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Friday, September 4, 2015

Is Fibromyalgia a Psychosomatic Illness? Med Student Asks Celeste Cooper






I received a request from a medical student taking an abnormal psychology class. He wanted to know if I thought fibromyalgia was a psychosomatic disorder.




The Psychology Dictionary defines psychosomatic disorder as:
Psychosomatic disorders are those in which psychological factors play a major role in the origin or course of the disorder.

Following is my response


[Medical student,]

You are offering others a great opportunity to learn by writing on this topic. I hope to give you the information you need [regarding whether fibromyalgia is a psychosomatic illness or not]… I will answer your questions bluntly.

"Fibromyalgia is NOT a psychosomatic illness."

While talk therapy, biofeedback, mindfulness for any chronic illness is important for coping, it will not cure or even eradicate symptoms from a physical underlying disorder. This is also true for fibromyalgia. There are many people, including myself, who have been through extensive therapy with the hopes that we could find something to help our pain. My co-author began as my therapist. He assured me that I do not have a psychosomatic illness, and encouraged me to validate that with a psychiatrist, which I did, and it was found that I do not. 

The Right Diagnostic Criteria is Critical to Understanding Fibromyalgia

Unfortunately, Dr. Frederick Wolfe has done a great deal of damage to the fibromyalgia patient. He has touted his criteria for diagnosing FM as the American College of Rheumatology criteria. I wrote to the ACR on this and they tell me they have NOT endorsed Dr. Wolfe’s or anyone else’s criteria. See my blog, [The ACR Responds to My Inquiry on the Fibromyalgia DiagnosticCriteria—Should I Scream or Cry?]  It is my understanding that the ACR is publishing an erratum on this matter in an issue of Arthritis Care and Research.

Dr. Wolfe resurrected the antiquated notion that fibromyalgia is a psychosomatic illness with his research on prevalence offibromyalgia in the German community (Wolfe, et. al., 2013).  What you don’t know is that he took a validated tool for assessing severity of somatic symptoms, the PHQ-15 (Kroenke, et. al., 2002) and tweaked it.

Dr. Wolfe’s “short form,” called the PHQ-8, regarded:

  1. stomach or problems going to the toilet
  2. pain in the back
  3. pain in the arms, legs, or joints
  4. headaches
  5. chest pain or getting out of breath
  6. dizziness
  7. feeling tired or having low energy
  8. trouble sleeping

First, why are stomach problems and problems going to the toilet lumped together? The PH-15 divides these somatic symptoms between 1) stomach pain 2) constipation, loose bowels or diarrhea and 3) nausea, gas, or indigestion. Secondly, is it 4) chest pain, or 4a) shortness of breath? These are divided in the PHQ-15. Where is the assessment for 5) fainting and 6) feeling your heart race? Patients with fibromyalgia do have 7) pain with intercourse, particularly if they have comorbid chronic pelvic pain. This “short form” could affect the outcome regarding severity of symptoms when compared to the validated PHQ-15 tool. Isn’t it possible that the validated tool is validated because of the way the questions are asked?

He even says, “The PHQ-15 is best characterized as a measure of somatic symptom severity.” So why didn’t he use it? That is the $100,000 question. Why did this escape a peer reviewed journal editor? 

The Role of Fibromyalgia Diagnostic Criteria

Roland Staud, MD et. al. (University of Florida, Gainesville, 2010) had this to say, in part, about the provisional diagnostic criteria which was later modified, but they bring up some good points to help with your questions.

“...After a series of analyses, Wolfe et al concluded that a widespread pain index was the best predictor of FM. When this index was excluded from the analysis, key predictors of FM were nonrefreshing sleep, fatigue, cognitive difficulties, and a host of somatic symptoms... there is a glaring omission of well-known mechanistic FM features, such as hyperalgesia, central sensitization, or dysfunctional pain modulation...Also, the somatic symptom list is extremely broad somatic symptoms, and the symptoms are ordered by neither relevance nor predictive value, etc., supposedly contributing equally to FM. In conclusion, whether or not these new criteria are easy to apply by practicing physicians will require empirical testing. Unfortunately, the new criteria are imprecise, ill-defined, lack mechanistic features, and are completely symptom focused…”

This has been my opinion as well. To simply list somatic complaints without further investigation is cause for alarm. The ACR suggests comorbid conditions, tension headache or migraine, digestive problems (i.e. irritable bowel syndrome, gastric reflux) irritable or overactive bladder, pelvic pain, and temporomandibular disorder, causing face or jaw pain, jaw clicking and ringing in the ears. And, they recognize depression or anxiety as a disorder that can accompany fibromyalgia, which can accompany any chronic illness. (Accessed 6-26-2015).  Other things may explain the somatic complaints, such as hypothyroidism, cancer, and much more.

