Did you know one of the hazards of fibromyalgia and chronic fatigue syndrome is liver damage? These conditions don't directly attack your liver, but the medications we take can do a lot of damage.
Anti-inflammatories (NSAIDs) and narcotics, especially those containing acetaminophen (such as Vicodin), send a constant stream of toxins through your liver. This means that the liver has to work extra hard, and that can take a toll. I've known this academically for a long time, but I recently came face-to-face with this very real complication of long-term medication use -- in a blood test last fall, my liver enzymes were through the roof. My doctor said I was at risk for developing fatty liver, with can lead to cirrhosis.
Now that scared the heck out of me! I can't really say I was surprised, but I was certainly shaken out of the "it won't happen to me" state of mind.
I've had heavy NSAID use since I was 13, when I was put on a daily dose of 1600 mg of Motrin (ibuprofen) for on-going pain from an earlier back injury. A year later, it was upped to 2400 mg. I stayed on that for a couple of years, until Motrin became available over the counter. I continued taking it then, but less frequently and in smaller doses. In my 20s, I also took a lot of Tylenol (acetaminophen) for carpal tunnel disorder. Since my fibromyalgia symptoms started about 4 years ago, I'd been on Relafen (nabumetone), a prescription NSAID, at the maximum daily dosage. Add in the occasional Vicodin, and my liver's been racing to keep up.
A couple months ago, I cut out the daily Relafen. I've taken some Aleve (naproxen sodium) and a little more Vicodin than usual, but I've tried hard not to medicate unless I really needed to. My doctor re-checked my liver enzymes recently, and one is normal and the other is only slightly elevated, so that's good news. The bad news is that my muscles have been tight, hard and spasmodic. (I should note that fibromyalgia is not considered an inflammatory condition, and much of my problems with inflammation are from myofascial pain syndrome and autoimmune thyroid disease.)
So I have 2 issues to deal with -- I need to get my muscle pain and inflammation under control, and I also need to protect my liver. For pain and inflammation, I'm stepping up my use of some treatments, including:
- Acupuncture
- Massage
- Heat and/or ice
- Epsom salt baths
I'm also trying to use my diet to lower inflammation. Here's more information about that:
To protect my liver, I'm taking an herbal supplement called milk thistle. While it's not a scientifically proven or FDA-approved treatment, milk thistle is a traditional remedy that's believed to help your liver process toxins. I'm also considering a detox diet. As I often do, I turned to Cathy Wong, About.com's Guide to Alternative Medicine, for more information about protecting my liver. Here are some great articles from her:
I'll be getting my liver enzymes checked on a regular basis to make sure they stay down. If you have a drug history that's anything like mine, it might be wise to ask your doctor about getting a liver function test periodically.
Have you had abnormal liver tests or liver problems because of medications? How bad has it gotten? What have you done to counter it? Do you get your liver enzymes checked regularly? Leave your comments below!
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Grape Seed extract is wonderful too:
http://www.pslgroup.com/dg/6C046.htm
I am a big fan for its ability to reduce skin problems among other things.
Another very important issue with NSAID use is gastrointestinal complications (stomach ulcers and GI bleeding). Occasional use is okay but everyday use, especially at maximum dosage, is not a good idea. In the 24 years I’ve had fibromyalgia, I’ve been hospitalized 3 times for GI bleeding due to NSAID use (this included aspirin, ibuprofen and Aleve). I will never take another NSAID again!
I’m now on the maximum dose of Lyrica for fibromyalgia — 450 mg day (150 mg taken 3 times a day). For breakthrough pain, I’ll occasionally take Tylenol. I’ve never taken narcotic painkillers for my fibromyalgia. If I build up a tolerance to the maximum dose of Lyrica, then I don’t know what I’ll do. I might have to resort to narcotics. Then I’ll have to start worrying about my liver.
Adrienne, you didn’t mention whether Lyrica is damaging to the liver. I never researched this myself. Thanks for your help.
From Adrienne: Great questions! Lyrica actually doesn’t damage the liver — it goes through the kidneys instead. Cymbalta and Savella both go through the liver. ~Adrienne
When my pain gets elevated, I use my wonderful, wonderful really hot! heating pad. When it was first suggested to me, I said , who would pay that much for a heating pad? But now that I’ve had one for so long, I can’t say enough good things about it. It takes some getting used to because it’s really hot and moist. Nearly everyone I’ve loaned mine to buys one. It has an automatic shut off. The heating pad somehow draws moisture from the air right into it.
http://www.thermophore.com
I also am learning to meditate and put my mind somewhere else. Taint easy, but I’m bound and determined…
Medications do scare me re: what they do to our liver.
Acetaminofen and ibuprofen do tax the liver. Milk Thisthle is an execelent liver cleaner. If you choose to use Narcs. you can get propoxephen w/o tylenol or asprin. dr. will need to actually spend a little time in the PDR to find it.
