Re: Trying to retrain with fibromyalgia

[Guest guest]

Pamela wrote:

<<Water therapy helps tremendously. I am monitoring

the pain levels after workouts so I can relate to the

people who come to me (in the future) for FM water

workouts. I want to be able to tell them how much it

will or will not hurt them and encourage them to keep

working out. I've been fighting with disability.

A lot of people with FM get on disability but I think

if we keep working through this, we can come out the

other side, healthier and in better control of our

bodies and our pain & fatigue levels.

So, my question to this group is; is there anyone out

there that is dealing with fibromyalgia patients and

if so, who? How is their routine laid out? Is there

anyone I may contact for more info on getting back

into working out in spite of the pain and fatigue?

Thank you all, Group!

Sincerely,

~Pamela

WA State

[Mod: Please sign all letters with full name and city

of residence, thanks] >>

****

Pamela I think that your approach to fibromyalgia is

not only the right one but admirable. You need to have

a positive attitude that you will overcome this

condition.

I have seen patients who just throw up their hands and

use fibromyalgia as a reason to decrease physical

activity and these individuals become truly disabled.

I have also seen patients who refuse to let

fibromyalgia get in the way of living their life.

As a Gastroenterologist I treat many patients with

Irritable bowel syndrome (IBS). IBS shares some

common pathophysiologic aspects with fibromyalgia and

many patients with Irritable bowel syndrome also

suffer from fibromyalgia. While I don’t see patients

specifically for fibromyalgia many of the patients I

do treat also have have fibromyalgia.

Generally Rheumatoloigists deal specifically with

fibromyalgia. And most of the medical research is

found in the Rheumatology literature.

In our community there is one Rheumatologists who

specializes in the treatment of this condition and

most of the other physicians and Rheumatologists refer

their patients to him.

I have included excerpts from several sources which I

think should be the beginning of your search for some

meaningful answers to your condition.

Over the last several years there has been quite a bit

of research into the pathophysiology of chronic

conditions such as irritable bowel syndrome and

fibromyalgia and therefore a better understanding in

the approach and treatment of these conditions.

Although all the answers as to cause, and treatment I

believe the research is making great progress in

understanding these conditions.

While there is no cure for these conditions

nevertheless there is better understanding of possible

treatments which can allow patients a means to better

deal with these conditions.

For many years the very existence of the fibromyalgia

was doubted because the muscles appeared to be

perfectly normal. Lab tests and muscle biopsies,

electromyograms are normal in the patient with

fibromyalgia. There was no evidence that there was

anything wrong with the muscles.

In fact if you read the full articles I have cited

below you will see that in fact fibromyalgia is not a

muscle disease but rather caused by

neuro-endocrinoligical abnormality.

<<Fibromyalgia is a common disorder of unclear

etiology that is characterized by chronic widespread

pain and several nonspecific symptoms, such as

anxiety, depression, fatigue, unrefreshing sleep, and

gastrointestinal complaints.

Patients seem to have a generalized abnormality in

pain perception, with a decline in pain threshold and

tolerance to an assortment of stimuli, such as

pressure, cold, and heat [1], [2], [3], [4].

It was suggested that the pathogenesis of fibromyalgia

involves aberrations in central nervous system

function that result in abnormal pain perception [5],

[6]

Rheumatic Diseases Clinics of North America

Volume 31 • Number 1 • February 2005

Copyright © 2005 W. B. Saunders Company >>

<<Studies have shown that several hormonal axes

controlled by the hypothalamus are disrupted in FMS

patients.[100] [117]

100. Neeck G, Crofford LJ: Neuroendocrine

perturbations in fibromyalgia and chronic fatigue

syndrome. Rheum Dis Clin North Am 26:989–1002, 2000.

117. Neeck G: Neuroendocrine and hormonal

perturbations and relations to the serotonergic system

in fibromyalgia patients. Scand J Rheumatol Suppl

113:8–12, 2000. >>

How and why these changes occur in a given individual

is still unclear but just as with Irritable bowel

syndrome there are probably several different

mechanisms by which an individual develops this

condition.

Not knowing your complete history I will not even

begin to suggest how or why you developed this

condition.

There are many suggested treatments for this condition

and only a practitioner who knows your medical history

in detail would be in a position to recommend an

appropriate course of action.

