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GREAT Exercises for Fibromyalgia

18 Aug

Fibromyalgia (FM) is a chronic, stubborn condition that many people struggle with – some to the point of being totally disabled from doing the things that are personally fulfilling. In the past, we have discussed how important it is to have a multi-disciplinary group of healthcare providers to help the FM patient manage this relentless condition. This month, we are going to look at the available research regarding FM patients who incorporate exercise into their lifestyle vs. those who do not!

There are MANY ways in which we can exercise – from simply contracting your abdominal muscles when you drive or sit at your desk to a full-body workout in a swimming pool. The KEY to exercise success is finding an exercise that you ENJOY, look forward to doing, and can foresee yourself doing for a long time into the future. To convince you of the benefits of exercise, let’s take a look at what has been published in peer-reviewed medical journals…

In a “systematic review” of randomized clinical trials regarding FM and exercise training, researchers reviewed relevant studies published between 1966 and 2000. They reported that aerobic exercise reduced the number of tender points and improved cardiovascular fitness, global well-being, fatigue, and sleep in participants. This review clearly demonstrates that exercise is a very important component in the self-management of FM.

Another study evaluated the effects of six months of pool-based exercises with six educational sessions in a 58 patient group that were divided between a treatment and a control group. They used a six-minute walking test, the Fibromyalgia Impact Questionnaire (FIQ), and several other tests and instruments that assess functional limitations, pain levels, social functioning, psychological distress, and quality of life. At the conclusion the trial, those who exercised experienced statistically significant improvement in ALL methods of assessment, CLEARLY demonstrating the importance of exercise!

A similar study looked at exercise benefits and how long they lasted after the activity was discontinued following a twelve-week program. During the twelve weeks, the researchers measured and reported significant improvements in all nine measurements (physical function, general health perception, vitality, social function, mental health, balance, stair climbing, bodily pain, and role-emotional). During follow-up, researchers found that participants were only able to maintain two of the health benefits three months after they stopped exercising! This study shows how important it is to KEEP UP with fitness in order to maintain the best long-term results.

Another study compared an aerobic exercise group vs. a group that only used relaxation and stretching techniques. The aerobic exercise group outperformed the stretch/relaxation group at the three-month point, and after one year, they reported a greater reduction of tender points and greater improvement if FIQ scores. The researchers concluded, “Prescribed graded aerobic exercise is a simple, cheap, effective, and potentially widely available treatment for FM.”

There are MANY more studies that support the use of exercise as a very important form of care for FM. The common thread is this – a structured, patient-specific, graded aerobic exercise leads to an improved quality of life for the FM sufferer.

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

Fibromyalgia – “How Do I Know I Have It?”

23 Jul

Fibromyalgia (FM) is a condition where widespread generalized pain limits a person’s ability to function, sometimes to the point of complete disability. This month, we’ll look at identfying markers that may be used to determine whether a patient has FM or not.

Chronic pain that arises from the muscles and joints affects nearly 20% of the adult population, with the highest percentages found among females and those in lower income brackets. It is very challenging to determine “the cause” of chronic pain, probably because it is influenced by and interacts with various physical, emotional, psychological, and social factors. Several studies have reportedly shown that the levels of certain neurotransmitters (chemicals that help our nerves transmit information) including serotonin, glutamate, lactate, and pyruvate are elevated in patients with localized chronic myalgias (like FM) and therefore may be potential biomarkers for various conditions causing chronic pain. Unfortunately, elevations in these potential markers are not specific or unique to FM.

However, researchers have identified muscle alterations in in fibromyalgia / chronic widespread pain patients. More studies are needed to confirm these findings before they have the potential for use as a diagnostic criteria for FM.

For the time being, in order to establish a diagnosis of FM, we must rely on the following:

1)             The presence of widespread pain by using the “Widespread Pain Index” or WPI.

2)             Determining the severity of the symptoms by using the “Symptom Severity Score” or SS score of which there are two parts:

  •  Scoring fatigue, waking unrefreshed, and cognitive symptoms using a 0-3 scale, 3 representing the most severe or disturbing of these daily functions.
  • Adding up additional symptoms associated with FM, resulting in a 0-3 range depending on the number of the “other symptoms.”

