Wednesday, August 31, 2011

Should the government be micromanaging physicians and their ability to do their job managing pain?

Please follow the link from the American Pain Foundation regarding a Seattle Times article on stringent laws being proposed for pain management. http://action.painfoundation.org/site/MessageViewer?em_id=13682.0&printer_friendly=1
You won't want to miss this one, and you better believe I left a comment as follows.

Since when does the government think they can tell a physician how to be a doctor? I am a chronic pain patient with severe osteoarthritis and inoperable severe spinal stenosis and premature degeneration. I also have fibromyalgia.

The trend set by pharmaceuticals is to treat pain with antidepressants and antiepileptic drugs because it raises their bottom line. I have tried them all and they either interact with my medications to treat my migraines, or leave me like a zombie, not to mention that during the courting period, they empty my pocketbook. Opioids are tried and true pain relievers that when used appropriately, improve function, but leave little room for profit margins. They are proven to be more effective in the treatment of acute and chronic pain.

Education is needed, some will become addicted, not to be confused with pseudoaddiction, options for education and medication vacations are in order, not government influence. I suppose the option is to treat all pain with antidepressants. I worked as an ER nurse for 20 years. I propose that these law makers or a close family member will one day have to make an ER visit for an accident that causes pain. I want to be there to see their reaction when the ER doctor explains the only thing he/she has to offer is a medication for depression or seizure. What happened to common sense?

Harmony and Hope, Celeste

All blogs, posts and answers are based on the work in Integrative Therapies for Fibromyalgia, Chronic Fatigue Syndrome, and Myofascial Pain: The Mind-Body Connection by Celeste Cooper, RN, and Jeff Miller, PhD. 2010, Vermont: Healing Arts press are for educational purposes and not meant to replace medical advice. www.TheseThree.com

Monday, August 29, 2011

One Day at a Time: symptoms, age, and FM.

I have not seen data on ruthlessness of fibromyalgia related by age. However, I know a great deal of younger FM patients who have severe symptoms, so anecdotally, I would say, that age is not a factor in the harshness of this painful and debilitating disorder.

As a patient aging with FM, I believe perpetuating factors and other co-existing conditions such as arthritis, and spinal diseases, metabolic disturbances and other disorders associated with aging to play a role in overall coping. The presence of untreated myofascial trigger points in muscles that don’t have the ability to build do to aging also make it more difficult to call a truce with fibromyalgia. Though I do believe fibro and ME/CFS don’t know the meaning of a treaty at any age.

The key is to identify perpetuating and aggravating factors and bring them under control as best you can. Try to participate in a mild stretching program you enjoy, such as Yoga or T’ai Chi. These activities have no age barrier, they even make Yoga props for those of us challenged by joint disease, and movement meditation has shown to help with balance and with the loss of proprioception associated with FM and chronic fatigue syndrome, ME/CFS. (See Chapter Two “Communicating Your Healthcare Needs.”)

Proprioception = Your own sense of where your body parts are in relationship to your environment when moving.
All blogs, posts and answers are based on the work in Integrative Therapies for Fibromyalgia, Chronic Fatigue Syndrome, and Myofascial Pain: The Mind-Body Connection by Celeste Cooper, RN, and Jeff Miller, PhD. 2010, Vermont: Healing Arts press are for educational purposes and not meant to replace medical advice. www.TheseThree.com


This question is based on my original answer as fibromyalgia expert at ShareCare, “Do fibromyalgia symptoms differ by age?”
http://sharecare.com/user/celeste-Cooper

Thursday, August 25, 2011

Fibromyalgia is complicated, but are there possible complications?

The greatest risk for complications in fibromyalgia is misdiagnosis, not identifying and treating the comorbid conditions in fibromyalgia, or drug interactions that can occur with other medications, and over the counter drugs, herbs and supplements.

The many comorbid conditions with FM have specific treatments. For instance, there is a higher incidence of hypothyroidism, and the medications used to treat FM will not treat hypothyroidism, or medications used to treat and IBS attack or medications to treat interstitial cystitis or Leaky Gut Syndrome might interfere with or exacerbate side effects of other medications, and this is just an example.

