphine) for chronic, moderate-to-severe pain (March 21, 2001). Available at: http://www.docguide.com/ news/content.nsf/news/ 8525697700573E1885256B830048A246+ avinza&hl=en&ie=UTF-8\Docguide. Accessed on April 21, 2003. RxList. Description of levetiracetam. Available at: http://www.rxlist.com/cgi/generic3/keppra.htm]Rxlist. Accessed on April 21, 2003. National Institute on Drug Abuse. Pain and opiophobia. Available at: http://www.nida.nih.gov/ResearchReports/Prescription/ Prescription6a.html\Nida. Accessed on April 21, 2003. Fujimoto D. Regulatory issues in pain management. Clin Geriatr Med. 2001;17:537-551. Available at: http://www.partnersagainstpain.com/ html/profed/profed.htm\Partnersagainstpain. Accessed April 21, 2003. “Millions of people suffer needlessly from agonizing pain because physicians have been reluctant to use ‘high-risk’ opioids” Crain & Shen 2000


Muscle spasms

Facial pain

Many people with Th1 diseaseAny of the chronic inflammatory diseases caused by bacterial pathogens. experience facial numbness and tingling. Some people will also experience facial tingling and numbness when their 1,25-DPrimary biologically active vitamin D hormone. Activates the vitamin D nuclear receptor. Produced by hydroxylation of 25-D. Also known as 1,25-dihydroxycholecalciferol, 1,25-hydroxyvitamin D and calcitirol. surges in response to sunlight sensitivity/sunlight exposure. See Why are my symptoms more intense after exposure to light &/or Vit D?

Diabetics often get something loosely called, “frozen shoulder”. Has anyone on the MP experienced improvements with this problem? Someone I know is looking at very extensive surgery.




The medical term for 'frozen shoulder' is adhesive capsulitis. It is due to inflammationThe complex biological response of vascular tissues to harmful stimuli such as pathogens or damaged cells. It is a protective attempt by the organism to remove the injurious stimuli as well as initiate the healing process for the tissue. resulting in pain that causes the person to guard their shoulder to avoid the pain. The result is loss of mobility.

I developed this condition a couple years before I began seeking treatment for other inflammatory symptoms. I was treated with ibuprofen (an NSAIDs) and physical therapy (ultasound and stretching exercises). It was a painful process but I regained 75% mobility, as much as could be expected I was told. I continued to have intermittent shoulder pain.

After one year on the Marshall ProtocolA curative medical treatment for chronic inflammatory disease. Based on the Marshall Pathogenesis., my shoulder was painfree and I had 100% mobility in that joint without any special exercises and complete resolution of pain. I suggest continue with PT, pain meds as needed and the MP. and avoiding surgery.

Surgery is done when physical therapy has failed. It is invasive, painful and only partially successful. Your friend has nothing to lose by trying the MP first.



P.S. This is not a particular phenomenon of diabetes but diabetes is a result of Th1 inflammationThe complex biological response of vascular tissues to harmful stimuli such as pathogens or damaged cells. It is a protective attempt by the organism to remove the injurious stimuli as well as initiate the healing process for the tissue. so your friend has at least two reasons to try the MP.

The Benicar blockade should provide some palliation for the pain of your shoulder inflammation but your immune system may still be killing CWD and causing increased inflammation even without antibiotics.

Adhesive capsulitis occurs when the shoulder is not moved to avoid the pain associated with acute inflammation. This inflammation can occur without an injury, as happened to me.

Physical therapy will improve the range of motion (ROM) in your shoulder but will do nothing to resolve the inflammation. My 'frozen shoulder' responded well the PT (yes, it was quite painful at times) with 80% ROM return. the acute pain had gradually faded before the PT was needed to restore ROM but I still had intermittent pain in that shoulder. It wasn't until 2 yrs or so into the MP that all pain resolved and I was able to move my shoulder with 100% ROM.

You can do both…..regain some range of motion with PT and attack the underlying cause with the MP….at the same time. It's fine to use palliative measures for pain control. Regaining the use of your shoulder will be an unavoidably painful process but well worth the effort.

It is prevented by moving the affected shoulder to maintain range of motion despite the presence of pain.

It's fine to use pain medication for palliative relief of pain exacerbated by your physical therapy to regain ROM.

IMO, your best course is to continue the MP with an increase in Benicar because it will protect your shoulder joint from further inflammatory damage.

For relief of symptoms due to immunopathologyA temporary increase in disease symptoms experienced by Marshall Protocol patients that results from the release of cytokines and endotoxins as disease-causing bacteria are killed., rather than palliative medications, we recommend management of the MP meds. «<

Later add: The symptoms you describe in your shoulder and arm are very likely due to inflammation and should be given a chance to improve with the MP. I have a history of bursitis in a shoulder with resulting adhesive capsulitis (frozen shoulder). The pain returned as immunopathology but I now have full function without pain.

Massage & Physical therapy Have you considered an osteopathic or chiropractic examination of the limb? Sometimes, manipulation can help.

