Fibromyalgia can be brutal. The pain, fatigue, cognitive mysteries, and more can make life terribly difficult. Being accurately diagnosed is crucial. Then it’s on to a tolerable coexistence. And there’s plenty to be hopeful about. Here’s how to manage…
Well, our friend continues to be in pain. She’s still fatigued and her thoughts remain scattered. But she worked with her doc and was diagnosed with fibromyalgia. Her expression has gone from desperation to contemplation, as she considers management.
We began a two-part series last week on fibromyalgia (FM), a chronic – incurable – medical condition featuring pain, fatigue, and cognitive issues. In part one we reviewed what it is and its causes. This go-round we’re going to discuss how to manage it.
Lots to review, so let’s dig right in…
How is fibromyalgia treated?
We know there is no cure for FM, but we also know it isn’t terminal. So that means living with FM comes down to managing what may be a wide variety of symptoms. So it’s best to use more than one form of intervention: medications, lifestyle changes, self-care activities, therapies. And you may need help from one or more medical specialists.
“I didn’t ask for fibromyalgia. But, I’ll do all I can to manage it.”
Here’s another factor to consider. If you have FM you’re dealing with a condition that’s often badly misunderstood – to the extreme of the uninformed questioning its legitimacy. That said, when you’re in need of insight and support, turn to people who are going to be open-minded and understanding about what you’re going through. The last thing you need is ignorance and intolerance.
And don’t allow yourself to question your illness. If you’ve been diagnosed with FM, you have a legit medical condition that requires dedication to management. Always believe in yourself and your ability to take good care of yourself.
What medications help with fibromyalgia?
There are a variety of medications that may help with the symptoms of FM. Here are some of the most commonly used…
Pain relievers: Over-the-counter pain relievers such as acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others), and naproxen sodium (Aleve, others). Opioids such as tramadol (Ultram) were once frequently prescribed; however, research has shown they’re not especially effective. And let’s not forget about issues of tolerance and dependence.
Antidepressants: duloxetine (Cymbalta) and milnacipran (Savella) may ease pain and fatigue. They may also help with sleep. Amitriptyline (Elavil) or the muscle relaxant cyclobenzaprine (Flexeril) may be prescribed to promote sleep. It’s thought that antidepressants may help with FM by rebalancing neurotransmitters.
Anti-seizure drugs: Used to help with certain types of pain are gabapentin (Neurontin) and pregabalin (Lyrica).
Three of the above are FDA approved for the treatment of FM: duloxetine (Cymbalta), milnacipran (Savella), pregabalin (Lyrica). Beyond those I mentioned above, there are other meds frequently being prescribed off-label for the treatment of FM.
Non-med treatments for fibromyalgia
Even if you’re taking medication for FM, there’s so much more you can be doing to secure relief. I mean, why count on just one treatment if you don’t have to? Consider these non-med interventions for FM…
Stress management: Develop a plan to avoid or limit physical, mental, and emotional overexertion and stress. Daily relaxation time is a must.
Sleep care: Good quality sleep is essential, given FMs fatigue factor. Going to bed and getting up at the same time each day and limiting naps are important.
Exercise regularly: Exercise may initially increase pain; however, getting into it gradually and doing it regularly often decrease symptoms. Find the activity that works best for you.
Pacing: Keep activity on an even level. If you do too much on your good days you may have more not so good days. But don’t limit yourself, or do too little, on days when symptoms flare-up.
Maintain a healthy lifestyle: Eat healthy foods, drink plenty of water, reduce sugar consumption, limit caffeine intake, don’t use tobacco products, and keep your weight in check. You know the drill.
Consider natural remedies: Acupuncture, massage therapy, yoga, meditation, tai chi, supplements such as 5-Hydroxytryptophan (5-HTP), and more. Do your research and chat with your doc.
Counseling: Helpful in confirming your ability to cope with FM, as well as managing the stressors it brings to life. And who doesn’t benefit from talking things out?
Physical therapy: You can learn exercises that will improve strength, flexibility, and stamina. Water-based work may be helpful.
Occupational therapy: Get help with adjustments to your work area or the way you perform certain tasks. It’ll minimize body stress.
Many more where these came from, right? Do what you can to research, learn and expand.