MTP = Myofascial trigger point, a knotted up piece of muscle fiber that is easily felt unless beneath bone or other muscle. It shortens the muscle involved causing pain and dysfunction and radiates pain and other symptoms including neuropathies in a specific pattern between patients.
The coexistence of chronic myofascial pain from myofascial trigger points (MTPs) occur frequently, according the research. The treatments for MTPs require hands on therapy, and when not considered, the pain can be a great complication in the life of a patient with FM. Not only are they a great source of our pain, MTPs are peripheral pain generators that keep the FM brain hyper sensitized.

Talk with your doctor about known comorbid and coexisting conditions. There are many helpful tools to help you understand the many conditions in chapter two of our book, “Communicating Your Healthcare Needs,” including Relating Your Symptoms and Health History, Identifying Aggravating and Alleviating Factors, Coexisting Conditions, Communicating with Your Physician and Other Health Care Providers, a Summary Exercise: Clear Expressions , Medication Log, Symptom Inventory Sheet, Anatomical Diagram of Pain, and Health History Log.

This blog is based on my original answer to “What are possible complications for fibromyalgia?” as fibromyalgia expert at ShareCare.

View my other answered questions as fibromyalgia expert
http://sharecare.com/user/celeste-Cooper


Resources:

Bazzichi L, Rossi A, Zirafa C, Monzani F, Tognini S, Dardano A, Santini F, Tonacchera M, De Servi M, Giacomelli C, De Feo F, Doveri M, Massimetti G, Bombardieri S. “Thyroid autoimmunity may represent a predisposition for the development of fibromyalgia?” Rheumatology International, Nov 18, 2010.

Bazzichi L, Rossi A, Giuliano T, De Feo F, Giacomelli C, Consensi A, Ciapparelli, Consoli G, Dell’Osso L, and Bombardieri S. “Association between thyroid autoimmunity and fibromyalgic disease severity .” Clinical Rheumatology Volume 26, Number 12, 2115-2120, DOI: 10.1007/s10067-007-0636-8

C Cooper, RN and J Miller, PhD. (2010) Integrative Therapies for Fibromyalgia, Chronic Fatigue Syndrome, and Myofascial Pain: The Mind-Body Connection. Vermont: Healing Arts Press.

Ge HY, Wang Y, Danneskiold-Samsøe B, Graven-Nielsen T, Arendt-Nielsen L. The predetermined sites of examination for tender points in fibromyalgia syndrome are frequently associated with myofascial trigger points. J Pain. 2010 Jul;11(7):644-51. Epub 2009 Nov 14.

Hubbard JE. Myofascial Trigger Points: What Physicians Should Know about these Neurological Imitators Minn Med. 2010 May;93(5):42-5.


This blog is for educational purposes and not meant to replace medical advice. www.thesethree.com

Wednesday, August 24, 2011

Where we are headed understanding the differences in FM and ME/CFS

What we know is that the first complaint of fibromyalgia is muscle pain and the primary reason ME/CFS patient seek treatment, is fatigue. Though in neither case is this where it stops.

Fibromyalgia and ME/CFS do share some common comorbid conditions, and both are thought to have central nervous system disruption, however, disruptions are different between the two, and newer research is showing a stronger connection to viral, infectious and immune overload in ME/CFS, and research on FM repeats the findings of previous studies on the disruption of the hypothalamus-pituitary-adrenal axis, oxidative stress, which is also seen in ME/CFS, and the peripheral pain generation by myofascial trigger points that keeps the central nervous system sensitized to pain impulses.

There are specific biological differences between FM and CFS/ME. Both are considered neuroendocrineimmune disorders, as is Lyme’s disease, Gulf War Syndrome, Lupus, and others. Though they fall under the same umbrella, they are different.

We explain the differences and the similarities, why they are confused and the importance in having the right diagnosis in Chapter One, “All about Fibromyalgia, Chronic Fatigue Immunodysfunction—The Muster to Master, and Chronic Myofascial Pain—Nerve to Muscle, and Double Cross. There are also checklists for each disorder that you can use to inventory your symptoms and provide to your physician or other healthcare provider. There is also a glossary of terms that describe pain.

