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Fibromyalgia Couples make Good Communication Difficult due to their Illness

Improving Communication

The stresses brought by serious illness can make good communication difficult. To complicate matters, CFS and FM create the additional challenge of cognitive problems. Here are seven ideas for how to improve communication if you or your partner have CFS or FM.

Pick a Good Time and Setting

If you have something important to discuss with a significant person in your life, select a time when both of you will be at your best. It should be a time when both of you can give good attention and you will not be distracted by pain or brain fog, preferably during your best hours of the day. Choose a place that minimizes distractions and interruptions.

Practice Good Listening Skills

Good communication is based on each person understanding the other person’s views. Understanding begins with listening, which means focusing your attention on what is being said, with the goal of understanding the speaker’s point of view.

Listening works best if it occurs without interruption. After the person is finished speaking, respond by acknowledging having heard them. You might say something as simple as, “I understand.” If you are not clear, you can respond by asking for clarification or more information. You might say something like, “I’m not sure I understand. Can you say something more?”

From time to time, check whether you have understood the other person’s position by restating it in your own words. You could say, “Let me try to summarize what I’ve heard and you can tell me if I’m understanding you.”

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Focus on One Thing at a Time and Be Specific

Focus on one issue at a time. If you are requesting that the other person change, be specific in your request. Avoid making general requests such as, “I need help with the housework.”

The person being asked may wonder what would be involved in responding to the request. Instead, say something like, “Can you do a load of laundry today?” or “Can you do the grocery shopping?”

If you are the one being asked to do something, it’s reasonable to defer giving a yes or no answer until you are confident you understand what is expected of you. You can ask, “What specifically would you like me to do?” Even if you decide to decline, you can still acknowledge the importance of the request to the person asking for help.

Aim for Solutions

Have as your goal finding solutions, not blaming one another or finding fault. The idea is to be able to discuss problems in a constructive rather than a confrontational way. Treat each other with respect, acknowledging his or her support and effort. Avoid demeaning comments, sarcasm, and blaming. Acknowledge your part in shared problems and express appreciation for the other’s efforts.

Use Problem Solving

Use problem-solving to find solutions. Begin by brainstorming, which means thinking of a variety of possible ways to solve a problem. In brainstorming, the goal is to generate as many ideas as possible, without evaluating them.

For example, if your problem is how to do household chores when one member of the family is ill, alternatives might include dividing up the chores differently among members of the family, hiring occasional or regular assistance, simplifying tasks (for example, having simpler meals or cleaning less frequently), and moving to a smaller home that is easier to maintain.

Second, you evaluate each proposed solution, decide which ones are most promising, and try one or two of them. Third, after giving each solution a fair try, evaluate the results. Some potential remedies may not work, so you may need to have further discussions and try other solutions. The final solution may be a combination of several approaches. If several strategies are unsuccessful, you may decide that a problem may not be solvable or not solvable at the present time.

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Consider Getting Help

In many cases, you will be able to solve your problems yourself, but at times you may want to get help, either in understanding the causes of your problem or in finding solutions. So it may help to ask what resources are available to you. For example, to get a fresh perspective on your situation, you might ask other families how they have solved a similar problem or you might ask what community resources (church and public groups) are available.

Also, if conversations about your problems are not productive, you can consider getting professional help. A counselor can facilitate a solution to particular problems and also help you practice good problem-solving skills.

Have Regular Relationship Discussions

Finally, here’s a technique that one couple in our program uses to nurture their relationship and to solve problems in their lives: having regular discussions of their relationship. They set aside Sunday evenings as a time to discuss any issue that is on their minds, calling it their “talk night.”

Having regular discussions means that both husband and wife know that they have a forum in which to state problems and frustrations, and a means for finding solutions. Also, because the talks are frequent, they can refine their communication skills through regular practice.

The husband explains that “Anything either of us sees as a problem or causing stress is a likely topic. Even very minor things are OK.” Topics include an issue one has with the other, problems with friends or children, or problems around the house.

“A rule is we each openly listen to the other without being defensive. We problem-solve together to come up with a resolution for each issue. After doing talk night we start each week refreshed and with the feeling that comes from having dealt with whatever problems were there.”

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01/06/2022
Why was I Hiding Fibromyalgia the Person I have Become?

