It was fascinating to me reading all of your comments. The first thing that became clear was – we want to heal! Everyone was so encouraged and excited about a resource tailored specifically to our needs, and to my testimonial as to how much yoga has improved my life. I was inspired by your enthusiasm.

Second there was the always present hesitation and fear we have all acquired through years of conditioned response to our symptoms. We hurt, and we tire of hurting, so we have become conditioned to avoiding and eliminating the things that cause us pain or that we even suspect may cause us pain. Completely reasonable, right?

My first experience with yoga was miserable. The teacher would have been better suited as a bootcamp instructor. There was nothing gentle or nourishing about her or her teachings. My fear of that painful experience closed my mind to yoga as a resource. Thank goodness I met someone to guide me to the true practice of yoga.

That is my hope for each of you. I hope that if I talk about it enough, maybe one, two, or even more of you will find a local teacher to guide you. For 13 years my muscles were a frozen, painful mess. With yoga they are quietly and slowly melting, releasing all the years of pain and tension. I want nothing less for each of you!

Thanks to everyone who left a comment. I plan to have more giveaways soon!

I was fortunate to have a great instructor introduce me to a gentle and restorative type of yoga. She also suffers from Fibromyalgia, and through yoga has learned to find balance, energy, and productivity in her life again. Her transformation with yoga was so encouraging she eventually became a certified instructor and began paying her good fortune forward to eager students like myself.

As my love and interest for yoga peaked, I began doing research and came across a great book on yoga tailored specifically for my needs: Yoga for Fibromyalgia, by Shoosh Lettick Crotzer. And as fate, destiny, coincidence or whatever you call it would have it, the instructor who taught me to love yoga, also uses Yoga for Fibromyalgia as the foundation for the style of yoga she teaches. How serendipitous is that?!

And now I am sharing this great book with you!

Yoga for Fibromyalgia is based on the principles that “yoga’s physical practices are noncompetitive and adaptable to any individual, including those with special needs, such as fibromyalgia.” The author, Shoosh, states clearly that it is her intention to help us find ways to improve our “quality of life by reducing stress, pain, fatigue, and muscle stiffness and by getting deeper sleep.” Don’t you just love her already?

About the Author

Copyright @David Martinez

Shoosh Lettick Crotzer has been teaching yoga since 1974 and now specializes in working with students with special needs. She has a masters degree in diagnostic education. In 1994, while teaching for the National MS Society, she founded the production and distribution company Mobility Limited and wrote and produced the video Yoga for MS. In 1997 she wrote and produced Yoga for Arthritis in partnership with the Arthritis Foundation. She has given workshops and made presentations on yoga and arthritis at international rheumatology conferences.

Shoosh began her yoga training in India in the 1970s and continued with Sivananda Yoga teachers in Los Angeles. She has a background in Iyengar-style yoga and has studied with Joel Kramer, Ganga White, and Tracey Rich. Shoosh has taught yoga at universities, yoga centers, health clubs, and privately throughout the country. She is the founder and director of the nonprofit organization Enhancement, Inc., which works to improve the quality of life for breast cancer survivors. She lives in Morro Bay, California, with her husband, Colby.

Impressive resume wouldn’t you say? Upon reading Yoga for Fibromyalgia it was clear to me that Shoosh understands and is sympathetic to the unique issues we face in regards to exercise. Her tone and knowledge put me at ease and encouraged me to progress through her teachings in a way that best served my needs.

Yoga for Fibromyalgia is organized into four parts:

Part 1 – Fibromyalgia and Yoga – Includes information on Fibromyalgia, yoga, and general guidelines. This is the section where you will learn to trust Shoosh and become eager to embrace her knowledge and expertise.

Part 2 – Yoga Poses for Fibromyalgia - Detailed explanations and photographs on how to do the poses and breathing techniques, explanation of the overall benefits of the poses and breathing techniques, and a list of any props you may need. Deirdre Carrigan models the poses in the photographs, and she too has Fibromyalgia and is a yoga teacher.

Part 3 – Practicing Yoga for Fibromyalgia – Shoosh gives guidelines to get us started such as where and when to practice. She also shares sequences of poses designed to target certain areas and to help with specific issues such as pain relief, improve sleep, reduce fatigue, and maintaining general flexibility and body awareness. (The Seated Eagle pose  on page 43 is awesome for stretching sore shoulder and upper back muscles, and I will be doing it the second I am done writing this post!)

