(Not) Just Kidding!

Medical evidence reports that juvenile FM affects 2% to 7% of school age children. Similar to adult cases, the juvenile form of the disorder primarily strikes females. Previous studies have shown that juvenile fibromyalgia patients are burdened with substantial physical, school, social and emotional impairments. However, studies for the treatment of the juvenile form have been limited.

A recent trial shows cognitive-behavioral therapy (CBT) reduces functional disability and depressive symptoms in adolescents with FM. The psychological intervention was found to be safe and effective, and proved to be superior to disease management education.

CBT is a form of talk therapy that helps people identify and develop skills to change negative thoughts and behaviours. CBT says that individuals — not outside situations and events — create their own experiences, pain included. And by changing their negative thoughts and behaviours, people can change their awareness of pain and develop better coping skills, even if the actual level of pain stays the same.

This 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 11 – 18 years of age who were diagnosed with juvenile FM. The trial was conducted at four paediatric rheumatology centres, 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.

Both groups displayed significant reduction in functional disability, pain, and depressive symptoms at the end of the trial; however, participants in the cognitive-behavioural therapy group reported a significantly greater reduction in functional disability compared to those receiving fibromyalgia education.

“Our trial confirms that cognitive-behavioural 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-behavioural therapy helps to improve daily functioning and overall wellbeing for adolescents with fibromyalgia.”

 

Walk and/or Talk

While three non-opioid drugs – Cymbalta, Lyrica, and Savella – have been approved by the FDA to treat FM pain; as we know, none adequately controls the multiple symptoms; but exercise and/or talking with a therapist on the phone once a week may significantly reduce chronic pain,  the authors of a new study write.

Nonetheless, up to 20% of visits to a primary health care provider generate a prescription for a narcotic painkiller, or opioid, say Seth Berkowitz, MD, and Mitchell Katz, MD, of the Los Angeles County Department of Health Services write..

The scientists assigned almost 450 patients with chronic widespread pain, some of whom had FM, to get either “talk therapy” by phone, exercise, both talk therapy and exercise, or their usual treatment.

Talk Therapy

Four therapists underwent three days of training to learn how to provide psychological help to study participants receiving talk therapy. Patients chose goals, such as identifying and evaluating unhelpful thinking styles or making lifestyle changes.

After an initial assessment that lasted an hour, those participants receiving talk therapy spoke on the phone with a therapist for 30 to 45 minutes once a week for seven weeks. That was followed by a phone session three months and six months after the study began.

Importantly, evidence suggests that this talk therapy delivered by phone is as effective as face-to-face therapy, researcher John McBeth, PhD, an epidemiologist at the University of Manchester.

Exercise

Those in the exercise group were invited to meet with a fitness instructor once a month for six months. The goal was to improve their fitness by exercising 20 minutes to an hour at least twice a week.

Long-Lasting Benefit

Three months after the study ended, the phone therapy and/or exercise patients showed more improvement than those who’d stayed with their usual care.

The people who engaged in both talk therapy and exercise did only slightly better than those who received one or the other.

The new study is the latest addition to an “extensive” body of clinical trials demonstrating talk therapy’s effectiveness in treating chronic pain and headache, says Russell Portenoy, MD, chair of the department of pain medicine and palliative care at New York’s Beth Israel Medical Center.

Cognitive behavioral therapy [talk therapy] should be offered to a far larger proportion of patients with chronic pain than currently is done,” Portenoy, who was not involved in the study. He cited several obstacles: Too few therapists trained to provide it, inadequate insurance coverage, a tendency among doctors to focus on medical strategies due to a lack of knowledge about talk therapy, and a lack of reimbursement incentives to offer other treatments.