Using the WPI and the SS scores, FM can be identified if one of the following two situations has been presend for three or more months:

WPI score > 7 and SS score > 5
WPI score between 3 and 6 and SS score > 9
If you, a friend or family member requires care for Fibromyalgia, we sincerely appreciate the trust and confidence shown by choosing our services!

Fibromyalgia and HOW TO IMPROVE SLEEP!

22 Jun

Last month, we reported some exciting news about the link between fibromyalgia (FM) and the importance of sleep, particularly getting to the deep sleep stage. However, we did not discuss the various strategies that YOU can use to improve your quality of sleep. Let’s take a look!

Establishing a consistent and better sleep pattern is essential in managing the complex symptoms associated with fibromyalgia (FM). By doing so, you may experience reductions in pain, fatigue, and “fibro fog.” Think of a flashlight. As the batteries wear down, the light becomes progressively dimmer and soon goes out. To recharge our batteries, we must sleep. According to the National Sleep Foundation (NSF), at least 40 million Americans suffer from over 70 different sleep disorders, and 60% of adults report having problems sleeping a few nights per week or more. Also, more than 40% of adults have daytime sleepiness that interferes with activities of daily living, and nearly 70% of children in a study reported they had problems sleeping at least one night a week. The “bottom line” is WE MUST SLEEP to be healthy!

SLEEP STRATEGIES: 1) Sleep ONLY as much as you need to feel refreshed the next day. Limiting the time seems to improve sleep quality while excessive sleep leads to fragmented and shallow / poor quality sleep. 2) Keep a sleep diary and write down how you slept each night as well as any triggers that interfered with your sleep. Review the notes from time-to-time to remind you of strategies that worked in the past. 3) Keep a strict sleep schedule when possible. Get to bed, and more importantly, wake up at a regular time each morning. A regular arousal time strengthens our circadian cycle and leads to a more consistent time of sleep onset at night. 4) Use relaxation therapies such as gentle massage, deep breathing, meditation, yoga, and more, all of which can boost sleep quality. 5) Cut down on noise, particularly sudden loud noise (trains, planes, automobiles, etc.) by soundproofing the room or using a noise machine. Your sleep can be disturbed without you waking up or having memory of it in the morning. 6) Avoid long daytime naps as these interfere with nighttime sleep. 7) Keep the room temperature cool. 8) Hunger can be also disturb sleep, so a light snack of carbohydrates at night can help in this regard. 9) Avoid caffeine or alcohol in the evenings as both disturb sleep. 10) Consider herbs/vitamins/supplements such as 5-HTP, Melatonin, St. John’s Wart, SAM-e, L-Carnitine, Probiotics, and more.

Remember, the goal is to get at least four hours of continuous sleep in order to reach the deep sleep stage. If this is not accomplished over time, the intensity of the FM symptoms can increase.

The management of FM is best when approached from multiple directions: nutrition, exercise (especially aerobic), many of the 10 “tips” described above, and care rendered by a “team” of healthcare providers from disciplines such as chiropractic, massage therapy, and primary care. Because FM is complex with no single cause, a multi-directed treatment approach seems to work best. Remember, doctors of chiropractic focus on structure, exercise, nutrition, and whole-body health. They also work with other health professionals on a regular basis when managing the needs of their patients.

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

Fibromyalgia and the Importance of Sleep

28 May

One of the most frustrating symptoms of fibromyalgia (FM) is the inability to get a good night’s sleep! Recently, at an Harvard-sponsored conference on the subject of pain, it was stated that “…no one should have to live in constant pain with what is known about pain management in this day and age (paraphrased).” Many attendees agreed that improving sleep quality may be the #1 way to improve the quality of life for patients with widespread pain. So the question is, what can be done to improve the sleep cycle for all of us, not only the fibromyalgia patient? Let’s take a look!

