Tag Archives: Pain

Fluoroquinolone Antibiotics Associated with Carpal Tunnel Syndrome

It is well-known and well-documented that fluoroquinolones weaken and destroy musculoskeletal tissues–especially, but not limited to, tendons. 

Additionally, it is known that fluoroquinolones cause neurological problems, and can lead to painful and debilitating peripheral neuropathy. (In 2013, fluoroquinolone warning labels were updated to note that Cipro/ciprofloxacin, Levaquin/levofloxacin, Avelox/moxifloxacin, and Floxin/ofloxacin can cause permanent and disabling peripheral neuropathy.)

Given that fluoroquinolones disproportionately affect the tissues in joints, and that they also adversely affect nerves (causing painful neuropathy), it’s not surprising that fluoroquinolone antibiotic use is associated with Carpal Tunnel Syndrome (CTS)–a medical condition that includes “pain, numbness, and tingling, in the thumb, index finger, middle finger, and the thumb side of the ring fingers,” as well as weakness and muscle wasting.

Both CTS and fluoroquinolone-use are common in America, and researchers Jasmine Z. Cheng, Mohit Sodhi, Mahyar Etminan, and Bruce C. Carleton, examined how they are related in “Fluoroquinolone Use and Risk of Carpal Tunnel Syndrome: A Pharmacoepidemiologic Study” published in the journal Clinical Infectious Diseases in August, 2017.

In “Fluoroquinolone Use and Risk of Carpal Tunnel Syndrome: A Pharmacoepidemiologic Study” the researchers found that, “Any use of FQ within the year prior to CTS diagnosis was associated with a 34% and 36% increased risk of CTS in the primary and sensitivity analyses, respectively” and that:

“The results of our study are consistent with an increase in the risk of CTS with FQs. The risk was consistent among all risk periods with a slight increase among past users, which may be due to the longer period elapsed for CTS to manifest itself. FQ-related neurotoxicity can persist cumulatively in relation to exposure levels [8, 9]. The exact mechanism by which this occurs is unknown [9], but proposed models include direct nerve inflammation and ischemia from toxic metabolite and free radical formation [10], and FQ-induced tendonitis/tendinopathy causing mechanical compression upon the adjacent nerves (eg, median nerve) that share the carpal tunnel [11]. Reports of nerve biopsy studies on patients who have experienced FQ adverse events have revealed significantly reduced nerve fiber density consistent with small fiber neuropathy, which may be a potential mechanism of CTS [12]. Although neurotoxicity is the second most commonly reported adverse event, with several studies documenting FQ association with central and peripheral nerve damage [8, 9], this is the first large-scale study exploring the relationship between FQs and CTS.”

CTS is a malady that affects thousands of people and has societal costs in the millions of dollars. In “Fluoroquinolone Use and Risk of Carpal Tunnel Syndrome: A Pharmacoepidemiologic Study” the researchers note that:

“CTS is a disease of significant societal burden with a prevalence of 5% and incidence of up to 2.3 per 1000 person-years [4, 5]. CTS causes loss of function and decreased quality of life for individual patients, and also comprises a large cumulative drain on healthcare and socioeconomic resources from loss of productivity and worker’s compensation claims [6]. One study of 4443 CTS claimants in Washington State estimated a cumulative socioeconomic cost of US$197–$382 million over 6 years for this cohort alone [6].”

Fluoroquinolones are increasing the risk of CTS in millions of people (20+ million prescriptions for fluoroquinolones are written each year). Are doctors or patients aware that they are increasing the patient’s chances of CTS–a painful, debilitating, and costly condition–when fluoroquinolone antibiotics are taken? I doubt it, but they should be.

