Frequently Asked Questions:  
History of the Guaifenesin Treatment

Who pioneered the guaifenesin treatment for fibromyalgia?
R. Paul St Amand, MD, who has been in private practice in southern California for 40 years and is an assistant clinical professor of medicine in the Department of Internal Medicine at UCLA Medical School. He is serving on the scientific advisory board of Seattle International FMS Team and the CFS and FMS Health Resource Scientific Advisory Board.   He has fibromyalgia.

He takes his teaching assignment of residents and fellows in the Department of Endocrinology at Los Angeles County Harbor General/UCLA Hospital in Torrance, CA, where he obtained his four years of post-graduate training in endocrinology under the auspices of UCLA with completion in 1956.  He immediately accepted a proffered teaching position in the UCLA Department of Medicine that he has held since then.  He began his 41st year on the UCLA staff on July 1, 1997.

He also teaches at Harbor/UCLA in the Diabetes Clinic, and in the Endocrinology Clinic.  Anyone who desires some kind of proof of Dr. St  Amand's credentials may gather more information by contacting his office.

Although Dr St Amand does not follow the treatment for fibromyalgia proposed by rheumatologists, he is otherwise very much mainstream medicine.  His approach differs because fibromyalgia was not recognized as a disease 37 years ago when he needed help for his own and his family's fibromyalgia.  He learned from his own and his patients' experiences about the illness and how to attain control. When FM was named and the current treatment proposed, he saw how it did not work, so he stuck to what he was doing successfully and safely for himself and his patients.

How was guaifenesin discovered as a treatment for fibromyalgia?
Over 30 years ago, one of Dr. St. Amand's patients taking Gout medication was readily able to strip pieces of tartar from his teeth. Though this was not, and is not, a usual occurrence in others, he was easily able to chip off pieces with his fingernails. Since tartar is a calcium phosphate deposit in a form chemically recognized as "apatite," Dr. St. Amand wondered if the same medication could remove the hard areas of swelling felt in the muscles of some of the patients who complained of rheumatism. It was from this attempt that patients gradually taught him about the entity we now recognize as fibromyalgia.'

Today, although we rarely use the two Gout medications available at the time: Probenecid (BenemidTM) and Sulfinpyrazone (AnturaneTM) to treat Fibromyalgia, another medication, Guaifenesin, is proving the most effective to date. This drug has been available as a treatment to loosen mucus (mucolytic effect) and is used in patients with conditions such as chronic sinusitis. Like the Gout medications listed above, it has a uricosuric, albeit weak, effect. All medications we have found with this ability to increase renal excretion of uric acid have also worked for Fibromyalgia although there is no connection between the two diseases, Gout and Fibromyalgia. Our current order of choice in prescribing is: Guaifenesin, Sulfinpyrazone, and Probenecid. Guaifenesin is not only extremely effective, but it has no known side-effects.

Medications such as Allopurinol that prevent the formation of uric acid do not work for Fibromyalgia. The effect appears to be on an entirely different abnormality that may be corrected in the same area of the kidneys.

Since dental calculus (tartar) is a calcium phosphate compound, a defect in phosphate metabolism was soon suspected to be the possible inherited cause of Fibromyalgia. Several reasons led us to this. Calcium carbonate taken with each meal allowed lower dosages of medications. Calcium taken with food will lessen the absorption of phosphates by binding them and causing them to be excreted in the stools. (Magnesium was added as well since carbonate caused constipation in some patients.)

Who was the first guai patient?
Dr. St. Amand tried guaifenesin on someone in the summer of 1992. His first patient was his nurse, Claudia's son, Malcolm. They tried guai, because they were unable to raise the dosage of their older drug, Anturane, sufficiently to keep up with his increased needs, as he grew, without upsetting his stomach. The second day on guaifenesin he came out of the bedroom hunched over and saying, "Mother! I can't walk." "We knew we had a winner: no pain, no gain!" said Dr. St. Amand.

What is Dr. St. Amand's theory of the cause of fibromyalgia?
Now the working hypothesis is that fibromyalgics have an inherited abnormality in phosphate excretion that ultimately causes an accumulation within the mitochondria of any cell in the body, the very site of a cell's energy production. One is born with the gene(s) for fibromyalgia, and it takes a certain number of years to accumulate enough to cause the first symptoms.

Has anyone else studied the guaifenesin treatment?
Dr. Robert Bennett of Oregon conducted a double-blind study of the guaifenesin treatment in 1993-94 under Dr. St. Amand's advisorship. Dr. Bennett claims the study shows that guaifenesin has no more effect than a placebo on fibromyalgia. The results of his study were presented as a poster at the annual meeting of the Rheumatology Association in Orlando, FL, in 1996. Dr. St. Amand's office has more information on the study. Despite disagreements, the two doctors remain friends.

Dr. St. Amand's rebuttal to Dr. Bennett's claims was due for publication in the October 1997 issue of the Journal of Myofascial Pain. Reprints of the article will be available from Dr. St. Amand's office. The thrust of the article is that the doctors did not know the effects of salicylates and hypoglycemia when the guaifenesin study began. Dr. St. Amand believes the guaifenesin was blocked in many of the patients in the study.                                                                                                                                                   

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