Dr. Katsuhiro Toda (Japan) wrote a letter to the editor or Arthritis Care and Research on the provisional criteria, (Wolfe, 2010) which you can access here. And,  he wrote a letter  tothe editor of the Journal of Rheumatology, The Modification of the American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia Should Be Supplemented and Revised (Wolfe, 2011) of interest. “…In Japan, many physicians have ignored fibromyalgia. Therefore, patients with fibromyalgia are often diagnosed with psychogenic pain or somatoform disorder…”  

You might also be interested in seeing this editorial in the journal “Rheumatology.”  and Dr. Smythe’s article, which also outlines the lack of specificity in the Wolfe criteria.

Dr. Robert Bennett has contributed over 500 papers on fibromyalgia, he is considered an expert, and he led the research for theAlternative Diagnostic Criteria (Bennett, et al., 2014). You can read my blog regarding the criteria, and on my website.

I encourage you to visit my blog, look in the archives and you will see that I have written on MANY topics regarding fibromyalgia.   

Be sure to search PubMed. Connect the dots by searching fibromyalgia along with any one of the comorbid disorders. For instance, a study just published on fibromyalgia and migraine. You will find there has been more than one connection made between fibromyalgia and small fiber neuropathy and fibromyalgia too.

I have found that when one person has a question, someone else will too. Therefore, I will be sharing this information on my blog.

I am attaching a resource list for you and I will include reference to some recent studies that might help you. Good luck and please keep me updated. I would love to see what you come up with for your class.

Best regards, Celeste Cooper


Resources:


Bennett R, Friend R, Marcus D, Bernstein C, Han BK, Yachoui R, Deodar A, Kaell A, Bonafede P, Chino A, Jones K. Criteria for the diagnosis of fibromyalgia: Validation of the modified 2010 preliminary ACR criteria and the development of alternative criteria. Arthritis Care Res (Hoboken). 2014 Feb 4. doi: 10.1002/acr.22301. [Epub ahead of print]

Kroenke K1, Spitzer RL, Williams JB. The PHQ-15: validity of a new measure for evaluating the severity of somatic symptoms. Psychosom Med. 2002 Mar-Apr;64(2):258-66.

J Rheumatol. 2011 Jun;38(6):975-8. doi: 10.3899/jrheum.110142.

Staud R, Price DD, Robinson ME. The provisional diagnostic criteria for fibromyalgia: one step forward, two steps back: comment on the article by Wolfe et al. Arthritis Care Res (Hoboken). 2010 Nov;62(11):1675-6; author reply 1676-8. doi: 10.1002/acr.20290.

Toda K. Preliminary diagnostic criteria for fibromyalgiashould be partially revised: comment on the article by Wolfe et al. Arthritis Care Res (Hoboken). 2011 Feb;63(2):308-9; author reply 309-10. doi: 10.1002/acr.20358.  


Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Katz RS, Mease P, Russell AS, Russell IJ, Winfield JB, Yunus MB. The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care Res (Hoboken). 2010 May;62(5):600-10. doi: 10.1002/acr.20140.

Wolfe F1, Clauw DJ, Fitzcharles MA, Goldenberg DL, Häuser W, Katz RS, Mease P, Russell AS, Russell IJ, Winfield JB. Fibromyalgia criteria and severity scales for clinical and epidemiological studies: a modification of the ACR Preliminary Diagnostic Criteria for Fibromyalgia. J Rheumatol. 2011 Jun;38(6):1113-22. doi: 10.3899/jrheum.100594. Epub 2011 Feb 1.

Wolfe F1, Brähler E, Hinz A, Häuser W. Fibromyalgia prevalence, somatic symptom reporting, and the dimensionality of polysymptomatic distress: results from a survey of the general population. Arthritis Care Res (Hoboken). 2013 May;65(5):777-85. doi: 10.1002/acr.21931.


Other:

Antonio R Zamunér MSc, PT*, Meire Forti PT, Carolina P Andrade PT, Mariana Arias Avila PhD, PT andEster da Silva PhD, PT RespiratorySinus Arrhythmia and its Association with Pain in Women with FibromyalgiaSyndrome. Article first published online: 1 JUN 2015 DOI: 10.1111/papr.12321

Caro XJ, Winter EF. Evidence of abnormal epidermal nerve fiber density in fibromyalgia: Clinical and immunologic implications. Arthritis Rheumatol. 2014 Apr 9. doi: 10.1002/art.38662. [Epub ahead of print]

Flodin P1, Martinsen S, Löfgren M, Bileviciute-Ljungar I, Kosek E, Fransson P.
Fibromyalgia Is Associated with Decreased Connectivity Between Pain- and Sensorimotor Brain Areas. Brain Connect. 2014 Aug 7. [Epub ahead of print]

García JJ1, Cidoncha A2, Bote ME3, Hinchado MD3, Ortega E3. Altered profile of chemokines in fibromyalgia patients. Ann Clin Biochem. 2014 Sep;51(Pt 5):576-81. doi: 10.1177/0004563213506413. Epub 2013 Oct 8.

