Explore the medications commonly used to treat Fibromyalgia, including pain relievers, antidepressants, and other options to manage symptoms effectively.
Neurontin and its newer more potent version, Fibromyalgia pain relief drug Lyrica, are widely used for off-label indications that are an outright flagrant danger to the public. These blockbuster drugs were approved for use even though the FDA had no idea what they actually did in the brain. A shocking new study shows that they block the formation of new brain synapses, drastically reducing the potential for rejuvenating brain plasticity – meaning that these drugs will cause brain decline faster than any substance known to mankind.
The problem of these drugs is compounded by their flagrant illegal marketing. Neurontin was approved by the FDA for epilepsy back in 1994. Fibromyalgia pain relief drug underwent massive illegal off-label promotion that cost Warner-Lambert 430 million dollars (the very first big fine for off-label promotion). The Fibromyalgia pain relief drug is now owned by Pfizer. Pfizer also owns Lyrica, a super-potent version of Neurontin. It has been approved by the FDA for various types of pain and fibromyalgia.
Lyrica for Fibromyalgia pain relief is one of four drugs that a subsidiary of Pfizer illegally marketed, resulting in a $2.3 billion settlement against Pfizer. Even though the marketing of these drugs has been heavily fined, they continue to rack up billions in sales from the off-label uses. Doctors use them for all manner of nerve issues because they are good at suppressing symptoms.
However, such uses can no longer be justified because the actual mechanism of the drugs is finally understood and they are creating a significant long-term reduction in nerve health. The researchers in the above study try to downplay the serious nature of the drugs by saying “adult neurons don’t form many new synapses.” That is simply not true.
The new science is showing that brain health during aging relies on the formation of new synapses. Even these researchers managed to question the common use of these medications in pregnant women. How is a fetus supposed to make new nerve cells when the mother is taking a drug that blocks them? These are the kind of situations the FDA should be all over.
As usual, the FDA is sitting around pondering a suicide warning for Fibromyalgia pain relief drug Lyrica while its off-label uses include bi-polar disorder and migraine headaches. The FDA is likely to twiddle its thumbs for the next decade on the brain damage issue. Consumer beware.
The surface of the body, usually on the back and neck. Here’s what you should know about this technique and what others have said about its use in pain management.
Gua sha (pronounced gwah sah) is a traditional east Asian healing technique – also known as cao gio, coining, scraping, and spooning. It uses friction and scraping on the back to treat numerous conditions. It may help with everything from pain and inflammation to stiffness and soreness.
Gua sha is believed to promote a healthier flow of energy. Ancient Chinese medical techniques are experiencing wide-spread popularity in the U.S. today. The wisdom and apparent effectiveness that is found in these Eastern healing arts are appealing as an alternative to an often over-medicated culture. Gua sha and other treatments may help alleviate pain in less invasive ways than other solutions. They may also be reasonable alternatives before considering surgical correction.
The procedure is done with light strokes from a smooth implement. Objects such as a smooth coin, ceramic soup spoon, and jade have been used in the past but the most common tool today is a rounded metal cap. Prior to rubbing the body with the implement, your therapist will lubricate your skin with oil.
While a gua sha treatment can feel uncomfortable, many people have experienced much pain relief from it.
All of the muscles of the body are encased in fascia, a thin membrane. This membrane may become tight or constricted due to various conditions, not the least of which is injury or chronic pain.
Gua sha is one way to help restore circulation to the fascia and break up tension and tightness. “Gua” means “to scrape,” and “sha” refers to the red rash that is a result of this scraping. According to Chinese practitioners, this friction breaks up adhesions in the tissues and releases stagnant “winds” or qi, releasing blockages in meridians that can be causing pain or soreness in the body.
Physiologically, gua sha increase blood circulation within the tissues. For this reason, it can be used for any conditions that may be caused by poor circulation of blood (e.g. Inflammation). The Graston technique or augmented soft tissue mobilization (ASTYM) is a similar technique. It’s used by athletic trainers to release scar tissue and ease fascial constriction. Other therapists, such as massage therapists and chiropractors, may use ASTYM to treat acute or chronic soft tissue pathology.
It is believed that this procedure allows the unhealthy energy from the affected area to leave the body and stimulates blood flow and healing. Gua sha may help with the following conditions:
Gua sha works by increasing the blood flow to different areas of the body. It is believed that this releases the body’s natural pain fighting systems and blocks the pain pathways creating relief. This increased blood flow, known as microcirculation, has been scientifically proven to occur in the areas treated with the gua sha technique.
Neither the literature nor the current national standards sufficiently address safety standards for gua sha. However, it is thought that gua sha should also be avoided in areas with bruising, or superficial skin lesions such as burns and open sores, and in areas overlying bony prominences such as the spine. This treatment is also contraindicated in the genitalia.
In the United States, a licensed acupuncturist generally performs this treatment. Before undergoing the gua sha treatment, your acupuncture therapist will discuss your specific pain and symptoms.
Most gua sha sessions begin with a deep tissue massage or palpations along the back to find adhesions or scar tissues. When an area of the skin is pressed, it will turn pale. After the pressure is released, that area should quickly refill with blood. A slow capillary response where blood does not quickly rush back to the area when pressure is released means that circulation to that area may be compromised. This tells the therapist which areas need more pressure. Massage, palpations, and testing capillary response help the therapist identify potential areas that need more pressure. The practitioner also looks for areas that display blanching or delayed capillary refill.
The color and duration of the rash helps the gua sha practitioner diagnose and tailor a treatment plan to suit the patient. For example, light-colored sha can indicate a “deficiency of blood,” whereas dark-colored sha suggest the blood has been stagnant for an extended period.
The therapist will use a circular tool – spoons are common- and either oil or an abrasive substance to sweep down the back. This can increase microcirculation in the tissues of the back. The result is a rash underneath the skin caused by petechiae or ecchymoses (small leakages of blood). The color of the rash (dark or light) helps the gua sha therapist to plan future treatments.
Research on gua sha is in its infancy. Scientifically valid studies of its efficacy are small, few, and far between, but there does seem to be a push for a deeper look based on a few solid positive outcomes. That being said, there is increasing evidence that reflex therapies such as massage, gua sha, cupping and acupuncture help to reduce symptoms of pain by affecting the function of nociceptors, or pain-sensing neurons, and the spinal cord. Moreover, these social, comforting therapies may benefit patients experiencing pain by promoting relaxation.
