Fibromyalgia and the Mind-Body-Spirit Connection with B. Salt II

[Guest guest]

" Season-Salt " ?

-

This article is from the WebMD

Live Events Transcript Archive

Fibromyalgia and the Mind-Body-Spirit Connection with B. Salt

II

By B. Salt II

WebMD Live Events Transcript

Moderator: Welcome to WebMD Live. Today we will be discussing

Fribromyalgia with

B. Salt, II, M.D., and Edwin H. Season, M.D.

B. Salt II, M.D., is board-certified in both internal

medicine and

gastroenterology. He received his M.D. degree from The Ohio State

University in

Columbus, Ohio, in 1972, where he currently holds an appointment as

Clinical

Associate Professor in Medicine. He trained for five more years in

internal

medicine and gastroenterology at Vanderbilt University Hospitals in

Nashville,

Tennessee, where he also served as a Chief Resident in Medicine.

Edwin H. Season, M.D., is board-certified in orthopedic surgery. He

received his

M.D. degree from The Ohio State University in Columbus, Ohio, in

1971, followed

by internship at the University of Virginia. He then returned to Ohio

State for

his residency and upon its completion, taught orthopedic surgery as

an assistant

professor in The Ohio State University College of Medicine from 1976

to 1980.

If you would like to ask the doctors a question, please type /ask

followed by

your question (e.g. " /ask How are you? " )

Dr. Salt, Dr. Season, welcome back to WebMD Live.

What is fibromyalgia?

Dr. Season: Fibromyalgia is wide-spread muscular aching pain and

stiffness,

associated with tenderness on palpation of characteristic paired

sights called

trigger, or tender points located in the neck, the back, and the

extremities.

Fibromyalgia, in addition to having widespread muscular pain, also

has fatigue,

a sleeping disorder, and some type of stress-anxiety and depression.

Moderator: What causes it?

Dr. Salt: Fibromyalgia is considered to be a functional illness, so

the symptoms

are real and not imagined, and the medical tests are normal. Most

patients and

doctors view and understand fibromyalgia and related functional

illnesses

through what we call a bio-medical model, that fails to explain

illness where

there is no evidence of disease. The model is based

upon " reductionism, " where

all problems can be explained A to B, cause and effect, and based

upon dualism,

that the mind and body are split and separate. But the reality is,

all illness

is multi-dimensional. In other words, fibromyalgia and other

functional

illnesses can really be understood through what doctors call a

biopsychosocial-spiritual model. Dr. Season and I propose that

people, patients

and doctors, need to use a common language to understand the cause of

fibromyalgia, and how to feel better with it. It's important then to

understand

that the functional illnesses like fibromyalgia are best addressed by

recognizing, understanding, and accepting the connection of body,

mind and

spirit, the inter-relationships of body, mind, and spirit with

genetics,

environment, and society, and the impact and influence of conscious

as well as

unconscious mind, though, and motion and stress.

Moderator: Are the symptoms all in the head?

Dr. Salt: The symptoms are not all in the head, but they are in the

mind-body-spirit. The organ in the head, the brain and the mind, is

connected to

the body, and we know this through the spinal cord connection,

through the

autonomic nervous system, and through the neuropeptide messenger

communication

system, that is, small protein molecules that circulate through the

body and

communicate messages back and forth between brain and body and vice

versa. So we

know that we have to look at the mind-body, and really the spirit,

from a

holistic perspective to begin to understand that the symptoms, though

real,

cannot be explained through a bio-medical model which looks at body

only.

We believe there's a relationship between fibromyalgia and an

abnormal reaction

to stress, or an abnormal stress response. Stress can be defined as

the

perception of a physical or psychological threat, and the perception

of being

ill-prepared to cope with that threat. Anytime an individual is

undergoing

excessive stress, that can be a contributing factor to fibromyalgia.

Remember 2

things about stress -- the first is that stress is perceptual. One

person's

poison is another person's potion. Second, the perception of stress

may be

occurring at an unconscious mind level, so we may be unaware that

we're under

the stress from a cognitive perspective.