Giannoccaro MP, Donadio V, Incensi A, Avoni P, Liguori R. Small nerve fiber involvement in patients referred for fibromyalgia.  Muscle Nerve. 2014 May;49(5):757-9. doi: 10.1002/mus.24156. Epub 2014 Jan 28. 

Garcia JJ, Ortega E. Soluble fractalkine in the plasma of fibromyalgia patients.
An Acad Bras Cienc. 2014 Dec 9;0:0. [Epub ahead of print]

Inal S1, Inal EE, Okyay GU, Oztürk GT, Oneç K, Güz G. Fibromyalgia and nondipper circadian blood pressure variability. J Clin Rheumatol. 2014 Dec;20(8):422-6. doi: 10.1097/RHU.0000000000000189.

Jones GT1, Atzeni F, Beasley M, Flüß E, Sarzi-Puttini P, Macfarlane GJ. The prevalence of fibromyalgia in the general population - a comparison of the American College of Rheumatology 1990, 2010 and modified 2010 classification criteria. Arthritis Rheumatol. 2014 Oct 16. [Epub ahead of print]

Kosek E1, Altawil R2, Kadetoff D3, Finn A4, Westman M2, Le Maître E2, Andersson M5, Jensen-Urstad M6, Lampa J2. Evidence of different mediators of central inflammation in dysfunctional and inflammatory pain--interleukin-8 infibromyalgia and interleukin-1 β in rheumatoid arthritis. J Neuroimmunol. 2015 Mar 15;280:49-55. doi: 10.1016/j.jneuroim.2015.02.002. Epub 2015 Feb 19.

Kosmidis ML1, Koutsogeorgopoulou L1, Alexopoulos H1, Mamali I1, Vlachoyiannopoulos PG1, Voulgarelis M1, Moutsopoulos HM1, Tzioufas AG1, Dalakas MC2. Reduction of Intraepidermal Nerve Fiber Density (IENFD) in the skin biopsies of patients with fibromyalgia: A controlled study. J Neurol Sci. 2014 Sep 28. pii: S0022-510X(14)00633-9. doi: 10.1016/j.jns.2014.09.035. [Epub ahead of print]

Light AR, Bateman L, Jo D, Hughen RW, Vanhaitsma TA, White AT, Light KC. Gene expression alterations at baseline and following moderate exercise in patients with Chronic Fatigue Syndrome and Fibromyalgia Syndrome. J Intern Med. 2011 May 26. doi: 10.1111/j.1365-2796.2011.02405.x. [Epub ahead of print]

Napadow V1, Harris RE.What has functional connectivity and chemical neuroimaging in fibromyalgia taught us about the mechanismsand management of 'centralized' pain? Arthritis Res Ther. 2014;16(5):425.

Oaklander AL, Herzog ZD, Downs H, Klein MM. Objective evidence that small-fiber polyneuropathy underlies some illnesses currently labeled as fibromyalgia. Pain. 2013 Jun 5. pii: S0304-3959(13)00294-7. doi: 10.1016/j.pain.2013.06.001. [Epub ahead of print]

Olivan-Blázquez B1, Herrera-Mercadal P2, Puebla-Guedea M2, Pérez-Yus MC2, Andrés E3, Fayed N4, Hoyo YL5, Magallon R6, Roca M7, Garcia-Campayo J8. Efficacy of memantine in the treatment of fibromyalgia: a double-blind randomised controlled trial with 6-month follow-up. Pain. 2014 Sep 10. pii: S0304-3959(14)00424-2. doi: 10.1016/j.pain.2014.09.004. [Epub ahead of print]

Riva R1, Mork PJ, Westgaard RH, Okkenhaug Johansen T, Lundberg U.Catecholamines and heart rate in female fibromyalgia patients. .J Psychosom Res. 2012 Jan;72(1):51-7. doi: 10.1016/j.jpsychores.2011.09.010. Epub 2011 Oct 24.