One study of 48 patients with neck pain in Kliniken Essen-Mitte, Academic Teaching Hospital of the University Duisburg-Essen, Germany found that those in the gua sha group found that their neck pain decreased significantly when compared to the control group (which utilized a heating pad for pain relief).
Another study wanted to examine the claim that gua sha increased microcirculation. Increasing circulation in the body can help on a number of levels, including in reduction of inflammation and pain. Researchers at the Beth Israel Medical Center’s Continuum Center for Health and Healing found a fourfold increase in microcirculation shortly after gua sha treatment was administered, a result that was significantly more pronounced in female study participants. This same study also found that there was a pain-relieving mechanism to the treatment, but researchers were unable to identify it.
There is also research that supports ASTYM, the therapy that is very similar to gua sha. This research is sponsored by the company that makes ASTYM therapy tools, but the results span the U.S. and include data from 10,000 study participants. The full report includes promising results, such as:
Decreased pain and increased range of motion where scar tissue is present
Increased fibroblast activation and number (fibroblasts are the most common cells in human connective tissue and help with wound repair and construction of cartilage)
Yet another meta-analysis of studies looking at gua sha found five randomized controlled trials and two controlled clinical trials that presented scientifically valid conclusions. The analysis focused on musculoskeletal pain and identified three possible pain-relieving mechanisms:
Chiropractors may best be associated with spinal adjustments and the popping sound that many people’s bodies make as their musculoskeletal systems click back into proper alignment. That noise is actually the sound of pockets of gas released by the joints as they fall back into place. But the science of chiropractic dates back to the earliest days of civilization, making appearances in texts discovered from ancient Chinese and Greek civilizations. Today, chiropractic care ranks as the third largest health profession, surpassed only by medicine and dentistry. Here’s how chiropractic works and how it can help you.
With 77,000 chiropractors practicing across the country, this rapidly expanding field offers thousands of patients hope for pain relief. Increasing numbers of everyday people are turning to this time-honored tradition, the same one used by every team in the National Football League to help its players recuperate from whiplash, muscles strains, and neck and low back pain, according to the American Chiropractic Association (ACA).
But, chiropractic care itself has existed since ancient times. Too many ignore these historic, effective traditions as fancy treatments and pharmaceutical interventions captured the public imagination over the past century.
Writings dating from 2700 B.C. and 1500 B.C. were uncovered in Greece and China that reference the use of chiropractic care. Later, Hippocrates, the famous Greek physician whose eponymous Hippocratic Oath all doctors take, famously wrote:
“Get knowledge of the spine, for this is the requisite for many diseases.”
Starting in the late 1800s, chiropractic care emerged in the U.S., pioneered by an Iowa doctor named Daniel David Palmer. Palmer founded the Palmer School of Chiropractic. This school lives on to today, steeping young doctors in the rich traditions of the practice.
During chiropractic school, students undergo four to five years of training. They spend at least 4,200 hours spent in the laboratory, classroom, and medical clinic. Before practicing, chiropractic doctors must pass a national board test along with any tests required on the state level. Each state also has its own licensing requirements. The depth and breadth of training confers chiropractors the ability to act as primary care providers, according to ACA.
Today, the harsh effects of harmful drugs and the reality that wellness comes from a healthy skeleton and lifestyle—not costly and dangerous drugs—is again taking hold. With it, the momentum builds for more natural, holistic, and effective treatments.
Chiropractors focus on the health and proper alignment of the musculoskeletal system. Many muscle and joint pains result when some component in this intricate system of muscles, joints, bones, tendons, and ligaments falls out of place. Whether you’re a sports star or desk jockey, anybody’s musculoskeletal system may experience a disturbance resulting from daily activity.
Chiropractic medicine is based on the idea that a person’s overall health is linked to spinal alignment. The spine is not just a column of bones. It also houses the central nervous system. And, this affects the way a person processes pain.
All body parts are intricately connected. A misalignment in one area can influence misalignments, or even pain, in other, seemingly non-related parts of the body. Through spinal adjustments and manipulations, chiropractors help patients ensure their bodies are in optimal alignment, which encourages the free flow of muscles and bones. Without restriction in the musculoskeletal system, most patients experience a reduction in pain.
The chiropractic approach is medicine-free, minimally invasive, and holistic. The most common techniques used are spinal adjustments or manipulations, but chiropractors treat the whole person. They examine lifestyle choices like diet, stress, sleep, and physical activity levels. These factors influence a person’s experience of pain and the degree of healing that’s possible.
A spinal manipulation may reduce a patient’s pain, but helping that patient possibly lose weight or reduce stress, for example, will support continued health.
Studies show that patients who actively participate in their treatment experience better outcomes and reduced pain. Many patients with low back pain find chiropractic care is an effective way to manage discomfort and find improved quality of life.
Another benefit is that the practice is minimally invasive. Injured workers are 28% less to undergo spinal surgery if they visit a chiropractor before an MD, ACA reports.
With prescription drug abuse skyrocketing and the dangers of opioids increasingly well known, more patients are gravitating toward chiropractors and their minimally invasive, effective methods of treatment.
Back pain is a pervasive and serious issue, affecting up to 80% of people at some time during their lives, according to the ACA. At any given time, about 31 million U.S. adults experience back pain.
While back pain has many lifestyle risk factors, such as poor posture and sedentary living, studies have shown that chronic back pain is related to changes in pain processing, according to research published in The Journal of Pain. The study found that patients receiving spinal manipulation therapy experienced less sensitivity to pain, and researchers said the procedure holds promise as a clinical treatment.
Another study published in The Spine Journal examined the benefits of spinal manipulation in patients with acute back pain and found the chiropractic technique outperformed other treatment methods like medication or exercise.
Back pain is one of the leading causes of disability and costs associated with treating it are estimated at $194 billion annually, according to the American Academy of Orthopaedic Surgeons. Studies show that chiropractors can alleviate some of that cost burden, with patients spending up to 20% less when they visit a chiropractor first instead of an MD, according to ACA.
Chiropractors, instead of prescribing drugs or invasive procedures, seek to understand pain conditions from musculoskeletal origins.
