Archive for the ‘Fibromyalgia’ Category

« Older Entries

Gluten free / dairy free diets and back pain….

Monday, June 6th, 2011

Every few years, I observe what I call the ‘condition of the month’- that is a specific medical condition which seems to become highlighted by the media, patients, journals- pretty much everywhere. When I was in medical school it was candida infections causing everything. During my residency, it became lyme disease. Early in my practice it was ADD. The current trend seems to be concern about celiac disease and gluten intolerance- and additional worries about milk & other dairy products causing trouble.

Now first and foremost- YES celiac disease is a real entity, and should be treated as such. There is reliable testing for the condition, and if you are worried you may have celiac- get tested.

Second- I have had way too many patients come in on gluten free diets that do not have celiac or gluten intolerance, after having been told by someone that this will help them with their back pain, fibromyalgia, or other painful condition.

I will state this as clearly as I can: If you do not have celiac disease, a gluten free diet will do NOTHING for you. It is an inconvenient and potentially expensive diet to follow. So don’t do it if you don’t need to!

If you DO have celiac, there is plenty of anecdotal evidence that suggests that in addition to all of the other GI symptoms it may cause, there can be associated joint pain- and back pain. In my own patient population, this seems to be one of the last symptoms to go away once a patient has transitioned to a gluten-free diet, so be patient and see if it makes a difference in your pain.

As for dairy- and in this case, this is purely anecdotal- it seems that some patients who DO have celiac disease have an unusual intolerance to some dairy products (that do not contain glutens) which can sometimes cause them fatigue, joint discomfort, and a few other often hard-to-pin-down symptoms. It is much easier to go dairy-free than it is to remain gluten-free, so this is an easier one to do your own trial with.

What are your experiences with celiac disease and back pain? Have you made any other dietary changes which have helped improve your symptoms? Share you experiences here on the blog.

Thanks for stopping by,

-Andy

Going gluten-free can be expensive and difficult- especially when cupcakes are involved! Be sure to check if this is something you really need.

Tags: , , , , , , , , , , , ,
Posted in Fibromyalgia, Nutrition | 4 Comments »

Medications for Fibromyalgia…

Sunday, April 10th, 2011

Over the past two or three weeks, several patients have asked me about different medications for fibromyalgia. Specifically, people wanted to know what medicine recommendations I generally make for treating this difficult and painful condition. The problem is, I don’t make any general recommendations for fibromyalgia, as I think that there are probably a few different, hard to differentiate conditions we have generally grouped together and labeled ‘fibromyalgia.’

This belief comes from clinical experience- there are some patients who respond well to a given medication, and those who have no response whatsoever. Others who find dietary links to their pain, and others who notice no relationship at all.

So, rather than making a blanket recommendation regarding medications for fibromyalgia syndrome or FMS, I thought I would review some of the broad categories of medications available and explain their use. Let’s take a look:

Pain medications: These drugs have a huge range of strengths, and their efficacy is highly variable from patient to patient. Mid potency non-narcotic pain killers such as Ultram and Ryzolt help some patients, and have the benefit of being less sedating and less assisting than narcotics. Commonly prescribed narcotics such as Percocet have more pain relieving ability, but are somewhat more addictive, and have other side effects including severe constipation and somnolence.

Interestingly, when I said there is variation from patient to patient, there is a subgroup of patients with FMS who get no relief from any pain medications.

SSRI’S and other antidepressant medications: This is always an interesting part of any discussion about FMS- as there is a contingency of physicians who believe strongly that FMS is a psychological condition- their argument being bolstered by the fact that some patients get relief from antidepressant medications. My response is this: if you are in pain 24/7 and you aren’t at least a little depressed, there is something wrong with you.

Doctors have been using these medications for chronic pain management for some time, and ‘old school’ medications such as Elavil have had some good effects for some of my patients. More recently, drug companies have started formulating SSRI medications specifically for the management of pain, such as Savella- which for the right patient is a wonderful drug.

These meds have the advantage of having a relatively low side effects profile when properly dosed.