Ask Dr if you can do range of motion exercises.

My immune response / symptoms are too strong. What should I do? .. Any time that your symptoms are going past tolerable: please check the precautions and the options one at a time to assess: do not hesitate to use any of the adjustments suitable to you. Tools to check: « if having any problems please check if you need to make adjustments in any area, and feel free to ask on the Board. thank you.

Why and when do you recommend taking Minocycline frequently?

also When and why should I use Valium?

see pain control tips …

What degree of healing FAQ re fibrosis.

We advise folks to postpone elective surgery as long as possible. Th1 inflammation interferes with the healing process and many folks discover they no longer need surgery once the inflammation is resolved. “…using anesthesia to be put under and then the Dr. manipulates the arm to break the adhesions” is a surgical procedure. It may be noninvasive but it will have a profound impact on the tissues in your joint and you cannot be guaranteed the outcome will be positive. See Adhesive Capsulitis of the Shoulder.



Both my wife and I had frozen shoulders. Mine reacted strongly to Phase 3 meds in terms of herx, so your friend really should look to the MP.

Suggesting that 'frozen shoulder' is infectious might not go over well; but you can point to success here. I haven't quite got to 100% like Meg, but there is only an infrequent twinge now and again to remind me that I should exercise a bit more.

Chris & PTMKaren

Add July 07: If I haven't mentioned it before, the bursitis in the right shoulder is gone, except for a minor discomfort when sleeping on that side.



Oh dear. Since I have been in phase 2-3 I have developed rotator cuff problems and now have adhesive capsulitis in both shoulders. A small amount in my right one and a lot in my left shoulder. I just went to a PT for my first visit on Thursday because it has gotten so painful and difficult to use my arms.

At first I reckoned my pain was herx related and waited for it to get better. But it has only gotten worse, especially when I'm herxing. But I have little range of motion in my left arm remaining.

Since I'm having trouble with getting my D level to budge downward I'm wondering if this is just a new symptom of my disease then and not injury related? (I haven't DONE anything in months so I don't know what I could have done to my shoulders.) My therapist thinks she can help me and I need any help I can get right now so I'm going for it.

Add: April 07: My pain and range of motion has greatly improved with the osteopathic physical therapy I've been having. I haven't used my TENS unit for weeks now.




Definitely find a good PT. They've got a lot of tricks to free up the joints; it only seems like they are disciples of Torquemada.

And do the exercises. the Phase three combos helped. Chris



I had no injury to my shoulder when it became painful. The name for that is bursitis and it's due to inflammation with or without injury. I recall my mother having a similar problem years ago.

I, erroneously, thought that time would resolve the pain as it often does. But the pain was so nasty that I was forced to limit my movements and that is what caused the joint to become 'frozen'.

Physical therapists have techniques and exercises to try to regain some of the range of motion. If that doesn't work, surgery is recommended to forcibly break apart the adhesions. When I went to PT and took NSAIDs, I had about 50% shoulder mobility. Like Chris said, it's a painful process but keeping the joint mobile while you heal the inflammation is important.

Consider your shoulder pain a signal Herx symptom and adjust your antibiotics accordingly to maintain tolerable Herxing.



Later add:

January 2007: About five years ago a massage therapist pointed out to me that my cervical spine felt very odd. When I asked my PCP, she said it appeared to be a 'curvature'. I had no symptoms at that time and I don't believe I've had this curvature all my life.

A few months ago, I had a period of severe spasms involving my left, anterior neck muscles. Lately, I've had intermittant muscle pain (sometimes severe), involving the muscles of my left upper back, neck and shoulder. Both these symptoms did not occur pre-MP.

I believe these muscle spasms indicate that the curvature in my cervical spine is slowly being resolved. And the bones in the back of my neck do feel less odd to me.

Belinda wrote:

Palliative measures may be needed while members are on the MP. We recommend members work with their medical professionals to determine their need for sleep aids, pain meds and anti-depressants. Like the other measures, chiropractic or osteopathic therapies may play a role in keeping pain and symptoms of immunopathology tolerable.

My experience using these therapies goes back more than 20 years, long before the diagnosis of my Th1 disease. My case challenged several practitioners because, no matter how well my body responded to the therapy initially, my symptoms eventually returned.

Using the MP to treat the bacterial cause of disease and manual therapy to alleviate symptoms helped me cope.. initially with my disease and then with the immunopathology of recovery. I no longer have a short leg or the slight curve in my spine that once showed on my skeletal x-rays.

I guess time will tell for you, but I wouldn't hesitate to seek this sort of treatment to alleviate problems along the way. (For instance, I used to cough ribs out of place, which made breathing painful.) I would expect your adjustments to “hold better” later, as you progress in your recovery, but it may take a long time.

Add: see PAIN CONTROL and re asking Doc re TENS machine. and if Doc has determined your pain medication is safe for you to take, it is not contraindicated on the MP.. We do not recommend the routine use of aspirin.

Lidocaine patch has brought relief to a Member.


