I have always been an advocate of utilizing a team approach with all healthcare disciplines represented when helping my patients with any chronic pain condition.  Over the past ten years there has been a lot of debate about Fibromyalgia with some pain management professionals not even recognizing it as a diagnosis to others over-diagnosing people with this condition.  I do believe it is a credible diagnosis and that medication alone is not the answer.

Management of fibromyalgia requires a multidimensional approach including patient education, cognitive behavioral therapy, exercise, and other treatment, according to a review published in the July 15, 2007 issue of American Family Physician.  Below is information from a great website www.medscape.com that I believe important.  If you want to review the entire report authored by News Author: Laurie Barclay, MD and CME (Continuing Medical Education) Author: Désirée Lie, MD, MSEd, please click here.

“Fibromyalgia is an idiopathic, chronic, nonarticular pain syndrome with generalized tender points,” write Sangita Chakrabarty, MD, MSPH, and Roger Zoorob, MD, MPH, from Meharry Medical College in Nashville, Tennessee. “It is a multisystem disease characterized by sleep disturbance, fatigue, headache, morning stiffness, paresthesias, and anxiety. Nearly 2 percent of the general population in the United States suffers from fibromyalgia, with females of middle age being at increased risk.”

Specific treatment recommendations are as follows:

1.   Suggested treatment modalities include patient education, cognitive behavior therapy, exercise, physical therapy, and pharmacotherapy (level of recommendation, A, based on 5 randomized controlled trials).
2. Antidepressant medications may alleviate pain and improve sleep quality and global well-being in patients with fibromyalgia (level of recommendation, B, based on few randomized controlled trials).
3. Cyclobenzaprine, 10 to 30 mg at bedtime, may decrease pain and improve sleep quality in patients with fibromyalgia (level of recommendation, A, based on systematic review of randomized controlled trials).
4. Aerobic exercise training may ameliorate fibromyalgia symptoms (level of recommendation, A, based on systematic review of randomized controlled trials).

To learn more about chronic pain management please check out our website at www.addiction-free.com and go to our Publications page and check out my book Managing Pain and Coexisting Disorders: Using the Addiction-Free Pain Management® System. If you want to learn more about multidisciplinary chronic pain management you can find my article The Need for Multidisciplinary Chronic Pain Treatment that you can download for free on our Ariticles page.

To check out our July Chronic Pain Solutions Newsletter please click here.

Before discussing the role of Neuroplasticity in chronic pain management it is important to have a working definition of the term. Neuroplasticity (variously referred to as brain plasticity or cortical plasticity or cortical re-mapping) refers to the changes that occur in the organization of the brain as a result of learning and experience. A surprising consequence of neuroplasticity is that the brain activity associated with a given function can move to a different location within the brain as a consequence of normal experience or brain damage/recovery.

In my article Chronic Pain and the Hijacked Brain I discuss how the pain system gets turned on and cannot be turned off.  I call this the “hijacked” brain or what is often referred to as Neuroplasticity (also called brain plasticity, cortical plasticity or cortical re-mapping).  A surprising consequence of neuroplasticity is that the brain activity associated with a given function can move to a different location as a consequence of normal experience or brain damage/recovery.  In the case of chronic pain this can mean that pain signals keep occurring despite lack of a trigger or tissue damage.

Research published in Pain Physician Journal (2006) indicated that 90 percent of people in the US receiving treatment for pain management are prescribed opiate medication. Of that number 9 percent to 41 percent had opiate abuse/addiction problems.

According to research published in Annals of the New York Academy of Sciences 933:175-184 (2001) titled “Spinal Cord Neuroplasticity following Repeated Opioid Exposure and Its Relation to Pathological Pain;” convincing evidence has accumulated that indicates there are neuroplastic changes within the spinal cord in response to repeated exposure to opioids. Such neuroplastic changes occur at both cellular and intracellular levels. Since so many people living with chronic pain are using opiates these neuroplastic changes need to be better understood.

To learn more about chronic pain management please check out our website at www.addiction-free.com and go to our Publications page and check out my book Managing Pain and Coexisting Disorders: Using the Addiction-Free Pain Management® System. If you want to learn more about neuroplasticity and chronic pain management you can find my article Chronic Pain and the Hijacked Brain that you can download for free on our Ariticles page.

To check out our July Chronic Pain Solutions Newsletter please click here.

It is important to know about the connection between stress levels and your pain symptoms, as well as understanding that stress management can also decrease your suffering. Physically, chronic pain raises your stress levels and drains physical energy, while psychologically it affects your ability to think clearly, logically and rationally, as well as to effectively manage your feelings or emotions. Remember that in most cases if you can learn to lower your stress levels, you will also experience a decrease in your perception of pain.
 
When you are more aware of your stress levels, you can then take action to reduce your stress, which in turn leads to a decrease in your pain symptoms. One effective stress management strategy is exercise. In addition to lowering your stress levels, regular exercise can also be an important part of your pain management program. It is also important to reduce, or even eliminate, nicotine, caffeine, and sugar, and to implement a healthy eating plan. Other stress management tools could include focused breathing and relaxation exercises, meditation, Yoga, Tai Chi, soothing music, being in nature, soaking in a hot bath (or Jacuzzi), etc.
 
In the past I trained in the martial arts for many years and learned several tools that helped me in all areas of my life but especially in my own chronic pain management. The other day I was researching stress management and came across a website www.about.com and found an article by Elizabeth Scott, MS who is an expert in stress management. This particular article was titled How to Reduce Stress Quickly with Karate Breathing Meditation. Below I’ve included some information from that article. If you want to read the entire article please click here.

1. Sit in a comfortable position. While most martial artists use the ‘seiza’ (“say zah”) position, with legs beneath the buttocks with knees directly in front, many people find this position to be uncomfortable. If this is the case, you may also sit cross-legged (’anza’) or in another position that’s more comfortable for you.
2. Close your eyes, but keep your back straight, shoulders relaxed, head up, your eyes (behind your lids) focused ahead.
3. Take a deep, cleansing breath, expanding your belly and keeping your shoulders relaxed, and hold it in for the count of six. Exhale, and repeat twice more. Then breathe normally, and focus your attention on your breathing. As you breathe, inhale through your nose and exhale through your mouth, still expanding your belly rather than moving your shoulders up and down.
4. If your thoughts drift toward the stresses of the day ahead or of the day behind you, gently refocus on your breathing and remain in the present moment. Feel the air move in, and feel the air move out. That’s it.
5. Continue this for as little or as long as you like, and you should notice that your body is more relaxed and your mind is more centered. Enjoy the rest of your day!

To learn more about chronic pain management please check out our website at www.addiction-free.com and go to our Publications page and check out my book Managing Pain and Coexisting Disorders: Using the Addiction-Free Pain Management® System.   If you want to learn more about stress and chronic pain you can find my article The Stress Pain Connection that you can download for free on our Ariticles page.

To check out our July Chronic Pain Solutions Newsletter please click here.