Links | Home | Individual Minerals | Mineral Blends | Vitamins| Order | Contact | Application |
|
| Educational Information on Magnesium and Fibromyalgia Syndrome | |
|
|
The following articles are presented as support for the possible use of ionic minerals and magnesium as a dietary supplement and nutritional supplement. You will find more on ionic magnesium here. You can also purchase this diet supplement below. MAGNESIUM DEFICIENCY IN FIBROMYALGIA SYNDROMEMagazine:
Journal of Nutritional Medicine, Spring, 1994 Since patients with either Fibromyalgia syndrome (FS) or low magnesium (Mg) levels can have fatigue, sleep disturbance and anxiety, it was necessary to determine if some patients with FS also have low Mg levels. Both red blood cell (RBC) and plasma Mg levels were measured in 100 consecutive FS patients and 12 osteoarthritis (OA) control patients. Compared to reference laboratory and OA controls, FS patients had significantly lower RBC Mg levels. The plasma Mg levels of FS patients were no different than the reference laboratory or OA controls. Some FS patients have low Mg levels, a problem that is potentially correctable. Keywords: Fibromyalgia, magnesium, fatigue, pain. INTRODUCTIONPatients with Fibromyalgia syndrome (FS), also called fibrositis syndrome, often suffer from myalgias, fatigue, sleep disturbance and anxiety [1-3]. The same symptoms are found in patients with low magnesium (Mg) levels [4]. In fact, abnormalities of muscle activity have been shown in Mg deficiency using myothermography [5]. Since treatment with Mg has been shown to be of benefit in patients with tiredness [6] and in patients with chronic fatigue syndrome (CFS) [7], measurements of Mg in FS patients might prove helpful in identifying those FS patients most likely to benefit from Mg supplementation. In fact, recently there was a preliminary report of low Mg in FS patients [8]. Both plasma and red blood cell (RBC) Mg levels of FS patients were measured to increase the sensitivity of the investigation. RBC Mg levels have been shown to be a better predictor of the body's Mg status than plasma levels [9] and low RBC Mg levels have been shown to be present while plasma levels were normal [7]. FS is a chronic disorder whose symptoms may be exacerbated by latent Mg deficiency. Recognition of such a problem in some FS patients would thus be the first step in more successful treatment and the easing of the suffering of many thousands of patients. PATIENTS AND METHODSOne hundred consecutive patients who fulfilled the American College of Rheumatology ACR criteria for FS [3] were examined for Mg deficiency. There were 20 men (mean age 46, range 29-57) and 80 women (mean age 48, range 28-64) studied. The mean tender point count in the FS patients was 16.2 (of a possible 18). Dolorimetric measurements were performed on six typical tender areas and three control areas. The mean dolorimeter scores of the tender areas were: occiput, 2.8 kg; trapezius, 2.4 kg; second rib, 3.2 kg; paraspinous, 3.6 kg; lateral humeral epicondyle, 3.4 kg; medial knee fat pad, 3.0 kg. The mean dolorimeter scores for the control areas were: thumbnail, 5.6 kg; midpoint of the third metatarsal, 5.4 kg; forearm midpoint, 5.2 kg. Dolorimetry was performed using a Chantillon dolorimeter as described previously [10] and the areas studied were on the right side of the body. Twelve patients with uncomplicated monoarticular osteoarthritis (OA) (four hip; six knee; two shoulder) were also studied. There were three men (ages 44, 48, 53) and nine women (mean age 50, range 42-64) in the OA group. None were taking diuretics or uricosuric drugs. None were bulemic, anorexic or using laxatives inappropriately to our knowledge. No FS patient was cachectic or on a 'crash' diet at the time of the study. All had simultaneous plasma and RBC Mg studies drawn. The samples were drawn into a heparinized tube from a peripheral vein. The samples were immediately refrigerated and then transported to a reference laboratory (National Medical Services, Willow Grove, PA, USA) where the assays were performed. The plasma and RBC Mg levels using washed cells were determined by using direct dilution techniques and atomic absorption [11, 12] and results reported in mg dl[sup -1] (mumol l[sup -1]). RESULTSThe mean RBC Mg level for the general population (reference laboratory) is 5.5 mg dl[sup -1] (2.3 mumol l[sup -1]) with a 'normal' range of 4.2 - 6.8mg