Part 4 – Living with Fibromyalgia – Focuses on lifestyle suggestions that may help us live more comfortably and with reduced symptoms. For example: the importance of sleep, good nutrition, exercise, non-exercise movement, and psychological well-being.

Yoga for Fibromyalgia is organized so thoughtfully that depending on your needs on a particular day, you will be able to create the perfect routine – whether it be a seated beginner sequence, a sequence for upper body pain relief, a sequence to improve your sleep, or a complete maintenance sequence – you can do as much or as little as you need.

While encouraging us to get started in our practice of yoga, Shoosh is clear to remind us to take our time, understand that not all techniques are appropriate for everyone, and to listen to what our bodies tell us. She understands and acknowledges that Fibromyalgia can vary from “person to person and often from day to day” and has based her practice in this book on that foundation.

Are you ready yet to let Shoosh guide you through the restorative powers of Yoga for Fibromyalgia?

Good! Because her lovely publisher Rodmell Press has generously agreed to give one copy of Yoga for Fibromyalgia to a randomly selected commenter to this post. Just leave a comment, and on Monday April, 5 I will randomly select someone to receive a copy mailed to you directly from the publisher.

I am clearly a huge fan of Yoga for Fibromyalgia. Since returning to work I have been unable to attend the daily yoga classes that once fit so nicely into my schedule. I have also been traveling and dealing with the stiffness and fatigue of 5 hour plane rides. Without many of the poses and sequences in this book, I am certain I would not be fairing so well.

Yoga is peace

Yoga is strength

Yoga is flexibility

Yoga is restorative

Yoga is life

Note: You may comment as many times as you like, but you will only receive one entry into the drawing,

Rare is the Fibromyalgia patient who embraces exercise.

Not only does it elicit a pain response in most of us, but it also sends our defenses up. Too, too many times we have heard the unsolicited advice, “If you would only exercise you would feel much better.” We could all give examples of some of the insensitive and inaccurate things we have heard, that is not at question here, but what is under consideration is what truth is there in those comments?

It is hard to consider the validity to a comment that has raised our defenses and left us feeling misunderstood. But what if, regardless of how misinformed the comment and commenter, there is an underlying validity to it? Should we continue to be defensive and ignore what instinctively we already know? Who are we hurting if we do this? Not them, that is for sure.

Be Mindful

The fact is, not all exercise is good or even possible for most Fibromyalgia patients, but some form of mindful movement is essential if we ever want to improve our symptoms and our overall wellbeing. And yet it seems so counterintuitive: “It hurts to move, so you are telling me I need to move?” How does that make sense?

A lot of research has been done on this topic. Article after article has been written touting the benefits of exercise for Fibromyalgia. Here is a summary of the benefits of exercise for those with Fibromyalgia from WebMD:

helps restore the body’s neurochemical balance and triggers a positive emotional state

boosts levels of natural endorphins — pain-fighting molecules

triggers the release of epinephrine and norepinephrine, hormones that are known to boost alertness

burns calories and makes weight control easier

gives range-of-motion to painful muscles and joints

improves a person’s outlook on life

improves quality of sleep

improves one’s sense of well-being

increases aerobic capacity

increases cardiovascular health

increases energy

places the responsibility of healing in the hands of the patient

reduces anxiety levels and depression

relieves stress associated with a chronic disease

stimulates growth hormone secretion

stimulates the secretion of endorphins or “happy hormones”

strengthens bones

strengthens muscles

Would your life and your symptoms benefit with even one of the listed improvements? Then let’s step back from our conditioned response to exercise and think about how we can approach mindful movement with more positive results.

Be Gentle

This really is a matter of reconditioning our response to, and expectation of movement. Societies idea of exercising for health is to push through the pain; No Pain No Gain. Absurd really, and an approach that will guarantee failure for those of us living daily in pain. Take that approach and turn it inside out and then upside down. Gentle, mindful movement is the key to exercising with Fibromyalgia.

If you are familiar with my blog at all you know I am a huge proponent of yoga. Well I learned the hard way recently that I need to revise my ardor of yoga.

I Love Yoga, But Not All Yoga Loves Me

My first experience with yoga years ago was a No Pain No Gain experience. Even though I made an attempt to explain Fibromyalgia and my limitations to the instructor, she still pushed me way beyond my means. It was an awful experience and I was done with yoga. Fortunately, Fibromyalgia has taught me to consider and reconsider everything, because, when given the opportunity to practice yoga again, I did and had a completely different experience. It was one of the greatest epiphany moments I have had. Movement without pain. Hallelujah!

