GREAT Exercises for Fibromyalgia

            Fibromyalgia (FM) is a chronic, stubborn condition that many people struggle with – some to the point of being totally disabled from doing the things that are personally fulfilling. In the past, we have discussed how important it is to have a multi-disciplinary group of healthcare providers to help the FM patient manage this relentless condition. This month, we are going to look at the available research regarding FM patients who incorporate exercise into their lifestyle vs. those who do not!

            There are MANY ways in which we can exercise – from simply contracting your abdominal muscles when you drive or sit at your desk to a full-body workout in a swimming pool. The KEY to exercise success is finding an exercise that you ENJOY, look forward to doing, and can foresee yourself doing for a long time into the future. To convince you of the benefits of exercise, let’s take a look at what has been published in peer-reviewed medical journals…

            In a “systematic review” of randomized clinical trials regarding FM and exercise training, researchers reviewed relevant studies published between 1966 and 2000. They reported that aerobic exercise reduced the number of tender points and improved cardiovascular fitness, global well-being, fatigue, and sleep in participants. This review clearly demonstrates that exercise is a very important component in the self-management of FM.

            Another study evaluated the effects of six months of pool-based exercises with six educational sessions in a 58 patient group that were divided between a treatment and a control group. They used a six-minute walking test, the Fibromyalgia Impact Questionnaire (FIQ), and several other tests and instruments that assess functional limitations, pain levels, social functioning, psychological distress, and quality of life. At the conclusion the trial, those who exercised experienced statistically significant improvement in ALL methods of assessment, CLEARLY demonstrating the importance of exercise!

            A similar study looked at exercise benefits and how long they lasted after the activity was discontinued following a twelve-week program. During the twelve weeks, the researchers measured and reported significant improvements in all nine measurements (physical function, general health perception, vitality, social function, mental health, balance, stair climbing, bodily pain, and role-emotional). During follow-up, researchers found that participants were only able to maintain two of the health benefits three months after they stopped exercising! This study shows how important it is to KEEP UP with fitness in order to maintain the best long-term results.

            Another study compared an aerobic exercise group vs. a group that only used relaxation and stretching techniques. The aerobic exercise group outperformed the stretch/relaxation group at the three-month point, and after one year, they reported a greater reduction of tender points and greater improvement if FIQ scores. The researchers concluded, “Prescribed graded aerobic exercise is a simple, cheap, effective, and potentially widely available treatment for FM.”

            There are MANY more studies that support the use of exercise as a very important form of care for FM. The common thread is this – a structured, patient-specific, graded aerobic exercise leads to an improved quality of life for the FM sufferer. 

            If you, a friend or family member requires care for Fibromyalgia, we sincerely appreciate the trust and confidence shown by choosing our services! 

Fibromyalgia – “How Do I Know I Have It?”

            Fibromyalgia (FM) is a condition where widespread generalized pain limits a person's ability to function, sometimes to the point of complete disability. This month, we'll look at identfying markers that may be used to determine whether a patient has FM or not.

            Chronic pain that arises from the muscles and joints affects nearly 20% of the adult population, with the highest percentages found among females and those in lower income brackets. It is very challenging to determine “the cause” of chronic pain, probably because it is influenced by and interacts with various physical, emotional, psychological, and social factors. Several studies have reportedly shown that the levels of certain neurotransmitters (chemicals that help our nerves transmit information) including serotonin, glutamate, lactate, and pyruvate are elevated in patients with localized chronic myalgias (like FM) and therefore may be potential biomarkers for various conditions causing chronic pain. Unfortunately, elevations in these potential markers are not specific or unique to FM.

            However, researchers have identified muscle alterations in in fibromyalgia / chronic widespread pain patients. More studies are needed to confirm these findings before they have the potential for use as a diagnostic criteria for FM.

            For the time being, in order to establish a diagnosis of FM, we must rely on the following:

1)                  The presence of widespread pain by using the “Widespread Pain Index” or WPI.

2)                  Determining the severity of the symptoms by using the “Symptom Severity Score” or SS score of which there are two parts:

·        Scoring fatigue, waking unrefreshed, and cognitive symptoms using a 0-3 scale, 3 representing the most severe or disturbing of these daily functions.

·        Adding up additional symptoms associated with FM, resulting in a 0-3 range depending on the number of the “other symptoms.”

            Using the WPI and the SS scores, FM can be identified if one of the following two situations has been presend for three or more months:

• WPI score > 7 and SS score > 5
• WPI score between 3 and 6 and SS score > 9

            If you, a friend or family member requires care for Fibromyalgia, we sincerely appreciate the trust and confidence shown by choosing our services! 

Fibromyalgia and HOW TO IMPROVE SLEEP!

            Last month, we reported some exciting news about the link between fibromyalgia (FM) and the importance of sleep, particularly getting to the deep sleep stage. However, we did not discuss the various strategies that YOU can use to improve your quality of sleep. Let’s take a look!

            Establishing a consistent and better sleep pattern is essential in managing the complex symptoms associated with fibromyalgia (FM). By doing so, you may experience reductions in pain, fatigue, and "fibro fog." Think of a flashlight. As the batteries wear down, the light becomes progressively dimmer and soon goes out. To recharge our batteries, we must sleep. According to the National Sleep Foundation (NSF), at least 40 million Americans suffer from over 70 different sleep disorders, and 60% of adults report having problems sleeping a few nights per week or more. Also, more than 40% of adults have daytime sleepiness that interferes with activities of daily living, and nearly 70% of children in a study reported they had problems sleeping at least one night a week. The “bottom line” is WE MUST SLEEP to be healthy!

            SLEEP STRATEGIES: 1) Sleep ONLY as much as you need to feel refreshed the next day. Limiting the time seems to improve sleep quality while excessive sleep leads to fragmented and shallow / poor quality sleep. 2) Keep a sleep diary and write down how you slept each night as well as any triggers that interfered with your sleep. Review the notes from time-to-time to remind you of strategies that worked in the past. 3) Keep a strict sleep schedule when possible. Get to bed, and more importantly, wake up at a regular time each morning. A regular arousal time strengthens our circadian cycle and leads to a more consistent time of sleep onset at night. 4) Use relaxation therapies such as gentle massage, deep breathing, meditation, yoga, and more, all of which can boost sleep quality. 5) Cut down on noise, particularly sudden loud noise (trains, planes, automobiles, etc.) by soundproofing the room or using a noise machine. Your sleep can be disturbed without you waking up or having memory of it in the morning. 6) Avoid long daytime naps as these interfere with nighttime sleep. 7) Keep the room temperature cool. 8) Hunger can be also disturb sleep, so a light snack of carbohydrates at night can help in this regard. 9) Avoid caffeine or alcohol in the evenings as both disturb sleep. 10) Consider herbs/vitamins/supplements such as 5-HTP, Melatonin, St. John’s Wart, SAM-e, L-Carnitine, Probiotics, and more.