All blogs, posts and answers are based on the work in Integrative Therapies for Fibromyalgia, Chronic Fatigue Syndrome, and Myofascial Pain: The Mind-Body Connection by Celeste Cooper, RN, and Jeff Miller, PhD. 2010, Vermont: Healing Arts press are for educational purposes and not meant to replace medical advice.
This blog is based on my original answer at ShareCare to, “How are fibromyalgia and chronic fatigue syndrome different?”

View my other answered questions as fibromyalgia expert
http://sharecare.com/user/celeste-Cooper


Resources:

Affaitati G, Costantini R, Fabrizio A, Lapenna D, Tafuri E, Giamberardino MA.Effects of treatment of peripheral pain generators in fibromyalgia patients. Eur J Pain. 2011 Jan;15(1):61-9.

Basford JR, An KN. New techniques for the quantification of fibromyalgia and myofascial pain. Curr Pain Headache Rep. 2009 Oct;13(5):376-8.

Bazzichi L, Rossi A, Massimetti G, Giannaccini G, Giuliano T, De Feo F, Ciapparelli A, Dell'Osso L, Bombardieri S.Cytokine patterns in fibromyalgia and their correlation with clinical manifestations. Clin Exp Rheumatol. 2007 Mar-Apr;25(2):225-30.

Burgmer M, Gaubitz M, Konrad C, Wrenger M, Hilgart S, Heuft G, Pfleiderer B.Decreased gray matter volumes in the cingulo-frontal cortex and the amygdala in patients with fibromyalgia. Psychosom Med. 2009 Jun;71(5):566-73. Epub 2009 May 4.

Cakit BD, Taskin S, Nacir B, Unlu I, Genc H, Erdem HR. Comorbidity of fibromyalgia and cervical myofascial pain syndrome. Clin Rheumatol. 2010 Apr;29(4):405-11.

Carvalho LS, Correa H, Silva GC, Campos FS, Baião FR, Ribeiro LS, Faria AM, d'Avila Reis D. May genetic factors in fibromyalgia help to identify patients with differentially altered frequencies of immune cells? Clin Exp Immunol. 2008 Dec;154(3):346-52.

C. Z. Hong and D. G. Simons, “Pathophysiologic and electrophysiologic mechanisms of myofascial trigger points,” Archives of Physical Medicine and Rehabilitation 79, no. 7 (1998): 863–72.

Hong-You Ge, Hongling Nie, Pascal Madeleine, Bente Danneskiold-Samsoe, Thoms Graven-Nielsen, Lars Arendt-Nielsen. Contribution of the local and referred pain from active myofascial trigger points in fibromyalgia syndrome. 2009. Pain.147; 233-240

Hubbard JE. Myofascial trigger points. What physicians should know about these neurological imitators. Minn Med. 2010 May;93(5):42-5.

HY Ge , Y Wang, B. Danneskiold-Samsøe , et. Al., “The Predetermined Sites of Examination for Tender Points in Fibromyalgia Syndrome Are Frequently Associated With Myofascial Trigger Points.” Pain. 2009 Nov 13.

Irwin M, McClintick J, Costlow C, Fortner M, White J, Gillin JC.
Partial night sleep deprivation reduces natural killer and cellular immune responses in humans. FASEB J. 1996 Apr;10(5):643-53.

Lekander M, Fredrikson M, Wik G.Neuroimmune relations in patients with fibromyalgia: a positron emission tomography study. Neurosci Lett. 2000 Mar 24;282(3):193-6.

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]

Lombardi VC, Hagen KS, Hunter KW, Diamond JW, Smith-Gagen J, Yang W, Mikovits JA. Xenotropic Murine Leukemia Virus-related Virus-associated Chronic Fatigue Syndrome Reveals a Distinct Inflammatory Signature. In Vivo. 2011 May-Jun;25(3):307-14.PMID:21576403

D. M. Niddam, R. C. Chan, S. H. Lee, T. C. Yeh, and J. C. Hsieh, “Central representation of hyperalgesia from myofascial trigger point,” NeuroImage 39 (2008): 1299–1306.

