Thriving with Fibromyalgia

Turn your bathtub into a hydrotherapy spa

There are a few research studies that have shown the benefits of Hydrotherapy, or what most of us call soaking in hot water, sometimes with minerals added. Most fibromyalgia patients do find that heat helps temporarily relieve their aches and pains.

How can you take advantage of this without spending a fortune? If you have a working bathtub, you can get some great benefits from soaking. Here are a few tips:
Get an inexpensive plastic bathmat with suction cups for the bottom of the tub; this will make it much more comfortable to lie on your back.
Get an inexpensive plastic bath pillow with suction cups for the bottom of the tub.
Use a washcloth under your rear end to keep from sliding around while you are lying down in the tub.
If you want to lie down so that your neck and shoulders are in the hot water, you will not be able to fill the tub up to the point that it covers your stomach. Fill the tub to the point where you can just barely feel your upper body lifting a tiny bit off the bottom of the tub, but so that your hips are securely on the bottom of the tub and your head is able to relax on the bath pillow.
Use a hand towel soaked in hot water to keep your chest and stomach warm (the water will not cover you up this far if you are actually lying down with your head in the tub).
If you have a little extra money, buy a small space heater, the kind that is oil filled and is safe for using in a bathroom. This will heat up a small bathroom quite quickly, and make you feel a lot more comfortable getting in and out of the tub.
Dry off quickly, and put on lotion, mineral oil, or sesame oil; soaking in hot water will be tend to dry your skin out.
You can buy Epsom salts pretty cheaply at the grocery store. Adding these to the water will help relieve bruises and aching muscles.

No pill treatments for fibromyalgia

Is there anything that really works for fibromyalgia aside from medications?  This was the subject of a systematic review of the literature, published in a peer-reviewed journal.  After doing their review of articles, they came up with 25 randomized controlled trials.  These are considered the gold standard of figuring out whether something works or not.  It means that people are assigned by chance to either get the treatment or not get treatment, and that information about whether you are getting the treatment or not is not available to the person doing the analysis.

The studies covered exercise therapy, educational intervention, relaxation therapy, cognitive behavioral therapy, acupuncture, and forms of hydrotherapy.  They found a lot of problems with the studies, with poor methodology, small numbers of people involved, and not enough statistical power to really give a good outcome.  The longest follow-up was 16 weeks.

The bottom line from all this was that strong evidence did not emerge for any single intervention, although there was some good support for aerobic exercise.  They ended by recommending more studies in the area.

Sim J, Adams N. systematic review of randomized controlled trials of non-pharmacological interventions for fibromyalgia.  The clinical Journal of pain, volume 18 (5), September/October 2002.  324-336.

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=12218504&ordinalpos=5&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

Treatments for irritable bowel syndrome

Too many bacteria in the small intestine (small intestinal bacterial overgrowth) is often the cause of irritable bowel syndrome.  One way to test for this is to see if patients have more methane on their breath after they eat some lactulose (lactulose breath test). One study showed that treating irritable bowel syndrome patients with non-absorbable antibiotics resulted in the symptoms going away completely.  This can happen after only 10 days of rifaximin, a non-absorbed oral antibiotic that acts mostly in the small intestine.  Even after patients stopped the antibiotics, they still felt better.  Probiotics have also been used in studies of irritable bowel syndrome with good results.

Othman M, Aguero R, Lin H. Alterations in intestinal microbial flora and human disease (Gastrointestinal infections: edited by Edgar C. Boedeker).

Bugs in your gut

It's not something we usually want to think about, but all of us are born with a variety of "bugs" in our intestines.  Shortly after birth, hundreds of species of bacteria and archaea establish themselves in the colon.  There are over 400 species of microbes that are normally concentrated in the colon, but surprisingly, the small intestine is not supposed to have very much.  When you get too much bacteria in the small intestine, it is called small intestinal bacterial overgrowth, or SIBO.  This can cause a lot of health problems, and has been shown to make acute pancreatitis worse, to cause irritable bowel syndrome, to make inflammatory bowel disease worse, and to be related to fibromyalgia.