dl[sup -1] (1.75-2.83 mumol l[sup -1]). The standard deviation (SD) is 0.65 mg dl[sup -1] (0.27 mumol l[sup -1]). In contrast, the mean Mg level of the FS population (100 patients) is 4.6 (1.92) with a range of 3.7-5.6 mg dl[sup -1] (1.54-2.33 mumol l[sup -1]) and SD of 0.48 (0.20). By using a comparison of means test, there was a statistically significant difference (z = 8; p < 0.001) between these two groups. The FS patient group contained 41 patients with a myofascial pain syndrome (MPS) diagnosed using criteria developed by Travell and Simons [13]. However, most FS patients (59 patients) did not have a concomitant MPS. There was no statistically significant difference between these two groups (z = 0.2; p > 0.05). While 15 FS patients had RBC Mg levels that were clearly below the 'normal' range (i.e. <4.2 mg dl[sup -1] (1.75 mumol l[sup -1])), anothev 48 FS patients had RBC Mg levels in the lower quartile (i.e. between 4.2 (1.75) and 4.85 (2.02)mg dl[sup -1] (mumol l[sup -1]) of this range. In addition to the reference laboratory controls, 12 patients suffering from uncomplicated OA were also studied. They had RBC and plasma Mg levels measured. Their mean RBC and plasma Mg levels were 5.3 mg dl[sup -1] (2.21 mumol l[sup -1]) and 2.0 mg dl[sup -1] 0.83 (mumol l[sup -1]), i.e. not significantly different than published controls (p > 0.4) but different from RBC Mg values of FS patients (p < 0.01). The mean plasma Mg level for the general population (reference laboratory) is 2.05 mg dl[sup -1] (0.85 mumol l[sup -1]) with a 'normal' range of 1.6 -2.5 mg dl[sup -1] (0.67-1.04 mumol l[sup -1]) and a SD of 0.225 mg dl[sup -1] (0.09 mumol l[sup -1]). The FS patients had a mean plasma Mg level of 2.05 mg dl[sup -1] (0.85 mumol l[sup -1]) with a range of 1.7 -2.6 mg dl[sup -1] (0.71-1.08 mumol l[sup -1]) and a SD of 0.275 mg dl[sup -1](0.11 mumol l[sup -1]). There was no statistically significant difference between the two groups. The Role of Magnesium in FibromyalgiaAn investigatory paper by Mark LondonMagnesium deficiency is very common in the general US population. Not only is our daily intake low, but we eat a diet which increases the demand for magnesium. And unfortunately, urinary magnesium loss can be increased by many factors, both physical and emotional. Magnesium loss increases in the presence of certain hormones. Stress can greatly increase magnesium loss. Even loud noises can extra magnesium loss. One article on the web goes so far as to say that that almost everyone is the United States is at least marginally deficient in magnesium. So there is an excellent chance that a person with fibromyalgia has a magnesium deficiency. But since people with fibromyalgia often have high levels of stress, and a disrupted hormonal system, they are more likely to be candidates for magnesium deficiency. Magnesium utilization is also increased by the presence of estrogen, and this might explain why many women are diagnosed with fibromyalgia after menopause, when estrogen levels would decrease. Additionally, the sleep disruption which occurs in fibromyalgia might also affect magnesium utilization, as sleep deprivation has been shown to cause lower magnesium levels. The reason lack of sleep causes a magnesium deficiency is probably due to the lower amounts of growth hormone secretion which occurs due to a sleep disturbance, especially the type that is found in people with fibromyalgia. Growth hormone is responsible for creating a substance known as IGF-1, or insulin growth factor. IGF-1 has been found to have many uses by the body. It's especially known for tissue repair. However, it can influence intracellular levels of magnesium, as the following studies show: http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9851785&dopt=Abstract Also, IGF-1 affects excretion of magnesium by the kidneys: Magnesium deficiency is therefore one of many problems in people with fibromyalgia which is due to or influenced by the sleep disturbance. So while it's possible to attain some benefit from taking magnesium, treating any sleep disorder is just as helpful, if not more so. Magnesium is extremely important to many functions in the body, which is why a deficiency can cause many different symptoms. It is most widely known for being needed for proper bone formation. With a deficiency, bones will be soft, and it can play a role in osteoporosis However, magnesium is also the activating mineral for