What makes your fibromyalgia body more wobbly some days than others? According to a study by Nuray Akkaya, M.D., and his research team in Turkey, your quality of sleep the night before plays a major role in how well you navigate movements the next day.* But sleep was not the only factor he found that was related to the potential for balance mishaps in people with fibro.

Akkaya compared the postural stability (e.g., balance) of 48 fibromyalgia patients and 32 healthy controls. The body mass index, which is a relative indicator of excess weight, was the same for both groups. The average age was also the same for each group (around 34 years old), so the participants were quite young. No one was on a sedating medication or a drug that might interfere with postural stability testing.

A balance testing system was used to produce a value for the relative fall risk for each person in the study. The fall risk computed for the fibromyalgia group was double that of the healthy control group.

Subjects stood on a platform that measured the relative pressure exerted by each foot when they were asked to modify their standing position, such as neck turned to the right or eyes closed. A person challenged by these simple changes will have more postural sway, meaning one foot presses down harder on the platform. It sounds easy, but many fibromyalgia patients found these tasks to be difficult.

Obviously, a person’s leg function can help keep a sturdy, upright posture when changing positions. Each participant’s lower-body muscle strength was measured along with their ability to stand on one leg. Questionnaires were used to assess various symptoms, such as pain, fatigue, and overall function.

“Postural performance was worse in the fibromyalgia patients compared to the control subjects and it was related to the severity of fatigue and sleep quality in the last 24 hours,” says Akkaya. “Fall risk was found to be related to lower-body strength and scores for the one-leg stance test.” However, the duration of fibro, rating of pain, overall function, and quality of sleep for the past week (not just the previous night) were NOT related to balance in the fibromyalgia patients.

Although all subjects with vestibular-related symptoms, such as ringing in the ears and dizziness, were excluded from the study, vestibular system abnormalities were still detected in the fibromyalgia group. In addition, the sensory signals from the feet (which inform the brain about your stance) and postural reflexes also might contribute to balance disturbances.

“There is no single mechanism that can account for postural instability in fibromyalgia patients,” says Akkaya. However, he points out that warm water therapy improves muscle strength and balance in fibro patients, which is consistent with his finding that reduced leg strength increased risk of falling. So improving lower body function (perhaps with a walking program) and the quality of sleep (using drug and nondrug approaches) should make you more steady on your feet.

* Akkaya N, et al. Assessment of the relationship between postural stability and sleep quality in patients with fibromyalgia. Clin Rheumatol [epub ahead of print] Nov. 21, 2012.

Animal-assisted therapy is a complementary approach to helping people with a wide range of medical conditions. Pets are often dogs trained to be obedient, calm, and comforting, and visits are typically provided through volunteer services at healthcare settings. Obviously, animals can be stress-relieving, but studies also show they boost the body’s production of pain-fighters and immune system healers.

Dawn Marcus, M.D., the lead author of a study at a Pittsburgh pain clinic, measured  the impact of a brief visit with a therapy-trained dog in fibromyalgia patients. During a 10 to 15 minute period prior to their doctor’s appointment, 84 patients received pet therapy  and another 49 fibro patients just spent the time in the waiting room. A short questionnaire before and after the therapy service or wait time was used to detect symptom differences.

“Overall, pain severity was significantly reduced after a brief therapy dog visit,” states Marcus. In fact, all measures including fatigue, stress level, calmness, and cheerfulness improved, not just pain. Slightly longer visits tended to produce better results in the pet therapy group, while cheerfulness and fatigue became worse as time increased for the waiting room group.

“Clinically meaningful pain relief was reported in 34% of the fibromyalgia patients after the dog visit versus only 4% in the waiting room controls,” says Marcus. “Effects did not appear to be substantially influenced by coexisting mood disorder symptoms.”

Satisfaction with the dog therapy visit was 92%. Also, the effectiveness of the pet intervention did not depend upon whether the patient viewed themselves as a “dog lover” or someone who prefers cats.

