Thursday, November 1, 2018

The GERD-Fibro Connection

Clinicians should be more alert to an association between gastroesophageal reflux disease (GERD) and fibromyalgia, says Don Goldenberg, MD, a fibromyalgia expert and affiliate faculty in rheumatology at Oregon Health & Science University in Portland, Maine. He also said in the interview, A Closer Look at the Interrelationship of Fibromyalgia and GERD, by Kathleen Doheny for Practical Pain Management, “For pain practitioners, routinely asking FM patients about any problems with irritable bowel and repeated reflux would be a very good start."

An article written last November for ProHealth, Is There a GERD—Fibro Connection?, continues to garner attention most likely for these reasons, so with ProHealth’s permission I am sharing the article in its entirety here on The Pained Ink Slayer’s blog.


By Celeste Cooper

Could gastro-esophageal-reflux-disease (GERD) be co-morbid to fibromyalgia? A new study (October 2017) published in the peer-reviewed journal Pain suggests the answer is YES. Researchers found fibromyalgia patients are slightly more likely to develop GERD than people with GERD are likely to develop fibromyalgia (FM), but there is a bi-directional connection. As to why this “bi-directional association” occurs is up for debate according to a Practical Pain Management interview of fibromyalgia experts who reviewed the study.

What is GERD?

Anyone who has experienced heartburn knows the symptoms of an isolated event of gastric reflux, usually caused a specific thing, such as seriously spicy or fatty food, or eating too fast. For some of us, though, these symptoms are persistent and can be aggravated by many things.

These persistent symptoms may be a sign of gastroesophageal reflux disease (GERD). If you have mild acid reflux that occurs at least twice a week or moderate to severe acid reflux that occurs at least once a week, your doctor may order certain tests to confirm a diagnosis of GERD.

What happens?

The esophagus, a tube-like structure behind the breathing tube (trachea) in our neck, provides the passageway for food and beverages from the mouth to the stomach. When the esophagus becomes irritated, symptoms of heartburn, sour taste, burning, a sore throat, hoarseness, nausea, regurgitation, problems swallowing, and sometimes even severe chest pain may occur.

*Caution - Never assume chest pain is GERD until heart problems have been ruled out. Symptoms can mimic a heart attack.

Two gates, in our esophagus, called sphincters, act to control the flow of things we ingest. As we swallow the upper esophageal sphincter opens, gravity and esophageal motility move things along, and the lower esophageal sphincter (LES) opens to allow the contents to flow into our stomach, where digestion continues. When the LES gate fails, backwash of stomach acid (gastric reflux) occurs.

esophageal motility = synchronized contractions in the esophagus that moves food toward the stomach.

Normally, the lower gate (LES) relaxes to let food pass into the stomach where special acids continue the digestive process. But, when this normally tight muscle becomes floppy or opens ad lib, permanent erosive damage can occur, affecting many things, including our sense of taste and even our sense of smell if it gets into our airway passages during sleep.

Why does the sphincter stop working?

Sphincter dysfunction can be the result of heredity, life-style choices, myofascial pain syndrome, connective tissue disorders, a stress response, obesity, hormones, slow stomach emptying, certain neurological conditions, medications, cancer of the esophagus, or any other thing that interferes with normal esophageal motility.

What can we do?

There are things we can do. We can make healthier lifestyle choices, such as avoiding alcohol, caffeine, foods that are acidic, fatty, or spicy, and carbonated beverages. We can stop smoking and assess the side effects of our supplements and medications. Exercise is important to our wellness, but exercise that creates gravitational reflux, such as jumping, aggressive jogging, and yoga poses (i.e. downward facing dog) can aggravate symptoms.
Sleeping with our upper body at a slight angle (head higher than our waist) can help prevent gravitational reflux. (Try putting four-inch blocks under the head of your bed frame.) Learn about and use an anti-inflammatory diet, eat small frequent meals, and exercise regularly by walking or doing things like T’ai Chi, which has been found helpful for those of us with fibromyalgia. There are supplements and medications that can help, too. So, if you have symptoms, discuss them with your doctor or pharmacist.