D. Racciatti, J. Vecchiet, A. Ceccomanncini, F. Ricci, E. Pizzigallo, “Chronic fatigue syndrome following toxic exposure,” Science of the Total Environment, Italy 270, no. 1–3 (2001): 27–31.

Schutzer SE, Angel TE, Liu T, Schepmoes AA, Clauss TR, Adkins NJ, Camp DG, Holland BK, Bergquist J, Coyle PK, Smith RD, Fallon BA, Natelson BH. (2011) Distinct cerebrospinal fluid proteomes differentiate post-treatment Lyme disease from chronic fatigue syndrome. PLoS ONE 6(2): e17287. doi:10.1371/journal.pone.0017287

Sikdar, J.P. Shah, E. Gilliams et al. 2008. “Assessment of myofascial trigger points (MTrPs): A new application of ultrasound imaging and vibration soloelastography.” Arch Phys Med Rehab 89(11): 2041-2226.

Smits B, van den Heuvel L, Knoop H, Küsters B, Janssen A, Borm G, Bleijenberg G, Rodenburg R, van Engelen B.Mitochondrial enzymes discriminate between mitochondrial disorders and chronic fatigue syndrome. Mitochondrion. 2011 Sep;11(5):735-8. Epub 2011 Jun 2.

Woynillowicz Kemp, Anne-Marie B.A., Dip.T., M. Ed. “Highlights of Dr. Daniel Person’s presentation to medical practitioners. Myalgic encephalomyelitis/Chronic Fatigue Syndrome” – The Research Frontier. Calgary: April 29, 2011.

Monday, August 22, 2011

Blood tests for diagnosing FM might be more than a vision


Currently there are no routine blood tests to diagnose fibromyalgia. However, studies are showing promise. Genetic markers have been found, and though still in the research stage, I suspect we will have a blood test for biological markers before long.

As reported in Fibromyalgia Network News, a new study by Dr. Alan Light (Light, et al. 2011) at the University of Utah, shows FM patients have an increased number of certain sensory receptors and three biomarkers are elevated in the FM patient compared to otherwise healthy study participants and those participants with MS and depression. This is a very important finding specific to FM.

Several comorbid conditions to fibromyalgia (meaning they occur more frequent in FM) do have blood or other tests, such as, hypothyroidism, interstitial cystitis and other bladder problems, gastrointestinal dysfunction, and Raynaud’s. Many Lupus, rheumatoid arthritis, and sjögren’s patients also have FM, and metabolic disorders seem to have a connection to the development of secondary fibromyalgia. There are blood tests that should be done when FM is suspected to make sure these other conditions are not present. They are all treated specifically and the medications used to treat the centralization of FM will not treat these other conditions successfully.

It is important to support the research if you are able. The American Fibromyalgia Syndrome Association, AFSA, has contributed to some very important studies that have helped us understand biomarkers and the presence of myofascial trigger points in FM.

www.afsa.org

Harmony and Hope, Celeste

This blog is based on my original answer as fibromyalgia expert at ShareCare, “How are blood tests used to treat fibromyalgia?” View my other answered questions as fibromyalgia expert

http://sharecare.com/user/celeste-Cooper

Citation:
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 [epub ahead of print], May 26, 2011

All blogs, posts and answers are based on the work in Integrative Therapies for Fibromyalgia, Chronic Fatigue Syndrome, and Myofascial Pain: The Mind-Body Connection by Celeste Cooper, RN, and Jeff Miller, PhD. 2010, Vermont: Healing Arts press

Saturday, August 20, 2011

Qi Gong and Biofeedback, tools for helping our bodies deal with FM & ME/CFS

The value of correctly executed deep meditative breathing practice, Qi Gong, and biofeedback has been well documented. There is a biological affect of these practices.

