Clinical Studies Update

1) The effect of transdermal T3 (triiodothyronine) on geloid masses found in patients with both fibromyalgia and myofascial pain: double-blinded, crossover N of 1 clinical study

2) Geloid masses in a patient with both fibromyalgia and chronic myofascial pain
 

Starlanyl DJ, Jeffrey JL, Roentsch G, Taylor-Olson C, 2001-2.  The effect of transdermal T3 (triiodothyronine) on geloid masses found in patients with both fibromyalgia and myofascial pain: double-blinded, crossover N of 1 clinical study.  Myalgies International 2-2:8-18. 

KEY WORDS: fibromyalgia, myofascial pain, trigger point, geloid mass, triiodothyronine.

SUMMARY:  Some patients with both fibromyalgia syndrome (FMS) and chronic myofascial pain (CMP) may develop geloid masses in areas of long-standing resistant TrPs [1].  Recent research indicates that a subset of people with FMS has been shown to have excess hyaluronic acid (HA) in their blood [2]. 3,3',5-triiodothyronine (T3) has been shown to modulate the production of HA.  We postulated that if HA, naturally occurring in the ground substance between cells, was an important component of these geloid masses, that transdermal administration of T3 may alter their consistency.  The majority of the clinical study participants reported significant improvement in symptoms and/or reduction of medication with T3 therapy.  The geloid mass does not appear to be a part of the TrP phenomenon per se but may be a discrete phenomenon which may occur in patients who have CMP as well as FMS and/or other chronic pain conditions which interact to create the geloid mass.  The repeated close association between the central portion of geloid masses and an underlying TrP suggests a meaningful relationship that is not yet clear.  T3 therapy improved the geloid mass but did not affect the taut bands or TrPs directly, merely rendered them more treatable.  The presence of these geloid areas may add to patient discomfort and loss of function, contribute to loss of range of motion, and complicate treatment even more than usual when both CMP and FMS are present.  It is important that therapists be aware of and palpate specifically for these masses, as they may be missed in the routine course of therapy and may provide one reason why TrPs are responding poorly to usually effective therapy.

ABSTRACT

PURPOSE:  To assess the effectiveness of topical 3,3’,5-triiodothyronine (T3) on patients who have fibromyalgia syndrome (FMS), chronic myofascial pain (CMP) due to trigger points (TrPs), and geloid masses.

SUBJECTS AND METHODS:  Ten subjects with documented FMS tender points, CMP, and geloid masses were enrolled in a randomized, double-blinded N of 1 clinical trial.  Initial questionnaires evaluated subjective patient perception of their pain and representative geloid mass areas were measured and rated with a tissue compliance meter.  Transdermal creams, one a placebo, one with topical T3, were compounded and distributed in increments of 10 days.  Participants filled out daily questionnaires and received a physical examination every 10 days.

RESULTS:  Topical T3 generally resulted in a softening of the geloid masses over time, allowing TrPs and taut bands to become more accessible and treatable.  Some patients reported reduced pain, reduced medication use, increased function, and/or improved mood and cognitive skills.

CONCLUSIONS:  T3 therapy did not affect the taut bands or TrPs directly, but by reducing the firmness of the geloid areas, made the TrPs more available for treatment.  The presence of geloid masses may add to patient discomfort and loss of function, may contribute to loss of range of motion, and complicate treatment.  It is important that clinicians be aware of and palpate specifically for these masses. 

Recent research indicates that hyaluronic acid is an important substance in the laryngeal area (Chan RW, Gray SD, Titze IR, 2001), so we urge people using the T3 or hyaluronic acid creme to use different areas of the body.  Avoid joints and try applying it directly over areas of the geloid masses.  It is vitally important that this use be under doctor oversight and with full awareness that it is experimental.

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CASE STUDY: Starlanyl DJ, Jeffrey JL.  Geloid masses in a patient with both fibromyalgia and chronic myofascial pain.  Phys Ther Case Rep 2001; 4:22-31.

ABSTRACT

PURPOSE: The purpose of this case is to document the existence of geloid  masses occurring in a patient who has both fibromyalgia syndrome (FMS) and chronic myofascial pain (CMP) and propose their possible origin.

PATIENT: This patient is a 53 year old woman with long-term FMS and CMP, with body-wide active and latent trigger points (TrPs) and 18 tender points.  Areas of geloid masses were measured and rated and the NRS pain scale was used.

CONCLUSION: In this patient, geloid masses were evident after careful palpation.  They were associated with TrPs and taut bands that were resistant to conventional TrP therapy.  These areas seemed to generate significant pain.

RELEVANCE: Patients with both FMS and CMP may have geloid masses which are resistant to standard TrP therapy and, in this patient, required modification of treatment technique.

KEY WORDS: fibromyalgia, myofascial pain, myotherapy, geloid mass.

References:

1. Starlanyl DJ, Jeffrey JL.  Geloid masses in a patient with both fibromyalgia and chronic myofascial pain.  Phys Ther Case Rep 2001; 4:22-31.

2. Yaron I, Buskila D, Shirazi I, Neumann I, Elkayam O, Parran P, et al.  Elevated levels of hyaluronic acid in the sera of women with fibromyalgia.  J Rheumatol 1997; 24:2221-4.

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