Chronic Pain & Fibromyalgia
“You Don’t Look Sick.” Sound familiar? Pain so often is invisible, so as a friend, caregiver, or relative of someone suffering from chronic pain, one of the more beneficial things you can do to help them feel better is simply acknowledge their pain.
Pain is the newest medical disease on the radar. According to the American Chronic Pain Association, as many as 1 and 3 Americans, and 1 and 5 adults around the world suffer with chronic pain. That’s over 76 million people in this country alone. It’s a staggering number. And yet we don’t know much more about chronic pain than we did 150 years ago. Long believed to be just a collection of nondescript and undiagnosable symptoms, now chronic pain is being recognized as the next big disease to be conquered. A disease of the mind and the body.
Doctors are scrambling for answers to this widespread problem. For two hundred years opiates like morphine, Percocet, and now Oxycontin were the only weapons in the battle against chronic pain; weapons with diminishing results that have devastating effects.
According to a new report from the Institute of Medicine, Chronic pain costs the U.S. more than $600 billion every year in medical bills and lost productivity. Back pain alone consumes nearly $90 billion in health-care expenses, roughly equivalent to what’s spent on cancer. Despite the increasing prevalence of chronic pain medical progress has been slow and halting. This is an epidemic we don’t know how to treat. While doctors realize that they are fairly good at treating the acute pain that occurs after surgery or an injury, they are still stymied by chronic pain.
It is so difficult to determine who is at the greatest
risk to develop chronic pain but we now know that
about 10% of patients develop a chronic pain
condition from surgery of any type, even routine
procedures like carpal tunnel surgery or knee
surgery. About 20 percent of cancer patients will
continue to experience pain for up to two years
after surgery or chemotherapy that saved their
lives. Recognizing pain as a disease of the mind
and body is a prelude to finally seeking
breakthroughs to treat it.
Each year in the month of September over 1,500 practitioners gather at a select location in the United States for Pain Week. Pain Week, organized by Aventine Co., is the nation's largest pain conference for front line clinicians who have an interest in pain management. Continuing medical education is presented in all areas of pain management.
“Pain is the human bodyguard. It is the most primitive mechanism by which we learn to avoid danger. Pain is protective. “Don’t do that.” But what happens when pain goes rogue?” – Time Magazine.
RSD, Reflexive Sympathathetic Dystrophy, otherwise known as Complex Regional Pain Syndrome, (CRPS) is a chronic pain syndrome characterized by pain of a burning type, tenderness and swelling of an extremity associated with varying degrees of sweating, warmth and/or coolness, flushing, discoloration, and shiny skin, and can occur after surgery or trauma. There is no cure for the disabling condition and the mechanism for RSD is poorly understood.
Thanks to Paula Abdul who suffers from Chronic Regional Pain Syndrome,more focus has been put on this disabling disease. There are various new drugs now to treat neuropathic pain such as neurontin, trileptal, keppra, enbrel, cymbalta, and lyrica but they are designed to help ease the symptoms and slow down the progression of the disease and unfortunately do not cure the disease. Work is also being done with spinal chord stimulators and morphine pumps for this exceeding lypainful disease.
“Pain stabs. It burns. It aches. It throbs. It gnaws at you. It knocks you for a loop. But sooner or later, it goes away. Unless it doesn’t.” That’s a nightmare come true for millions of Americans who spend every day in a world of hurt. And the problem will only get bigger. “As our demographics change, and we live longer, more people will experience chronic pain,” says Dr. Lynn Webster, medical director of the Lifetree Clinical Research and Pain Clinic in Salt Lake City.”
– Los Angeles Times Special Section, 2012
Fibromyalgia alone affects 1 in 50 Americans, or between 3 and 6 million people according to the American College of Rheumatology. It is the second most common ailment affecting the musculoskeletal system after osteoarthritis.” Long thought to be “rheumatism” of the muscles, more current research indicates that fibromyalgia is actually a disease of the central nervous system, often caused by a viral or bacterial infection or prolonged stress, or an acute trauma. Some researchers are examining how the central nervous system (the brain and spinal chord) process pain. Other scientists speculate that a person’s genetic make up may affect their ability to process pain and that there may be a familial link to fibromyalgia.