Oxygen is needed in the Krebs cycle for cellular metabolism and without oxygen cellular damage will occur. We know from the research that oxidative stress is prevalent in both FM and ME/CFS, and this is something you can do even if you are physically challenged.

We also know that stress affects vital signs such as a rise in blood pressure, heart rate and even temperature. This is particularly important in the FM and ME/CFS patient because our homeostasis is already metabolically challenged and we need to decrease cellular stress for healing. If we work at regulating exterior forces that we can help control, we in affect help our bodies by eliminating one more thing it is trying to deal with. Biofeedback is a great tool for learning what happens to your body when your mind is in overload, and teaches us ways of helping control this.

All blogs, posts and answers are based on the work in Integrative Therapies for Fibromyalgia, Chronic Fatigue Syndrome, and Myofascial Pain: The Mind-Body Connection by Celeste Cooper, RN, and Jeff Miller, PhD. 2010, Vermont: Healing Arts press are for educational purposes and not meant to replace medical advice.

Harmony and Hope, Celeste

Wednesday, August 17, 2011

Helping your doctor diagnose fibromyalgia

Though there will be a change in the diagnostics for FM, the consensus remains, there are common symptoms that have generally lasted for more than three months. Note and evaluate any measures that help or worsen the following and report them to your doctor:

•Widespread pain, check presence of myofascial trigger points (MTrPs).
•Secondary, anxiety and/or depression
•Sleep disturbance, non restorative or difficulty getting to sleep or maintaining sleep, primary or could be an autoimmune disorder, Hashimoto’s
•Morning stiffness, check presence of MTrPs.
•Fatigue
•Bladder difficulties, pelvic floor dysfunction, now being successfully treated w/ intravaginal trigger point injections by a uro-gyenocologist
•Bowel habits altered (IBS, diarrhea, constipation, cramping, bloating, gas, leaky gut syndrome or small intestine bacterial overgrowth).
•Chemical sensitivity
•Chest wall pain, check presence of MTrPs
•Cognitive disturbances, primary or from comorbid hypothyroidism
•Cold intolerance, primary or result of comorbid hypothyroidism or Raynaud’s
•Dizziness, check MTrPs in muscles close to vital organs or vessels, or comorbid nuerally mediated hypotension (NMH) or postural orthostatic tachycardia (POTS)
•Dry eyes and mouth, primary or secondary to a metabolic disturbance or autoimmune such as Sjogrens
•Gynecological disturbances or premenstrual syndrome (PMS), See bladder difficulties.
•Headaches, severe and chronic, including migraine, MTrPs have been related to migraine
•Impaired coordination, could be primary but check presence of MTrPs
•Irritability or mood changes, secondary to chronic pain and primary to centralization in FM
•Jaw pain, most likely secondary to TMJ, bruxism (teeth grinding), which exacerbate MTrPs
•Paresthesias, unexplained numbness, most likely related to MTrPs in muscles close to major nerves
•Photophobia (sensitivity to light)
•Raynaud’s syndrome
•Restless leg syndrome (RLS) and/or periodic limb movement (PLM), has central and peripheral component, it is possible that MTrPs are keeping the brain in wind-up
•Ringing in the ears, could have a myofascial component
•Sensitivity to odors
•Sensitivity to noise
•Skin sensitivities and rashes
•Subjective swelling
•Visual problems, could have a myofascial component or be related to a comorbid condition


There is a checklist at the end of the section, “All about Fibromyalgia,” called Summary Exercise: Fibromyalgia. Our publisher has given permission to copy these helpful sheets found at the end of each section or chapter. Share them with your doctor or other healthcare provider.

Tips for communicating with your healthcare provider at
http://www.thesethree.com/fibromyalgia/communication-tips.php


All blogs, posts and answers are based on the work in Integrative Therapies for Fibromyalgia, Chronic Fatigue Syndrome, and Myofascial Pain: The Mind-Body Connection by Celeste Cooper, RN, and Jeff Miller, PhD. 2010, Vermont: Healing Arts press

This question is based on my original answer at ShareCare, “How can I help my doctor diagnose fibromyalgia?”

