DR ST AMAND (Part I): Fibromyalgia Nodules and Diagnosis

  • September

    In a recent post “FIBROMYALGIA IN CALIFORNIA”, Dr. Melissa Congdon (Paediatrician MD) recommended visiting Dr. St. Amand’s Fibromyalgia Clinic in Los Angeles, California which I was fortunate enough to experience. I had the pleasure of watching and aiding Dr. St. Amand during my visit to Los Angeles this week and spent 2 days at his clinic with his assistants Claudia Marek and Gloria Martinez learning the ins-and-outs of the clinic and his Guaifenesin Protocol.

    Dr. St. Amand was a joy to work with and he even gave me an autographed copy of his book, What Your Dr May Not Tell You About Fibromyalgia: The Revolutionary Treatment That Can Reverse the Disease of St. Amand, R. Paul, Craig Marek, Claudia 3 Rev Upd Edition on 26 July 2012

    Amazingly, Dr. St. Amand is 85 years old and is still actively practicing medicine. Even more impressive is he, himself lives with Fibromyalgia and is highly functional, which is enough evidence for me to inquire about the effectiveness of his treatment. Dr. St. Amand is a wonderful man who takes great pride in his work and building a strong relationship with his patients. He spends time collecting information from his patients and educating them on his research and the Guaifenesin Protocol.

    Dr. St. Amand is a trained Medical Endocrinologist and has devoted over 50 years of his practice to treating Fibromyalgia. In 1945 while in the armed forces, he developed what appeared to be Rheumatic Fever with symptoms of red, swollen limbs and sore muscles, however all his lab tests were normal. Six weeks later all his symptoms spontaneously disappeared but left him with new chronic joint pain.

    Dr. St. Amand had no idea what he was suffering from and began exploring different treatments for himself and other patients with common symptoms.

    Fibromyalgia describes widespread pain experienced in muscles and fibres, specifically tendons and ligaments that lasts for more than 3 months (St. Amand, 2012). Fibro means fibrous tissue, which includes tendons and ligaments, myo refers to muscle, and algia means pain (Bested, 2008).

    In 1990, the World Health Organization (WHO) and American College of Rheumatology distinguished 18 specific points symmetrically on the upper and lower body to exam. Applying 4 kilograms of pressure, enough to blanch the whites of your nail, is required to illicit pain by the patient before the point is noted as ‘tender’.

    Many health practitioners are familiar with the ‘11 of 18 tender points’ to aid in the diagnoses of Fibromyalgia, however Dr. St. Amand has an alternate physical exam that he believes is more reliable than the Tender Point Test.

    Fibromyalgia 18 Tender Points

    Dr. St. Amand believes that the tender points are not reliable because people have varying pain tolerances and the absence of pain with pressure should not mean that they do not have Fibromyalgia. For example, many of his patients are highly competitive athletes who have high pain thresholds and may not even complain of a serious acute injury.  Also, Dr. St. Amand describes Fibromyalgia as a spectrum and it should be addressed despite lack of adequate tender points.

    The physical exam that Dr. St. Amand utilizes with every patient at every visit is a full body palpation for nodules which he maps on a diagram. These ‘nodules’ are key to diagnosing and monitoring progress of his patients with Fibromyalgia.

    He has noted from the thousands of patients and over 50 years working with this population that there are many common areas to observe these nodules:

    • Neck
    • Back (especially along the right side)
    • Medial and lateral aspects of the elbow
    • Anterior, posterior and lateral aspects of the thigh (especially left sided)
    • Medial-posterior aspect of the knee
    • Soles of the feet

    I was able to feel the nodules on Dr. St. Amand’s patients and most were very obvious. I can best describe them as what the normal person would call a ‘knot in the muscle’. Put your hands in between your neck and shoulder then squeeze. Do you feel that hard lump in you shoulder? Well, that is probably a nodule.

    Dr. St. Amand and I blindly drew up body maps of the same patients and after 2 days of palpating I was able to create comparable maps to his. Seeing and feeling the difference between treated and non-treating patients was significant.

    The support of the Guaifenesin Protocol results in a reduction in the number and size of nodules in Dr. St. Amand’s patients which helps to guide the dosage and disease progression. Read “PART II: GUAIFENESIN PROTOCOL” to see the explanations and mechanism behind Dr. St. Amand’s success with Guaifenesin.

    An example of nodules found in a patient with Fibromyalgia.

    An example of nodules found in a patient with Fibromyalgia.

    The map above is similar to my own. It may appear that I have Fibromyalgia based on the wide spread distribution of nodules (note the classic left thigh pattern) but the body map is only part of the Fibromyalgia diagnosis. The other considerations besides muscular pains and nodules are the following systemic symptoms:

    Fatigue Sugar cravings Dizziness Restless legs Bladder infection
    Irritability Salt cravings Faintness Leg cramps Weight changes
    Nervousness Sweating Blurring vision Gas Brittle nails
    Depression Hunger tremors Irritated eyes Bloating Itching
    Insomnia Palpitations Nasal congestion Constipation Rashes/ hives
    Impaired memory Panic attack Abnormal tastes Diarrhea Neurodermatitis
    Impaired concentration Occipital headaches Ringing ears Dysuria Growing pains
    Anxiety Frontal headaches Numbness Pungent urine Vulvodynia
    Dr. St. Amand, MD Endocrinologist

    Dr. St. Amand, MD Endocrinologist

    Dr. St. Amand’s theory behind the mechanism of Fibromyalgia is very interesting and requires more interest and research. I believe the medical profession is on the brink of discovering the corresponding lab tests to aid in the diagnosis of Fibromyalgia, which in turn will help with successful treatment options.

    I encourage you to return back to my site for PART II: GUAIFENESIN PROTOCOL and visit Dr. St. Amand’s website (www.fibromyalgiatreatment.com).


    Please note that the information in this post represents Dr. St. Amand’s theories and I may not agree completely with them.  As health practitioners and patients interested in learning about optimal health, the best we can do is gather as much information as needed to make educated decisions and choices about treatments to pursue.  These experiences only help to further support my journey to becoming a naturopathic doctor and healer, so if you have any clinical pearls or recommendations I would love to hear about them at  info@DrAlisonChen.com.



    1. Bested, A. C. MD, Logan, A. C. ND, Howe, R (2008). Hope and Help for Chronic Fatigue Syndrome and Fibromyalgia, 2e.CumberlandHouse.Illinois,USA.

    2. St. Amand, R. P. MD and Marek, C (2012). What Your Dr May Not Tell You About Fibromyalgia: The Revolutionary Treatment That Can Reverse the Disease of St. Amand, R. Paul, Craig Marek, Claudia 3 Rev Upd Edition on 26 July 2012, 3rd edition. Grand Central Life & Style.New York,USA.

    Keep up-to-date on the latest research for Fibromyalgia and Chronic Fatigue Syndrome by read other related topics:

    Here are my FM/CFS book recommendations from fellow medical colleagues:

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