Othman M, Aguero R, Lin H. Alterations in intestinal microbial flora and human disease (gastrointestinal infections: edited by Edgar C. Boedeker).

More hardware issues

Sorry I have been unable to write for awhile.  In continuing to tweak my computer after its return from the HP workshop, I had several trips to Fry's for various cables and missing bits.  Helpfully now things are working better, although half the time my Golden Touch keyboard seems to have trouble getting recognized.  Here's hoping everything will keep on working without further glitches!

Scalp stimulation as a treatment for fibromyalgia

C2 area neurostimulation: a surgical treatment for fibromyalgia.

Thimineur M, De Ridder D.

Pain Management Division, Department of Anesthesiology, Griffin Hospital, Derby, Connecticut, USA.

Twelve patients got a surgical implant to stimulate the scalp.  The researchers thought this might work because it has been effective for patients with chronic migraine.  Pain levels went down, fatigue  and depression also improved.  There were no problems with infections related to the implant that delivered the scalp stimulation.

Medicines for fibromyalgia

There is only one medication that has been approved by the Food and Drug Administration specifically for fibromyalgia.  It is Lyrica; the generic name is pregabalin.  Lyric is in a class of medications called anticonvulsants that were originally developed for treating seizures and also for nerve pain.  Some of the benefits of Lyrica include improved sleep, less fatigue, less pain and a better quality of life.  Side effects include dizziness, sleepiness, and sometimes swelling of the feet.  The most commonly prescribed medication for fibromyalgia is antidepressants.  Several different studies have shown that antidepressants do help with sleep, tenderness and stiffness.  The most commonly prescribed antidepressant is in the tricyclic category.  Studies have shown mixed results in terms of antidepressants called selective serotonin reuptake inhibitors and dual acting serotonin and noradrenaline reuptake inhibitors.

Turk DC, Vierck CJ, Scarbrough E, Crofford LJ, Rudin NJ.  Fibromyalgia: combining pharmacological and non-pharmacological approaches to treating a person, not just the pain.  Journal of Pain, 2007 Oct 10.

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=17936075&ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

Restless legs syndrome

It turns out there's a connection between restless legs syndrome and small intestinal bacterial overgrowth (SIBO).  Restless legs syndrome occurs in many patients with fibromyalgia.  In this study, patients who had irritable bowel syndrome received treatment to take care of the bacterial overgrowth.  10 of the 13 patients that were included in the study had at least an 80% improvement in their restless legs symptoms once the bacterial overgrowth problem was taking care of.  Too bad the study didn't look at whether the fibromyalgia symptoms improved after this treatment.

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=17934858&ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

More on your dentist and fibromyalgia

Balasubramaniam, Laudenback, and Stoopler have an article in "Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology" volume 104, issue five, November 2005, pages 589-602.  Fibromyalgia: an update for Oral healthcare providers.  One of the things your doctor can help you with during your regular checkup is to check for tight muscles in your jaw joints and sore spots from your teeth grinding.  In addition, your dentist should avoid keeping your jaw open for long periods of time, allowing you frequent breaks and/or providing support for keeping your mouth open so you don't get sore.

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=17964475&ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

Your dentist and fibromyalgia

It turns out that your dentist should be looking for a few things when you go for your regular exam if you have fibromyalgia.  A lot of fibromyalgia patients also have problems with job pain, headaches, and other oral complaints.  The dentist should be looking at whether you have sore muscles in your jaws and any problems with your bite.  The dentist should also check to see if you are grinding your teeth at night.  All of these problems can contribute to your fibromyalgia pain.  Headaches are reported by half to almost all of fibromyalgia patients, depending on the study.  Migraines and chronic headaches are pretty common.  Other oral complaints include dry mouth, a burning pain in the time, and a bad taste in the mouth.  These complaints can often be related to the medicines that are prescribed for fibromyalgia.

One little gem from this article is that antidepressants called SSRIs can often increased tooth grinding at night.