            Remember, the goal is to get at least four hours of continuous sleep in order to reach the deep sleep stage. If this is not accomplished over time, the intensity of the FM symptoms can increase.

            The management of FM is best when approached from multiple directions: nutrition, exercise (especially aerobic), many of the 10 “tips” described above, and care rendered by a “team” of healthcare providers from disciplines such as chiropractic, massage therapy, and primary care. Because FM is complex with no single cause, a multi-directed treatment approach seems to work best. Remember, doctors of chiropractic focus on structure, exercise, nutrition, and whole-body health. They also work with other health professionals on a regular basis when managing the needs of their patients.

Fibromyalgia and the Importance of Sleep

            One of the most frustrating symptoms of fibromyalgia (FM) is the inability to get a good night’s sleep! Recently, at an Harvard-sponsored conference on the subject of pain, it was stated that “…no one should have to live in constant pain with what is known about pain management in this day and age (paraphrased).” Many attendees agreed that improving sleep quality may be the #1 way to improve the quality of life for patients with widespread pain. So the question is, what can be done to improve the sleep cycle for all of us, not only the fibromyalgia patient? Let’s take a look!

            The importance of sleep has long been discussed as being not only key in managing the FM patient, but some experts even suspect it's the probable cause of the disorder itself. It has been found that we must get at least four hours of continuous sleep in order to reach a deep sleep stage, and only at this level of sleep can we fully relax. If we can’t get to that deep sleep stage, our muscles (and mind) can’t fully relax and over time, the gradually increasing tightness may result in pain and the vicious cycle continues to chip away at the quality of life of the FM patient.

            Exciting new research from the United Kingdom reports that for those over age 50, non-restorative sleep – the type where you wake up tired, foggy, and listless - is STRONGLY tied to widespread pain, the “hallmark” of FM. The researchers also report that anxiety, memory loss, and poor physical health are linked to widespread pain in older adults. In the journal Arthritis & Rheumatology, author Dr. John McBeth wrote that musculoskeletal pain becomes more common with aging and affects four out of five seniors on a daily basis! Widespread pain is a KEY FEATURE of FM, which also includes fatigue and tenderness in muscles, joints, tendons, and other soft tissues. It is estimated that about 5 million American adults are affected by FM with women being affected four times more often than men (for reasons unknown). FM can occur insidiously (for no known reason) or secondary to an injury or illness.

            After studying a group of 4,300 adults (> age 50) of which 2,700 had some pain but not widespread pain, Dr. McBeth and his colleagues found several factors that can increase an older individual's risk of developing widespread pain. At the start of the study, participants completed questionnaires about pain, mental and physical health, lifestyle and health behaviors, medical conditions, and more. After three years, they were reassessed in a similar manner and 19% reported NEW widespread pain. This included 25% of participants who initially reported some pain and 8% who reported no pain at the study’s start. The most important link for the development of widespread pain was non-restorative sleep. Other links included pain status, anxiety, physical health-related quality of life, and some form of cognitive complaint (such as memory loss). They also note that brainwave studies of FM sufferers often show the inability to reach deep sleep. Moreover, in an experiment where healthy volunteers were woken during each period of deep sleep, a number of them soon developed typical signs and symptoms of FM!

            Chiropractic care includes treatment methods that reduces pain and muscle spasm and as a result, frequently improves an interrupted sleep pattern. Doctors of chiropractic are also STRONG ADVOCATES of home exercise and typically offer in-office training. Before attempting drugs with significant side effects, you owe it to yourself to include chiropractic care in your FM management “team!”

Fibromyalgia – Drugs vs. Herbs & Supplements?

  

            Fibromyalgia (FM) is characterized by a whole body, widespread pain that affects millions of people and continues to be a challenge for both doctors and patients to manage. This is probably because there is no one cause that can be clearly identified with the onset of FM. The “best” approach to managing FM requires a “team” of healthcare providers and a multi-modal treatment approach including (but not limited to): medications, chiropractic adjustments, exercise training, relaxation techniques, proper nutrition/diet, and structured sleep habits. The focus of this month’s article is on various oral treatment options, both prescription and non-prescription varieties that focus on deep muscle pain, sleep problems, anxiety, and depression.

            DRUGS: The following is a partial list of medications commonly prescribed for FM, according to WebMD. Please consult with your medical doctor as to which medication(s) may be best for you, if any: Cymbalta, Lyrica, and Savella.

            HERBS/SUPPLEMENTS: Last month, we discussed getting enough vitamin D, avoiding food additives such as MSG and aspartame, consuming omega 3 fatty acids, avoiding caffeine, eating veggies, taking anti-oxidants (such as vitamin A, C, and E, and coenzyme Q10), and avoiding gluten. Additional considerations include: 

1. 5-HTP: This is a “building block” for a powerful brain neurotransmitter called serotonin, which is thought to play a significant role in reducing FM-related pain, reducing depression, and helping to facilitate sleep – especially deep sleep! One study reported improvement in depression, anxiety, and insomnia as well as FM-related pain. This is usually well-tolerated by FM patients.
2. Melatonin: This is a natural hormone used to induce drowsiness and improve sleep patterns. It may also be effective in reducing pain associated with FM. This is regarded as being safe with few-to-no side effects, though it may cause daytime sleepiness for some so don't drive or operate heavy machinery until you see how it affects you.
3. St. John’s Wart: Though NOT specific or unique in FM treatment, it is often used to treat depression, which is a common FM symptom and therefore, may be helpful. Several studies found this to be more effective than placebo and equally effective as some antidepressants called “tricyclics” in those with mild-to-moderate depression. Other studies found similar results when compared to selective SSRI antidepressants such as Prozac or Zoloft. It is usually well-tolerated with the most common side effects including stomach upset, skin reactions, and fatigue. This reportedly should NOT be mixed with other antidepressants or other supplements.
4. SAM-e: How this exactly works in the body remains unknown, but some feel this natural supplement increases serotonin and dopamine levels (two brain neurotransmitters). Studies support mood improvement and increased restful sleep but it is not significantly beneficial for FM pain reduction or FM-related depression. Additional studies are needed.
5. L-Carnitine: L-Carnitine intake has been linked to FM-related pain relief and general mental health benefits.
6. Probiotics: These “good guy” bacteria or yeast supplements may assist in digestive disorders such as IBS (irritable bowel syndrome), which is commonly associated with FM. Other uses include diarrhea management and urinary tract and female genital tract infections.
7. Other herbs/supplements that may help FM include: Echinacea, black cohosh, cayenne, lavender, milk thistle, and B vitamins. Caution is recommended with using herbs during pregnancy, with children, the elderly, those with immune system deficiency, and those taking a blood thinner.

