Fibromyalgia (FM) is a chronic condition that impacts its victims in every aspect of their lives. The day has to be planned around how one might feel at certain times of the day and is always in the foreground of a FM victim’s mind. Many patients who present for treatment of FM ask us about what resources are available for them and therefore, this is the subject of this month’s Health Update.

The National Fibromyalgia Association (NFA) was founded in 1997 in Orange, California and has become the largest nonprofit (501c3) FM specific organization. The initial goal was to help patients with FM find doctors who were willing to treat and manage FM patients as this was a BIG CHALLENGE and remains an important focus of the organization today. The mission of the NFA is to improve the quality of life for the FM patient and to find a team who embraces that premise by creating and offering many programs, high profile media campaigns, and providing training to support group leaders across the country. Their philosophy is to, “…empower patients and to provide them with a new level of hope for the future.” To that effect, the NFA evolved to include the development of an educational web site, the publication of an international magazine (“Fibromyalgia AWARE”), as well as developing medical education programs. The NFA website includes a “Resource” tab at the their homepage that leads to a listing of many great options that can be accessed at the click of a button:

http://fmaware.org/PageServer4a00.html?pagename=resources_directory

Here is an interesting place for health care providers and patients with FM to review research articles on FM from 1981 to 2002, with over 300 references available:

http://www.myalgia.com/refs%2081%20to%200302.htm

Another good resource for information on FM is the New York Times Health Guide:

http://health.nytimes.com/health/guides/disease/fibromyalgia/resources.html

There are many places one can acquire information about FM. The list provided here barely scratches the surface. Simply google “fibromyalgia resources” to find almost anything you’ll need.

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

Fibromyalgia (FM) is a chronic condition that impacts its victims in every aspect of their lives. The day has to be planned around how one might feel at certain times of the day and is always in the foreground of a FM victim’s mind. Many patients who present for treatment of FM ask us about what resources are available for them and therefore, this is the subject of this month’s Health Update.

The National Fibromyalgia Association (NFA) was founded in 1997 in Orange, California and has become the largest nonprofit (501c3) FM specific organization. The initial goal was to help patients with FM find doctors who were willing to treat and manage FM patients as this was a BIG CHALLENGE and remains an important focus of the organization today. The mission of the NFA is to improve the quality of life for the FM patient and to find a team who embraces that premise by creating and offering many programs, high profile media campaigns, and providing training to support group leaders across the country. Their philosophy is to, “…empower patients and to provide them with a new level of hope for the future.” To that effect, the NFA evolved to include the development of an educational web site, the publication of an international magazine (“Fibromyalgia AWARE”), as well as developing medical education programs. The NFA website includes a “Resource” tab at the their homepage that leads to a listing of many great options that can be accessed at the click of a button:

http://fmaware.org/PageServer4a00.html?pagename=resources_directory

Here is an interesting place for health care providers and patients with FM to review research articles on FM from 1981 to 2002, with over 300 references available:

http://www.myalgia.com/refs%2081%20to%200302.htm

Another good resource for information on FM is the New York Times Health Guide:

http://health.nytimes.com/health/guides/disease/fibromyalgia/resources.html

There are many places one can acquire information about FM. The list provided here barely scratches the surface. Simply google “fibromyalgia resources” to find almost anything you’ll need.