at least 350 different enzymes in the body, more than any other mineral, so it is crucial for many of the metabolic functions in the body. Magnesium is necessary for almost all the enzymes that allow the glycolytic and Krebs cycles to turn the sugar and fat we eat into ATP. Low levels of ATP have commonly been found in people with fibromyalgia, and it is believed that this plays an important role in many of the fibromyalgia symptoms. Thus, a magnesium deficiency would definitely be a factor in worsening those symptoms. Magnesium is extremely necessary for proper ATP synthesis, because ATP is stored in the body as a combination of magnesium and ATP, which is known as MgATP. ATP requires magnesium in order to be stable. Without magnesium, ATP would easily break down into other components, ADP and inorganic phosphate. The brain heavily relies ATP for many functions. In fact, 20% of total body ATP is located in the brain. Thus, low levels of ATP can diminish brain cognitive functions, a common problem in people with fibromyalgia. And since ATP influences transport of magnesium into cells, a vicious cycle can arise in which low ATP levels give rise to even lower intracellular magnesium, causing still further ATP reduction. Adequate magnesium is necessary for proper muscle functioning. Magnesium deficiency promotes excessive muscle tension, leading to muscle spasms, tics, restlessness, and twitches. This is due to an imbalance of the ratio of calcium to magnesium, as calcium controls contraction, while magnesium controls relaxation. Plus, in fibromyalgia, changes are seen in the muscles, such as "significantly lower than normal phosphocreatine and ATP levels" and "values for phosphorylation potential ... also were significantly reduced": But all of these same changes are found also in magnesium deficiencies: http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8988330&dopt=Abstract Magnesium may also help Myofascial Pain Syndrome. According to Devin Starlanyl's web page "Myofascial trigger points can be identified and documented electrophysiologically by characteristic spontaneous electrical activity (SEA). They may also be identified histologically (which means that the structure of the cells have changed) by contraction knots-- the lumps and bumps we know only too well. Both of these phenomenon seem to result from excessive release of the neurotransmitter acetylcholine (ACh) from the nerve terminal of the motor endplate (the complex end formation of the nerve)." But magnesium is well known for being able to inhibit ACh release: And in fact, intravenous magnesium sulfate is used in emergency situations because of this effect on acetylcholine: http://www.templejc.edu/ems/drugs/Magnesium.html Magnesium is known to regulate or inhibit many nerve receptors, such as NMDA or 5-HT3, which have been considered as sources of certain types of fibromyalgia pain. Neurontin, for example, is used because inhibits NMDA activity. Since magnesium also blocks NMDA receptors, studies have used intravenous magnesium therapy to try and treat similar types of neuropathic pain: http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10687324&dopt=Abstract And it's because of magnesium's ability to regulate nerve functions that other fibromyalgia symptoms occur. Migraine headaches, mitral valve prolapse, and Raynaud's phenomenon, all problems commonly found in people with fibromyalgia, are also problems that have been associated with a magnesium deficiency. Without enough magnesium, nerves fire too easily from even minor stimuli. Noises will sound excessively loud, lights will seem too bright, emotional reactions will be exaggerated, and the brain will be too stimulated to sleep, all symptoms commonly found in fibromyalgia. And if the oversensitivity to light and noise reminds you of someone suffering from a hangover, they are one and the same problem, as alcohol is known for decreasing magnesium levels, and magnesium supplementation has been found to relieve hangover symptoms. Another commonly found condition in fibromyalgia which has nervous related symptoms is reactive hypoglycemia. Anxiety related symptoms occur after carbohydrate intake, and this is believed to be due to either an excess release of adrenaline, or a higher sensitivity to adrenaline. In either case, a deficiency of magnesium could be a factor, as "magnesium has been found to slow the release of both adrenaline and