Often times, pain results from tissue injuries that lead to hypermobile or restricted joints. Injuries sometimes develop from accidents, but may also result from daily repetitive stress, such as poor posture.
When tissues become injured, they become inflamed and painful, limiting muscle and joint mobility and often causing seemingly unrelated pain.
Chiropractors are able to uncover the musculoskeletal issues underlying many painful conditions and perform the necessary adjustments. In addition to approaching pain from this alignment perspective, chiropractors also frequently suggest rehabilitation techniques and lifestyle changes such as diet, exercise, and stress management to support a path to healing.
Chiropractors use a whole-body approach with patients. The doctors are trained in specific diagnostic techniques that range from skeletal imaging to observing how patients’ bodies move to identify areas needing adjustment.
During a chiropractor appointment, patients may undergo an examination, receive hands-on treatment to correct misalignments, or receive information about possible lifestyle modifications to help reduce pain.
The short answer is yes, but let’s dive a little deeper.
First, one of the most commonly used methods of treating back and other types of musculoskeletal pain is painkillers. However, even over-the-counter medications like Advil and Tylenol are not without danger when taken over long periods of time.
These medicines are intended for short-term issues, like healing a headache or acute injury. When taken continually, these medications may cause gastrointestinal problems such as ulcers or bleeding. Other risks include high blood pressure, kidney problems, or even heart issues.
With many medical treatments emphasizing invasive methods, chiropractic care offers a refreshingly non-invasive approach. And even among non-invasive therapies, chiropractic care ranks among the safest there is.
No treatment is 100% safe, and there are risks, however those risks are very small. Some patients experience feelings of soreness or achiness following treatment, but that discomfort usually disappears within 24 hours.
Some claims have linked a specific type of neck manipulation with a stroke known as vertebral artery dissection. However more complete evidence suggests that this stroke may take place spontaneously, and chiropractic care is not a trigger.
Other reports have connected the stroke to normal activities like turning the head while driving or even getting shampooed in a hair salon. These patients have specific symptoms involving neck pain and a headache for which they seek treatment. Only one in 5.85 million patients will experience this type of stroke connected to a high-velocity upper neck manipulation, making this an extremely rare occurrence.
Patient satisfaction for chiropractors is extremely high, with low-back pain patients giving the doctors high marks, above even physical therapists, surgeons, or primary care physicians.
Chiropractors believe in conservative care first. They believe that non-invasive treatments should come before more drastic measures. Further, medications should be used sparingly, and not as the first line of defense. As the American Chiropractic Association (ACA) says:
“For years, many patients would find relief through conservative forms of care such as chiropractic services only after unsuccessfully trying a range of other, more complex, and riskier treatments. Today, that approach has been reversed.”
Chiropractic care promotes non-invasive, drug-free treatments when possible to support patient health.
Over the past few years, increasing awareness about the dangers associated with opioid drugs, which are frequently used to treat back pain, has led to a resurging interest in methods such as chiropractic and associated treatments, including acupuncture.
Opioids are dangerous because they can lead to addiction, and even overdose or death. Meanwhile, these powerful drugs don’t address pain’s root cause. Instead, they leave patients reliant on these pills, which aren’t 100% effective, for the rest of their lives. As these ill effects become better known, alternative therapies such as chiropractic are growing more popular.
Chiropractic doctors focus on the body’s musculoskeletal and nervous systems. These specially trained physicians perform treatments including spinal manipulations, also known as adjustments. These work to increase mobility of a patient’s spinal vertebrae and ensure they’re in the proper alignment.
Notoriously difficult to diagnose, fibromyalgia causes very real pain to those affected by it despite remaining a mystery in many other ways. A musculoskeletal disorder, it’s characterized by a lowered pain threshold and extra sensitivity to situations that would cause an unaffected person no pain at all. Fibromyalgia research is constantly looking for emerging therapies that could help a patient reduce their pain. Here’s three of the latest.
Although fibromyalgia affects roughly 2 to 4 percent of the U.S. population (about 9.5 million people), its exact cause remains unknown. Maybe a single cause is so hard to pin down because the development of fibromyalgia has been linked to a number of different factors, some combination of which could be the culprit.
For example, a genetic mutation might make someone more likely to develop the disorder, while others argue that fibromyalgia can be triggered by an infection or sickness. And some experts link the onset of the disorder to physical or emotional trauma, as patients who present with fibromyalgia have often also been diagnosed with anxiety, depression, or post-traumatic stress disorder.
One thing’s for sure: Fibromyalgia affects more women than men, with nine women diagnosed for every one man. This may be a result of certain reproductive hormones present in women, but nothing can be decisively said as to why women are at a higher risk than men.
The cause may be unclear, but the pain is easier to explain. Once the condition presents itself, fibromyalgia pain results from an unusually high amount of certain chemicals in the brain that are responsible for triggering pain signals. This is also called a neurochemical imbalance.
At the same time, although we don’t completely understand why, pain receptors in the brain become extra sensitive to pain, causing contact that would otherwise not be uncomfortable to be very painful for a person suffering from fibromyalgia.
These pain symptoms can be accompanied by a range of other problems, including:
Irritability
Trouble falling asleep or staying asleep
Difficulty remembering things, also called fibro fog
Unfortunately, there is no chemical test available to directly confirm a person is afflicted with fibromyalgia. Instead, a doctor must use a number of other methods to make a diagnosis.
Initially the doctor will observe the patient’s pain symptoms. According to the American College of Rheumatology, fibromyalgia is characterized by widespread pain endured for a minimum of three months. The term “widespread” means the pain should be present on both sides of the body as well as on both the upper and lower body.
The ACR also describes fibromyalgia as tenderness or pain felt at specific places on the body, including the shoulders, the upper chest, the elbows, the hips and the knees. There are a total of 18 of these specific points listed by the ACR, and a person must experience pain in at least 11 of these for the condition to be considered fibromyalgia.
But the surest way a doctor can determine a patient suffers from fibromyalgia is actually to rule out every other possible condition — a process which can be involved and lengthy. Patients shouldn’t be discouraged at the sometimes long process, however, as it means the doctors and medical staff are being as thorough as possible.