But then recently I had a setback to my love affair with yoga. For financial reasons I was no longer able to attend the gentle yoga classes that were having such a positive impact on my health and my symptoms. I was forced to look for alternatives; I tried YouTube videos with no success; found a few sources on Facebook that were okay, but not great; rented a few DVD’s, not even close. Then I resorted to buying a Yoga for Beginners DVD. I mistakenly interpreted “for beginners” as meaning “gentle.” Boy was I wrong. Massive failure and major flare-up.

But We Are Resilient – Remember

So I looked again specifically for “gentle” yoga, and I found a free class being offered at a local library. My love was back. I spent the next restorative hour in mindful movement so gentle I sometimes wonder if it is really benefitting me, but it is. The result was no flare, days of improved cognitive function, better sleep, and decreased pain – all from one class!

Not All Movement is Created Equal

So you tried yoga and it hurt and sent you into a flare and now you are done with exercising. Exercising is not for you. I could not possibly understand how severely exercise hurts you because if I did I would not be telling you to do it.

I understand all of the reasoning behind not exercising, because I used them all myself for many years. And if I had tried yoga again and it had been anything other than gentle and restorative, I would still be reasoning myself out of attempting any form of movement. It is understandable. We have become conditioned by our pain. But the really great thing is that we can also become reconditioned.

First you must trust that your muscles need movement. The longer they remain inactive, the more severely they will continue to hurt, the less energy you will have, and the harder it will be for them to support your frame. Your muscles want and need to move.

Next you have to find the appropriate movement for you. It may not be yoga. Maybe it is Tai Chi or Qigong. Maybe it is some form of water movement. Maybe it is a slow and gentle walk. Find what works best for you. Find what you love and what makes your body say Hallelujah.

Finally you need to accept that you will feel sore and there may be some discomfort, but you should not become discouraged by it. Consider how long you have been inactive. Honor you body and your limitations, but do not use them as the reason for not trying.

As with all things Fibromyalgia, there is no easy answer or quick fix, but if you intend to get better, then mindful movement is a necessary step towards wellness. Do not give up if your first attempt is a failure. Regroup and recommit yourself to mindful movement. When you find what works for you the rewards will be many, including an increased range of pain free movement. And as I like to say – be sure to take baby steps to avoid the making the painful leaps.

Finley

Monty

Moby

But then Koko happened. My sister’s friend Judi volunteers for an awesome animal rescue and placement service Barks of Love. Most of their animals are rescued from shelters before they are euthanized or rescued from people no longer able to care for them. It is a great organization staffed by caring and committed volunteers. Judi and Barks of Love will do whatever it takes to rescue an animal and place it into a good home. Fortunately for me, she thinks we have one, because when she posted a picture of a foster pup needing a good home, I was done. In my heart she was already mine.

Koko

My health was definitely a consideration for all of us when deciding if Koko was a good fit for us. It would not be reasonable or fair for me to adopt a high energy dog that needs excessive exercise. My husband is already the designated dog-walker, so adding one more leash was not an issue for him, but if she needed more walking than he has time for it would be a problem. Dogs are great to help encourage us to walk and be active, but as we all know there are days when it is just not possible. I know I am fortunate to have a husband to compensate for my unpredictable health. And it turns out that Koko is the perfect fit for us after all.

She is smart beyond belief! Mostly house trained when we got her thanks to the great fosters with Barks of Love. Her name was Justice, but we changed it to Koko and she answered to it by the end of her first day here. She is playful but not crazy. In fact she gets most of her energy out on her walks with Rob and in playing with Finley. They have become great friends. I was fortunate with Casey and Finley. They had the knack of matching their energy to mine. If I needed to sleep in, they let me. If I needed quite time and space, they respected it, and somehow, Koko is already doing the same. She really is amazing!

Give her a toy to play with or a bone to chew on and she is in heaven. She puts herself into her crate when she is ready for a nap. She seldom whines, she respects authority, and has already learned several tricks. Did I mention she is amazing?

Rob and I were not blessed to have children of our own. Koko, Finley, Monty and Moby are as close as we will get to raising a family. Casey filled my heart with love for 15 years, and when she was gone I had no place to direct it. Lucky little Koko is the new beneficiary of all that love. She is not replacing Casey. She is honoring Casey. I had a dream the night before we were to meet Koko. I was standing at my front door and Koko was on the other side. As I reached to open the door I looked down and Casey was standing there wagging her tail, excited to meet the newest member of our family. It was all the reassurance I needed that Casey is fine, and that Koko belongs with us.

