Abstract: OT;Alternative Treatment of Fibromyalgia Using the Oxytocin-Hormonal-Nutrient Protocol to Increase Nitric Oxide” by Jorge Flechas, MD, MPH

In this 38 page document, Dr. Flechas presents the technical perspective (Section I) and treatment plan (Section II) of the protocol he has developed for treatment of fibromyalgia (FM) chronic fatigue and immune dysfunction syndrome (CFIDS).

He feels both diseases are most likely due to a neuroendrocrine/metabolic disorder with chronic hypoxia which causes abnormalities in the biochemistry of patients.

In Section I (the first part is given below), The Medical Perspective, Dr. Flechas reviews the following:

  • Oxytocin
    1. Functions of Oxytocin in the metabolism
    2. Natural sources of Oxytocin production in the body

    Introduction from the first few pages of the document:

    Dr. Flechas is a family practitioner in North Carolina who works with patients who have fibromyalgia (FM), and patients with chronic fatigue and immune dysfunction syndrome (CFIDS). He has developed a new protocol for treatment of these illnesses using oxytocin (OT), dehydroepiandrosterone (DHEA) and some natural nutrients. He feels both diseases are most likely due to a neuroendocrine/metabolic disorder with chronic hypoxia, which causes abnormalities in the biochemistry of patients.

    This summary of information is divided into two sections. Section I contains the technical perspective and section II the treatment plan. Some readers may wish to review the treatment plan for its applicability to their situation and then become familiar with the technical perspective.

    Section I: Medical Perspective

    FM and CFS are different diseases but closely related. Patients with these diseases have in common a decrease in corticotrophin releasing hormone (CRH) which controls cortisol output from the adrenals. Both groups of patients have shown a decrease in levels of arginine vasopressin (AVP), a hormone that controls the ability of the body to release fluid. With a lack of this hormone the patients would feel increasingly thirsty and have frequent urination with having to urinate about every 20-30 minutes. Both of these hormones are produced in an area of the brain called the supraoptic nucleus. Another hormone of importance, called oxytocin, is produced by the same nerve cells. The same neurons that make OT also have the capacity of making CRH and AVP. As of December of 1998, no one in the medical literature has described an OT deficiency. An attempt to define an OT deficiency will be done here. The vast majority of the medical literature has been written about the medical problems of FM. Hence the bulk of references referred to in this paper pertain to FM.


    OT is a hormone produced in many parts of the body. In the brain, it is produced and released on a daily rhythm with it’s peak in the human brain occurring at around noon. OT is also produced in the posterior retina, in the pineal gland, thymus, pancreas, testicle, ovary, and adrenal glands. Oxytocin’s known functions will be discussed below.

    Microcirculation: OT is known to be one of the controlling factors of the microcirculation of the human body and brain. A decrease in OT can cause problems with decreased circulation in the extremities. Therefore, patients often complain of cold hands and feet, along with history of recurrent headaches. Oxytocins ability to vasodilate the blood vessels is due to its capacity to stimulate the body’s cells to produce nitric oxide, a powerful vasodilator of the microcirculation. If vasodilation, such as blushing, does not occur when OT is given intramuscularly to a patient, then a serious defect in nitric oxide production is present. This defect of poor circulation is often present among patients with FM patients.

    Lactation and Libido: OT is released as a mother nurses her baby. Stimulation of the hormone release causes the mother to have an instinct to want to cuddle. As she nurses the child, her desire to cuddle intensifies. This same feeling can be experienced during intimacy–OT has the ability to increase libido. Therefore, patients lacking this hormone may often notice that they do not wish to cuddle, to be held, or to be intimate. It has been noticed that stress can restrain the production of OT.

    Mental Function: OT seems to stimulate the ability of the brain to concentrate, contributes to mental alertness and improves memory. Patients lacking this hormone may find difficulty in concentrating, and feel like they are thinking in a fog. This has been noted in FM.

    Pain: OT can occupy multiple hormonal receptor sites in the body. Dr. Flechas theorizes that an empty receptor for OT can potentially cause pain. Administering OT causes the empty OT receptor sites to become full, thereby diminishing or completely obliterating pain. Animal studies reveal that because of this particular characteristic, OT has been an effective tool in weaning addicted animals from narcotics, suggesting that OT has the ability to occupy not only its own receptor sites, but opiate (narcotic) receptor sites as well. Oxytocin has been given to humans to kill cancer pain, low back pain and bowel pain from irritable bowel syndrome.

