Cognitive dysfunction, brain fog, is common in fibromyalgia and chronic fatigue immunodysfunction. It could be due to the centralization of pain found in FM or CFID (ME/CFS) or it could be due to one of the comorbid conditions such as, insulin resistance, reactive hypoglycemia, hypothyroidism, other hypometabolism, poor sleep regulation, or some type of organic brain syndrome. It is important that you discuss all of your symptoms with your doctor so that any comorbid condition can be ruled in or out and be appropriately treated.
I know only too well how frustrating brainfog can be, losing words midsentence, transposing words and numbers. I cannot be trusted to write down a phone number for instance. Short term memory loss can be affected too, and at a greater degree than that of your friends who say, “Oh, I do that too.” In fact, they probably do that too, but not EVERY time they walk into a room, look around, and wonder what they are doing there, if they do, I suggest they too have the above mentioned conditions investigated. Comments like this makes us want to ask them how many times they have driven to their doctor only to be lost in a parking lot, not having a clue as to where they are or how to get to a place they have been many times before, then wondering if someone will want to take their license away if we share that information. (I do suggest that if you are in a flare, have someone else drive if at all possible. Asking for help is ok.) Frustrating seems a simple word to describe this dilemma that has robbed many of us from our livelihood.
We have tried about every supplement available to regain our cognition, and that can be a dangerous thing too, because many interfere with other medications we take.
There is no cure for brain fog, but it is important to understand there could be underlying conditions contributing to this unwanted side effect. There are helpful tools, which we discuss in our book. Being organized and learning to manage time can be very helpful. Will these tips broom away the dust bunnies? Probably not, but they will help with the frustration that is created as a result. Deep breathes, and try to treat yourself with loving care, understanding that your brain is trying to function, despite the road blocks getting in its way. It is chugging along, and we should too. Try to turn the experience into something positive. I am certain if we wrote down each episode, we could put together a really good comedy book.
Things always look brighter when we can look back on it and laugh.
Healing, harmony and hope, Celeste, RN, author, FM expert at Sharecare.com
All blogs, posts and answers are based on the work in Integrative Therapies for Fibromyalgia, Chronic Fatigue Syndrome, and Myofascial Pain: The Mind-Body Connection by Celeste Cooper, RN, and Jeff Miller, PhD. 2010, Vermont: Healing Arts press and are not meant to replace medical advice. http://www.thesethree.com
Author of Chapter Five, Living with and Coping Effectively Through Fibromyalgia: Detecting Barriers, Understanding the Clues, in Fibromyalgia Insider Secrets: 10 Top Experts, 2nd Ed. Ebook complied by Deirdre Rawlings, ND, PhD
Friday, February 3, 2012
Thursday, January 26, 2012
Does 2+2=3? The tender point model of fibromyalgia.
This is a great question and one that has always confused me too. First, the tender point model was never meant to be the diagnostic hallmark which has evolved. It was originally developed as a tool to be used for analyzing participants for a study.
Most likely the tender points were paired to indicate that the tenderness and pain of fibromyalgia occurs on both sides of the body. I doubt there was any other significance because the criteria actually says one must have at least 13 of the 18 tender points for a diagnosis of FM. Thirteen tender points would mean that at least one of the pairs was broken up.
Excerpt ©
Unlike other disease processes, the symptoms of fibromyalgia affect all four quadrants of the body equally. In other words, tender points are found on both sides of the upper body (above the waist) and both sides of the lower body (below the waist). If there is a tender point in the left elbow, there will be another tender point in the same spot on the right elbow. Painful tender points are consistent and are considered chronic because they persist for a period of at least three months. (Cooper and Miller, pg. 9, 2010)
An exact description and tender point model can be found at http://www.thesethree.com/fibromyalgia/tender-points.php Be sure to browse the site for more important information.