Treatment plans for fibromyalgia can be complex. Since there’s no cure for the condition itself, treatment must instead focus on the symptoms, on any coexisting conditions, and on any underlying medical problems that could have triggered or aggravated the fibromyalgia in the first place. We’ll discuss some of these more common treatment plans, before discussing the emerging treatments that fibromyalgia research is focusing on.
Over-the-counter pain relievers, such as acetaminophen, or non-steroidal anti-inflammatory drugs (nsaids) like ibuprofen or naproxen might be recommended to alleviate some discomfort, or the doctor may prescribe something a little stronger, for example, tramadol. In some cases, anti-seizure drugs can be prescribed to effectively reduce fibromyalgia pain symptoms.
The combination of medications a doctor prescribes will ultimately depend on the patient’s exact symptoms, since these are rarely identical from patient to patient. Every person’s case is unique, with different triggers, different levels of pain, and different conditions or symptoms occurring simultaneously. For example, an antidepressant might also be necessary to fight lethargy, or a relaxant may be required to initiate sleep.
Limiting intake of caffeine, nicotine and other stimulants
Due to fear of their symptoms and the associated pain and discomfort, people who suffer from fibromyalgia can be inclined to withdraw from society and become inactive. Doctors recommend against this, however, as those patients who remain as active as possible — without overdoing it — on a consistent basis, seem to have the best success with managing their symptoms and leading normal lives.
Many people also benefit from therapy sessions, in which they can not only discuss with a professional counselor the impact fibromyalgia has had on their lives, but also explore strategies for overall stress reduction on a day-to-day basis. This type of training can be crucial for giving patients the confidence to keep living their lives to the fullest potential, without the concern of being limited by their condition.
Fibromyalgia frequently doesn’t respond well to traditional medications, but the good news is that many people find alternative remedies helpful. Therapies like oxygen chamber therapy, low-level laser therapy, and transdermal magnesium are hitting the market, giving fibromyalgia patients new options for managing pain and improving quality of life.
Oxygen chamber therapy in particular has researchers making grand promises—promises not just of pain relief, but of the possibility to reverse fibromyalgia. The treatment is still early in the study stage. However, researchers understand more about fibromyalgia every day, and this increasingly deep knowledge could one day result in a cure.
This treatment, which involves breathing in pure oxygen from a tube or while sitting in a pressurized room—hence the term “chamber”—has shown promise for helping people with fibromyalgia.
Officially known as hyperbaric oxygen therapy, the treatment been used for some time to help scuba divers heal from decompression sickness, which is when gasses in the blood form bubbles as divers move toward low pressure. The treatment also works for slow-healing wounds related to diabetes or serious infections, according to Mayo Clinic.
Research from Rice University has also found the treatment offers hope for fibromyalgia patients. Scientists evaluated 48 women with fibromyalgia who underwent oxygen chamber therapy for two months and found that 100% of them experienced some form of benefit.
An increasing body of clinical evidence shows that fibromyalgia develops from abnormalities in the nervous system and brain pathways, many of them related to pain processing. Rice researchers found that hyperbaric oxygen therapy enhanced functioning in these faulty areas.
Fibromyalgia affects about five million people, most of them women. Researcher Eshel Ben-Jacob says:
“Symptoms for about 70% of the women who took part have to do with the interpretation of pain in their brains… They’re the ones who showed the most improvement with hyperbaric oxygen treatment. We found significant changes in their brain activity.”
In the study, participants underwent 40 treatments, each lasting 90 minutes, for five days each week over the course of two months. During treatment sessions, patients breathe in oxygen that’s pressurized three times higher than normal air. The highly pressurized nature allows lungs to absorb greater quantities of oxygen, which then gets absorbed systemically by the body.
Fibromyalgia patients receiving oxygen chamber therapy also experienced a dramatic reduction in pain. The body thrives off this pure oxygen and is better able to heal, fight off bacteria, or in the case of fibromyalgia patients, process pain. Many patients who participated in the study were able to decrease the amount of medications they were taking or, in some cases, stop taking pills all together.
Researchers said oxygen chamber therapy actually reversed fibromyalgia, targeting the condition’s source, while all the pills did was ease pain, and not heal the underlying condition. Researcher Shai Efrati says:
“The results are of significant importance since, unlike the current treatments offered for fibromyalgia patients, (oxygen chamber therapy) is not aiming for just symptomatic improvement…(It’s) aiming for the actual cause—the brain pathology responsible for the syndrome. It means that brain repair, including even neuronal regeneration, is possible even for chronic, long-lasting pain syndromes, and we can and should aim for that in any future treatment development.”
These promises aren’t as grandiose as they may seem: Efrati says 70% of the research participants no longer had diagnosable criteria for fibromyalgia at the end of the study.
Oxygen chamber therapy currently has federal approval for use in 14 conditions, including serious infections and burns, but not yet for fibromyalgia, according to webmd.
Unfortunately, until future studies prove the benefit on a wide scale and the Food and Drug Administration (FDA) approves the treatment, insurance plans won’t cover the treatments, which can cost tens of thousands of dollars because so many are needed.
We’ll be sure to keep you up to date as this exciting area of fibromyalgia research develops.
With laser therapy, lasers shoot through soft tissue, and the light of the beam raises the temperature. Data is so far mixed on whether the technology works, but fibromyalgia research does show benefits that are promising. Scientists aren’t sure how the treatment works, but are working to learn more.
One possible theory that explains how low-level light laser therapy works involves a process known as photo bio stimulation. This idea holds that when the energy of the laser penetrates the tissue, it creates adenosine tri-phosphate (ATP), which helps produce cellular energy.
Enhanced delivery of life-supporting materials like water, oxygen, and other nutrients
Research results for this therapy have been mixed, but several have shown promise. More research is needed to better quantify the potential for this therapy to treat pain from fibromyalgia.
Other names for low-level laser therapy are cold laser therapy, low-energy laser therapy, low-intensity laser, and monochromatic infrared light energy (MIRE) therapy.
Magnesium is an important nutrient for optimal body functioning, however many people don’t ingest enough of mineral. Fibromyalgia, chronic fatigue, and anxiety may all be symptoms of a deficiency.