Healthcare providers may struggle with recommending alternative care to fibromyalgia patients due to limited studies on a therapy’s benefits, as well as cost and availability constraints. Although these latter two issues are not a barrier for doctors who wish to provide pet therapy for patients in their waiting room, this study offers a starting basis for such a practice.

Of course, you don’t have to wait for your physician to offer you a slice of pet therapy to receive the potential benefits from it. If you don’t already have a pet, contact your local Humane Society, animal organization, or veterinarian clinic to find out about programs in your area. You may also volunteer for a while to determine what type of animal best suits you and your pocketbook.

For those of you who have a pet or two, please comment about pros or the cons of owning various types of animals. Also, if you have a photogenic pet or one that has lots of character, please copy a picture with a comment to our Facebook page album at www.facebook.com/FibroNetwork. Animals can be hilarious, so don’t hesitate to give other fibromyalgia patients a chuckle.

* Marcus DA, et al. Impact of Animal-Assisted Therapy for Outpatients with Fibromyalgia. Pain Medicine [epub ahead of print] Nov.21, 2012.

The evaluated patients were referred by Melbourne physicians to a local rheumatology clinic between March 2008 and September 2010. No one was pre-selected based on symptoms or treatments because the study goal was to look at factors in a community sample of people with fibromyalgia.

Out of 150 patients, 63% met the strict tender point criteria (i.e., they had at least 11 of the 18 specified tender points), while the remaining study participants were diagnosed with fibro based on symptoms. The latter method is common practice by many physicians who recognize the widespread pain of fibromyalgia and its associated symptoms. Both approaches are described in our website section on diagnosis.

As expected, patients meeting the tender point criteria had higher ratings for pain, fatigue and trouble sleeping, as well as a greater number of associated conditions. Among all 150 patients the average number of associated conditions was five. The two most common were chronic headaches and irritable bowel syndrome, as shown below.

“A higher number of associated conditions in this group of patients was correlated with a longer duration of symptoms, worse pain, and a higher illness impact,” states Guymer. Why more associated conditions were found in patients with a longer illness duration was not addressed.

Study participants’ average age was 47 and duration of fibro was 10 years. Guymer found that the younger a patient’s age, the more serious they rated their fatigue. She suggests that may be because “younger people expect to have higher than usual energy levels in keeping with their peers.” This implies older patients are more apt to attribute fatigue to aging, which could be a false assumption.

What about the use of various treatments and their rated benefits? At the time of the study, low-dose tricyclic antidepressants (such as amitriptyline), Cymbalta, and Lyrica were available in Australia, although not specifically approved for treating fibromyalgia. Guymer’s research report emphasizes that these three medications have “evidence of significant benefit in the management of fibromyalgia.” But as it turned out, these meds did not live up to expectations.

Only 35% of the patients were taking the medications Guymer described as “evidence-based.” Perhaps the low usage of these meds was due to their poor performance. The only benefit obtained from them was a slight improvement in physical function, but they did not reduce the key symptoms of pain, fatigue, or disrupted sleep.

Psychological approaches to pain management had been tried by 30% of the 150 fibro patients, but did not produce improvements. “Complementary or alternative therapies were being used regularly at least once a month for the past three months by almost half of the patients,” says Guymer. Examples included naturopathy, osteopathy, physical therapy, massage, acupuncture, chiropractic treatment, and movement therapies such as tai chi. These treatments provided a significant decrease in anxiety.

Patients engaged in regular aerobic exercise at least 20 minutes twice per week (44%) had reduced illness impact scores, better physical function, and less fatigue, anxiety and depression. Whereas patients who were less likely to exercise had a greater number of other associated conditions and higher scores for pain, fatigue, and sleep disruption. It’s difficult to know whether those who exercised were just more able to do so.

Staying fit is an important goal for maintaining overall health and function for anyone, with fibro or not. Surprisingly, milder movement therapies, such as tai chi and yoga, were not considered forms of exercise in this study despite reports showing they help fibromyalgia patients maintain function.