Anti-inflammatory medications: Anti-inflammatories or NSAIDs have found some use in the treatment of FMS. Like pain medications, they seem to have a subgroup of patients for whom they work, and others for whom they do nothing. There is a huge select of different medications in this category, in various strengths. While these drugs are essentially safe, they can be hard on the stomach for some patients and should be taken with food. Also, since these medications are excreted by the kidneys they should not be used in patients with kidney issues or poorly controlled diabetes.

Neurontin / Lyrica: These medications work on the central nervous system, and they essentially raise the firing threshold- the minimal input from a nerve required for it to send a signal- of the nerves causing pain. Originally used as an anti-seizure medication, Neurontin has a relatively benign side effects profile- the most common problem being somnolence- which usually goes away after the initial dosing phase. There is a very wide range of prescription doses, and finding the right level can often take some trial and error. Another benefit of this type of medication is that they interact poorly with vey few drugs, making them a good choice for patients with other medical problems.

This is just an overview of the major groups. There are others, as well as some alternative and supplemental therapies which I won’t go into at this time.

What have your experiences been with FMS and medication? Have you found any ‘wonder drugs’? Please share your experiences here on the blog.

Best,

Andy

Only 4 weeks until Kylie returns to New York. Here she is singing with my daughter Ella. Who’s waiting in line with us?

Tags: , , , , , , , , , ,
Posted in Fibromyalgia | No Comments »

Another practitioner claiming fibromyalgia is a psychological disorder…

Sunday, November 7th, 2010

Every once in a while, I get a viewer question on this topic. This one comes from a viewer on the my YouTube channel, backtogethertv:

“Great video :o ) You are very clear and easy to understand, which is very important when educating people. What would you say to a psychologist that claims that FMS is purely a psychological disorder and not a “real disease”? This is what my counselor told me yesterday. I have severe chronic pain from multiple causes,when it came up in our session yesterday that FMS is one of my Diagnoses she flatly said “FMS is a psychological disorder.It is not a real disease.” What would you say in response?”

First, thanks for your question.

Now, if you’ve done some research, you probably know that fibromyalgia is one of those conditions that tends to divide the medical community. There are those who feel it is purely a psychological condition, and others like myself who recognize it as a painful physiological condition.

In my clinical experience, stress, anxiety and other physiological conditions don’t actually cause any physical problems- they take the ones you have and make them worse.

Fibromyalgia, or FMS has some pretty well defined physiological findings associated with it- specifically the presence of trigger points (painful points which cause referred pain elsewhere when touched.) These points are a physical finding identified on exam, and follow relatively consistent patterns from patient to patient. While often a diagnosis of exclusion, the complete diagnosis includes the presence of 11 of 17 ‘classic’ trigger points, again which are largely present from patient to patient.

Feel free to ask your therapist to research something called the Copenhagen Declaration, which was presented in 1992 at the conference of the World Health Organization which specifically asks clinicians to recognize fibromyalgia as a physiological condition and stop writing it off as psychological.

Hope this helps,

Andy

Tags: , , , , , , , , , ,
Posted in Fibromyalgia, Viewer Question | No Comments »

Fibromyalgia Part 4: Some thoughts on exercise.

Monday, August 30th, 2010

One of the most complicated aspects of managing the symptoms of fibromyalgia is integrating exercise into your daily routine. On the one hand, cardiovascular exercise has multiple health benefits which are largely understood, and regular movement has been shown to help reduce the symptoms of fibromyalgia. On the other hand, if you try to exercise and overdo it even a little, you find that your FMS symptoms are way worse than they were before.

Here are some suggestions for integrating exercise into your life without exacerbating your FMS symptoms:

-If you have not been exercising, start off slowly. A short walk. A light jog or swim. Resist the temptation to go full out.

-If you use weights, be sure to go lighter weights with a moderate amount of reps. The conventional wisdom is that higher weights and low reps build muscle, and high reps with lower weights for tone. FMS presents a special set of issues, so go with lighter weights and fewer reps- but more sets spread throughout the day (This is easy if you have a few lighter dumbells in your home.)

-As always, hydration is key. Water before, during, and after your exercise will help to keep the myofascial layers (where the trigger points associated with fibromyalgia live) good and lubricated.

-For FMS, I love water based exercise. It reduces stress and impact, and is generally more gentle than land based exercise. Water walking, water aerobics, a light swim- these are all great choices.

