Dear Fibromyalgia

Category: Chronic Pain

A comprehensive guide on chronic pain, its causes, symptoms, and effective management strategies to improve your quality of life.

  • When Chronic Pain Leads to ‘Appointment Fatigue’

    Breaking the Cycle of Appointment Fatigue in Chronic Pain Management

    Living with chronic pain means navigating a constant balancing act—managing symptoms, medications, work, relationships, and self-care. At the core of this juggling act lies an unspoken burden many patients face: appointment fatigue. This term refers to the emotional, mental, and physical exhaustion that comes from attending endless medical appointments, undergoing tests, meeting new specialists, and often, repeating the same explanations of symptoms without seeing long-term improvement.

    For individuals dealing with persistent pain, medical visits become a routine, yet their frequency can slowly wear down one’s motivation and hope. What begins as a path to healing may transform into a cycle of burnout, disillusionment, and disengagement from healthcare altogether.

    This article dives deep into the phenomenon of appointment fatigue, what causes it, how it impacts chronic pain sufferers, and how patients can reclaim their autonomy in the face of healthcare overload.

    Understanding Appointment Fatigue in the Context of Chronic Pain

    Chronic pain is not simply a lingering ache. It is a long-term condition that can stem from various sources including autoimmune diseases, nerve damage, past injuries, fibromyalgia, and musculoskeletal disorders. Unlike acute pain that resolves with treatment, chronic pain persists beyond the typical healing window and often requires ongoing care from multiple providers.

    As a result, patients may attend appointments with:

    • Primary care physicians
    • Pain specialists
    • Physical therapists
    • Psychologists
    • Rheumatologists
    • Occupational therapists

    Each of these visits involves waiting times, transportation planning, paperwork, billing concerns, and sometimes disappointing news. The repetitive nature of these experiences, coupled with limited improvements or inconsistent care, builds up over time. This accumulation can give rise to a deep sense of frustration, helplessness, and a strong desire to simply stop showing up.

    Common Signs That Indicate Appointment Fatigue

    Recognizing appointment fatigue early can prevent further deterioration in one’s healthcare engagement. Some common signs include:

    • Canceling or rescheduling appointments frequently, even when not sick or physically unable
    • Feeling dread, anxiety, or anger when thinking about medical visits
    • Becoming emotionally numb or indifferent during consultations
    • Not following through with referrals, tests, or treatment plans
    • Avoiding contact with healthcare providers or clinics altogether
    • Declining in health due to untreated symptoms or complications

    It’s important to understand that appointment fatigue is not laziness or irresponsibility. It is a valid response to an overextended emotional bandwidth in an already stressful healthcare experience.

    The Emotional Toll of Navigating a Fragmented Healthcare System

    For chronic pain sufferers, the road to diagnosis and treatment is rarely straightforward. Often, it involves seeing multiple specialists who may offer conflicting advice. Patients may be forced to re-explain their pain journey at every appointment, recount failed treatments, or defend their need for pain management, especially amid growing stigma around opioid use.

    All of this contributes to a feeling of being unheard, unvalidated, and overly medicalized. Instead of feeling supported, patients may feel reduced to a list of symptoms on a chart. This emotional toll erodes trust and contributes to appointment fatigue.

    Financial and Logistical Strains Amplify the Burden

    The cost of chronic pain management is another contributor. Even with insurance, copays, transportation costs, unpaid time off work, and prescription expenses add up quickly. If appointments don’t deliver tangible results, the perceived cost-benefit ratio becomes unfavorable. Patients begin to question, is this really worth it?

    Logistical hurdles like coordinating care between specialists, scheduling appointments months in advance, and finding available practitioners who truly listen can become overwhelming. These tasks consume energy that patients would rather use for daily life or symptom management.

    Healthcare Inequities Worsen the Experience for Some

    Those from marginalized communities may experience even deeper levels of fatigue due to systemic barriers. Language differences, implicit bias from healthcare providers, lack of nearby specialists, or financial instability can all lead to fewer options and worse experiences. Appointment fatigue for these individuals often includes an additional layer of distrust or previous medical trauma, further discouraging engagement.

    How to Cope and Break Free from Appointment Fatigue

    While appointment fatigue is real and challenging, it doesn’t have to become a permanent obstacle. There are steps chronic pain patients can take to regain control over their healthcare experience.

    Prioritize Appointments Based on Value

    Not every follow-up is essential. Patients can work with a trusted provider to identify which appointments are crucial and which can be delayed, reduced in frequency, or combined. Prioritizing value over volume gives patients more control over their time and energy.

    Set Clear Goals for Each Visit

    Approaching appointments with a purpose can help reduce frustration. Write down specific questions, concerns, or goals beforehand. If possible, share these in advance with your provider to focus the conversation and avoid wasted time.

    Use Telehealth When Available

    Virtual appointments eliminate travel time, reduce scheduling stress, and may be more manageable on bad pain days. While not ideal for every visit, they are a helpful tool for routine check-ins or medication management.

    Track Symptoms and Share Concisely

    Using pain journals or digital symptom trackers can streamline communication during visits. When providers see patterns and progress laid out clearly, appointments tend to be more productive and less repetitive.

    Build a Core Care Team You Trust

    Rather than relying on multiple specialists, try to work closely with a few key providers who understand your history and goals. A coordinated team reduces duplication and provides more personalized care.