Commonly Asked Questions about Fibromyalgia

WHAT IS FIBROMYALGIA? FM is a relatively common chronic disorder where widespread pain, diffuse tenderness, and potentially a host of other symptoms may be present. The word “fibromyalgia” is derived from the Latin term “fibro” (fibrous tissue) and the Greek term “myo” for muscle and “algia” for pain. Even though FM is often described as an arthritis-type of condition, it does NOT cause inflammation of the joints, muscles, or other tissues as is observed with some types of arthritis. However, FM does “look” like arthritis in that FM can cause significant pain that can interfere with a person’s tolerance to daily activities, including work.

WHO GETS FM? It has been reported that FM affects five million Americans ages 18 and older. For unknown reasons, between 80-90% of those affected are women, but men and children can also develop FM. Most people are diagnosed during their middle years. Several studies have reported that women with a positive family history of FM are more likely to develop FM, but it remains unclear if this is from a shared environment vs. a true heredity issue, or both. Currently, researchers are looking at variations in certain genes that cause some people to be more sensitive to stimuli, which may lead to pain syndromes like FM. People with rheumatic diseases (such as rheumatoid arthritis, lupus, or ankylosing spondylitis – a special type of spinal arthritis) may be more likely to have FM as well.

WHAT CAUSES FM? Even though no one REALLY knows why some people develop FM and others do not, we have learned that FM is linked to the central nervous system. There are two types of FM: Primary (no known cause) and Secondary (occurs with a known underlying condition). Secondary FM has been associated with a physical/emotional stress or traumatic event such as a motor vehicle accident, and some develop FM after sustaining a repetitive motion injury or after an illness. In primary FM, it seems to develop spontaneously with no known cause or associated condition.

HOW IS FM TREATED? Treatment is challenging as not all doctors are familiar with FM and may not even “believe” it’s real (they may think it's depression or all in the patient's head). It is therefore BEST to find a “TEAM” of healthcare providers knowledgeable about FM and willing to work with you. This team may include primary care doctors, chiropractors, physical therapists, clinical psychologists, and perhaps rheumatologists, among others. Massage therapists, acupuncturists, and nutritional therapists can also be part of the multi-dimensional treatment approach. However, the MOST important team member is YOU because keeping track of sleep hours, exercise amounts, diet, and knowing when to rest are critical for a good treatment outcome. You can guide us in finding care that works, what doesn’t, and at what “dose” feels best for you. Focusing on “control” rather than “cure” is important so you do not get too discouraged during the treatment process.

            If you, a friend or family member requires care for Fibromyalgia, we sincerely appreciate the trust and confidence shown by choosing our services!

                                      

Tests for Fibromyalgia?

            Wouldn’t it be nice if you could just tell your chiropractor, primary care doctor, nurse practitioner, or physician assistant about how you’re feeling and have the condition easily diagnosed and treated? With fibromyalgia (FM), it NEVER works that way! Some doctors even think FM is a mental issue and don’t believe it’s a “real” condition. Others over-diagnose everyone with FM and place them on medications that sometimes carry side effects that are worse than the condition. Let’s take a look at the diagnostic criteria for FM and discuss what you might expect in regards to tests....

            The Diagnostic Guidelines for Fibromyalgia currently state three things: 1) Pain that is widespread in all four quadrants of your body. 2) Pain that has been present for at least three months. 3) There are no other diseases causing these symptoms. In other words, a patient's health history can satisfy the first two criteria and a physical examination and BLOOD TESTS help us rule out other diseases that can cause similar symptom-producing conditions. A commonly ordered blood test is a  “CBC” (complete blood count), which tells us if you have an infection (elevated white blood cells – WBCs) or if you are anemic (low red blood cells – RBCs, low hemoglobin, which makes the blood red). Other tests may look for signs of rheumatoid arthritis, gout, a prior strep infection, lupus, inflammation, or Lyme disease. NONE of these tests tell us if you have FM, but they do help us determine if you have some other underlying condition that may be participating in the symptom picture.

            However, there is a NEW blood test that may predict fibromyalgia that was introduced in October of 2013 at the annual meeting of the American College of Rheumatology. EpicGenetics of Santa Monica, CA calls it the “FM/a” test, and it’s being described as “…objective, very accurate, and definitive.” Because of its high cost ($744) and short track record, it’s currently being used primarily in the difficult-to-diagnose cases. The test works by measuring proteins in the body that lessen pain (which were found to be low in FM patients). Researchers ran this test on 100 lupus patients, 98 RA patients, 160 FM patients and 119 healthy patients and found it positive in 93% of KNOWN FM patients and negative 89% of non-FM patients! Because this was presented at a conference and not yet “peer reviewed” (published in a medical journal), these findings are “preliminary” and must be interpreted with caution.

            A simple/FREE “screen” called the “Widespread Pain Index” (“Google” it) contains two main parts: 1) A pain diagram where you can check off the body parts that hurt; 2a) a Symptom Severity Score where you indicate your level of symptom severity over the past week and 2b) where you check off “Other Symptoms” from a list. There is a scoring method that is simple and described on the form that result in two numbers to determine if you meet the “diagnostic criteria.” We recommend starting with this approach. Print off the form, fill it out and score it yourself, bring that into our clinic, and then ask about your specific case. The MOST important part of this process is the third criteria discussed above: ruling out other conditions (we MUST see you!).

            Chiropractic is “A MUST” on the management “TEAM” for FM patients, and we’re happy to keep you INFORMED of your diagnostic and treatment options!

The Diagnosis and Misdiagnosis of Fibromyalgia

            Fibromyalgia (FM) is a condition that the medical community has long had difficulty defining. As stated last month, FM is often considered a “musculoskeletal disorder” (MSK) because of the aches and pains it produces in the muscles and joints. However, this is not really accurate since FM includes many other symptoms beyond just severe muscle pain, such as extreme fatigue, mental fog, sleep disorders, irritable bowel, and more. As such, “misdiagnosis” is more common than an accurate diagnosis when it comes the FM. Let’s take a closer look!

            FM is described as a “syndrome,” meaning it includes multiple complaints and findings that commonly occur together such as (but not limited to) widespread pain, decreased pain tolerance or threshold, multiple tender points, incapacitating fatigue, anxiety, and/or depression. Though the intensity of these symptoms can vary, persistent and chronic fatigue is one of the most common complaints, second only to the whole body deep muscle aches. Unlike “normal” fatigue, the type of fatigue, weakness, and exhaustion associated with FM often leads to social isolation, and as a result, anxiety and/or depression.