    Vision: OT is produced in the posterior retina of the eye. A decrease in OT level can cause problems with intermittent blurring of vision. When OT is given, it can sharpen the vision. (clinical observation) In a patient with a reduced level of OT, one can expect complaints of pain in the posterior eye, sometime so severe that only narcotics provide effective pain relief. Visual disturbances in FM have been observed.

    Sleep: OT is made in the pineal gland of the brain, as is melatonin, a hormone which enhances sleep. In animal studies, as the level of OT goes up in the brain, the animal is induced to go into a deep sleep. (Insomnia is a sleep disorder frequently seen in patients with FM/CFIDS, and could indicate a deficiency in melatonin). Note: Recent research indicates that melatonin has the ability to activate the immune system, so the use of this product is usually contraindicated in the presence of autoimmune disease (such as lupus, rheumatoid arthritis).

    Ovary: The ovaries make OT. In the ovary, OT helps in the fine- tuning of progesterone release. When patients are lacking OT, they may frequently complain of ovarian pain, even though pathology does not support the presence of either cysts or tumors. Ovulation function may be impaired with menstrual irregularity.

    Adrenals: OT is synthesized in the adrenal glands where it can stimulate or inhibit steroid production. Patients with a decreased OT level often complain of flank pain underneath the posterior ribs. Malfunction in the adrenal steroid production has been seen in FM.

    Thymus: OT is created by the thymus gland of the body. The thymus gland utilizes OT to help process white blood cells which help control autoimmunity. Normal levels of OT also help stimulate these cells into greater action. For example, it is a known fact that women who nurse their children have a much lesser incidence of breast cancer. This hormone may be protective in its ability to prevent breast cancer, through its influences on the immune system.

    Pancreas and Bowel Function: OT is produced by the pancreas. In the pancreas, OT is known to stimulate the production of glucagon, a hormone which helps the intestines to relax. Therefore, in treating a patient with decreased levels of this hormone, one would expect to see problems with increased intestinal spasms, secondary to a lack of glucagon production from the pancreas.

    Anxiety: OT can function as an antianxiety agent in the brain. It can also stimulate social behavior. A lack of this hormone may be expressed as antisocial behavior with some anxiety.

    Depression: OT can function as an antidepressant. In low levels of OT one would expect to see depression, which has been noticed in FM/CFIDS.

    Blood Pressure Control: OT can serve as a regulator of cardiovascular function and autonomic nervous system function. This explains why patients lacking this hormone have trouble controlling their blood pressure when going from a sitting to upright position, or when standing for a long period of time This is known as neurally mediated hypotension. They often complain of near syncope (light headed) and possible dizziness. OT is found in those sections of the brain where the baroreceptors of the body are controlled. A drop of OT levels in the brain, leads to manifestation of baroreceptor malfunction. Restoration of OT as an oral tablet (Belmar Pharmacy), corrects the symptoms of neurally mediated hypotension. (clinical observation)

    Body Fluid Control: OT has the capacity to induce the body to mildly retain fluid. This is in part due to its physical and biological similarity to arginine vasopressin. AVP is a hormone that controls fluid metabolism, pain and memory. With a lack of OT, patients have increased thirst. They also have increased urinary output due to decreased ability to retain fluid.

  • Nitric Oxide (NOS)
    1. Functions of NOS in the metabolism
    2. Stimulation of NOS production
    3. Causes of decreased production of NOS
    4. Correlation of nutrition with production of NOS
  • Dehydroepiandrosterone (DHEA)
    1. Physiologic functions of DHEA
    2. Production of DHEA in the Adrenals
    3. Relationship of DHEA to immunity, disease and metabolic regulation
    4. Use of DHEA in treatment of disease and dysfunction
  • The relationship between Oxytocin, DHEA and other biochemicals

In Section II, The Treatment Plan, Dr. Flechas states the following:

“Understanding that the true success of any approach to treatment lies in the ability to reach patients outside the parameters of a single medical practice, a protocol has been developed for other treating physicians using Oxytocin, nitroglycerine, and other preparations. Double-blind, placebo-controlled testing of these hormones and nutrients has not been performed because of lack of funding. The clinician may wish to try them sequentially in individual patients.”

The results of an open trial study and a physician’s decision making tree are presented.

This paper can be ordered through this Website, or by contacting Dr. Flechas at (828) 693-3015.