Casey

Welcome to the family little Koko!

Ever notice when you are sitting at the beach, or walking through a forest you feel more relaxed, more connected, more observant? Even simply gazing out a window onto a garden or nature setting is calming and soothing. Nature’s healing power is undeniable.

I am blessed to live in North San Diego County. There is a great energy and spirit here – magical really. It is hard to explain, but the land and the community seem to promote health and wellness. Just two miles from my front door is a beautiful lagoon and nature preserve Batiquitos Lagoon. I have lived in this neighborhood for over a year, but just recently began walking the serene nature path along the lagoon’s edge. What took me so long?

Walking is good for me. Right?

As we all know, walking, while it is touted as something we should all be doing, can often cause as severe a flare as high-impact activity. While yoga has become my new go-to exercise, I have shied away from walking very much because it is more problematic for me. But there are so many things about the lagoon trail that make it perfect for me, and now I look forward to walking it as frequently as possible.

The trail itself is a flat, easy, two mile walk one way. The lagoon is just off the ocean so even in the hottest time of the day there is a cooling breeze, and much of the trail is shaded by giant Eucalyptus trees. And if that were not comfortable and inviting enough, every tenth of a mile or so, there is a strategically placed bench welcoming trail enthusiasts to have a seat and take in the serene surroundings.

From Great Blue Heron, to the endangered Least Turns, there are birds a plenty to watch flying overhead or feeding along the shoreline. I have no idea what crazy kind of fish are in the lagoon, but it is impossible not to see them leaping up out of the water, taunting pelicans with their acrobatics. The habitat is beautiful and diverse. My favorite is the gigantic, pre-historic looking sago palms – 30-40 feet in height, I can just imagine what lives amid their great fronds.

I love the the Batiquitos Lagoon!

It is my new meditation spot and happy place. Serenity finds me each time I am there. I have walked more in the past month then I did all year, and for the most part, flare-free. What more could I ask for?

Plus, did I mention? Finley loves it too.

This morning I found ProHealth’s June newsletter, Fibromyalgia HealthWatch. I have read many interesting Fibromyalgia articles on ProHealth. That is where I learned of the Fibromyalgia Wellness Project. I think they do a great job interviewing important people and sharing pertinent information. A lot of their articles are excerpts from books that they sell in the ProHealth bookstore. I have yet to purchase a book from them because information on Fibromyalgia is so fluid and ever-changing, I think newsletters and online resources keep me more current. Here are some highlights of the Fibromyalgia articles in their newsletter this month.

Nutritional Approaches in Fibromyalgia – A Review of Common Deficiencies & Basic Supplement Strategies

Excerpted from Dr. Pellegrino’s very popular book Fibromyalgia: Up Close and Personal.* Dr. Pellegrino has seen more than 20,000 FM patients in his practice at the Ohio Rehab Center, and has been a fibromyalgia patient himself since childhood.

The Healing Power of Exercise – Advice from a Fibromyalgia Patient-Expert 

Claudia Craig Marek, MA, is an FM patient, medical assistant to Paul St. Amand, MD, a specialist in FM patient counseling, and author of  The First Year – Fibromyalgia. Claudia has counseled FM patients for some 20 years, and is co-author with Dr. St. Amand of What Your Doctor May Not Tell You About Fibromyalgia and other books.

Fibromyalgia Myth Busting: The Truth about Five Stubborn Misperceptions

A concise explanation of what fibromyalgia is and is not – suitable to print out for your family, friends, and doctors – by NFA co-founder and ‘expert patient’ Karen Lee Richards.

These are just a few of the many articles in the June newsletter, and that is why I am signed up to receive newsletters from many different resources – The National Fibromyalgia Association, American Pain Foundation, The Chopra Center, etc.. They take the time to put their articles into bullet points – easy to digest reading – and then I get to chose what interests me and what I am going to take the time to read. It is a great way to stay informed and educated.

So that is my recommendation to you – sign up for newsletters! I do not receive spam, only what I register for, and if you sign up for one and find it does not interest you, it is just as easy to remove yourself from their list. But on the other hand, if you really aren’t interested in finding newsletters in your e-mail each morning, keep coming back here, because I am certain to report on what I find to be relevant and beneficial. Hey… maybe I should start my own Fibromyagia newsletter!