Keep moving forward
No doubt, the pain, fatigue, cognitive challenges, and other symptoms of fibromyalgia can be brutal. And being a chronic condition, learning how to manage them becomes a life priority.
If you have fibromyalgia, think you might, or know someone in the same boat, I hope you found the series helpful. When it comes to any life-interrupting condition, knowledge is huge. I wanted to give you that along with best wishes for your journey.
As always, keep moving forward, okay?
Once again, be sure to read part one to learn what fibromyalgia is, as well as its causes.
Pain is awful. Chronic pain is worse. Toss in fatigue and cognitive challenges and things can be brutal. That’s the way it rolls with fibromyalgia. Like any condition we discuss, dicey information is easy to come by. Here’s what to understand…
Looks like our friend is stressed and struggling. Fact is, she’s in pain, terribly fatigued, and can’t think straight. “This has been going on for months. Could I have fibromyalgia?” I’m thinking she needs to see her doc.
Fibromyalgia (FM) is a complicated disorder. To give it its due, we’re going to handle biz in two parts. This article will address what FM is, as well as its causes. And we’ll come back next week with how to manage it.
Good? Well, let’s get busy…
What is fibromyalgia?
Fibromyalgia is a chronic medical condition for which there is no cure. Some four million American adults have been diagnosed. It’s thought that FM ramps-up sensations of pain by changing the way the brain and spinal cord process painful and nonpainful signals.
Symptoms of FM often commence after an event, such as physical or emotional/mental trauma, surgery, or an infection. But, go figure, symptoms may accumulate and grow stronger over time, having no identifiable trigger.
Here are FMs primary symptoms…
Multisite pain: Was once referred to as widespread pain. FM pain is often described as a constant dull ache that’s lasted for at least three months. To qualify for multisite, the pain has to occur on both sides of the body and above and below the waist.
Fatigue: Those with FM often awaken tired, even though they report sleeping for long periods of time. Sleep is often interrupted by pain, and many with FM deal with sleep-occurring disorders like sleep apnea and restless leg syndrome.
Cognitive challenges: Known as “fibro fog,” this symptom impairs the ability to focus, pay attention, and concentrate on mental tasks. Faulty memory may also become an issue.
18 Tender Points
As if the primary symptoms aren’t enough, often experienced with FM are depression, anxiety, irritable bowel syndrome (IBS), myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), migraine and other headaches, temporomandibular joint disorders (TMD), postural tachycardia syndrome, and interstitial cystitis (painful bladder syndrome).
Now, once upon a time, doctors would check 18 tender points to see how many were painful when pressed firmly. The American College of Rheumatology issued new guidelines that don’t require a tender point exam for diagnosis.
So then, to meet current diagnostic criteria for FM, multisite pain has to have been experienced throughout the body, at a similar intensity, for at least three months. Also, there has to be pain in at least four of these five areas…
Left upper region: Includes shoulder, arm, or jaw
Right upper region: Includes shoulder, arm, or jaw
Left lower region: Includes hip, buttock, or leg
Right lower region: Includes hip, buttock, or leg
Axial region: Includes neck, back, chest, or abdomen
Also included in the diagnostic criteria are a pain index and symptom severity scale.
A couple of final tidbits: Though FM is a chronic condition, there may be periods of improved pain and fatigue. There are no specific tests for FM, so anything ordered is to rule-out other disorders.
What causes fibromyalgia?
The best place to start a discussion of FM cause is to consider these risk factors…
Sex: FM is diagnosed more in females.
Age: FM is more commonly diagnosed in middle age and risk increases as one gets older. But FM can be diagnosed at any age, including in children.
Family history: One may be more likely to develop FM if a parent or sibling has it.
Other disorders: A diagnosis of osteoarthritis, rheumatoid arthritis, or lupus may make a FM diagnosis more likely.
As was mentioned, it’s believed that FM is caused by changes in the brain and spinal cord. These changes in pain processing involve an abnormal increase in levels of specific pain signaling chemicals. In addition, the brain’s pain receptors seem to develop a kind of memory of the pain and become sensitized. That allows them to overreact to painful and nonpainful signals.
Keep in mind, the cause of FM is likely a matter of interacting factors. The workings may be a genetic predisposition brought to life by one or more triggers.