In Australia, you can establish a GP Management Plan with your GP that, if eligible, will allow you a Medicare rebate for a maximum of 5 visits each calendar year (nowhere near enough but a start in the right direction). This could be any of the following (not a full list):

  • Chiropractor
  • Dietitian
  • Exercise Physiologist
  • Mental Health Worker
  • Occupational Therapist
  • Osteopath
  • Physiotherapist
  • Podiatrist
  • Psychologist

To all: make sure to take advantage of each and every (if there are any) benefit available to you.

 

Realistic Expectations With Pain Management

I read this post by  (Creator and founder of FibroTV.com) in FibroTV Blog and thought it might get you thinking about how YOU manage your pain:

Realistic Expectations With Pain Management When You Have Chronic Pain

Pain management is essential when you have a chronic pain condition. Unmanaged pain can rip your life apart in all areas. When most people think of pain management the first thing that pops in their head is pain medication or medication to control the pain. There are many other options than just medication and you can also use an integrative approach to manage your pain by using medication and non traditional treatments  for pain management. Having realistic expectations with pain management is also very important. When you have chronic pain nothing is going to take away all the pain and if you keep reaching for that you are setting yourself up for a lot of frustration, discouragement, and disappointment. The only way to resolve pain completely is to address the underlying cause if at all possible.

Medication is not the only option, in fact it should be your last option!

We have been taught all our lives that when you hurt or get sick you go to the doctor and get a prescription. Medication has it’s place for pain and for sickness but why do we always reach for that first?  Medication does not fix anything they just cover up symptoms and is just another toxin in the body that can cause more pain and illness. There are some people who would have NO quality of life without medications or would not be able to stay alive without medication and these are not the people I am addressing. We really need to think if medication is the right thing for us or just a quick fix. We tend to want the most amount of results with the least amount of effort in this world and sometimes that is not the healthiest approach. You need to ask yourself some serious questions when debating how you want to manage your pain and make a personal choice that is best for YOU and your overall health. You need to be your own advocate and be very clear to your medical providers your wants and needs when it comes to pain management. Doctors are taught to write prescriptions and do not come from a place of healing the underlying cause so it is something you will have to do for yourself and make your wishes clear if you want to try alternative options.

