Now, I’m not going to go into a long rant about this, but let me briefly respond in two ways:

First, antidepressant medications have long been used as an adjunct therapy for treating chronic pain- in particular, the class of drugs known as SSRI’s have been known to help reduce chronic pain.

Secondly, and in my opinion far more important, is the fact that your physicians don’t recognize the mind-body connection. It would be unreasonable to believe that someone in chronic pain would not eventually develop symptoms of depression- which would make the perception of their pain worse. Conversely, it makes complete sense that by relieving the depression symptoms that your pain would improve.

All of the systems of your body interact in various ways, and your psychological state governs how you perceive sensations from any of these symptoms. I’m sorry your physicians don’t acknowledge this connection, because it is real, and has ramifications on how you feel every day.

If you are dealing with chronic pain, perhaps you should consider finding a physician more understanding of your situation.

Thanks for your letters. I am writing a post for Martha Stewart’s Whole Living Daily blog this week about the winter blues, how they can effect your pain, and what you can do about it.

Be well!

Andy

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

Martha Stewart Whole Living Daily

Bronze 'Roots' by Steve Tobin, installation in Pocono Mountains, PA.

Hobbies can be pushed aside when you are suffering from back & neck pain, which is particularly sad as hobbies and passtimes can do so much to restore a sense of normalcy and help psychologically when you are hurting. Think about some of the things you really enjoy, and find ways to bring them back into your daily activities.

-Set aside some time, several times a week to do the things you love. Again, obvious, but we all get so wrapped up in the stuff we have to do, that we often forget to make room for the things we like to do.

-If your hobby exacerbates your pain, perhaps finding an adjunct to your hobby can provide some satisfaction. For example, if you are a bodybuilder dealing with a bout of low back pain, while now is probably not the time to resume bodybuilding- maybe you could train someone else, or better yet- write an article about your experience and send it to me here to post on the blog!

-You may have to modify how you participate in certain activities. In Susan’s case (from the video) she had to take regular breaks while painting in order to remain comfortable. When I had low back pain following an accident, I  found that frequently changing the height of my piano bench helped prevent discomfort. You may need to experiment to find what works.

Our bodies and minds are so tightly linked, that leaving the activities you love behind will most certainly contribute to your pain. It may take some trial and error to find ways to make it work- but do the things you love- you will almost certainly feel better.

Be well!

-Andy

A view of our little patio garden- one of my hobbies.

“Don’t overidentify with your back pain. There are far more interesting things you and I should be known for.”

I was so happy to read this!

So many people suffering with back & neck pain start to accept their pain as being such a fundamental, unavoidable component of their lives, that it actually starts to become part of their identity- shaping all they do, and influencing their attitudes about just about everything. Now that’s not to say that pain doesn’t or shouldn’t effect your life when you are suffering- that would be unreasonable. What I am concerned about is something more insidious.

I often make a differentiation between a person who is sick, and a sick person. Let me explain…

Assume there are two people with the same physical medical conditions:

The first, a person who is sick, wakes up and says “I am very sick, and it will be really difficult to all of the things I need to do today.”

The second, a sick person, wakes up and says “I am very sick, and I won’t be able to do all of the things I need to do today.”

It is a subtle distinction, but an important one.

When you are in pain- especially if the pain lingers for a while- it can so easy for it to become part of your who you are. You can see why- it’s always there- reminding you of its’ presence.

It is really important to avoid this quagmire, as it changes who you are, and gives the pain more power over you than it should. There are a few things you can do to help:

-Take a few minutes out of the day to reflect on those times when the pain was not so bad.

-Find gratitude for all of the things in your life which may be going well, so you don’t start to believe that nothing is right.

-Even if they are uncomfortable, try to participate in some of the activities you normally would.

-Remind your partner that you are still you, even when you are in pain. Don’t allow them to treat you as though you are fragile. That approach will only worsen matters, and make it harder to get out of this mindset, as you now have a reinforcer.

-Make sure you don’t give up on hobbies and diversions, even if it means modifying your participation in the activity (You may not be able to go horseback riding when you are in pain, but perhaps you could instruct kids on how to ride.)

These are just a few suggestions. It is critical to your overall well being that you not allow yourself to become your back pain.

Thanks for stopping by.

-Andy

My good friend Jorden Gold doing facilitated stretching on former Eagle, Chad Lewis

An article in the Proceedings of the National Academy of Sciences describes a gene which has been identified as SCN9A which plays a role in how you tolerate pain. Researchers found this gene was ‘underrepresented’ in patients suffering from rare conditions where patients don’t sense pain, and that it was over active in patients who had hypersensitivity to pain.

Now this news is probably not real comfort to you if you are hurting at this very moment. But clearly, there need to be other factors which can influence how you experience pain, otherwise you wouldn’t have ‘good days’ and ‘bad days.’

Here are just a few thoughts on getting more ‘better days.’…

-If you stick around this blog long enough, you will know what a big role I feel psychology has in how you feel. More and more studies cite the importance of the mind-body connection. Knowing this, take a few minutes out of each day to improve your psychology- this can come from meditation, a hobby, reading- doesn’t matter what- JUST DO IT!

-Regular exercise will keep your body ‘lubricated’ and as close to peak as possible. Take a few moments out of your day to work on your fitness.

-Maximize the quality of your sleep. Good sleep gives your body a chance to recharge and recuperate- both physically and mentally.

-Give yourself time for good social interactions- both with your partner/spouse and with friends. These interactions help solidify your feelings of worth and participation in community- key positive emotions.

These are just a sampling of the things you can do. Check back here often for more tips, and if you have specific questions or comments about your personal situation send ‘em in- as always, your contributions are what keep this place interesting!

Be well!

-Andy

My father & I with the late, great Oscar Peterson- the greatest jazz pianist ever.

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