One of the reviewers of the study, “Bidirectional association between fibromyalgia and gastroesophageal reflux disease,” Don Goldenberg, MD, a fibromyalgia expert and affiliate faculty in rheumatology at Oregon Health & Science University in Portland, Maine, told Practical Pain Management that this study should serve to raise awareness about the likelihood of an increased prevalence of co-morbidity. He suggests clinicians be alert to the possibility of this association and routinely assess for irritable bowel and GERD in their fibromyalgia patients. I couldn’t agree more. I have had GERD for many decades but never considered it might be related to fibromyalgia. So, if you are experiencing symptoms, be sure to discuss this connection with your heath care provider. I know I will.


Additional Reading

Wang JC, Sung FC, Men M, et al. “Bidirectional association between fibromyalgia and gastroesophageal reflux disease: two population-based retrospective cohort analysis.” Pain. 2017 Oct;158(10):1971-1978. doi: 10.1097/j.pain.0000000000000994

In healing,

Celeste Cooper, RN / Author, Freelancer, Advocate

Think adversity?-See opportunity!

~ • ~ • ~ • ~ • ~ • ~

Learn more about Celeste’s books here. Subscribe to posts by using the information in the upper right hand corner or use the share buttons to share with others. 

Friday, October 12, 2018

A Fall Lesson on Mindfulness

If I Could See Further - Celeste's Photography

Neuroscience can't tell us why, but it does tell us that our brain changes when we use cognitive and meditative therapies. This is especially important for those of us who experience chronic pain, because "chronic background noise" surfaces to our conscious mind when it reaches a point of saturation. At that point it screams out for attention. But, that’s the wonderful thing about our mind. If we stay alert and recognize background noise before it reaches the point of maximum saturation, we can bust through harmful thoughts using intentional mindful awareness.

“Mindful awareness expands my being
and encourages me to live consciously, without judgment.”
~Celeste Cooper

Broken Body, Wounded Spirit:
Balancing the See-Saw of Chronic Pain

Our pain is not the villain here; it is the result of a bad actor invading our body. It doesn’t want to exist anymore than we want to experience it. So, being hard on it isn’t helpful, it won’t make it go away, and it won’t make us feel better.


by Celeste Cooper, RN and Jeff Miller, PhD

Think of a bright fall day, briskness on the edge of arriving, leaves a colorful artist’s pallet, and migrant birds are flying overhead in the backdrop of a crisp blue sky. These are examples of being mindful. All we have to do is be present and aware in the moment admonishing our role as critic.

How is being mindful important to me today?

Excerpt Fall Devotions, Day 10
Available on Amazon and all major outlets.


Being mindful of our pain without judgment redirects our thoughts to create an environment that is appreciated fully.​  

To unleash victory, I must have an open mind and willing heart,
judge not, embrace change, and be a steadfast observer of self.

Additional Reading:

Pained Ink Slayer Series: Mindfulness and Chronic Pain
Getting Physical with Our Body Talk 

In healing,

Celeste Cooper, RN / Author, Freelancer, Advocate

Think adversity?-See opportunity!

~ • ~ • ~ • ~ • ~ • ~

Learn more about Celeste’s books here. Subscribe to posts by using the information in the upper right hand corner or use the share buttons to share with others. 

Wednesday, October 3, 2018

10 Fast Facts Fibromyalgia is Real

The original article, 10 Fast Facts Fibromyalgia is Real, appeared September 17, 2016 on ProHealth. The article continues to garner attention, so with ProHealth’s permission I am sharing the article in its entirety here on The Pained Ink Slayer blog.

Those of us who live with fibromyalgia know the pain, cognitive dysfunction, poor sleep quality, and fatigue. We understand and can discuss these things with fellow patients, but when we are confronted with someone who knows very little about FM, we sometimes become tongue-tied. Maybe that’s because fibromyalgia is a complex disorder and fibrofog gets in our way. Maybe we let others play on our vulnerabilities, making us feel insecure about our response.

And, maybe we can do better by being prepared with some quick facts.

Following are ten fast facts that will allow your tongue to flow freely as it forms the words that prove fibromyalgia is real.

