Collector Comfort Bling Spoons

These are made by my friend and fellow “spoonie” Cindy – she’s a great artist and a great gal and I love supporting her work! So check out her new spoon project. Maybe early holiday presents…? Or just a gift for a special spoonie in your life? https://www.etsy.com/shop/Dancingbearsnetangel spoon fibromyalgia chronic illness cmatusky.com medeakarrfnp.com celestial spoon fibromyalgia chronic illness cmatusky.com medeakarrfnp.com flowerpower spoon fibromyalgia chronic illness cmatusky.com medeakarrfnp.com love spoon fibromyalgia chronic illness cmatusky.com medeakarrfnp.com frog spoon fibromyalgia chronic illness cmatusky.com medeakarrfnp.com


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Source: Collector Comfort Bling Spoons

FibroDog!!!!

FibroDog Pinterest fibromyalgia www.medeakarrfnp.com



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Some of you may have been hearing the whispers on the wind (or me blabbing to everyone I know because I can’t control myself) about KoiBoy’s upcoming project to get super famous while helping to educate kids about fibromyalgia. Well, the whispers are true, and we are officially ready to introduce… FibroDog!!!!!! We’ll be rolling the project out slowly, and we may start with a kickstarter project to get funding for startup costs (go-pro camera, lighting equipment, swag/merch, small stipends for guests and tech crew, lots of meat to fatten up our still slightly underweight star, etc.) 
In the meantime we need some help from you, our dear friends and supporters:
I just learned what a hashtag is. I’m a dork, I know. But I suspect we’ll need some hashtags for this project. Something like “#FibroDog_GotSnout?” So can you guys please reply with some ideas of other hashtags we might want to use while we’re in the planning stages of the project? If we use your hashtag at any point along the way you’ll get a prize: a free bumper sticker (or window sticker) with your hashtag on it! If you’re really skilled at this and we end up using 5 of your hashtags, guess what, you’ll get all 5 stickers! Woohoo! So start sending those hashtags our way!

Fibromyalgia versus Myofascial Pain Syndrome (Part 1)

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These two conditions are frequently confused by both patients and medical providers. Many patients suffer from both of these conditions at the same time.
Fibromyalgia is defined by the American College of Rheumatology as a condition with widespread pain lasting over 3 months, with no other medical explanation for symptoms (citation below).  The definition also used to include certain tender points located in specific places on the body, but this requirement was removed in 2010 because many fibromyalgia patients don’t have the specific tender points, or they only have them during flares, or they have them in different locations from the “classic” locations.

Fibromyalgia tender points map from ADAM.com

Fibromyalgia tender points map from ADAM.com

Tender points are basically areas of the skin that are extremely tender to light or moderate touch, that most people wouldn’t perceive as tender at all. There is nothing physiologically wrong with these tender regions, they are simply tender because the nervous system misinterprets the signals when these points are touched. The important thing is not specifically which areas are sensitive to touch, but the fact that there are multiple areas that are sensitive, with no known reason for them to be tender. In addition to the widespread pain and unusually tender areas, fibromyalgia patients also have fatigue, unrefreshing sleep, and a variety of other symptoms. These symptoms tend to wax and wane in flares. Sleep and central pain amplification are key factors  in fibromyalgia, and addressing these issues is the mainstay of most fibromyalgia treatments.

Myofascial Pain Syndrome is a condition in which the patient has abnormal clumps of muscle fibers or knots or bands known as trigger points. (Not to be confused with tender points, more on this in a future post….) These trigger points “trigger” or “refer” pain to other locations in the body.

Trigger point - NOT a fibromyalgia tender point!

Trigger point – NOT a fibromyalgia tender point!

Trigger points can be felt in the muscle tissue, and the muscle fibers can be gradually remodeled or “released” using a combination of pressure, massage, stretching, and sometimes more invasive measures like electrotherapy, acupuncture, and injections. If you’ve ever had a knot in a muscle that “hurt so good” when it was massaged and sent pain into a distant area that was then relieved by the massage, then you know what a trigger point feels like. Trigger points are common causes of headaches, including migraines, sciatica, plantar fascia pain, and TMJ pain, among many other painful conditions.

Classic SCM trigger points (the

Classic SCM trigger points (the “X’s”) radiate pain into the head and eye, causing migraine symptoms.

The good news is that once the trigger points are identified they are fairly simple to treat. The bad news is that trigger points are frequently missed because most medical providers aren’t trained to recognize them. So the two conditions both cause severe pain, but the reasons for the pain are very different. This was a very brief and oversimplified introduction to these challenging conditions, and in the next post I will go into more detail about the differences between tender points and trigger points and the different approaches needed to manage them. Stay tuned!