Since the adoption of the tender point model as a diagnostic tool, it has met much criticism. Some patients have tender points in other areas of the body, more than 18 or less than 18, but still meet other criteria that have continued to evolve as we learn more about fibromyalgia. As a matter of fact there are those that think the tender point model should go by the wayside. The new preliminary proposed criteria only considers a WPI, wide-spread pain index. This concerns me because it is a reported complaint and the examiner will not have to put their hands on the patient at all. A physical exam has always been the greatest diagnostic tool the physician or nurse practitioner has.
Other considerations of the tender point model is the suspicion these are not tender points per se, but myofascial trigger points (MTPs) or pain in the MTP referral pattern of pain and neuralgia and other consequences. This has been shown in several studies. Read more about this at http://www.thesethree.com/cmp/chronic-myofascial-pain.php
Other helpful information can be found at In with the New, Out with the Old: Fibromyalgia diagnostics
Blogger http://fmcfstriggerpoints.blogspot.com/2011/08/in-with-new-out-with-old-fibromyalgia.html
And
Helping your doctor diagnose fibromyalgia
Blogger http://fmcfstriggerpoints.blogspot.com/2011/08/helping-your-doctor-diagnose.html
All blogs, posts and answers are based on the work in Integrative Therapies for Fibromyalgia, Chronic Fatigue Syndrome, and Myofascial Pain: The Mind-Body Connection by Celeste Cooper, RN, and Jeff Miller, PhD. 2010, Vermont: Healing Arts press and are not meant to replace medical advice. http://www.thesethree.com
This blog is based my answer to the question “Why are all of the fibromyalgia tender points paired?” as fibromyalgia expert at ShareCare.com
Most likely the tender points were paired to indicate that the tenderness and pain of fibromyalgia occurs on both sides of the body. I doubt there was any other significance because the criteria actually says one must have at least 13 of the 18 tender points for a diagnosis of FM. Thirteen tender points would mean that at least one of the pairs was broken up.
Excerpt ©
Unlike other disease processes, the symptoms of fibromyalgia affect all four quadrants of the body equally. In other words, tender points are found on both sides of the upper body (above the waist) and both sides of the lower body (below the waist). If there is a tender point in the left elbow, there will be another tender point in the same spot on the right elbow. Painful tender points are consistent and are considered chronic because they persist for a period of at least three months. (Cooper and Miller, pg. 9, 2010)
An exact description and tender point model can be found at http://www.thesethree.com/fibromyalgia/tender-points.php Be sure to browse the site for more important information.
Since the adoption of the tender point model as a diagnostic tool, it has met much criticism. Some patients have tender points in other areas of the body, more than 18 or less than 18, but still meet other criteria that have continued to evolve as we learn more about fibromyalgia. As a matter of fact there are those that think the tender point model should go by the wayside. The new preliminary proposed criteria only considers a WPI, wide-spread pain index. This concerns me because it is a reported complaint and the examiner will not have to put their hands on the patient at all. A physical exam has always been the greatest diagnostic tool the physician or nurse practitioner has.
Other considerations of the tender point model is the suspicion these are not tender points per se, but myofascial trigger points (MTPs) or pain in the MTP referral pattern of pain and neuralgia and other consequences. This has been shown in several studies. Read more about this at http://www.thesethree.com/cmp/chronic-myofascial-pain.php
Other helpful information can be found at In with the New, Out with the Old: Fibromyalgia diagnostics
Blogger http://fmcfstriggerpoints.blogspot.com/2011/08/in-with-new-out-with-old-fibromyalgia.html
And
Helping your doctor diagnose fibromyalgia
Blogger http://fmcfstriggerpoints.blogspot.com/2011/08/helping-your-doctor-diagnose.html
All blogs, posts and answers are based on the work in Integrative Therapies for Fibromyalgia, Chronic Fatigue Syndrome, and Myofascial Pain: The Mind-Body Connection by Celeste Cooper, RN, and Jeff Miller, PhD. 2010, Vermont: Healing Arts press and are not meant to replace medical advice. http://www.thesethree.com
This blog is based my answer to the question “Why are all of the fibromyalgia tender points paired?” as fibromyalgia expert at ShareCare.com
Monday, January 16, 2012
Sleep oh sleep, where art thou? Could your fibromyalgia medications be causing insomnia?