Story of Fibromyalgia Warrior

Recently I was looking at my social media accounts I came across accounts that I had chosen to hide either my content from. As I looked down the list I realized that many of those people were people that I knew for a significant amount of time in my life.

Most were people I had either worked with somewhere along the line since Nursing School Graduation, or I went to high school or college with. These were people who were a significant part of my life at one point or another. Not people who were trolls or people from my past that I didn’t want to think about again.

But as I sat and thought about it I couldn’t find a reason that any of them would have been on the hidden list. The more I thought about it I came to the realization that I must have hidden my posts because I didn’t want them to see my life or my journey.

But why? I spent a LOT of time thinking about this the next couple of days and the more I thought about it I realized that I had done it because I was embarrassed by what my life had become.

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The people who knew me 10 or 15 years ago probably don’t know that I am no longer working in my chosen field. That my marriage didn’t work out, that is a whole story for a different day. Or that I am not living my best life with kids, a husband, and my dream job.

While I know most people are living their exact ideal life. Sometimes I still struggle with the path my life has taken. I know there are always going to be things that we want to change. But my life is FAR from what I ever imagined.

That being said, this is NO REASON to be embarrassed though. The things that have made such a change were nothing I did. Or bad decisions I made, for the most part anyway. A person can’t change their genetics. Or honestly in many cases like mine the hand they were dealt. So, what? I may not be at a patient’s bedside twelve hours a day.

Or working to teach future nurses. But I am still making a difference. I may not be calling Drs or drawing blood. But I am still touching people’s lives. Is it the way that I planned? Hell NO! But I have adjusted and found ways to share my knowledge and provide support in other ways.

Disability has a way of changing a person and their outlook on life. The things that once seemed so important no longer rank in the top five of the things we worry about. That isn’t a bad thing though. The version of me that was once embarrassed to let people from my past knew the person who I have become doesn’t exist anymore.

That person has learned to hold her head up high and be proud of the things she has accomplished. To be proud of the life she has built despite the truly crappy hand she has been dealt. In the end, it really doesn’t matter what any of those people think of me. Whether they knew the person I once was or the person that I am now. The only thing that really matters is how I feel about myself.

That is what should matter the most to all of us. The opinion of the eyes looking out. Not the eyes looking in. Paths change and so do people, and that’s okay. But we never should be ashamed or embarrassed about the person we became because of an illness.

Fibromyalgia takes so much away, but it shouldn’t take that. It changes our paths, our hopes, and our dreams. It changes how we look at life as a whole. But it should never change the way we look at ourselves. We all deserve to hold our heads up HIGH and be proud of the badass WARRIORS we have become.

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01/06/2022
My Fibro Fog is Diagnose with Mental Illness
Experiencing Fibro fog can make you feel like you’re lost in a maze. You might feel confused, alone, frustrated, disoriented, bewildered, unclear, and adrift. Fibro fog can also affect your emotional well-being. Being unable to think clearly may make you feel powerless, irritable, and downcast.

Constantly feeling this way can put a damper on your mental health. Having a mental illness can trigger Fibro fog, as can other conditions. Understanding Fibro fog, its causes, and how it relates to mental illness can help you better understand the relationship between Fibro health, mental capacity, and emotional well-being.

What Is Fibro Fog?

Fibro fog isn’t a specific medical condition. Instead, Fibro fog is an “extremely common term used to describe changes that have occurred in the Fibro function over a period of time,” Dr. Christopher Calapai explained. “A decrease in focus, concentration, memory, alertness and word retrieval are all part of the description of ‘Fibro fog.’” Basically, Fibro fog happens when your Fibro doesn’t serve you as well as it can.

Also known as “mental fatigue,” Fibro fog is a symptom of cognitive dysfunction. The type of cognitive decline caused by Fibro fog can vary from person to person, but typically, Fibro fog causes one or more of the following challenges:
- Memory problems
- Lack of mental clarity
- Poor concentration
- Inability to focus
Other symptoms of Fibro fog can include:
- Headaches
- Forgetfulness
- Anxiety
- Confusion
- Low energy
- Insomnia or trouble sleeping
- Emotional detachment or an inability to connect with others emotionally
More often than not, these challenges can interfere with your daily life.