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

Fibromyalgia (FM) is a disorder involving chronic pain that has no known cause. It is characterized by widespread musculoskeletal pain, sleep disturbance, fatigue and mood disorders. FM affects about 2% of the US population and ranges between 1% and 11% in other countries. It is more prevalent in adult women than men (3.4% vs. 0.5%) and is most common with increasing age with the highest occurrence between 60-79 years of age. The criteria for the diagnosis of FM was established in 1990 by the American College of Rheumatology as widespread pain of at least 3 month duration and pain on palpation (pushing with the fingers) of at least 11 of 18 specific tender sites on the body. Pain, fatigue and sleep disturbance are observed in all patients with FM. Additional features can include: stiffness, skin tenderness, post-exertional pain, irritable bowel syndrome, cognitive disturbances, overactive bladder syndrome or interstitial cystitis, tension or migraine headaches, dizziness, fluid retention, paresthesias (numbness), restless legs, Reynaud’s phenomenon (white finger disease), and mood disturbances. FM is also strongly associated with anxiety, depression, chronic fatigue syndrome, myofascial pain syndrome, hypothyroidism, and many of the inflammatory arthritic diseases. Though there are no specific tests for FM, neurotransmitter deregulation including serotonin, norepinephrine, and substance P, result in an abnormal sensory processing in the brain and spinal cord. This results in a lower pain threshold commonly seen in FM.

The treatment of FM may be best looked at from 3 specific goals which include: 1. Alleviate pain; 2. Restore sleep; and 3. Improve physical function. Thus the most successful approach to the treatment of FM has been reported to be multidisciplinary or, involving several different types of health care providers. Clinical tools often used by doctors to monitor symptom change include a 0-10 pain scale, a body function scale called the Fibromyalgia Impact Questionnaire (FIQ) which measures physical function, common FM symptoms and general well-being; and, for measuring the physical and emotional side of FM, the SF-12 or SF-36 (SF = “short form” and either a 12 or a 36 item tool). The use of these tools helps monitor the success of the treatment that is being applied to the patient.

Though medications are reported as an important treatment option (such as an anti-inflammatory, analgesic, anticonvulsant, hypnotic, corticosteroids, opiates, various injections and more), the focus of this discussion is aimed at the alternative or complementary treatment approaches, as many FM patients cannot tolerate the side effects of the many different medications. Alternative approaches include cognitive behavioral therapy (counseling), exercise (strength & flexibility), acupuncture, and chiropractic treatment approaches, particularly manipulation but also soft tissue therapies and guided exercise training. Physiological therapeutic approaches frequently used in chiropractic clinics include low-power laser therapy, hydrotherapy such as whirlpool, Balneotherapy – using minerals and oils in the moving water, pulsed electromagnetic field, traction and massage therapy. Another exercise approach that can have great value in managing stress and facilitating sleep is Yoga. The key to a successful treatment outcome requires finding a “team” of health care providers that are willing to listen to the patient and work together to improve the patient’s quality of life. Through this concerted team approach, in addition to the patient taking responsibility by performing exercises on a regular basis, following a proper diet, and getting adequate restful or restorative sleep, FM can be quite well “controllable” and, a relatively “normal” lifestyle can be enjoyed.

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

Fibromyalgia (FM) is a chronic condition where the diagnosis is made by elimination since there are no specific lab tests for diagnosing FM. In the past, we’ve discussed the different types of FM, the lack of good diagnostic tests, many management recommendations derived from interviews with FM patients, and more.

One of the many causes of FM involves the autoimmune system, thus suggesting that FM may be an autoimmune disease. In summary, the autoimmune system is very important system for all of us, as it controls the means by which our body fights off unwanted foreign particles like viruses, bacteria, and a host of other triggers that can negatively affect our body. The autoimmune process is best explained by example: Let’s say a certain type of food is eaten to which the person has an allergy. As particles from that food are absorbed into the blood stream, the body senses that something is wrong –foreign particles are there that shouldn’t be there. As a result, our body produces antibodies, which function like an army trained to “fight” the foreign particles. If the body’s autoimmune system handles it without a problem, the person may not even know anything is “wrong” or that this process is going on. However, if the foreign particle is not handled easily or properly, all kinds of symptoms can occur. In this food allergy example, stomach pain, nausea, cramping, diarrhea and perhaps hives on the skin may even occur. Another common autoimmune example occurs in the spring when flowers bloom, grass grows, trees bud, and so on. Many of us suffer from what is commonly referred to as “hay fever” and possible symptoms include a runny nose, itchy watery eyes, and sneezing (lots of it).