Speaking of which…
Genetics: FM tends to run in families. That says there may be genetic mutations that may make one more susceptible to developing FM.
Infections: Some illnesses, past and present, appear to either trigger or aggravate FM. Of note are influenza, pneumonia, GI infections, such as those caused by Salmonella and Shigella bacteria, and the Epstein-Barr virus.
Trauma: FM may be triggered by, say, a car accident or traumatizing encounter. Prolonged emotional/mental stress may also be a trigger. Makes sense that FM has been linked to posttraumatic stress disorder (PTSD).
It’s interesting that FM symptoms are very similar to those of the autoimmune disorders. It’s been a theory that FM actually is an autoimmune disorder, but it can’t be proved because FM doesn’t cause inflammation. In addition, autoantibodies have yet to be found.
That’s a wrap
Yes, pain is awful. Chronic pain is worse. Adding fatigue and cognitive challenges to the mix can make life brutal. Fibromyalgia can be very difficult to live with. But we’re here to provide accurate information…
When was the last time you busted-out with a belly-jiggling, eye-watering laugh? Hey, there’s a lot more to the “best medicine” angle than you might think. Let’s talk about why laughter is a powerful remedy…
…laughing during a funny movie elevates the pain threshold and aids in breaking the cycle between pain, sleep loss, depression, and immunosuppression.
Did you ever wonder how laughter originated? Well, to our long-ago ancestors, relationship quality was crucial to survival. One theory suggests that laughter likely evolved from labored breathing during play, such as tickling. That shared arousal experience in young mammals created and deepened social bonds.
To this day, the goal remains the same, doesn’t it? It’s about becoming fonder of those with whom we share the odd sound and physical signs of laughter.
Let’s take our discussion to the personal remedy neck of the woods, led by a Psychiatric Times article, Laughter Is the Best Medicine, written by Kavita Khajuria, MD.
Laughter is the best medicine
Dr. Khajuria takes the importance of humor in medical treatment all the way back to the 13th century. That’s when the “Father of French Surgery,” Henri de Mondeville, was known to add humor to his post-operative treatments.
Khajuria goes on to highlight author and professor Norman Cousins, who did quite a bit of research on the biochemistry of human emotion. In fact, he believed emotion was the key to success in fighting illness.
Unfortunately, he had the opportunity to personally test his theories when he was crippled by sudden-onset connective tissue disease and arthritis.
Cousins developed his own recovery program, which included self-induced laughter sessions fueled by comic films. From Cousins…
I made the joyous discovery that ten minutes of genuine belly laughter had an anesthetic effect and would give me at least two hours of pain-free sleep…When the pain-killing effect of the laughter wore off, we would switch on the motion picture projector again and not infrequently, it would lead to another pain-free interval.
Cousins’ wrestling match with his illnesses is detailed in his 1979 book, Anatomy of an Illness: As Perceived by the Patient. Check it out.
Laughter and the body
“It just feels great to laugh.”
Dr. Khajuria shares that numerous studies reveal the beneficial effects of laughter. For instance, laughing during a funny movie elevates the pain threshold and aids in breaking the cycle between pain, sleep loss, depression, and immunosuppression. (Just ask Mr. Cousins.)
Laughter also lowers blood pressure, epinephrine (adrenaline), and glucose levels; as well as increasing glucose tolerance.
And how ’bout this? Laughter assists in the recovery and prevention of cancer by increasing natural killer cell activity, the response of gamma interferon and T cells, and it amps-up the defense against respiratory infections.
And, of course, humor and laughter generate the discharge of endorphins, encouraging calm.
Okay, have you ever heard of laughter yoga? Indeed, to achieve positive psychological outcomes, the practice encourages participants to mimic the act of laughing.
And it works, as significant improvement in positive emotions and reductions in the severity of stress and anxiety symptoms have been noted.
Dr. Khajuria even presents an interesting discussion of Sigmund Freud’s views on humor. According to Khajuria, Freud suggested humor may be the highest of the psyche’s defense processes.
And Khajuria goes on to submit that humor can have a place in individual and group therapy for a variety of mood and anxiety disorders.
Hey, how ’bout a personal example. I was feeling especially wound-up a few nights ago. You know the drill, so much going-on throughout the day and then a hard time dimming the lights on the old gray matter. Yes, I was moody and anxious.