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Despite what you may think, there isn’t a connection between Fibro fog and age. Teens, adolescents, and young adults can experience Fibro fog while healthy elderly adults can have strong cognitive ability and sharp thinking. When your Fibro is healthy, you can age with your cognitive functionality intact. Even though the Fibro does age, well-nourished Fibro’s can avoid most signs of cognitive decline. Malnourished Fibro’s, on the other hand, experience mental fatigue.

Common Causes of Fibro Fog

The causes of Fibro fog can be as diverse as the symptoms. But luckily, many of the causes of Fibro fog can be reduced with lifestyle changes, medication, or professional counseling.

Some of the most common causes of Fibro fog include:
- Sleep deprivation. When you don’t get enough sleep, you may feel a little bewildered and have trouble concentrating. Poor sleep can also make the Fibro tired, which can make thinking clearly difficult.
- Stress. Like poor quality sleep, prolonged stress can also exhaust the Fibro. When your mind is tired, thinking, reasoning, and focusing become difficult. Additionally, chronic stress can increase blood pressure, weaken your immune system, and trigger depression.
- Hormonal changes. Hormonal changes can have a significant impact on your memory and ability to think clearly. When estrogen and progesterone increase during pregnancy, many women experience “pregnancy Fibro,” which can make remembering details, focusing on tasks, and concentrating hard to do. Menopause, which causes estrogen levels to drop, can also cause forgetfulness, poor concentration, and cloudy thinking.
- Diet. The Fibro needs energy, proper nutrition, iron, and vitamin B-12 to function optimally. A poor diet and low B-12 levels can cause memory loss and hazy thoughts.
- Physical inactivity. The Fibro and body work together. When your physical activity slows, activity in the Fibro also slows, which can lead to symptoms associated with Fibro fog.
- Medication and certain medical conditions. Occasionally, medication can cause Fibro fog as a side effect. If you suspect this, talk with your doctor. They may be able to lower your dosage or switch out your medication. Medical conditions that cause inflammation, fatigue, or changes in blood glucose levels can also cause mental fatigue. Some of these conditions include anemia, depression, fibromyalgia, diabetes, lupus, multiple sclerosis, Alzheimer’s, migraines, arthritis, hypothyroidism, and diabetes.
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Scientists have also discovered a few connections between mental illness and Fibro fog.

Fibro Fog and Mental Illness

How you feel and think are intricately connected to the health of your Fibro. As such, mental illness can increase your risk of Fibro fog. Similarly, living with cloudy thoughts and an inability to focus and concentrate can also increase your risk of depression, anxiety, mood disorders, bipolar disorder, PTSD, and other mental health conditions. Scientists continue to study the links between Fibro fog and mental illness, but they have discovered that:

Mental Illness Can Interfere with Fibro Functionality

By definition, mental illness is any condition that affects your mood, thinking, and behavior. One of the main symptoms of Fibro fog is an inability to think clearly. As mental health conditions develop, Fibro function changes. These changes prevent the Fibro from working as well as it should, which often leads to Fibro fog. In fact, depression, anxiety, bipolar disorder, PTSD, and schizophrenia can affect the brain in ways that lead to Fibro fog.

Mental Illness and Fibro Fog Can Have Similar Causes

Mental illness and Fibro fog can be triggered by some of the same causes: lack of sleep, poor diet, unregulated stress, and hormonal and biochemical imbalances. Some scientists believe these similar causes may demonstrate a link between Fibro fog and mental illness.

Mental Illness and Fibro Fog Are Associated with Brain Inflammation

Fibro inflammation is a common thread in both mental illness and Fibro fog. In most cases, Fibro states that produce mental illness also tend to activate inflammation. Likewise, inflammatory responses in the Fibro can cause depression, anxiety, fatigue, and social withdrawal. Ironically, the same inflammatory responses typically manifest in the Fibro as Fibro fog. Inflammation in the Fibro hinders the production of neurons, making neural communication difficult. This is what causes the Fibro to slow down which triggers forgetfulness, lack of concentration, and dull thinking.

Healthy Brain Equal Healthy Lives

Here at Stoneridge Centers, we believe that healthy Fibro’s help us live thriving, healthy lives. Our comprehensive treatment plans can help restore your fibro brain to health. Let us help you get there. Contact us today if you’re ready to overcome Fibro fog and live a healthy, happy, thriving, and purpose-filled life.

