What are your own plans and hopes for the future How has FM contributed to those plans

I'm a freelance writer and have many ideas for books and stories I want to write. I think FM has given me empathy for those who are suffering and has given me a deeper appreciation for life. These are things that make my writing stronger, and I am able to touch more people with my writing as a result. I am also planning to be a sign language interpreter. I'm hoping to graduate and start part-time work in a few months. It's a little bit harder to see how my FM contributes positively to that,...

Dysautonomia

Known dysautonomia diagnoses include Postural Orthostatic Tachycardia Syndrome Faintness and racing heart in response to prolonged motionless standing. Neurally Mediated Hypotension A steep drop in blood pressure after prolonged motionless standing, sometimes including nausea and visual changes. Vasovagal Syncope Fainting from a change in body position, commonly lying to standing. Mitral Valve Prolapse Syndrome Chest pain, palpitations, agitation of uncertain cause. Joint Hypermobility...

Conversations between a Counselor and a Client with Fibromyalgia

The following example of a counseling session was written by Rebecca Ross RN, PhD, Psychiatric Mental Health Nurse Practitioner The purpose of this appendix is to depict conversations between a counselor and a patient with fibromyalgia (FM). The theme of the interaction is The 'New Normal' Thriving in the Here and Now Many people who are newly diagnosed with a chronic illness such as FM struggle with the forced changes in their lives. Fibromyalgia-related changes occur in many spheres of life...

Autonomic Nervous System Dysfunction

The Autonomic Nervous System (ANS) is the portion of the nervous system that controls the function of organ systems for the body. Many think of it as the automatic nervous system because the mind does not rule its performance it works below the conscious level. For instance, it regulates body temperature, blood pressure, breathing, heart rate, bowel and bladder tone, and myriad other functions necessary to maintain life. The peripheral autonomic system is divided into two branches sympathetic...

Gender Age and Genetics

The two greatest known risk factors for FM appear to be a family history of the disease and being female. In fact, two recent studies have revealed that FM in a first-degree female relative is the greatest predictor of developing FM. No one knows why more women are diagnosed with FM than men. Various studies based on prevalence data show that women are seven to nine times more likely to have fibromyalgia than men and that the female peak age for diagnosis is during the childbearing years. This...

Family History AgeProblems DeceasedDeath

How bad are your best and worst days of pain Best days (0-10) Worst Days (0-10) Please check symptoms below and indicate whether they are current or past Muscle weakness Hands change color in cold Pain after exertion Excessive fatigue for more than six months Frequent headaches Abdominal cramping Swelling or bloating Abdominal distension Difficulty swallowing Intermittent loose stools Daytime sleepiness Dry or itchy eyes Light headedness Depressed moods Breathlessness Dizziness Impaired...

Restless Legs Syndrome RLS

RLS and its closely associated cousin, periodic limb movement disorder, cause jerking movements intermittently throughout the night, typically every twenty to thirty seconds. In the United States, 3 to 15 percent of the general population is thought to have RLS, whereas 30 to 60 percent of people with FM report the same set of symptoms. Symptoms include an irresistible urge to move the legs, sensations of creeping, crawling, numbness, itching, tugging, and tingling. These symptoms tend to...

Complementary and Alternative Therapies

Many persons with FM turn to providers of complementary and alternative medicine (CAM). CAM providers are consistently ranked highly by FM patients. Unfortunately, the studies on the efficacy of CAM therapies in FM are somewhat inconsistent. Nonetheless, many patients experience relief from alternative medicines, and CAM treatments can be considered additionally helpful in restoring hope and confidence for the future this outcome should not be minimized. The fine line to be negotiated when...

Precipitating Events and the Possible Role of Central Sensitization

Scientists know that a local injury resulting from trauma can lead to lingering pain. Pain that lasts for weeks, months, or years is termed chronic pain and is accompanied by changes in the chemical and anatomical makeup of the brain and spinal cord. Chronic pain that goes untreated can increase in intensity and spread from an original site to body areas that weren't previously affected, further damaging health and functioning. At that point, chronic pain becomes a disorder in itself. Why this...

Patient Education

After assembling the FM treatment team, education about FM is invaluable. Education can occur individually between the provider and patient, in support groups, or through carefully selected books, media, and Internet sites. The primary provider is tasked with providing education regarding the validity of the FM diagnosis and the nondestructive nature of the condition on muscle. The provider outlines a rational treatment plan focusing on minimizing symptoms and restoring functionality. It is...

How has FM affected your schooling your friendships your recreational activities

The college program I am in is difficult even for healthy students. I'm training to be a sign language interpreter, which means cognitive processes and physical movements are vital. I've failed several tests because I happened to be having a fibro-fog day with almost no short-term memory or was having language production problems. Also, when I'm sore and stiff, I can't sign as clearly or as long. Of course, fatigue and concentration problems can make homework a challenge. However, God has given...

