as to the mechanism whereby some of
Dr. St. Amand's fibromyalgia patients experienced
improvement while taking guaifenesin
There is no doubt that many fibromyalgia patients have been
helped by Dr. St. Amand. Thus it is instructive to consider why
guaifenesin use was associated with a beneficial outcome in many
fibromyalgia patients when used by Dr. St. Amand. This current
study provides compelling evidence that guaifenesin has no
beneficial action by itself in the treatment of fibromyalgia.
Thus the real benefits reported by Dr. St. Amand, over many
years, probably have an alternate explanation. This is most
likely in the realm of a placebo response aided by powerful
cognitive restructuring. Dr. St. Amand was very convinced that
uricosuric drugs were of benefit. This was at a time when many
fibromyalgia were told that "the problem was all in their
head" and nothing could be done. Patients want to hear that
they have a legitimate disease for which their is a cure. Dr. St.
Amand provided this hope to numerous patients and backed it up by
an infectious enthusiasm and a pleasant engaging personality.
Gradually many patients started to experience "good
days" (as all do at some time) and attributed these to the
effects of guaifenesin. This was reinforced by Dr. St. Amand's
caveat that worsening (a self fulfilling prophecy in fibromyalgia
patients) would precede the promised improvement. The arrival of
the promised improvement, with its renewed sense of optimism,
would lead many individuals to attempt vocational and avocational
experiences that they had given up as being too daunting.
Inevitably many patients found that they were indeed more
functional than they had thought and took this as a further sign
that guaifenesin was all that had been promised. This sequence of
events would be a classical example of cognitive changes leading
to increased self efficacy.
A simple definition of self-efficacy is the enhanced sense of
control that derives from a perceived ability to manage symptoms.
Interestingly, it is the perception and not the actual capability
that determines enhanced self-efficacy and resulting positive
behaviors. Four techniques for altering beliefs about self
capabilities that can enhance self-efficacy have been described
1. Social persuasion -- health-care professional and peer
pressure that persuades people that they have the capability to
be more functional. Mastery experiences -- actually performing a
previously off-limits activity. Modeling -- observing someone who
is similarly afflicted being successful in performing the desired
2. Physiological feedback. This is basically "listening
to one's body" by monitoring pain, fatigue, anxiety levels,
etc., as a way of optimizing the timing of the new activities.
3. Although self-efficacy enhancement is an exercise in
positive thinking, it is the element of "mastery
learning" that is the most powerful technique --nothing
succeeds like success. In other words, success in performing a
function, that was previously off-limits, promotes confidence in
repeating that activity and moving on to new activities. success
of a few encouraging others. Repetition and mastery of new
behaviors using the feedback from small successes, as well as
observing successes in one's peers, seem to be critical features
in promoting self-efficacy.
All these ingredients were present in Dr. St. Amand's approach
to treating fibromyalgia patients. Indeed he often used
testimonials from "recovered patients" to encourage
patients to persevere with the prescribed treatment regimen. In
this way Dr. St. Amand has unknowingly used guaifenesin as a
powerful focus in a program of cognitive behavioral therapy, in
which his empathy, enthusiasm and charisma were the real
instruments in effecting a beneficial change.