People often take magnesium in pill form, but transdermal magnesium involves applying magnesium directly to the skin. One way of doing this involves rubbing oil directly on the skin, where it can easily be absorbed and distributed throughout the entire body. Another option is to take a bath with Epsom salt, which is magnesium sulfate.
Gels and patches are also available, however rubbing oil on the body and taking baths have relaxation and other therapeutic benefits, and are wonderful ways to receive healthy amounts of magnesium.
Only a few small trials of fibromyalgia research have found transdermal magnesium has a large benefit, but the anecdotal evidence is vast. Plus, with magnesium deficiencies so common, transdermal magnesium is a good health practice to have.
While fibromyalgia research continues to pave the way for new and innovative treatments, patients should first make sure they have an accurate diagnosis. You can work closely with a pain doctor to find out if you have fibromyalgia. They can also help you learn more about complementary and advanced treatments for reducing your pain.
It has long been a common recommendation that chronic patients maintain a pain diary. The idea behind a pain diary is simple. Using either an electronic device or a paper journal, pain patients keep track of:
The theory behind the recommendation is that doctors and patients can gain a better understanding of certain chronic pain syndromes than they might with simple patient reporting at a visit. Keeping track of pain levels allows a patient to give a more accurate reporting than trying to remember them on the day of the visit, especially if the patient is feeling particularly good or bad on the day they see the doctor. In theory, this allows doctors and patients to identify triggers and potentially avert painful episodes by changing behaviors.
A small-scale study by the University of Alberta Faculty of Medicine & Dentistry found that keeping a pain diary actually lengthened the time of recovery for study participants who were recovering from lower back sprains. For four weeks, 58 patients in the study were divided into two equal groups, one of which was asked to keep a pain diary, documenting pain levels, and one of which did not. When patients were re-assessed at the four-month mark, the differences in the two groups were clear.
Robert Ferrari, a clinical professor in the Faculty of Medicine & Dentistry’s Department of Medicine and a practicing physician in several Edmonton medical clinics explains the results:
“What we found is that the group who kept the pain diary — even though we didn’t ask them to keep an extensive diary, and even though many of them didn’t keep a complete diary — had a much worse outcome. The self-reported recovery rates were 52% in the group that kept a pain diary and 79% recovery at three months in the group that did not keep a pain diary. That’s a fairly profound effect. There aren’t many things we do to patients in terms of treatment that affect the recovery for a group by 25%.”
These results are mirrored in study by Luis F. Buenaver, phd, an assistant professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine. This study included 214 patients suffering from jaw and face pain due to temporomandibular joint disorder (TMJ). This condition can be acute or long-term but is very painful and can lead to sleep disturbances and other painful issues in the neck and upper back.
Buenaver and his colleagues examined each patient and then distributed questionnaires to ascertain participants’ pain levels, quality of sleep, and emotional response to pain. They were trying to see if patients tended to dwell on pain or exaggerate it. Those patients who did dwell on the pain were unable to shift their focus away from it when winding down for sleep, their pain was rated as much more severe, and patients’ sleep was more disturbed than those patients who did not focus on their pain.
A pain diary can be a remarkable communication tool for you and your doctor. If you are living with chronic pain that has yet to be diagnosed, keeping a pain diary can help identify triggers or things that make pain worse. Keeping a pain diary can also identify times of day that pain is most prevalent, and it may be helpful in seeking reasonable work accommodations under the Americans with Disabilities Act (ADA).
There are many different ways to keep a pain diary. One of the easiest seems to be using apps for tracking chronic pain, widely available for free or a nominal fee for both iphones and Android operating systems. If you choose to keep a pain diary and want to make it positive and forward-thinking, try these four tips:
Add gratitude: Make a list of five things you are grateful for at the end of every day.
Don’t make pain the focus: Think of it more as a daily journal. When pain symptoms are tracked or specifics are added, circle them or highlight in another color for easy reference, but focus more on telling the whole story of the day.
Think outside of the page: Frida Kahlo, a painter who lived her entire life in excruciating pain, often painted her experiences while lying down. Your pain diary doesn’t have to be just words. You can illustrate your day or create a collage. Add photographs or bits of flotsam from your day (e.g., a key you found on a walk, a ticket stub from a movie, or a note from your child).
Make it totally you: You are not your chronic pain. Yes, pain is part of your daily experience, but it does not make up the entire person you are. Use your pain diary as a way to explore your inner self, not just document an experience from one to ten.
It’s been about a year since we became Pain Doctor and began sharing information with you about everything pain- and health-related. In that time, we’ve covered a lot of information, but we’ve tried to make sure that all of it is centered around the topics that you, as a health–conscious pain patient, might care about the most. It was tough, but we narrowed down a year’s worth of information into our top ten favorite posts from Pain Doctor, covering everything from resources to lifestyle changes.
In no particular order, here are our top ten favorite posts on Pain Doctor.
It can be hard to start a new exercise routine, especially if you’re in pain, but the payoff will be worth it. In this post, we touched on a few studies that looked at the benefits of exercise for people with chronic pain, noting:
“Several studies have looked at the effects of exercise on chronic pain conditions. The results are often very similar: decreased pain and a better quality of life.”
We also gave you some suggested types of exercise, along with a few tips, to get you started on your fitness journey.
We’ve mentioned several times on Pain Doctor that stress is bad for you, particularly if you live with chronic pain. Self-care is one of the absolute best ways to combat chronic stress and, by extension, improve your health and reduce your pain. Also, the more often you allow yourself a few minutes of self-care, the better, because your body will eventually come to associate a certain activity or routine (like the motions of brewing a pot of tea for an afternoon break) with relaxation. Once your body has built up this association, you’ll begin to experience the physiological signs of relaxation more quickly. If you need ideas for self-care or relaxation, look no further: this post has plenty.
Health literacy is all about knowing how to find and understand health information so you can make informed decisions about your own healthcare. Pain conditions, like lots of medical conditions, can get confusing and overwhelming very quickly, so having the health literacy skills to do research, find information, and know what questions to ask your physician is vital. This post breaks down how to judge the reliability of an online resource by asking five simple questions:
After you’ve been dealing with a chronic pain condition or medical condition for long enough, managing your medications will become almost automatic. If you’re newly diagnosed, or if your medication regime has changed recently, it can be scary trying to keep all those pills (and maybe even injected medications) straight. Here we gave you some tips and tricks about medication management, like using a medication sheet and letting your everyday activities (such as meals or bedtime) act as reminders. The bottom line is to make sure you talk about your medications with your physician and then take them as directed.