Thanks Chris and Meg,

I have a great PT who did wonders for my lower back about 10 months ago so I'm encouraged she will be able to help me now. She understands the limitations of the FM patient and doesn't push things too far too fast.

I learned from past escapades that doing the exercises is mandatory to success. And, Meg, when you wrote “consider your shoulder pain a signal Herx symptom” it made my little heart smile with pleasure to think that my body IS herxing. Herxing = killing bugs = fighting to get better and not always just getting worse. Hooray!!

November 2006 Add: I have noticed that using my TENS unit and, especially, more frequent dosing with Benicar has been more useful against the pain. I'm sure that is the better way to go.

Feb 2007 add: For what it's worth… I too came down with “frozen shoulder” after being on the MP for awhile. No injury and in both shoulders. Physical therapy helped some, more frequent dosing of Benicar helped, and the use of my TENS unit for pain was very helpful.

I've been on an abx break for a month now and the shoulders have freed up quite a bit… hmm, definitely a pathogen connection there wouldn't you say?

May 2007 add: I found the TENS unit helped me. I've had the best success with the physical therapy I've been in over a number of months now. I haven't had to use the TENS unit for weeks for pain and my range of motion is much better.



“Adhesive capsulitis” sounds like the label used to describe adhesions and scar tissue or fibrotic tissue resulting from injury and/or chronic inflammation.

Janice, Leanne,

I've also had something similar to a partially 'frozen shoulder,' like Meg, but it's resolved on its own on the MP as well. Some of my “shoulder” problem actually resides in my back, stemming from an injury originating underneath my shoulder blade or “wing.”

The only sort of “therapy” I've done for it for the past several years has been that when I go to the Chiropractor, 2x/week, while I wait for her to enter the room, I lie on the table, on my back, arms fully extended over my head.

When I used to do this, my left arm wouldn't touch the table, and oftentimes, due to pain and muscle spasm, I would recoil my left arm to a more comfortable position, but I would go back to trying to stretch out that arm until the Chiropractor would enter. I could never get that arm to touch the table until very recently.

Now, my left arm, although not totally pain free, (yet/still) my range of motion is nearly 100%

Last edited on Sun Sep 17th, 2006 11:27 by Reenie



I have suffered from an intermittent painful frozen left shoulder for over 15 years, it even sometimes spread into my neck restricting my head movement. I have not had full range of motion in all that time.

I have had herx in that region and now have full range of motion and also can now painlessly raise my left hand all the way up behind my back with no pain what so ever.


First my wife, then I experienced a sudden 'frozen shoulder' … She went through some chiro and PT and ultrasound therapies and has regained most of her mobility. Mine came on suddenly a while later and it is slowly but steadily resolving. BTW she's still on phase one, I'm on phase two about to start three. Grant: Beginning Phase Three Update


In conjunction with adjusting your MP meds My immune response / symptoms are too strong. What should I do? .. Any time that your symptoms are going past tolerable: please check the precautions and the options one at a time to assess: do not hesitate to use any of the adjustments suitable to you.


I found a UK website that claims to be able to treat frozen shoulder using the Niel-Asher Technique but the closest practioner in the US in in Virginia. They sell a do it yourself version. If anyone is familiar with this method I would appreciate hearing about their experience.

Dr Trevor Marshall

Geow, Most people have an immune system which is functional enough to deal with incidents of localized parasitic inflammation, especially since that healing is accelerated by heat, and mechanical stress (to break up the calcifications and intra-cellular biofilm A structured community of microorganisms encapsulated within a self-developed protective matrix and living together. exoskeletons) (eg: the chiropractic 'ultrasound machine').

The problem is that those who are symptomatically ill, already have an immune system which is no longer able to cope, or heal. Those folk need to deal with the underlying pathogens first.


When a shoulder is painful, it's important to do gentle range of motion exercises 2-3 times a day to maintain flexibility and prevent frozen shoulder.

  • trigger finger (Dupuytren's Contracture)

s339: pasted under notes and comment below

* factors exacerbating pain

(filelink) Factors that exacerbate pain


Immunopathology may cause an increase in pain. See Immunopathology (Herx)….What is it?

Do not hesitate to use any of the medication adjustment options in My immune response / symptoms are too strong. What should I do? Check the precautions and the options one at a time and assess the issues listed in Tools to check. Ask in your progress report if you need help.

If you are concerned do not hesitate to contact your Doctor.


Anxiety can be a immune reaction and it can magnifiy the perception of other symptoms. Some folks have reported that taking Valium (do not use generic diazepam) also reduces pain.

Valium is also a useful adjunct for the relief of skeletal muscle spasm due to reflex spasm to local pathology (such as inflammation of the muscles or joints, or secondary to trauma). See:

How can I control my anxiety?

When and why should I use Valium?


Inadequate rest can contribut to an increased perception of pain. See I have insomnia and fatigue. What should I do?

Idiopathic pain

Lymph nodes are located all over the body:

and these should be considered the prime suspects to swell and produce pain from immunopathology in Th1 disease.