    Take Mental Health Seriously

    Psychological support is vital. Seeing a therapist familiar with chronic illness can help process the emotional exhaustion that feeds appointment fatigue. Therapy can also provide strategies for setting boundaries and communicating more effectively with medical professionals.

    Reclaiming Your Voice in a Complex System

    Chronic pain does not just impact the body; it infiltrates every aspect of a person’s life. When medical care starts feeling more like a burden than a support system, it’s a sign that the balance needs to be restored. Patients have every right to advocate for themselves, to ask for care that meets their needs, and to opt out of what is not serving them.

    This might mean switching providers, taking breaks between appointments, or even re-evaluating which symptoms need professional management versus home care. The most important thing is for patients to feel like active participants, not just subjects of an endless medical routine.

    Frequently Asked Questions

    1. What is appointment fatigue?
    Appointment fatigue refers to the mental and emotional exhaustion experienced from attending frequent medical appointments, particularly when managing chronic illnesses like chronic pain.

    2. Is appointment fatigue common among chronic pain patients?
    Yes. Many people with chronic conditions report feeling overwhelmed by the frequency and burden of medical visits, especially when results are minimal or progress is slow.

    3. Can appointment fatigue lead to worse health outcomes?
    Avoiding or skipping appointments can result in missed diagnoses, unmanaged symptoms, or complications, potentially worsening a patient’s condition over time.

    4. How can I talk to my doctor about appointment fatigue?
    Be honest and specific. Explain how the frequency of visits impacts your life and ask whether some appointments can be spaced out or handled differently, such as via telehealth.

    5. Are there ways to manage my care with fewer appointments?
    Yes. Coordinating care through a central provider, using digital symptom logs, and setting clear health goals can reduce the need for frequent appointments.

    6. Should I feel guilty for needing a break from medical visits?
    Absolutely not. Taking a step back to recover emotionally and mentally is valid and may ultimately improve your engagement and outcomes in the long term.

    Conclusion

    Appointment fatigue is a real and often overlooked side effect of managing chronic pain. It affects motivation, emotional well-being, and the overall healthcare journey. Understanding this phenomenon allows patients to take proactive steps toward regaining control, creating more meaningful medical interactions, and protecting their energy for healing. Empowerment begins when patients recognize they are not just their symptoms—they are people who deserve respect, rest, and choices in how they pursue wellness.

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    References:

    Fibromyalgia Contact Us Directly

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    Official Fibromyalgia Blogs

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  • What is Myofascial Pain Syndrome and How it is affiliated with Fibromyalgia.

    Fibromyalgia and myofascial pain syndrome often go together. Because of the frequent overlap and some similar symptoms, they’re often mistaken for the same condition and, as a result, people with both are sometimes only diagnosed with and treated for one.

    That’s a real problem, for three major reasons:

    1. they require different treatment
    2. MPS’s trigger points can be eliminated
    3. MPS pain can exacerbate FMS, and lowering MPS pain can calm FMS symptoms considerably

    Some researchers use the name “chronic myofascial pain” (CMP) instead of myofascial pain syndrome because of evidence it’s a disease, not a syndrome. (A “syndrome” is a set of symptoms without a known cause.)

    Overview

    In MPS, muscles and connective tissues (which make up the fascia) develop what’s called a trigger point (TrP). These are not the same as FMS tender points.

    A trigger point is a small, hard knot that you can sometimes feel under your skin. The knot itself can be painful, especially when poked, but it often causes pain in another area, which is called referred pain.

    Trigger points typically form as a result of trauma to the tissue. Experts don’t know why damage that heals normally in most people causes TrPs in others. However, studies suggest that muscle injury in some people leads to abnormalities where the nerve cells connect to muscle cells. This suggests MPS is a neuromuscular disease.

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    Association

    Why people with MPS frequently develop FMS isn’t yet clear, but a growing body of evidence shows that, in some people, chronic pain can make changes to the central nervous system, resulting in central sensitization. If theories are correct, early treatment of MPS may help prevent FMS.

    An emerging umbrella term for FMS, MPS and other conditions involving central sensitization is central sensitivity syndromes.

    Symptoms

    Some symptoms associated with MPS are similar to symptoms associated with FMS, while others are linked to only one of them.

    The symptoms they have in common include:

    Symptoms associated with MPS but not with FMS include:

    • numbness in the extremities
    • popping or clicking joints
    • limited range of motion in joints, especially the jaw
    • doubled or blurry vision
    • unexplained nausea

    Symptoms associated with FMS but not with MPS include:

    For more fibromyalgia symptoms, see The Monster List of Fibromyalgia Symptoms.

    Diagnosis

    Referred pain makes MPS especially hard to diagnose and treat. Typically, a doctor says, “Where does it hurt?” and then looks where you point. To treat MPS, you and your doctor need to examine your symptoms and figure out where your trigger points are.

    Your doctor can find trigger points by feel or based on symptoms.

    Tests such as magnetic resonance elastography and tissue biopsy may show abnormalities in TrPs, but their roles in diagnosing MPS still aren’t clear.

    By contrast, no test or scan reveals abnormalities in the tissues where people with FMS experience pain.