Shmygalev S, Dagtekin O, Gerbershagen HJ, Marcus H, Jübner M, Sabatowski R, Petzke F. Assessing Cognitive and Psychomotor Performance in Patients with Fibromyalgia Syndrome. Pain Ther. 2014 Oct 25. [Epub ahead of print]

Sugimoto C1, Konno T2, Wakao R3, Fujita H1, Fujita H1, Wakao H1. Mucosal-associated invariant T cell is a potential marker to distinguish fibromyalgia syndrome from arthritis.
PLoS One. 2015 Apr 8;10(4):e0121124. doi: 10.1371/journal.pone.0121124. eCollection 2015.
http://www.ncbi.nlm.nih.gov/pubmed/25853812

Tsai PS1, Fan YC, Huang CJ. Fibromyalgia Is Associated With Coronary Heart Disease: A Population-Based Cohort Study. Reg Anesth Pain Med. 2014 Nov 26. [Epub ahead of print]

Nurcan Üçeyler, Susanne Kewenig, Waldemar Kafke, Sarah Kittel-Schneider and Claudia Sommer. Skin cytokine expression in patients with fibromyalgia syndrome is not different from controls. BMC Neurology 2014, 14:185  doi:10.1186/s12883-014-0185-0

Veldhuijzen DS, Sondaal SF, Oosterman JM. Intact cognitive inhibition in patients with fibromyalgia but evidence of declined processing speed.J Pain. 2012 May;13(5):507-15. doi: 10.1016/j.jpain.2012.02.011.

Vij B1, Whipple MO2, Tepper SJ1, Mohabbat AB2, Stillman M1, Vincent A2. Frequency of Migraine Headaches in Patients With Fibromyalgia. Headache. 2015 May 21. doi: 10.1111/head.12590. [Epub ahead of print]

Wallace DJ1, Gavin IM, Karpenko O, Barkhordar F, Gillis BS. Cytokine and chemokine profiles in fibromyalgia, rheumatoid arthritis andsystemic lupus erythematosus: a potentially useful tool in differentialdiagnosis. Rheumatol Int. 2014 Nov 7. [Epub ahead of print] 



 ~ • ~ • ~ • ~ • ~ • ~

"Adversity is only an obstacle if we fail to see opportunity."  
Celeste Cooper, RN
Author—Patient—Health Central Chronic Pain ProAdvocate


Learn more about what you can do to help your body function to its potential in the books you can find here on Celeste's  blog

All answers and blogs are based on the author's opinions and writing and are not meant to replace medical advice.  




Friday, August 28, 2015

On the Heels of Fall


My respite is over, and how inspirational the Rockies were for me. The orange sunsets were unforgettable.

As we came down out of the mountains, I became acutely aware that the summer heat and humidity are still present, but I also know we are on the heels of fall. The lazy days of summer could easily slip away and surrender to crisp chilly air over night here in the Midwest.

I know it is time to prepare for the next season. A need for my own daily reminders of things to apply from our first book is what prompted the idea to write what I lovingly refer to as the BBWS series. With short-term memory loss, I need written prompts, a string tied to my little finger or a note pinned to my jacket isn’t enough.

If you aren’t familiar with the series, you can learn more at my author profile.  There is also detailed information on my website at the following links if you want more information before you decide if this is a book for you. If you have the book, it's time to get it out and re-explore. I suspect you will see things from a different perspective, and you will learn something new to share.



Fall is the season for reaping the rewards of summer and preparing for the winter. It is a time to reflect and look forward. I hope you enjoy Fall Devotions. We have been told it offers encouragement, practical advice, comfort, and aesthetic appeal.

Here’s to a colorful and hearty fall season.



Available:

Amazon in paperback 
Amazon UK Kindle 
Amazon Canada Kindle 
Barnes and Nobel paperback 





Thursday, August 27, 2015

When a Peek at Chronic Pelvic Pain Isn't Enough




Chronic pelvic pain comes in many forms and there are different symptoms and diagnoses to consider. Following are links to my three part series as contributing chronic pain pro at Health Central.




1 - Essential Elements of Pelvic Pain in Men and Women 

Pelvic pain can originate from different sources and it can be acute or chronic. Regardless, there are contributing factors to consider. Some are very treatable and others can be more difficult to manage. Acute pelvic pain is a warning sign that comes on suddenly lasting a few minutes to a few days depending on the cause. Chronic pelvic pain can be constant or come flares and symptoms can vary in character and intensity. Knowing what and when to report any unusual symptoms to your doctor is important, because some causes of pelvic pain when left untreated can cause permanent damage that could be avoided when we know what to do…

2 - The Secret to Pelvic Pain and the Myofascia 

If you have chronic pelvic pain (CPP), you know the symptoms. What you may not know is that myofascial trigger points, shortened pieces of muscle fiber that form a knot and shorten the muscle involved, play a role of their own in this painful disorder... 

3 - Why knowing the cause of pelvic pain is essential to treatment

Chronic pelvic pain can be constant or come and go with a flare up of symptoms. Symptoms can be mild to severe and can vary in intensity during the day or with a flare. The character of pelvic pain can be different too. For instance, someone with painful bladder syndrome or prostatitis has a symptom in common, burning with urination (dysuria), but pain associated with irritable bowel syndrome is described as cramping or churning. Symptoms vary depending on the underlying cause of their pain. That’s why it is important to know how to report your symptoms... 