-Take a few minutes, several times a day to gently stretch your large muscle groups. Non-ballistic (NO BOUNCING) stretches will help decrease the sensitivity of trigger points, and keep you more comfortable.

What are your experiences with FMS and exercise? What has helped? What has made things worse? Please share your thoughts here on the blog.

Thanks for visiting- see you soon.

-Andy

The Royal Albert Hall, Kensington.

Tags: , , , , , , , , ,
Posted in Fibromyalgia, Tips | 1 Comment »

Live From Fire Island: Fibromyalgia Part 3

Monday, August 23rd, 2010

fibro3fireisland

The next part in my short series on fibromyalgia syndrome. This one focuses on some common misconceptions about fibromyalgia, and then discusses one of the first things you can do to help get your symptoms under control.

Thanks for all of your kind comments and suggestions. I look forward to seeing you soon.

Be well!

-Andy

Tags: , , , , , , , , ,
Posted in Fibromyalgia, Tips | No Comments »

Fibromyalgia: It’s not in your head PART II…

Monday, August 16th, 2010

Thanks for your kind responses to the FMS piece from last week. I kind of suspected I had some FMS sufferers as readers- but I really didn’t know how many.

In this part of the post, I would like to review what Fibromyalgia Syndrome (FMS) is, and almost more importantly, what it is not.

I posted a video on this topic a while ago- and since that time, for reasons I cannot explain, the number of patients with FMS in my own practice has more than tripled. This post will be a little different, as I would really like to focus on eliminating the notion that somehow FMS is a psychological condition.

FMS is what is known as a diagnosis of exclusion, meaning, there are no diagnostic tests or radiologic studies that can confirm the diagnosis, rather, after you haver ruled everything else out you can then start considering FMS as the likely diagnosis.

Some of the conditions which can (depending upon the stage of the illness) symptomatically be similar to FMS:  Lupus (SLE), scleroderma, Lyme disease, MS, chronic fatigue syndrome (CFS), rheumatoid disease, and depression. There are others, but these are some of the most common. The thing with each of these diagnoses is that with the exception of CFS and depression, there are clear diagnostic studies that can be done to confirm or reject the diagnosis. Depression is reasonably well understood, and the diagnosis is not that difficult to make in most instances. The interesting thing about CFS and depression is that they often accompany fibromyalgia.

Once you have ruled those things out, you can begin to consider FMS as a diagnosis. Now, there are certain criteria which you look for all of which should be exhibited to confirm FMS as your diagnosis:

-There are 17 classic trigger points (tender point which trigger pain in a different location than the one being touched) which are commonly associated with FMS. A patient should demonstrate 11 of these 17 points, and not necessarily all at the same time.

-FMS is non-articular, meaning it does not directly affect the joints.

-Patient has fatigue levels which do not change appreciably, regardless of the amount of sleep/rest they get.

-There is a somewhat higher incidence of depression in fibromyalgic patients or ‘fibromites’ than in the general population.

This last point is what directs many in the medical community to continue to hold on to the notion that FMS is a psychological issue rather than a physical one. As someone who has had two periods of time in his life addled by extreme pain, I can tell you this- I defy anyone in pain 24 hours a day, 7 days a week to not be depressed. In 1992, the World Health Organization met in Copenhagen, and produced what became known as the Copenhagen Declaration. In this document, the WHO asked the medical community at large to stop writing off FMS as a psychological condition and start treating it as a physiological one.

That was 1992. Why are so many physicians still so reluctant to accept this?

Wednesday, I will review some of the treatment options available for FMS.

Thanks for stopping by!

-Andy

The lovely Chateau Frontenac, Quebec City, Canada.

Tags: , , , , , , , , , , ,
Posted in Fibromyalgia | 2 Comments »

Fibromyalgia- This is NOT in your head!

Wednesday, August 11th, 2010

For some reason, I have seen a literal deluge of emails and questions about fibromyalgia, and there seems to be one common theme throughout most of them- each of the patients dealing with fibromyalgia syndrome or FMS, has been told by a physician that their condition was ‘in their head’, and that essentially they were just going to have to ‘get over it.’