The importance of sleep has long been discussed as being not only key in managing the FM patient, but some experts even suspect it’s the probable cause of the disorder itself. It has been found that we must get at least four hours of continuous sleep in order to reach a deep sleep stage, and only at this level of sleep can we fully relax. If we can’t get to that deep sleep stage, our muscles (and mind) can’t fully relax and over time, the gradually increasing tightness may result in pain and the vicious cycle continues to chip away at the quality of life of the FM patient.

Exciting new research from the United Kingdom reports that for those over age 50, non-restorative sleep – the type where you wake up tired, foggy, and listless – is STRONGLY tied to widespread pain, the “hallmark” of FM. The researchers also report that anxiety, memory loss, and poor physical health are linked to widespread pain in older adults. In the journal Arthritis & Rheumatology, author Dr. John McBeth wrote that musculoskeletal pain becomes more common with aging and affects four out of five seniors on a daily basis! Widespread pain is a KEY FEATURE of FM, which also includes fatigue and tenderness in muscles, joints, tendons, and other soft tissues. It is estimated that about 5 million American adults are affected by FM with women being affected four times more often than men (for reasons unknown). FM can occur insidiously (for no known reason) or secondary to an injury or illness.

After studying a group of 4,300 adults (> age 50) of which 2,700 had some pain but not widespread pain, Dr. McBeth and his colleagues found several factors that can increase an older individual’s risk of developing widespread pain. At the start of the study, participants completed questionnaires about pain, mental and physical health, lifestyle and health behaviors, medical conditions, and more. After three years, they were reassessed in a similar manner and 19% reported NEW widespread pain. This included 25% of participants who initially reported some pain and 8% who reported no pain at the study’s start. The most important link for the development of widespread pain was non-restorative sleep. Other links included pain status, anxiety, physical health-related quality of life, and some form of cognitive complaint (such as memory loss). They also note that brainwave studies of FM sufferers often show the inability to reach deep sleep. Moreover, in an experiment where healthy volunteers were woken during each period of deep sleep, a number of them soon developed typical signs and symptoms of FM!

Chiropractic care includes treatment methods that reduces pain and muscle spasm and as a result, frequently improves an interrupted sleep pattern. Doctors of chiropractic are also STRONG ADVOCATES of home exercise and typically offer in-office training. Before attempting drugs with significant side effects, you owe it to yourself to include chiropractic care in your FM management “team!”

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

Commonly Asked Questions about Fibromyalgia

16 Feb

WHAT IS FIBROMYALGIA? FM is a relatively common chronic disorder where widespread pain, diffuse tenderness, and potentially a host of other symptoms may be present. The word “fibromyalgia” is derived from the Latin term “fibro” (fibrous tissue) and the Greek term “myo” for muscle and “algia” for pain. Even though FM is often described as an arthritis-type of condition, it does NOT cause inflammation of the joints, muscles, or other tissues as is observed with some types of arthritis. However, FM does “look” like arthritis in that FM can cause significant pain that can interfere with a person’s tolerance to daily activities, including work.

WHO GETS FM? It has been reported that FM affects five million Americans ages 18 and older. For unknown reasons, between 80-90% of those affected are women, but men and children can also develop FM. Most people are diagnosed during their middle years. Several studies have reported that women with a positive family history of FM are more likely to develop FM, but it remains unclear if this is from a shared environment vs. a true heredity issue, or both. Currently, researchers are looking at variations in certain genes that cause some people to be more sensitive to stimuli, which may lead to pain syndromes like FM. People with rheumatic diseases (such as rheumatoid arthritis, lupus, or ankylosing spondylitis – a special type of spinal arthritis) may be more likely to have FM as well.

WHAT CAUSES FM? Even though no one REALLY knows why some people develop FM and others do not, we have learned that FM is linked to the central nervous system. There are two types of FM: Primary (no known cause) and Secondary (occurs with a known underlying condition). Secondary FM has been associated with a physical/emotional stress or traumatic event such as a motor vehicle accident, and some develop FM after sustaining a repetitive motion injury or after an illness. In primary FM, it seems to develop spontaneously with no known cause or associated condition.