Please spread the word about how dangerous fluoroquinolones are by sharing posts, news articles, and research articles that connect fluoroquinolones with other illnesses. It wouldn’t occur to most people that a commonly prescribed class of antibiotics could be connected with CTS, psychiatric illness, pain, pseudotumor cerebri, tendon damage and ruptures, or multi-symptom chronic illnesses. But fluoroquinolones ARE connected with those, and other, diseases and syndromes. Articles like “Fluoroquinolone Use and Risk of Carpal Tunnel Syndrome: A Pharmacoepidemiologic Study” help to provide evidence of the extensive damage that fluoroquinolones do, and I am grateful to the researchers who examined the connections. Please spread the word so that doctors and patients alike are informed. Thank you.

 

 

Cipro is no better than a PLACEBO at treating chronic prostatitis / chronic pelvic pain syndrome

It is noted in the book, A Headache in the Pelvis, that, “Ciprofloxacin, one of the most powerful antibiotics, on a long-term basis proves to be only as effective as a placebo” for treatment of chronic prostatitis / chronic pelvic pain syndrome (CP/CPPS).

I just about fell out of my chair when I read that.

Ciprofloxacin, not only one of the most powerful antibiotics, but also one of the most dangerous antibiotics, is NO MORE EFFECTIVE THAN A PLACEBO for treatment of chronic prostatitis.  Despite their lack of effectiveness, “Quinolones, such as ciprofloxacin, are commonly used to treat CP/CPPS because of their excellent penetration into the prostate.”

Ciprofloxacin penetrates the prostate, and every cell in the body well, but that doesn’t seem like a good enough reason to give it out to the 9-12% of men who suffer from prostatitis if it is NO MORE EFFECTIVE THAN A PLACEBO in treating chronic prostatitis.

Let’s do a cost/benefit analysis of ciprofloxacin versus a placebo.

Placebo

Benefits:  Some potential alleviation of symptoms, as well as potential increases in physical and mental health scores.  (The placebo effect is amazing – it’s not the same as doing nothing.)

Costs:  The potential for “nocebo” effects exists – the experience of adverse effects based on the expectation of adverse effects.  A placebo is a sugar pill though, and the potential for adverse effects is negligible.

Ciprofloxacin

Benefits:  Some potential alleviation of symptoms, as well as potential increases in physical and mental health scores.  (Same potential benefits as the placebo.)

Costs:  Ciprofloxacin and other fluoroquinolones can kill people – DEATH is a potential effect.  If they don’t kill the patient, they can still structurally weakening of every tendon in one’s body, cause mitochondrial dysfunction and potentially increase the risk of all of the diseases related to mitochondrial dysfunction (including neurodegenerative and autoimmune diseases), lead to serious central nervous system adverse effects including seizures, anxiety, depression, suicidal ideation and intracranial pressure, cause liver and kidney failure, PERMANENT peripheral neuropathy, and more.  There is a 43 PAGE warning label for ciprofloxacin.  Many things are missing from the warning label, and a list of some of the adverse effects can be found HERE.  When patients are given ciprofloxacin, they are not only risking a single adverse effect listed on the warning label, they are risking multiple, devastating effects that may be permanent.

Opting for the sugar pill seems pretty reasonable—better, actually.

It is criminal to subject people to a drug as dangerous as ciprofloxacin for a condition that it isn’t effective at treating.  It is NOT a benign drug.  It is a topoisomerase interruptera chemo drug – and it should NOT be used frivolously.  Ciprofloxacin, and all the other fluoroquinolones, should only be used in life-threatening situations and they should NEVER be used for conditions that they are not proven effective at treating.  They should NEVER be used in situations where they have been shown to be no more effective than a placebo.

This isn’t rocket science.  Don’t give people dangerous drugs that don’t even have the potential for helping them.  It’s not hard.  But men with CP/CPPS are given ciprofloxacin, and other fluoroquinolones, as if they’re candy, to “treat” their condition.  It’s absurd.