A little background…

When I was an intern and resident, each month I would spend time with preceptors in different specialties, learning the essentials for the practice of medicine. One of the interesting things I observed during that time was the various ways different physicians dealt with FMS. When some docs saw the diagnosis on the medical chart they recognized it for what it was (a really painful condition) and treated the patients with care and compassion. However, there was a fair number of physicians who upon learning that the patient they were about to see had FMS rolled their eyes, got annoyed, or worse would announce to me that ‘our next patient is a head case.’ They would often go on to explain that FMS was a psychiatric condition (which it is not) and that FMS was caused by stress and depression (which it is also not.)

A word about stress…

So that we are clear, stress alone does not cause anything (except perhaps more stress.) What stress does do is take whatever condition you are dealing with and makes it worse. Stress can make your hypertension worse . It takes the pain from your ulcer, and makes it worse. It makes your migraines worse. It makes the symptoms of FMS, and makes them worse.

A word about depression and FMS…

Some doctors point out the fact that many patients with FMS are also suffering with depression, and use that as the basis for their argument that FMS is a psychiatric condition. Hear is the deal- if you are in pain 24 hours a day, you are going to get depressed. This happens with patients who have had surgery and have postoperative pain. It happens with people passing kidney stones. It happens with people who have orthopedic conditions which prevent them from participating in life. These aren’e psychological conditions- and neither is FMS.

Over the coming weeks, I will be posting some thoughts on FMS, many based upon my experiences with real patients, and some responding to the questions I’ve received over the past couple of weeks. Please share your experiences with FMS here on BackWords. I am really interested to hear what you have to say.

Thanks for stopping by!

-Andy

Tags: , , , , , , , , , , ,
Posted in Fibromyalgia | 1 Comment »

Fibromyalgia Part 3: Medications / Drugs for Fibromyalgia

Monday, February 15th, 2010

Welcome back!

I hope you all had a great Valentine’s Day and Chinese New Year. We celebrated both events yesterday with the whole family in Chinatown, where we saw the Dragon traveling up and down Race Street ushering the new year. I attached a short video of the dragon leaving one of the restaurants in the city (It was WAY too crowded to try and capture the Dragon in the restaurant- but it was really a beautiful spectacle.)

IMG_0176

Onto Fibromyalgia Part 3: Medications for Fibromyalgia…

Thanks for returning for Part 3 of the fibromyalgia mini-series- So far we’ve covered what fibromyalgia syndrome (FMS) is, how it is diagnosed, some lifestyle modifications and considerations which can help FMS, as well as some psychological approaches to dealing with the discomfort of FMS.

As you may be aware if you are a regular visitor to BackWords, I generally try to find the most conservative ways of dealing with pain, so it is no surprise that I have saved the medications portion of the series for last.

I should start off by saying that there are no great medications for FMS- just a few things which can help the symptoms to varying degrees. I group then broadly into three categories: Pain medications, Neurological medications, and ‘others.’

Pain Medications:

Several weeks ago, I did a post about pain medications which you can review here. Any of the categories of pain medications can be used to help reduce FMS pain- although as a rule, these medications, regardless of category seem to be less effective for FMS pain than they are for other pain conditions/syndromes.

I will often meet new patients with FMS who have come from other physicians with myriad prescriptions for everything from anti-inflammatory (such as ibuprofen) to narcotics (such as Percocet or Oxycontin), and pretty much all of them are frustrated with the poor level of pain relief they get, and are also often saddled with all of the side effects which go along with those medications. I discussed the side effects at length in the aforementioned post. As you already know, FMS carries with it a whole host of symptoms, and the side effects are not a welcome addition to the discomfort patients are already suffering.

That being said, I will still use pain medications during a ‘fibro flare’ where patients have a severe exacerbation of their symptoms due to drastic changes in the weather, increased stress, or other factors.

Neurological Medications:

There are several medications which work on the neurological component of FMS- the four most common are Nuerontin (gabapentin), Lyrica (pregabalin), Klonopin, and Savella (milnacipran.) These drugs all began their lives as anti-siezure medications, and found their way into the FMS world over time.

These medications work by raising the firing threshold of a nerve, or the minimal amount of stimulation required to cause a sensory nerve to respond. The theory is that ‘fibromites’ have increased sensitivity to pain because their firing threshold is too low.