Not only is exercise not contraindicated for

fibromyalgia, but if the approach is done properly,

exercise can help make fibromyalgia manageable.

<<Subjects who have fibromyalgia who actively

participate in a low-intensity aerobic exercise

program may show improvement in fitness and

improvement in symptoms of fibromyalgia [99], [100],

[101]. (Hypothalamic–Pituitary–Adrenal and Autonomic

Nervous System Functioning in Fibromyalgia Gail K.

Adler, MD, PhD a, * Rinie Geenen, PhD>>

<<EXERCISE

Aerobic exercise is one of the best validated

treatments for fibromyalgia and CFS.[180] [181] [182]

Unfortunately, it is a difficult task to get patients

to agree to exercise training when they are

experiencing severe pain, fatigue, or both. It is

advisable to reassure them that exercise is safe and

effective for patients with their condition and to

advise them to start slowly and increase duration or

intensity only slowly. It is important to acknowledge

the difficulty patients will have following the

exercise program while expressing the hope that they

will benefit from perseverance. s Kelley's Textbook of

Rheumatology, 7th ed.

Pg 531 >>

It is important to understand that for reasons which

are not well understood your body no longer responds

to pain and stress the way it did prior to your

becoming ill. You have become extremely sensitive to

pain from even the slightests of stimuli. Discomfort

which most of us would judge as a 2 or 3 on a scale

of 10 is interpreted by your nervous system and feels

like a 8-10 out of 10.

Stress while not the cause of your condition tends to

worsen the pain of fibromyalgia. Any therapy which

is aimed at lowering stress will help with management.

Meditation, Relaxation therapay are also helpful and

there are studies which indicate that Accupuncture may

also be helpful

<<COGNITIVE BEHAVIORAL THERAPY

Cognitive behavioral therapy (CBT) is a process that

examines a patient's way of reacting to experiences

and attempts to restructure maladaptive coping habits

into effective coping skills. CBT has been shown to be

effective in reducing disability and increasing

function in patients with OA, RA, and CFS.[183] [184]

[185] [186] [187] A few studies of CBT in fibromyalgia

have been done, with most showing an improvement.[188]

Most experts suggest that CBT works by allowing

patients to experience a greater locus of control over

their symptoms and their illness. It has been shown to

improve patients' compliance with other aspects of

their care, such as exercise programs Kelley's

Textbook of Rheumatology, 7th ed.

Pg 531>>

You seem to have already started some these therapies.

Hydrotherapy can be considered an excellent tool.

Moving away may have helped in easing some previous

stresses. Properly paced exercise can and should be

the basis of starting your recovery. Just be patient

and don’t over do it.

..

I would agree with your therapist who suggested that

you start and exercise program even if it is only 5

minutes at a time several times a day. I would

recommend that each day you extend your exercise time

just a little.

Start simply by walking, or swimming, hydrotherapy

etc. Avoid initially trying to do too much. With

time you will be able to increase your volume of

exercise (time) and intensity. Be patient and don’t

over do it.

If you wish to communicate with me through personal

email feel free to do so. Perhaps I can be more

specific in answering some of your questions.

I would suggest that you read the excepts of the

article below and if possible get the entire article.

You should be able to obtain copies of the articles or

the books through your local Hospital Library.

I would also recommend that you see a Rheumatologist

who specializes in the treatment of Fibromyalgia.

ragiarn@...

Ralph Giarnella MD

Southington, CT

<<<Rheumatic Diseases Clinics of North America

Volume 31 • Number 1 • February 2005

Copyright © 2005 W. B. Saunders Company

Hypothalamic–Pituitary–Adrenal and Autonomic Nervous

System Functioning in Fibromyalgia

Fibromyalgia is a common disorder of unclear etiology

that is characterized by chronic widespread pain and

several nonspecific symptoms, such as anxiety,

depression, fatigue, unrefreshing sleep, and

gastrointestinal complaints. Patients seem to have a

generalized abnormality in pain perception, with a

decline in pain threshold and tolerance to an

assortment of stimuli, such as pressure, cold, and

heat [1], [2], [3], [4]. It was suggested that the

pathogenesis of fibromyalgia involves aberrations in

central nervous system function that result in

abnormal pain perception [5], [6]

Disturbances in neuroendocrine and ANS function can

result in many symptoms that are observed commonly in

fibromyalgia, including fatigue, weakness, and

orthostatic intolerance.