Moderator: Why do people get fibromyalgia?

Dr. Season: There are a number of factors, and stress is just one

factor. What

we have found is that fibromyalgia patients commonly have a sleep

disorder, and

they commonly are deconditioned, or out of condition. From that

standpoint, we

feel that these factors are associated with the development of

fibromyalgia.

Whether the condition of fibromyalgia produces the sleep disorder or

the

deconditioning, or vice versa, the sleep disorder and the

deconditioning

produces fibromyalgia, we just can't be sure... but there is a strong

association. There are other factors as well.

Moderator: What does " fibromyalgia " mean? Where does the word come

from?

Dr. Season: " Fibro " means fibrous tissue, and fibrous tissue is part

of the

connective tissues that hold the body together in the muscular-

skeletal system.

" Myalgia " means painful muscles, and all patients with fibromyalgia

have

widespread muscular pain.

Moderator: Is it commonly misdiagnosed?

Dr. Season: Yes, it's commonly misdiagnosed, although there are

accepted

criteria for making the diagnosis, and physicians who have an

interest in

fibromyalgia should be able to make the diagnosis reasonably readily.

Moderator: How is fibromyalgia related to Irritable Bowel Syndrome?

Dr. Salt: Fibromyalgia and IBS are what doctors call functional

illnesses, and

the word or term " functional " means the symptoms are real and not

imagined, but

when medical tests are conducted such as x-rays, or endoscopies, or

biopsy, or

laboratory tests, the tests turn out to be normal. This can be very

frustrating

for both patient and doctor. There are actually many functional

illnesses;

fibromyalgia and IBS are two of the more common. Most of the symptoms

that bring

people to doctors today can't be explained by medical testing. Other

examples

are tension headache, non-cardiac non-heart-related chest pain,

chronic fatigue,

and interstitial cystitis. Many patients have more than one, and

often several

functional illness diagnoses. Scientific studies do confirm that 30

to 70% of

patients diagnosed with fibromyalgia also have IBS, and that 30 to

70% of

patients diagnosed with IBS also have fibromyalgia. The relationship

is that

functional illnesses are rooted in the biopsychosocial-spiritual... or

mind-body-spirit model. Another common condition that's a functional

condition

like these is jaw pain. Or temporal joint pain.

Moderator: How can information about the MindBodySpirit help solve

the symptoms?

Dr. Salt: We feel strongly that the most important element for people

and

patients with fibromyalgia, IBS, and other functional illnesses, is

knowledge

and understanding, that it is important to understand and accept the

mind-body-spirit connection. We feel that everyone, people, patients

and

doctors, tend to underestimate our individual power to heal. We feel

strongly

that treatment and healing are not the same; treatment is the

application of

something external, or something given to the patient, often by a

doctor but

even a natural substance like an herbal preparation.... but healing,

by

contrast, comes from within. We believe that people and patients who

suffer with

these conditions, tend to underestimate their own power to heal and

that they

are more powerful than we all give them credit for. Neuropeptides can

be turned

on and off through thought, belief, relaxation, exercise, diet,

sleep, and

medication. And so in an effort to heal patients with fibromyalgia,

improved

health habits that involve exercise, proper diet, good sleep, and

medication,

specifically anti-depressants, can be beneficial.

stinger251_WebMD: Is there any connection between hypothyroidism and

fibromyalgia?

Dr. Season: There's no known relation between hypothyroidism and

fibromyalgia.

MAMAJOY_WebMD: Have studies been done to show that " HSP's " or " highly

sensitive

people " are more likely to suffer from FMS?