1.     Fibromyalgia is not a new disorder. As reported in our book, the collective symptoms of fibromyalgia (a syndrome) were first documented in the early 1800s by British surgeon, William Balfour. Nearly a century later, another British pioneer, Sir William Gowers, gave the syndrome its first name, fibromyocitis. Throughout time, fibromyalgia has been known by names that reflect the understanding of the era. (1)
2.     Fibromyalgia is a physical problem that has demonstrated abnormal blood flow in specific areas of the brain (2) and brain scans show unique brain activity (3) in response to pain.
3.     The primary, consistent symptom of chronic body-wide pain and tenderness is present in ALL fibro patients, just as the primary symptoms of other illnesses define that syndrome or disease.
4.     Fibromyalgia is consistently accompanied by cognitive dysfunction that is significantly more challenging than simple forgetfulness and there is evidence. For instance, the hippocampus, located in the brain, is thought to be the center for emotion, memory, and the autonomic nervous system regulation. It plays a crucial role in maintenance of cognitive functions, sleep regulation, and pain perception, and hippocampus metabolic dysfunction has been seen in fibromyalgia. (4, 5)
5.     Fibromyalgia is more than not sleeping well for a night or two. It’s like never sleeping at all, and we don’t “bounce back” when we do get eight hours. Because we don’t get normal slow wave sleep progression (6), the healing stages of sleep, the micro-healing that occurs with normal sleep patterns is impaired. This phenomenon could very well explain cellular oxidative stress identified in fibromyalgia. It’s far more than not getting a good night’s sleep for those of us with fibromyalgia.
6.     Fatigue is a symptom of fibromyalgia; it is not laziness. Sometimes, we have to remind our peeps of our “before person.”
7.     While depression can accompany fibromyalgia or any chronic illness, it is not a primary symptom. Major depression has its own diagnostic criteria.
8.     Fibromyalgia is usually accompanied by another disorder. (7)  So, when someone tells you no one could have all that wrong, let him or her know that in fact, we can and do.
9.     There is a blood test for fibromyalgia, it’s called the FM/a Test® and some insurance carriers are now covering it. I did have the test and I do have the physical cellular changes seen with this test that are specific to fibromyalgia. (8)
10.While some believe fibromyalgia is progressive in nature and others do not, fibromyalgia is considered a life-long central nervous system disorder. (9)  It is not going away because our friends, many times eager to help, tell us they just read about a miracle cure in some tabloid magazine.

I once had a neurologist tell me he would not see me for my migraines, because he didn’t “believe in” fibromyalgia. After I recovered, I simply said, “fibromyalgia is not a belief system, I will not be back.” I was thankful I didn’t “come in like a wrecking ball” like Miley Cyrus and hit him upside the head with my purse.


I have learned from various encounters that some folks are innocently ignorant and want to know more. For those folks, I spend the time. I have also learned there are closed-minded people who are not worth the effort because they have no intention of listening. If someone makes you defensive, simply reflect their words back to them and change the subject, even if it’s a healthcare provider. We do not need a healthcare provider who is stagnant in a profession that is in a constant state of learning. Give these ten facts to a staff member or leave some copies in the waiting room. They are sure to generate some discussion.


  1. Cooper, C. and Miller, J. 2010. Integrative Therapies for Fibromyalgia, Chronic Fatigue Syndrome, and Myofascial Pain: The Mind-Body Connection. Vermont: Healing Arts Press.
  2. Guedj E, Cammilleri S, Niboyet J, Dupont P, Vidal E, Dropinski JP, Mundler O. Clinical correlate of brain SPECT perfusion abnormalities in fibromyalgia. J Nucl Med. 2008 Nov;49(11):1798-803. doi: 10.2967/jnumed.108.053264. Epub 2008 Oct 16.    
  3. Kim J, Loggia ML, Cahalan CM, Harris RE, Beissner F, Garcia RG, Kim H, Barbieri R, Wasan AD, Edwards RR, Napadow V. The somatosensory link in fibromyalgia: functional connectivity of the primary somatosensory cortex is altered by sustained pain and is associated with clinical/autonomic dysfunction. Arthritis Rheumatol. 2015 May.   
  4. Emad Y, Ragab Y, Zeinhom F, El-Khouly G, Abou-Zeid A, Rasker JJ. Hippocampus dysfunction may explain symptoms of fibromyalgia syndrome. A study with single-voxel magnetic resonance spectroscopy. J Rheumatol. 2008 Jul;35(7):1371-7. Epub 2008 May 15.   
  5. Ichesco E, Puiu T, Hampson JP, Kairys AE, Clauw DJ, Harte SE, Peltier SJ, Harris RE, Schmidt-Wilcke T. Altered fMRI resting-state connectivity in individuals with fibromyalgia on acute pain stimulation. Eur J Pain. 2016 Aug;20(7):1079-89. doi: 10.1002/ejp.832. Epub 2016 Jan 15.   
  6. Vijayan S, Klerman EB, Adler GK, Kopell NJ. Thalamic mechanisms underlying alpha-delta sleep with implications for fibromyalgia. J Neurophysiol. 2015 Sep;114(3):1923-30. doi: 10.1152/jn.00280.2015. Epub 2015 Aug 5.   
  7. Bennett, RM.  Pain management in fibromyalgia. Pain Manag. 2016 May;6(4):313-6. doi: 10.2217/pmt-2016-0026.   
  8. FM/a® Blood Test – “How To” and My Results. June 2016 Blog. 
  9. Fibromyalgia Has Central Nervous System Origins. American Pain Society, Press Room, May 16, 2015. (Accessed 2016, September 9).  
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In healing,

