PAIN RELIEF AND SYMPTOM COPING STRATEGIES:
In medicine, all treatments are probabilistic, and each individual will have treatments to which they do not respond even though others do. FQ ADR sufferers tolerate supplements and natural treatments at a much higher proportion than pharmaceuticals, but pharmaceuticals are more powerful in their effects. Some sufferers develop idiosyncratic reactions to previously tolerated medications and supplements, though those having only musculoskeletal ADRs generally do not.
Oral anti-inflammatory medications like aspirin, ibuprofen, Motrin, Advil, naproxem, Aleve, and Celebrex (celecoxib) are often ineffective for the first few months or years after FQ adverse reactions, worsening symptoms (esp. nerve symptoms) in about 25% of reporting sufferers, with about 25% reporting these has helpful. Use during or within 10 days of FQ use is associated with worsening of central nervous system and peripheral neuropathy symptoms. Tylenol / paracetamol / acetaminophen is a bit different in mechanism of action. Research recent to 2011 suggests NSAIDs delay normal (that is, sports-induced) tendon healing and should be used as short a duration as possible. Dozens of biopsies show normal tendinopathy, though it may last many months, loses its inflammatory components within the first few weeks. However, the healing pattern of FQ induced tendinopathy does not resemble normal tendinopathy. An individual should decide if he/she wants to use NSAIDs or not.
For tendon pain and muscle pain, pain relief has been reported with: the topical prescription NSAID Voltaren Gel (only in the first few weeks on any given tendon); and with over-the-counter (OTC): ice massage; Tylenol / paracetamol / acetaminophen (which shouldn’t be taken with alcohol); Tiger Balm; Icy Hot topical analgesic; juice of a lemon in a cup of water twice daily; and to a minor extent transdermal magnesium oil. Ultrasound and TENS units sometimes help, but low level laser has generally not been of benefit. Massage is sometimes pain relieving. For Achilles tendinopathy, benefit has been reported from heel shoe lift inserts and orthotics, while those with shoulder tendinopathy report overnight pain benefit from: foam mattress pads on their beds, specialty pillows, and sleep number beds. Those with tendon pain in hands, forearms, and knees reportedly benefit by sleeping with braces on affected knees and wrists to protect from motion and pressure overnight. Techniques that may increase healing rate in those showing healing capacity include: nitroglycerin patches and 0.2% ointment; deep and slow gua sha performed from tendon insertion across muscle to tendon origin; ASTYM; and (again only for those showing existing healing capacity) prolotherapy and platelet rich plasma.
For muscle pain, relief has also been reported with cyclobenzaprine; Soma (carisoprodol). OTCS: rest; massage; NSAIDs. Supplements: magnesium oil.
For joint pain, relief has been reported with NSAIDs and with fish oil at 4-6 g once or twice daily (wild caught sources recommended). Collagen supplements have not been found helpful.
For TMJ-area pain, temporary relief has been reported with: heating pads, massage for TMJ, topically applied magnesium oil (a general pain reliever), and mouth splints from a TMJ specialist.
For nerve pain, Neurontin (gabapentin) and Lyrica have been tried successfully, but there are side effects to those medications. The SSNRI Cymbalta works very well for some but is terrible for others, and withdrawal is harsh. Several consider nerve gliding performed by a physical therapist as the most helpful treatment. As OTCs: Benadryl; epsom salt baths; tennis ball massage for foot neuropathy; if good circulation present then icing and/or wearing compression socks; ginkgo biloba; acetyl L-carnitine sometimes with alpha lipoic acid (if tolerated).
For depression, talk therapy, connecting with others, and religious practices have all been found beneficial. Studies show talk therapy is as effective or more effective for depression than medication. SSRI’s Lexapro and Celexa and SSNRI Cymbalta (hit or miss) have been tried successfully sometimes with simultaneous reduction of nerve pain, but Prozac and Zoloft worsen any nerve pain. As OTCs, transdermal magnesium oil and SAM-e have minor anecdotal support. There are a number of reports of amitryptyline worsening neuropathy and some CNS symptoms. Article on anti-depressants after FQ’s here.
For pain in general, opioids are rated highest of all treatments tried, with OxyContin having better reviews than Vicodin. Opioids do not appear to have a significant effect on mitochondrial function. Tramadol also has many positive reviews. Morphine has been tried successfully. A small percentage about 15% report help with pain from legal cannabis with a balanced CBD/THC 1:1 ratio. As OTCs, typical chronic pain syndrome techniques help, with: strong support for warm baths enhanced by Epsom salt and for massage; moderate support for acupuncture and for tolerated light exercise at least every 3 days. Level of activity tolerated changes with progression of symptoms and relapses; as a general rule, pain from exercise lingering more than two hours means it was overdone. As for supplements, there is strong support for turmeric/curcumin and minor support for chlorella. Detox diets have not been particularly helpful.
Pain medications should be started at the lowest standard dose, and then increased to the expected dose while watching for adverse reactions.