Yes, fibromyalgia medication could be causing your insomnia.
Cymbalta® (Duloxetine) and Savella® (milnacipran) which have been approved for treating fibromyalgia are in a class of drugs called selective serotonin and norepinephrine reuptake inhibitors (SNRIs) and insomnia is a side effect for both medications.
Also note worthy is that many fibromyalgia patients have migraine headaches as a comorbid condition. Selective serotonin and norepinephrine reuptake inhibitors (SNRIs) and selective serotonin reuptake inhibitors (SSRIs) can have serious, even life threatening interactions when combined with triptans such as zolmitriptan and sumatriptan used to treat migraine. If you are a migraineur, be sure to remind your doctor, close monitoring is suggested. If you have frequent migraine that requires abortive medications, I would certainly think twice before taking an SSRI or an SNRI. We are in an era where we must be our own best advocate.
Neurontin® (gabapentin) and Lyrica® (pregabalin) are anti-seizure drugs and are also used to treat the pain of fibromyalgia. Neither was found to have an insomnia effect in the studies except during the withdrawal process. However, there have been anecdotal complaints, which could suggest a paradoxical (opposite) reaction. When you have fibromyalgia, just about any reaction or sensitivity is possible. The important thing is to report any untoward effects to your doctor.
Because cognitive deficit and fatigue are common complaints by the fibromyalgia patient, medications to treat ADHD have been used to improve vigilance. This particular group of medications has a higher incidence of insomnia. With that said, there is also a group of patients that these type of medications help in slowing the brain response down.
We are each different, with different co-existing conditions and different responses to various medications. It is important to check with your pharmacist regarding your medications, any potential interactions, and side effects. Always report reactions to your pharmacist and healthcare provider and seek immediate help if you have an allergic reaction, swelling of the mouth, tongue or throat, which can block your airway.
This blog is based on my original answer at ShareCare, Could my fibromyalgia medications be causing my insomnia?
Cymbalta® (Duloxetine) and Savella® (milnacipran) which have been approved for treating fibromyalgia are in a class of drugs called selective serotonin and norepinephrine reuptake inhibitors (SNRIs) and insomnia is a side effect for both medications.
Also note worthy is that many fibromyalgia patients have migraine headaches as a comorbid condition. Selective serotonin and norepinephrine reuptake inhibitors (SNRIs) and selective serotonin reuptake inhibitors (SSRIs) can have serious, even life threatening interactions when combined with triptans such as zolmitriptan and sumatriptan used to treat migraine. If you are a migraineur, be sure to remind your doctor, close monitoring is suggested. If you have frequent migraine that requires abortive medications, I would certainly think twice before taking an SSRI or an SNRI. We are in an era where we must be our own best advocate.
Neurontin® (gabapentin) and Lyrica® (pregabalin) are anti-seizure drugs and are also used to treat the pain of fibromyalgia. Neither was found to have an insomnia effect in the studies except during the withdrawal process. However, there have been anecdotal complaints, which could suggest a paradoxical (opposite) reaction. When you have fibromyalgia, just about any reaction or sensitivity is possible. The important thing is to report any untoward effects to your doctor.
Because cognitive deficit and fatigue are common complaints by the fibromyalgia patient, medications to treat ADHD have been used to improve vigilance. This particular group of medications has a higher incidence of insomnia. With that said, there is also a group of patients that these type of medications help in slowing the brain response down.
We are each different, with different co-existing conditions and different responses to various medications. It is important to check with your pharmacist regarding your medications, any potential interactions, and side effects. Always report reactions to your pharmacist and healthcare provider and seek immediate help if you have an allergic reaction, swelling of the mouth, tongue or throat, which can block your airway.
This blog is based on my original answer at ShareCare, Could my fibromyalgia medications be causing my insomnia?
(Signature
line appended, April 2018)
In healing,
Celeste Cooper, RN / Author, Freelancer, Advocate
Think adversity?-See opportunity!