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    Treatments

    You have several options for treating MPS:

    • Trigger-Point Injections: The doctor inserts a needle directly into a TrP or in several places around it to loosen up the taut bands. The doctor may inject a pain-relieving medication, such as corticosteroids or lidocaine. (Note: some doctors believe corticosteroids can exacerbate fibromyalgia symptoms.) When no medication is used, it’s called dry needling.
    • Acupuncture: Acupuncture is an ancient Chinese practice similar to dry needling. While studies of its use in MPS are limited they are promising, and many patients and practitioners report good results.
    • Physical Therapy: A special kind of therapy called spray-and-stretch is common for treating MPS. A physical therapist guides you through stretching exercises while spraying a numbing substance on your muscle. The therapist may also use certain massage techniques to loosen your muscles and TrPs. In addition, a therapist can work with you on factors such as poor posture that may contribute to MPS.
    • Medications: Common drugs for MPS include nonsteroidal anti-inflammatory drugs (NSAIDs) such as Aleve (naproxen) or ibuprofen-based drugs like Advil and Motrin, and tricyclic antidepressants such as amitriptyline, doxepin, and nortriptyline.

    MPS Treatments vs. FMS Treatments

    Here again, there is some overlap but also important differences. Treatments used for both MPS and FMS include:

    Studies show trigger-point injections are not effective at relieving fibromyalgia tender points, and NSAIDs are not effective at treating FMS pain.

    For more on fibromyalgia treatments, see Treating Fibromyalgia – A Multidisciplinary Approach.

    Coping

    With significant differences in their symptoms, diagnostics, and treatment, it’s clear that fibromyalgia and myofascial pain syndrome are not the same conditions. However, it can be extremely difficult to determine which condition is causing which pain when a person has both of them.

    By working both on your own and with your doctor and/or physical therapist, you may be able to figure out where you have trigger points and how best to treat them without exacerbating your fibromyalgia. Relieving the myofascial pain is likely to quiet your fibromyalgia symptoms, so you could well see a double benefit.

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    For More Information Related to Fibromyalgia Visit below sites:

    References:

    Fibromyalgia Contact Us Directly

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    Official Fibromyalgia Blogs

    Click here to Get the latest Chronic illness Updates

    Fibromyalgia Stores

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  • If You’ve Ever Been Called Overly-Emotional Or Too Sensitive, This Is For You

    Emotional: a word used often nowadays to insult someone for their sensitivity towards a multitude of things. If you cry happy tears, you’re emotional. If you express (even if it’s in a healthy way) that something is bothering you, you’re sensitive. If your hormones are in a funk and you just happen to be sad one day, you’re emotional AND sensitive.

    Let me tell you something that goes against everything people have probably ever told you. Being emotional and being sensitive are very, very good things. It’s a gift. Your ability to empathize, sympathize and sensitize yourself to your own situation and to others’ situations is a true gift that many people don’t possess, therefore many people do not understand.

    Never let someone’s negativity towards this gift of yours get you down. We are all guilty of bashing something that is unfamiliar to us: something that is different. But take pride in knowing God granted this special gift to you because He believes you will use it to make a difference someday, somehow.

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    This gift of yours was meant to be utilized. It would not be a part of you if you were not meant to use it. Because of this gift, you will change someone’s life someday. You might be the only person that takes a little extra time to listen to someone’s struggle when the rest of the world turns their backs.

    In a world where a six-figure income is a significant determinant in the career someone pursues, you might be one of the few who decides to donate your time for no income at all. You might be the first friend someone thinks to call when they get good news, simply because they know you will be happy for them. You might be an incredible mother who takes too much time to nurture and raise beautiful children who will one day change the world.

    To feel everything with every single part of your being is a truly wonderful thing. You love harder. You smile bigger. You feel more. What a beautiful thing! Could you imagine being the opposite of these things? Insensitive and emotionless?? Both are unhealthy, both aren’t nearly as satisfying, and neither will get you anywhere worth going in life.

    Imagine how much richer your life is because you love others so hard. It might mean more heartache, but the reward is always worth the risk. Imagine how much richer your life is because you are overly appreciative of the beauty a simple sunset brings. Imagine how much richer your life is because you can be moved to tears by the lessons of someone else’s story.

    Embrace every part of who you are and be just that 100%. There will be people who criticize you for the size of your heart. Feel sorry for them. There are people who are dishonest. There are people who are manipulative. There are people who are downright malicious. And the one thing people say to put you down is “you feel too much.” Hmm.

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    For More Information Related to Fibromyalgia Visit below sites:

    References:

    Fibromyalgia Contact Us Directly

    Click here to Contact us Directly on Inbox

    Official Fibromyalgia Blogs

    Click here to Get the latest Chronic illness Updates

    Fibromyalgia Stores

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  • Link Between Allodynia and Fibromyalgia

    Have you ever tried resting in bed, but the sheets are somehow painful enough to keep you awake? Have you ever been outside on a warm day only to have a cool breeze or gust of wind hurt your body all over? Or how about this one: has the elastic on your sleeves, pants, or socks bothered you so badly that you just had to change clothes or go naked for a bit? If you’re reading this and don’t have fibromyalgia, these scenarios may sound absurd. But the struggle is real, folks, and it’s called allodynia.

    Allodynia and fibromyalgia often go together. For example, I’ve literally had to get up in the middle of the night a few times in life just to shave my legs because the irritation and pain from my pajamas or sheets touching the hair was keeping me awake. So I’ve been shaving every day of my life for years now just to avoid that sensation.