HOW IS FM TREATED? Treatment is challenging as not all doctors are familiar with FM and may not even “believe” it’s real (they may think it’s depression or all in the patient’s head). It is therefore BEST to find a “TEAM” of healthcare providers knowledgeable about FM and willing to work with you. This team may include primary care doctors, chiropractors, physical therapists, clinical psychologists, and perhaps rheumatologists, among others. Massage therapists, acupuncturists, and nutritional therapists can also be part of the multi-dimensional treatment approach. However, the MOST important team member is YOU because keeping track of sleep hours, exercise amounts, diet, and knowing when to rest are critical for a good treatment outcome. You can guide us in finding care that works, what doesn’t, and at what “dose” feels best for you. Focusing on “control” rather than “cure” is important so you do not get too discouraged during the treatment process.

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

The Diagnosis and Misdiagnosis of Fibromyalgia

30 Dec

Fibromyalgia (FM) is a condition that the medical community has long had difficulty defining. As stated last month, FM is often considered a “musculoskeletal disorder” (MSK) because of the aches and pains it produces in the muscles and joints. However, this is not really accurate since FM includes many other symptoms beyond just severe muscle pain, such as extreme fatigue, mental fog, sleep disorders, irritable bowel, and more. As such, “misdiagnosis” is more common than an accurate diagnosis when it comes the FM. Let’s take a closer look!

FM is described as a “syndrome,” meaning it includes multiple complaints and findings that commonly occur together such as (but not limited to) widespread pain, decreased pain tolerance or threshold, multiple tender points, incapacitating fatigue, anxiety, and/or depression. Though the intensity of these symptoms can vary, persistent and chronic fatigue is one of the most common complaints, second only to the whole body deep muscle aches. Unlike “normal” fatigue, the type of fatigue, weakness, and exhaustion associated with FM often leads to social isolation, and as a result, anxiety and/or depression.

The reason WHY FM is so difficult to diagnose is that: 1) These same symptoms are found in many other conditions and, 2) There is no one test that can diagnose FM like a blood test or x-ray. The diagnosis process must RULE OUT all the other conditions that present with similar symptoms. Hence, blood tests are used to rule out anemia or hypothyroid (for fatigue), inflammatory arthritis, and Lyme disease. Sleep studies are used to rule out sleep apnea (which can co-exist with FM). X-rays are used to rule out a bone or joint cause of the patient’s muscle pain. Many diseases or conditions have a pattern of complaints, but FM doesn’t consistently follow a similar presentation. There are so many different degrees of FM and the symptoms include so many different systems of the body that FM sufferers often have to go from doctor to doctor before they find one willing to take the time needed to properly assess for fibromyalgia. Some doctors firmly believe there is no such thing as FM stating that “…it’s all in the head!” This can only adds to the frustration, anxiety, and depression for the FM sufferer.

Common misdiagnoses include (but are not limited to) depression, inflammatory arthritis (like rheumatoid or lupus), chronic myofascial pain syndrome, or chronic fatigue syndrome. Conditions commonly associated with FM may include some of the above as well as irritable bowel syndrome (IBS), thyroid deficiency, and others, which only makes the diagnosis of FM even more challenging!

Some doctors and researchers use the term “primary FM” for FM that is not caused by something else vs. “secondary FM” where something like a trauma (eg., car accident), IBS, or an inflammatory arthritis either precedes the start of FM symptoms or is closely associated with its onset. The important point is that FM is unique and it must be properly diagnosed so accurate and effective treatment can be administered. The diagnostic Guidelines for FM include three main things: 1) Widespread pain in all four body quadrants; 2) At least three months of symptoms; and 3) No other disease is causing these symptoms.  You can expect us to check for the following: 1) Widespread pain; 2) Trigger point evaluation; 3) Ask about fatigue; 4) Ask about sleep disturbances; 5) Ask about stress levels; and 6) Ask about depression. Proper treatment is often best approached with a “team” consisting of chiropractic, primary care, clinical psychology and/or counseling, and sometimes others.

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