Exercise and certain medications (tricyclic antidepressants, Cymbalta and Lyrica) are all touted to improve the pain of fibromyalgia, yet this study failed to substantiate these claims. Guymer and her colleagues did not point this out in the article, but the data was clear about lack of pain relief. One could only guess this omission is somehow related to the consultation fees received by the authors from the makers of Cymbalta and Lyrica (Eli Lilly and Pfizer).

* Guymer EK, et al. Clinical characteristics of 150 consecutive fibromyalgia patients attending an Australian public hospital clinic. Int J Rheumatic Dis 15:348-57, 2012.

“Fibromyalgia patients have long been described as having a disorder that lacks face validity,” writes Ferrari. “The feeling or implication that one’s symptoms, especially pain, is described as ‘medically unexplained’ is of concern to patients, to the point of being offensive.”

Why shouldn’t you be a bit unnerved when your condition is put in the “medically unexplained” category? It implies your illness is poorly defined, despite three FDA-approved drugs for treating fibro and more than 20 years of active research on this condition.

“Patients have indicated exactly this: while the diagnosis may confer some legitimacy, it does not improve their understanding of their own illness, nor help them explain their illness to others,” writes Ferrari. Based on this perception, he compared a group of 104 fibromyalgia patients to a group of 272 “other” chronic pain conditions. This latter group had either rheumatoid arthritis, whiplash-associated disorder, osteoarthritis, tendinitis, bursitis, or back pain.

Ferrari found people with fibro were four times more likely to have trouble understanding and explaining their pain to others than people in the group of “other” disorders. Admittedly, the diagnosis of fibromyalgia has been controversial and patients are stigmatized for having such a wide range of symptoms. However, many patients in the “other” group had ill-defined or difficult-to-describe conditions as well.

“Whiplash is a highly controversial disorder,” notes Ferrari, “and rheumatoid arthritis patients have only ‘autoimmune’ and ‘inflammation’ to rely on for explanation.” Despite the complexity of these terms, rheumatoid arthritis patients feel confident understanding their pain and explaining it to others. Ferrari found patients with tendinitis, bursitis, and back pain often view their pain as a form of arthritis, which is what they told others. While this belief is incorrect, it sure makes life easier.

“It is not accuracy and proper explanation that matters in one’s sense of understanding,” claims Ferrari. Perhaps people with fibromyalgia have too many symptoms and too much information about their likely causes, which makes it more difficult to put into a few words, like “arthritis” and “inflammation.” For whatever reason, people tend to automatically understand these two words mean serious pain.

Attempts to explain your fibromyalgia in terms of everything that is going wrong in the nervous system and the muscles could be overwhelming. After all, scientists are still trying to iron out the details of what causes fibromyalgia pain and other symptoms. Although describing your fibro in terms of current research findings may be more accurate, it could also be an added burden you don’t need. Maybe if you just said you had widespread arthritis (even though you know this is not the case), life would be easier.

Knowledge is power for helping you adapt and understand why certain treatments may reduce your fibromyalgia symptoms. But when it comes to everyone else, view the explanation of your fibro on a need-to-know basis, with less info being the easiest for most people to grasp.

* Ferrari R. Quantitative assessment of the “inexplicability” of fibromyalgia patients: a pilot study of the fibromyalgia narrative of “medically unexplained” pain [published online ahead of print]. Clin Rheumatol. July 22, 2012.

Going All Out

Shelly Echtle, of the North Texas Fibromyalgia Group

“I asked every member to contact their city officials (as well as doctors) to make a proclamation of fibromyalgia awareness day. Three got it done, and I was proud,” says Echtle. They also set up an awareness both outside their local Walmart, passing out 80 brochures, Fibromyalgia Network Journal copies, as well as buttons, bookmarks, and other awareness items.