The most common gastrointestinal problems fall under the condition of “antibiotic associated diarrhea” which is caused by overgrowth of anaerobic and/or resistant bacteria species not targeted by FQs and affects about 20% of all FQ users. Short term success has been reported with: bananas to control diarrhea; Pepto Bismol. Long term success has been reported with: the antimicrobial rifaximin; probiotic supplements containing multiple bacterial strains especially refrigerated probiotics at health food stores; and replacing entire meals with probiotic containing foods. Probiotic containing foods include yogurt with active cultures and Kefir (a yogurt drink found in health food stores). A special restriction regarding only probiotic foods is that they should not contain inulin, maltitol, or any other sources of dietary fiber, or any sugar alcohols, which can feed “bad” bacteria. Regarding gastrointestinal symptoms, removing sugars from the diet for a few weeks is sometimes necessary. The FODMAP diet has been used successfully in this context. Current research indicates yeasts are always present in the digestive tract and moderately increased yeast presence after antimicrobials is a side effect of antibiotic associated diarrhea, not the cause of it. Development of thrush and need to take an anti-fungal drug is less common, affecting 3-4% of all FQ users; FQ ADR sufferers report tolerating anti-fungals Diflucan (fluconazole, more systemic) and nystatin (more local but easier on liver).
Gastrointestinal symptoms of acid reflux, nausea, and constipation also occur and have been associated with autonomic nervous system damage or dysfunction of digestive system acetylcholine neurotransmission. For both nauseau and acid reflux, sufferers may find some relief from: avoiding acidic foods; avoiding some nightshade foods (sometimes just when cooked). For just nausea: prescription Zofran; Dramamine (dimenhydrinate); Dramamine II (meclizine); ginger; colostrum. For just acid reflux: proton pump inhibitors like Nexium (esomeprazole) and Prilosec (omeprazole); histamine H2 receptor antagonist Pepcid (famotidine); the supplement slippery elm bark. For constipation relief has been reported with: eating prunes; eating wheat bran; eating rice bran. As OTCs: Miralax; fiber products; supplement alpha lipoic acid (which also helps with food tolerance); triphala.
For insomnia, success has been reported with: Benadryl (which should only be used in short term); the supplement melatonin; Ambien; Valium; Tylenol; Klonopin; gabapentin; the supplement chlorella; hawthorn; magnesium; Hemi-Sync CD’s with binaural beats; and many other prescription and OTC methods but not as consistently with valerian. Many people found caffeine worsens insomnia while a few found alcohol, vinegar, and carbohydrates worsen their insomnia; still others found reasonable amounts of alcohol helpful. About 25% report CBD (without THC) helps with sleep, while a smaller percentage about 15% report insomnia help with CBD/THC 1:1 ratio.
For anxiety, Xanax and Ativan have good reviews, but should only be used for periods of several consecutive days to prevent dependency. OTCs: Epsom salt baths; warm milk; chamomile tea; the supplement inositol; and two juiced limes (as an inositol source) twice daily.
Dry eye which can cause light sensitivity (photophobia), difficulty focusing, and halos can be treated by: inserting a drop of preservative-free eye drops hourly; washing Meibomian glands upon waking; holding a hot wet towel against the eyes for 3 minutes to stimulate Meibomian glands; having an ophthalmologist plug tear ducts with temporary, dissolving plugs (“punctal plugs”); prescription restasis eyedrops; protecting light-sensitive eyes with sunglasses. Specific brands recommended have included Allergan Refresh Plus Lubricant Eye Drops in Single-Use Vials, and Optive Lubricant Eye Drops for Single Use.
Improvement of visual problems of floaters and dark black specks has been reported with the supplements bilberry and lutein and grape seed extract for several months.
For poor peripheral circulation, relief has been reported with: heating pads to encourage vasodilation; wearing thin gloves with finger holes cut; submersing limb in buckets of warm water; the combination of double dose gingko biloba + odorless garlic + pycogenol.
Back pain relief has been reported from: TENS units; inflatable seat cushions for car travel (e.g. ThermaRest “camp seat cushion”); orthopedic pillows designed to raise legs for sleeping (e.g. “ortho bed wedge“); the muscle relaxant cyclobenzaprine; ice.
Brain fog symptoms have been reported to improve with the supplements alpha lipoic acid and acetyl L-carnitine, though alpha lipoic acid may exacerbate neuropathy for a few hours in those less than one year into ADRs, while improving nausea + acid reflux, and double vision in others.
Improvement of fatigue has been reported with: vitamin B’s (if blood tests show existing levels are not too high); D-ribose; colostrum; getting plenty of rest; thyroid supplementation that includes T3 triiodothyronine. Specifically for males also having low testosterone: subcutaneous prescription hCG injection; and/or testosterone therapy.
Relief from fasciculation has been reported with various benzodiazepines (which should not be taken more than periods of a few consecutive days to prevent developing dependency), and magnesium supplements.
Male low testosterone has been successfully treated with subcutaneous prescription hCG injection; and/or testosterone therapy..
Tachycardia (rapid heart rate) is reportedly worsened by stress and lessened by beta blockers, like Toprol (metoprolol).
The supplement rutin and its component quercetin (which binds to DNA gyrase like FQs) have purportedly worsened symptoms in some.
Alternative therapy techniques leading to several days of overall feelings of improvement for a portion of so-inclined users include: glutathione and vitamin IV infusions; hyperbaric oxygen therapy; ozone therapy; Traditional Chinese Medicine bloodletting. Some find low-sugar diets like the Paleo diet, Caveman diet, Candida diet, or other variations such a FODMAP diet helpful, which help with a diverse set of symptoms. N acetyl cysteine (NAC) was found helpful by some. Religious Faith was also identified as helpful by some.
This is a deliberately abridged summary of successes reported daily in support groups, and the best solutions may still be waiting for your discovery.
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