According to The National Institute of Arthritis and Musculoskeletal and Skin Diseases 1999, Fibromyalgia primarily affects primarily women of childbearing age, but children and men may also be affected. Fibromyalgia often occurs concurrent (up to 25% to 60%) to other conditions such as rheumatoid arthritis, lupus, and ankylosing spondylitis, (according the Center for Disease Control, 2009),
Ninety percent of people with fibromyalgia suffer from jaw pain known as TMJ and 50% percent of patients suffer with chronic headaches or migraines. Adults with fibromyalgia are also three to four times more likely to develop major depression than adults without fibromyalgia. The disease presents a daunting challenge for patients.
Traditional mainstream medical treatments include the use of non-steroidal anti-inflammatories such as Naproxyn and Advil as well as narcotic medications such as Percocet for pain relief. Tri-cyclic antidepressants such as Elavil and SSRI’s, (serotonin re -up take inhibitors), which include Prozac or Zoloft can sometimes effectively treat the pain and the often-concurrent depression of fibromyalgia. However, only three drugs have been FDA approved for Fibromyalgia. Cymbalta was originally developed for and is still used for depression but is now used for fibromyalgia along with Savella, a similar anti-depressant. Lyrica is a medication developed to treat neuropathic pain (chronic pain caused by damage to the nervous system.) that has been approved by the FDA for the treatment of fibromyalgia.
Newer drugs such as neurontin,trileptal, keppra and enbrel are being used currently to treat nerveand neuropathic pain with some success.
Now, thankfully, doctors are also investigating the use of non-drug therapies for chronic pain.
"Complementary and Alternative Medicine, otherwise known as CAM, is defined by the National Center for Complementary and Alternative Medicine, a division National Institute of Health, (NIH), as a group of diverse medical and health care systems, practices and products that are not generally considered part of conventional medicine. Boundaries between CAM and traditional medicine are not absolute and CAM practices are becoming widely accepted, in particular, in the treatment of chronic pain"
- Pain Pathways Magazine, Winter 2012
.Massage therapy, chiropractic, vitamin therapy, acupuncture, yoga, herbal remedies, mineral baths and mind body practices like meditation and tai chi offer many patients some relief from their pain. Recently, one of the most effective alternative treatments on the scene is Animal Assisted Therapy or simply pet therapy.
Animal Assisted Therapy (specifically bunny therapy) was one of the most effective alternative treatments for me.
Taking me away from my pain was one of the many things that Bunny Boy did to help me triumph over chronic pain.
I was so busy happily caring for all of his ailments that I barely had time to focus on mine. I was also on the receiving end of pet therapy everyday when I had to get up and change his litter pan, feed him or play with him when he binkied at my heels and wiggled his little nose, looking for attention. Isn’t movement and gentle exercise great medicine for fibromyalgia? Bunny Boy also had an uncanny ability to sense when I was in pain. He would cuddle with me in bed under my armpit or lie on my chest and comfort me with his warmth and affection. What an incredible gift he was!
According to a study published in Pain Med, January 13, 2012, and subsequently presented at the 18th Annual Conference of the International Society of Anthrozoology in Kansas City Missouri, “Adults who use pet therapy while recovering from total joint-replacement surgery require 50 percent less pain medication than those who do not.” That’s huge! The study also showed that therapy dog visits in an outpatient setting provided significant reduction in not only pain but also decreased emotional distress and improved the well being of the patients, their caregivers as well as the providers.
“You cannot underestimate the power of pets when one is in pain. A pet comforts you and at the same time takes out of yourself as you care for them. A pet is more powerful than any medication when it comes to comforting, soothing, and distracting you when you are experiencing pain,” quoted in Everyday Health, (March, 2012).
According to Chronic Pain Resource, “Animals trained in supporting people that are not feeling well can provide unconditional love and a sense of well-being. Chronic Pain Resource provides that service for anyone suffering in chronic pain. They have seen profound changes with using trained dogs n this area of health and wellness, so why not bunnies also? Just ask “Bunnies in Baskets” how successful and well received their bunny therapy has become.
