CHAPTER 1 FIBROMYALGIA AND CHRONIC GLOBAL PAIN SYNDROMES--CLEARING UP THE CONFUSION I decided to write this book in response to the mass confusion over fibromyalgia and the associated syndromes incorrectly diagnosed as fibromyalgia. Together, these syndromes afflict literally millions of Americans.1 For decades, too many have suffered in silence from these illnesses because medicine has been slow to understand them--and slower still to offer the right diagnoses and specific treatments. Sadly, there are millions of people who fit one of the following categories. .People who have been diagnosed with fibromyalgia but still have questions about their condition .People who are being treated for fibromyalgia but aren't feeling better yet and wonder if something else might be wrong .People who have been told that they have fibromyalgia but have been misdiagnosed and may be suffering from another illness .People who are still struggling to identify what is wrong with them, even though they've been to countless doctors The bottom line is that those who experience fibromyalgia and other chronic global pain syndromes are one of the most substantial--and underserved-- segments of pain sufferers. If you suffer from global pain, I feel for you. I am writing The Fibro Fix because, after working with so many patients who have struggled with global pain, I know your struggle. In fact, my mother- in-law was once a sufferer until I married her daughter and helped fix her fibromyalgia! My approach begins with understanding the complexity of this interrelated cluster of illnesses, which--for now--I discuss under the broad term fibromyalgia syndrome, or FM. This is the foundation for finding and implementing new and more effective treatments. The first step is to determine precisely what you are experiencing, and the second is to identify what is causing your specific complaints. Surprisingly, standard health care often fails to explore those two simple steps. In this book, my goal is to help you understand why it has been so hard until now to get answers and solutions for your pain. FM is mysterious because each case is individual, and without an individualized approach, people and their doctors can't readily arrive at the right treatments. Unfortunately, the US health care system is not yet ready to accommodate individualized treatment--even though that is what is required to help you resolve your pain. Later in this chapter, and throughout the book, I will examine the factors in our health-care system that make it unnecessarily challenging for patients with FM. You need to fully grasp this in order to move forward, put past hardships behind you, and be ready for all the benefits you'll get from this new approach. I want you to feel those benefits right away. So, as soon as you read this chapter--or for that matter, as you read it--I invite you to undertake my 21-day foundational program, which you'll find in Chapter 2. By following just three simple steps you'll begin to alleviate your symptoms at once, whatever their underlying cause may be. You'll automatically revive low energy; reduce any inflammation that may be driving your pain; eliminate food allergens and sensitivities, which can also cause inflammation; reduce your stress; and start to regain critical mobility. As you follow the plan, go on to read Chapter 3, where I explain that along with fibromyalgia, we need to look at additional kinds of health problems that aren't fibromyalgia--but are often misdiagnosed as such. Both fibromyalgia and each kind of FM mimic require their own specific treatment, which I discuss in Chapters 4, 5, and 6. Understanding the distinctions among classic fibromyalgia and its imitators is half the battle. You'll also take a test to help you determine if there's a likelihood that your issue is classic fibromyalgia. In Chapter 7, I will troubleshoot additional and more advanced treatments, tests, and options, should these be necessary, as determined by your progress through the program. And in Chapter 8, I present a maintenance plan for going forward as your health improves. This book will ensure that you have all the resources you need to get to the bottom of your chronic pain syndrome and regain your health. Who Suffers from Fibromyalgia Syndrome? About 15 million people in the United States and about 20 million in the rest of the world are suffering from FM, according to a 2011 National Institutes of Health finding. And that figure may be even higher, for several reasons. A prime reason, as you'll hear me say over and over again, is that fibromyalgia is notoriously hard to diagnose; you'll learn from reading this book that it's often mistaken for illnesses with strikingly similar symptoms. Another reason the statistics may be skewed is that men and women tend to perceive pain differently, and as a group, women have been shown in research to perceive pain at lower pressure thresholds when it is applied to their soft tissues than men.2 THE COSTS OF FIBROMYALGIA Fibromyalgia costs a lot of money--both to patients and to society. A 2014 study found that 34 percent of fibromyalgia sufferers