Dr. Salt: The prevailing concepts of what underlies fibromyalgia and

IBS include

a very important issue, which is that something is occurring at the

level of the

mind-brain, such that the individuals who suffer with symptoms of

fibromyalgia

and IBS have an increased sensitivity to stimuli, and the stimuli may

be subtle

stimuli, that is something eaten that would not ordinarily cause the

stress or

discomfort to someone who is considered to be " normal. " But we

believe that

there is an alteration at the level of mind-brain so that sensitivity

is

increased; in the field of digestive medicine, we call this " enhanced

visceral "

sensitivity. That mechanism of enhanced bodily sensitivity seems to

be operating

in fibromyalgia as well. That is why Dr. Season had emphasized the

stress issue,

since it's thought that stress both operating at a conscious and

unconscious

level, are at least contributing if not causing the alteration of

sensitivity.

Highly sensitive people, the term, is probably a label much like the

labels of

IBS and fibromyalgia.

Dr. Season: What Dr. Salt is talking about is actually abnormal pain

processing.

That's very closely related to an abnormal stress response, and this

can be at a

conscious or unconscious level.

CntLQQKbck_WebMD: I was dx w/ Lupus and Fibromyalgia at the same

time, and this

just following a very traumatic, emotionally stressful time in my

life. Is there

a connection? If so, will I ever be able to go back to my " old " self

again?

Dr. Salt: That brings up two very important issues; the first is that

it's very

common for people and patients who suffer from functional illnesses

such as

fibromyalgia and IBS to report the onset of their condition and

symptoms in

conjunction or related to some kind of stress, be it physical or

psychological

stress or strain. The second is that it's also common to have

fibromyalgia in

association with, or concurrent with another organic condition, and I

think it'd

be appropriate for Dr. Season to address that.

Dr. Season: Functional symptoms can be associated with organic

arthritic

conditions that are considered diseases; fibromyalgia is considered

an illness.

Rheumatoid arthritis, lupus, are considered diseases. The two can go

hand in

hand, and if an individual presents with functional symptoms, the

physician has

the responsibility to be sure to check for all types of actual

organic diseases.

Dr. Salt: It would be therefore possible, to have a very mild case of

lupus, and

have most of the symptoms occurring related to fibromyalgia, so that

if

treatment were directed to the very mild form of lupus, one could see

that very

potentially strong or even toxic medications could be given in an

effort to

relieve symptoms that would be better relieved by directing towards

fibromyalgia. Fibromyalgia commonly occurs with other disease

processes, and may

be the primary producer.

Dr. Season: In addition to that, the types of treatments and healing

that we

recommend for fibromyalgia, are usually simpler and safer treatments

than for

more serious conditions such as lupus. Oftentimes it makes sense to

go with the

simpler approach first.

MAMAJOY_WebMD: How do you suggest using Mind/Body/Spirit to help the

pain?

Dr. Salt: We feel that it is a matter of becoming conscious, or aware

of the

relationship of the mind-body-spirit connection, rather than simply

looking at

the words, truly becoming conscious of this connection. This

consciousness may

require considerable effort, and may require some study, in order to

integrate

the knowledge of it into the belief system, that this connection is

very real.

This consciousness of this connection, can bring relief in and of

itself, but

it's the first place to start. So it requires good information and

knowledge to

begin this healing process. A rather simple, practical approach using

mind-body-spirit is to start an individual with fibromyalgia on a

simple

exercise program, and even though this seems like just a prescription

of

activity as opposed to anything that has to do with mind and spirit,

the

exercise program will produce benefits, particularly with respect to

stress

management.

Dr. Season: I think all of us on aerobic exercise programs understand

how the

aerobic exercise helps us to manage our stress. In addition to that,

it also

deals with one of the other problems associated with fibromyalgia,

the sleep

disorder. That is, exercise will encourage deeper sleep, more stage

4... which

is the sleep that is deficient in a fibromyalgia. Just the simple

exercise

program will then help in terms of the stress and also help in terms

of the

sleep disorder.

Moderator: What are some ways to use diet and exercise to help and

what are some

specific foods that help or harm the body to this extent?

Dr. Season: I think the first rule of exercise is to start gradually

and to

progress gradually. Patients with fibromyalgia generally are

deconditioned, and

they find exercise challenging, painful, and difficult to initiate. I

often

recommend that patients with fibromyalgia start with a water exercise

program,

but any type of program that is not too strenuous and is progressed

gradually is

satisfactory.