            The reason WHY FM is so difficult to diagnose is that: 1) These same symptoms are found in many other conditions and, 2) There is no one test that can diagnose FM like a blood test or x-ray. The diagnosis process must RULE OUT all the other conditions that present with similar symptoms. Hence, blood tests are used to rule out anemia or hypothyroid (for fatigue), inflammatory arthritis, and Lyme disease. Sleep studies are used to rule out sleep apnea (which can co-exist with FM). X-rays are used to rule out a bone or joint cause of the patient's muscle pain. Many diseases or conditions have a pattern of complaints, but FM doesn’t consistently follow a similar presentation. There are so many different degrees of FM and the symptoms include so many different systems of the body that FM sufferers often have to go from doctor to doctor before they find one willing to take the time needed to properly assess for fibromyalgia. Some doctors firmly believe there is no such thing as FM stating that “…it’s all in the head!” This can only adds to the frustration, anxiety, and depression for the FM sufferer.

            Common misdiagnoses include (but are not limited to) depression, inflammatory arthritis (like rheumatoid or lupus), chronic myofascial pain syndrome, or chronic fatigue syndrome. Conditions commonly associated with FM may include some of the above as well as irritable bowel syndrome (IBS), thyroid deficiency, and others, which only makes the diagnosis of FM even more challenging!

            Some doctors and researchers use the term “primary FM” for FM that is not caused by something else vs. “secondary FM” where something like a trauma (eg., car accident), IBS, or an inflammatory arthritis either precedes the start of FM symptoms or is closely associated with its onset. The important point is that FM is unique and it must be properly diagnosed so accurate and effective treatment can be administered. The diagnostic Guidelines for FM include three main things: 1) Widespread pain in all four body quadrants; 2) At least three months of symptoms; and 3) No other disease is causing these symptoms.  You can expect us to check for the following: 1) Widespread pain; 2) Trigger point evaluation; 3) Ask about fatigue; 4) Ask about sleep disturbances; 5) Ask about stress levels; and 6) Ask about depression. Proper treatment is often best approached with a “team” consisting of chiropractic, primary care, clinical psychology and/or counseling, and sometimes others.

Fibromyalgia: The Top 10 Most Common Signs

            Fibromyalgia (FM) causes widespread pain to an estimated 5.8 million Americans. FM is considered a “musculoskeletal disorder” even though many of the symptoms include other systems, especially the gastrointestinal system, as conditions such as IBS (irritable bowel syndrome) often co-exist. It is thought that FM is a disorder that amplifies the manner in which the brain processes pain, making the body’s pain receptors hypersensitive. For example, FM can result in a 3/10 pain level (normally tolerated) being amplified to 7 or 8/10, enough to interfere with daily activities. FM often follows some type of severe physical or mental trauma, such as a car accident, surgery, or a significant psychological stress. The widespread pain results in fatigue, sleep deprivation, depression, and more. The following are ten of the most common symptoms associated with FM:

1. Pain: This is the primary symptom, and it is typically widespread/whole body but doesn’t necessarily occur all at once. It can flair at times of stress, weather changes, sleep schedule change, and it can be achy, stabbing, burning, tingling, pins/needles, or a mix.
2. Sensitivity to Touch: FM pain can be so sensitive that the weight of bed sheets or a light touch can be excruciating. Simple traumas like stubbing a toe or a bruise can be much more intense and last a lot longer in the FM patient.
3. Environmental Sensitivity: Things such as exposure to tobacco smoke, loud noise, chemical cleaners, and/or bright lights often intensify or bring on FM symptoms.
4. Muscle and Joint Stiffness can occur frequently, especially in the mornings and after prolonged sitting.
5. Muscle Spasms: Cramps, “Charlie horses,” RLS (restless leg syndrome) are common, especially during the night, thus interfering with sleep.
6. Exhaustion: Sleep deprivation can lead to exhaustion and insomnia (lack of sleep) is a common FM issue. This can lead to chronic fatigue, causing energy levels to crash.
7. Concentration Problems: Brain or “cognitive” function is a frequent problem affecting short term memory, information retention, “mental fog”, trouble concentrating/staying on task, and at times, dizziness.
8. Chronic Headaches: Tension and stiffness in the neck, shoulders, and upper back often results in tension and / or migraine headaches. Environmental triggers may be associated with the headache onset such as smells, light, or loud sounds (see #3).
9. Bowel Problems: FM and conditions like irritable bowel syndrome (IBS) often co-exist which can cause diarrhea and constipation, often changing back and forth. Here, a change in diet can be particularly helpful!
10. Depression: Like IBS, depression and FM are commonly matched and it often arises from having to deal with chronic, amplified pain, not being able to participate in family or social events, and low energy levels. This can be a “vicious cycle” as the more that activity interference occurs, the greater the risk/level of depression. This can lead to becoming afraid to walk, exercise, and getting out, which can feed the depression.

            Obviously, there are many other signs and symptoms commonly associated with FM, but these seem almost “universal.” Next month, we will look at ways to “beat” these 10 common complaints and offer some treatment solutions! Chiropractic care has been found to greatly facilitate FM sufferers and is an important player in managing the FM patient.

Fibromyalgia and Vitamin D Deficiency

            Utilizing dietary approaches to help with fibromyalgia (FM) management has been our main topic these past two issues and serves as GREAT background information for this month’s topic: Vitamin D and its role in the management of pain associated with FM. Let’s take a look!

            Vitamin D is found in foods such as fish, eggs, fortified milk, cod liver oil, and more. The sun also helps the body produce vitamin D with as little as 10 minutes of exposure reported to be enough to prevent deficiency. There are several different forms of vitamin D, of which two are important in humans: vitamin D2 (made by plants), and D3 (made by human skin exposed to sunlight). Foods may be fortified with either type, and supplements are available in both forms (D3 is preferred). The main role of vitamin D is to maintain normal blood levels of calcium and phosphorus. Calcium and vitamin D are often taken together to improve bone health and reduce fractures. Research has also shown that vitamin D may protect against osteoporosis, high blood pressure, cancer, and other diseases. “Classic” vitamin D deficiency diseases include bone softening conditions such as rickets (in children) and osteomalacia (in adults). People at high risk include the elderly, individuals who are obese, and those with limited sun exposure. Individuals with conditions such as cystic fibrosis (mucous build-up in the lungs) or inflammatory bowel disease are also at risk for vitamin D deficiency. With that background information, can vitamin D help FM patients with chronic pain?