Between holding an awareness picnic (complete with a balloon release, pinata, egg toss, and car painting), scrap-booking a fibromyalgia display for their local library, a Facebook campaign showing the faces of FM, and a post card campaign, this group went all out. Using the slogan, “Fibromyalgia is a pain in our sass,” this support group even held a garage sale several days later to raise money for next year’s support group!

Talk Radio & Talent Show

Laura Roza, of Tampa Fibro Friends

“On May 8, 2012, two group members and myself were invited to speak about fibromyalgia on a talk radio show called ‘Prescribed Comedy,’” says Roza. Following this appearance, Tampa Fibro Friends also set up a booth at the Largo Community Center’s grand opening in Largo, Florida for the all-day event. By handing out flyers and information, they were able to spread awareness to a large number of people.

In addition to appearing on the hour-long talk show, Roza’s support group held an annual talent show fund-raiser on May 18. “We set up a small booth at the show, along with having about five minutes of stage time to talk about fibromyalgia and how it can affect a person’s life.” This group is also working on getting bigger next year.

High Tea Event

Kaye Brand, of the Fibromyalgia Support Network

“In Perth, Australia, we celebrated International Fibromyalgia Awareness Day with a High Tea at a local function center,” says Brand. The food was combined with poetry readings by the support group’s members. The group also sought to acknowledge awareness as prizes were given out to commemorate May 12th.

The goal is to make this an annual event. “We need to talk about what fibromyalgia is; we need to educate our communities about how many of us with this condition may not always be at our best and our bodies are unreliable. We have to overcome the stigma of our supposed hypochondria and educate the uneducated in this matter. This is what increases community awareness,” says Brand, the group’s president.

Pets for Pain Patients

Ginnilee Berger, of GentleHugs4Paws Kitty Therapy

“My big awareness project is a group called GentleHugs4Paws—dedicated to helping all chronic pain sufferers who need a therapy animal,” says Berger. She is also part of a fund-raiser to generate money to support the project, and firmly believes that having an animal makes dealing with FM and chronic fatigue syndrome easier.

The intention of her fund-raiser is to help those who are unemployed and can’t afford pets, to adopt them and pay for the costs to keep them. “It benefits both chronic pain sufferers and the shelters where all of these sweet animals live who want someone to love them, and share their own love,” says Berger.

Craft Show

Mary Langley and Maria Spinnato-Fogassy, of the Maryville Fibromyalgia Support Group

This group held a Fibromyalgia Awareness Day craft show to raise money for research and their support group. They also organized a community “Wear Purple” day to spread awareness, and passed out flyers promoting the event. Members stood outside local stores to pass out information on the Craft show and wear purple day to support the cause.

“This is our first Fibromyalgia Awareness Day since our group just started in January,” says Mary Langley, the support group leader. The story of these events were published in the town newspaper, and they even got Governor Jay Nixon to sign a fibromyalgia proclamation. Not bad for a first event!

The remaining winners are: Kat Foote of the Santa Barbara FMS/CFS Support Group, Mindy Cohen of the Rahway Fibromyalgia Support Group, Anuradha Pentapalli, and Colleen Tarver.

All of the top ten winners will be rewarded with a free one-year Membership or renewal to the Fibromyalgia Network. Congratulations to all on a great job this year! We hope everyone is inspired and proud of the awareness efforts being made to promote better public understanding of fibromyalgia.

Do you like Lyrica, Cymbalta or Savella? Have any of these meds cured you? Or has cognitive behavioral therapy been the answer for your fibromyalgia symptoms? According to the FibroCollaborative, a program funded by Pfizer and made up of 25 physicians, these would be your only options.¹ This is what they promote as the roadmap to success, but actually, it is the roadmap to doom for all fibromyalgia patients.