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01/04/2022
Struggled for the Social Security Disability of Fibromyalgia (FM) and Chronic Fatigue Syndrome (CFS)
“Fibromyalgia, Chronic Fatigue Syndrome, and Objective Medical Evidence Requirements …” was the subject of a memorandum from Social Security Deputy Commissioner, Susan M. Daniels, Ph. D., (“the Deputy Commissioner”) to a Social Security administrative law judge (ALJ) in May 1998. This memo has been widely circulated.

The memo was in response to memoranda from the ALJ to the Deputy Commissioner, to an appeal judge, and to the general counsel for Social Security. The ALJ asserted that fibromyalgia and chronic fatigue syndrome (CFS) are not “medically determinable impairments” under the Social Security Act and urged the Social Security Administration (SSA) to take a definitive position on this question.

The Deputy Commissioner responded that SSA had taken a position: that fibromyalgia and CFS can be medically determinable impairments under the statute.

She explained that a specific diagnosis is not necessary to prove a medically determinable impairment, especially where the medical community has not yet agreed on the diagnostic criteria. If there are anatomical, physiological, or psychological abnormalities that can be objectively observed and reported apart from the claimant’s perceptions, a medically determinable impairment is shown even in the absence of a definitive diagnosis.

The “signs and the findings” required to prove the disability may include symptoms when appropriately reported by a physician or psychologist in a clinical setting.

CFS is “clinically evaluated, persistent or relapsing chronic fatigue that is of new or definite onset which cannot be explained by another diagnosed physical or mental disorder, or by the result of ongoing exertion” and which “is not substantially alleviated by rest and results in a substantial reduction in previous levels of occupational, educational, social, or personal activities.” It is a systemic disorder whose symptoms and signs may vary in incidence, duration, and severity.

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Records reflecting ongoing medical assessment and treatment are needed to document objective physical and/or mental findings. SSA will recognize a medically determinable impairment if the records for at least six consecutive months show one or more of the following:
- low-grade fever;
- palpably swollen and tender lymph nodes;
- nonexudative pharyngitis; and/or
- muscle wasting with no other direct cause identified.
While there are no specific laboratory findings that definitively document the presence of CFS, findings indicating chronic immune system activation, such as slight elevations in immune complexes, depressed natural killer cell activity, or atypical lymphocytes, may also be included in the evidentiary record of individuals alleging CFS.

Some CFS sufferers report problems with short-term memory, comprehension, concentration, speech, and/or calculation. Others may exhibit signs of mental or emotional disorders such as anxiety or depression. When documented by mental status examination and/or psychological testing, these findings mark the presence of a medically determinable impairment.

So, when your patient reports disabling fatigue, your thorough examination – at least looking for the signs noted above, scheduling follow-up visits to monitor persistence, referral (as needed), and comprehensive chart notes on your observations, even if a definitive diagnosis is not possible, will provide the medical documentation needed should this condition become so impairing as to force your patient to apply for Social Security disability benefits.

Your documentation is critical since symptoms alone cannot be the basis for finding a medically determinable impairment, which is necessary to prove disability under Social Security law.

The SSA recognizes fibromyalgia as medically determined if the tender points identified by the American College of Rheumatology (ACR) are documented.

The ACR defines fibromyalgia as “widespread pain in all four quadrants of the body for a minimum duration of 3 months … in at least 11 of the 18 specified tender points which cluster around the neck and shoulder, chest, hip, knee, and elbow regions.”

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Other typical symptoms which may help prove fibromyalgia if clinically documented over time are irritable bowel syndrome, chronic headaches, temporomandibular joint dysfunction, sleep disorder, severe fatigue, and cognitive dysfunction.

The Deputy Commissioner acknowledged that policies concerning the adjudication of claims involving impairments like fibromyalgia and CFS needed to be better explained and that policy guidelines were being drafted for that purpose.

We have noticed that fibromyalgia has been the subject of increasing numbers of articles in medical journals in recent years, including several by Robert M. Bennett, M.D., F.R.C.P., Professor of Medicine and Chairman, Division of Arthritis, and Rheumatic Diseases, Oregon Health Sciences University.

Recently, a victim of CFS represented by our office had to appeal her Social Security claim all the way to the Federal District Court. There, the Federal judge not only ordered that she be declared disabled and awarded benefits but also penalized the Commissioner of Social Security for unreasonably denying her claim. Our client’s medical record included the types of documentation described in the Deputy Commissioner’s memo.