noradrenaline, and to partially block adrenergic receptors." Not only that, but magnesium also affects carbohydrate metabolism in a different manner, as a magnesium deficiency appears to create resistance to insulin, Insulin resistance increases levels of insulin, which may result in a form of diabetes. Additionally, insulin resistance by itself can distrupt intracellular magnesium levels, as the following web page explains. Thus, "insulin resistance and magnesium depletion may result in a vicious cycle of worsening insulin resistance and decrease in intracellular Mg(2+) which may limit the role of magnesium in vital cellular processes." Magnesium also appears to be able to also affect the nervous system by regulating the release of hormones, which occurs due to many different forms of stress. However, this hormonal activity is disrupted in fibromyalgia. Often there is an exaggerated release or high levels of noradrenaline (also known as noepinephrine), as the following studies show: http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2532682&dopt=Abstract However, magnesium appears to play a role in regulating noradrenaline levels. For example, in the following study on mitral valve prolapse, magnesium supplementation not only relieved symptoms, but also reduced the high level of urinary noradrenaline excretion: And genetically bred mice with low magnesium levels have also been found to have high noradrenaline levels: And ,as was previously mentioned, sleep deprivation appears to lower magnesium levels. However, in another study, sleep deprivation was found to raise noradrenaline levels: Thus, there appears to be a strong link between high noradrenaline levels, and low magnesium levels. And this imbalance of hormones could play a role in exercise tolerance in fibromyalgia. High noradrenaline levels are associated with low exercise tolerance. This might be due to the fact that noradrenaline causes constriction in blood vessels, and this could reduce oxygen flow during exercise. This is made worse by the lower than normal adrenaline levels in fibromyalgia, as adrenaline is able to dilate blood vessels in the skeletal muscles and the liver. However, magnesium is able to relax smooth muscles around blood vessels, and thus has a strong vasodilatory effect, which could counteract the vasoconstriction effect of the hormones. Related to this is the previously mentioned study of patients that were sleep deprived which resulted in low magnesium levels. They were also found to have lower levels of exercise tolerance. But in a subsequeent study, it was found that magnesium supplementation was able to raise that tolerance: Respiratory problems such as asthma have also been associated with high levels of noradrenaline, and thus magnesium might be of help for those conditions. A magnesium deficiency also increases levels of substance P, a chemical which has been implicated as being responsible for increased pain levells in FMS. Several studies, such as the following, show this: However, even just as important is the fact that this study also shows a rise in inflammatory cytokines. Cytokines are part of the immune system. However, raised levels of certain cytokines have been implicated in many health problems and diseases, and some researchers feel that they may be responsible for many of the symptoms of FMS and CFS, as these cytokines play a role in metabolic and many other functions. Sleep deprivation studies also show an increase these cytokines, not surprising since we have shown that sleep deprivation can cause a magnesium deficiency. The following study showed a significant increase in one of these cytokines, interleukin-6. This cytokine appears to play a role in the fatigue and other health symptoms that directly result from lack of sleep: Since a sleep disturbance could cause a rise in these cytokines, and since this study also postulates that these cytokines themselves play a role in regulating sleep, a spiraling effect could occur, as the high levels of these cytokines could cause sleep to be constantly disturbed Such a circular effect has been proposed for the cause of FMS. Magnesium is thus involved in many functions in the body, and so it's no wonder that the chemical brain imbalances in fibromyalgia somehow seem connected to processes involving magnesium. Surprisingly, little is known about magnesium, as compared to other minerals in the body, as the following recent