Sleep might not seem like that much of a deal, but it is. Getting enough sleep can have big benefits on your health, just as being chronically sleep deprived carries some serious risks. If you deal with pain on a regular basis, sleep can be a struggle. Hopefully this post convinced you that, if your pain is interfering with your sleep, you should talk to your physician about it. After all, as we noted:
“Sleep deprivation lowers the pain threshold. This means that the more tired an individual is, the more likely he or she is to experience sensations as painful. The increased pain can make falling asleep and staying asleep difficult, which often leads to more sleep deprivation. This becomes a repeating cycle, until it’s difficult to tell which came first – the sleep deprivation or the pain.”
There are a lot of surface similarities between chronic pain and depression. For instance, people suffering from these conditions often face similar misconceptions, like the problem being “all in your head” or that you can “just get over it.” With both chronic pain and depression, though, this is certainly not the case. Both conditions are serious, diagnosable medical conditions that need attention from a physician. And the similarities go even deeper, right down to some of the same centers of the brain being involved in both chronic pain and mood disorders.
This post is a must-read for anyone who takes opioids (or who has a family member or friend who takes opioids). It covers all the nuts and bolts of opioids, from how they work to the different types to what they treat best to the risks involved.
A common opioid painkiller, hydrocodone, was reclassified last year, along with hydrocodone-based painkillers. We know that for a lot of people with chronic pain, opioids are commonly used for as-needed or breakthrough pain relief, until a less risky pain management technique can be found. In this post we delved into why hydrocodone-based painkillers have been reclassified and how it might impact you.
Dogs are good for your health in lots of ways, and they can even help you manage your pain. For some people, it’s only thanks to their assistive or service dogs that they’re able to function independently. Therapy dogs can make a huge difference to people who are hospitalized or living in assisted care. What it boils down to, though, is that no matter the breed, age, size, or training, your canine best friend does more for you than you realize.
Hopefully this post was as interesting to read as it was to write. Dogs’ super-sensitive noses have been used for jobs like search and rescue or bomb-sniffing for years, but now they’re being trained and put to work in the medical field. Some of these amazing dogs can detect oncoming seizures, allergic reactions, or blood sugar fluctuations in their owners. Others are taught to identify infections or cancers. The really amazing thing is that oftentimes, the dogs are more sensitive than modern medical equipment.
At Pain Doctor, we try to help you live your best life possible, and we truly think that part of that is arming you with all the knowledge you need to make the best decisions about your lifestyle and healthcare. We hope we’ve accomplished that for you, and we hope that we can continue to help you control your pain and enjoy your life to the fullest.
As you may have noticed, products with CBD are now touted for all sorts of conditions, including pain relief (for fibromyalgia, for example), anxiety, depression, insomnia, Parkinson’s, Alzheimer’s and cancer. But how effective is CBD, what risks are associated with using CBD and why are we suddenly seeing it advertised and sold everywhere? (For example, this flag has appeared outside a small pharmacy across the street from where I live.) Many important questions do not yet have answers.
The proliferation of CBD products is an important women’s health issue for several reasons. First, chronic pain is a concern for many women – it’s the focus of Chronicillness.co first scientific summit, Chronic Pain in Women, on July 17 and 18. Second, as a fat-soluble compound, CBD (like THC), crosses the placenta, and is present in breast milk. And third, it is possible that CBD products could cause a woman to fail a drug test. (If a CBD product contains THC (the chemical in marijuana that causes a “high”) above the 0.3% threshold allowed under the new federal law, or a drug test is sensitive enough to detect low levels of THC, an individual could test positive. Likewise, if an individual has used a lot CBD products containing low levels of THC, or if a test is specifically looking for CBD, a positive drug test is possible.)
CBD is cannabidiol, one of many compounds found in the cannabis family of plants, which includes marijuana and hemp. Products containing CBD can be “pure” (if it is the single compound), or it can be “full spectrum” when they contain all the compounds extracted from the plant material, (i.e., hemp), and some products many indicate “active hemp extract” without mentioning CBD.
The manufacturing and sale of CBD products have exploded since a December 2018 federal law removed CBD from the list of controlled substances and allowed hemp production, as long as the hemp doesn’t contain more than 0.3% THC.
So, what might CBD good for? The FDA has approved a medicine with CBD (Epidoliex®) for two very rare forms of childhood epilepsy. Some of the advertised CBD products tout benefits for neurological conditions, which may be based on research showing CBD interacts with certain types of neuroreceptors, and some limited clinical data. This information was summarized in a 2017 report from the National Academy of Medicine: “The Health Effects of Cannabis and Cannabinoids.” However, CBD (like its psychoactive cousin THC) has not been rigorously studied outside of the clinical trials for the FDA-approved medicine, and most of the claims about CBD are based upon anecdotes or poorly conducted investigations. What this means for women’s health is that there are significant unknowns and many questions still to be researched.
The FDA is moving forward with developing rules about CBD. A hearing was held in late May, but it is unclear how long it will take FDA to develop and implement new regulations. (See the FDA’s Q&A page about CBD, related products and its regulatory activities here.) In this regulatory void, some states have enacted rules about how CBD products can be sold, marketed, or labeled.
Until the FDA acts, CBD products (with the exception of Epidoliex®) are not being regulated as prescription drugs, over-the-counter medicines, vitamins or as foods, (including dietary supplements). Therefore, adding CBD to any of those products is in violation of federal rules. Because of potential risks to consumers, the FDA has sent warning letters to some companies selling CBD products, particularly when claims are made about the CBD product as if it were a medicine, such as a treatment for cancer or other medical conditions.
Using CBD products rather than FDA-approved or physician-prescribed treatments is another risk associated with the proliferation of CBD products. As the FDA Commissioner wrote about CBD products in April 2019, “We also don’t want patients to forgo appropriate medical treatment by substituting unapproved products for approved medicines used to prevent, treat, mitigate or cure a particular disease or condition.”
