Fed Up With Fibromyalgia? A Pain Expert Gives Advice
Bob & Brad have special guest Adriaan Louw (PT PhD) on to discuss how to manage pain with fibromyalgia. Dr. Louw discusses specifics of pain and how naturally manage or reduce it. You can find out more from his book “Your Fibromyalgia Workbook” or check out any of his other books with the link provided below.
Researchers led by a team from The University of Texas Medical Branch at Galveston were able to dramatically reduce the pain of fibromyalgia patients with medication that targeted insulin resistance.
This discovery could dramatically alter the way that chronic pain can be identified and managed. Dr. Miguel Pappolla, UTMB professor of neurology, said that although the discovery is very preliminary, it may lead to a revolutionary shift on how fibromyalgia and related forms of chronic pain are treated. The new approach has the potential to save billions of dollars to the health care system and decrease many peoples’ dependence on opiates for pain management.
The UTMB team of researchers, along with collaborators from across the U.S., including the National Institutes of Health, were able for the first time, to separate patients with fibromyalgia from normal individuals using a common blood test for insulin resistance, or pre-diabetes. They then treated the fibromyalgia patients with a medication targeting insulin resistance, which dramatically reduced their pain levels. The study was recently published in PlosOne.
Fibromyalgia is one of the most common conditions causing chronic pain and disability. The global economic impact of fibromyalgia is enormous – in the U.S. alone and related health care costs are about $100 billion each year. Despite extensive research the cause of fibromyalgia is unknown, so there’s no specific diagnostics or therapies for this condition other than pain-reducing drugs.
“Earlier studies discovered that insulin resistance causes dysfunction within the brain’s small blood vessels. Since this issue is also present in fibromyalgia, we investigated whether insulin resistance is the missing link in this disorder,” Pappolla said. “We showed that most – if not all – patients with fibromyalgia can be identified by their A1c levels, which reflects average blood sugar levels over the past two to three months.”
Pre-diabetics with slightly elevated A1c values carry a higher risk of developing central (brain) pain, a hallmark of fibromyalgia and other chronic pain disorders.”
The researchers identified patients who were referred to a subspecialty pain medicine clinic to be treated for widespread muscular/connective tissue pain. All patients who met the criteria for fibromyalgia were separated into smaller groups by age. When compared with age-matched controls, the A1c levels of the fibromyalgia patients were significantly higher.
“Considering the extensive research on fibromyalgia, we were puzzled that prior studies had overlooked this simple connection,” said Pappolla. “The main reason for this oversight is that about half of fibromyalgia patients have A1c values currently considered within the normal range. However, this is the first study to analyze these levels normalized for the person’s age, as optimal A1c levels do vary throughout life. Adjustment for the patients’ age was critical in highlighting the differences between patients and control subjects.”
For the fibromyalgia patients, metformin, a drug developed to combat insulin resistance was added to their current medications. They showed dramatic reductions in their pain levels.
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New research from Purina and Mayo Clinic brings a pet-centered treatment option to the forefront for patients with fibromyalgia, a chronic centralized pain sensitivity disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues. A newly published study by Mayo Clinic and Purina researched the impact of animal-assisted activity sessions in patients with fibromyalgia and found benefits of the interaction to patients and the therapy dogs working to help them.
The National Fibromyalgia Association estimates 10 million Americans and between 3 and 6 percent of the world population suffers from fibromyalgia. Purina and Mayo Clinic designed the Better Together study to investigate the direct effects of animal-assisted activity in patients with fibromyalgia. At the same time, the study measured the emotional state of the therapy dogs during the treatment session to better understand the impacts on these specially trained canine companions. For both patients and the therapy dogs, researchers used multiple non-invasive physiological biomarkers, including salivary oxytocin and cortisol concentrations, tympanic membrane temperatures and various cardiac parameters.
“The Better Together study showed therapy animals could be an evidence-based treatment option, and healthcare professionals should strongly consider utilizing animal-assisted activity in the care of their patients with fibromyalgia,” said Arya Mohabbat, M.D., assistant professor of medicine in the Division of General Internal Medicine at Mayo Clinic, and lead Mayo Clinic researcher on the project.
While fibromyalgia has some effective treatment strategies, most individuals live with chronic symptoms and look for non-conventional treatments in search of relief. For 221 patients, each enrolled in the Mayo Clinic Fibromyalgia Treatment Program, an outpatient program staffed by physicians from the Mayo Clinic Division of General Internal Medicine, the Better Together study provided reprieve for those in the treatment group and hope for those in the control group.
The Better Together study found the patients in the treatment group were in a more positive emotional-physiologic state as a result of the animal-assisted activity session compared to the control group. People who interacted with therapy dogs saw their oxytocin levels increase significantly, while their heart rates decreased. They reported less negative emotions and more positive emotions. The results suggest a 20-minute therapy dog visit can significantly and positively impact the physical and mental health of patients with fibromyalgia.
