Sahar Swidan, Pharm.D.

Sahar Swidan, Pharm.D.

BCPS, ABAAHP, FAARFM, FACA

Personalized Medicine in Fibromyalgia

“We know Fibromyalgia is a multi-factorial disorder and most of these patients have genetic predisposition, high levels of neuroinflammation, and a hypersensitive pain transmission system. Moreover, many patients have endocrine insufficiency and deficiency in cellular energy. A multi-modal treatment approach of these patients usually include an anti-inflammatory diet, mild exercise-especially water based, cellular energy aids such as Coenzyme Q10, and hormone replacement if clinically indicated. Hormone replacement should only occur after the levels are assessed and determined to need replacement as hormones must all be balanced to optimize body function.”

Effect of Coenzyme Q10 on Psychopathological Symptoms in Fibromyalgia Patients. (Nov 2016)

Objective: To explore the effect of Coenzyme Q10 (CoQ10) on the psychopathological symptoms of fibromyalgia, such as fatigue, sleep disorders, depression, and others.

Design: Twenty female patients were randomized to receive either CoQ10 or placebo in a double-blind fashion for 40 days. Symptoms were measured before and after the treatment period using the Symptom Checklist-90-R’ (SCL-90-R).

Treatment: Patients in the treatment group received CoQ10 300 mg/day in three divided doses.

Results: Symptomatic improvement was noted in all categories of the SCL-90-R, with statistically significant reduction in interpersonal sensitivity, depression, anxiety, hostility, and psychoticism (p< 0.001). No adverse effects were noted in the CoQ10 group.

Conclusion: CoQ10 supplementation can improve the psychological components of fibromyalgia, through larger clinical trial need to confirm these findings.

Study: Effect of Coenzyme Q10 on Psychopathological Symptoms in Fibromyalgia Patients. (Nov 2016)

The usual starting dose of CoQ10 is 100mg daily which will help with cellular energy and replenish levels as many medications fibromyalgia patients use also lower CoQ10 levels.

 

Treatment of pain in fibromyalgia patients with testosterone gel: Pharmacokinetics and clinical response. (Aug 2015)

Objective: To examine the effect and safety of testosterone supplementation on pain and fatigue in fibromyalgia.

Design: This was an open-label pilot study that included 12 women, 40-55 years of age, with fibromyalgia. They applied testosterone every morning for 28 days. 24-hour pharmacokinetic measurements were taken on the 1st and 28th days, as well as pain assessment questionnaires (based on the Fibromyalgia Impact Questionnaire) in which patients reported their symptom severity over the past week.

Treatment: Patients applied 0.75 g of 1% testosterone gel (0.75 mg bioavailable) to their lower abdomen every morning for 28 days.

Results: Mean free testosterone levels were increased on day 28 but remained safely within the normal reference ranges for women. Questionnaire and physical exam results demonstrated significant reduction in muscle pain, stiffness, and fatigue, as well as increased libido. 33% of patients experienced a 50% or greater reduction in pain after 4 weeks of treatment. No adverse events were recorded during the duration of the study.

Conclusion: Patients with chronic pain conditions, such as fibromyalgia, and low serum testosterone levels could benefit from testosterone replacement. Larger placebo-controlled studies should be performed to confirm these things.

Study: Treatment of pain in fibromyalgia patients with testosterone gel: Pharmacokinetics and clinical response. (Aug 2015)

Most females secrete around 200 mcg of testosterone daily, therefore a recommended starting dose of testosterone if levels are low and replacement is appropriate and they are appropriate candidates for hormone replacement is around 0.25mg daily transdermal. Usual dose is Testosterone 0.25mg/gm in versabase cream to apply 1gm topically daily.