So what did I do? I grabbed my phone and opened the YouTube app looking for comic relief. In short order I came upon a clip from a UK game show. I laughed ’til I cried. And, dang, I’ll bet I watched it a dozen times.
The result? I chilled and hit the sack.
The last laugh
So I’ll ask you again? When was the last time you busted-out with a belly-jiggling, eye-watering laugh? If it’s been way too long, you’re missing-out on so much relief.
Give it a go, okay? I mean, laughter-inducing material is easy to find.
You’re devastatingly fatigued. And you’re experiencing concentration and memory issues, lousy sleep, lightheadedness, and joint pain. “What the heck is going on? I mean, could I have chronic fatigue syndrome?” You deserve to know…
ME/CFS is characterized by extreme fatigue that’s often exacerbated by physical, emotional, and mental activity. And the thing is, the fatigue doesn’t resolve with rest.
We’ve been living in fatiguing times, so it’s understandable that many of us feel absolutely wiped-out. But if the fatigue won’t resolve, and a variety of other symptoms hit, we may be dealing with chronic fatigue syndrome.
Just like our frustrated, worn-out, and angry friend above, we deserve to know what’s going on.
Let’s see what we can figure-out…
What is chronic fatigue syndrome?
What has been traditionally known as chronic fatigue syndrome is now medically recognized as myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). In some circles it’s referred to as systemic exertion intolerance disease (SEID).
Though acceptance of ME/CFS in the medical world has greatly increased, and it’s garnering more research attention, it remains a mysterious load of misery.
ME/CFS is characterized by extreme fatigue that’s often exacerbated by physical, emotional, and mental activity. And the thing is, the fatigue doesn’t resolve with rest. A variety of unpleasant symptoms, which vary by case, are also involved.
Symptoms of ME/CFS may peak and stabilize early in its presentation, and may come and go over time. Complete recovery is a possibility; however, not to be counted upon.
Okay, the symptoms of ME/CFS can be all over the board and there isn’t a detectable pattern. Here are the biggies…
Fatigue that interferes with daily activities and doesn’t resolve with bed rest
Extreme fatigue lasting for more than 24 hours after physical, emotional, or mental exercise (post-exertional malaise – PEM)
Sleep problems: unrefreshing, insomnia, others
Concentration and memory problems
Frequent sore throat
Mildly enlarged and tender lymph nodes in the neck and armpits
Muscle and/or joint pain
Lightheadedness that worsens with moving from lying down or sitting to standing (orthostatic hypotension)
Pain that moves from one joint to another with no swelling or redness
Keep in mind, ME/CFS symptoms may present in cycles. They may even disappear, only to come back down the road. Of course, with the exception of fatigue issues, one doesn’t have to have all of the symptoms to qualify for a diagnosis.
“And now I can’t even concentrate? Something’s up.”
Some 2.5 million Americans are believed to have ME/CFS. And I’m betting there are a significant number of undiagnosed cases.
ME/CFS can present at any age; however, it’s more likely to strike those in their 40s and 50s.
Although gender isn’t a proven risk factor for ME/CFS, the record shows that women are two to four times more likely to be diagnosed. A lot of that may have to do with the fact that women are typically more inclined to report symptoms and seek treatment.
What causes chronic fatigue syndrome?
As I said, ME/CFS research has ramped-up. Still, its cause remains a mystery. As we discuss cause, it’s really important to keep in mind that ME/CFS may well be an end-stage phenomenon of any number of conditions.
Here are the most widely recognized – suspected or researched – causes…
Physical or emotional trauma
Viral infection (e.g., Epstein-Barr virus, human herpesvirus 6, Ross River virus, rubella virus)
Again, ME/CFS may be an end-stage phenomenon of a variety of conditions, especially viral and bacterial infections.
Is there a test for chronic fatigue syndrome?
There was a time when testing for ME/CFS was out of the question. However, these days, testing research is in the works.
The first bit of good news came in 2019 when Stanford University scientists identified a biomarker for ME/CFS. My understanding is they developed a blood-based test that accurately identified individuals with ME/CFS.
And just last year, researchers at CHU Sainte-Justine and Université de Montréal devised a unique two-step testing method.