The study that found that CP/CPPS is no more effective than a placebo was published in the Annals of Internal Medicine in 2004 and it was entitled “Ciprofloxacin or Tamsulosin in Men with Chronic Prostatitis / Chronic Pelvic Pain Syndrome: A Randomized, Double-Blind Trial.”  The article notes that:

“Chronic prostatitis / chronic pelvic pain syndrome (CP/CPPS) is a common disorder and accounts for approximately 2 million visits to physicians annually in the United States.  The substantial impact of CP/CPPS includes bothersome lower urinary tract symptoms, sexual dysfunction, reduced quality of life, and increased health care expenditures.  The syndrome is diagnosed only on the basis of symptoms, principally pain or discomfort in the pelvis region.  No objective measures can help define the disease.  Although bacteria can infect the prostate, most men with prostatitis have a negative midstream urine culture, indicating that bacteria may not be the cause of their symptoms.”

“Because the cause of CP/CPPS is unknown, affected men receive many empirical therapies.  The 2 most common treatments prescribed by physicians are antimicrobial agents and a-adrenergic receptor antagonists, although there is little objective evidence to support their use.  Quinolones, such as ciprofloxacin, are commonly used to treat CP/CPPS because of their excellent penetration into the prostate and broad spectrum coverage for uropathogens and other organisms traditionally believed to be associated with the syndrome.” 

After completing a randomized, double-blind trial on men suffering from CP/CPPS, and comparing those who received ciprofloxacin, tamsulosin, a combination of both ciprofloxacin and tamsulosin, and a placebo, it was concluded that, “Ciprofloxacin and tamsulosin did not substantially reduce symptoms in men with long-standing CP/CPPS who had at least moderate symptoms.”

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Ciprofloxacin, and other antibiotics, are given to men with non-bacterial prostatitis for no good reason whatsoever.  They are often given long courses as well – 6 to 12 weeks of the drugs.  That’s a long enough course for many of the men who are given these drugs to cross their tolerance threshold for the drugs and get floxed.

If ciprofloxacin was effective at treating CP/CPPS, perhaps it would be worth the risk of getting floxed.  But ciprofloxacin isn’t effective at treating CP/CPPS.  It’s no more effective than a sugar pill and it is beyond ridiculous and wrong to expose men to a dangerous drug that doesn’t even help them.

CP/CPPS has been shown to be treatable through the techniques outlined in A Headache in the Pelvis: A new understanding and treatment for prostatitis and chronic pain syndromes.  The effective treatments include trigger point therapy and concomitant relaxation training.  More information about the treatments can be found in the article, “6-Day Intensive Treatment Protocol for Refractory Chronic Prostatitis/Chronic Pelvic Pain Syndrome Using Myofascial Release and Paradoxical Relaxation Training,” as well as on the web site http://www.pelvicpainhelp.com/.

Many symptoms of CP/CPPS, and other pelvic pain syndromes, react well to relaxation training and appear to be a response to stress and anxiety.  “Chronic pelvic pain reflects tension in the pelvic floor, initiated or exacerbated by cycles of mental tension, anxiety and stress.”  Pelvic pain syndromes are no more a choice than other bodily manifestations of stress such as heart attacks, back pain or tension headaches.  The pain is real and it is not “in the patient’s head.”  The brain is not separate from the body though, and what is going on in the head can have bodily manifestations.

The effects of ciprofloxacin, and other fluoroquinolones, on neurotransmitters may exacerbate CP/CPPS and other diseases related to stress and anxiety.  Fluoroquinolones block GABA-A receptors.  GABA receptors are the neurotransmitters that induce a calming response.  When GABA receptors are blocked by fluoroquinolones, anxiety, insomnia, fearfulness, loss of confidence, loss of self, psychiatric illness and even seizures can result.  Floxed patients often report being unable to relax, a reduced threshold for stress, autonomic nervous system dysfunction, and other symptoms of GABA neurotransmitter dysfunction.  Fluoroquinolones activate the sympathetic nervous system and disrupt the balance between the sympathetic and parasympathetic nervous systems.

If CP/CPPS is primarily a response to anxiety, stress and disregulation of the sympathetic/parasympthetic nervous systems, ciprofloxacin may not only fail to improve chronic pelvic pain conditions, it may exacerbate them.

Prescribing ciprofloxacin, or any other fluoroquinolone, to patients with chronic pain and non-bacterial prostatitis, is not only not helpful – IT IS HARMFUL, and may exacerbate the condition it is prescribed to treat.