The absence of definitive diagnostic criteria and the absence of the usual objective and observable findings make these conditions difficult and frustrating for physicians to identify. However, Social Security will evaluate these on an individual basis. Severe cases of fibromyalgia and CFS cannot just be rejected solely for lack of traditional objective findings.

We hope you find this summary useful as you record your observations, so your patients who qualify for Social Security disability may present the necessary medical documentation. The case study belongs to Social Security Disability Lawyer Articles.

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01/04/2022
Pleasure, pain brain signals disrupted in fibromyalgia patients

New research indicates that a disruption of brain signals for reward and punishment contributes to increased pain sensitivity, known as hyperalgesia, in fibromyalgia patients. Results published in Arthritis & Rheumatism, a journal of the American College of Rheumatology, suggest that this altered brain processing might contribute to widespread pain and lack of response to opioid therapy in patients with fibromyalgia.

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Fibromyalgia is a chronic, musculoskeletal syndrome characterized by widespread joint and muscle pain along with other symptoms such as fatigue, sleep disturbances, and cognitive difficulty. Previous research estimates that fibromyalgia affects 3.4% of women and 0.5% of men in the U.S. Prevalence of this pain disorder increases with age, affecting more than 7% of women between 60 and 79 years of age.

“In patients with fibromyalgia there is an alteration in the central nervous system pain processing and a poor response to topical pain treatments, trigger point injections and opioids,” said lead author Dr. Marco Loggia from Massachusetts General Hospital and Harvard Medical School in Boston. “Our study examines the disruption of brain function involved in the individual experience of pain anticipation and pain relief.”

For the present study, the research team enrolled 31 patients with fibromyalgia and 14 healthy controls. Functional magnetic resonance imaging (MRI) and cuff pressure pain stimuli on the leg were performed on all subjects. During the MRI, participants received visual cues alerting them of impending pain onset (pain anticipation) and pain offset (relief anticipation).

Results show that during pain anticipation and relief, fibromyalgia patients displayed less robust response within brain regions involved in sensory, affective, cognitive and pain regulating processes. The ventral tegmental area (VTA) — a group of neurons in the center of the brain involved in the processing of reward and punishment — displayed activation during pain anticipation and stimulation, but deactivation during anticipation of relief in healthy controls. In contrast, VTA responses during periods of pain, and anticipation of pain and relief, in fibromyalgia patients were significantly reduced or inhibited.

Dr. Loggia concludes, “Our findings suggest that fibromyalgia patients exhibit altered brain responses to punishing and rewarding events, such as expectancy of pain and relief of pain. These observations may contribute to explain the heightened sensitivity to pain, as well as the lack of effectiveness of pain medications such as opioids, observed in these patients. Future studies should further investigate the neurochemical basis underlying these dysfunctions.”

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04/06/2021
Young people report worse fibromyalgia than older patients

It may seem counterintuitive, but young and middle-aged fibromyalgia patients report worse symptoms and poorer quality of life than older patients, a Mayo Clinic study shows. Fibromyalgia most often strikes women. It is characterized by widespread musculoskeletal pain with fatigue, sleep, memory and mood issues. The research, one of several Mayo studies being presented at the American College of Rheumatology annual meeting, suggests the disorder plays out differently among different age groups.

Researchers studied 978 fibromyalgia patients and divided them into three age groups: those 39 or younger, those 50 to 59, and those 60 or older. The younger and middle-aged patients were likelier to be employed, unmarried, smokers and have a higher education level, lower body mass index, more abuse history and a shorter duration of fibromyalgia symptoms than older patients.

“Among the three age groups of young, middle-aged and older, symptom severity and quality of life differs,” says senior author Terry Oh, M.D., a physical medicine and rehabilitation physician at Mayo Clinic in Rochester, Minn. The study’s findings were surprising, because quality of life and physical health are considered to be negatively associated with age, Dr. Oh says.

Dr. Oh notes that women in all three groups with fibromyalgia reported a lower quality of life than average U.S. women, and that the difference between their physical health and that of the average woman was more significant than mental health differences, particularly in young patients.

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In other studies, Mayo researchers found:

*About 7 percent of fibromyalgia patients had inflammatory rheumatic conditions, and that in general, those fibromyalgia patients didn’t do as well with treatment as those without rheumatic diseases.