Gout is a disease resulting from the deposition of urate crystals caused by the overproduction or underexcretion of uric acid. The disease is often, but not always, associated with elevated serum uric acid levels. Clinical manifestations include acute and chronic arthritis, tophi, interstitial renal disease and uric acid nephrolithiasis. The diagnosis is based on the identification of uric acid crystals in joints, tissues or body fluids.

Excess serum accumulation of uric acid can lead to a type of arthritis known as gout. Gout can occur where serum uric acid levels are as low as 6 mg/dL (~357µmol/L), but an individual can have serum values as high as 9.5 mg/dL (~565µmol/L) and not have gout. It isn't necessary to keep uric acid levels within normal range during the process of recovery.

Standard treatment for acute attacks is nonsteroidal anti-inflammatory agents, colchicine or intra-articular injections of corticosteroidsA first-line treatment for a number of diseases. Corticosteroids work by slowing the innate immune response. This provides some patients with temporary symptom palliation but exacerbates the disease over the long-term by allowing chronic pathogens to proliferate.. Probenecid, sulfinpyrazone and allopurinol may be ordered to prevent recurrent attacks.

NSAIDs are the preferred form of analgesia for patients with gout. Indomethacin is the most commonly prescibed NSAIDs used to relieve the pain of gout.

It is okay to take allopurinol to reduce uric acid to prevent recurrant attacks unrelieved by pain meds and adjustment of MP meds.

Several agents (including allopurinol and benzbromarone) are reported to lower urate levels with varying degrees of success in preventing acute attacks of gout. Several folks on the MP have used allopurinol for a short time without ill effect.

We recommend testing urate periodically and discontinuing the urate-lowering medication when the level is normal. Be sure and drink adequate fluids.

* pain management


(filelink) The Poor Management of Pain

by Richard Lee

Government restrictions to discourage the growing concern of drug abuse, trafficking, and physical dependence are resulting in physicians undertreating patients with chronic pain.

It is seemingly a no-win situation. On the one hand, the more you treat pain with opioids, the more likely you will be investigated by state or federal authorities. But, on the other hand, the less you treat pain with opioids, the greater your chances of being sued for civil damages on the grounds of undertreatment.1

“Lawyers are lining up right now…looking for cases of poor pain management,” according to remarks given by Bill McCarberg, MD, director of the Chronic Pain Management Program at Kaiser Permanente in San Diego and an assistant clinical professor at the University of California, San Diego, who also serves on the board of the American Pain Society. “Whenever you encounter litigation against doctors for pain management, it is never because…we do not allow the patient to get a muscle relaxant…It is always about opioid management. We get sued because we’re not using opioids.”1

William Marcus, JD, a consultant on pharmacy-controlled substances, pain management, and administrative law (he is also a part-time administrative law judge with the Office of Administrative Hearings in Los Angeles), told a lecture audience that physicians are just as nervous about criminal prosecution as they are about being the target of a personal injury case when it comes to ordering potent relief for pain.2 Indeed, fear of regulatory scrutiny for prescribing controlled substances has been shown to discourage physicians from prescribing opioids of sufficient strength for the patient’s pain, especially for chronic nonmalignant pain.3 Such fears can result in the selection of less effective analgesics and, ultimately, undertreatment of the patient’s pain. Of course, fears of getting into trouble with authorities or of being hauled into civil court are not the only factors making physicians reluctant to prescribe. Many physicians worry that their patients will become addicted to opioid and codeine medications,3 or that insurance companies will make it hard for patients to access the medications in the first place.3

Meanwhile, studies have found that the reluctance to prescribe opioids for noncancer pain treatment has resulted in ineffective relief for large groups of patients.3 For example, in a recent study of 805 chronic pain sufferers, it was reported that more than 50% found it necessary to change physicians in their quest for pain relief.3

That is unfortunate, because “pain is highly prevalent in our society, and it is being grossly undermanaged,” in the words of McCarberg, who noted that pain (as a symptom in itself) is the third most common reason sick patients give for missing work. And, with 75% of the US adult population regularly using over-the-counter pain medicine, 35% of that total also take prescription drugs for pain.1

Further, stated McCarberg, “pain is frequently disproportionate to the injury involved when it becomes chronic. This is why it’s hard: It persists well beyond expected healing, you frequently have numerous, fruitless diagnostic interventions, and our biomedical model fails. The biomedical model states that if a patient’s in pain, there is a pain generator that’s causing that pain. All you have to do is find the generator, fix that—that disc, or that facet joint, or that muscle that’s tight—and [theoretically] the pain goes away.”1

Overcoming Reluctance

Taking a closer look at the laws and regulations concerning the prescribing of medicines covered by the federal Controlled Substances Act (CSA), it is easy to see why orthopedists and other practitioners are skittish, but the fact is that these rules are not intended to interfere with the legitimate processes of the doctor-patient relationship. The goal of the CSA is simply to prevent abuse, trafficking, and diversion of medications with a potential for producing psychological or physical dependence. However, the CSA recognizes that such medications “are necessary for public health and that their availability for medical and scientific purposes must be assured.”4