    The best way I have found to help people understand what I’m dealing with is to say, “Think about the most sensitive places on your body. It could be your lips, fingertips, tongue, or whatever. Now imagine that your whole body and even your muscles are made from the same nerves that are found in those places. Then think about how it would feel if it was overly stimulated all the time. That’s a lot like what I experience when the wind blows and even sometimes when I’m gently touched by my partner or pet.”

    Just What is Allodynia?

    Researchers at the UK-based Cardiff University explain that “neuropathic pain is caused by damage to- or dysfunction of- the peripheral and central nervous system, rather than stimulation of pain receptors.” If you’ve done any reading at all about fibromyalgia, then these are ideas you should definitely be familiar with. In fact, they add that “neuropathic pain commonly results in ‘spontaneous’ pains. Some of these sensations appear to have a ‘life of their own and are bizarre.” Bizarre and spontaneous sensations and pains? Sounds like an average day when you’re dealing with fibromyalgia, doesn’t it? Well, allodynia is one of those spontaneous pains.

    You see, allodynia falls into a category of “evoked pains” which are “usually exaggerated responses to innocuous events that do not cause pain in people with ‘normal’ pain pathways.” Ok, now we’re getting somewhere, aren’t we? This explains why those without fibro usually have no concept of what this is like. Allodynia is specifically pain that comes from simple contact which isn’t usually painful. Like blowing wind, unshaven legs, and sheets touching your skin.

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    Kinds of Allodynia

    There are three forms of allodynia. First is touch or tactile, meaning the pain that comes from the touch of, for example, clothing against the skin. Second is mechanical allodynia which is caused by movement across the skin from things like towels used for drying off, the brushing of bed sheets, and yes, even the wind. Lastly is thermal or temperature-related allodynia. That’s referring to hot or cold temperatures that are not extreme enough to damage your tissues. Indeed, the temperature may be rather. But with allodynia, it feels extreme so we might refer to it as temperature sensitivity.

    You can actually have just one form or any combination of allodynia, and even all three. As you can see from the personal examples I shared, I obviously have the first two kinds. The third is hit or miss for me, but it’s definitely a problem. And your fibro experience may be similar to mine or very different. Nevertheless, allodynia and fibromyalgia go hand-in-hand as should be evident by now.

    Treating Allodynia and Fibromyalgia

    Allodynia is a type of pain commonly associated with fibromyalgia. It can be really difficult for non-fibro people to understand. And unfortunately, like fibromyalgia, allodynia cannot be cured. Rather, they must be managed. One treatment often recommended to help the muscular pain associated with fibro is massage. However, I have to use this method sparingly and in short bursts. My allodynia keeps me from enjoying a massage for longer than 45 minutes if I’m lucky. So be mindful that massage therapy can make it worse, but it also helps to simply know your limitations and tell the therapist when you’ve had enough.

    Some fibro patients get allodynia pain relief from topical creams like Tiger Balm, Aspercreme, Lidocaine, or BioFreeze. Certain drugs used for the moderate treatment of pain have helped some fibro patients deal with their allodynia as well. Medications such as Tramadol, Lyrica, and Gabapentin are effective for treating a number of symptoms, including the pain from allodynia and fibromyalgia.

    Have you found a particular treatment, method, or remedy for allodynia and fibromyalgia that works for you? Please share it with us because every little bit helps in this community!

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    For More Information Related to Fibromyalgia Visit below sites:

    References:

    Fibromyalgia Contact Us Directly

    Click here to Contact us Directly on Inbox

    Official Fibromyalgia Blogs

    Click here to Get the latest Chronic illness Updates

    Fibromyalgia Stores

    Click here to Visit Fibromyalgia Store

  • Fibromyalgia Supplements | A Miracle Thyme Tea Reliefs Fibromyalgia and Chronic Fatigues

    Thyme is an herb from the mint family. This is a truly ancient herb, used by the Egyptians, Greeks, and Romans for ceremonial and ritualistic purposes. Through the Middle Ages where it was also used for religious and medicinal reasons. It is an incredibly potent yet simple herb affecting multiple systems in the body and capable of treating dozens of diseases. It contains one of the strongest antioxidants known and is proven to kill 98% of breast cancer cells.

    Thyme contains thymol which is a natural antiseptic, antibacterial, and an expectorant, making this tea with honey and lemon a delicious remedy for all of you suffering from sore throats and coughs.

    Wild thyme tea is recommended for cough, hangover, flu, and sore throat. Thyme has primarily been used for respiratory ailments for its infection-fighting and cough suppressive qualities. Thyme honey is ideal for sweetening herb teas. Blend thyme with nettle for allergies and mints for colds and congestion. It is also help’s if you have fibromyalgia, rheumatoid arthritis, lupus & multiple sclerosis.

    Thyme Tea Recipe

    Ingredients:

    -1c Boiling Water
    -1tbs dry or 1T fresh Thyme
    -1tbs dry or 1T fresh sage
    -1-1 Ginger slices
    -Honey to taste

    Directions:
    -Warm your teacup with hot water.
    -Pour away the water.
    -Put herbs in the cup. Add fresh boiling water and cover.
    -Leave to steep 3 to 5 minutes. Add more herbs for a stronger flavor.
    -Steeping too long will make the tea bitter. Use Honey or a natural herbal sweetener like Stevia.
    -Add ginger slices and/or lemon slices if desired.