Celeste Cooper, RN / Author, Freelancer, Advocate

Think adversity?-See opportunity!

~ • ~ • ~ • ~ • ~ • ~

Learn more about Celeste’s books here. Subscribe to posts by using the information in the upper right hand corner or use the share buttons to share with others. 

Tuesday, September 18, 2018

Chronic Pain: Does Sex Matter?


September is chronic pain awareness month and a perfect time to recognize that when it comes to chronic pain, women are treated differently than men.


As reported in my article Women, Pain, Bias, and Discrimination, written for Health Central, there is a century’s old bias against women, and I am sorry to say not much has changed in the twenty-first century. Our pain remains misunderstood, mistreated, undertreated, and often times, untreated all together—simply because we are women.

The Wandering Womb = Wandering womb was the belief that a displaced uterus was the cause of many medical pathologies in women. The belief originates in the medical texts of ancient Greece, although it persisted in European academic medicine and popular thought for centuries. Wikipedia (accessed, September, 2018)

The National Pain Strategy tells us bias, stigma, and discrimination exists, and women exhibiting pain from chronic fatigue syndrome, fibromyalgia, and other conditions are among the vulnerable. So, why might that be? 


There are specific factors that influence pain in women that are different from men. Researchers (2016) propose this is because of genetic, anatomical, physiological, neuronal, hormonal, psychological, and social factors.

Gender matters because:

“Women do not want to appear “too strong or too weak, too healthy or too sick, or too smart or too disarranged and struggle for the maintenance of self-esteem or dignity as patients and as women.”

3.     The character of our pain is different.
6.     Our risks for chronic pain are significantly different and higher.

Evidence is mounting. 

“Medical researchers recently found that a specific manipulation of receptors in the nervous system for the neurotransmitter dopamine impairs chronic pain in male mice, but has no effect on females.” Science News (March 6, 2018, accessed September 2018)

There are biological differences in pain processing between the sexes.


I think it is imperative that we understand the differences in the way pain is experienced, reported, and treated as women. We desperately need more research on women’s health that focuses on intractable pain.

However, everyone is vulnerable when it comes to chronic pain. We all share the threats to our self-esteem and well-being when bias is present.

"Although pain is known to be prevalent across society, reliable data are lacking on the full scope of the problem, especially among those currently underdiagnosed and undertreated, including racial and ethnic minorities; people with lower levels of income and education; women, children, and older people; military veterans; surgery and cancer patients; and people at the end of life; among others."

Institutes of Medicine Report, 2011, Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research

That report was in 2011. It’s unfortunate, but the dialogue in 2018 has not improved, in fact, it has gotten much worse. Now everyone is discriminated against…


I always like to end on an encouraging note. It is out of adversity that opportunity exists. Use this time to raise awareness. Send a note, tag the CDC, NIH, and your congressional representatives in a tweet. You can find contact information and other helpful information in the Advocates Corner tab at the top of this page.

"A bird doesn't sing because it has an answer,

it sings because it has a song."