Hydrocodone is not avail. w/o the junk. Oxy is avail. in a pure form. Do be aware that rebound pain does occur with strong narcs. I think the opiod recp. create a sudo pain but it seems to occur when oxy and hydro opiods are ingested as a form of on going releif. I know the pain is intense and pass judgement on NO one. Milk Thistle is a wonder herb and will lower liver enzimes. Not for Preg. or nursing women. Excuse my spelling. Big Phar could care less if your liver survives and they certainly will not advise you to keep the MT going as they set themselves up for law suits. I suggest taking 330 mg. daily for a 140 lb woman. When I did use the narcs. my liver was clean with MT. after 30 days of use.
Hi Adrienne,
May I ask how many mg’s of acetaminophen you were/are on per day?
From Adrienne: The only acetaminophen I’ve been on over the past few years is what’s in Vicodin. I generally take 1-3 tablets a week, with 500 mg of acetaminophen each. When I had carpal tunnel disorder, I took the maximum daily amount for several months, but then I was able to taper off. ~Adrienne
So sorry to hear about your liver issues. That has always been a concern of mine as I take a statin. My liver function is checked every 6 months and so far so good. Perhaps I should thank my doctor for refusing to give me painkillers all these years! Danged if we do, danged if we don’t. No fun either way.
I share your concerns. I had fibromyalgia diagnosed 15 years ago after syptoms inc. chronic fatigue for many years before, myofacial pain too. I have been hypermobile all my life meaning dreadful pains in adulthood. 3rd generation autoimmune thyroid probs (both sides of family.) On a lot of pain meds, Trammadol top dose, and Paraecetemol aka Acetaminofen, Trazadone anti depressants, tiny dose of clonazepan when cramps are severe. At that point only hot aroma baths, hot wheat pillows and rest help but not easy with disabled husband (love of my life) and tiny diabetic grandchild most of the week. Other than that I have a happy life, I love & feel loved but I find it difficult to pace myself (despite self managment course) as when I am up I want to do everything, then suffer the anticlimax and disabling pain. Addrienne, thank you for sharing with us when you have so much to cope with yourself. Your honesty informs others.
Have taken too many meds for too many autoimmune diseases plus fibro for too many years. Liver enzymes suddenly skyrocketed even though we had been doing monthly labs. Drs. had thought high levels were from meds but biopsy showed autoimmune hep. Meds are certainly hard on the liver (as well as other organs) but having good doctors and staying on top of our labs and overall health are paramount to keeping us safe and as healthy as possible. Just another line of thought on what we have to keep in mind and that the first line of thought on what’s causing our problems isn’t always the right path to take.
Unsweetened cranberry juice is also good for eliminating toxins from the liver. I have 2-3 oz ever morning diluted w/lots of water. Warning – it is SOUR!!!
I think it best to avoid alcohol as well. It not only increases inflammation, it screws up my sleep. Combine that with our increase risk of liver damage and forget about it..
Have gotten Porphryia from taking SSRIS for 13 years…Of course, noone tells you that they are of course, hepatically metabolized and along with a certain element contained in these drugs, some of us may get PCT…I go for therapeutic phlebotomy every 2 weeks for 2 years now to get my ferritin levels down and get my liver healthy….I took zoloft, paxil and lexapro…they did help but never agin will I take a drug…doing acpuncture and it is helping, but it is a slow process……If you try it, you must stick with it for results…I do need another modality to go along with it but am at a loss; perhaps chirophractic intervention….
I have been a Fibro patient for about 20 years now–along with a host of other “painful” dx’s. I have gone up the “pain med” ladder–to now where I take morphine for pain. However, for years now, I have had a reading of a certain liver enzyme called GGTB that is more than through the roof. I saw a rheumy dr for it–he said it was a abnormality of my body–but I still dont understand just what it is or what it means? Has anyone else had a extremely high GGTB result? Have you ever gotten an explanation for it? Thanks so much–and painfree days to all!
I learned about liver toxicity resulting from use of NSAIDs and acetaminophen a long time ago. As a result, I stopped taking any mixed drugs that included acetaminaphin, and switched to the single-compound version. Now I take oxycodone, just that with no aspirin or acetaminaphen included. Because I have fibromyalgia only (with some osteoarthritis as well), I learned that NSAIDs and other anti-inflammatory drugs provide no relief for our pain, and so never took them after trying them early on after diagnosis. They produced absolutely no pain relief, so I stopped taking them. I believe the simpler the better, you know? Additionally, I understand that the FDA is reviewing the compound drug painkillers and is considering taking them off the market because of the acetaminaphen-related liver complications. Yes, over the long term the plain narcotics can affect the liver, but nowhere near to the extent and the NSAIDs and acetaminaphen do. Thanks for bringing up this topic.
Some herbs have caused elevated liver enzymes in me, so I discontinued them. I have found that my tight muscles, knots and horrible spasms improved 90% after using high dose T3 according to Drlowe.com protocol since I have low thyroid. Prednisone 7.5mg also helps with adrenal function and spasms. Very low dose Doxepin also loosens spasms and I take 10mg/day (20 drops). Now I only get one back spasm per month during my period and don’t need any pain meds any more. I just take it easy at that time.