These drugs are a mixed bag in terms of efficacy. They seem to be really effective for some people, and provide practically no results for others. The most common side effect for all of them is fatigue and somnolence- which is a problem in itself as fatigue is already one of the most prevalent symptoms of FMS. The good things about this group of medications is that they are pretty benign (Neurontin in particular), in as much as they don’t interfere with many medications. A key recommendation I make to patients is that if they try these medications (Neurontin and Lyrica in particular) is that they should start with a low dose and taper up slowly. In this way you can a) get away with the smallest dose possible and b) minimize the side effects.

Others:

There are several other medications and supplements which patients have used with varying efficacy for their FMS symptoms, and they are in several categories- let me just give you a couple of examples…

Guaifenesin is a mucolytic / expectorant medication common in many cold medications. Many physicians feel it helps lubricate soft tissue and improve flexibility by reducing stiffness. I have had some success with patients utilizing this medication- and here, the good news is that this med is relatively low in side effects. For most patients there is no real down side to trying it.

Patients with the worst fatigue symptoms have reported success utilizing a medication known as Provigil (modafinil) to help reduce their fatigue. I personally have little clinical experience with this medication. If you are considering it, be sure to have a conversation with your physician to understand its use/ benefits/ and risks.

There are many other medications and nutritional supplements out there with  claims to be beneficial for FMS. There are too many to review here. The bottom line here is that there are lots of options, all with varying degrees of efficacy, and highly variable side effects profiles- so my parting though with medications is that if you are trying medications, try one at a time in order to really gauge what they are or aren’t doing for you.

Conclusion:

I hope this 3 &  1/2 part introduction to FMS has given you some useful information. In my clinical experience treating this enigmatic condition, it has slowly become clear to me that the thing we are calling Fibromyalgia is likely several separate conditions that we do not yet possess the knowledge to accurately differentiate. This is supported by the observation that things that can provide fantastic benefit to some patients have absolutely no benefit for others.

One thing is abundantly clear: no matter what the ‘flavor’ of FMS a patient is experiencing, all forms benefit from an active lifestyle.

Thanks for visiting. Look for my series on spinal surgeries to begin later this week.

Be well!

-Andy

IMG_2476

Tags: , , , , , , , , , , , , ,
Posted in Fibromyalgia, General Health Information, Low Back Pain, Neck Pain, Tips | No Comments »

Fibromyalgia: Part 2.5 (had to throw in a little extra!)- Psychology

Tuesday, February 9th, 2010

The response from viewers about the fibromyalgia pieces has been remarkable- not because the piece was so great (I hope it was good)- but more because so many were happy to see anybody writing about it at all. This condition can make sufferers feel so alone and alienated- the letters I received were grateful for the coverage.

People with fibromyalgia syndrome (FMS) often feel overlooked, largely because a fair number of physicians (not me!) feel that it is a psychological rather than physical condition. As I stated in a previous post, this belief is fostered by the fact that many FMS sufferers get relief from antidepressant medications.

The psychological ramifications of any pain syndrome can be wide reaching, and the tips I outline below will be beneficial to anyone suffering with pain.

-Pain can cause people to give up hobbies and pursuits which might otherwise give them opportunities to relax. Latch on to the things you enjoy, and slowly introduce them back into your life, even if this introduction can be uncomfortable at times. I have a friend with FMS who began tango dancing several years ago, and she will tell you her symptoms would be way worse without this activity/diversion.

-Take a few minutes out of each day to focus on, and feel gratitude for the times of day where you don’t feel pain, or simply feel less pain. It can be easy to fall into the trap of feeling as though you always feel terrible. Think about the various times of day; are there times you feel better or worse? Try to take advantage of the times you feel less pain.

-Maintain a moderate level of physical activity. As I mentioned in part 2, physical exercise is often abandoned as FMS sufferers think they would be better off resting. Worst idea- find physical activities you can do- and DO THEM. A sedentary lifestyle is extremely deleterious to FMS symptoms- and you will experience the added benefits of exercise.