For further information on animal assisted therapy go to:
From a personal standpoint, the lessons that I have learned from being in chronic pain are plentiful.
First, be your own advocate. Being well informed and in control of my own treatment was very comforting. Also, don’t be afraid to ask your physician detailed questions regarding medications and any treatments before you accept them as the bible.
Research and try alternatives or holistic treatments for pain and see which works best for you.
Eat a diet rich in fruits and vegetables, low in carbohydrates, (preferably gluten free). Gluten is shown to cause chronic inflammation. I found that eating a diet low in processed sugar and avoiding products that contain yeast while taking over the counter yeast supplements such as caprylic acid or grapefruit seed extract helped dramatically with the diffuse muscle pain and foggy brain consistent with fibromyalgia. In addition, I found an immunologist who treated me with systemic yeast with oral Diflucan for six months. Steroids, sugar consumption, antibiotics and birth control pills are all known to cause systemic overgrowth of yeast.
You can read about the yeast connection in Dr. Crook’s book, The Yeast Connection. His research, which was once thought of as voo doo medicine, is now finally entering mainstream medicine. A large percentage of fibromyalgia patients suffer with irritable bowel syndrome, which can be dramatically improved with systemic yeast treatment.
Regular sleep hours are critical for anyone suffering with fibromyalgia. Most pharmaceutical sleep aides are highly addictive and eventually stop working. I found that melatonin was helpful for sleep as well as chamomile, valerian root and hops.
For further information on yeast and fibromyalgia go to nutritioninstitute.com
Diet & Sleep
Magnesium and Malic Acid have been found to be extremely helpful to ease muscle pain. They relax the tense muscles of fibromyalgia. and play a vital role in the production of ATP, a source of critical energy for our body. Malic acid is an organic compound that may be found in many fruits, in particular apples and cherries.
For further information on magnesium and malic acid go to fibromyalgia-cfs-treatment.info
Vitamin B, the stress vitamins were also very helpful to me for energy, pain and stress. Vitamin B-6 has been shown to be very beneficial for proper nerve conduction. Vitamin B-12 is critical for formation of red blood cells and is also an important vitamin for the health of your central nervous system. Quite often chronic pain patients are deficient in B-12 as well as SAMe (S-Adenosylmethionine). SAMe is a chemical component your body makes from amino acids. Supplementation with both can show substantial improvement in pain symptoms as well as depression, which is so often concurrent with chronic pain syndromes.
Vitamin D, which comes from the sun, is essential and many Americans have been found to be deficient in this very important vitamin. The overuse of sunscreens prevents our body from deriving the beneficial properties from the sun’s UV rays. Recent studies show that lack of vitamin D can actually mimic fibromyalgia symptoms. While the function of vitamin D receptors in most tissues has not been clearly defined, it is clear that vitamin D performs as a hormone in your body and it affects multiple organ symptoms. Some investigators theorize that vitamin D plays a role in regulating your pain response. A study done by the Mayo Clinic showed that chronic pain patients taking narcotics for relief needed more medication if their vitamin D levels were low.
Aspartate (a component in aspartame), along with monosodium glutamate (a component of glutamate), are both amino acids which have been found to be harmful to fibromyalgia patients. Aspartate and glutamate are both excitotoxins which exist within our body. Research shows that these amino acids called excitotoxins are high in fibromyalgia patients. The job of excitotoxins is to stimulate neurons—the cells that send and receive electrical messages—and in the proper amount they are beneficial. They are essential for proper brain function but in high doses they become harmful and can cause the nerves to misfire, amplify and cause uncontrollable anxiety and irritability. If you adhere to a diet, which contains monosodium glutamate and aspartame, you increase the level of these excitotoxins within your body, which already has been shown to be high in fibromyalgia patients, and that translates into more pain amplification and more excitability and anxiety.
For further information on excitotoxins, go to chronicfatigue.com
Acupuncture, an ancient Chinese practice, is shown to be very beneficial for overall health and pain of all types. Most insurance companies will pay for acupuncture now due to the impressive success rate in treating chronic pain, in particular fibromyalgia.
