A Country Doctor Writes:

Mary Madore is no stranger to pain, but it seems that over our last couple of visits, I have eliminated or mitigated all her painful conditions. She didn’t make good on it, but the other day she proclaimed “I could kiss you”.

Like many other people who have had their gallbladder removed, she has had terrible yellow diarrhea and abdominal pain, not just after her surgery, but even decades before. I explained simplistically “you seem to have too much random bile in your gut” and prescribed her cholestyramine pills to bind her bile. That worked like a charm.

Then we had her gout (read my basic treatise on gout here). She gets emotionally imbalanced on prednisone, so I tried her on colchicine for her smoldering, chronic gout. It worked, but I didn’t see my way to starting allopurinol for her, since it often aggravates gout in the beginning and patients often need prednisone then. It is taking two colchicine pills a day to control her symptoms, and we had to first get her off her blood pressure medication, carvedilol, because of the interaction between it and colchicine, but it’s working.

Not only that, but she told me her fibromyalgia pain is half of what it used to be and her chronic, debilitating back pain is 90% better.

This sent me googling the literature.

My search results were mixed:

Intravenous colchicine has shown some, albeit temporary, benefit for back pain. Oral colchicine has not shown benefit in double blind studies.

There is no good evidence that it helps fibromyalgia. In fact, there are reports that long term use can cause fibromyalgia or something like it.

Of course, we know colchicine is a powerful anti inflammatory drug that can treat many conditions. Its use dates back to ancient Egypt 1,500 BC. A short list from an excellent review article includes the following:

• Gout

• Pseudogout

• Pericarditis

• Bechet’s Disease

• Actinic keratosis

• Familial Mediterranean Fever

• Secondary Amyloidosis

• Epidermolysis bullosa acquisita

• Leukocytic vasculitis

• Sweet’s syndrome

• Recurrent aphtous stomatitis

• Chronic urticaria

• Granuloma Annulare

• Hennoch Shönlein Purpura

Colchicine was briefly studied as a potential Covid drug with dismal results.

Colchicine appears to lower overall cancer incidence and cardiovascular disease. An older study by Crittenden found that the myocardial infarction prevalence in colchicine treated gout patients was 1.2% versus 2.6% in patients on other treatments. A more recent study found a 49% lower risk of primary cardiovascular events in colchicine users and also a 73% reduction in all cause mortality.

This is better than the 25% risk reduction of the latest fad drug, Jardiance, which reduces blood sugar by lowering the renal threshold for peeing out sugar. It is now recommended by cardiologists for reducing cardiovascular deaths even in non-diabetics. Colchicine is more in the benefit range of atorvastatin, Lipitor, which was at one point the best selling drug in this country.

Will colchicine ever climb to those heights? Not likely, because it is old, generic and now cheap again. But there is an irony here: Colchicine never underwent the rigorous approval process of modern times because it was such an old drug. The FDA disallowed several such old medications and an enterprising drug company offered to do the testing in return for an exclusive patent of this ancient drug. They got what they wanted and the price went up astronomically. But now colchicine is generic again and there is no money to be made from these promising newer cardiovascular and cancer reducing properties.