~ • ~ • ~ • ~ • ~ • ~

"Adversity is only an obstacle if we fail to see opportunity."  
Celeste Cooper, RN
Author—Patient—Health Central Chronic Pain ProAdvocate


Learn more about what you can do to help your body function to its potential in the books you can find here on Celeste's  blog


All answers and blogs are based on the author's opinions and writing and are not meant to replace medical advice.  

Sunday, August 16, 2015

The Why and the Way Fibromyalgia Studies are Important to You


To get a better understanding of fibromyalgia and the disorders that cluster with them, we need to study them side-by-side so any trends are exposed. Also important is screening for the presence of myofascial pain syndrome (MPS) to assure the participant pool has been identified correctly, because MPS is known as the great imitator.

It’s Not Just Fibro

Many pain disorders have centralization affects, probably most, so while looking at centralization in fibromyalgia; we may need to be more diverse in our thinking. Dr. Robert Bennett and his team 
found that fibromyalgia is often accompanied by another pain disorder. Therefore, while we do experience body-wide pain not directly related to injury or peripheral disease (which indicates centralization-involvement of the brain), and sleep problems, fatigue, and cognitive issues, we also have clustering of disorders. The American College of Rheumatology identifies depression or anxiety, migraine, tension headaches, digestive and bladder problems, pelvic pain, and TMJ. The CDC suggests FM occurs with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and ankylosing spondylitis (AS), and it could have a loose underlying genetic factor. Low back pain syndrome is also considered a disorder of centralization, but chronic low back pain patients do not share a clustering of noted disorders. If we compare the two, it suggests that centralization of pain is not the only factor at play in fibromyalgia. It could be, and is suggested in some studies that the amplification of pain by the brain (centralization) is not the only central nervous system involvement.

Investigators are doing some interesting work by looking at fibromyalgia and chronic fatigue syndrome together because they are often associated. Gene expression  might help us understand clustering in a meaningful way. Leaky gut syndrome has been associated with fibromyalgia and a study on ME/CFS and the association and treatment of leaky gut holds some promise. Since these two disorders frequently occur together, this might help us find better treatments. Though the results differ somewhat, studies suggest the need for more research regarding abnormal immune reactions in both FM and ME/CFS (SEID). Interestingly, leaky gut syndrome has been implicated in many autoimmunedisorders and in irritable bowel syndrome,  prevalent in fibromyalgia.


Myofascia and Fibromyalgia: Could There Be an Answer to Your Question?

Any time a person tells me their physician cannot explain neuropathy symptoms (numbness, tingling, sensitivity, weakness, cramping, spasms, etc.), I ask them to learn more about myofascial pain syndrome (MPS).  Myofascial trigger points  are pain generators in many of the comorbid conditions identified in this article. Rheumatologists are internal medicine doctors and many do not understand MPS, how to assess for it, or what treatments work. However, there are physicians and therapists who do.

You will find an article I did at Health Central from an interview with pain specialist, Dr. Karl Hurst-Wicker quite interesting.   It is a necessary read for anyone who wants to understand the role of centralization and peripheral pain generation in fibromyalgia and other unexplained pain.

It’s time to get it right. When funding by unbiased organizations is at an all time low, such as the NIH, we need to make every effort to do it the right way. If you have any of the clustering of symptoms, report them to your doctor and share this blog. Every piece of data counts and so do you.


Resources linked:

American College of Rheumatology, Fibromyalgia

Center for Disease Control, Fibromyalgia


Health Central, Fibromyalgia Centralization and Peripheral Myofascial Pain: Interview with Karl Hurst-Wicker, MD





Myofascial Pain Syndrome at CelesteCooper.com


~ • ~ • ~ • ~ • ~ • ~

"Adversity is only an obstacle if we fail to see opportunity."  
Celeste Cooper, RN
Author—Patient—Health Central Chronic Pain ProAdvocate


Learn more about what you can do to help your body function to its potential in the books you can find here on Celeste's  blog


All answers and blogs are based on the author's opinions and writing and are not meant to replace medical advice.  

Friday, July 17, 2015

Coenzyme Q10 (CoQ10) for Fibromyalgia, ME/CFS, and Migraine





“Coenzyme Q10 is a natural compound produced by the body… On a cellular chemistry level, this antioxidant helps convert food into energy.” 
- Cooper and Miller, 2010 




CoQ10, also known as ubiquinone, is a fat-soluble supplement that is believed to help with many things from heart failure to cancer. But, for this post we will focus on how it might help fibromyalgia, ME/CFS (chronic fatigue syndrome), migraine, and related symptoms.

Effects of CoQ10 on Gene Expression and Human Cell Signaling

CoQ10 affects expression of genes in mice, and gene expression in human cell signaling,   metabolism and transport. It is thought that the effects of CoQ10 supplementation may be due to this property.