Dr. Salt: It is important to include diet in any type of self-care

plan. While

we don't have time to pursue matters of the specifics of diet, we

obviously need

to be thinking in terms of a low-fat, relatively plant-based diet

with plenty of

fruits and vegetables, as a start. There are modifications and

variations of

diet; it doesn't mean you have to be a vegetarian and eat no meat,

but we do

need to look at the types of foods we eat, and the amounts we eat.

Being

overweight is not healthy for any of us, particularly if we have a

painful

muscular-skeletal condition like fibromyalgia. Caffeine can be a

problem; it's a

stimulant and can potentiate the stress response to any stressor that

may be

perceived or experienced, so it may be helpful to remove caffeine

from the

dietary regimen, for at least 2 to 4 week trial period, to determine

if it might

be beneficial.

Dr. Season: Chapter 28 in our book is entitled " Weight " , and we have

information

on the body mass index, which is the best way to determine ideal

weight for an

individual. If indeed the fibromyalgia patient can manage the weight

problem in

such a way to achieve ideal weight, that will help in terms of the

overall

feeling of the patient, and particularly will help self-esteem which

is

important. That along with the regular exercise program will bring

benefits.

MAMAJOY_WebMD: We have a group that uses AA's 12 step program for

helping deal

with chronic pain and illness. How do you feel about this?

Dr. Salt: The AA program is a very strong, very valid, very helpful

program for

dealing with all types of problems. This is a spiritually based

program as well.

My personal response would be that it could be very helpful.

stinger251_WebMD: Is severe upper arm muscle pain characteristic of

fibromyalgia?

Dr. Season: Upper arm pain associated with pain at the neck and upper

back is

common in fibromyalgia. I think this is a good time to distinguish

between

fibromyalgia and myofascial pain syndrome. Myofascial pain syndrome

is regional

muscular pain involving the shoulders, but it can be any region of

the body...

and it's associated with stiffness and a tender point. However, it's

different

from fibromyalgia in that usually the other components of

fibromyalgia, that is

the rather profound fatigue, difficulty sleeping, and the stress,

anxiety,

and/or depression problems are not present with myofascial pain. Both

pain

problems, that is those of myofascial pain and fibromyalgia pain, are

treated in

a similar manner. However, with fibromyalgia, attention has to be

directed

towards the fatigue, sleep disorder, and stress, anxiety, depression.

Moderator: What is the diagnosis of myofascial pain syndrome and what

treatments

are there?

Dr. Season: With respect to treatments and healing that are directed

at the

muscular pain, the medical approach is the same. However, with

fibromyalgia,

there are other conditions that need to be addressed as I mentioned.

Moderator: What proven methods are there to heal through diagnosis and

education?

Dr. Season: I think that it's important to understand that the

physician is very

important in terms of making the diagnosis of fibromyalgia. There are

criteria

that are used and need to be satisfied for making the diagnosis,

specifically

those established by the American College of Rheumatology, and

doctors should be

involved in the diagnosis so they evaluate the patient and rule out

other

conditions that may mimic fibromyalgia. However, the doctor generally

has only a

short period of time to evaluate and treat the patient; oftentimes it

averages

10 minutes, and that doesn't allow him to fully understand the

patient's

condition, and to embark on a comprehensive treatment program. From

that

perspective, the patient has to shoulder some responsibility

herself/himself,

and 90% of patients with fibromyalgia are women. There are 10% of the

patients

who are men, and from that standpoint, the patient has to become

educated

hopefully through reputable resources, and we consider our book to be

a

reputable resource, and then through knowledge and an understanding

of a good

holistic health habit; the patient can make progress in dealing with

the

symptoms.

Dr. Salt: A recent article in the annals of behavioral medicine

entitled " A Meta

of Fibromyalgia Treatment Mechanisms " , 1999 vol 21 pp 80. Non-

pharmacological,

or non-drug treatments, specifically cognitive behavioral therapy,

and that

would be realizing that the way we think about ourselves and about

our symptoms

will influence how we feel, and exercise, preferably aerobic, should

be

prescribed to help manage fibromyalgia symptoms and daily functions.