Additional Reading:

Coming soon: Brain Under Siege: Centralization, Chronic Pain, and Fibromyalgia (watch for it here.)

In healing,

Celeste Cooper, RN / Author, Freelancer, Advocate

Think adversity?-See opportunity!

~ • ~ • ~ • ~ • ~ • ~

Learn more about Celeste’s books here. Subscribe to posts by using the information in the upper right hand corner or use the share buttons to share with others. 

Wednesday, September 5, 2018

BCG Fibromyalgia Vaccine Trials Receive FDA Approval

As I stated in a blog I wrote in July (2018), the FM/a® Test is making a huge impact on the way fibromyalgia is diagnosed and now it is being used for very important research into the cause and treatment of our symptoms. - treatment

In April of 2017, I reported on a press release.  Excerpts:

EpicGenetics to detect fibromyalgia disease-specific gene markers. Additionally, Bruce Gillis, M.D., CEO of EpicGenetics, has made a research gift to the Immunobiology Laboratory at the Massachusetts General Hospital directed by Denise Faustman, M.D., Ph.D., to continue its robust clinical research regarding a direct treatment for fibromyalgia. 

The FM/a® Test is an FDA-compliant blood test that diagnoses fibromyalgia by identifying the presence of specific white blood cell abnormalities that have been documented to exist in these patients…

Based upon the findings of [Whole-Exome genetic] testing and once treatment protocols have received regulatory and institutional approvals, FM/a® Test positive patients will be invited to participate in a fibromyalgia-specific vaccine clinical trial to reverse the biology of fibromyalgia…

Today, I would to share with you “…the Food and Drug Administration (FDA) has approved the clinical trial of the BCG vaccine to treat fibromyalgia.”

Dr. Bruce Gillis, CEO of Epicgenetics, says, "This trial has the potential to impact the biology of fibromyalgia and now with clinical testing, it will be determined over the next four years whether this vaccine has clinical validity, as well.  Since the generic BCG vaccine is affordable and safe, the clinical trial introduction of this vaccine will perhaps transform the live of the patients who currently have no other direct treatments available to combat this very debilitating disease."

These are exciting times thanks to Dr. Gillis and others who desire to do away with the same labels and stereotypes once suffered by those with SLE (Lupus) and MS (multiple sclerosis) prior to having technology that allows physicians to make a diagnose. Because of his generosity and persistence, despite the naysayers supported by Big Pharma, we will get answers to some very important questions.

1.     Are there genetic factors that can identify the risk of developing fibromyalgia, like the BRCA gene indentifies breast cancer risk?
2.     Can the immune cell dysfunction found in fibromyalgia patients using the FM/a Test be treated with an old, safe, and cheap vaccine that is showing promise as a treatment for type-1 diabetes, and nearly irradiated tuberculosis?

This important, responsible randomized, double blind clinical trial could result in restoring the quality of life for those of us with fibromyalgia. The trial will be over four years. So, if you would like to be a candidate,


You will also find answers to frequently asked questions, a brochure to download, personal testimonies, access to peer-reviewed medical publications, and a scrolling list of insurance companies known to cover the test (at the bottom of the page). In addition, there is plenty of information to answer questions like why me, and how do I know if I am a candidate for the FM/a Test?  If you have more questions, you are encouraged to give their staff a call.

Additional Reading:

In healing,

Celeste Cooper, RN / Author, Freelancer, Advocate

Think adversity?-See opportunity!

~ • ~ • ~ • ~ • ~ • ~

Learn more about Celeste’s books here. Subscribe to posts by using the information in the upper right hand corner or use the share buttons to share with others. 

Saturday, September 1, 2018

PAINS Project Moves to Academy of Integrative Pain Management (AIPM)

A mission to transform the way pain is perceived, judged and treated.


I can’t think of a better time than Pain Awareness Month to make the following announcement.

As many of you know, I have had the pleasure of sharing information and participating in the Center for Practical Bioethics initiative, the PAINS Project. I have encouraged you to join me. My participation has allowed me to connect with many wonderful, caring people and organizations that have been an integral part
Myra, Jan Chambers (NFMCPA), and myself
2012 PAINS Conference
of PAINS, Pain Action Alliance to Implement a National Strategy, spearheaded by my friend Myra Christopher. Myra has an innate ability to connect people, serve on their behalf, and I think those who know her would agree a stubbornness to accept the status quo. Her service to others is exemplified in her work. Myra has retired, but her vision and her work will continue.