The Clinical Exercise Specialist CES

The CES is a fitness professional who has advanced training in working with special populations, including those with chronic illnesses. In this developing field, the CES works as a bridge between the medical clinic and a home or public exercise setting where ongoing postrehabilitative workouts can take place. They provide guidance that takes into account the recommendations of the primary provider, the PT, the OT, and the ST. The CES may work as a specialized in-home personal trainer or lead...

The Endocrinologist

An endocrinologist might be called on if a patient with FM has any of the following four conditions 1) thyroid dysfunction not controlled with standard therapies, 2) peripheral neuropathy, 3) hormone deficiencies such as low HGH and testosterone, and 4) statin intolerance due to musculoskeletal pain. Some endocrinologists have expertise regarding human growth hormone (HGH) deficiency in adults. Those who are interested in treating HGH will most likely order a growth hormone stimulation test....

Hope For A Cure

Chronic illnesses are chronic simply because, as yet, there is no cure. An acute illness like strep throat used to be chronic or even deadly because scientists had not isolated the bacteria causing the illness and had not developed the antibiotics to cure the illness. In the past scarlet fever, which is a consequence of strep throat, was a death sentence for millions. Now, it is just an inconvenient day away from work and school and a trip to the pharmacy. More recently, gastric ulcers were a...

Treatment by Health Providers

By definition, no single surgery or round of medications will cure a chronic illness. Since that is the case, treatments for chronic illnesses are ongoing and lifelong. A bio-psycho-social treatment schedule has proved to be the best approach for regaining good quality of life when living with FM. The ultimate goal of health treatment is to reduce symptoms, promote physical fitness, and optimize the ability to perform activities of daily living. One health-care provider alone cannot hope to...

Irritable Bowel Syndrome IBS

IBS is one of the most common co-morbidities in FM, affecting 30 to 80 percent of FM patients. Previously, IBS has been known by names such as irritable colon, spastic colon, nervous indigestion, and functional colitis. Sometimes IBS is predominated by constipation, at other times by diarrhea, but it can also occur as constipation alternating with diarrhea. Symptoms include chronic constipation or frequent diarrhea associated with abdominal pain, tenderness, bloating, and gas. Sometimes...

Pelvic Pain Syndrome PPS

Endometriosis Growth of endometrial cells in a location outside of the uterus. Dysmenorrhea Painful uterine contractions in the lower abdomen during menstruation. Vulvodynia Chronic burning, stinging, irritation, or rawness of the female genitalia. Vulvar Vestibulitis Painful inflammation of small glands at the entrance to the vagina. Prostatodynia Painful inflammation of the prostate. PPS affects one in seven women in the United States and a smaller proportion of men. These syndromes are...

Lack of Restorative Sleep and the Possible Roles of Substance P and HPA Axis

In the 1990s, researchers proposed that exposure to stressful conditions could alter the function of the hypothalamic-pituitary-adrenal (HPA) axis, a major part of the neuroendocrine system that controls reactions to stress and regulates many body processes. Variations in HPA function are characterized by high levels of cortisol, which in turn is associated with the development of widespread pain. When cortisol excretion levels were measured in one research study, with a sample of forty-seven...

Chronology of Problems

Date of onset of FM symptoms Date of FM diagnosis Who first diagnosed FM The onset was related to which of the following (please circle) Other (describe below) Y N Did you have pain all over from Day One If No, how many areas were painful at onset Describe sites of initial pain (such as neck, left arm, etc.) arthritis, diabetes, high blood pressure, heart disease, osteoporosis, alcoholism, ulcers, kidney disease, liver disease, migraine, tuberculosis, stroke, psychiatric problems, epilepsy,...

Pain Medications

The simplest form of pain medications includes over-the-counter acetaminophen (ah-seat-ah-MIN-oh-fen), ibuprofen (eye-bee-PRO-fen), and aspirin. These might come marketed in solo form or in a combination, and with or without the addition of caffeine. Nearly all people with FM take these medications due to their accessibility and low cost. Unfortunately, their efficacy in clinical trials has been shown to be minimal. The Drug Enforcement Administration (DEA) is a U.S. government watchdog agency....

Appendix B

The Fibromyalgia Clinic Questionnaire When patients are evaluated for FM, the health-care provider needs a great deal of information about current and past medical problems. The Fibromyalgia Clinic Questionnaire, excerpted here, is a patient form that can be used to help health-care providers quickly and accurately evaluate people for the possible diagnosis of FM. Because FM is more than pain, there are questions about physical functioning, mood, fatigue, sleep, restless legs, and other...