~ • ~ • ~ • ~ • ~ • ~
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Sunday, January 8, 2012
Chest wall pain mimic costochondritis in fibromyalgia: Successful treatment
The muscles between the ribs are formed in such a way to allow our chest to expand and relax with breathing. It performs its job many times a day. The average adult breaths about 20 times per minute, that is a lot of work. Many fibromyalgia patients and some chronic fatigue (ME/CFS) patients complain of chest wall pain and restriction of movement. Often this restriction and pain is misdiagnosed by the health care provider as costochondritis, which is inflammation of the muscles between our ribs, usually seen when there is a viral or infectious process present.
I want to make this very clear; fibromyalgia is not considered an inflammatory disorder. It is a disruption in the central nervous system that is hyper-sensitized by the presence of peripheral pain generators such as chronic myofascial pain.
More often than not FM patients have comorbid myofascial trigger points (MTPs) of, , chronic myofascial pain (AKA, myofascial pain syndrome). These MTPs shorten the muscle involved cause pain and dysfunction, radiate pain (in some cases neuropathy and other symptoms) in a consistent pattern for the location of that specific trigger point. It is my belief and the belief of other experts that the chest wall pain found in FM is from intervertebral (between the ribs) myofascial trigger points, which restrict the motion of the chest wall during inspiration. This restriction then leads to ineffective breathing.
The treatment for chest wall pain found in FM is not medications for inflammation unless there is a known inflammatory condition present, (MTPs are not inflammatory in nature either). The treatment is trigger point therapy. If you can feel the tender painful knot apply 80% pressure with stroking motion for 30-60 sec. There can be many, because the rib cage is a lush environment because of the muscle complexity necessary to operate effectively. Myofascial trigger points can be behind bone or other large muscles, the rib bone in this case. This make it difficult to treat them, however, also helpful is deep breathing exercises such as Qi Gong.
Cellular oxidative stress has been indicated in fibromyalgia, even better reason to get that chest wall moving. We explain deep breathing techniques in our book and the comorbid condition, chronic myofascial pain at length, the dos and don’ts, therapies that can help, and what to avoid.
All blogs, posts and answers are based on the work in Integrative Therapies for Fibromyalgia, Chronic Fatigue Syndrome, and Myofascial Pain: The Mind-Body Connection by Celeste Cooper, RN, and Jeff Miller, PhD. 2010, Vermont: Healing Arts press and are not meant to replace medical advice. http://www.thesethree.com
I want to make this very clear; fibromyalgia is not considered an inflammatory disorder. It is a disruption in the central nervous system that is hyper-sensitized by the presence of peripheral pain generators such as chronic myofascial pain.
More often than not FM patients have comorbid myofascial trigger points (MTPs) of, , chronic myofascial pain (AKA, myofascial pain syndrome). These MTPs shorten the muscle involved cause pain and dysfunction, radiate pain (in some cases neuropathy and other symptoms) in a consistent pattern for the location of that specific trigger point. It is my belief and the belief of other experts that the chest wall pain found in FM is from intervertebral (between the ribs) myofascial trigger points, which restrict the motion of the chest wall during inspiration. This restriction then leads to ineffective breathing.
The treatment for chest wall pain found in FM is not medications for inflammation unless there is a known inflammatory condition present, (MTPs are not inflammatory in nature either). The treatment is trigger point therapy. If you can feel the tender painful knot apply 80% pressure with stroking motion for 30-60 sec. There can be many, because the rib cage is a lush environment because of the muscle complexity necessary to operate effectively. Myofascial trigger points can be behind bone or other large muscles, the rib bone in this case. This make it difficult to treat them, however, also helpful is deep breathing exercises such as Qi Gong.
Cellular oxidative stress has been indicated in fibromyalgia, even better reason to get that chest wall moving. We explain deep breathing techniques in our book and the comorbid condition, chronic myofascial pain at length, the dos and don’ts, therapies that can help, and what to avoid.