Alternative options for treating chronic pain

  • Meditation Meditation cultivates an “awareness that develops when you’re paying attention, on purpose, in the present moment, without judgment,” says Jon Kabat-Zinn, PhD, former executive director of the Center for Mindfulness in Medicine, Health Care, and Society at the University of Massachusetts Medical School, in Worcester, Mass. The idea is if you can calm and focus your mind and your body you may be able to control your pain and the degree to which you feel it.”You cannot experience pain unless you focus on it,” says Gabriel Tan, PhD, a pain psychologist at the Michael E. DeBakey Veterans Affairs Medical Center, in Houston. “Let’s say you’re focusing on your pain and then the next moment a person comes into the room with a gun and threatens to kill you; you won’t feel pain because you’ll be focusing on the man with the gun. Meditation helps you shift your focus in somewhat the same way,” explains Tan.
  • TENS unit  “TENS” is the acronym for Transcutaneous Electrical Nerve Stimulation. A “TENS unit” is a pocket-size, portable, battery-operated device that sends electrical impulses to certain parts of the body to block pain signalsThe electrical currents produced are mild, but can prevent pain messages from being transmitted to the brain and may raise the level of endorphins (natural pain killers produced by the brain). For some chronic pain patients, a TENS unit provides pain relief that can last for several hours. For others, a TENS unit may help reduce the amount of pain medications needed. Some patients hook the unit onto a belt turning it on and off as needed.
  • Chiropractors Chiropractors can treat chronic pain. They use a variety of non-surgical treatments, such as spinal manipulation, to address chronic pain symptoms, such as inflammation and muscle tension.
  • Cognitive behavioral therapy Cognitive behavioral therapy (CBT) is a form of talk therapy that helps people identify and develop skills to change negative thoughts and behaviors. CBT says that individuals — not outside situations and events — create their own experiences, pain included. And by changing their negative thoughts and behaviors, people can change their awareness of pain and develop better coping skills, even if the actual level of pain stays the same.
  • Aquatic (water) therapy Aquatic (water) therapy is quickly becoming well-known for its amazing effects on decreasing chronic pain, speeding recovery, and improving function. Aquatic therapy, or pool therapy, consists of an exercise program that is performed in the water. It is a beneficial form of physical therapy that is useful for chronic pain. Aquatic therapy uses the physical properties of water to assist in patient healing and exercise performance.
  • Restorative Yoga Restorative yoga turns on the healing relaxation response by combining gentle yoga poses with conscious breathing. Although these poses may look as though you are doing nothing, this is far from the truth. Restorative yoga rests the body but engages the mind. The breathing elements of each pose make restorative yoga an active process of focusing the mind on healing thoughts, sensations, and emotions.
  • Dietary Changes and Proper Nutrition   You are what you eat, at least that’s the old adage. It’s also one I believe in — what you put into your body has a big effect on how you feel. There are Foods that fight fat, detox foods, and foods that help you get stronger. There are even foods that help you sleep better and look fresher. Adding to the list of foods that fuel with a purpose are foods that help ease pain. Whether it’s a headache, post-workout soreness, chronic pain or an injury, there are foods that  will help ease the pain away in a totally natural way.
  • Reiki Reiki is a Japanese technique for stress reduction and relaxation that also promotes healing. It is administered by “laying on hands” and is based on the idea that an unseen “life force energy” flows through us and is what causes us to be alive. If one’s “life force energy” is low, then we are more likely to get sick or feel stress, and if it is high, we are more capable of being happy and healthy.
  • Massage  Massage for chronic pain works by interrupting the cycle of chronic pain. When you have pain in a certain area of the body, the muscles tighten around that area to “protect” it, mobility is limited, and often, circulation is reduced. Additionally, pain that began with an injury or illness can cause emotional and psychological stress that exacerbates the pain and even remains after the physical condition has healed. Massage for chronic pain restores mobility by loosening tight muscles and trigger points and by lengthening muscles. Massage also improves circulation by increasing blood flow, as well as promotes relaxation and helps relieve emotional stress and anxiety that can contribute to chronic pain.
  • Acupuncture A new study of acupuncture — the most rigorous and detailed analysis of the treatment to date — found that it can ease migraines and arthritis and other forms of chronic pain.The findings provide strong scientific support for an age-old therapy used by an estimated three million Americans each year. Though acupuncture has been studied for decades, the body of medical research on it has been mixed and mired to some extent by small and poor-quality studies. Financed by the National Institutes of Health and carried out over about half a decade, the new research was a detailed analysis of earlier research that involved data on nearly 18,000 patients. The researchers, who published their results in Archives of Internal Medicine, found that acupuncture outperformed sham treatments and standard care when used by people suffering from osteoarthritis, migraines and chronic back, neck and shoulder pain.

Medications Medicines can often help control chronic pain. Many different drugs, both prescription and non-prescription, are used to treat chronic pain. All these medicines can cause side effects and should be taken exactly as they are prescribed. In some cases, it may take several weeks before medicines work to reduce pain. To avoid dangerous drug interactions, tell your doctor all the medicines you are taking (including herbal and other complementary medicines).

Your Choice! Your Body! Your Life!

When it comes to pain management you have to make choices that are best for you because it is YOU that has to live with the consequences and results of that choice. Everyone feels pain different and copes with pain different. Just because Suzi Q is doing something that is helping her it does not mean it will help you. We are all very unique beings and your chronic pain management is going to be as unique as you. The one thing I do recommend to EVERYONE with chronic pain and illness is to eat a well-balanced and nutritious  diet. Even if it does not resolve any of your pain you will be healthier and be able to cope better. You can never lose by eating healthy :-)

Sensitive Sensations

Being highly sensitive could play a role in your fibromyalgia pain.