In their most recently newsletter, the main article was a feature on Fibromyalgia: Treating Fibromyalgia Naturally — So You Can Shine Again.  I found this to be the most realistic, in touch and accurate assessment of Fibromyalgia I have ever read. Several times throughout my reading of it I wanted to clap for Dr. Marcelle Pick, or stand up and bow. Here are just a few of the things she wrote that made me want to cheer her:

I see many women in my practice who feel discouraged and disheartened by the advice they’ve received about fibromyalgia. The sleeplessness, extreme fatigue, and widespread chronic pain that accompany fibromyalgia can be unbearable for some women, but the medical community has long been stumped by this confusing and controversial condition. It was ignored by conventional medicine for years, and in some circles fibromyalgia is still questioned as a “real” diagnosis. But fibromyalgia is real, and I know there are thousands of women out there who deserve compassionate and effective care. We don’t have all the answers yet, but pain specialists and functional practitioners are working to get to the root of fibromyalgia and similar pain syndromes, to give you the answers you want and deserve.

I think women with fibromyalgia deserve more than a prescription for their pain and suffering.

I see this as a condition that strikes at the very core of a woman’s being.

But you can feel good again, if you’re willing to roll up your sleeves, do some digging, and learn some new ways of being.

At this point in the article Dr. Skin goes into a very thorough discussion of Fibromyalgia and its underlying issues. She uses the word SHINE as an acronym for what she believes to be the main issues of FM – Sleep, Hormone Imbalance, Immune Health, Nutrition and Emotions. (Some of you may recognize this as a protocol of Dr. Teitelbaum, author of From Fatigued to Fantastic. I am very familiar with his name, but have yet to read his book. After reading this article I certainly plan to.) Dr. Skin also addresses Stress, Detox, Exercise and Mind-body Work. She shares a lot of valuable information in her article and is clearly invested in helping women with Fibromyalgia shine again.

Dr. Skin ends her article with encouragement and hope:

Find hope in your own light

We all glow in our own unique ways, and when we are feeling good, the world can feel our warmth and positive energy. I know fibromyalgia can dim this light, making us too tired, too discouraged, and too achy to find hope in anything, let alone feeling better. Especially if you’ve been told by your practitioner, or by several practitioners that there is nothing they can do — or worse, that your symptoms aren’t real — it can seem like you just have to live with this. But please know that you don’t have to live in pain, and you don’t have to be on a prescription medication for the rest of your life, either.

Fibromyalgia is a syndrome caused and influenced by many, many factors, and if you start to work on even one or two of these factors, you will find that light within starting to shine again. With this new hope, you can regain the energy to work on more aspects of your life that may be affecting your health — and in time, you’ll be enjoying each brand new day.

 

I encourage you to take the time to read the article for yourself. It is refreshing to read a perspective from a doctor who actually understands the many levels of Fibromyalgia, and hopefully you will decide on one or two factors of FM that you will want to work on. Articles like this go a long way in encouraging us to take steps towards better health and wellbeing. Thank you Dr. Skin.

15/30

Since I was diagnosed in 1997, I have tried an unimaginable number of times to find an exercise that would get me up and moving, and not send me spiraling back down into FM hell right after. Try and fail. Try and fail. I tried and failed so many times that I became fearful of trying again. I HATE PAIN! I AM SICK OF PAIN! Why was I constantly putting myself through that vicious cycle? Well, for one because I missed exercise and being active, and two, because deep down I still believed that the less I moved, the more intense and chronic my pain. Even with Fibromyalgia, it is possible and important to exercise, and yet I still continued to fail. Something as seemingly simple as a short and gentle walk could send me into a two week flare-up. I wish I could see all of you nodding your heads right now, because I know you understand what I am talking about.

Now let me tell you why yoga is different. Yoga is not painful! After numerous sessions over the past two months I have not had a single flare-up caused by yoga. Yoga is about the freedom of movement; slow, gentle, controlled movements during which your muscles are active but not strained. Yoga is personal. It is not competitive. If the person next to you can reach their toes and you cannot – so what! It is your session. Do your best and get your most out of it. Next time I bet you will reach further and if you stick with it, eventually you will reach your toes. I was a sprinter in high school. I have short, strong, compact muscles – but I can visible see my muscles elongating! I can feel the long stored tension releasing. My body changes with each session, and I like the changes I am seeing. But that is just an esthetic bonus really. The real reason I am loving yoga is because without a doubt, my Fibromyalgia symptoms are improved since I began practicing. My overall pain and stiffness is improved, my mental clarity has increased, I sleep better and wake up more refreshed. 