I have also shared a great deal with you from Bob Twillman, Executive Director at the Academy of Integrative Pain Management. That is because we share the same objectives and values that reflect patient centered care. I cannot think of a better organization to take the PAINS Project under their wing. The AIPM has been actively engaged with the Center for Practical Bioethics initiative since the very beginning. Forward we go…


Statements from the Center for Practical Bioethics and the Academy of Integrative Pain Management on the transition of the PAINS Project (Effective August 1, 2018)

John G. Carney, President/CEO of the Center for Practical Bioethics

The leadership that AIPM has exhibited in the complex arena of pain care treatment ensures that the investment the Center has made over the last decade will continue and flourish. The Academy’s commitment to excellence in interdisciplinary, patient-centered and evidence-based care with virtually every stakeholder group provides the confidence the Center needed in transitioning our work as Myra Christopher retires.

Those living with chronic pain rely on strong, respected and accomplished organizations to advance person-centered, integrative models of care by uniting clinicians in the fight against chronic pain. AIPM fits that profile and we are pleased and grateful that AIPM has agreed to honor the mission of the PAINS project and the decade long charitable efforts of the Center in this duty of care to vulnerable patients.

Clay Jackson, President of the Board of the Academy of Integrative Pain Management

At AIPM, we are grateful for the tremendous work that has been accomplished by everyone involved in the PAINS Project, and we feel that important milestones such as the publication of the National Pain Strategy would have been impossible to achieve without their commitment to patient advocacy and sound medical evidence.

As the only professional organization comprising members of every discipline that treats persons with pain, AIPM is uniquely positioned to continue to serve as the central repository of information regarding best practices in integrative pain care, and as a powerful force for advocating for making those treatments available to all patients. 

Please take a few minutes to read “Building Cathedrals: PAINS Transition to the Academy of Integrative Pain Management.” The brief will tell you how and why the PAINS Initiative was established in 2011, give an account on the opioid conundrum, what the Pain Management Best Practices Inter-Agency Task Force is, and more.


With financial support from PAINS, the Integrative Health Policy Consortium (IHPC), and the Alliance for Balanced Pain Management, AIPM convened the first Integrative Pain Care Policy Congress in October 2017. This first-of-its-kind meeting brought together more than 75 participants from more than 50 organizations, representing professional societies covering the full scope of licensed and certified healthcare providers, patient advocacy organizations, governmental agencies, private payers, and other important stakeholders. In a monumental task, these disparate parties agreed on a consensus definition of comprehensive integrative pain management, one that closely mirrors a definition previously offered in a PAINS policy brief:

Comprehensive Integrative Pain Management includes biomedical, psychosocial, complementary health, and spiritual care. It is person-centered and focuses on maximizing function and wellness. Care plans are developed through a shared decision-making model that reflects the available evidence regarding optimal clinical practice and the person’s goals and values…

PAINS’ six-year experience with its Citizen/Leaders Advisory Group demonstrates the strength of character, stamina, and ingenuity of chronic pain sufferers and their family caregivers. Those who have advised leaders of the PAINS Project are not only committed to helping themselves but also to helping others who cannot engage in reform efforts because of physical limitations—those who are often isolated, stigmatized and falsely accused of being drug seekers. This perception must change. As recent media is beginning to tell stories of chronic pain sufferers as well as those of people living with opioid use disorders which have dominated media coverage for several years, stereotypes are beginning to be dispelled, and ultimately these narratives will fuel reform efforts…

[comment: I was gifted with the opportunity to be an inaugural participant of the PAINS-KC patient leadership group thanks to the encouragement of Myra Christopher.] 

You will still find the PAINS Project at

Be sure to bookmark the new social media handles.

In healing,

Celeste Cooper, RN / Author, Freelancer, Advocate

Think adversity?-See opportunity!

~ • ~ • ~ • ~ • ~ • ~

Learn more about Celeste’s books here. Subscribe to posts by using the information in the upper right hand corner or use the share buttons to share with others. 

Celeste's Website

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