Therapy Dogs Calmer
Despite the widespread use of therapy dogs in clinical settings, there’s a lack of understanding of the impact of animal-assisted activity sessions on the emotional state of the dogs. In addition to interacting with patients of all ages in varying physical and emotional states as part of their work, therapy dogs are exposed to novel environments that may include new sights, sounds and textures that require ongoing focus and adaptation.
The study found the dogs – all members of the Mayo Clinic Caring Canines program, which varied in breed, age and size – did not show signs of stress during the animal-assisted activity session and may have been in a more relaxed state at the end of the session. For most parameters, there were no changes in the dogs, signaling contentment; however, for those that did change, they pointed to a more positive emotional and physiological state, such as a significantly lower heart rate, at the end of the session. This signals the dogs were not only good at their jobs, but in many cases, enjoyed the work they were doing with patients.
“We need to expand our understanding of how animal-assisted activity impacts therapy dog’s wellbeing, and this sizeable study with 19 dogs of various breeds provided solid evidence that animal-assisted activity done in the right condition does not have negative impacts on well-trained therapy dogs,” said François Martin, M.A., Ph.D., Applied behavior and welfare research section leader at Purina, and lead Purina scientist on the project. “This only encourages us to do more research to continue to demonstrate the power of the human-animal bond on people while ensuring assistance animals also experience positive wellness as a result of their work.”
The Better Together study is the first one to utilize physiologic parameters to provide scientific evidence that animal-assisted activities is a valid option for the management of fibromyalgia. The authors of the study believe that animal-assisted activity should become a standard treatment strategy to help patients manage this chronic condition.
Queen’s University researcher Ian Gilron has uncovered a more effective way of treating fibromyalgia, a medical condition characterized by chronic widespread pain typically accompanied by fatigue, as well as sleep, mood and memory problems.
The results of the trial suggest that combining pregabalin, an anti-seizure drug, with duloxetine, an antidepressant, can safely improve outcomes in fibromyalgia, including not only pain relief, but also physical function and overall quality of life. Until now, these drugs have been proven, individually, to treat fibromyalgia pain.
“Previous evidence supports added benefits with some drug combinations in fibromyalgia,” says, Dr. Gilron (Anesthesiology, Biomedical Sciences). “We are very excited to present the first evidence demonstrating superiority of a duloxetine-pregabalin combination over either drug alone.”
Fibromyalgia was initially thought to be a musculoskeletal disorder. Research now suggests it’s a disorder of the central nervous system – the brain and spinal cord. Researchers believe that fibromyalgia amplifies painful sensations by affecting the level and activity of brain chemicals responsible for processing pain signals.
“The condition affects about 1.5 to 5 per cent of Canadians – more than twice as many women as men. It can have a devastating on the lives of patients and their families,” explains Dr. Gilron. “Current treatments for fibromyalgia are either ineffective or intolerable for many patients.”
This study is the latest in a series of clinical trials – funded by the Canadian Institutes of Health Research (CIHR) – that Dr. Gilron and his colleagues have conducted on combination therapies for chronic pain conditions. By identifying and studying promising drug combinations, their research is showing how physicians can make the best use of current treatments available to patients.
“The value of such combination approaches is they typically involve drugs that have been extensively studied and are well known to health-care providers,” says Dr. Gilron.
Recent studies have suggested that most people who have been diagnosed with fibromyalgia by physicians may not actually have the condition. A new Arthritis Care & Research study found that overall agreement between clinicians’ diagnosis of fibromyalgia and diagnosis by published criteria is only fair.
For the study, 497 patients visiting a rheumatology clinic completed a health assessment questionnaire as well as a questionnaire that assessed fibromyalgia diagnostic variables used by the American College of Rheumatology. Patients were also evaluated and diagnosed by rheumatology clinicians.
Of the 497 patients, 121 (24.3 percent) satisfied fibromyalgia criteria while 104 (20.9 percent) received a clinician’s diagnosis of fibromyalgia. The agreement between clinicians and criteria was 79.2 percent; however, agreement beyond chance was only fair. Physicians failed to identify 60 (49.6 percent) of criteria-positive patients and incorrectly identified 43 (11.4 percent) of criteria-negative patients.
“We have recently studied the same issue in 3,000 primary care patients and found about the same results. Therefore, our conclusions are secure,” said lead author Dr. Frederick Wolfe, of the National Data Bank for Rheumatic Diseases.
In an accompanying editorial Dr. Don Goldenberg, of Oregon Health & Science University, noted that to conclude that expert physicians often misdiagnose fibromyalgia implies that published criteria are superior to expert clinical judgement for the diagnosis of individual patients. He stressed that this fails to account for many of the variables present in clinical encounters, including time spent in evaluating and categorizing each patient’s multiple symptoms. “The diagnostic gold standard for fibromyalgia will continue to be the rheumatologist’s expert opinion, not classification criteria, no matter how well-refined and intentioned,” he wrote. “This is the only way to capture the variability and severity of inter-related symptoms as they play out over time.”