"The concept that the mind is important in the treatment of illness is integral to the healing approaches of traditional Chinese medicine and Ayurvedic medicine, dating back more than 2,000 years. Hippocrates also noted the moral and spiritual aspects of healing and believed that treatment could occur only with consideration of attitude, environmental influences and natural remedies." - Pain Pathways Magazine, Winter 2012
For further information on acupuncture and fibromyalgia go to webmd.com
Mind & Body Work Therapy
Gentle exercise such as walking and stretching can be very beneficial to keep the contracted muscles of fibromyalgia loose. Vigorous aerobic exercise, however, can be counter productive for fibromyalgia patients and cause a worsening of their pain.
Thai chi is a mind & body therapy which incorporates gentle exercise, meditation and breathing techniques designed to relax the central nervous system, restore chi to the body and work the muscles and joints. It can be extremely effective for fibromyalgia patients whose
autonomic nervous system is hyped up as well as for others who suffer from any form of arthritis.
Yoga, another form of mind/body therapy also eases the pain of fibromyalgia or other chronic pain syndromes by also combining proper breathing techniques, gentle stretching, and meditation. A study published October 14, 2010 in WebMD showed that women could reduce their fibromyalgia symptoms significantly practicing the mind/body techniques of yoga.
For further information on that study go to: webmd.com
Massage therapy has also been shown to have positive results with fibromyalgia patients. While no one is 100% sure exactly how massage relieves pain, we believe it has to do with both the central nervous system and the release of built up lactic acid and other toxins stored in the muscles. It is theorized that massage therapy actually enhances the production of certain pain blockers, including endorphins, serotonin, and norepinephrine. These hormones work to counteract pain signals conducted by the brain, and this would explain why massage offers such dramatic pain relief. Massage therapy can improve flexibility and range of motion and improve sleep. a study of fibromyalgia patients, massage therapy was rated the number treatment for their pain by a wide margin.
“Massage therapy dates back thousands of years. References to massage appear in writings from ancient China, Japan, India, Arabic nations, Egypt, Rome and Greece (Hippocrates defines massage as “the art of rubbing.' - PainPathways Magazine, Winter 2012
For further information on massage therapy go to fibromyalgia-symptoms.org
Sauna and Epsom Salt Baths bring relief to many fibromyalgia and chronic pain patients.
The heat helps relax the sore muscles as well as helps the body to rid itself of any toxins which in turn helps reduce inflammation. Toxins and lactic have long been known to cause widespread muscle pain. Just fifteen minutes a day in a sauna can ease the discomfort of most muskoskeletal problems.
Epsom salt is magnesium sulfate. According to an investigative report titled, "The Role of Magnesium in fibromyalgia" Mark London discusses the role of magnesium for regulation of or inhibition of nerve receptors with relation to fibromyalgia.
Regular Chiropractic Adjustments has been one of the more beneficial treatments for me. Research shows that keeping your spine in alignment allows for proper nerve conduction, which is so important for individuals with fibromyalgia. Chiropractic treatment can also dramatically reduce headaches along with back and neck pain which so often accompanies other fibromyalgia symptoms.
“Spinal manipulation has been used since the time of the ancient Greeks and was incorporated into chiropractic and osteopathic medicine in the late 19th century.”
-Pain Pathways Magazine, 2012
For further information on chiropractic care for fibromyalgia go to medicalnewstoday,com
Myofascial Pain Release, Myofascial pain release involves a manual therapy technique often usedin massage therapy. The technique focuses on pain believed to arise from myofascial tissues - the tough membranes that wrap, connect and support your muscles." This therapy is very effective for fibromyalgia and many types of chronic back pain.
For further information on Myofascial Pain Release go to mayoclinic,com
In the end, find the treatment that works for you.
Try not to let your pain control you.
“Pain is a bully. Chronic, long term pain doesn’t play fair.
It bullies with jobs, relationships and families.”
- Arthritis Today Magazine
So we need to bully back with everything we have!