Medications

including anti-depressants and muscle relaxants can be used for sleep

and pain

symptoms, but its important to stress the power of non-pharmacological

treatments, including information and good health habits.

MAMAJOY_WebMD: How does heredity factor in?

Dr. Season: Fibromyalgia is not thought to be inherited; there's no

hard

evidence of a genetic predisposition. However, multiple members

within a family

may be diagnosed as having fibromyalgia.

suebe_05_WebMD: How do we overcome the fatigue with fms? have had it

for 9 yrs

dx and symptoms 20+. I am worse today than last year. How do I regain

energy?

Dr. Season: Fatigue is the major disabling characteristic of

fibromyalgia, and

we believe that it is a reflection of the sleep disorder and the

deconditioned

status of the patient with fibromyalgia. Probably the best

theoretical approach

would be to initiate and progress an exercise program, preferably an

aerobic

exercise program. Exercise is known to improve levels of energy, and

will also

enhance good sleep and we know that when patients improve their

sleep, they have

more energy to get through the day.

Dr. Salt: It would be important to take a look at the diet, and make

certain

that we are eating a well-balanced diet with adequate nutrients and

protein.

That we realize the power of thought and belief on how we feel and

the illness

experience. And that we do not underestimate our ability to overcome

this.

Dr. Season: We also need to appreciate the value of relaxation

techniques, and

meditation in terms of managing stress and improving energy level.

sandilb_WebMD: If stress is a major factor in fms, can I assume that

as the

stress is resolved, so will my fms symptoms.

Dr. Season: As I mentioned previously, widespread muscular pain,

fatigue,

difficulty sleeping and stress, anxiety and/or depression, are

symptoms and

conditions associated with fibromyalgia, and since we've commented

about an

abnormal stress response, it's particularly important. It's one thing

to

recognize that there is stress, it's another thing to manage the

stress. All of

us are challenged by managing stress. If one can make changes in

health habits,

improve diet, maintain an ideal weight, there's no doubt in my mind

that the

stress factor will be managed, and the fibromyalgia will be under

better

control.

Dr. Salt: To illustrate the mind-body relationship and the expression

of stress

and emotion into the body, one of the administrators at my hospital

shared an

interesting observation; she said, " When I'm under stress, I have a

numbness and

tingling that occurs in my left arm between my elbow and my wrist. " I

thought

that was fascinating and evident of the mind-body connection. But

then she

added, " And I have learned that I may not be actually aware that I am

under

stress at the time. I may not actually feel stressed at the level of

my mind,

such as anxiety. I have become aware that when that physical symptom

occurs,

that I am under strain and then I become aware of that strain. " This

brings us

back to one of the points Dr. Season and I would like to emphasize.

We all

experience stress and emotion expressed in the body, and that stress

and

emotions occur at the conscious and unconscious level. It is not a

weakness or

mental illness to have the expression of stress and emotion in the

body.

MAMAJOY_WebMD: Are the hundreds of lumps in my arms and legs due to

FMS or MPS?

Dr. Season: The lumps you are describing are probably are

fibromyalgia trigger

or tender points. In order to officially be diagnosed as having

fibromyalgia by

the American College of Rheumatology criteria, you must have greater

than 10 out

of 18 trigger points on the body. Those trigger points can be treated

with

various approaches. For example, massage can be quite helpful for a

trigger

point. In my practice, I will inject a trigger point and when I do

that, I will

use a syringe or needle, and local anesthetic, and usually that can

bring on

some relief of those trigger points. Probably the best treatment for

the

widespread pain and trigger points, as I mentioned previously is

regular

exercise.

Dr. Salt: Our book is entitled Fibromyalgia and the MindBodySpirit

Connection;

we have broken the book down into 7 steps.