Several recent reviews have described, in detail,

studies of neuroendocrine and autonomic dysfunction in

fibromyalgia [8], [9], [10], [11]..

In response to a stressful event, the neuroendocrine

and autonomic nervous systems function in a

coordinated fashion.

The stress response varies depending on the specific

stress and stress history of the individual. In

healthy individuals, pre-exposure to an acute stress

[34], [35] reduces the neuroendocrine and ANS

responses to a subsequent acute stress.

Chronic stress also may result in impaired

neuroendocrine and ANS responses to an acute stress.

.. Drugs alter the stress response. Caffeine

consumption increases exercise-induced activation of

the HPA axis and sympathoadrenal system [42]. These

increases are postulated [42], [43] to account for the

delayed fatigue and increased exercise performance

that are associated with caffeine ingestion [44],

[45]. Gender also influences the stress response;

women have smaller increases in corticotropin in

response to a brief psychosocial stress [46] and

smaller increases in plasma catecholamines in response

to exercise than men [47].

Even after taking gender into account, baseline ANS

and neuroendocrine function vary between individuals.

For example, baseline corticotropin levels are higher

in male marathon runners than in healthy men who

exercise moderately [48]. Individuals can be

categorized as high or low corticotropin responders;

this categorization seems to be maintained across

different types of stress [49].

Thus, the neuroendocrine and ANS response to a

specific stress vary based on a wide range of factors,

including inherent differences between individuals,

gender, physical fitness, drugs, and acute or chronic

stresses.

The extent of the neuroendocrine and ANS response to

stress seems to be important. Enhanced responses may

be associated with increased exercise performance and

reduced fatigue [42], [43], whereas reduced

neuroendocrine and ANS stress responses may result in

inadequate physiologic responses, as occurs in

patients who have HAAF [39], [40].

Furthermore, the neuroendocrine and ANS systems

function in concert, so that mild impairments in

multiple systems may have profound effects. Therefore,

in examining stress responses in individuals, it is

important to examine multiple aspects of this

response.

THE ORIGIN OF CHANGED STRESS RESPONSIVENESS

A major dilemma exists in interpreting the source of

altered ANS and HPA stress responsiveness [11], [75].

It may reflect an impairment that is constitutional or

acquired by being exposed to severe trauma in the

past; however, it also is possible that reduced stress

responsiveness reflects the current consequences of

stress, low physical fitness, sleep disturbance, or

pain. Fig. 1 presents a model for understanding the

possible interactions between stress, the stress

response, and symptoms of fibromyalgia.

SUMMARY

The small numbers of studies that have examined

coordinated HPA axis and ANS functioning in

fibromyalgia showed hyporeactivity to applied stress.

This altered neuroendocrine responsiveness seems to be

due to changes in hypothalamic function, not to a

primary adrenal defect. It is unknown whether these

neuroendocrine alterations are involved in the

pathophysiology of fibromyalgia and contribute to its

ongoing symptomatology or are a consequence of pain

and its associated symptoms (eg, fatigue, low physical

fitness, sleep and mood disorder) or both. The changes

in HPA axis function do not meet set criteria for

hormone deficiency; hormone supplementation therapy is

not recommended. Subtle impairments in multiple

systems function in concert and together may result in

more intense and clinically significant alterations in

the response to stress. If so, factors that improve

HPA and ANS responses to stress may be beneficial;

this may explain why exercise can be helpful for

patients who have fibromyalgia.

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========

Goldman: Cecil Textbook of Medicine, 22nd ed.,

Copyright © 2004 W. B. Saunders Company

============

======

DISORDERED STRESS RESPONSE AND ENDOCRINE OR HORMONAL

FACTORS

: Kelley's Textbook of Rheumatology, 7th ed.,

Copyright © 2005 Saunders

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NEUROPLASTICITY OR CENTRAL NERVOUS SYSTEM

PAIN-PROCESSING PATHWAY DYSFUNCTION

: Kelley's Textbook of Rheumatology, 7th ed.,