Let’s put to the side the past stigmas associated with Fibromyalgia. For many years a majority of physicians did not believe in Fibromyalgia and there are still a few physicians who refuse to recognize or treat Fibro patients. While rounding on patients in the hospital, I have overhead a colleague label Fibromyalgia as the “depressed, overweight, middle age, housewife syndrome”.
Luckily, the medical community is finally coming around to recognizing this chronic pain condition. Current Fibromyalgia research and treatment philosophy resolves around the theory of Fibromyalgia being a mixed component of a central nervous system dysfunction with a chronic myofascial component.
Fibromyalgia is a diagnosis of exclusion, make sure to have labs to rule our other connective tissues diseases first, like Rheumatoid Arthritis, before accepting the Fibro diagnosis.
Below is a list of recommendations we make to all of our Fibromyalgia patients on there first visit:
- Every Fibro patients needs a sleep study to treat any underlying sleep disorders that will directly complicate pain.
- Treat any underlying depression, this can not be understated! Whether with counseling, psychiatric treatment, meditation and if needed medication
- Check underlying vitamin deficiencies that can complicate pain, including Vitamin D, Vitamin B12, Vitamin B1, Vitamin B2 and Vitamin B6.
- Start a daily home exercise/stretching program, Fibro will worsens with inactivity. We have heard every argument from patients that it hurts to much to exercise but it is critical to do some daily stretching/exercise routine. We recommend low impact yoga, pilates, tai chi, aquatic therapy.
- Eliminate all soda’s immediately, totally toxic and can increase inflammatory levels in the body complicating pain.
- Restrict the ‘nightshade plants’ from the diet to limit their inflammatory related issues.
- Limit yeast foods, so many of our patients struggle with this one but it will dramatically improve your energy
- Work with a local physician and consider one of the FDA approved medications for Fibromyalgia: Cymbalta, Lyrica or Savella.
- Consider a workup for gluten allergy.
For motivated patients we encourage them to study and incorporate mindfulness into their daily routine. Mindfulness is the psychological process off bringing one’s attention to experiences in the moment. It is best accomplished with training and the practice of meditation. Mindfulness interventions are effective in reducing rumination and worry. Rumination on one’s pain or illness exacerbate depression and underlying anxiety conditions. A classic example is with our Fibromyalgia patients, they commonly ruminate on the condition and identify themselves as ‘Fibro’ instead of focusing on a more positive aspect of their life.
Classic mindfulness treatments we recommend to patients include a very basic mindfulness meditation where a patient sits and quietly focuses on their natural breathing. The patients are taught to allow thoughts to come and go without any judgement, simply allow the thoughts to dissolve away and then focus back on their breathing. A simple 3-5 minutes per day will start to show dramatic benefits in as little as 2 weeks as patients learn to wipe away anxiety and help to distract from the negative effects of pain on the mind.
A few apps that we have found helpful for patients to practice mindfulness include: Headspace, Aura and the app Stop Breath & Think.
As a patient incorporates a mindfulness approach to their daily routine, pain levels decrease, anxiety decreases, empowerment increases and patients inch closer to a cure for their pain.
Meditation is an effective tool to help avoid additional prescription medications and help cure pain. Meditation can rewire the brain’s pain circuitry. Neuronal pathways within the brain get programmed every time you expect pain to occur — in time, less and less stimulus is needed to trigger the pain reflex. Eventually, the simple thought of pain becomes the true source, not necessarily the ailment itself.
Meditation can unhook your emotional reaction to pain. Our patients can get stuck in a brutal feedback loop, without even realizing it. Their anticipation of pain creates stress, stress leads to physical tension within the body — especially near the painful area, which ultimately leads to more pain.
Meditation teaches you how to emotionally detach from your negative thoughts and physical sensations, where you no longer expect pain, nor resist it when it does occur.
Meditation can also help us treat our natural flight or fight response to pain which can be abnormally triggered in chronic pain patients. The flight or fight increases cortisol stress levels. Elevated stress levels increase blood pressure, increase inflammatory markers and increase pain. Meditation helps to reduce these harmful stress hormone levels.