The major safety and quality concerns about CBD products can be divided into a few categories:
The good news is that there doesn’t seem to be many direct side-effects of CBD for most people – although the clinical trials for Epidoliex® found some patients developed liver problems. However, outside of the studies on children with rare forms of epilepsy, large well conducted trials are limited, which especially raises concerns about health effects from long-term use. For women with chronic conditions and taking prescription medicines (including birth control pills), the unknown side effects and drug-drug interactions could be particularly important.
Quality, dosing and contamination issues are also serious concerns. How CBD is manufactured or purified is important because different extraction and purification methods produce different mixtures of compounds. Also, extraction from cannabis plant material has traditionally been done using butane or propane, which can leave petroleum residues in the final product. There are potentially other quality and safety problems that can arise in manufacturing – particularly when there is so little oversight or regulations. Specifically, researchers have found CBD products can contain THC, pesticides, lead or other heavy metals. The lack of data also means there is great uncertainty about what appropriate dosage levels might be for particular people or for different uses. And, of course, accurate dosing is a problem when quality control is inconsistent, i.e., how do you know how much CBD you are receiving, if the manufacturer may not be certain about the concentration of CBD in their products.
And why is CBD being added to foods (both for humans and pets) despite this violating FDA regulations because CBD is an active ingredient in an approved medicine? Maybe it is trendy and sounds like a great new thing? Or maybe it is a revenue-driven marketing strategy that is leveraging off state laws allowing the legalization (and taxation) of medical and recreational marijuana – despite marijuana still being illegal under Federal law.
The bottom line is that you likely can get CBD oil, capsules or foods where you live, but are there possible harms? Yes. But what these harms may be is still largely unknown. Therefore, until there are clear rules about the types of CBD products that can be sold and quality manufacturing requirements, including the information that manufacturers and sellers must make available (perhaps similar to the labels on foods or for OTC medicines), what is appropriate dosing, and of course, what CBD might actually be good for, it is “buyer beware.”
This is an amazing time to be a woman in our country. In the past six months alone we’ve had women at the helm of three network morning shows, we’ve had a record number of women running Fortune 500 companies, and our thrilling women’s national team just won the World Cup.
But this is not enough. Women aren’t running the three major networks, the record number of Fortune 500 CEOs was just 33, and when our female athletes get injured their doctors may not have the ability to treat their pain as well as their male counterparts simply because they just don’t know how.
Understanding women from the perspectives of both sex and gender are going to be critical as we look to drive sustainable change in the health arena and particularly in pain management. Nearly a third of Americans experience long-lasting pain, and approximately 20 percent of the population lives in chronicpain. The cost of chronic pain to the country is more than $558 billion each year, which is more than the annual cost of heart disease.
Yet, as much as we talk about pain management, if we don’t explore the disparity of male and female pain, we will not achieve the change that is needed to overcome this crisis.
To help get the conversation started on chronic pain management, Chronicillness.co will convene a Chronic Pain Summit on July 17 and 18, in Ellicott City, MD. The event will feature presentations from prominent pain specialists and is designed to foster dialogue between patients, clinicians, researchers, and industry experts, and will include representatives from federal agencies and other non-profit organizations as well. I am thrilled to be the keynote speaker during this summit.
Together, we aim to raise awareness about chronic pain in women, address existing challenges and knowledge gaps, and encourage everyone to work together as we strive to find new and innovative solutions. Here is a sneak peek at what we will cover during the summit.
In the meantime, here is what you should know right now.
Hormones regulate our systems in the inner workings of how our body is built. Hormones are also involved in biological mechanisms that play a critical role in how women and men feel pain. It was just ten years ago that researchers recognized that female mice responded differently to pokes and prods then male mice. This moment spurred the discovery that pain pathways can vary significantly, and has us now exploring the differences between male pain and female pain.
This discovery was only made because a researcher bucked the trend and included female mice in his research, which was not common practice. If we are going to make an exact change in pain management for women, women need to be a part of trials. If men don’t feel the same pain, we are going to need to adjust how we treat women’s pain.
Gender is societal. It is the expectation that we place on people and the social influences that define who we are, and it plays a role in how women’s pain is managed. The fact is that women report pain differently than men, and doctors respond to women’s pain differently than they to do men’s pain. We also know that doctors assume people who look “better” are healthier and require less treatment.
This issue of gender expectations is critical. Women with chronic pain are more likely to be wrongly diagnosed with mental health conditions than men and be prescribed psychotropic drugs. We also know that women are more likely to be prescribed prescription pain medicines, be given higher doses, and remain on them for longer. And women are less likely to remain on a treatment plan that conflicts with other responsibilities.
Ultimately, when you put misses of love and gender together, it can be toxic. Consider this:
Post-surgery studies have shown that women consistently reported slightly more intense pain than men for 30 different types of surgery, ranging from an appendectomy to knee replacement. At the same time, some studies show that following breast surgery, women who receive a nerve block and regional anesthesia recover better. We also know that among surgical patients, there are more female chronic opioid users than male, and females are more likely to be chronic users than males.
So the question becomes, in treating women like men are we fueling a more significant crisis?
The fact is that we are at a great moment of awareness that we must harness to drive change. We must explore new paths, recognize the impact of sex and gender differences in patient care, and power a new momentum to define best steps to manage pain in women.
Juggling a career—and social life, family, and the demands of fibromyalgia–can be challenging. Find the help you need from Jenni Prokopy—a woman living with the chronic, widespread pain and fatigue of fibromyalgia. Watch the video below as she shares some of her favorite tips for working smart and healthy. A transcript of the video is also available.
Hi, and welcome to Fibromyalgia: 3 Strategies for Workplace Success. My name is Jenni Prokopy and I’m just like you—a woman living with the chronic, widespread pain and fatigue of fibromyalgia. Juggling a career – and social life, family, and the demands of our illness – can be challenging. Today, I’m here to share some of my favorite tips for working smart and healthy.
Tip 1: Evaluate Your Skills and Abilities Tip one: Evaluate your skills and abilities. Whether you’ve recently been diagnosed or you’ve been living with fibromyalgia for years, it has likely impacted your work style and abilities. Now is the time to evaluate your skills: What are you good at? What do you enjoy doing? How do you measure workplace success; is it financial stability? Positive reinforcement from peers or a supervisor? Climbing another rung on the career ladder?
