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.

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

I will resume the fibromyalgia series and some other cool things at that time. Sorry for the wait, and sorry for the inconvenience.

See you Monday!

-Andy

I have been working feverishly on finishing the Back Together iPad application, and as it starts to come together it is looking more and more like something special. I have integrated some features that have never been done before in any back pain program, or on any iPad application for that matter. I will have a better sense of the release date with in the next week or so- so stay tuned for updates.

Fibromyalgia Syndrome Series

I have gotten plenty of feedback on the first two parts of the fibromyalgia series- mostly complementary or in the form of requests for aspects of the condition people would like to see covered here on the blog. I did receive 3 emails from pain-sufferers with a completely different take on the syndrome. I posted and replied to one of them yesterday. It seems that even though most of the medical community accepts and understands the diagnosis of FMS to be a real diagnosis, there are still hold-outs.

The main issue I have with these hold outs is that people suffering with fibromyalgia syndrome often feel as though the deck is stacked against them already, without other individuals falsely stating that their diagnosis is wrong, or is something else altogether. I welcome constructive discussion on the topic, so please share your thoughts here on the blog.

See you tomorrow!

-Andy

Katz's Deli on the Lower East Side of Manhattan. You know, you still can't get a good corned beef sandwich in Philadelphia?

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.

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

In the US, this is a way more complicated issue than it is where this conversation took place- Jamaica, where marijuana is often viewed as a cultural staple.

There has been a lot of discussion recently about the changing laws regarding marijuana use for medicinal purposes. Several states have modified or completely rewritten their laws in recent months to either make pot easier or harder to get, depending upon where you live and upon your particular circumstances.

I don’t want to get into the legal aspects of marijuana use- it is far too complicated an issue to get into here. This wedding guest asked me point blank whether I thought pot was useful for the treatment of low back pain.

My answer to this question is in three parts:

1) I think marijuana is a good muscle relaxant, and additionally reduces the perception of pain such that pain sufferers do not notice it as much.

2) Too much marijuana can ultimately decrease your activity levels, keeping you from going out and re-establishing good body mechanics as the source of your pain heals/resolves. And…

3) there is frequently some weight gain associated with pot smoking (the oft cited ‘munchies’ are to blame) which can get in the way of recovery.

I have several patients from around the world who use pot as a method of reducing their pain, and for them it works. I would not condone using something that is illegal, but perhaps that situation will change in the not too distant future. In the mean time, there are several legal alternatives to marijuana- not the least of which would be one of Back Together’s fine products….

Thank you for visiting today. Please keep those cards & letters coming- you help to keep the discussion interesting.

-Andy

Half Moon, Rose Hall Jamaica

I love when I can learn about local remedies and treatments for back & neck pain. The chef at the hotel made it a point of telling me that this unusual looking fruit- the soursop- was good for treating low back pain. I looked it up on line, and apparently it can also be useful for headaches, skin disorders, blood pressure problems, as well as sexual dysfunction.

Do you have any experience with foods which have helped you with any health issues? How about back pain? Please share them here.

Thanks for visiting,

-Andy

I am working on some posts from Montego Bay Jamaica- look for them to start tomorrow.

Thanks for visiting!

-Andy