            In a February 2014 study (journal: Pain 2014, Feb 01;155(2)261-268), the first known randomized, placebo-controlled trial was conducted on 30 FM women with serum D3 levels below 32ng/mol/L (80nmol/L). Half were assigned to either vitamin D replacement or a control group that received a placebo (NOT vitamin D). The two groups were re-evaluated again after 24 weeks. The main hypothesis was that those treated with vitamin D3 would have less pain (as measured on a 0-100 pain scale and several additional questionnaires). The study found that there was a marked reduction in pain perception in the FM women treated with D3. Though a larger scale study was recommended to solidify these findings, the authors conclude, “This economical therapy with a low side effect profile may well be considered in patients with FMS.” This study is important, as dosing of vitamin D3 (preferred over D2 commonly prescribed) was based on deficiency levels and provided at 1200 to 2400 IU/day. By the end of three months, those receiving D3 improved from an average of 20 ng/ml to almost 50 ng/ml and reported a 20 point decrease in pain on a 0-100 scale. Further, about 20-25 weeks after discontinuing D3, their levels dropped back to ~26 ng/ml with a corresponding increase in pain levels (by 30%).

            WebMD reports similar chronic pain benefits with D3 replacement. In 2003, they reported that D3 deficiency is high “among all U.S. ages, races, and ethnic groups over the past two decades.” They add that a then-recent study found that out of 150 chronic pain patients, 93% of them had “extremely low” D3 levels!

            If you, a friend or family member requires care for Fibromyalgia, we sincerely appreciate the trust and confidence shown by choosing our services! 

Fibromyalgia: Dietary Considerations (Part 2)

                                                                                 

          Fibromyalgia (FM) management requires a multi-dimensional approach, of which nutrition plays a BIG role. Last month, we discussed the importance of keeping an accurate food journal and grading the reaction that certain foods, vitamins, herbs, etc. have on you. This month, let's discuss the nutritional use of probiotics.

            Probiotics can be defined as the “good guy,” or friendly bacteria, that we need and have in our gastrointestinal (GI) tract. Certain “strains” or types of probiotics have been linked to many health benefits ranging from calming IBS (irritable bowel syndrome) to stimulating the immune system.  As a result, probiotics can help “fight off” MANY conditions, including bacterial and/or viral infections and related conditions. Probiotics may also benefit those suffering from autoimmune diseases such as rheumatoid arthritis, MS, lupus, and more. Common questions surrounding the use of probiotics include:

1)      Are these FDA regulated? ANSWER: In 2001, the FAO (Food and Agriculture Organization - NOT the FDA or Food and Drug Administration) defined probiotics as “live microorganisms which, when administered in adequate amounts, confer a health benefit on the host.” At this time, the FDA has NOT approved any specific health benefit related to probiotics. This may be because the amounts of probiotic that studies have reported to be beneficial vary from strain to strain and condition to condition. In 2007, the FDA placed regulations requiring all dietary supplements to be a) produced in a quality manner, b) to be free of contaminants / impurities, and c) accurately labeled. Probiotic researchers are hoping this will improve the quality of the probiotic supplements and research quality in the United States.

2)      Which probiotic strain does what? ANSWER:  According to probiotic microbiology consultant Dr. Mary Ellen Sanders, strains that help modulate and support the immune system include: Bifidobacterium lactis HN019 – this helps older people in particular (sold as an active ingredient for dairy and supplement products); Lactobacillus reuten ATCC55730 (available in BioGaia Gut Health products); Lactobacillus casei DN-114 001 (in DanActive products); and d) Bifidobacterium lactis Bb-12 (available in Yo-Plus yogurt, LiveActive cheese) -  best used uncooked. To help combat diarrhea associated with antibiotic use, consider: S. cerevisiae (S. boulardii) (found in Florastore powder and Lalfor capsules); Lactobacillus rhamnosus GG (LGG) (found in Danimals drinkable yogurt and Culturelle capsules); Lactobacillus casei DN-114 001 (in DanActive products); Lactobacillus acidophilus CL1285 and Lactobacillus casei Lbc80r (found as BioK + CL1285 fermented milk, BioK + CL1285 soy milk, and capsules).

3)      What information should be looked at on the label of probiotic foods? ANSWER: a) Look for the full probiotic name, which includes the genus, species followed by the strain, as many only list the genus/species (such as “Bifidobacterium lactis” found in Kraft’s LiveActive Cheddar Cheese Sticks). b) Find out how much probiotic is contained in each serving, and what research supports the health benefit and the amount they used (search the website of each individual product to find these answers).

4)      Are probiotic supplements worthwhile? ANSWER: When consumed in food or pill form, YES! Dr. Sanders says food sources are more nutritious, but pills are more convenient and may have greater amounts of probiotic. Most important, You MUST receive adequate amounts of Probiotics for your needs!

5)      Are Probiotics safe? ANSWER: Usually, but those acutely ill or those with a compromised immune system should be cautious, as this area is currently being researched with unknown answers. A Tufts University expert writes that no harm has been reported in healthy people – BUT those with terminal cancer or leaky bowels, including acute pancreatitis, should NOT consume probiotics. Work with us and your primary care physician for guidance.

Fibromyalgia: Dietary Considerations

                                                                                      

            Fibromyalgia (FM) management requires a multi-dimensional approach, of which nutrition plays a BIG role. Last month, we discussed the importance of keeping an accurate food journal and grading the reaction that certain foods, vitamins, herbs, etc. have on you. This month, let's discuss the nutritional use of probiotics.

            Probiotics can be defined as the “good guy,” or friendly bacteria, that we need and have in our gastrointestinal (GI) tract. Certain “strains” or types of probiotics have been linked to many health benefits ranging from calming IBS (irritable bowel syndrome) to stimulating the immune system.  As a result, probiotics can help “fight off” MANY conditions, including bacterial and/or viral infections and related conditions. Probiotics may also benefit those suffering from autoimmune diseases such as rheumatoid arthritis, MS, lupus, and more. Common questions surrounding the use of probiotics include:

1)      Are these FDA regulated? ANSWER: In 2001, the FAO (Food and Agriculture Organization - NOT the FDA or Food and Drug Administration) defined probiotics as “live microorganisms which, when administered in adequate amounts, confer a health benefit on the host.” At this time, the FDA has NOT approved any specific health benefit related to probiotics. This may be because the amounts of probiotic that studies have reported to be beneficial vary from strain to strain and condition to condition. In 2007, the FDA placed regulations requiring all dietary supplements to be a) produced in a quality manner, b) to be free of contaminants / impurities, and c) accurately labeled. Probiotic researchers are hoping this will improve the quality of the probiotic supplements and research quality in the United States.