    Other Health Benefits Of Thyme

    -Lower Blood Pressure
    -Boost your Immunity
    -Boost your Mood
    -Improves bone health
    -Antioxidant Capacity
    -Immune System
    -Anti-fungal Ability

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    For More Information Related to Fibromyalgia Visit below sites:

    References:

    Fibromyalgia Contact Us Directly

    Click here to Contact us Directly on Inbox

    Official Fibromyalgia Blogs

    Click here to Get the latest Chronic illness Updates

    Fibromyalgia Stores

    Click here to Visit Fibromyalgia Store

  • CFS | Light and Noise Sensitivity in Chronic Fatigue Syndrome

    CFS | Light and Noise Sensitivity in Chronic Fatigue Syndrome

    Light and noise sensitivity in fibromyalgia (FMS) and chronic fatigue syndrome (ME/CFS) have been scientifically established since the early 1990s, but they’re still underrecognized and rarely make symptoms lists. Rest assured that you’re not alone in experiencing this symptom!

    When I used to take my kids to daycare, some mornings the noise would hit me like a brick wall. In an instant, I’d have pain, nausea, dizziness, trembling, and a looming panic attack.

    More than once, I had to call in sick as a result of it. I’ve had similar experiences with bright or flashing lights, or with visual chaos in general.

    Causes

    We don’t know the causes of light and noise sensitivity, but they’re often called “generalized hypervigilance.” That means our bodies are constantly on high alert. It’s also a symptom of post-traumatic stress disorder.

    Hypervigilance is beneficial for people in potentially dangerous situations, such as soldiers or police officers, because it speeds up to several processes and helps with crisis response.

    In FMS and ME/CFS, however, hypervigilance overwhelms us. We don’t know why, but possibilities include:

    • Nervous system abnormalities
    • Stress-system (HPA axis) problems
    • Neurotransmitter dysregulation
    • Blood pressure irregularities

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    Symptoms of Generalized Hypervigilance

    Common symptoms of hypervigilance include:

    • Anxiety
    • Rapid heartbeat
    • Trembling
    • Rapid or labored breathing
    • Sweating
    • Irritability
    • Fatigue
    • Sleep disturbances

    Treatments

    So far, we don’t have research showing that specific treatments alleviate light and noise sensitivity in FMS and ME/CFS.

    In people with PTSD, treatment for the anxiety related to generalized hypervigilance can include mental-health counseling and medications, especially antidepressants.

    Supplements for anxiety and stress may help you cope better with light and noise sensitivity as well. Some people also benefit from treatments such as massage or acupuncture.

    Coping

    Light and noise sensitivity can have a huge impact on your life. You may avoid certain situations and even fear them, which increases anxiety. It can also contribute to social isolation, which is common in people with FMS or ME/CFS and can worsen depression.

    Some work environments are difficult to endure. I used to be a television news producer, which meant sitting under a lighting grid in a room with dozens of TVs and ringing phones. I went from thriving in the chaos to having regular anxiety attacks. I decided to leave the job. Other people may be able to get reasonable accommodation to lessen the impact of this symptom.

    You might be able to eliminate or avoid many sources of excess noise and light, but you probably can’t eliminate all of them. Several simple things can help you deal with light and noise sensitivity in your daily life:

    • Sunglasses are a must outside.
    • If fluorescent lights bother you, lightly tinted sunglasses or a hat with a brim may help.
    • In a noisy environment, earplugs or listening to music on headphones may help some people.
    • Deep breathing and other relaxation techniques can help you get through episodes of sensory overload due to light and noise.
    • Teach your family and friends about the impact that light and noise have on you so they understand your requests to turn off lights or turn down the volume.
    • If your computer screen bothers you, try adjusting the brightness and contrast.
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    Click Here to Visit the Store and find Much More….

    For More Information Related to Fibromyalgia Visit below sites:

    References:

    Fibromyalgia Contact Us Directly

    Click here to Contact us Directly on Inbox

    Official Fibromyalgia Blogs

    Click here to Get the latest Chronic illness Updates

    Fibromyalgia Stores

    Click here to Visit Fibromyalgia Store

  • Medications | Why Doctors Over prescribing Gabapentin and Pregabalin (Lyrica) for Pain?

    Let’s be perfectly honest. Most doctors have a difficult time with chronic pain patients. One physician described it to us many years ago: “When I see a patient suffering severe chronic pain come in the front door I want to go out the back door.” That’s because there are few good options. Drugs like hydrocodone or oxycodone used to be prescribed in huge quantities. Now gabapentin (Neurontin) and pregabalin (Lyrica) are on the ascendency and opioids are shunned.
    The Opioid Epidemic:
    Doctors are dismayed by the opioid epidemic sweeping the nation. Over the last year, the drumbeat of headlines about opioid overdoses and deaths has scared a lot of physicians into cutting back on prescribing drugs like hydrocodone or oxycodone.

    Many of the overdose deaths are caused by illicit fentanyl. People OD because they have no idea how potent the narcotics are that they are snorting, swallowing, or injecting. According to the CDC (Nov. 3, 2017):

    “Preliminary estimates of U.S. drug overdose deaths exceeded 60,000 in 2016 and were partially driven by a fivefold increase in overdose deaths involving synthetic opioids (excluding methadone), from 3,105 in 2013 to approximately 20,000 in 2016. Illicitly manufactured fentanyl, a synthetic opioid 50–100 times more potent than morphine, is primarily responsible for this rapid increase. In addition, fentanyl analogs such as acetylfentanyl, furanylfentanyl, and carfentanil are being detected increasingly in overdose deaths and the illicit opioid drug supply.”