spend from $100 to $1,000 per month over and above their insurance on health professionals. In addition there's lost work time. Researchers estimate that fibromyalgia is responsible for a 1 to 2 percent loss in the nation's overall productivity. And failure to diagnose FM correctly has its own costs, in doctor visits, prescriptions, lab tests, and lost time.3 Based on the statistics we have, although fibromyalgia strikes both genders and all races, it generally strikes people between the ages of 20 and 55 and affects women about ten times more than men. The typical fibromyalgia sufferer is a Caucasian woman. But since white women are also the segment of the public most likely to schedule an office visit when they experience a health problem, it's possible that is skewing the statistics somewhat.4 Although a precise cause is not known, classic fibromyalgia is a disorder of the central nervous system--in effect, a wiring problem--that may be triggered by trauma or early psychological issues. While environmental factors play a role, there is very likely a genetic component, as well: Up to 28 percent of children born to a parent with fibromyalgia develop it themselves.5 Symptoms of Fibromyalgia While there may be many other possible symptoms of FM, let's start with the most common one: pain. The pain of true, or classic, fibromyalgia is referred to as global, affecting the upper and lower extremities on both sides of the body as well the torso. This type of pain is not just in one region, or even several regions, of the body--for example the shoulder, lower back, and pelvis. Global pain is experienced all over the body. Do You Have Global Pain or Regional Pain? The pain diagrams filled out by patients in Figure 1.1 illustrate the difference between global pain and regional pain. It's actually quite easy to distinguish global pain from localized or regional pain. Suppose you accidentally hit your finger with a hammer. It will hurt like crazy! Doctors call this localized pain since it's confined to a specific area that you can readily pinpoint. The pain also comes from a clearly known cause--in this case, the hammer. In contrast, global pain is not limited to any particular area of the body. The pain you feel is widespread. It involves your arms and legs on both sides of the body and is usually felt in your torso, as well. There is acute sensitivity to touch and sometimes light and sound. Even mild stimuli, like a pat on the back, may feel painful. But while the pain is real, the source of the pain seems like a mystery; this is one keynote of chronic global pain syndromes. FIGURE 1.1 GLOBAL PAIN VERSUS REGIONAL PAIN Other Common Symptoms Global pain is usually accompanied by other symptoms, like extreme fatigue, depression, brain fog, and irritable bowel syndrome (IBS). A troublesome standalone disorder in itself, IBS often accompanies true fibromyalgia and may include intestinal cramping, bloating, gassiness, diarrhea, and/or constipation. This broad range of potential symptoms makes fibromyalgia and other associated chronic pain syndromes that can masquerade as FM hard to diagnose. I wish I could tell you that there's one single test that your doctor can use to confirm a diagnosis. Unfortunately, there's not. There's no fibromyalgia box that you can check off on a lab report request. Yes, there are test results that are highly correlated with fibromyalgia. But the reality is that to arrive at an accurate diagnosis it requires first ruling out other illnesses. All of this makes it very difficult for both you and your health-care providers. If you're suffering from chronic global pain, it's hard enough to function at all, let alone run around looking for the rare doctor who knows how to figure out what's wrong with you.6 That is why I wrote this book--to help you navigate your symptoms and start to heal. Why Is FM So Tough to Deal With? Fibromyalgia syndrome is not merely difficult for the people who suffer from it. It's also hard on their relationships and families. As time drags on, with no remedy or relief, with the raised and dashed hopes of finding a doctor who can help, the families, colleagues, and friends of fibromyalgia sufferers may themselves begin to doubt whether their loved one's or friend's pain and other symptoms are really real. Many people have aches and pains, especially as they age. So how do you validate the difference between more routine complaints and global chronic pain syndromes? WHAT FM SUFFERERS MAY EXPERIENCE Deep muscular aches and pains. You may experience deep muscular aches-- especially in the most used muscle groups, such as the large muscles of the legs, pelvis, upper shoulders, and arms--along with throbbing, shooting, or stabbing pain. Burning. You may feel intense burning sensations in these areas, as well. Exhaustion. You may feel as though your arms and legs are weighed down by concrete blocks, and your body may be so drained of energy that every task requires great effort. Sleeplessness. You may experience various forms of sleeplessness, such as discomfort or active pain that keeps you awake or wakes you up, the inability