CSA requires that prescriptions for Schedule II drugs (the most potent of controlled substances) must be in written form and may not be refilled, while five refills are permitted for drugs in Schedules III and IV. CSA imposes no limits on the sizes of the prescription or on the duration of prescribing.4

The imposition of limits is left to the states, which in most cases have stepped up to that responsibility with considerable zeal. All of the states’ own versions of CSA permit prescribing of controlled substances, although it is hit-or-miss as to whether they specifically reflect the recognition by federal law of the medical uses of controlled substances.4

Typically, the criminal provisions of the state acts are enforced by state and local police agencies, while the drug regulatory aspects of state-controlled substances laws are administered by a variety of state agencies, including departments of regulation and licensing and medical or pharmacy boards. These agencies often have their own regulations governing the prescribing and dispensing of controlled substances, and they are usually more stringent than the provisions of the federal CSA. For example, some states limit the amount that can be prescribed at one time, and limit the validity of a controlled substance prescription to a few days or weeks. Some have overly broad definitions of the term “addict” that can be interpreted to include physically dependent pain patients (in several jurisdictions, prescribing to such persons is outright prohibited; in others, physicians are required to supply names of patients receiving controlled-substances prescriptions to one or more state agencies).4

Some states have also adopted laws that require physicians and pharmacists to use special government forms when prescribing and dispensing certain controlled substances. These programs allow state health departments or law enforcement agencies (and even licensing boards) to monitor prescriptions of potent pain drugs and uncover fraud and abuse. State special-prescription programs differ considerably: they require use of either a triplicate, duplicate, or single-copy form, usually state-issued.4

In recent years, many states have adopted “intractable pain treatment acts” (IPTAs). These are often modeled after an 1989 measure adopted by Texas. The idea is to address physician reluctance to prescribe opioids for the treatment of chronic pain by providing—at minimum—immunity from discipline at the hands of state medical boards.5

Most states that have IPTAs have also taken the step of adopting practice statements or guidelines to further clarify physician responsibilities and, hopefully, further reassure them on prescribing opioids.2 As one example, California law now requires 12 hours of continuing medical education on effective pain-management techniques and medication.2

“The more practitioners, regulators, and the public understand pain and pain management, the better care we will all get because there’s no regulator who is so converted as the regulator who’s been in pain, or whose family has been,” Marcus contended in his lecture.2

That notwithstanding, many experts believe the best way to avoid problems with authorities—and with patients’ lawyers—is to get in the habit of producing accurate and thorough documentation on your cases requiring pain management. Records on each such patient should include: medical history and physical examination findings; diagnostic, therapeutic, and laboratory results; evaluations and consultations; treatment objectives; discussion of risks and benefits; treatments; medications (including date, type, dosage, and quantity prescribed); instructions and agreements; and periodic reviews.6

Rapid Advances

McCarberg made the point that advances in the field of pain management are these days arriving faster than in any other branch of medicine: “Everything I learned in medical school about pain management is outdated today.”1

Among the relatively recent innovations worth noting are medications that include diclofenac sodium with misoprostol, extended-release morphine sulfate capsules, and levetiracetam.

Diclofenac sodium with misoprostol is indicated for treatment of pain associated with symptoms of osteoarthritis or rheumatoid arthritis in patients at high risk of developing NSAID-induced gastric and duodenal ulcers and their complications (diclofenac sodium is a nonsteroidal anti-inflammatory drug with analgesic properties, while misoprostol is a gastrointestinal mucosal protective prostaglandin E1 analog).7

In pharmacological studies, diclofenac sodium has been shown to be effective as an anti-inflammatory and analgesic agent (it is also used for reducing fever). The mechanism of action of diclofenac sodium (like other NSAIDs) is not completely understood, but may be related to prostaglandin synthetase inhibition. It achieves peak plasma levels in about 2 hours (the range is 1 to 4 hours).7 Each tablet consists of an enteric-coated core containing 50 mg or 75 mg of diclofenac sodium surrounded by an outer mantle containing 200 mg of misoprostol. For osteoarthritis, the recommended dosage for maximal gastrointestinal mucosal protection is 50 mg three times a day (patients who experience intolerance can be given 75 mg twice daily or 50 mg twice daily, but these are less effective in preventing ulcers). For rheumatoid arthritis sufferers, the recommended dosage is 50 mg three or four times daily (intolerance can be addressed the same as with the alternate dosing for osteoporosis patients).7

The cost of 60 tablets, 50 mg/200 mg, runs about $100.