The steps are: 1, connecting mindbodyspirit. 2, learning about

fibromyalgia and

myofascial pain. 3, healing with diagnosis and education. 4, making

the

connection. 5, emphasizing self-care and wellness. 6, managing your

fibromyalgia. 7, taking action if symptoms persist.

The book can be obtained by calling 1-888-599-6464. And it is

available on the

internet at www.parkviewpub.com. It will be available in bookstores

on a

widespread basis within the next month or so, and locally within a

bookstore.

The official publication date is only this month, and can be obtained

now at the

telephone number and website.

Dr. Season: We feel that our book merges the best of scientific

medicine with

the best of natural and holistic healing. Our book recognizes the

value of the

physician as the facilitator and teacher, rather than the controller

or primary

manager of treatment. We're really interested in the patient taking

control of

fibromyalgia. The physician is, however, essential for making the

diagnosis by

proper criteria, and ruling out other conditions that can mimic

fibromyalgia.

The physician is necessary for writing the prescription for

medication and

specifically, anti-depressants when necessary to help enhance sleep.

The

physician is the primary educator and teacher for the fibromyalgia

patient.

However, other resources... our book, support groups, websites, are

helpful in

terms of supplying additional information. The physician can provide

valuable

feedback and direction for the patient during treatment and healing.

We also

feel that our book recognizes the power of the patient in gaining

knowledge

about fibromyalgia and healing. Hopefully the book is a good source

for that

knowledge. Most importantly, our book emphasizes the patient's role

in self-care

and wellness.

Dr. Salt: Dr. Season and I have been frustrated in attempting to

explain

functional illnesses in patients in the very brief time allotted in

the current

medical environment; in the range of 7 to 10 minutes, to help patients

understand the complexity, in that most doctors and some patients do

not think

in terms of mind-body-spirit connection and use that kind of

language. We feel

that patients need to have a scientifically-based resource which

helps patients

and doctors understand the biopsychosocial-spiritual mind-body-spirit

healing

approach. We feel our book is the only current resource that provides

this.

angel49_WebMD: What if your doctor tell you that there is absolutely

nothing you

can do for fibromyalgia?

Dr. Salt: It's essential to find a doctor in whom you have confidence

and where

there is optimism. We can heal, we all have the potential to heal,

and the

relationship as Dr. Season pointed out, is important, almost magical

in

facilitating the healing.

Dr. Season: You may want to search for a support group in your

neighborhood.

Often the patients in support groups can provide resources for

knowledge for

fibromyalgia, and can direct you to the most knowledgeable and

sympathetic

physicians, as well as other caregivers on the team for treating

fibromyalgia.

Moderator: Is there a cure for fibromyalgia? Are there cases where

patients

returned to " normal? "

Dr. Season: I don't believe there is a cure for fibromyalgia. I think

fibromyalgia is a condition that can be managed adequately, and I

believe that

the patient has to seek out the proper resources to become educated

about

fibromyalgia, as well as finding the right physician and caregivers.

Dr. Salt: Fibromyalgia, like health, requires the active application

of a plan

for living. Health is not the absence of disease and living; it

requires an

active pursuit and process of being healthy. When one has an illness

such as

fibromyalgia or IBS, that becomes even more important.

Dr. Salt: Dr. Season and I are very grateful for the audience and the

time each

has taken time out of their busy lives to be with us tonight. We want

everyone

to know that there are many doctors who care about them, and that

they have the

potential to heal. We all do, and we are optimistic that they can be

successful.

They need a new way of thinking and understanding, but perhaps we all

do. But

we're grateful for the audience tonight. 888-599-6464 is the number

for the

book, and the website is: www.parkviewpub.com

Moderator: Doctors, thank you both very much for joining us today.

Please join

us again on tomorrow at 7 pm EST here in the World Watch and Health

News

Auditorium when we discuss " Tests and Procedures " with Jim Rippe, M.D.

Moderator: I'm very sorry that we couldn't get to all of your

questions but I

thank you for joining us and hope the chat was beneficial.