Today was my first day back after a two week break. I did not intend to take a two week break, but we went on vacation, and while there I suffered a minor concussion, which of course lead to an FM flare. Maybe if I was not dealing with dizziness and nausea from the concussion, I might have tried to practice yoga through the flare, I am not sure. I cannot tell you how or if you should practice while in a flare because I have not tried, but I can only say that on a average day, with mild to normal FM symptoms, yoga is not only doable, it is restorative. I have yet to leave a session feeling worse than when I arrived.

So here is my advice. Try it. Find a yoga studio, a YMCA or a community center and look for the GENTLE yoga class. Most studios charge $10-$15 dollars for a session, but if you purchase packages, each session costs less. Talk to the instructor. Let them know you have Fibromyalgia, that you may need modifications to some of the poses, and that this is your first time trying yoga. If a pose hurts, DON”T DO IT. Personalize the class to your needs. Don’t feel like you need to compete with those around you. Relax, breathe deep, and enjoy the experience.

If going to a studio is not an option for you, there are tons of DVD’s on yoga. I do not have a personal recommendation, but again look for the for gentle practice yoga. After a quick search on Amazon I located a well reviewed DVD called Yoga for Healing – 5 out of 5 stars – for $39.95. Sounds like a great choice! Read the reviews for yourself and consider it. Be sure to invest in a good mat too, and don’t be afraid to use a blanket or towel for extra padding and comfort.

I cannot emphasis enough how much I have come to love yoga and the way it makes me feel. My goal is to do three to four sessions a week, but I have been doing more like one or two, and even at this infrequent rate I am seeing and feeling the benefits. We all need as many tools as possible to make living with Fibromyalgia less painful and more bearable. I still believe one day I will be symptom free, and I know when I get there, yoga will have played a huge part in my freedom from chronic illness.

4/30

Sharon B. Stanford, MD is the Assistant Professor of Psychiatry and Family Medicine, Assistant Director, Women’s Health Research Program, University of Cincinnati College of Medicine. The article is partly an examination of the current drugs approved and used in the treatment of Fibromyalgia, and Dr. Stanford discloses that she receives grant/research support from several drug companies, but beyond the drug exploration, Dr. Stanford has written a very accurate and empathetic report on Fibromyalgia. She even touches on a recent conversation we had here on FibroHaven – which came first, the pain or the emotion. 

Stanford offers Ms. D as a cases study:

Ms. D, age 50, has a history of migraine headaches and is referred by her primary physician for evaluation of depression and anxiety. She reports deteriorating mood over 6 months, beginning when a minor car accident left her “very sore the next day.”

“Nothing helps” the persistent pain in her back, shoulders, and thighs, which she rates as 7 to 8 on a 0-to-10 pain scale. She describes an intense ache, “like having the flu,” that worsens with activity and in stressful situations. She also experiences nausea and intermittent diarrhea, debilitating fatigue, and sleep disturbance.

Ms. D reports she is depressed because she feels “just too tired” after work to keep up with social activities or housework. Her physician’s referral notes a normal physical exam except for tenderness over her upper back and hips. Laboratory testing is negative.

As you elicit more details about Ms. D’s mood, she continues to focus on her physical symptoms. She states that some days she wishes to die because her pain gets so bad, but she denies any plan or intent to harm herself. She worries that her symptoms will worsen and that she will become completely disabled.

Her primary physician attempted to relieve Ms. D’s pain with multiple trials of nonsteroidal anti-inflammatory drugs (NSAIDs) and cyclobenzaprine. She says she gained no benefit from the NSAIDs and discontinued the muscle relaxant because it made her too sleepy.

 

Sound familiar? We all understand the horrible cycle of pain Ms. D is in and the frustration she is experiencing just hoping and looking for some relief. Dr. Stanford is frustrated too and here is the treatment she proposes for Fibromyalgia patients.

TREATING THE WHOLE PATIENT

As a clinician who specializes in fibromyalgia, I counteract my patients’ and my own frustration with this condition by structuring office visits, determining realistic treatment goals, and treating all symptoms as part of a common syndrome rather than individual illnesses.