FM is sometimes thought to be associated with rheumatoid arthritis but the scientific evidence is not in full agreement with this theory either. More consistent evidence for causation seems to support the following possibilities: 1. Following trauma or injury. 2. A central nervous system origin (the topic of last month’s FM Health Update). 3. Changes in muscle metabolism. 4. A decrease in muscle blood flow.

However, there are still those who support the cause of FM being triggered by an infectious agent like a virus in susceptible people, even though no specific agent has yet to be identified. For those who state that FM is not an autoimmune disease, they do admit FM may have an “autoimmune component” to it. One study reported, “…that scientists have discovered a new antibody in the blood of many FM patients,” which was reported in the Journal of Rheumatology. Subsequently, a new test was developed for detection of the “Anti-Polymer Antibody” (APA) that was reportedly found in more than 60% of FM patients with severe symptoms. The idea of a specific blood test for FM is certainly welcomed by all experts and clinicians who manage FM as a reported $16 billion/year in direct medical costs are associated with FM. Unfortunately, when comparing the APA levels in FM patients to those with rheumatoid arthritis and controls with neither, the APA levels were not able to distinguish between the groups. Unfortunately, until better testing methods are developed, doctors and researchers will continue to look for the “gold standard” FM test.

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

Fibromyalgia (FM) is a chronic condition where the diagnosis is made by elimination since there are no specific lab tests for diagnosing FM. In the past, we’ve discussed the different types of FM, the lack of good diagnostic tests, many management recommendations derived from interviews with FM patients, and more.

One of the many causes of FM involves the autoimmune system, thus suggesting that FM may be an autoimmune disease. In summary, the autoimmune system is very important system for all of us, as it controls the means by which our body fights off unwanted foreign particles like viruses, bacteria, and a host of other triggers that can negatively affect our body. The autoimmune process is best explained by example: Let’s say a certain type of food is eaten to which the person has an allergy. As particles from that food are absorbed into the blood stream, the body senses that something is wrong –foreign particles are there that shouldn’t be there. As a result, our body produces antibodies, which function like an army trained to “fight” the foreign particles. If the body’s autoimmune system handles it without a problem, the person may not even know anything is “wrong” or that this process is going on. However, if the foreign particle is not handled easily or properly, all kinds of symptoms can occur. In this food allergy example, stomach pain, nausea, cramping, diarrhea and perhaps hives on the skin may even occur. Another common autoimmune example occurs in the spring when flowers bloom, grass grows, trees bud, and so on. Many of us suffer from what is commonly referred to as “hay fever” and possible symptoms include a runny nose, itchy watery eyes, and sneezing (lots of it).

FM is sometimes thought to be associated with rheumatoid arthritis but the scientific evidence is not in full agreement with this theory either. More consistent evidence for causation seems to support the following possibilities: 1. Following trauma or injury. 2. A central nervous system origin (the topic of last month’s FM Health Update). 3. Changes in muscle metabolism. 4. A decrease in muscle blood flow.

However, there are still those who support the cause of FM being triggered by an infectious agent like a virus in susceptible people, even though no specific agent has yet to be identified. For those who state that FM is not an autoimmune disease, they do admit FM may have an “autoimmune component” to it. One study reported, “…that scientists have discovered a new antibody in the blood of many FM patients,” which was reported in the Journal of Rheumatology. Subsequently, a new test was developed for detection of the “Anti-Polymer Antibody” (APA) that was reportedly found in more than 60% of FM patients with severe symptoms. The idea of a specific blood test for FM is certainly welcomed by all experts and clinicians who manage FM as a reported $16 billion/year in direct medical costs are associated with FM. Unfortunately, when comparing the APA levels in FM patients to those with rheumatoid arthritis and controls with neither, the APA levels were not able to distinguish between the groups. Unfortunately, until better testing methods are developed, doctors and researchers will continue to look for the “gold standard” FM test.