-As you know, my ‘thing’ is the couples/partners approach to pain management. If you are fortunate enough to have a partner or spouse, participate in ‘normal’ activities. Don’t allow your significant other to treat you like broken china- if you do, you will become broken china- if you get my meaning.

I just wanted to throw these few extra thoughts into the mix. Stay tuned for Part 3: Medications for Fibromyalgia.

If you missed parts 1 & 2, here they are:

Part 1: What is fibromyalgia?

Part 2: Lifestyle modifications which can help fibromyalgia.

Thanks for joining me, and thanks for your questions & comments.

-Andy

Enjoy this video of Argentinian students visiting South Beach, Florida. I had so much fun watching them have fun:

argentina

Tags: , , , , , , , , ,
Posted in Fibromyalgia, General Health Information, Tips | No Comments »

Part 2 of fibromyalgia series- lifestyle modifications that help.

Monday, February 8th, 2010

In the first part of this 3 part series on fibromyalgia, I provided a brief definition of fibromyalgia. You can revisit that video post here. Below are the main points:

-Fibromyalgia is tricky to identify, as there are no definitive diagnostic tests to confirm the diagnosis.

-Fibromyalgia may cause pain, often debilitating, in any region of the body. It occurs bilaterally, upper & lower body.

-It is non-articular (does not directly affect joints.) It affects soft tissues- particularly muscles.

-It can be partially identified through the presence of trigger points- tender areas that cause radiating pain elsewhere.

-There are 17 ‘classic’ trigger points, and sufferers need only have 11 of them to ‘rule in’ fibromyalgia.

-These points need not occur simultaneously, and may reveal themselves over time.

-Fibromites (folks with fibromyalgia) experience fatigue, poor sleep, difficulty focusing, and other symptoms.

Some things you can do for fibromyalgia:

Like any painful condition, fibromyalgia can affect virtually every activity in which you participate. The pain from this enigmatic syndrome can often be reduced with some simple lifestyle modifications:

-Remain active. When in pain, it can be tempting to try and ‘rest’ in an effort to calm pain. With fibromialgia syndrome (FMS), remaining sedentary seems to worsen the pain and stiffness. FMS seems to improve with moderate amounts of cardiovascular exercise, several times a week.

-Stretch. Take a few minutes twice a day to gently stretch the back muscles. Be sure it is a gentle dynamic stretch which lengthens muscles slowly over time. Never perform a ballistic stretch in which your body ‘bounces’ to enhance a stretch.

-Defend your sleep. Protect your sleep by making your bed as comfortable as possible, Use supportive pillows, and be sure your mattress is not too old. Be sure to have curtains which block out the morning sun. If ambient noise is a problem, try a white noise generator (there are lots of alarm clocks which offer this feature for around 30 bucks) or an electric fan can often provide some of the same benefit. Get to bed at roughly the same time each night, allowing for adequate rest.

-Avoid diets high in dairy, gluten and refined flours.

-Remain adequately hydrated. This one tip can occasionally do more than all the other ones combined. Several glasses of water a day can do much for some patients. The thinking is that trigger points are caused by accumulations of waste products in the soft tissue, and that ‘flushing’ these waste products out via the lymphatic system will help to reduce the pain from these points.

-Take a moment to breathe. Take a few minutes, several times a day to do a few deep breaths. Inhale deeply & slowly through your nose, and gently push the breath out through pursed lips until there is nothing left, then repeat a few times. These types of breaths stimulate something called the thoracic duct which helps to clear more debris from your lymphatic system.

-Relax & Enjoy! Chronic pain often undermines pretty much all ‘normal’ activities. There is a definitive, universally recognized link between your body and mind. Try to reincorporate enjoyable activities back into your life- even if they are a little difficult at first, the long term benefit to your psyche is immeasurable.

These tips alone will not rid you of your fibromyalgia pain, but they will likely help. As always, please share your experiences- those things which have helped and those which haven’t.

Thanks for joining me. Look for Part 3: Medications, later in the week.

Be well!

-Andy

Glass 'Doors' by renowned artist Steve Tobin, Allentown PA

Glass 'Doors' by renowned artist Steve Tobin, Allentown PA

Tags: , , , , , , , , , ,
Posted in Fibromyalgia, General Health Information, Tips | 2 Comments »

« Older Entries