Then there is the morphine sulfate extended-release capsule for once-daily treatment of chronic, moderate-to-severe pain in patients who require continuous, long-duration, around-the-clock therapy (each capsule provides relief for a full 24 hours). A morphine sulfate extended-release capsule product approved 2 years ago by the FDA features a novel dual release formulation containing immediate and sustained-release morphine beads. Once steady-state plasma levels of morphine are achieved, the immediate-release beads enable morphine sulfate extended-release capsules to provide rapid exposure to morphine. The sustained-release beads enable morphine to be absorbed by the body gradually, thus maintaining plasma morphine levels over a 24-hour dosing period.8

In a double-blind, placebo-controlled trial, this particular morphine sulfate extended-release capsule product improved physical function in patients with chronic moderate-to-severe osteoarthritis pain. The lead author of the study was quoted as saying, “Opioids are never the first tier treatment choice for osteoarthritis. But I think it is useful to point out that morphine is not end-organ toxic, which cannot be said for [nonsteroidal anti-inflammatory drugs].”8 Capsules come in strengths of 30, 60, 90, and 120 mg.

Levetiracetam provides an intriguing twist in that it is primarily intended as adjunctive therapy in the treatment of partial onset seizures in adults with epilepsy. However, some new studies suggest that levetiracetam also exhibits pain-blocking properties, and so may be useful in treating chronic pain.9

Levetiracetam is available in strengths of 250, 500, and 750 mg tablets for oral administration. The main drawback of levetiracetam is that it is substantially excreted by the kidney, and the risk of adverse reactions to this drug may be greater in patients with impaired renal function. Thus, dosing must be individualized according to the patient’s renal function status.9 The cost is about $50 for 30 tablets at 250 mg strength.

Patients Phobic, Too

The National Institute on Drug Abuse (NIDA) reports, “Many health care providers under-prescribe painkillers because they overestimate the potential for patients to become addicted to medications such as morphine and codeine. Although these drugs carry a heightened risk of addiction, research has shown that providers’ concerns that patients will become addicted to pain medication are largely unfounded.” NIDA refers to this fear of prescribing opioid pain medications as “opiophobia.”10 NIDA insists that “most patients who are prescribed opioids for pain, even those undergoing long-term therapy, do not become addicted to the drugs. The few patients who do develop rapid and marked tolerance for and addiction to opioids usually have a history of psychological problems or prior substance abuse. In fact, studies have shown that abuse potential of opioid medications is generally low in healthy, non-drug-abusing volunteers. One study found that only four out of about 12,000 patients who were given opioids for acute pain became addicted. In a study of 38 chronic pain patients, most of whom received opioids for 4 to 7 years, only two patients became addicted, and both had a history of drug abuse.10

But try convincing patients otherwise. In one survey, fear of addiction (as well as fear of developing tolerance and experiencing side effects) was described by patients as their most important concern—the very kind of concern that can readily result in reluctance to report pain or comply with a regimen that involves opioid medication.

In other words, blame for the underutilization of pain medications can be placed on patients’ fears, not just those of physicians.11 No matter who is to blame, many will likely agree that there is just too much fear at play in the system. The sooner it is tamed, the better off everyone will be.

Richard Lee is a contributing writer for Orthopedic Technology Review.

Pain specialists…one member's experience

As far as pain management, I relayed to you that specialists usually were not interested in treating my pain. Thankfully we found a family doctor who was as compassionate as knowledgeable about pain control. Dependency and Tolerance to strong pain medications are dealt with when the unrelenting pain/disease ceases. He is very willing to treat the symptoms, including pain. He keeps excellent records and does very thorough exams.

It may take some searching, and you may want to question the receptionist, doctor's nurse, or ask if you might speak with the doctor for a few minutes prior to scheduling an appointment. Ask if you could pay for a 10 minute consult via phone. Your husband will have to discuss this with the doc due to laws, but when you do go to the office, you can sign papers giving the doctor permission to directly discuss his case with you also.

Weeding those out via phone, who will not treat unrelenting chronic pain will certainly save you the agony of preparing for office visits, and if not willing to treat—the desperation one feels when they leave the office, with the same pain with which they entered–and the rejection of not being treated. I know how horrible and hopeless that feels, when it happens over and over.

I have heard others finding pain specialists who have worked well with them, and then I have heard that some weren't very helpful. I think it will be readily apparent on the first visit, who will , and who will not help, and a phone call ahead of time may weed some out, too. ~hrts

  • see vitamin D and bone density
  • Legacy content
    • s339:

Trigger finger - any better?

Moderated by: Dr Trevor Marshall Topic closed New Topic Print

Author Post Mellie

I noticed a post by Carole talking about “trigger thumb”. Is this also related to the sarc? And if so, how and what is causing it?

When I started coughing back in 2002, I also noticed at that time that I constantly started needing to “crack” my thumbs. It seems they want to get “stuck” if I don't crack them. I must do this at least every few minutes. Is this leading up to “trigger thumb”?

I recall that many years ago, my late husband, who died from primary systemic amyloidosis (a very deadly autoimmune disease, and, IMH unscientific opinion, acts very much like sarcoidosis), got trigger thumb and carpal tunnel in both hands. It was ONE of his first symptoms of amyloids. The trigger thumb was also one of my first signs of sarc.