2)      Which probiotic strain does what? ANSWER:  According to probiotic microbiology consultant Dr. Mary Ellen Sanders, strains that help modulate and support the immune system include: Bifidobacterium lactis HN019 – this helps older people in particular (sold as an active ingredient for dairy and supplement products); Lactobacillus reuten ATCC55730 (available in BioGaia Gut Health products); Lactobacillus casei DN-114 001 (in DanActive products); and d) Bifidobacterium lactis Bb-12 (available in Yo-Plus yogurt, LiveActive cheese) -  best used uncooked. To help combat diarrhea associated with antibiotic use, consider: S. cerevisiae (S. boulardii) (found in Florastore powder and Lalfor capsules); Lactobacillus rhamnosus GG (LGG) (found in Danimals drinkable yogurt and Culturelle capsules); Lactobacillus casei DN-114 001 (in DanActive products); Lactobacillus acidophilus CL1285 and Lactobacillus casei Lbc80r (found as BioK + CL1285 fermented milk, BioK + CL1285 soy milk, and capsules).

3)      What information should be looked at on the label of probiotic foods? ANSWER: a) Look for the full probiotic name, which includes the genus, species followed by the strain, as many only list the genus/species (such as “Bifidobacterium lactis” found in Kraft’s LiveActive Cheddar Cheese Sticks). b) Find out how much probiotic is contained in each serving, and what research supports the health benefit and the amount they used (search the website of each individual product to find these answers).

4)      Are probiotic supplements worthwhile? ANSWER: When consumed in food or pill form, YES! Dr. Sanders says food sources are more nutritious, but pills are more convenient and may have greater amounts of probiotic. Most important, You MUST receive adequate amounts of Probiotics for your needs!

5)      Are Probiotics safe? ANSWER: Usually, but those acutely ill or those with a compromised immune system should be cautious, as this area is currently being researched with unknown answers. A Tufts University expert writes that no harm has been reported in healthy people – BUT those with terminal cancer or leaky bowels, including acute pancreatitis, should NOT consume probiotics. Work with us and your primary care physician for guidance.

            If you, a friend or family member requires care for Fibromyalgia, we sincerely appreciate the trust and confidence shown by choosing our services! 

Fibromyalgia and Sleep

            Last month, we focused on how important sleep is in the management of the fibromyalgia (FM) and the relationship between sleep dysfunction and Restless Leg Syndrome. Now that it’s clear that the sleep and FM pairing is so important, how can we improve sleep quality? As stated last month, FM and sleep dysfunction go hand in hand and is a consistent complaint of the FM patient. The need to establish better “sleep hygiene” has been found to be one of the most important treatment strategies for those suffering from FM. This can help decrease pain, fatigue, and the “fibro fog” that is often described that impairs the ability to concentrate and work efficiently.  Listed below are some sleep strategies that work very well, all you have to do is try them!

1.                   SLEEP QUANTITY: The advice is to only sleep as much as is needed to feel refreshed and alert the following day. Getting too much sleep does not equate to good quality sleep. In fact, reducing the time in bed seems to improve the quality of sleep, as excessively long periods of time in bed result in fragmented, superficial or shallow sleep and doesn’t allow one to enter the deeper, restoring stages of sleep.

2.                   KEEP A SLEEP LOG: Document the amount you sleep each night and pay attention to things that may have interfered with that night’s sleep. You will find that reviewing these notes over several weeks will give you strong clues as to the triggers that interfere with your ability to sleep so you can develop strategies to deal effectively with these sleep barriers.

3.                   BE CONSISTENT: Establishing a regular time to wake up each morning as a consistent routine will help establish and strengthen your circadian rhythms, and a regular arousal time puts you on a consistent sleep cycle and leads to a regular time of sleep onset at night.

4.                   USE RELAXATION TECHNIQUES: The use of relaxation therapies such as visualization, deep breathing, a gentle massage, and southing background music or sounds are all great ways to boost restful sleep.

5.                   EXERCISE REGULARLY: This sounds counterintuitive but REALLY WORKS well! The KEY to exercise is to do this at least 3 hours prior to going to bed. Exercise not only “clears your head” but it provides a great way to reduce the accumulation of stress and exerts beneficial effects by promoting better, deeper sleep. Start slowly and gradually increase the duration and intensity of a form of exercise that you enjoy and look forward to doing. Pilates, Yoga, Ti Chi, Qui Gong, water aerobics, walking in the woods, or working out at your favorite gym or health club with some pals are some options.

6.                   BACKGROUND NOISE: Some FM sufferers really benefit from background “white” noise. Sound machines offer a variety of sounds that can help immensely! Avoiding sudden loud noises like low flying air craft or the slamming of a door or cupboard can disturb sleep quality even if we cannot remember the event the next morning.

7.                   NO NAPS PLEASE: Avoid a daytime nap; however, if you have to “recharge,” keep the time short  (no more than a 15-30 min. “power nap”). Long naps interfere with nighttime sleep.

8.                   TEMPERATURE: Keep your bedroom cool; warm temperatures interfere with sleep.

9.                   APPETITE: Consider a light snack rich in carbohydrates if hunger interferes with sleep.

10.               NO CAFFEINE: Avoid caffeine or alcohol in the evenings as they both can interfere with sleep quality and the ability to get to sleep.

            If you, a friend or family member requires care for FM, we sincerely appreciate the trust and confidence shown by choosing our services! 

Fibromyalgia - More Tips From Real Patients

            Last month, we listed many great “pearls” of wisdom direct from patients suffering with Fibromyalgia (FM), some of which we would like to directly focus on this month and expand as these truly arise from the heart of the experienced and deserve more attention (plus, we couldn’t include them all last month and can expand on them now).

1.     “Keep a journal every day about what you do and how you feel.” Many times when discussing your symptoms of FM with us, it is very hard to remember important details and keeping a journal is REALLY appreciated as it serves as a reminder for the patient of the things that trigger a flair-up.  The journal can often save an immense amount of time trying to determine what can be done to help the patient, such as when to employ biofeedback skills, like visualization. This is performed any time or place where you may find yourself in a situation that is totally out of your control and you sense your ability to cope is failing. At uncontrolled times such as this, shutting the eyes and visualizing a calming and relaxing scenario is usually very helpful and can be exercised as often or for as long as needed. Again, write down the most effective visualization scenarios or thoughts so you can refresh your memory from time to time.

2.     “Sleep is very important. Try not to nap during the day so you can sleep better at night.” One of the biggest complaints from FM patients is sleep disturbance, whether it’s getting to sleep or waking up multiple times a night and/or not being able to return to sleep. Many “pearls” were found that dealt with sleep quality and methods for improving sleep.  One of the most important issues is stated above – try to avoid napping during the day. Another is to go to sleep at the same time each night, or, to stay on a schedule that is consistent. Some recommended avoiding thoughts about the day that are stressful or situations you can’t control prior to going to sleep.