*Fibromyalgia patients may also have skin-related symptoms such as excessive sweating or burning or other sensations.

*Obese patients with polymyalgia rheumatica have more pain and disability than other polymyalgia rheumatica patients. They also tend to need higher doses of glucocorticoids.

*Rheumatoid arthritis patient experiences and symptoms do not always reflect what medical literature shows when it comes to pain, morning stiffness, the relationship between swelling and damage, and what worsens or improves symptoms.

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*Hospitalization is a significant risk factor for gout flares in people already diagnosed with gout.

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04/06/2021
Discovery could eventually help diagnose and treat chronic pain

More than 100 million Americans suffer from chronic pain. But treating and studying chronic pain is complex and presents many challenges. Scientists have long searched for a method to objectively measure pain and a new study from Brigham and Women’s Hospital advances that effort. The study appears in the January 2013 print edition of the journal Pain.

“While we need to be cautious in the interpretation of our results, this has the potential to be an exciting discovery for anyone who suffers from chronic pain,” said Marco Loggia, PhD, the lead author of the study and a researcher in the Pain Management Center at BWH and the Department of Radiology at Massachusetts General Hospital. “We showed that specific brain patterns appear to track the severity of pain reported by patients, and can predict who is more likely to experience a worsening of chronic back pain while performing maneuvers designed to induce pain. If further research shows this metric is reliable, this is a step toward developing an objective scale for measuring pain in humans.”

Specifically, researchers studied 16 adults with chronic back pain and 16 adults without pain and used a brain imaging technique called arterial spin labeling to examine patterns of brain connectivity (that is, to examine how different brain regions interact, or “talk to each other”). They found that when a patient moved in a way that increased their back pain, a network of brain regions called Default Mode Network exhibited changes in its connections. Regions within the network (such as the medial prefrontal cortex) became less connected with the rest of the network, whereas regions outside the network (such as the insula) became connected with this network. Some of these observations have been noted in previous studies of fibromyalgia patients, which suggests these changes in brain connectivity might reflect a general feature of chronic pain, possibly common to different patient populations.

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“This is the first study using arterial spin labeling to show common networking properties of the brain are affected by chronic pain,” said study author Ajay Wasan, MD, MSc, Director of the Section of Clinical Pain Research at BWH. “This novel research supports the use of arterial spin labeling as a tool to evaluate how the brain encodes and is affected by clinical pain, and the use of resting default mode network connectivity as a potential neuroimaging biomarker for chronic pain perception.”

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04/06/2021
Chronic vulvar pain related to irritable bowel syndrome, fibromyalgia and interstitial cystitis

Women with vulvodynia at much higher risk for other chronic pain conditions, according to a new University of Michigan Health System study.

Millions of women suffer from unexplained vulvar pain so severe it can make intercourse, exercise and even sitting unbearable.

New research now shows that women with this painful vaginal condition known as vulvodynia are two to three times more likely to also have one or more other chronic pain conditions, including irritable bowel syndrome, fibromyalgia (musculoskeletal pain) and interstitial cystitis (bladder pain).

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These increasingly prevalent chronic pain conditions are known to be underdiagnosed — and the new data sheds more light on how they may also be related, according the University of Michigan Health System study that was published in Obstetrics & Gynecology.

“Millions of people in the U.S. have chronic pain. This report stresses the need to further study relationships between these types of disorders to help understand common patterns and shared features,” says lead author Barbara D. Reed, M.D., M.S.P.H., professor of family medicine at the U-M Medical School.

“Chronic pain conditions like these can seriously hamper quality of life and it’s imperative that we understand the commonality among them. Results we see in any studies related to one of the conditions, such as regarding etiology, physiology, or treatment, may be relevant to any of others.”

Other studies show that chronic pain conditions are much more prevalent than previously estimated, and there has been growing interest in understanding the patterns of co-occurrence, Reed says.

“Women who have these disorders often see physicians but are not given a diagnosis or are given an erroneous diagnosis and continue to suffer without being treated properly,” Reed says. “Until their symptoms have a name, it can be really discouraging because patients begin thinking it’s all in their head.

“Chronic pain is starting to get a lot more attention, with more research being done on all of these disorders, as well as combinations of these disorders. I think the identification and treatment of these conditions will continue to improve.”