Routine testing for ME/CFS isn’t available yet, but given recent developments, I wouldn’t be surprised if good news was announced sooner rather than later.
In the meantime, we’re going to have to continue to rely upon signs, symptoms, and rule-outs. Speaking of which, the most significant rule-outs are mononucleosis, Lyme disease, multiple sclerosis, systemic lupus erythematosus, hypothyroidism, fibromyalgia, major depressive disorder, sleep disorders, severe obesity, and drug and alcohol side effects.
How is chronic fatigue syndrome treated?
Most important in the treatment of ME/CFS is seeing a physician as soon as possible if you suspect you have it. Early diagnosis is the key to management and possible remission.
That said, there’s no specific treatment for CFS. Certainly no cure. So that means physicians and counselors typically recommend a combination of strategies and techniques to manage symptoms based upon individual presentation.
Given the significant role post-exertional malaise (PEM) plays in ME/CFS, pacing (activity management) is a significant treatment strategy. It helps to balance activity and rest in an effort to avoid ME/CFS flare-ups. In pacing, the individual determines their limits (“energy envelope”), plans activities, and rests to stay within those limits. A diary is kept.
Other common interventions…
Moderating physical, mental, and emotional stress
The gradual onset of an exercise program or adjustments to a current regimen. Vigorous exercise could be a problem.
Maintaining healthy lifestyle habits
Limiting caffeine to help with sleep, as well as nicotine and alcohol
Establishing a sleep routine, while limiting napping
So much pain, so many forgotten, ignored, or unknown remedies. Someone being dragged about by a mood or anxiety disorder can’t let that stand. Aromatherapy would be a great discussion topic right about now. Here’s why…
Aromatherapy is a holistic healing treatment that uses natural plant extracts – aromatic essential oils – to improve emotional, mental, and physical health. It’s been around for thousands of years and has been getting a lot more attention these days in the worlds of science and medicine.
How does aromatherapy work?
Aromatherapy works through skin absorption and the sense of smell (“aroma”). It’s delivered via diffusers, aromatic spritzers, bathing salts, body oils, creams, lotions, hot and cold compresses, and more.
For each essential oil, there’s a characteristic healing property, use, and effect. Combining oils is frequently done to create additional benefits.
Speaking of benefits, we don’t have the space to include all of the suggested benefits and targeted miseries of essential oils. Suffice it to say there are plenty, some of which you’ll see when we review the most popular essential oils.
But keep in mind, there are benefit claims that may be a little dicey. These include using aromatherapy as a treatment for Alzheimer’s, Parkinson’s, and heart disease.
Also be aware that though most essential oils are safe to use, there are precautions and side effects to consider. For instance, don’t apply essential oils directly to your skin. Use a carrier oil to dilute your chosen oil. Beware if you’re taking a prescribed medication, checking-in with your doc and/or pharmacist. Touching base with a doc before using essential oils is a good idea for pregnant or breastfeeding women, as well as children. There are others, so be sure to do your due diligence.
I’ll also add that using essential oils for the mood and anxiety disorders may be best considered a complimentary treatment. Just my opinion.
When it comes to using essential oils, you can go it alone, purchasing product online and at retail outlets. But be mindful that essential oils aren’t regulated by the FDA, so you’ll want to make sure your source is trustworthy. You may want to consider working with an aromatherapist. Do an internet search to find one or you can hit the National Association for Holistic Aromatherapy website.
The most popular essential oils
Rose Essential Oil
Okay, so now you know what aromatherapy is and how it works. At this point you may be ready to give it a go, but you need specifics.
It’s time to name names.
According to the National Association for Holistic Aromatherapy, here are the most popular essential oils with some of their reported benefits or what they’re believed to address…
Clary Sage: antispasmodic, menstrual cramps, anxiety and stress
Eucalyptus: expectorant, decongestant, cold and flu, bronchitis, clearing the mind, energizing (don’t apply to or near the face of infants or children under 10, dilute to 1% or less for children’s topical preparations)
When it comes to managing the mood and anxiety disorders, aromatherapy – essentials oils – may well be one of the forgotten, ignored, or unknown remedies. But given their helping potential, we can’t let that stand.
As you’re considering your mood or anxiety disorder treatment strategy, think about including aromatherapy – essential oils. Could be one slick move.