You may have initially viewed the FDA-approval of Lyrica as a milestone, but chances are you did not know what was brewing behind the scenes. Soon after the FDA-approval of the three drugs, new criteria for fibromyalgia appeared in print in early 2010.^2,3,4 They don’t require a doctor to examine or talk to you; identifying your illness has been reduced to filling out a 2-page form. The criteria were disguised as an easier way for primary care providers to diagnose fibromyalgia, but more than likely, it expands the diagnosis to anyone who has muscle pain and trouble sleeping.

This new way to sell more drugs (even though each one only works in one out of 8 to 15 patients) can be credited with one of the big chiefs of the FibroCollaborative, Daniel J. Clauw, M.D., of the University of Michigan in Ann Arbor.⁵ Clauw is the author of many research papers, but lately, the majority have just been about pushing certain drugs. He and his Pfizer-affiliated colleagues want all primary care doctors to know there are three drugs for treating fibro: Lyrica, Cymbalta, and Savella. Although many medicines are available to treat you, few others are mentioned.

While everyone thinks of researchers as working on the patient’s behalf, when it comes to the 25 members working on Pfizer’s behalf, it is hard to believe that your interests will trump profits. But don’t think this money-making plan was solely cooked up by Clauw. He shares the podium with:

Lesley M. Arnold, M.D., of the University of Cincinnati,
Bill H. McCarberg, M.D., of Kaiser Permanente,
L. Jean Dunegan M.D., JD, of Brighton, MI,
and Dennis C. Turk, Ph.D., of the University of Washington.

What’s more, there are another 20 members who dance to Pfizer’s tune that deserve acknowledgment as well:

Kenneth Barrow, PA–C, MHS – Wilmington, NC
*Lucinda Bateman, M.D. – Salt Lake City, UT
Larry Culpepper M.D., MPH, – Boston University
Cassandra Curtis, M.D. – Greenfield, IN
Yvonne D’Arcy, M.S., CRNP – Johns Hopkins
Kevin B. Gebke, M.D. – Indiana University
*Robert Gerwin, M.D. – Bethesda, MD
*Don L. Goldenberg, M.D. – Newton-Wellesley Hospital
James I. Hudson, M.D., ScD – McLean Hospital
Rakesh Jain, M.D., MPH – Lake Jackson, TX
Arnold L. Katz, M.D. – Overland Park Medical Center, KS
Andrew G. Kowal, M.D. – Burlington, MA
*Charles Lapp, M.D. – Charlotte, NC
*Michael McNett, M.D. – Chicago, IL
*Philip J. Mease, M.D. – Seattle, WA
Danielle Petersel, M.D. – Pfizer, NY
*I. Jon Russell, M.D., PhD – San Antonio, TX
Stephen M. Stahl, M.D., PhD – San Diego, CA
*Roland Staud, M.D. – Gainesville, FL
Alvin F. Well, M.D., PhD – Oak Creek, WI

Those with an asterisk used to advocate for fibromyalgia patients (along with Clauw), but how can anyone view their actions with integrity given their alliance with a drug initiative that only promotes three medications for treating fibro? If you need something to help you fall asleep at night, you best get hip with Lapp’s behavior modification program.

Perhaps it is good news that Lapp’s behavior program is free on his website. Of course, once you have given all of your contact details on the website, who is to say they won’t get passed along to Pfizer?

While talented physicians and researchers have placed their loyalty to the drug company, rather than remaining independent-minded scientists, the question is: why? There had to be a draw to the drug company’s scheme. Money? Power? Or maybe a little of both? Regardless of the reasons, it appears that treating patients is no longer their primary interest.

These days, one may automatically assume patient organizations are working in collaboration with the drug companies. It can be a sneaky way of connecting you to Pfizer’s initiative, to collect info about you as a fibro consumer in order to improve their marketing strategies. Is that really what you want as a patient, to be viewed as marketing income from the organizations you trust to have your back?

Take for example, the National Fibromyalgia Association (NFA), who even in the midst of legal troubles keeps sending out emails to patients to collect more data on you. They have a disconnected phone number and an address that is nothing more than a box. Now the National Fibromyalgia and Chronic Pain Association (NFMCPA) out of Utah has taken over the patient-related reins of the NFA. They promote the FibroCollaborative on their website, so perhaps they sit at the same table with the NFA, the American Chronic Pain Association, and others to help Pfizer’s bottom line.