paper summarizes: http://www.bioscience.org/2000/v5/d/romani/fulltext.htm So it could be that magnesium even has more effects that we are not yet aware of. And it's because magnesium is involved in so many processes in the body, that a deficiency has a spiraling effect. Low magnesium levels causes metabolic functions to decrease, causing further stress on the body, reducing the body's ability to absorb and retain magnesium. A marginal deficiency could easily be transformed into a more significant problem. Any stressful event could trigger magnesium loss. So one could postulate that stressful events which trigger fibromyalgia are doing so by creating a high loss of magnesium. Perhaps people in a fibromyalgia flare could be helped by additional magnesium. Unfortunately, magnesium deficiency is not easily detected, as serum levels do not reflect the levels of magnesium in tissues. This is the reason why it is so overlooked and ignored, both by doctors and by studies. And unfortunately, oral magnesium supplementation can be difficult because of absorption problems. Digestion and diet play a key role in absorption. People with fibromyalgia often have conditions like Irritable Bowel System, gluten intolerance, or other problems that might limit absorption. Phosphate can bind to magnesium in the gut, creating magnesium phosphate, an insoluble salt that can't be utilized. Many forms of oral magnesium supplements are hard to assimilate. The most common, magnesium oxide and citrate, happen to be the worst to assimilate, which is why both have a strong laxative effect. If you suffer from that effect when you take magnesium, it is often not because you are taking too much, but because you are not assimilating it well. And it may take long term use of supplements before magnesium levels are raised in all the tissues, and for damaged cell functions to be restored. Further information about magnesium as it relates to fibromyalgia, see the following web pages: http://www.fibromyalgie.net/artikelen/hypothesis_management_of_fibromy.htm It especially has some good information regarding magnesium's ability to regulate calcium and phosphate within cells, which is necessary to maintain proper ATP synthesis. It also discusses magnesium in regard to proper cell membrane permeability. Further discussions of this and other topics regarding magnesium deficiency can be on this web page: http://www.mgwater.com/dur18.shtml And the disruption of proper cellular membrane permeability is believed to lead to a decrease in the intracellular antioxidant system, shown in the following study, one of several in MEDLINE: This might explain recent studies which have shown oxidative damage in people with fibromyalgia. http://bubl8.lib.strath.ac.uk/journals/soc/cbomt/v03n0198.htm#2metabolic And the changes in cell membranes and subsequent intracellular imbalance in cells reduces the body's defenses against toxins such as heavy metals. A long term magnesium deficiency may lead to many other secondary problems that have their own host of symptoms. A magnesium deficiency causes an increase in intracellular calcium levels, which may lead to calcification and cell death. And a few more studies for those interested on the effects of a magnesium deficiency on cell disturbances and mitochondria damage: http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9529585&dopt=Abstract And if you are still skeptical of the importance of magnesium, I suggest you read the following: http://www.mgwater.com/dur30.shtml While most symptoms which are directly due to magnesium are reversible, magnesium indirectly causes problems that may not be reversible. "With a high aluminum diet alone, aluminum content in the nervous system in rats showed no difference with a control group aluminum serum aluminum was high. However, with an insufficient intake of magnesium the same aluminum load induced an increase in aluminum and calcium concentrations in the nervous system and neurodegeneration with precipitation of insoluble hydroxyapatites." Combined aluminum intoxication with calcium-magnesium deficiencies is not reversible through physiological oral magnesium supplementation. And also from that web page: " "nervous consequences of magnesium deficiency" ... "are completely reversible since they can be restored to normal with simple oral physiological magnesium supplementation but it should also be pointed out that a prolongation of