I forgot to mention that Nexium 20mg/day also helps with spasms. I believe because it blocks histamine release in the stomach by the paretial cells and histamine can cause muscle spasms.
I have had Fibromyalgia and Psoriatic Arthritis for 6 years. Before graduating to Humira, I took Sulfasalazine and Methotrexate pills. About six months into treatment, my liver count came back very high. I was taken off the sulfasalazine and switched to Humira and Methotrexate injections. I have blood tests every 2 months. My liver count has been fine for the past 3 yrs. I suggest that everyone follow their Rheumatologists advice. Herbs and OTC pain relievers can have bad side effects too. You also have to get to a place mentally where you accept your condition and realize that you will never be completely pain free. Once you are diagnosed with an AutoImmune Disease you have a higher chance of developing another autoimmune disease (ie Autoimmune Hepititis) Do not drink alcohol. Everyone has their cross to bear in life. Also, if you have an autoimmune disease think twice before having children. Would you want a child to go through the pain that you are going through? I am divorced after 17yrs of marriage and I am glad that I kept putting off having kids.
I just love what you said up there it so what I’m going threw right now. which is why I must tell in Utah the drug companies want to put Health food stores where you can buy supplement to help you but now legislater are trying to pass to pill to stop this and bascilly you have to get a written perscription from your docter if he ok it and then pay the drug companies for the drug! It’s a big deal when people can’t afford their meds all ready, just live another day. Do you buy food or do buy the prescritions? now we wont be able to buy anything and how will people like me survive! its a big deal if it all goes well and they get what they want. Then the other state are going to try it out for them self!! please if you live in salt lake utah call this number (202) 224-3121 that number is the capital swithboard or email them at——— ————-www.anh-usa.org Tell your senators and congress man of how this bill is misguiged bill and tell them not to support this bill! Your health will no longer be up to you if this billl pass! for more addition question go to this email: info@csofh.org
thanks so much for taking the time to reading this.
I have been worried about liver problems and meds for years- past few years liver enzymes were up, and doc said fatty liver, lose weight. Finally referred to GI, liver specialist -don’t know what outcome will be.
I was on NSAIDS for over 20 years -chronic pain after whiplash accidents before FMS diagnosed. Also added TCI’s for sleep and pain and then SNRI’s for pain. Now I’ve also read that combo of SSRI and NSAID can cause more bleeding.
So…then tried to cut down on NSAIDS, and took more Tylenol -but that’s really bad for liver.
So what are we supposed to do???
And if real problem to lose weight, have been told can be due to FMS, also due to meds, then what does this mean? Other doc just says eat less -but that doesn’t work….
The last few times I’ve requested lab tests, my doctor has said they were not necessary. When I first began seeing her, she tested more frequently and was more open to my requests for certain tests. I don’t know whether the insurance company has put pressure on her to decrease testing, or whether she thinks I just don’t need to have tests repeated. But, it’s been two years since I had any blood work-ups.
I hate to change doctors and start over, as I may likely end up in the same situation, or worse!
It’s not just meds that effect your liver when you have fibro or an auto-immune disease/diseases associated with fibro. Everything possible that is toxic has an effect on the liver…pesticides on the food we eat (try to eat organic), chemicals in the cleaning products (try to use natural green products in the home, toxins in the air we breathe, cosmetics that we use (esp. hair dye has now been associated with primary bilary cirrosis), and on & on. So we have to pay special attention to almost everything that goes in our body, on our body, or around us to protect the liver from becoming more damaged. I gave up nail polish & hair dye, try to eat more organic & stop using toxic chemicals in my house to try to get my liver back in shape.
For me, what helps the most is heat and positive attitude. If I get stressed, the pain increases, if I am calm and relaxed, the pain subsides.
I get chilled easily and when I’m cold, the pain increases. I keep several natural heating pads that I heat on the microwave, I get them here http://www.agentlestrength.com/
Having an immediate heat source is a necessity for me, if I wait to long, it takes me that much longer to recover.
Im a massage Therapist and have several clients with fibromyalgia.
What I hear from them is that massage and heat and activity is what works best for them (outside of meds) They will often say that it is very hard to get active but they know they will feel better if they do, but it is so hard to get started when you are in chronic pain. Sometimes massage is painful at first but gradually the pain subsides.
I would think that yoga would be very beneficial and helpful. I would love to hear some feedback from fibromyalgia sufferers that practice yoga and what it does for them.
Move, I have to keep moving, I cant let myself be still for very long. I have to keep moving and stretching throughout the day. And heat, those are my two best friends. Im in the hot tub am and pm and will often carry my heat pad around with me
I was so relieved to find this blog. I just recently got the shock of my life when I was told I had high liver enzymes. I have been on an increasingly large amount of prescription drugs! I will in deed take Milk Thistle! I am hoping that I do not already have fatty liver and that the damage can be reversed.