I keep saying it, but I am very blown away by the similiarities of our diseases, yet they are not the same disease. That is why I so believe in Trevor's theory of the bacteria. And every day I wonder if something as simple as the MP could have “cured” him. Yet, they are doing stem cell transplants on these patients…one of the few “cures” they have found to slow it down (or chemo or dex, etc). The meds are almost as deadly as that disease. I'm not worried that I have amyloidosis; I know I don't. But sometimes, I just have to get this off my chest!

i was diagnosed with thumb arthiritis and carpal tunnel. trigger thumb is a common condition associated with these diagnosis of arthiritis and carpal tunnel. a year ago i was finally diagnosed with the causutive agent of all my medical diagnosises,-lyme disease and co infections. which means that all my diagnosises including trigger finger are caused by cwd bacteria which causes th1 inflammatory disease. i feel trigger finger is yet another th1 symptom that will be cured by the mp. to me there is no sense tryng to get any more non curable disease diagnosises, i am just going for the big cure, good luck deb

Hello, Mellie and Debbie!

Yes, I also feel that inflammation is the key element in this malady. I know of a secretary who regularly suffers from trigger fingers and needs help almost annually. Her surgeon said that it is job-related, from typing all day. (I think I need to talk with her about Th1 inflammation. Actually, her surgeon is the arrogant one who ignored my warnings about possible drug reactions. )

I remember my second surgeon in Indy thinking that it was unusual that both of my thumbs were affected at the same time. I've had many, many issues throughout the years before my diagnosis, but that was a new one. It was also reported that the pulley of my left thumb was very thick, and there was also a small nodule there. (The surgery actually consists of removing a section of the pulley flexor sheath to allow a release.)

Wishing you both the best . . . Carole

Hello all, one of my early herx's was trigger finger acting up. I have had the symptoms of carpal tunnel for years with the peripheral neuropathy that has not gotten any worse on MP, a slight bit better. Both my mom and friend Rose (both on MP) have had surgery on hands, and Rose on her feet too. I feel certain TH1 activity is related to these problems. I think the MP will cut 'em off at the pass and I will avoid carpal tunnel surgery! P.B.


This is Fred in WV. I never heard of a trigger thumb. I do know that my right thumb, since being on the MP, had a hard lump in it, numbness, sore, and red. I have showed it to dermatologist and my family doctor but they did not say anything. Could this be trigger thumb???

Hello, Freddie!

I don't have the pamphlet handy, but you can find the details of the problem if you google trigger thumbs. I know that the Indiana Hand Center had information on their site, as well:

( note this link removed - info no longer on site at that place AND LINK WAS UN-HIDING Notes and Comments

This is what I said to DaveW:

Hello again, Dave!

Trigger thumbs are like trigger fingers–they literally get stuck in a certain position. This comes from inflammation involving the tendon. In my case, my thumbs started to feel “strange” and weak. They sometimes tingled and/or ached. When I would bend them after several months of the above, I would feel a snap or a pop. Finally, one became fixed in a bent position and the other in a straight position. The swelling and pain intensified throughout this time in my thumbs and the surrounding area in my palm.

Actually there is more involved like the sheath, pulleys, etc., but I don't remember all of the specifics. I do remember that I thought I was herxing after just beginning Phase 2, so I temporarily stopped everything but the Benicar. Nothing I tried helped, so I was referred to a surgeon.

Good luck, Freddie! . . . Carole


This is Fred in WV. This is not what my thumb is doing, but I have what you described in my little fingers from time to time. Thanks again.

Your friend in sarcoidosis


Hello again, Freddie!

I'm having that now with my left little finger and palm! How interesting!

Have a great Thanksgiving! . . . Carole

I saw a few old posts of people who were suffering from trigger finger and I was wondering if the MP has resolved this problem for you. Can anybody comment?

Sallee Here are some related topics.. You may wish to contact some of these Members by PM if they do not see/respond to this post..

Please Explain Trigger Thumb? ..

steroid shot in finger ..

Morton's Neuroma -Nerve Inflammation..

re surgery or steroids etc..

Information from the FAQ I need to have surgery. What should I know about anesthesia and the Marshall Protocol?

Dr. Marshall wrote: If your surgery is elective and can be postponed until more of your inflammation is resolved you may have a better outcome because high levels of angiotensin can cause poor wound healing.

“Patients with Th1 inflammatory diseases tend to have problems healing after surgery, and we deprecate all but the most urgent interventions until the patient recovers more fully.” «<

Why do I need to ask for a local anesthetic without epinephrine? Your Dentist and your Surgeon need to know

I need to take a different antibiotic for awhile. What should I do?


My immune response / symptoms are too strong. What should I do? re adjsuting meds.

Why are my symptoms more intense after exposure to Light & / or Vitamin D? Light exposure can also increase these symptoms.

When you can, please fill further required details into your signature line < see this link for details to include Thank You ..