Structure office visits. Before every visit, have patients rate each symptom domain and write their top 2 or 3 concerns for that day (Click here for a sample form). Focusing on the patient’s most troublesome symptoms can help both of you feel greater satisfaction with treatment.

Educate patients. Ask them to discuss their beliefs about fibromyalgia; many know others with this condition or have researched diagnosis and treatment. Before developing a treatment plan, explain that their symptoms are chronic and all part of the same syndrome. Describe their pain as a complex phenomenon with possible peripheral and CNS components. Guide them to reputable Web sites and resources (see Related Resources).

Set realistic expectations. Many patients expect to resume an energetic and pain-free life, which usually is not the case with fibromyalgia (Box). Most medications are considered successful if they reduce pain by 30% to 50%, and side effects can be problematic. Discuss side effects before treatment begins to reduce patients’ anxiety and improve compliance in the first weeks.

Cognitive-behavioral therapy (CBT) for fibromyalgia incorporates relaxation techniques, helping patients view symptoms as manageable, reinforcing adaptive coping skills, and teaching them how to monitor thoughts, feelings, and behavior to change the view that they are helpless victims. A modest course of 6 weekly group CBT sessions significantly improved physical functioning in 25% of fibromyalgia patients (n=76) compared with 12% in a standard-care group (n=69), even though patients’ pain severity did not improve.¹⁶

Recommend exercise, lifestyle changes. Aerobic exercise can significantly improve well-being and physical functioning in fibromyalgia patients.¹⁷ Low-impact aerobics, such as done in warm water, usually are well tolerated, although any low-impact exercise can help. Because fibromyalgia symptoms often increase with physical activity, counsel patients to begin with a few minutes daily and increase very slowly each week.

 

Lifestyle changes are as important as medications in controlling fibromyalgia symptoms. In addition to exercise, recommend that patients:

• follow a daily routine
• pace activity to avoid exacerbating symptoms
• reduce stress.

Sometimes, I use the analogy of diabetes: treating fibromyalgia with medication but without changing lifestyle is like prescribing medication for a diabetic patient without changing diet. Follow up on this “homework” at each visit to reinforce that patients helping themselves is an important part of treatment.

 

 

There is nothing “murky” about Dr. Stanford’s approach to Fibromyalgia. I appreciate that her approach is to treat the WHOLE patient, not just individual symptoms, and she provides resources to help the patient and the doctor. Click on the sample form above. I think it is a great tool to use before any doctors visit. How often do we forget or feel too rushed to cover everything we intended at an appointment? This sheet will help improve communication between patient and doctor. The link to the box is also a useful summary on managing unrealistic expectations of Fibromyalgia patients. It is worth the read.

Even though I chose drug-free management for my Fibromyalgia, I was able to appreciate Dr. Stanford’s article very much. She clearly cares and is invested in helping her Fibromyalgia patients. Her article will help countless other psychiatrists treat their FM patients as well. And it is another step forward in promoting Fibromyalgia Awareness and Visibility.

The Wellness Center I recently joined offers Qigong (pronounced chee-gong) in addition to many other mind and body disciplines. Fay McGrew is the instructor and this is how she describes Qigong:

The practice of Qigong is used for stress reduction, to enhance the body’s natural healing abilities and to increase vitality and awareness of internal energy that furthers the mind and body. We do breathing techniques and very gentle movements to relieve the energetic and physical stress on the body. You don’t need full mobility to benefit from Qigong. You need the mind’s intention.

The movements are all very gentle, and she constantly reminded the class not to push ourselves, and that at the first sign of discomfort we should release the position. I was able to follow her every move although I was not nearly as smooth and could not hold some poses as long. I did not feel graceful, but I felt good. I could actually feel the tension leaving my upper back, shoulders and neck.

The breathing we did was controlled and meditative. I was so incredibly relaxed at certain points in the hour that I found myself doing the movements with my eyes closed. A few times, for very brief moments I felt weightless.

At the end of the session the top of my head and the bottoms of my feet were tingling. I did not know if this was good or bad, but when Fay came up and check with me to see how I liked Qigong and I told her about the tingling, she clapped her hands and jumped up and down like a school girl. I guess I had really tapped into my Qi! We were both pleased.

I will certainly be taking her class again. I mentioned how relaxing it was, and that I felt a discernible release of tension in my upper body, but I also felt energized and clearheaded after the hour. It was a great experience and I highly recommend it.