Take some time to get clear about what you can and like to do, and see if it matches your current employment situation. Maybe you can’t do everything you did before you developed fibromyalgia, but you can probably still do some things. Maybe there’s a way to adapt your work, or maybe it’s time to consider a different kind of job.
The answers to these questions will help you shape your working future. If you’re struggling with the process, there are some talented career coaches out there who can help you find your path, so don’t be afraid to ask for help.
Tip 2: Managing Your Work Day Tip two: Manage your work day. So much of living well with fibromyalgia is energy management, so take a close look at how you spend your day at work. Acknowledge your limitations; maybe you need help with some tasks, or you need to delegate them…or maybe you just need to take short breaks throughout the day. Work with your supervisor to create a schedule that suits your needs.
You may even want to ask for the option to work remotely. Not all companies offer this option, but if you think you’ll be more productive in the comfort of your own home, it’s worth the effort to ask. I know I’ve done some of my best work in my PJs. And when you’re not feeling your best, working from home—on your schedule—is a great alternative to using up all your sick days.
And speaking of sick days, it’s inevitable that you will have to take some, so drop any guilt you’re feeling about taking time off. Fibromyalgia can be unpredictable—some days are just going to be worse than others—so it’s understandable not to have a perfect attendance record.
If you’re concerned about handling your workload (or what your supervisor might think about your absence) create a backup system so someone can step in when you’re gone, or build extra time into your deadlines so a sick day here or there won’t throw off an entire project. Most important: Your health must come first. Honor your body and take time off when you need it. You may experience overall greater health and productivity.
Tip 3: Focus on Self-Worth Tip three: Focus on self-worth. Besides the obvious financial benefits of working, most of us derive a great sense of self-worth from being part of the workforce. When our illness limits our ability to work—or even forces us to stop working altogether—it can be a huge blow to our self-esteem.
Whatever career path you follow, keep asking yourself if you’re deriving pleasure and value from the work you do. If you’re forcing yourself to continue working in a way that’s not healthy, what good is that? Instead, you may want to find a different kind of job, one that’s physically easier, or more enjoyable.
And even if you can’t work at all right now, you may want to find some way to volunteer or otherwise participate in your community. The friendships we build at work can nurture us; you can also build valuable personal connections outside the workplace, connections that keep you feeling positive. No matter your situation, reach out and become part of something bigger than yourself—it’s just one small way you can feel better.
For 5 simple ideas for traveling well in spite of pain, a woman living with the pain and exhaustion of fibromyalgia. Despite her condition, Jenni needs to travel many times throughout the year and, in this video, she shares her favorite tips for traveling well. A transcript of the video is also available.
Hi, and welcome to Fibromyalgia: 5 Tips for Traveling Like a Pro in Spite of Pain. My name is Jenni Prokopy and I’m just like you—a woman living with the pain and exhaustion of fibromyalgia. But I need to travel many times throughout the year, so I’ve collected some of my favorite tips for traveling well. I’m excited to share them with you!
Tip 1: Plan Ahead for Accommodations Tip one: Plan ahead. I’m not just talking about making hotel and rental car reservations—you need to think about each step of your trip and the accommodations you may need.
If you have a hard time walking long distances, ask for a hotel room near the elevator. Of course, if you’re a light sleeper, elevators can be noisy so you might want to request a room a little further down the hall. If you’re attending a trade conference at a large convention center, you may need to reserve a scooter for transport; even some resort areas make scooters road-legal.
If you use a wheelchair, make sure your hotel can accommodate you and that rental car or shuttle companies are aware of your needs. Check some of the top travel Web sites or disability-specific travel Web sites for recommendations and specials. Plus, the FAA even has recommendations for navigating airports with assistive devices.
Tip 2: Medications: Do You Have Enough? Tip two: Bring enough medication. One of the biggest travel mistakes I ever made was visiting a Gulf Coast vacation spot with just enough medication to last the trip. Of course, the inevitable happened: a hurricane threatened to extend our trip by days.
The painful lesson I learned then was to always pack an extra week’s worth of medications, no matter where I’m going. You may want to keep your pills organized in counters like these (show pill organizer) but it’s safest to travel with your meds in their original containers with the prescription labels still attached. Not only will you have an easier time with security personnel who may search you, but if you do need a refill while traveling, it will be easier to get one with that information handy.
And remember to always pack your medications in a carry-on bag! A lost suitcase with vital meds can ruin a vacation.
Tip 3: Channel Your Inner Packing Goddess Tip three: Pack smart. Fatigue and pain from toting huge bags is often just an accepted part of travel. But one way I minimize these negative effects is to pack smart and pack light.
Spend time a few days before your trip to plan each outfit; jeans can be worn a few times, and well-organized coordinates make it easier to make multiple outfits out of just a few pieces. One gorgeous handbag can work for almost any occasion. Roll up anything you can to increase room in your suitcase, and coordinate colors for even greater flexibility.
If you have a hard time remembering what to bring when traveling (I always do!) make a list and save it for future trips.(show an example of a packing list) I tweak mine every year or so, and it saves valuable time and keeps my load light.
Tip 4: Luggage Matters Tip four: Find your perfect bag. It may take a bit of research, but it’s worth the effort. A great bag that meets FAA guidelines for overhead bin storage can still accommodate a week’s worth of belongings, if it’s designed right.
Today’s best bags are made of lightweight materials and have long extendable handles and wheels that rotate to make pulling the bag easy. (show bag with matching carry-on [blur any logos]) You don’t have to sacrifice style, either. Many designers have attractive suitcases with matching carry-ons. Visit discount commerce Web sites for periodic sales, checking user reviews for the best finds.
Tip 5: Transport—Choose Wisely Tip five: Travel smart each step of the way. So you’re packed, rested and ready to go. Getting to the airport is just the beginning of your travel day. If need be, did you call ahead for a cab that accommodates a wheelchair? Does your shuttle company guarantee a driver who will lift your bag? Did you check in with your airline ahead of schedule to avoid long lines? Will your rental car offer air conditioning and GPS for when you arrive tired and hungry? Does your hotel offer free shuttle pick-up?
Before every step of your journey, do your homework using trip planners, Web sites and referrals from trusted friends. You don’t have to use up all your valuable energy when you travel…as long as you plan ahead and ask for what you need.