Let us know if you have any questions about implementing MP. Thanks. all best, Barb …

Later Information ADD:

Debbie y wrote: June 2006: I have a Dupuytren's contracture on my index finger.One amazing thing I noticed after my FIRST dose of the new med is that the pain was almost completely gone and my finger which is normally bent, was able to be straightend out completely. My husband and I stared at this finger for almost 20 minutes before we turned the lights off to go to sleep! I could bend and straighten it without any problem. I could not straighten it out at all before. This finger has been like this since last year and before the MP was started. I am now fascinated and may be able to cancel the surgeon's appt. and just give this more time as I have just begun Phase 2. The mino did not affect it, it was after I added the the next antibiotic. This protocol continues to amaze me! May 2008: I have had a history of Dupuytren's contracture. In fact, I have a very long history of trigger finger problems from diabetes, Dequervain's and carpal tunnel.

I am now in phase 3 and have been on MP for 2.5 years. I did have 1 prednisone shot in my finger but that was a very long time ago. As I have progressed on MP I have no pain in my finger anymore and it is totally functional. No stiffness either. Even my erythema in my palms has dramatically improved.

It is easier to be further along on MP and look back. You realize that if you are patient, things will go away, it REALLY is true. I avoided any more surgeries. Even my old scars from previous surgeries did some funny things earlier in ph 2 but again, all of it has gone. And did not last long. Keep getting things monitored but from what I've been through, carefully waiting and watching prevented me from a whole lot of misery. Good luck!

Mod Note: Dupuytren's Contracture is sometimes confused with Trigger finger Trigger finger is not the same as Dupuytren's contracture - a condition that causes thickening and shortening of the connective tissue in the palm of the hand - though it may occur in conjunction with this disorder.

Hello, Sallee–

As you may have read in my other posts, I had bilateral trigger thumb surgery a year and a half ago; and since October, I have had a trigger “little” finger. I wanted to try an alternative to the cortisone shot and to surgery, so I opted for the splint. However, I only wore it for less than 24 hours, so I have been carefully attempting to shield it from more trauma.

So far, it really hasn't progressed as my thumbs did. After a few months, my thumbs locked into the bent and straight positions. It's now been seven months, and it “catches” on occasion, but seems to be less painful as time passes. I feel my inflammation still plays a major role, but I can often touch my thumb and little finger together with greater ease.

I believe as my D levels continue to decline, the inflammation is resolving at a more rapid rate. I haven't yet accomplished making a “perfect” fist, but perhaps one day I may. I'll remain hopeful that it, too, will resolve.

Take care . . . Carole

June 11th 2006: Moderator add from Carole posts:

As you may have read from my previous posts, I have also had the “trigger thumb and finger” issue, as well as toe and foot problems. The trigger thumbs were very hard to manage because of the obvious need to grasp. One can better manage the lesser need to use the “little trigger finger,” with which I am presently plagued.

After the bilateral trigger thumb surgery in November 2004, it took about a year for my thumbs to completely recover (strength and pain-wise). I've elected to “wait and see” the outcome of the little finger issue, which began in October of 2005. The swelling and flexibility have improved, especially within the last few weeks as I have progressed to the full Phase III of M, Z, and C. It occasionally locks for a few seconds, but is manageable. I personally believe that the reduction in my overall inflammation has made a favorable impact on this issue. However, if I have a nodule, it may one day have to be taken care of. Nevertheless, I'll just wait patiently for now.

My foot and toes are also improving since September 2005. I will have a slight, occasional aggravation with pain and pressure, but I believe it is now only herx. I'm able to speed-walk our spaniel and comfortably wear most any casual or dress shoe, as I no longer limp from pain.

The full Phase III is making a BIG difference overall, which has taken me over two years to achieve. I wish you the best with your surgery and progress on the protocol.

Take care . . . Carole

Hello again,

I can appreciate your hesitations re surgery; but when a thumb is involved, it is very inconvenient (not even counting the pain). Let me add more information for your consideration.

Negative aspects: First of all, you probably read of my blood pressure and heart issues with the first surgery attempt. Even with that near-death episode, I felt it was necessary to have my thumbs repaired. I was very worried about a repeat of the same scenario, but took the risk (with problems). The second surgeon was concerned about the time period that had elapsed in which my thumbs had remained locked (for more than 2 months). It was very painful to manually unlock them for examination or when I accidentally bumped them, but he eluded to the longer they were immobile, the less likely they could be successfully repaired.

Positive aspects: Even though my thumbs did not return to the same “operational” strength and totally painfree state, the “movement and usage” of my thumbs were WONDERFUL! Instead of wearing dresses or skirts, I wore slacks so that I would not have to pull and tug on pantyhose.

I am still very protective of them today. I definitely use them, but they do become “uncomfortable and a little problematic” at times.

If I were you, I would not “overuse” them, especially with gardening tasks. If they have not become locked, you may have a chance to recover. That's what I am personally hoping for–for you and for me.

If you wish, you are welcome to send me a PM. I will be happy to call you, if you want to discuss this further. I have no medical background, but plenty of personal experiences.

Take care . . . Carole

P.S. To answer your last two questions–

1.) Instead of following doctor's orders and taking a few days off, I went to school the next day. I was also ahead of schedule in recovery, in that I did my “thumb exercises” as prescribed and received an excellent report from the therapist. 2.) With “locked” thumbs, yes, I would do it again.


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