3.     “Exercise on a regular basis.” This too, was a popular recommendation.  Most felt “light exercises” was better, while a few favored strenuous exercises.  Some gave specific recommendations like yoga, stretching, or swimming (“…because it’s easier on my joints.”). Some gave specific instructions like, “…Exercise! Keep those muscles and bones flexed and firm. But do not overdo it!” Another recommended wearing a sweat suit to keep the muscles warm. Most importantly, develop a routine that includes regular exercise doing something you like! This will ensure consistency and flow.  Exercise also has the very important ability to reduce stress simply from “working out,” and stress reduction and control was mentioned by itself multiple times. Not mentioned is the fact that endorphins and enkephlins are released with exercise that can reduce pain, as they are “natural pain killers,” morphine-like substances our body produces.

4.     Diet: This too, was popular and frequently mentioned.  Some gave very detailed information about what to eat such as, “Balance your meals with a low-fat, high-protein diet. Drink plenty of water.” A low gluten diet is anti-inflammatory and very helpful.

5.     Miscellaneous: Educate yourself about FM by gathering as much information as possible, reading about FM on a regular basis, starting or attending a support group, choosing a doctor who understands FM were also very common themes. Perhaps most important was, “accept your limitations,” and in doing so, don’t be afraid to ask for help – create a list of reliable friends and family who are willing to help out when needed.

                If you, a friend or family member requires care for FM, we sincerely appreciate the trust and confidence shown by choosing our services! 

Fibromyalgia and the Weather

            Recently, a doctor had a patient tell him she had a “break-through” in her fibromyalgia (FM) symptoms that she was VERY excited to share. Having known this patient for a long time, he was intrigued by her enthusiasm.  She told her doctor that her family had never had an air conditioner before until late last fall before the winter and hadn’t used it yet until recently. She discovered that her generalized, whole body aches were significantly improved by running the AC, even when set at 79°F when the temperature outside may not have required it.

            We all know that FM causes many symptoms such as relentless fatigue, muscle pain, depression, dizziness, nausea, and the list goes on.  It’s also no secret that FM symptoms vary considerably between seasons, as well as with certain weather changes, not to mention temperature changes, air pressure or barometric changes, and when it rains. Changes in fatigue, sleep patterns, headache intensity/frequency, muscle pain, severe episode flair-ups are frequently reported by the FM patient. As far back as 1981, a study reported that a large percentage of FM patients may be more sensitive to changes in weather compared to non-FM subjects. In fact, they stated 90% of the FM patients reported weather was one of the most important factors influencing their FM symptoms. Weather changes commonly affect symptoms in patients with other conditions such as rheumatoid arthritis, multiple sclerosis, and osteoarthritis. But, the question remains, how does weather affect fibromyalgia?

            There are 5 major weather factors that appear to affect FM symptoms:

1.       Temperature: especially rapid changes in temperature and cold tend to irritate while warm temperatures are less troublesome.

2.       Barometric Pressure: This is the measure of weight (pressure) that is exerted by the air that is all around us. Sunny days create a high barometric pressure while storms result in a sudden drop. These changes can trigger muscle aches in FM patients.

3.       Humidity: This refers to the amount of water vapor present in air. Humidity is associated with headaches, stiffness and widespread pain flare-ups in FM patients.

4.       Precipitation: This refers to any type of water that falls from the sky to the ground (rain, sleet, snow, hail) and is usually associated with a change (usually a drop) in barometric pressure. This can result in increased pain and fatigue in FM patients

5.       Wind: In general, wind usually causes a decrease in barometric pressure regardless of its force and therefore can trigger fatigue, headache, and muscle pain in FM patients.

            Though a number of studies are available that support weather’s adverse effects on the FM patient, researchers still are not exactly sure why this occurs but offer several explanations for this. One has to do with our sleep cycle. It appears that changes in the sleep cycle occur at times of extreme temperature – either hot or cold and this can negatively affect the FM patient. Another explanation involves the changes in our Circadian Rhythm that normally occurs with the changes in seasons due to the amount of light our body receives, less in the winter, more in the summer causing fatigue and achiness. The third explanation is the relationship between low temperature levels and an increase in the number of “pro-inflammatory cytokines” in the body, which increases pain intensity. FM patients have reported benefits from dressing in layers, avoiding cold temperatures, and increasing the amount of light inside the house (halogen bulbs, a light box, and also, taking Vitamin D can help too!).

            If you, a friend or family member requires care for FM, we sincerely appreciate the trust and confidence shown by choosing our services! 

Fibromyalgia: Why Water Exercises?

            Fibromyalgia (FM) is a condition associated with tight, sore muscles but no one REALLY knows where FM comes from or why it picks on certain people and not others.  Some feel it’s caused by lack of sleep, specifically deep sleep, eventually resulting in chronically tight muscles. Others theorize it’s the underlying stress of a person’s lifestyle that leads to the tight muscles. Either way, tight muscles lead to poor blood flow through the muscle and just like pumping up a blood pressure cuff too high and not releasing the tourniquet effect quick enough, pain results when the muscle is starved from lack of oxygen.  Dr. Doris Cope, MD, director of Pain Management at the University of Pittsburgh Medical Center, wrote that many people (especially FM patients) tense their muscles and probably don’t even realize it, which reduces blood flow to the muscles, resulting in pain. So, the question is raised, how can the FM patient get their muscles to relax so blood can flow through, bringing it the necessary amount of oxygen to the muscle so it doesn’t hurt?

            One method of muscle relaxation is exercise. When the pulse rate increases, more blood reaches the muscle, which reduces pain. The studies are clear that walking, stretching and strength training all help reduce fibromyalgia pain. Exercise also relieves fatigue, helps sleep quality and reduces depression – WHAT A GREAT ANSWER for the FM patient! The key is finding the right combination of exercises and how much should one do. Our advice is to START SLOW and gradually increase the dose once you’ve proven good tolerance to the last workout session. Consider flexibility exercises (stretching) such as Yoga classes, walking around the block, or even playing golf (initially a few holes, then 9 and eventually a full round).

            Many FM patients have found water exercises are uniquely helpful because of the weight reduction or buoyancy effect.  This is especially true for the overweight FM patient as land-based exercises may be too traumatic on the feet/ankles, knees, hips, or low back. Also, warm water can be quite comforting. Another nice advantage of water exercises is that you can do these anywhere, as long as there is a pool! The exercises can be taught in a formal water exercise class, which is a good place to start if one is available locally or through a health care service. Studies from Spain report that water exercises improve the FM patient’s quality of life not just for the moment, but also over the long term! Over a 12-week timeframe, they discovered women who exercised in warm water for 60 minutes, 3 times per week improved both mentally and physically, had less FM related pain, and more energy (“vitality”). They reported less depression and found an improved desire to be sociable.  The KEY for exercise to be successful is to increase the pulse rate. As Dr. Cope pointed out, a 20 minute, four times per week workout can make a big difference!