The Mitochondria and CoQ10

“In order to understand how CoQ10 works, it is first necessary to understand mitochondria.  Imagine that each cell in your body is a car. Mitochondria are the engines – or energy producers – in each cell that make your “car” run. It is the job of the mitochondria to supply this energy in the form of adenosine triphosphate (ATP). This is where CoQ10 comes in. To continue the car analogy, it is the oil that enables the engine to work. [It] is the catalyst that makes it possible for the mitochondria to produce ATP, the molecule upon which all cellular functions in the body depend.” 

Coenzyme Q10 is essential to the functioning of the cells in our body, and deficiency has been related to several serious health consequences. This does not mean it comes without precautions and side effects, or drug interactions.  So, if you decide to try it, please make sure your doctor and pharmacist have a complete list of all your medications and all the over-the-counter supplements and remedies you use. You can review tips for medication safety on my website.

Could CoQ10 Help Fibromyalgia and ME/CFS? 

According to the Mayo Clinic, early study suggests CoQ10 may be helpful for fibromyalgia and related symptoms of dry mouth, muscle weakness and dystrophies, nerve pain, tinnitus (ringing in the ears).

One study on mitochondrial dysfunction shows that CoQ10 could help. Interestingly, in this study IL-8 (a proinflammatory cytokine) was elevated. This was also found in another study relating neuroinflammation to heart rate variability (an autonomic effect) in fibromyalgia. This begs the question,

“Could coQ10 also help fibromyalgia patients 
with autonomic nervous system involvement?"

“It is argued that mitochondrial dysfunctions, e.g. lowered ATP production, may play a role in the onset of ME/cfs symptoms, e.g. fatigue and post exertional malaise, and may explain in part the central metabolic abnormalities observed in ME/cfs, e.g. glucose hypometabolism and cerebral hypoperfusion.”  (Morris and Maes, 2014.)  Though further trials are suggested, it was found in another study that CoQ10 along with NADH, might be beneficial in treating ME/CFS. The results of another study showed “lowered levels of CoQ10 play a role in the pathophysiology of ME/CFS and that symptoms, such as fatigue, and autonomic and neurocognitive symptoms may be caused by CoQ10 depletion.”  

Mitchondria, CoQ10 and Migraine

In a literature review published in the journal Headache (Markley, 2012), it was concluded,
"Arising from these extensive neurophysiological studies, the treatment of metabolic encephalomyopathies with pharmacological doses of riboflavin and coenzyme Q10 has shown positive benefits. The same treatment has now been applied to migraine, adding clinical support to the theory that migraine is a mitochondrial disorder.”


According to a Health Central Clinician,  CoQ10 is showing promise for preventing migraine. Research was presented at an American Headache Society meeting, showing 300 mg per day to be effective. It is also reported that gel capsules are absorbed and utilized best by the body. 

Taking CoQ10




As with all supplements, CoQ10 is not regulated by the FDA, so please check the manufacturers safety and purity standards.  You can check to make sure it is USP verified


Coenzyme Q10 should not be taken on an empty stomach because it will reduce absorption. It is absorbed best when taken with foods that have fat, such as olive oil (a healthy choice) because it is fat-soluble. Taking it in smaller doses several times a day will help maintain the level circulating in your body and provide the greatest benefit. 

While CoQ10 is relatively safe, as we age, so does our metabolism and our production of CoQ10. What is a recommended dose for one person might not be so for another, that’s why having the guidance of your physician is important.  If you experience common side effects, talk it over with your doctor, it could be you need to start with a lower dose. 

~ • ~ • ~ • ~ • ~ • ~

"Adversity is only an obstacle if we fail to see opportunity."  
Celeste Cooper, RN
Author—Patient—Health Central Chronic Pain ProAdvocate


Learn more about what you can do to help your body function to its potential in the books you can find here on Celeste's  blog


All answers and blogs are based on the author's opinions and writing and are not meant to replace medical advice.  





Friday, July 3, 2015

Myofascial Trigger Points and Chronic Pain


This blog is packed full of resources for understanding the pain and treatment of chronic myofascial pain and the knotted up pieces of muscle fiber in a taut band of muscle that causes it. 



Understanding myofascial trigger points and their role in sustaining chronic myofascial pain can be confusing at first; it was for me. But, I was very fortunate to have a mentor, Devin Starlanyl (author of several books on fibromyalgia and myofascial pain, her latest, Healing Through Trigger Point Therapy with John Starkey). Unbeknownst to many, unless you read the forward to our book, Integrative Therapies for Fibromyalgia, Chronic Fatigue Syndrome, and Myofascial Pain…,  she spent many tiring days and nights helping me. My gratitude to her goes far beyond words. All she ever asked in return was that I pay it forward, and that is exactly what I am trying to do.