Although the specific cause of FM remains a mystery, how the nervous system perceives pain may very well play a role. Kristi Mizelle, MD, MPH, director of the Rheumatology Holistic Care Clinic at Johns Hopkins Hospital in Baltimore, agrees with most of us, that ‘it’s like the volume is turned up on the pain.”

In many of us, our entire sensory system is amplified, making us highly sensitive to touch and other stimuli: how many of you can’t stand a clothing tag on the back of the neck, or even a hug from a loved one?. What about noisy gatherings or crowds? And some people with FM disorder are much more sensitive to medications and chemicals, Dr. Mizelle says.

Sensory sensitivities, FM, IBS, and other chronic pain syndromes seem to ‘travel together,’ she adds. Emerging data are showing that these factors are somehow connected and may be part of a group of disorders being called central sensitization syndrome, she says.

The Highly Sensitive Person and the Fibromyalgia Connection

Barbara Keddy, PhD, considers herself a highly sensitive person (HSP – are you?) with FM. A professor emerita at Dalhousie University School of Nursing in Halifax, Nova Scotia, Canada, Keddy is the author of Women and Fibromyalgia: Living With an Invisible Dis-ease. “In my book, I wrote about a theory I developed, which suggests that in order for a person to develop fibromyalgia, that person’s personality must be that of a highly sensitive nature,” Keddy says. “By the term ‘highly sensitive person,’ I mean someone who is hyper-vigilant, easily aroused with too much stimulation, highly intuitive, and so on.”

Elaine Aron, PhD, a San Francisco psychologist and author of the The Highly Sensitive Person, says there’s no evidence to support the idea that HSPs are more prone to fibromyalgia than less sensitive people. But she says, in general, HSPs “who are living a stressful life or had a stressful childhood tend to be more prone to illness than others, and they are certainly more sensitive to pain.”

Keddy agrees that being a highly sensitive person does not mean you’re destined to develop fibromyalgia. That being said, she notes, “I have never met anyone who has fibromyalgia who is not highly sensitive.”

In the research for her book and through her blog posts, Keddy says she’s interviewed and heard comments from hundreds of people with FM. She says a common thread exists: They all say that even as children they were “overly empathetic, unable to tolerate violence in movies, cannot bear loud noises, and have a tendency to be caregivers over and above what is necessary.”

Coping With Both Fibromyalgia and Sensitivity

Mizelle suggests developing adaptive techniques, (easier said than done) especially if you are sensitive to touch. She says a complaint she hears a lot from people with FM is that they can’t hug their loved ones. To help loved ones understand what you’re experiencing, try saying, “When you hug me this way, it’s painful.” Placing hands in a different way may help, she says, or come up with a special signal to show affection and love that doesn’t involving hugging at all – although sometimes we just miss hugging!

Because chronic pain can lead to depression and other mood disorders, psychological therapy can also help people living with fibromyalgia, says Mizelle. She suggests that cognitive-behavioral therapy (CBT) is especially helpful for people with FM who have a tendency to catastrophise, or have thoughts like “my pain is never going to get any better.” These types of repetitive, negative thoughts can end up being a self-fulfilling prophecy, she explains. Therapy teaches that you’re not helpless in the face of your pain and that you can learn how to manage it. CBT, according to Mizelle, can help you change the way you look at the world and your illness.

Keddy says she always ends up feeling pain and fatigue when she’s over-stimulated. Because of that, she keeps a “fairly quiet” routine that involves meditation, exercise, and qi gong, a Chinese relaxation technique that uses gentle movements, mental focus, and deep breathing. “I do these things throughout the day – not all at once; and listen to music and read quietly,” she says. Along with medication and being careful about avoiding sugar, this way of life helps her take control of her nervous system. Keddy, however, says nothing about how this affects the rest of her life.

For people living with fibromyalgia pain, says Keddy, planning such a routine does require some discipline. But since there’s no cure for FM, “we must become experts in our own lives,” she adds.