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

p>Fibromyalgia (FM) is a chronic condition that does not limit itself to just one area but rather, it manifests as a generalized, whole body condition where basically, everything hurts. The diagnosis is typically made by exclusion or, by eliminating all other possible conditions as there is no single blood test for FM and unless other conditions that are test sensitive are present at the same time, most tests come back negative. Of course, this leaves the FM patient upset because, “….no one can figure out what’s wrong with me.” We all seem to want a test to prove what we have is “real.”

Unfortunately, in the real world, no blood test, x-ray, or exam procedure is 100% accurate (sensitive and specific), so even when tests return positive, there can be “false positives” that are caused by many things such as drug induced test alterations and/or other conditions that alter the same test. On the other hand, there are “false negatives,” so even though the test came back negative, it’s still possible that the problem one is present but the test may just not be sensitive (accurate) enough to detect it. FM is one of those conditions where only after a myriad of tests have been run and come back negative, can the diagnosis of FM be made with some degree of confidence.

Essentially, we have to prove that you don’t have something else causing similar symptoms before we can confidently (or at lease more confidently) diagnose you with fibromyalgia. To complicate this further, in “secondary FM,” the cause of FM is known and is due to an underlying condition such as rheumatoid arthritis, lupus, hypothyroid, HIV, cancer, as well as physical trauma such as after a car accident or a work injury. When an accident is involved, the symptoms may be more confined to one area (then called “regional FM”) making the diagnosis even more challenging as the classic 11 of 18 tender points may not hold up in these cases.

Finally, there are doctors out there that simply don’t “believe in” the condition and may say to the FM patient, “…there is no such thing, it’s all in your head, you simply have learn how to live with it. There’s nothing that can be done.” Well, they actually may be partially right – that is, the “…it’s all in your head” part (don’t get mad… just wait!). Another finding that is well-published in peer review literature is the concept called central and peripheral “sensitization.” This occurs when increased incoming sensory information from injured skin, muscles, and/or organs, in a sense bombard areas in the central nervous system (spinal cord and brain) leaving it “sensitized” or, more sensitive to “normal” incoming information. This is because the threshold or tolerance to normal incoming sensory stimuli is reduced and results in increased muscle pain commonly described by patients with FM.

To better illustrate this, hypersensitivity or central sensitization was found in people after a whiplash injury. They recruited 14 whiplash patients and 14 “normals” to compare their responses when stimulating the leg (the non-injured area) as well as the neck (injured area). Theoretically, if central sensitization didn’t exist, the responses to the exact same stimulus on the healthy leg of both the whiplash patients and the normal subjects would be equal. Instead, what was found was that the whiplash patients had significantly lower pain thresholds for 2 of 3 tests (a single electrical stimulus in the muscle, repeated electrical stimulation in the muscle and on the skin, but not from heat when applied to the skin). Each pain threshold was measured at the neck and leg before and after local anesthesia was applied to the painful, sore neck muscles. In the whiplash cases, the lower pain threshold was found when stimulating both skin and muscles at the healthy leg and at the injured anesthetized neck equally. That proves that the central nervous system (brain and spinal cord) has a “pain memory” which lowers the threshold so the whiplash patients feel pain more intensely and quicker than the non-injured people. This can help patients understand the answer to the question, “…why won’t this pain go away?” This pain memory or hypersensitization is similarly found in FM patients.

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

Fibromyalgia (FM) is surrounded by much controversy in what establishes a diagnosis, what are the consistent historical features, and most importantly, what can be done about it – the treatment strategies. Doctors seem polarized, either they “believe in it” or don’t. The result is a frustrated patient because after multiple attempts, they can’t get a straight answer from their health care provider. Consequently, the patient doesn’t know where to turn. A very important article, published in September 2011, discusses from the patient’s point of view, their experience in living with this condition.