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    Fentanyl powder does not come from your local pharmacy. Most of it is illicit and is coming from foreign countries (CBS News; New York Times, Aug. 10, 2017). China and Mexico are major suppliers. It is being added to heroin or even counterfeit opioid pills that look like Percocet (CNN June 8, 2017) or Oxycontin. The government does not seem to know how to stem the flow of illicit fentanyl that is flooding the country.
    Doctors and Opioids:
    It is hardly any wonder that doctors have cut back on prescriptions for hydrocodone and oxycodone. Like the rest of us, they read horrifying reports about opioid deaths. The evening news often leads with graphic accounts of accidental overdoses. Federal guidelines and restrictions have made it harder for physicians to prescribe opioids.
    Gabapentinoids: What Are They?

    As a result of the negative publicity and constraints about opioids, many people who are in severe pain have been left without relief. Consequently, physicians are searching for other drugs they can prescribe instead of narcotics. They may turn to gabapentinoids (gabapentin and pregabalin).

    Gabapentin (Neurontin) and pregabalin (Lyrica) are both used to treat nerve pain. Doctors prescribed these medications three times more often in 2015 than they did in 2002, despite no radical change in the number of patients with neuropathic pain (JAMA Internal Medicine, online Jan. 2, 2018).
    The author advises his colleagues to use these drugs cautiously:

    “The combination of a dearth of long-term safety data, small effect sizes, concern for increased risk of overdose in combination with opioid use, and high rates of off-label prescribing, which are associated with high rates of adverse effects, raises concern about the levels of gabapentinoid use. While individual clinical scenarios can be challenging, caution should be advised in the use of gabapentinoids, particularly for those individuals who are longterm opioid users, given the lack of proven long-term efficacy and the known and unknown risks of gabapentinoid use.”

    A perspective published in the New England Journal of Medicine goes even further (Aug. 3, 2017).

    The authors note that guidelines from the CDC recommend acetaminophen and NSAIDs as first-line options for osteoarthritis and low back pain. The physicians point out that “acetaminophen is often ineffective, and NSAIDs are associated with adverse effects that limit their use…”
    They go on to say:

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    “The CDC guidelines also recommend gabapentinoids (gabapentin or pregabalin) as first-line agents for neuropathic pain. We believe, however, that gabapentinoids are being prescribed excessively — partly in response to the opioid epidemic”

    They conclude:

    “Patients who are in pain deserve empathy, understanding, time, and attention. We believe some of them may benefit from a therapeutic trial of gabapentin or pregabalin for off-label indications, and we support robust efforts to limit opioid prescribing. Nevertheless, clinicians shouldn’t assume that gabapentinoids are an effective approach for most pain syndromes or a routinely appropriate substitute for opioids.”

    Gabapentin Side Effects:
    The history of gabapentin (Neurontin) is fascinating. It was originally approved by the FDA for treating epilepsy in 1993. There is a tale of woe and intrigue about how the company that marketed Neurontin got into trouble with the FDA for illegal off-label marketing practices. We won’t go into that here, but you can read all about it in this article:
    Surprising Gabapentin Side Effects
    Gabapentin has become a go-to drug for doctors who are trying to control chronic pain problems. At last count, dispensed prescriptions have gone from 39 million in 2012 to 51 million in 2014 to 64 million in 2016 (Quintiles IMS, May 2017, now IQVIA Institute).

    Gabapentin can cause depression, dizziness, fatigue, drowsiness, digestive tract upset, trouble with balance, cognitive difficulties, and visual problems. The official prescribing information warns:

    “Antiepileptic drugs (AEDs), including gabapentin, increase the risk of suicidal thoughts or behavior in patients taking these drugs for any indication. Patients treated with any AED for any indication should be monitored for the emergence or worsening of depression, suicidal thoughts or behavior, and/or any unusual changes in mood or behavior.”

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    Official Fibromyalgia Blogs

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  • Researchers Find Main Source Of Pain In Blood Vessels

    Are you experiencing constant muscle pain and fatigue? There is a good chance that you are suffering from fibromyalgia. As many as 5 million Americans that are aged 18 or older are affected by it. Women are the primary targets of this chronic disease, affecting up to 90% of them, and it’s very hard to treat.

    For many years, research has pointed to this pain and fatigue just being “in the patient’s head.” It’s been characterized as a psychosomatic disorder, which means that it’s caused by mental factors that attribute to a person’s imagination.

    Many people complain about pain in their neck, shoulders, back, and legs. But no research has been able to pinpoint what is causing this pain. Until now! Recent research has finally determined that this pain is in fact not just an imagination, but actually caused by a sensory nerve in blood vessels found in the palms!

    Scientists at Integrated Tissue Dynamics were responsible for the study. They found that the fibres that were supposed to be only responsible for the blood flow in the skin are also responsible for sensing touch and pain.

    In order to be sure about their findings, the team conducted a second study to see if they could locate any pathology in the blood vessels that could also contribute. After analyzing skin samples they collected from women who suffered from fibromyalgia, they discovered that there was a large increase in sensory fibres at certain sites within blood vessels of the skin.