Meditation can also boost natural endorphin levels which act as a natural pain reliever, decrease cortisol levels and allow patients to be in control of their pain
To ‘cure’ your pain you will need to actively seek a health care team dedicated to achieving your goals. Although our practice is only one example, you will want to seek providers that take a multidimensional approach. Ideally you will have a healthcare provider who can manage any approach medication options needed. Find a provider that doesn’t treat you like cattle. Find a provider that takes the time to know their patients and not someone who kicks you out the door after 10 minutes. Avoid the ‘pill mill’ clinics! If you suffer with underlying anxiety and depression, which is almost every patient, you will want to also work with a pain psychologist or psychiatrist to help with coping skills.
Some alternative add-ons that we recommend would involve joining a pain support group, either one specifically for your pain condition or one for chronic pain. Having a support group to vent at, share ideas, share victories or frustrations is a critical component. I like to call it the “Oprah effect” as Oprah has done wonders with addressing issues and bringing them into the viewer’s living room. So can these support groups be your “Oprah effect”.
As you become a more active participant, we then encourage our patients to actively seek an exercise instructor with experience in pain patients. Yoga, Tai Chi, Pilates, aquatic Therapy are all wonderful examples of improving strength and flexibility while decreasing pain.
The goal is finding the right members to fill out your pain fighting team!
To help ‘Cure’ your pain you must become more active and vigilant in your own recovery and yes this also applies to taking advantage of your rest. Rest come in many forms from improving your sleep, which we have already discussed in an earlier blog, naps, meditation, stretching, and an approach to activity known as a active rest.
So much of our life seems to be some automated loop, whether that is our routine of running off to work in the morning or running our kids to school and various activities. People adapt to their hectic loop of a life by running from one activity to the next, pumping caffeine into their bodies at the local java hut to keep moving.
There is an argument that hitting the pause button and trying to find a better balance to our hectic lives and finding opportunities to rest is an excellent way to heal our body and our soul. A conscious approach to adding active rest based activities is a a natural approach to living within your bodies circadian rhythm. Most research show that humans are designed to take an afternoon nap. Although a nap is not possible for most, finding 10 minutes to meditate or take a nature stroll seems to do wonders. For patients able to exercise, we recommend alternating between a heavy exercise day with a lighter exercise day to not over stress our body. For patients with more disabilities to activity, we recommend trying to stagger doctor appointments or busy days so as to not overwhelm yourself psychologically or physically.
We are not promoting a couch potato lifestyle rather, we are simply recognizing that making a conscious decision to rest on the couch and read a book or relax the mind periodically is a healthy choice.
Music has the ability to be an amazing adjunctive therapy to help ‘Cure’ your pain. Neuroscientists have discovered that listening to music heightens positive emotion through stimulating dopamine levels. Dopamine has powerful effects on the reward center in the brain that affect emotion and pain control. Dopamine release from music has also been tied to improving motivation which helps gives pain patients the energy to be more active. Numerous studies have shown that athletes who train with music have improved endurance.
Music helps manage and control pain in a multitude of factors. Music has the ability to reduce stress and anxiety. Research shows music can prevent anxiety-induced increases in heart rate and high blood pressure. Listening to music can help reduce cortisol levels, a stress hormone. The power of music seems to act on both a physiological as well as psychological level to help patients better manage their pain. Music therapy is now being used as a means of conditioning patients to relax and release pain and stress.
So crank up your favorite tunes to decrease pain, improve mood, improve motivation and get yourself on the road to recovery and a ‘cure’.
To ‘cure’ your pain you must learn to become a champion. A champion is defined as an individual who overcomes great odds to achieve their goals.
This is an active approach to taking back your life. The first step is to pick one activity that you had quit due to you pain. This can be as simple as walking up the hill to the mailbox or going to the grocery store. There is no quit in a champion, you will start by telling your pain “I’m taking this back!” As you start to slowly add back more activities you will gain more confidence and improve your quality of life. These small victories will improve you mood and outlook. Just like any champion, the road to success will have its highs and lows. Don’t become frustrated if you have a setback, only by failing can we learn to succeed.
By winning more and more of these small victories you will learn to control you pain and not let your pain control you. When you learn that you control your pain you will become a champion!