All blogs, posts and answers are based on the work in Integrative Therapies for Fibromyalgia, Chronic Fatigue Syndrome, and Myofascial Pain: The Mind-Body Connection by Celeste Cooper, RN, and Jeff Miller, PhD. 2010, Vermont: Healing Arts press and are not meant to replace medical advice. http://www.thesethree.com
Saturday, January 7, 2012
December '11 Blogs for Fibromyalgia, Chronic Fatigue Syndrome, and Myofascial Pain
Following is a recap of my blogs on FM and CFID (ME/CFS) at both my profile as expert for Dr. Oz on Sharecare, and blogger. Please feel free to disseminate the information as you see fit for the better good of all FM and ME/CFS patients. In healing, harmony and hope for awareness.
A years worth of blogs can be found in the archives of the right column at Google Blogger. There might be something of particular interest there for you.
December 2011
These Three, Fibromyalgia, Chronic Fatigue Syndrome, and Myofascial Pain.
In a word – What we know about terms and fibromyalgia
http://www.sharecare.com/user/celeste-cooper/blogs/show/in-a-word-what-we-know-about-terms-and
http://fmcfstriggerpoints.blogspot.com/2011/12/in-word-what-we-know-about-terms-and.html
Ironic, the P in Substance P: The Relationship of Pain in Fibromyalgia
http://www.sharecare.com/user/celeste-cooper/blogs/show/ironic-the-p-in-substance-p-the-relationship-of-pain
http://fmcfstriggerpoints.blogspot.com/2011/12/ironic-p-in-substance-p-relationship-of.html
Ups and Downs; unpredictability of FM and CFID. How can I avoid a flare?
http://www.sharecare.com/user/celeste-cooper/blogs/show/ups-and-downs-unpredictability-of-fm-and-cfid-how-can
http://fmcfstriggerpoints.blogspot.com/2011/12/ups-and-downs-unpredictability-of-fm.html
Nerve to Muscle and the Role in Fibromyalgia
http://www.sharecare.com/user/celeste-cooper/blogs/show/nerve-to-muscle-and-the-role-in-fibromyalgia
http://fmcfstriggerpoints.blogspot.com/2011/12/nerve-to-muscle-and-role-in.html
All blogs, posts and answers are based on the work in Integrative Therapies for Fibromyalgia, Chronic Fatigue Syndrome, and Myofascial Pain: The Mind-Body Connection by Celeste Cooper, RN, and Jeff Miller, PhD. 2010, Vermont: Healing Arts press and are not meant to replace medical advice
A years worth of blogs can be found in the archives of the right column at Google Blogger. There might be something of particular interest there for you.
December 2011
These Three, Fibromyalgia, Chronic Fatigue Syndrome, and Myofascial Pain.
In a word – What we know about terms and fibromyalgia
http://www.sharecare.com/user/celeste-cooper/blogs/show/in-a-word-what-we-know-about-terms-and
http://fmcfstriggerpoints.blogspot.com/2011/12/in-word-what-we-know-about-terms-and.html
Ironic, the P in Substance P: The Relationship of Pain in Fibromyalgia
http://www.sharecare.com/user/celeste-cooper/blogs/show/ironic-the-p-in-substance-p-the-relationship-of-pain
http://fmcfstriggerpoints.blogspot.com/2011/12/ironic-p-in-substance-p-relationship-of.html
Ups and Downs; unpredictability of FM and CFID. How can I avoid a flare?