Be sure to read all the articles and resources provided here. I attended many seminars during my days as healthcare educator. I became frustrated if I didn’t grasp the information. What I found is that the same material presented in a different way was what I needed. Maybe it was the fibro or the Hashimoto’s undiagnosed, I will never know for sure, but I do know the sheer pleasure, that feeling of accomplishment when I had that “AH” “ HA” moment. 

If you are like me, you will need to take this information in slowly. Save the link to this blog, then come back. Take each article in succession until you think you have it. If you struggle to understand (as I did), please leave comments and ask questions on Health Central  so we can discuss them together. If one person has a question, so does someone else.

As a prelude, watch my interview on the myofascial trigger points (TrPs) with Frank Gresham, certified myofascial trigger point specialist, of the Chronic Pain Center. Frank studied the work of the pioneers of myofascial medicine, Dr. JanetTravell  and Dr. David Simons.  




There has been a great deal of confusion regarding fibromyalgia tender points and myofascial trigger points. THEY ARE NOT THE SAME. They should NEVER be used interchangeably. Even though there are some researchers who think tender points may have been trigger points all along, there is other evidence by researchers and educators, such as my friend Dr. Robert Bennett who knows how to assess fibromyalgia AND myofascial pain syndrome, who say they are not. Thanks to Dr. Bennett, who led the research for the Alternative Diagnostic Criteriawe know how different FM is from MPS, even though they can, and often do, co-exist in the same patient. Read all the articles on Health Central and on my website and you will have a better understanding.





~ • ~ • ~ • ~ • ~ • ~

"Adversity is only an obstacle if we fail to see opportunity."  
Celeste Cooper, RN
Author—Patient—Health Central Chronic Pain ProAdvocate


Learn more about what you can do to help your body function to its potential in the books you can find here on Celeste's  blog


All answers and blogs are based on the author's opinions and writing and are not meant to replace medical advice.  



Wednesday, June 24, 2015

David Simons, MD: Pioneer of Myofascial Medicine




Dr. Simons joined Dr. Janet Travell in her intense efforts to understand and educate other physicians regarding myofascial dysfunction, and the contribution of myofascial trigger points to myofascial pain syndrome


"Dr. David Simons started his medical career as a military clinician and research scientist. Since 1965 he [practiced] physical and rehabilitative medicine. Dr. Simons, a world leader in myofascial medicine, [lectured and advocated] for research in this “new field” of medicine. Drs. Travell and Simons co-authored Myofascial Pain and Dysfunction: The Trigger Point Manual, Vol. 1, published in 1983, and Vol. 2 in 1992. The revised edition of Vol. 1 was published in 1999." (Cooper and Miller, 2010


What you may not know is that Dr. David Simons, born in 1922, was Project Officer for Animal Studies in V-2 rocket flights until 1949. He graduated from the USAF School of Aerospace Medicine at Randolph Air Force Base. He is well known for his part in the part in the “Manhigh project, a series of balloon flights to record altitudes to study the effects of a near-space environment on human physiology.” Because of this any many other aeronautical achievements, he was inducted into the International Space Hall of Fame in 1987.

It was after retiring from the Air Force that he began his work with Dr. Janet Travell and they published the first medical textbooks on myofascial medicine. Dr. Simons also published approximately 200 publications on myofascial trigger points and chronic pain management. He and Dr. Travell are recognized internationally as trustworthy researchers.

To say that it was an honor to exchange email with Dr. Simons regarding myofascial pain syndrome is an understatement. When Dr. David Simons passed away in 2010, it was a great loss. He did so much to help so many, including myself. It is because of him and Dr. Travell that we can have better pain management today by pain specialists, chiropractors, and body workers who know their work.

A friend of mine, Dr. John Whiteside (Australia), studied directly under Dr. Janet Travell. We became connected when he gave me permission to publish his protocol for treating trigger points in our book. When I expressed my remorse for the loss of Dr. Simons, he had this to say:  

"Great scientists and teachers outlive their mortal lives.”
--Dr. John Whiteside

No truer words have ever been spoken.



Janet Travell, MD: Pioneer of Myofascial Medicine




"The pioneer in the study of chronic myofascial pain as we know it today is Dr. Janet Travell, later joined by Dr. David Simons. Travell discovered as early as 1940 that by applying pressure to a trigger point, she could establish and predict referred pain patterns. After successfully treating President John F. Kennedy for residual effects from bouts with myofascial pain and longstanding back problems, she was the first woman and first non-military doctor to be appointed to the post of White House physician. Dr. Travell is considered to be an expert authority, and her work and dedication continue to be internationally referenced.


Thanks to [Dr. Travell and Dr. Simons] dedication to scientific study and education, we now know that specific triggerpoints cause specific pain patterns and symptoms." (Cooper and Miller, 2010) 

One only has to visit Dr. Travell’s family tribute to understand the huge impact she had as White House physician to President John F. Kennedy. I hope you will take a moment to honor her by visiting the family’s memorial website. It is a testament to her work, her dedication, and to her life.