The study consisted of 6 female patients diagnosed at a university hospital with FM, which by the way, means all other conditions that create similar symptoms have to be “ruled out” or, considered first. Therefore, many tests are typically run to make sure there isn’t some other serious underlying condition hiding behind the symptoms associated with FM. As a background, the authors describe FM as “…a chronic syndrome with no cure.” Because of this, they state, “…a thorough understanding of the illness experience is therefore key in the palliative care of patients…” They acknowledge that care givers of FM patients often include chiropractors and other manual therapists and knowledge of the “…meaning and reality of living with this condition” is reported as being ESSENTIAL for all health care providers who manage FM patients. The focus of the study was to carefully look at the personal, occupational, and social impact of the condition on patients’ lives and their views about the future. Structured interviews with each participant were analyzed.

Results showed that FM impacted all aspects of life with 4 main themes arising from the data: 1) Personal life impact; 2. Occupational life impact; 3. The forecasted impact on future life; 4. Social interaction impact. Specifically, most of the participants had stopped working and felt useless. Leisure activities were greatly affected, as many described opting to not participate in various leisure oriented activities (such as going for walks, shopping, attending social events). FM was described as altering family bonds with some being made stronger while others were destroyed, resulting in separation and/or divorce. FM patients were reported to be “relieved” when a diagnosis was “finally” made, as it marked an end to a period of uncertainty. The participants were often ambivalent to interaction and despite some positive points, frustration prevailed from “perceived incomprehension” or, not really understanding why they feel the way they do. At times, this made it hard to discuss their symptoms and personal experiences. This study reveals the negative impact of FM and how complex and individual that is.

What is important about this study is that it alerts those of us who treat FM that we need a more efficient diagnostic process and we need to be better educated so that we can provide a multifaceted treatment option approach as each FM patient’s needs vary because of how each patient “deals with” the condition. We need to really listen to the patient to determine what treatment goals they are interested in and we must create treatment plans that center around those needs and desires, possibly including checklists so everyone stays on task as it’s quite easy to become distracted by the symptoms of FM. We are sharing this information with you so that you can feel comfortable approaching us with the many concerns and issues that surround FM.

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

Fibromyalgia (FM) is a condition associated with tight, sore muscles with generalized, whole body pain, which can dramatically affect a person’s lifestyle. However, there are ways to fight back! Last month, we discussed the benefits of water exercises and this month, we’re going to illustrate some specific exercises that can be performed in water. Remember to start slow and gradually introduce more exercises (as well as repetitions and the length of exercise time) AFTER you have proven to yourself that the previous exercises are well tolerated. MOST IMPORTANT, have fun with these, and modify them as needed to make them “yours.”

Diving Forward
Prep: Arms straight, stretched out from sides, palms forward.
Action: Push hands together, then outward.

Diving Downward
Prep: Arms straight, stretched out from sides, palms down.
Action: Swing hands down and inward across front, then outward; repeat down and inward behind back, then outward.

Squats
Prep: Legs straight.
Action: Bend at knees to lower body down, then up.

High Kick
Prep: Legs straight, pointing forward
Action: Swing one leg forward to backward; repeat with other leg.

Backward Kick
Prep: Legs straight, hold onto support.
Action: Ben one knee to raise foot backward, then down; repeat with other knee.

Deep-water Walking
Prep: Start in a dog-paddling position
Action: Climbing motions with both arms and legs.

Horizontal Walking
Prep: Legs straight, floating face down holding stairs.
Action: Bend one knee forward and back, then other knee.

Of course, there are many other maneuvers that can be done in water. Simply walking in water at various depths works well. Another good/easy exercise is taking empty 1 gallon milk jugs with the caps on and squat down in the shallow end of a pool so only your neck is exposed and move your arms underwater back and forth in different directions, at different speeds, gradually increasing the speed of the movement.

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