Resources:
  1. Fibromyalgia and Chronic Myofascial Pain: A Survival Manual (2nd Edition). Jun 30, 2001. by Devin J. Starlanyl and Mary Ellen Copeland. This is my desert-island resource book, I keep copies at home and at my office. (FYI: This is an affiliate link, which means we get a small percentage of money if you purchase this book or any other product through this link, thank you in advance!)
  2. Devin Starlanyl MD’s website at Sover.net
  3. and Measurement of Symptom Severity”, published in Arthritis Care & Research Vol. 62, No. 5, May 2010, pp 600–610 DOI 10.1002/acr.20140 © 2010, American College of Rheumatology.
  4. Muscle Trigger Point Anatomy app for smartphones and tablets. The trigger point image above is from this app, and it has wonderful graphics with multiple views of the muscles and common trigger points, and their typical pain referral patterns.

Fibromyalgia versus Myofascial Pain Syndrome (Part 2) – What Can I do About It?

Now that you know the difference between fibromyalgia and myofascial pain syndrome, and maybe you’re suspecting that you have one or the other or both, you are probably asking yourself “What next?” How are they treated?

First a recap: fibromyalgia is basically a syndrome of pain amplification and sensitivity, while myofascial pain syndrome is basically pain caused by tiny knots (trigger points) in the muscles. Fibro is more of a brain and nervous system problem, while myofascial pain is more of a muscle fiber problem. (Remember, I am really oversimplifying here to make this easy to grasp for folks without a medical background. There are many scientific articles and books available that go into more detail on these conditions, see references below.)

So as you can imagine, treating fibromyalgia is very different from treating myofascial pain. We honestly don’t understand much about fibromyalgia, although advances are being made every year. In my experience there are a variety of causes and types of fibro, so I tackle each case based on what seems to be causing it. Many times I’ll discover along the way that a patient doesn’t really have fibro at all, and instead has hypothyroidism, or chronic muscle pain and fatigue from perimenopause, or hypermobility syndrome causing constant strain on tendons/ligaments/connective tissue, or sleep apnea that causes fibro symptoms from years of poor sleep quality. If none of these are the case, and a patient really has fibromyalgia and no obvious other cause for their symptoms, then the general consensus is to address sleep, maximize serotonin levels in the brain, and find ways to “turn down the volume” of the overactive nervous system. This can be accomplished by various medications, supplements, exercise, acupuncture/Chinese herbs, electrotherapies/laser therapies, massage, etc. I am able to do many of these treatments in my medical practice, and I refer out for the ones I’m not trained in (acupuncture for example.) There are a lot of scams out there aimed at desperate fibro patients, so I am very cautious when it comes to new or unproven treatments, especially if they cost a lot of money. Keeping that caution in mind, however, I do believe if something has been proven to be safe and is relatively inexpensive it’s certainly worth a try if there’s a chance it could help!

Treating myofascial pain is much simpler in theory. It is usually just a matter of disrupting the trigger points/muscle knots, and stretching them out to prevent their return. Trigger points can be disrupted mechanically using massage or acupuncture or electrotherapies, or chemically using oral or topical or injected medications, and providers frequently use a variety of these methods. The tricky part is if the trigger points have been there for many years, or if there is a severe anatomical or other issue that tends to encourage them to return quickly. For example, some patients with hypermobility syndrome continually develop new trigger points and releasing them is a lifelong project, which can seem overwhelming at times. But most people can learn to treat their own trigger points using self massage tools, so they only need to seek professional help periodically.

Hopefully this series of  articles helped to clarify the basic differences between fibromyalgia and chronic myofascial pain syndrome, and gave you some ideas about the treatment options available for both conditions. Please leave comments or questions below, and check out the following links for more useful info on both conditions.

National Fibromyalgia Association: http://www.fmaware.org

Devin Starlanyl MD: http://homepages.sover.net/~devstar/

Trigger Point Maps: http://www.triggerpoints.net/information

Fibromyalgia and Exercise

Multiple studies have shown that exercise is absolutely essential for people with fibromyalgia and other types of chronic pain. The trick is finding the amount of exercise you can do each day without throwing yourself into a full blown flare. A little bit of pain or discomfort in the muscles during or after exercise is ok, but it’s hard to know how much is too much. So I always tell my patients (and myself!) to start with a quarter of what you think you can or should be able to do. Then track how you feel for the rest of the day and the next day in your pain journal. If you’re a little sore do the same amount again. If you’re REALLY sore skip a day, and the next day do half what you did the first time. If you go into a flare skip 2 days, and then only do a quarter of what you did the first time. If you follow these general guidelines you’ll be able to discover the amount of exercise you can do. Be patient- if you haven’t exercised in a long time it will take time to build up stamina again. But we absolutely must find an exercise routine that we can tolerate every day in order to prevent getting weaker and weaker- even with fibro our muscles are able to get stronger and stronger. Go into training to fight fibro! (But not without clearance from your medical provider first!)

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