Essential Exercises for Fibromyalgia

The following is a series of essential exercise recommendations for the fibromyalgia patient written by co-author Janice H. Hoffman, Certified Clinical Exercise Specialist. The areas of the body most affected by FM include the abdomen and low back muscles, chest wall and upper back muscles, front and back thigh muscles, and lower leg calf muscles. Some of these areas need to be loosened with flexibility work and others require strengthening to help reduce unnecessary pain and fatigue in...

Temporomandibular Joint Dysfunction TMD

TMD was previously called TMJ syndrome. The temporomandibular joint allows the lower jaw to move up and down and side-to-side, to enable talking, chewing, and yawning. Symptoms of TMD include pain that moves through the face, jaw, or upper neck. Muscles feel stiff and the joint itself may lock, click, or pop. In the United States, 10 percent of the population will seek professional treatment for TMD, whereas 75 percent of people with FM are thought to have TMD. This dysfunction's onset may be...

The Physical Therapist PT

A PT can evaluate and treat regional pain, balance issues, and discuss energy conservation to manage fatigue. Treatments employed by PTs may include rehabilitation exercise, manual therapies, neurosensory balance analyses (measuring nerve transmission information to and from peripheral extremities to the CNS), gait analyses with corrective orthotics fitting, and a multitude of management strategies for long-term self-care. They can also teach patients to use spray-and-stretch. Spray-and-stretch...

Common CoMorbidities

There are multiple co-morbidities (associated disorders) that commonly coexist with FM. Some of these are diagnosable diseases within themselves, whereas others are not considered a separate disease but are considered symptoms. The connection between FM and the associated disorders that are considered symptoms is not yet fully understood. Overall, the common co-morbidities associated with FM are thought to be changes resulting from alternations (changes that occur in a successive manner) in the...

The Rheumatologist

The rheumatologist is a specialist who manages autoimmune rheumatic diseases, such as rheumatoid arthritis (an autoimmune disease causing joint pain and deformity), and degenerative joint diseases such as osteoarthritis (an inflammation that causes joint pain). It is common for patients with FM to have stiff joints that feel swollen, but they should not have inflammation, synovitis (fluid around the joints), or signs of major joint degeneration. FM patients who see rheumatologists may be given...

Major Depressive Disorder

There is strong evidence that major depression is associated with FM, although the nature of the association has remained controversial. For example, some clinicians still hold that psychosomatic illness plays a large role in chronic pain conditions, including FM. In the past, clinicians endorsed a theory of Tension Myositis Syndrome (TMS). Practitioners who treat TMS consider that when pain cannot be relieved by standard medical treatments, psychosomatic illness is the likely cause, especially...

Glossary

Acellular Unable to grow through cell division. acetaminophen A common over-the-counter medication used for the relief of fever, headaches, and minor aches and pains. This class of drugs are called analgesics (pain relievers) and antipyretics (fever reducers). ACh (acetylcholine) One of many neurotransmitters in the ANS and the only neurotransmitter used in the somatic nervous system. ACR (American College of Rheumatology) The official organization for health-care professionals who treat...

Dietary Recommendations for Fibromyalgia Patients

The following is a series of practical dietary recommendations for the fibromyalgia patient written by Katie Holton, MPH. It is no surprise that many people find it challenging these days to know how to eat healthy, much less how to lose weight. We are bombarded with conflicting information that we are left to wade through on our own. This article will give you some solid strategies that you can use no matter if your quest is to lose weight or just to improve your diet in the hopes of improving...

Chronic Headaches

Chronic headaches occur in 3 to 5 percent of adults worldwide. And at least 25 percent of people with FM experience chronic headaches, with chronic migraines and chronic tension headaches being most common. The definition of chronic headache is a headache that occurs at least fifteen days per month for three or more months. Symptoms will vary depending on the type of headache. Chronic migraines usually affect one side of the head and are characterized by pulsating, throbbing, severe pain. The...

The Sleep Medicine Physician

Physicians who have studied in this subspecialty can administer and interpret a sleep study. Sleep studies are critical for patients with signs or symptoms suggestive of sleep apnea (a disorder characterized by pauses and gasps while breathing during sleep) or narcolepsy (a neurological condition characterized by extreme tiredness and or falling asleep during the day at inappropriate times). Symptoms of sleep deprivation may include extreme daytime sleepiness, going to sleep while driving, loud...

Chronic Fatigue and Immune Dysfunction Syndrome CFIDS

In the U.S. population, 0.5 percent of people meet the criteria for CFIDS, compared to 5 to 15 percent of the population who are diagnosed with FM. The overlap between the two shows that 35 to 70 percent of those with CFIDS have FM, whereas 20 to 70 percent of those with FM report an additional diagnosis of CFIDS. Earlier terms for CFIDS included yuppie flu or chronic Epstein-Barr Syndrome. CFIDS is defined by the Centers for Disease Control as a medically unexplained, persistent, or relapsing...