    These nerves are part of the arteriole-venule shunts, which are responsible for heat regulation in our body by controlling the blood flow in our blood vessels. In warm conditions, the shunts shut down which forces blood into the skin surface so it can be released.

    In cold conditions, the shunts open up and allow the veins to conserve heat, thus our hands and feet become cold.

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    The lead scientist on the study, Dr. Albrecht, explains that this excess sensory innovation may be because of painful hands that fibromyalgia patients experience.

    “Since the sensory fibres are responsible for opening the shunts, they would become particularly active during cold conditions, which are very bothersome times for fibromyalgia patients.”

    The research team also came to another conclusion; they explain that our hands and feet usually contain more blood than they needed, so they’re used as reservoirs for blood which can be delivered throughout the body. Because of the pathology that occurs in these shuts, the blood flow is usually mismanaged.

    President of Integrated Tissue Dynamics, Dr. Rice, elaborated on their findings, “The pathology discovered among these shunts in the hands could be interfering with blood flow to the muscles throughout the body. This mismanaged blood flow could be the root cause of muscle pain and achiness and the sense of fatigue that fibromyalgia patients experience.”

    These findings are a step in the right direction for those suffering from fibromyalgia; it offers a proper treatment instead of the usual painkillers and antidepressants.

    So if you’re suffering from fibromyalgia, or know someone that is, it’s good to finally know that you’re not crazy, and you can certainly be sure that fibromyalgia is real!

    Causes of Fibromyalgia: Doctors are not completely sure of what actually causes a person to get fibromyalgia, a variety of factors may work together.

    Genetics: In most cases, fibromyalgia runs in the family, so there could be a certain genetic mutation that can cause you to be more susceptible to the disorder.

    Infections: Certain illnesses have the ability to trigger fibromyalgia.

    Physical or Emotional Trauma: Fibromyalgia can sometimes be triggered by physical trauma, like a severe car accident. Psychological stress can also be a triggering factor as well.

    Just because there is a new breakthrough that has discovered what might cause the pain for fibromyalgia patients, doesn’t mean that they should stop doing certain things that keep it from acting up. You need to continue taking care of yourself and layout a program that helps with that.

    You should first try and reduce the amount of stress in your life. This could mean putting some time aside to just relax. Getting enough sleep is another key point. Since fatigue is one of the main characteristics, getting enough sleep is essential. Also, you should try and exercise regularly. It may hurt at first but it will eventually reduce the pain significantly.

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    Official Fibromyalgia Blogs

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  • Wearable Tech Emerging For Chronic Pain Relief

    The opioid crisis has revealed another real ongoing problem: a lot of people have chronic pain. For example, Lady Gaga recently revealed that she suffers from fibromyalgia, a chronic pain condition that the Centers for Disease Control and Prevention (CDC) says afflicts 4 million people (or 2% of the adult population). This number may actually be an underestimate because determining the real number of people that have fibromyalgia can be a pain.

    Fibromyalgia is frequently underdiagnosed or misdiagnosed. Many people, including doctors, are not fully aware of the condition. People may try to maintain a “Poker Face” when afflicted with the symptoms of fibromyalgia, such as pain and stiffness throughout their body, fatigue, depression, anxiety, difficulties sleeping, memory problems, and headaches. Or they may attribute the symptoms to something else. Also, until the FM/a Test was approved by the U.S. Federal Drug Administration (FDA) in 2012, no simple test for fibromyalgia was available.

    The Netflix documentary ‘Gaga: Five Foot Two‘ revealed Lady Gag’s struggles with fibromyalgia. Here Lady Gaga is pictured during the premiere during the film’s premiere at the 2017 Toronto International Film Festival.

    While fibromyalgia is certainly not the only reason someone may be started on opioids, a publication in the Journal of Clinical Rheumatology discussed how fibromyalgia has contributed to the increase in opioid medication prescriptions since 2004. Opioid medications, if you haven’t heard, can be quite addictive and lead to the use of other drugs like heroin. Therefore, there is an urgent need for more alternatives to opioid medications to help manage chronic pain.

    Enter the wearable movement. While some wearables may seem unnecessary (e.g., the No More Woof headset supposedly translates dog barks into English so that you can know when your dog is saying “what an idiot”), wearable technology for pain relief is an intriguing emerging area.

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    It may sound a bit like a late-night infomercial or something from a mystical healer: wear this band around your leg to decrease the pain throughout your whole body. But there is real scientific reasoning behind devices such as NeuroMetrix’s Quell that received U.S. Food and Drug Administration approval for over-the-counter use in July 2014.

    The Quell device is a band that looks a bit like a blood pressure cuff that you wear around your upper calf. The device does not utilize any medications but instead generates electric signals that stimulate your body to produce naturally occurring substances (endogenous opioids) that can then inhibit nerve signals that lead to feeling pain. In other words, the device helps activate your body’s natural system for regulating pain.

    Shai N. Gozani, M.D., Ph.D., Founder and CEO of NeuroMetrix, Inc. explained that “fibromyalgia is believed to result from problems with the central nervous system. There is no injury per se in the peripheral nerves. The balance between positive and negative signals regulating the pain neurons may be off. The nerve signals that inhibit pain signals may be decreased. The Quell device can help boost this part of the system.”

