Hope for Fibromyalgia

There is soooo much foolishness on the net regarding fibromyalgia and so few good articles. When I come across a good one, I simply must share it. Here is the link for the full text. Below are a few highlights:

“It’s a strange and different pain that seems to be in the muscles but really isn’t,” Epstein said.

“It’s not a muscle disease,” Bushan said. “It’s a pain perception disease.”

Epstein said there is nothing wrong with the parts of the body that hurt. Instead the disorder is in the chemical messages that the nerves use to send pain sensation to the brain.

“That doesn’t mean the person is crazy,” Epstein said. “It means the pain nerves are turned on when they’re not supposed to be. The result is this pain that appears to make no sense.”

…………..Fibromyalgia often affects sleep, said Epstein.

“It is almost always associated with a chronic sleep disorder,” she said.

Addressing the sleep disorder is critical because if the underlying sleep disorder is not corrected, the fibromyalgia will not get better, Epstein said.

Fibromyalgia is a treatable condition.

What kind of treatment do I need: Part II

Once we have ruled out the nasty causes of back pain (cancer, infection, etc.) and we know we are dealing with a musculoskeletal condition (disc herniation, arthritis, back sprain, etc. etc.), we can talk about treatment options. There are two main types of treatment for neck and back pain: passive care and active care.

Passive Care

Passive care includes things that are done to you. This includes massage, chiropractic adjustments, ultrasound, microcurrent, traction and more. The general rule on passive care is that it should be a bigger part of your care at the start and a smaller part of your care as you get better.

Passive care can be great. It makes you feel better! However, if you are not getting active care, more than likely you are getting less than the best treatment.

Active Care

Active care is things that you do to and for yourself. Usually active care means some type of exercise. Walking is a form of active care that everyone should do. However, general exercises like walking are not enough by themselves. Most neck and back pain needs some specific exercises to correct your specific problems.

The good news is that you almost never need any fancy or expensive equipment or a lot of time. For most, five minutes per day five days per week is enough – for your specific therapy exercises, not your exercise for general health (darn!).

An example of a specific therapy exercise that is commonly needed is in my earlier column, “The Back Pain Vaccine”.

My back hurts. What kind of treatment should I get?

It is hard to be a patient with back pain. Everywhere is conflicting advice. Surely, though, your healthcare team will give you up-to-date and unbiased advice, right?

In short, not a chance! Most (MD’s, DC’s, LMP’s, PT’s, DO’s, ABC’s, etc) are going to tell you either: a) you’ll be fine, just wait b) you need whatever it is that I do. If their treatment fails, you may get one referral to someone else that they like (personally). Otherwise, the pain is in your head…or there is nothing more to do…or just keep getting my treatment…or….

Since nobody is going to give you a straight answer, here is my guide on how to use the different providers:

Family Practitioner (MD or DO): They are going to be fairly good at ruling out a nasty cause of your pain, particularly cancer and infection. If you have an exotic arthritis, they will probably figure it out with time.

Massage Therapist (LMP): Massage is a great adjunct to other treatment, but not enough usually on it’s own. Combine with Physical therapy and/or chiropractic.

Chiropractor (DC): I wish I could say, go find a chiropractor and he will help you with what he can and manage the referrals for the other care that you need (massage, physical therapy, surgical consults, etc.). Many do this, but not most.

Chiropractic adjustments are very efficient and effective treatments for a majority of back and neck complaints. Combined with physical therapy exercises it is even better in most cases. Generally, the chiropractor should be able to guide you through the exercises that you need, which should not be too many – if so, you may need a physical therapist.

Unfortunately, many chiropractors treat everyone the same and just crack your back without good diagnosis or making sure you get the other treatment you need. Finding a good chiropractor can be difficult, but it is worth it.

Physical Therapist: For most back pain, physical therapy exercises are effective and often necessary. PT’s tend to give to many useless exercises along with the useful ones. Often a chiropractor can give you the exercises that you need more efficiently, but if it is more complicated, or your chiropractor can’t handle it, you will need a PT. You can’t throw a dart at the phone book here either and have a reasonable chance, but good PT’s are out there.

Surgeons (MD, DO): You probably should not have back surgery. Just having a herniated disk does not mean you need back surgery. However, if you do, go to a neurosurgeon that does mostly spine surgeries. You will have the best luck here.

What about cortisone injections and prolotherapy and those fancy traction machines with an “86% success rate” and…and how much treatment do I need? Next time.