untreated chronic magnesium deficiency can produce irreversible lesions with histological changes." If you are considering taking magnesium, please note that not all forms are the same. Magnesium oxide and citrate are the most common, but also are the worse to assimilate, causing a laxative effect. Most doctors recommend taking a chelated form, and spreading out the doses throughout the day, in order to better absorb it. Taking magnesium with calcium is suggested because the 2 minerals work together in buildling bones, plus the calcium can offset some of the laxative effect. However, you don't need to take calcium in the ratio of 2/1. This ratio is based on the amount of calcium and magnesium in bones, but there is no reason not to take more magnesium than this, as more magnesium does not increase the need for more calcium. In fact, some doctors believe the ideal ratio is 1/1. If one brand of magnesium does not work for you, or if you experience a side effect, consider switching to a different brand, as the amino acid which is combined with the magnesium has been known to cause side effects in some people. Many people have found that liquid forms of magnesium help when pills do not help. There are various forms of liquid magnesium, i.e. magnesium chloride, gluconate, and citrate. Magnesium chloride is well absorbed, although the liquid form has to be kept refrigerated. Liquid gluocate (magonate) contains not only a lot of glucose, but also several additives to make it taste better, but also a perservative to keep it from spoiling. On the other hand, the best form of magnesium might be a time released version. Having a steady source of magnesium has been found to help in cases when plain magnesium does not help. One can do this by taking lots of small doses, but this is inconvenient. Time released supposedly is released over a 8-10 hour period. There are 2 available forms, magnesium chloride and magnesium lactate Two products contain magnesium chloride, Slow Mag and Pro-Mag. Slow Mag contains several additives that Pro-Mag does not. The latter is made by Douglas Laboratories, and I personally have had good results with it. Time released forms are more expensive, so most people recommend a combination of pills and time released, which is what I do. It should also be noted that B vitamins are necessary for proper utilization of magnesium. Some people with fibromyalgia might have B vitamin deficiencies, especially B12. One study, has shown that homocysteine levels are high in the cerebrospinal fluid, and this indicates low levels of B12 in the brain. Additionally, homocysteine causes a depletion of intracellular free magnesium:, and according to the following study, only a combination of B6, B12, and folate acid can stop this depletion of magnesium. Thus, some people with fibromyalgia might benefit from B vitamin supplementation. (However, certain B12 deficiencies require B12 shots, as some people are unable to orally absorb enough B12.) I personally started taking magnesium for spasms and facial tics, only doing so on my own after neurologists simply told me to either get better sleep or take a prescription drug. The magnesium helped almost immediately, and I then slowly increased the dose to about 225% the RDA (balanced with 100% calcium RDA) At that point, all spasms and tics stopped completely, and they have not returned since starting that dose several years ago. I doubt any traditional doctor would have been willing to prescribe that much magnesium. The RDA is 400mg, but many people believe this is too low. Traditionally, it's been recommended to take calcium and magnesium in a ratio of 2/1, because that is the ratio that these minerals are found in bone. But magnesium is less easily absorbed than calcium, so this ratio may not be valid for a lot of people, and in fact many cal-mag combinations found in health food stores often have additional magnesium. Magnesium is just one of many helpful remedies and/or supplements for that might be helpful for fibromyalgia. It's not a cure, but it may be helpful in relieving some of the symptoms. For more information about magnesium, click here to read Sandy Simmons's web page on magnesium. Copyright (c) 2000