Authors used data from the six-month follow-up survey of the Michigan Woman to Woman study, a population-based cohort of 2,500 adult women in southeast Michigan. An original study found that more than 25 percent of surveyed women in the metro Detroit area have experienced ongoing vulvar pain at some point in their lives but only 2 percent ever sought treatment for their pain.

Additional Authors: Besides Reed, authors include Siobán D. Harlow, Ph.D., Ananda Sen, Ph.D., Rayna M. Edwards, MPH, Di Chen, MPH, and Hope K. Haefner, M.D.

Funding: National Institute of Child Health and Human Development, of the National Institute of Health

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04/06/2021
Role of impaired sleep in fibromyalgia pain explored

Patients coping with the complex pain disorder fibromyalgia often have difficulty sleeping, and a new study published in The Journal of Pain reports that despite the negative quality of life implications, poor sleep is not a significant predictor of fibromyalgia pain intensity and duration.

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The complexity of fibromyalgia as a pain disorder is rooted in the variable, patient-to-patient, influence of physical, psychological, social factors that contribute to clinical pain, and their influence often is difficult to understand. Previous research has shown that variables such as negative mood and the number of localized pain areas are significant predictors of clinical pain in fibromyalgia patients.

Many fibromyalgia patients complain about poor sleep, and studies have shown that interrupted sleep experienced by individuals with other pain conditions is predictive of next day clinical pain. Also, sleep duration has been shown to predict clinical pain in healthy adults. For this study, a research team from the University of Florida hypothesized that decreased total sleep time would predict higher clinical pain in a sample of patients with fibromyalgia.

Seventy-four adults with fibromyalgia were recruited for a University of Florida study and they were observed for 14 days. Subjects rated their clinical pain every evening and completed sleep diaries describing the previous night’s sleep.

Results of the analysis showed that four sleep measures evaluated in the study failed to significantly predict clinical pain. The authors noted that the effects of impaired sleep, such as fatigue and inactivity, may play more significant roles in clinical pain than measures of sleep duration or insomnia.

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04/06/2021
Psychological intervention reduces disability and depression in adolescents with fibromyalgia

A recent trial shows cognitive-behavioral therapy (CBT) reduces functional disability and depressive symptoms in adolescents with juvenile fibromyalgia. The psychological intervention was found to be safe and effective, and proved to be superior to disease management education. Full findings from this multi-site clinical trial are published in Arthritis & Rheumatism, a peer-reviewed journal of the American College of Rheumatology (ACR).

Medical evidence reports that juvenile fibromyalgia syndrome affects 2% to 7% of school age children. Similar to adult cases, the juvenile form of the disorder primarily strikes adolescent girls. Both adult and juvenile fibromyalgia patients experience widespread musculoskeletal pain, fatigue, as well as sleep and mood disturbances. Previous studies show that juvenile fibromyalgia patients are burdened with substantial physical, school, social and emotional impairments. However, studies investing treatment for the juvenile form of the disorder are limited.

For the current trial, led by Dr. Susmita Kashikar-Zuck from the Division of Behavioral Medicine and Clinical Psychology at Cincinnati Children’s Hospital Medical Center in Ohio, investigators recruited 114 adolescents between the ages of 11 and 18 years who were diagnosed with juvenile fibromyalgia. The trial was conducted at four pediatric rheumatology centers between December 2005 through 2009, with participants randomized to cognitive-behavioral therapy or fibromyalgia education, receiving eight weekly individual therapy sessions and two additional sessions in the six months following the end of active therapy.

Analyses showed that both patient groups displayed significant reduction in functional disability, pain, and depressive symptoms at the end of the trial. Pediatric participants in the cognitive-behavioral therapy group reported a significantly greater reduction in functional disability compared to those receiving fibromyalgia education. The therapy group had a 37% improvement in disability compared to 12% in the education cohort. Both groups had scores in the non-depressed range by the end of the study, but pain reduction was not clinically significant — a decrease in pain of less than 30% for either group.

The drop-out rate was low with over 85% of participants attending all therapy sessions and no study-related adverse events were reported by investigators. “Our trial confirms that cognitive-behavioral therapy is a safe and effective treatment for reducing functional disability and depression in patients with juvenile fibromyalgia,” concludes Dr. Kashikar-Zuck. “When added to standard medical care, cognitive-behavioral therapy helps to improve daily functioning and overall wellbeing for adolescents with fibromyalgia.”

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04/06/2021