Post-script note – Many people, especially elderly women, are given fluoroquinolones to treat asymptomatic urinary tract infections after a urinalysis shows bacteria in their urine.  It has recently been noted that URINE ISN’T STERILE.  And again, people are getting floxed for no good reason.

Sources:

A Headache in the Pelvis, a New, Revised, Expanded and Updated 6th Edition: A New Understanding and Treatment for Chronic Pelvic Pain Syndromes by David Wise and Rodney Anderson

Alexander RB, et al. “Ciprofloxacin or tamsulosin in men with chronic prostatitis/chronic pelvic pain syndrome: a randomized, double-blind trial.” Annals of Internal Medicine, 2004 Oct 19;141(8):581-9.

Anderson RU, et al. “6-day intensive treatment protocol for refractory chronic prostatitis/chronic pelvic pain syndrome using myofascial release and paradoxical relaxation training.” The Journal of Urology, 2011 Apr;185(4):1294-9. doi: 10.1016/j.juro.2010.11.076. Epub 2011 Feb 22.

“What is the mechanism by which the fluoroquinolone antibiotics (e.g., ciprofloxacin, gemifloxacin, levofloxacin, moxifloxacin) can increase a patient’s risk for developing a seizure or worsen epilepsy?Pharmacology Weekly, ©2008 – 2014 Pharmacology Weekly, Inc.

 

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Survivor’s Guilt after Fluoroquinolone Toxicity

Guilt is such a useless emotion.  It induces stress and anxiety for no good reason.  Guilt feels horrible.  It feels like a kick to the gut; a twist in the heart and the soul.

A particularly useless form of guilt is survivor’s guilt.  On top of being useless and destructive, it’s narcissistic.  I feel better but you still feel lousy and that makes me feel bad – as if I have any control over how you feel.  Yuck.  Seriously, it’s disgustingly narcissistic.  It is ridiculous and I know it.

Yet I feel it.  I have been having horrible survivor’s guilt lately.  My stomach has been in knots over the fact that people are suffering.  It hurts me to hear stories of pain and hardship, and it especially hurts me to hear stories of injustice.  Everyone who has been hurt by the pharmaceutical industry, who is suffering because of a stupid drug, is suffering not only physically, but also from a grave injustice.

I want to stop this injustice from occurring.  I see the injustice.  Not everyone sees it.  It’s not real to most people.  But I see it.  It is very real me and to all the other people who have lived through it or who are affected by it.  I see it, but I can’t seem to stop it, and this makes me feel horrible.  I feel guilty.  I feel guilty about not doing more to change the system.  I feel guilty about not warning the people who got hurt after me.  I feel horrible about not doing more.

It’s funny that this feeling has come up as I’ve started to do something about the travesty that is Floxing (I’m thinking that this blog is “something” – you can disagree).  While I was doing nothing, just focusing on healing myself, not focusing on changing the world, I didn’t feel guilty about anyone else’s suffering.  Now that I’ve started reaching out to people, now that I see that my words can have power, I feel horrible about the fact that I’m not doing enough, that my words don’t have as much power as I’d like them to, that I didn’t use the power of my words earlier.

I’m sorry.  I really am.  I’m sorry for your pain and I’m sorry for not preventing it.  I’m really sorry for being narcissistic and whiny about it too.  And I’m trying.  Truly.  I’m doing what I think I can.  These systems that we’re fighting are really big and powerful.  But I’m still trying.  I’m doing my best.

I am way too sensitive to be an activist.  I’m way too sensitive to be a fighter.  But I don’t really see what choice I have.  People are being hurt.  I have to do something to stop it.  I have to try.  The world needs people who try.  Who am I not to try?

So, I’ll deal with the higher blood pressure and the stupid, stupid guilt.  I’ll even deal with knowing that I’m a narcissist.  Because this fight is worth fighting.  Hopefully I’ll learn how to make it less painful at some point.

 

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