http://www.sharecare.com/user/celeste-cooper/blogs/show/ups-and-downs-unpredictability-of-fm-and-cfid-how-can
http://fmcfstriggerpoints.blogspot.com/2011/12/ups-and-downs-unpredictability-of-fm.html
Nerve to Muscle and the Role in Fibromyalgia
http://www.sharecare.com/user/celeste-cooper/blogs/show/nerve-to-muscle-and-the-role-in-fibromyalgia
http://fmcfstriggerpoints.blogspot.com/2011/12/nerve-to-muscle-and-role-in.html
All blogs, posts and answers are based on the work in Integrative Therapies for Fibromyalgia, Chronic Fatigue Syndrome, and Myofascial Pain: The Mind-Body Connection by Celeste Cooper, RN, and Jeff Miller, PhD. 2010, Vermont: Healing Arts press and are not meant to replace medical advice
Friday, December 30, 2011
In a word – What we know about terms and fibromyalgia
Historical terms for what we know today as fibromyalgia:
fibromyocitis
muscular rheumatism
tension myalgia/ tension rheumatism
psychogenic rheumatism
neurasthenia
fibrositis
(Cooper and Miller, 2010)
Fibromyositis
Fibromyositis is still alive and we now know it is not interchangeable with FM. It is an inflammatory condition of muscle associated with overgrowth of the connective tissue.
Muscular rheumatism
Muscular rheumatism is today used to describe what we know as polymyalgia rheumatica.
Sneak Peek, Polymyalgia Rheumatica©…Tension myalgia
Because muscle pain and stiffness are associated with PMR, it could be confused with FM, CFID, or CMP. However, it is a different condition all together. Polymyalgia rheumatica is inflammatory in nature. Because muscle pain and stiffness are associated with PMR, it could be
confused with FM, CFID, or CMP. However, it is a different condition all together….
(Cooper and Miller, 2010, pg 104)
Tension myalgia implies muscle pain from tense muscles, Mayo Clinic says, “Tension myalgia is a diagnosis that has been in use at the Mayo Clinic for more than 40 years. The term describes a common muscle pain disorder that is conceptually similar to other muscle pain disorders such as fibrositis, fibromyalgia, and myofascial pain syndrome. This article outlines the history of these disorders and proposes "tension myalgia" as a term that unifies these separate diagnoses under one conceptual framework. Because the diagnostic criteria for tension myalgia have been vague, the Department of Physical Medicine and Rehabilitation at the Mayo Clinic has developed specific criteria for generalized, regional, and localized forms of this disorder. The recommended treatment approach includes reassurance, elimination of contributing factors, physical therapy to restore normal neuromuscular function, conditioning, and medications.” (Thompson, 1990)
It is my opinion that tension myalgia may be related to what we know today as myofascial pain syndrome (MPS) referred to in our book as chronic myofascial pain (CMP). MPS/CMP is a prevalent peripheral pain generator to the centralization of pain found in FM.
Psychogenic rheumatism
Psychogenic rheumatism is an old term that implies muscle pain is a psychiatric disease. Unfortunately, despite the overwhelming evidence to the contrary, there are still those that would like to put us in this category.
Neurasthenia
Neurasthenia is an old term that denoted what they thought was a psychological disorder manifested by chronic fatigue and weakness, loss of memory, and widespread pain, thought to be from an exhausted nervous system. This definition of an old term certainly does relate to what some of us still experience from our healthcare providers today. I would like to think our practitioners know that the breakdown in the central nervous system in FM is a biological problem that is caused by the presence peripheral pain generators called myofasical trigger points. Though they knew nothing of MPS/CMP in those days (long before the work of Travell and Simons), somehow I feel they would have embraced modern studies better than they are received in our healthcare delivery system today.
Fibrositis
Fibrositis is still used as a synonym for fibromyalgia by some who haven’t kept up with the research. Even though “itis” is the suffix for inflammation and we now know that fibromyalgia is not an inflammatory disorder. It is a syndrome that affects the central nervous system, perpetuated by peripheral nerve to muscle deregulation.
(Signature line appended, March 2018)
In healing,
Celeste Cooper, RN / Author, Freelancer, Advocate
Think adversity?-See opportunity!
Cooper C and Miller J, Integrative Therapies for Fibromyalgia, Chronic Fatigue Syndrome, and Myofascial Pain: The Mind-Body Connection. Vermont: Healing Arts, 2010
Thomson, TM, Tension myalgia as a diagnosis at the Mayo Clinic and its relationship to fibrositis, fibromyalgia, and myofascial pain syndrome. Mayo Clin Proc. 1990 Sep;65(9):1237-48.
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