Dear Dr. Dean,

I have suffered from chronic muscle tension and pain for almost 10 years, along with chronic fatigue, insomnia, sometimes severe anxiety, and depression. I have what appears to be poor muscle recovery after strenuous activity (I stay painfully sore for days after exercise. So bad that I find it difficult to return to exercise for 5-6 days.) Muscle relaxers bring no relief. Heat and weightlessness of a pool are the only things that bring natural relief. Narcotic painkillers work, but … that doesn’t lead me in a very good direction. In April of 2014 I was diagnosed as being compound heterozygous for MTHFR 677 and 1298. My doctor began me on a protocol of high dose methylfolate (7.5 mg in the product Enlyte) and methylcobolamin 12.5mg/ml injection 3 times per week.

Initially, I found some relief from the anxiety and noted a very strong sense of well being, but that has ended. I have been taking other supplements as well. Ubiquinol, magnesium citrate, acetyl L-carnitine, vitamin D3 (10,000 IU) (have true deficiency) and Omega 3’s. My pain has increased significantly over the past year or I am just more sensitive to it. My depression is not as severe, but emotionally, I am crying or reliving old feelings almost daily. My question is, what is the connection with MTHFR and chronic debilitating pain and is there a possibility of over-methylation causing greater pain? I am not convinced this is fibromyalgia, because in addition to pain, I do have a LOT of muscle knots and tension. Massage helps, but I have to do it weekly/ biweekly to maintain any kind of relief.

I am very grateful to have found out that there are more alternative medicine practitioners in the area and I appreciate your time!


Dear Sir (writer is anonymous),

I am sorry to read of your plight. Although you may have the MTHFR deficiencies that you’ve discovered, I’m not sure if they’re the cause of your condition.

It sounds to me that you may suffer from Reflex Sympathetic Distrophy (RSD) (old name), now renamed Chronic Regional Pain Syndrome (CRPS).


Unfortunately, that’s the name of a condition with no clearly determined cause, and no well-recognized treatment that is effective. As you’ve found out, even heavy-duty pain medications don’t provide much relief, and the condition tends to wax and wane. As you suggested, I think it’s a very severe form of chronic fatigue/fibromyalgia.

Most people with this condition are very debilitated, and are often unable to work. In many cases, there was a traumatic event that preceded the onset of the symptoms. Usually, as you have done, sufferers can name almost precisely when their symptoms began. If your problem was with your MTHFRs, it would have been present since birth. Your genetic problem didn’t start ten years ago.

I have found the best treatment for this condition—in addition to frequent massages, as you have found—is gabapentin. Gabapentin is not a pain medication–it is a nerve stabilizer. It may give you some relief. Take a dose high enough during the day to reduce the pain, but not cause sleepiness–and a higher, sleep-inducing dose at night. You may require massive doses. Fortunately, gabapentin is not a controlled drug, does not adversely interact with other medications, and is safe even at very high doses.

I hope this information will be helpful,

Ward Dean, MD