to go to sleep, waking up too early and not getting back to sleep, or sleeping and waking up feeling groggy and unrefreshed. Acute sensitivity to stimuli. You may be extremely sensitive to touch, light, or sound. Depression. You may experience a sadness with no clear-cut cause, a loss of pleasure in enjoyable activities, feelings of guilt and worthlessness, a wish for death, and weight loss or gain due to emotional eating. Skin changes. You may have swelling, and your skin may become blotchy, shiny, blue, or have itchy red bumps similar to hives. Abnormal sweating. You may experience abnormal sweating. Brain fog. You may also suffer from brain fog, a condition in which you have trouble concentrating, finding words, or retaining new information, with the density of the fog corresponding to the severity of your pain. Joint stiffness. You may perceive stiffness in your joints, especially in the morning. Headaches. Recurrent tension headaches or migraines are present in 50 to 70 percent of fibromyalgia sufferers. The symptoms can be severe, can occur one or two times per week, and can be accompanied by a migraine. Balance issues. You may have trouble balancing, which can affect your walking and increase your chances of falling. Digestive disorders. A large percentage of FM sufferers have gut issues, such as constipation, diarrhea, abdominal pain, gas and bloating, irritable bowel syndrome, nausea, acid reflux, or slowed digestion. This becomes more challenging when, from the outset, there's a common bias that people experiencing pain are whiners or complainers who should just grin and bear it. Men in particular are more likely to hold such mistaken attitudes. These unhelpful beliefs were reinforced for many decades by the medical profession. For example, in the 1950s, doctors classified fibromyalgia as psychogenic rheumatism, a form of rheumatism originating in the mind. Translated, this would mean that the arthritis, or joint pain, is somehow imaginary. But this was wrong on both counts--FM isn't a form of rheumatism, and it isn't imaginary. When people who suffer from global pain do finally manage to begin the all- too-often extended process of dragging their exhausted bodies around to doctors, instead of getting the help they need, they often encounter misdiagnosis or end up with prescriptions for drugs that do little to improve their condition, and may even worsen it. Ultimately, many FM sufferers turn to mental-health professionals to help them manage the depression, anxiety, and social isolation that result from living for years with an illness that many people doubt is genuine, that doctors can't identify, and for which they believed there was no real answer. But there are answers, and the whole aim of The Fibro Fix is to offer you the ones exactly right for your condition. Why Most Doctors Can't Help "I've seen fibromyalgia patients who have pain all over and doctors have said, 'Well you have this type of neck pain, you have elbow pain, and you have knee pain,'" reports Robert Bonakdar, MD, director of pain management at the Scripps Center for Integrative Medicine in San Diego. "Patients then see different specialists, but no one puts the pieces together."7 Initially, I too felt this same perplexity. In taking medical histories in the early years of treating people with fibromyalgia, I was frankly shocked to learn how often these folks, suffering with pain and other challenges, were discounted, misdiagnosed, and even mistreated by their doctors. At the outset, I felt less than totally convinced that what I had been taught during my clinical training would help me help them. Were the conventional medical approaches, like pain and antidepressant medications, effective in treating this disorder? Were common alternative and complementary approaches--like chiropractic manipulation, acupuncture, and massage-- effective? I began to discover that while sometimes they were, often they were not.8 Along with the dawning awareness that our simplistic approaches didn't deliver real relief, I was in for another surprise: Many, if not most, of my colleagues, despite their limited success and incomplete knowledge of this disease, were convinced that they understood fibromyalgia and were offering their patients the right treatments. It's as if health-care professionals themselves were in a kind of brain fog, confused by the vast array of symptoms and their possible causes. As my doubts about the approach du jour collided with my colleagues' misplaced certainties, I began to realize that we were all stumbling in the dark without a flashlight. The only difference was that I knew it and they, it seemed to me, did not. So I began to search for a flashlight, for the understanding that would shed light on the true nature of fibromyalgia and how to treat it. The Quest for an Answer Excerpted from The Fibro Fix: Reverse Fibromyalgia, Chronic Pain, and Fatigue by David M. Brady All rights reserved by the original copyright owners. Excerpts are provided for display purposes only and may not be reproduced, reprinted or distributed without the written permission of the publisher.