Dr Janet Travell (1901 – 1997) was not only personal physician to President Kennedy, she was a Associate Clinical Professor at the George Washington University and made many other contributions to medicine. A collection of her work consists of manuscripts, reports, correspondence, research data, articles, newspaper clippings, photographs, and a variety of material from Dr. Travell's service in the White House. It is said to include 104 boxes, or 44.5 linear feet of materials. The collection was donated to the Gelman Library University Archives in 1998 by her daughters with the stipulation that it can only be used to further the research and study of myofascial medicine. (Accessed,1-24-2015).  Her work will live on.

She made a huge impact on our knowledge of myofascial pain syndrome, its perpetuators to pain, and the role of the myofascial trigger point not only in pain, but also as a contributing factor to many other autonomic, circulatory, and nerve related symptoms. One might say she was also the founder of ergonomics because she understood, studied, and educated others about the effects of furniture, clothing, and posture on the body. She studied relentlessly to identify and map out the pain and symptom referral patterns associated with the location of each specific myofascial trigger point

She and Dr. David Simons and published the first medical text books on myofascial medicine.

Few in medicine have made such an impact and she and Dr. David Simons have made. Both were children of physicians.



Sunday, June 21, 2015

ME/CFS Advocates Making a Difference: Giving Thanks, Celeste Cooper


It’s time to say thank you. Advocates work tirelessly to change the perceptions of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).

According to the CDC, more than one million Americans have ME/CFS, I happen to be one of them. And while my own advocacy focuses on fibromyalgia and chronic pain, and I write articles on chronic pain for Health Central,  I must support those who carry the torch for ME/CFS. There are correlations between ME/CFS and fibromyalgia, and many of us have been diagnosed with both. Maybe incorrectly, I don’t know. They do share underlying immunological changes, even if chemokines and other neuroimmune markers differ between the two of them. Who knows, maybe having a better understanding of ME/CFS will provide information so we can grasp what is happening with other invisible illnesses. We won’t know any of this without research. This is what our advocates know.


Voices Constantly Running in the Background 


As an RN, I am a member of Medscape, which is an organization for continuing education for physicians and nurses. I receive notification of CME and CEU programs and article updates. For the first time, I am seeing articles on the views of important game players, such as Dr. Komaroff.  There is a drive to educate physicians and nurses on ME/CFS as a biological illness. This wouldn’t be happening without the voices that are constantly running in the background.




Gratitude is Motivating

Many donate their time and talent. But, even if some are paid, money isn’t their driving force; it is passion for the cause. Our words of gratitude motivate them. I know this because of my own advocacy for fibromyalgia and chronic pain. So, please tell them thank you!

If I single out any particular person or group, it is only because I have personal communication with them. It by no means says there aren’t others doing the same for us. You may know someone different than I do who is making a huge impact. Show your support by telling them thank you on Facebook, Google+, or Twitter.


In alphabetical order:

Jeannette Burmeister Attorney,  ME activist, and blogger.
On Twitter

Health Rising.  Cort Johnson interprets research and collaborates with many people to improve education and awareness. Health Rising now has forums for ME/CFS and fibromyalgia.
On Twitter

The Massachusetts CFIDS/ME&FM Association.  Their mission is “To improve the lives of all people affected by ME/CFS and FM, advancing awareness, care, treatment and research.”
On Facebook – CFS Solutions

ME-CFS Community.   A world-wide community for individuals who wish to learn from, and directly communicate with those who are afflicted with ME/CFS.

Open Medicine Foundation. Supporting research and patient engagement for treatments and a cure for Neuro-Immune Diseases
On Twitter

P.A.N.D. O.R.A  Seeking to alleviate the suffering caused by neuro-endocrine-immune diseases, including ME/CFS, fibromyalgia syndrome, multiple chemical sensitivities / environmental illnesses, chronic Lyme disease and Gulf War illnesses.
On Facebook

ProHealth. Educating patients and providers to improve treatment and awareness, and donating 10% of profits to fund research and patient advocacy. Founder Rich Carson  provides forums on ME/CFS, FM, Lyme’s Disease. and general health, and topic related collaborative news and information on ME/CFS,  fibromyalgia,  and natural wellness.
On Twitter

Jennie Spotila’s blog, Occupy CFS.  Jennie’s legal savvy holds people accountable.
On Twitter


Our advocates are making a difference. 





~ • ~ • ~ • ~ • ~ • ~

"Adversity is only an obstacle if we fail to see opportunity."  
Celeste Cooper, RN
Author—Patient—Health Central Chronic Pain Pro —Advocate


Learn more about what you can do to help your body function to its potential in the books you can find here on Celeste's  blog

All answers and blogs are based on the author's opinions and writing and are not meant to replace medical advice.  

Celeste's Website

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