Symptoms And Diagnosis

As seen, FM symptoms can vary widely between patients. One person's quality of life might be most altered by unremitting pain, whereas a second person may suffer mainly from deep fatigue. Still others might find themselves confronted with anxiety and panic attacks that limit their confidence to travel or work outside the home. Those most severely affected by FM may struggle with all of these symptoms and further co-morbidities. Additionally, the severity range of FM symptoms is quite...

Irritable Bladder Syndrome IB

IB has gone by many names including irritable bladder syndrome, overactive bladder, idiopathic bladder spasm, and detrusor instability (detrusor is the medical name for the bladder muscle). Of all people with FM, 5 to 50 percent are thought to have IB. In this syndrome the bladder suddenly contracts, even without being full. These contractions cause an irrepressible need to urinate, medically termed urgency. IB causes urination frequency, meaning that people often have to urinate seven to ten...

Medication generictrade Alprazolam Xanax

Clinical pearl This medication has an extremely short half-life. It may not be suitable as a through-the-night sleep aid if taken earlier in the evening, at bedtime. FM usage Panic attacks, anxiety, or early morning awakenings Patient example Mary is a 31-year-old female who grew up in an abusive home environment. Even though she is safe now as an adult, she has found she sometimes has nightmares that leave her heart racing and body sweating, and she is unable to go back to sleep after...

The Registered Dietitian RD

The RD is helpful in FM because many people's quality of life will improve through dietary change. The RD can help people learn not only what foods to avoid or minimize but how to introduce new foods into the diet and how to really enjoy those new foods. In FM, obesity is often a problem, especially due to the sporadic nature of FM flare cycles and the resulting disruption of an exercise routine. The RD can individualize an eating plan based on each patient's food preferences. In general, they...

The Urologist

A urologist (a specialist focusing on the urinary tracts of men and women and on the reproductive system of men) may be helpful for patients with severe irritable bladder. Like other specialists, they can rule out malignant and progressive diseases and reassure the patient that irritable bladder is the correct diagnosis. Many times specialists are aware of therapies that are not FDA-indicated for the treatment of various ailments. For example, some patients find some degree of relief from...

Central Dopamine Dysfunction COMT Gene Disruption

Dopamine plays a critical role in pain perception and pain relief. It is a cate-cholamine neurotransmitter perhaps best known for its various roles in Parkinson's disease, schizophrenia, and drug addiction. It also appears related to Restless Legs Syndrome (RLS), which is a common co-morbidity in patients with FM. The theory of central dopamine dysfunction suggests that the main abnormality responsible for FM symptoms is disrupted dopamine neurotransmission. This conclusion supposes that FM is...

The Gastroenterologist

One specialist that may be called on is a gastroenterologist (a specialist in the digestive system and its disorders), also commonly known as a GI doctor. A gastroenterologist may be helpful for people with GI distress such as irritable bowel syndrome that does not respond to traditional therapies. Ideally, the gastroenterologist would screen for other GI conditions such as inflammatory bowel disease or celiac disease (autoimmune disorders that are often genetic), symptomatic diverticulitis...

Multiple Chemical Sensitivities MCS

MCS is one of the least understood co-morbidities associated with FM. MCS previously has been termed toxic injury, chemical injury syndrome, twentieth century syndrome, sick building syndrome, idiopathic environmental intolerance, and toxic-induced loss of tolerance. Due to alterations in the central nervous system, all people diagnosed with FM are more sensitive to light, noise, smell, and pain. MCS, however, is a more pronounced, debilitating chronic sensitivity to low levels of chemicals or...

Abnormal Neurotransmission Serotonin Norepinephrine and Dopamine

Serotonin is a neurotransmitter that regulates sleep patterns, mood, a feeling of well-being, and inhibition of pain. Since those with FM experience abnormal pain, it has been hypothesized that the pathophysiology underlying FM may be an impairment of serotonin metabolism. This hypothesis is supported by finding decreased serotonin metabolites in FM patient plasma and cerebrospinal fluid. However, medications such as selective serotonin reuptake inhibitors (SSRIs, a type of antidepressant that...

Cognitive Behavioral Strategies

Cognitive behavioral strategies are a skill set used to minimize symptom severity and reduce unhelpful thinking. Many people, when first diagnosed with FM, experience an existential crisis that may last several years. This crisis has to do with loss of their previous selves and acceptance of their new selves. The cognitive behavioral strategies outlined on the following pages work to help the newly diagnosed move toward acceptance of their changed lifestyle and can ultimately improve their...