DISCUSSIONThe clinician is often frustrated when treating FS patients since symptoms are numerous and solutions inadequate. The finding of a potentially reversible problem (i.e. Mg deficiency) in some FS patients is encouraging. This study, as well as a previous report [8], identified a subgroup of FS patients that may benefit from Mg supplementation. More importantly, this finding may inspire further investigation into other easily treated problems that may cause FS patients difficulty. For a disorder such as FS which has no cure, the correction of any other problem which may be an exacerbation or perpetuating factor may not only be of help to the patient but may be critical in getting the FS under reasonably good control. There is certainly precedent for such reasoning. Travell and Simons [14] have maintained for many years that MPS sufferers cannot be treated adequately unless perpetuating factors such as vitamin deficiencies, electrolyte imbalances, poor posture, etc. are eliminated or ameliorated. The question of whether Mg deficiency is pathogenic or simply an epiphenomenon is not known and requires further study. However, to he able to identify a correctable problem in FS sufferers is certainly desirable. Thus, Mg deficiency should be considered in FS patients especially if they are not responding to conventional treatments [15, 16] as expected. It is important to note that the Mg deficiency in FS patients was discovered only when RBC Mg levels were measured. Thus, FS patients who are suspected of suffering from low Mg must be tested for both RBC and plasma Mg before Mg deficiency can be ruled out. CONCLUSIONSMany FS patients suffer from Mg deficiency. While the former condition can be treated but not cured and the latter is potentially corrigible, it is important to assess Mg levels in all FS patients for optimal management of their musculoskeletal problem. REFERENCES [1] Smythe HA, Moldofsky H. Two contributions to understanding of the 'fibrositis' syndrome. Bull Rheum Dis 1977; 28: 928-31. [2] Yunus MB, Masi AT, Calabro JJ, Miller KA, Feigenbaum SL. Primary fibromyalgia (fibrositis); clinical study of 50 patients with matched normal controls. Semin Arthritis Rheum 1981; 11: 151-71. [3] Wolfe F et al. The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis Rheum 1990; 33: 160-72. [4] Webb WL, Gehi M. Electrolyte and fluid imbalance: neuropsychiatric manifestations. Psychosomatics 1981; 22: 199-203. [5] Howard JMH. Muscle action, trace elements and related nutrients. In: Chazot G et al., eds. Current Trends in Trace Elements Research. London: Smith-Gordon, 1989, 79-85. [6] Johansson BW. Magnesium infusion in decompensated hypomagnesemia patients. Acta Pharmacol Toxicol (Copenhagen) 1984; 54: 125-8. [7] Cox IM, Campbell MJ, Dowson D. Red blood cell magnesium and chronic fatigue syndrome. Lancet 1990; 337: 757-60. [8] Abraham GE, Flechas JD. Management of fibromyalgia: rationale for the use of magnesium and malic acid. J Nutr Med 1992; 3: 49-59. [9] Alfrey AC, Miller NL, Burkus D. Evaluation of body magnesium stores. J Lab Clin Med 1974; 84: 153-62. [10] Romano TJ. Clinical experiences with post traumatic fibromyalgia syndrome. West Virginia Med J 1990; 86: 198-202. [11] Tietz NW, ed. Fundamentals of Clinical Chemistry, 3rd edn. Philadelphia: WB Saunders, 1987, 17-18. [12] Brown SS, Mitchell FL, Young DS, eds. Chemical Diagnosis of Disease. Amsterdam: Elsevier/North-Holland, Biomedial Press, 1979, 440. [13] Travell JG, Simons DG. Background and Principles in Myofascial Pain and Dysfunction. The Trigger Point Manual. Baltimore, London: Williams and Wilkins, 1983, 18-19. [14] Travell JG, Simons DG. Perpetuating Factors in Myofascial Pain and Dysfunction. The Trigger Point Manual. Baltimore, London: Williams and Wilkins, 1983, 103-64. [15] Romano TJ. Fibromyalgia Syndrome. In: Taylor RB, ed. Difficult Medical Management. Philadelphia, London: WB Saunders, 1991, 259-66. [16] Yunus M, Masi AT. Fibromyalgia restless legs syndrome, periodic limb movement disorder, and Psychogenic Pain. In: McCarty DJ and Koopman WJ, eds. Arthritis and Allied Conditions. A Textbook of Rheumatology, 12th edn, Vol. 2. Philadelphia, London: Lea and Febiger, 1993, 1383-98. ~~~~~~~~ BY
THOMAS J. ROMANO MD PHD FACP FACR[1] AND JOHN W. STILLER MD[2] 1
Faculty American Academy of Pain Management--Private Practice,
Wheeling, WV 26003, USA; 2 Private Practice, Lakeland, FL 33813, US Correspondence to: Dr Thomas J. Romano, Suite 201, Center 3, Medical Park, Wheeling, WV 26003, US
|
|
Links |
Home
| Individual Minerals | Mineral
Blends | Vitamins| Order
| Contact | Application
© 2001 {Rainbow Minerals L.L.C.} |
|