    Of course, you don’t just put on the band and presto your pain disappears. As Dr. Gozani related, you typically have to wear the device for a week or two before noticing the reduction in pain. Typically, people will wear the band for 6 to 8 hours a day. The device periodically cycles on and off and can also collect information on your activity and pain levels to help you adjust the device and manage your pain. The device offers the option of tapping into the Quell Health Cloud, which stores data on the usage, sleep, pain levels, and activity for many different users and thus can provide analysis that can in turn help with pain management.

    Neurometrix reported that Quell contributed $3.0M out of NeuroMetrix’s $4.3M in revenue in the second quarter of 2017 and that they shipped their 100,000th Quell device in July 2017.  Quell device shipments in the second quarter of this year were almost ten times what they were in the second quarter two years prior.

    There are certainly many advantages of replacing medications with wearables. For example, addiction is less of an issue (e.g., wearing many bands all over your body probably won’t help). Finding and using ways to stimulate and modulate your body’s pain regulating mechanisms is certainly not a new approach to pain control. This is the basis of transcutaneous electrical nerve stimulation (TENS) and some physical therapy and alternative medicine approaches such as needling.

    But developing wearables so that you can go about your daily activities while receiving non-medication pain treatments is new and opens up a whole new avenue of potential ways to manage pain. Furthermore, having such devices interface with digital platforms could help better track pain management, combine treatments, generate data to provide scientific insights, and interface with other types of wearables. Who knows, someday maybe your dog can help you more with your pain management.

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  • Dyskinesia And Fibromyalgia: Causes and Treatment

    We still don’t know what causes fibromyalgia. But we often treat it with a class of drugs that are usually used to treat disorders like seizures. While these drugs can help manage the symptoms of fibromyalgia, they can also cause a range of side effects, including dyskinesia.

    Dyskinesia is a condition that causes frequent, uncontrollable movements of the limbs. And it can become very difficult to manage if you suffer from it for a long time. So what exactly is dyskinesia, what’s the link to fibromyalgia, and what can you do to treat it?

    What Is Dyskinesia?

    Tardive dyskinesia, or TD, is a common side effect of drugs used to treat seizures. One in particular that we should look at when it comes to fibromyalgia is Gabapentin. Gabapentin works by calming the interaction between nerves in the brain. This is effective for treating seizures which are caused by rapid-firing interactions between these nerves. But it’s also frequently used to treat fibromyalgia.

    Gabapentin can work to manage many of the symptoms of fibromyalgia. Interestingly, in addition to the pain, it’s often prescribed to treat some of the chronic itchings that come along with fibromyalgia. It’s a symptom we don’t often think of when it comes to fibromyalgia, but chronic itching can be one of the worst elements of the condition if you suffer from it.

    Because chronic itching seems to be the result of interactions between the nerves, Gabapentin can help to treat the itching.

    But it can also lead to dyskinesia. Dyskinesia is basically an uncontrollable tendency to jerk your legs or arms. But it can also include other less obvious things like a tendency to purse or smack your lips together. The condition is usually worse when you have been resting, which can make the sleep issues caused by fibromyalgia even worse. But in addition, TD can cause you to jerk your head, blink your eyes, or even stick out your tongue without really realizing that you are doing it.

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    Dyskinesia And Fibromyalgia

    It’s believed that TD is caused by low levels of a neurotransmitter called dopamine. Low levels of dopamine are actually quite common in people with fibromyalgia, though we don’t know why. But TD seems to be more of a side effect of medications used to treat fibromyalgia than a complication of fibromyalgia itself.

    The most likely reason that someone would develop TD is if they’ve been taking a drug like an SSRI or anti-seizure medication for at least three months. And we know that the majority of people who suffer from both TD and fibromyalgia tend to be older women.

    So, people who have fibromyalgia currently being treated with these kinds of drugs have an elevated risk of developing it. And there are many anecdotal accounts of people who have developed it as a result of their fibromyalgia medication. If you’re interested, you can likely ask around within the fibromyalgia community and find people who have had a similar experience.

    How Is It Treated?

    The best way to cure TD is to simply stop taking the medications that cause it. Of course, this isn’t always an option. Many people depend on those medications to keep their fibromyalgia symptoms in check. And you should never stop taking a medication on your own without first consulting a doctor.

    If you think you’re suffering from TD, you can go to a doctor for a test. The doctor will determine if you’re suffering from involuntary movements. They may decide that it is the result of your medication, or it’s possible that you’re suffering from another condition that causes involuntary movements. There are a number of these conditions including cerebral palsy, brain tumors, or Parkinson’s disease. Going to a doctor is a good way to eliminate some of these other possibilities.

    There’s no medication that’s currently approved by the FDA to treat TD, but some psychiatric drugs might help. Others have reported success with treating the condition with dietary supplements like Gingko, but the scientific evidence for this is somewhat limited.

    If the TD is really debilitating, you may have to judge with your doctor whether the benefits you get from the medication are worth the side effects. It’s an unfortunate position to be in, but we don’t really have any other good alternatives at the moment.

    So, let us know. Do you suffer from TD? Is it related to your fibromyalgia medication? How did you decide what you needed to do? Did any supplements help you? Tell us in the comments.

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    Fibromyalgia Contact Us Directly

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    Official Fibromyalgia Blogs

    Click here to Get the latest Chronic illness Updates

    Fibromyalgia Stores

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