Warning: This is a (very) general guide on who does what well. It is to help you find someone to treat you, not so you can diagnose yourself and ignore medical advice given to you. If you are unsure of your current treatment or diagnosis, etc, get a second opinion from a live person in the flesh, not a blog!

Can massage rub-out fibromyalgia?

Please forgive the corny title. In the books I read on blogging, I was told that idiosyncrasies are encouraged (everything from corny humor to bad grammar)!

Researchers have consistently found high levels of Substance P (a pain chemical) in fibromyalgia patients. Sleep quality is also usually awful. Fibromyalgia patients have few hours of sleep and also tend to have trouble getting into the deepest stage of sleep.

In addition to this the pain and anxiety areas of the brain are “souped-up” also. Many researchers think that these extra-sensitive brain regions are the only problem in fibromyalgia sufferers. Though, this is controversial.

With this background, I want to share the results of a research study comparing massage therapy to relaxation treatment. This study, from the Journal of Clinical Rheumatology, followed patients for 5 weeks. During this time half got massage 30 minutes twice per week and half got relaxation group therapy twice per week.

The results are pretty interesting. I will let them tell the rest:

only the massage therapy group reported an increase in the number of sleep hours and a decrease in their sleep movements. In addition, substance P levels decreased, and the patients’ physicians assigned lower disease and pain ratings and rated fewer tender points in the massage therapy group.

Perfectionism, Fibromyalgia and Irritable Bowel Syndrome

Here is an article from the BBC (at the psychology of pain blog) on perfectionism and irritable bowel syndrome.  They noted that these patients were also more likely to report psychosomatic symptoms. I assume (a dangerous thing to do) that they mean, pain without a known physical cause.

This same mechanism is very likely to be involved in fibromyalgia. And as we discussed in my the earlier post (Do I have fibromyalgia?), irritable bowel syndrome and fibromyalgia often go together.

Do I have fibromyalgia?

How do we diagnose fibromyalgia….mri, x-ray, blood test, ouija board? Answer: none of the above.

Usually fibromyalgia is a wastebasket diagnosis – meaning if you have pain that lasts a long time, that’s is over a large area and we can’t find anything: you’ve got fibromyalgia. It is, in common practice, a diagnosis by exclusion.

Given that, it should not be too surprising that a recent study found that fibromyalgia is diagnosed incorrectly two times out of three. (That’s not to say that the 2/3 without fibromyalgia were faking it or head cases. They just had a different diagnosis.)

Fibromyalgia is notoriously difficult to diagnose and treat, but this poor performance is unacceptable.

Fibromyalgia is more than just some back pain that doesn’t go away on it’s own. Classically fibromyalgia commonly presents with many symptoms including: headache, sleep disturbances, anxiety, depression, irritable bowel, memory problems and more. Researchers argue back and forth about specific items on this list.

But, researchers DO agree on one thing. Fibromyalgia patients have pronounced and widespread allodynia. Allodynia is when something that shouldn’t be painful, causes pain. An example would be poking someone lightly with a finger. This is not painful in healthy people, but can be very painful to someone with fibromyalgia.

Studies have shown that fibromyalgia sufferers are extra sensitive to pain from heat and electrical stimulation as well. In case any of you are wondering, this has also been confirmed with functional MRI studies. When fibromyalgia patients complain of pain to mild pressure, heat or whatever, the pain part of their brain lights up. They aren’t just making it up.

So, where is this coming from…..what’s going on? More next time.

Fibromyalgia: Introduction

What is fibromyalgia? What causes it? Does it even exist? How is it treated? Does anything work?

With fibromyalgia, there seems to be no shortage of questions. Answers, however, are a different story. Many, including most physicians, know nothing about it – or worse yet, they know things that aren’t true.

The good news is that we are starting to learn about fibromyalgia. There are over 4000 research articles that discuss fibromyalgia. Some of it has to be good. It is.

The bad news is that there is no cure; magic, or otherwise. But most cases can be managed effectively – not perfectly, though. And to really benefit you need to be patient and sometimes it takes hard work. You also need to educate yourself. Many practitioners claim to treat fibromyalgia. Some of them can even help. But, many helpful treatments will be less effective on their own.

The question is not: what treatment do I need? The question is: what mix of therapies do I need. So, how do I find a good doctor to help me through this? Honestly, I don’t know.

That is why you need to take responsibility for your treatment. The first step is understanding fibromyalgia. Finding an effective treatment mix is the second step.

Over the next few articles we will discuss what fibromyalgia is, what it isn’t and then discuss treatment options. I look forward to this. Please leave comments or ask questions! (click here to send a question)