            If you, a friend or family member requires care for FM, we sincerely appreciate the trust and confidence shown by choosing our services! 

Fibromyalgia: Exercise is “Key”

                                                                                

            Fibromyalgia (FM) is now considered a central nervous system (CNS) disorder rather than a musculoskeletal condition. FM is managed best from a balance of different approaches including chiropractic adjustments, soft tissue therapies, modalities, exercise, diet, supplementation, sticking to a schedule, taking naps, stress management, cognitive behavioral therapy, and more. Common symptoms of FM include chronic fatigue and mental fog. The focus this month is on exercise and the benefits of exercise as it relates to improving quality of life!

            Recent research has been published about the benefits of walking – not just for the FM sufferer, but for EVERYONE! Dr. Marily Oppezzo, a Stanford University doctoral adjunct professor in educational psychology and Dr. Daniel Schwarz, a professor at Stanford, have published very convincing evidence that walking is not only physically good for the body, but it’s also mentally good for the brain! In fact, they’ve discovered walking actually improves CREATIVITY! The study found that walking either indoors on a treadmill or outdoors BOTH similarly boosted creative thinking in participants! Hence, for those stranded indoors during climactic weather, whether snowbound in Wisconsin or heat bound in Florida, equal benefit can be obtained from indoor walking, even if it’s not as much fun as being outdoors! Though past research has shown that aerobic exercise generally protects long-term cognitive (brain) function, until this study, the benefits of walking when compared to sitting had not been considered as important. These authors point out that TWICE AS MANY creative responses were produced by subjects when they walked (whether on a treadmill facing a blank wall vs. walking outdoors in the fresh air) than when they sat from a prolonged period of time. This surprised the authors who thought thinking outdoors would easily be favored. They also found that these creative juices continued to flow when the person sat back down shortly after a walk! Now that we know that walking not only facilitates our bodies but also our brain, are there other exercises that can help the quality of life for the FM sufferer?

            Dr. Lesley Arnold, a psychiatrist and FM expert at the Univesity of Cincinnati, College of Medicine in Ohio, recommends “a slow but steady pace” when starting a program, making sure that pain and fatigue are under control prior to introducing aerobic exercise. She recommends an initial assessment of the person’s current fitness level and then starts patients at one to two levels below that level, gradually building up stamina to a goal of 20-30 minutes of moderate aerobic activity 5-6 days/week. Exercises that emphasize low-impact, high-aerobic output are the best, and water-based exercises really fit that ticket due to the buoyant nature of water. Running in water against or without a resisting current and simply swinging the arms and legs against the resistance of water are extremely effective. A study published in Arthritis Research & Therapy reported improved health-related quality of life in women with FM for those participating in water aerobics. The soothing benefits of warm water is a good starting point, and classes are often group-based, adding social benefits of camaraderie and motivation, which creates a fun experience that participants can look forward to.  Since FM is a CNS vs. a muscle condition disorder, another “brain” stimulating exercise includes simply balancing. Depending on the age, agility, and comfort of the person, try adding balance-challenging exercising to the mix. A good program to try can be found here: http://beta.webmd.com/fitness-exercise/ss/slideshow-off-balance-core-moves

            If you, a friend or family member requires care for Fibromyalgia, we sincerely appreciate the trust and confidence shown by choosing our services! 

Fibromyalgia “(More) Facts”

                Fibromyalgia (FM) has been described as being a “myth” as well as “real” (and probably everything in between the two). This is a VERY controversial disorder that some doctors push under the rug by saying, “….there is no such thing,” while others stake their reputation on it. So with this wide variance in attitude and beliefs about FM, what ARE the facts?

                Fibromyalgia has been defined as, “…a complex chronic pain disorder that affects an estimated 10 million Americans” (ref: National Fibromyalgia Association). Women are affected the greatest, but it can affect men and children as well. This condition can be subtle, hardly interfering with life and all of its activities to being totally disabling, disallowing participation in work and the most desired aspects of daily living.

DIAGNOSIS: In 1990, the American College of Rheumatology (ACR) introduced the diagnostic criteria for FM. This includes a patients history of “wide spread pain” for at least three months, AND pain in 11 or more of the 18 specifiic tender points using 4 kg of pressure. Due to the significant controversy about the reality of the disease (as stated in the opening paragraph), ONLY a physician knowledgable about FM should make the diagnosis. Along with this diagnostic responsibility, ALL other conditions having similar presenting symptoms as FM, “…must be ruled out” BEFORE making the diagnosis of FM.

SYMPTOMS: Though the hallmark of FM is widespread, generalized pain (in all four body quadrants), a number of other symptoms are common amongst FM sufferers. Some of these include fatigue (moderate to severe), sleep disorders, brain fog, irritable bowel syndrome (IBS), headaches (including migraine), anxiety, depression, and environmental sensitivities. Studies suggest that there is a “neuroendocrine” (nerves and hormones) abnormality that may contribute to the FM symptoms.

CAUSES: Research has found a genetic link, as FM is OFTEN seen in several family members (among siblings and/or mothers and their children). “Secondary fibromyalgia” arises AFTER other health-related issues occur such as physical trauma (like an acute injury or illness), which can act as a “trigger” for initiating FM. Recently, more attention has been directed to the central nervous system as the “underlying mechanism” for developing FM. Here, the threshold or level of a stimulus that triggers a painful response is found to be much lower in FM patients compared to a healthy group of people (this is called “central sensitization”). Thus, a pain response is amplified in the FM patient due to this lowered threshold of pain tolerance.

TREATMENT: As there is NO KNOWN cure for FM, symptomatic support and functional improvement are two important primary goals when treating patients with FM. In the medical world, there are MANY drugs that have been utilized for FM (such as sleep aids, muscle relaxers, anti-inflammatory, analgesics, and anti-depressants / -anxiety meds). ALTERNATIVE therapies include massage therapy, chiropractic, myofascial release, acupuncture, herbal supplements, yoga, and other exercise approaches such as swimming and/or simply walking are popular care options for many FM patients. Increasing rest, pacing daily activities (to avoid “over-use”), stress management (relaxation tapes, exercise, and nutritional support can ALL HELP reduce FM symptoms and improve quality of life!

            If you, a friend or family member requires care for Fibromyalgia, we sincerely appreciate the trust and confidence shown by choosing our services!