View my other answered questions as fibromyalgia expert
http://sharecare.com/user/celeste-Cooper



Thursday, August 11, 2011

Fibromyalgia and the Workplace

Telling your boss you have fibromyalgia is a personal choice. If you require specific needs, such as time off for doctors appointments, make special revisions to your work area to accommodate your needs, or apply for FMLA, then you may not have a choice.

Staying productive is important, but if your needs exceed what your employer believes is acceptable, there are certain rules that may protect you and certain rules that may protect your employer.

Chapter Seven, Dealing with the System Systematically, in our book, Integrative Therapies for Fibromyalgia, Chronic Fatigue Syndrome, and Myofascial Pain: The Mind-Body Connection covers the laws and programs devised to provide you with protection and help you remain in the workforce.

This blog is based on my original answer as fibromyalgia expert at ShareCare to the question. Do I need to tell my boss about my fibromyalgia?”
View other answered questions on my profile at
http://sharecare.com/user/celeste-Cooper


All blogs, posts and answers are based on the work in Integrative Therapies for Fibromyalgia, Chronic Fatigue Syndrome, and Myofascial Pain: The Mind-Body Connection by Celeste Cooper, RN, and Jeff Miller, PhD. 2010, Vermont: Healing Arts press and are not meant to replace medical advice.

Friday, August 5, 2011

In with the New, Out with the Old: Fibromyalgia diagnostics

Times are changing, but we aren't quite there yet. The preliminary diagnostic criterion intends to do away with the tender point model, which has become the hallmark for diagnosing FM.

Fibromyalgia is a central sensitization problem thought to be brought on by a dysfunction of the HPA (hypothalamus-pituitary-adrenal) axis and other central nervous system (CNS) disruptions. The criterion considers the effects of FM on CNS sensitization, and comorbid conditions; migraine, IBS, irritable bladder, cognitive deficit, RLS, hypothyroidism, Raynaud’s, disordered sleep etc.

However, it does not address the co morbidity of chronic myofascial pain, a peripheral nerve to muscle disease that causes myofascial trigger points (MTrPs). Trigger points are knotted up muscle fibers in a taut (tight) band of muscle. They are EASILY felt unless behind bone or other muscles, or the band of muscle affected is too tight. It is an objective piece of evidence to indicate the presence of chronic myofascial pain (CMP) in FM and research suggests possibly all FM patients have them. This is not new to me, and is why myofascial pain is covered extensively in our book. These MTrPs are peripheral pain generators that bombard the brain with pain messages keeping the central nervous system sensitized. Exercising a muscle riddled with MTrPs, will only make the pain and dysfunction worse, leading both the patient and the physician down a road of misguided confusion.

Hashimoto’s thyroiditis may put the patient at greater risk of developing FM. The proposed criteria considers hypothyroidism as a comorbid condition in FM, however, waxing & waning hormones in Hashimoto’s makes it difficult to detect in routine tests. I have had the honor of discussing this with Dr. I Jon Russell, one of the co-authors of the proposed criteria. I believe it prudent that patients with a normal thyroid panel, but symptoms of thyroid disease, (the ups and downs of thyroid hormones, palpitations one minute, and unable to get out of bed the next), should have thyroid antibodies drawn.

For now the tender point model is being used to diagnose fibromyalgia. See a complete account of the tender point model at http://www.thesethree.com/fibromyalgia/tender-points.php

And symptoms at http://www.thesethree.com/fibromyalgia/fibromyalgia-symptoms.php

As fibromyalgia expert at ShareCare.com, this question is based on my original answer to, “What criteria must I meet to be diagnosed with fibromyalgia?

View other answered questions on my profile at
http://sharecare.com/user/celeste

All blogs, posts and answers are based on the work in Integrative Therapies for Fibromyalgia, Chronic Fatigue Syndrome, and Myofascial Pain: The Mind-Body Connection by Celeste Cooper, RN, and Jeff Miller, PhD. 2010, Vermont: Healing Arts press

Information here is not meant to replace medical advice.

Direct links at www.TheseThree.com

Celeste's Website

Celeste's Website
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