This is not the case for the Fibromyalgia Network (or the American Fibromyalgia Syndrome Association). There is a price to pay for not being a puppet on Pfizer’s or anyone else’s string. Although the Network makes lots of info available for free, we have to charge for our publications. That’s the price you pay for objectivity.

1. Arnold LM, Clauw DJ, et al. Mayo Clin Proc 87:488-96, 2012.
2. Wolfe F, Clauw DJ, et al. Arthritis Care Res 62:600-10, 2010.
3. Wolfe F, Clauw DJ, et al. J Rheumatol 38:1113-22, 2011.
4. Arnold LM, Clauw DJ, et al. Mayo Clin Proc 86:457-64, 2011.
5. Clauw DJ, et al. Mayo Clinic Proc 86:907-11, 2011.

This year, the Fibromyalgia Network invites you to submit information about your awareness activities. Getting others to understand your symptoms and improve public perception can be done in countless ways. Here are some examples:

• health fairs
• proclamations from government officials
• hosting or assisting in an educational event
• posting/distributing public information
• special support group meetings
• or any other creative ideas

Email us a photo and a short description (one to three paragraphs) of your fibromyalgia Awareness activities. The top ten entries will receive a free Membership or renewal to the Fibromyalgia Network. The best five will be posted to our website’s Latest News blog. Deadline for submissions is Thursday, May 31st.

Our Awareness campaign is designed to remind people that while your illness may be invisible, it is still very real.

The overall impact of fibromyalgia symptoms were measured using validated tools in a recent investigation headed up by Virginia Aparicio, Ph.D., and her research team in Spain.¹  Health status, physical function, overall well-being, work missed, work difficulty, pain, fatigue, morning tiredness, stiffness, anxiety, and depression were assessed. From these measurements, Aparicio was able to decipher how each gender is impacted by fibromyalgia.

Differing from most other fibro studies, this one contained a larger sample of 20 male and 79 female patients age-matched with similar characteristics. Using multiple procedures to match the men and women according to height, weight, and body mass index, Aparicio and her team aimed to take a closer look at the differences between the male and female quality of life and set of symptoms. So which faired better?

Perhaps neither. Women with fibromyalgia were found to have less vitality/more fatigue than men. This finding could imply that strength and energy are more dwindled in women, whose metabolic processes can be more demanding. Otherwise, it could mean fibromyalgia symptoms affect the female body in a different way than males.

On the other hand, fibromyalgia created more physical impairments in the men compared to the group of women. The overall impact of the condition was also harder on the men. This coincides with an earlier study conducted by Isabel Ruiz-Perez, M.D., also of Spain, who found, “Men with fibromyalgia had a worse perception of their health” and “more impact of the disease.”²

But the primary symptom of fibromyalgia is pain, although fatigue and physical function are certainly important. “Nevertheless,” says Aparicio, “concerning pain perception, gender differences appear to be low or nonexistent.”

So the question of whether men or women are more impacted by fibromyalgia remains to be determined. The female patients in Aparicio’s study displayed greater fatigue and morning tiredness. Yet it’s not as simple to interpret the study by saying men with fibro are more affected functionally, and women with fibro are more drained of energy. Each person is different, and summing up how one handles such a complex disease is not likely to be that simple.

While Aparicio’s study is still early research on gender differences in fibromyalgia, this study is of growing importance as doctors struggle to treat and monitor both male and female patients. Treatment plans require individual approaches. Men may need to work to aid their physical function, while women may need more focus on reducing the symptom of fatigue. It’s certainly research deserving of more attention.

1. Aparicio V, et al.  Am J Men’s Health [epub ahead of print] Apr 11, 2012.
2. Ruiz-Perez I, et al.  Rev Clin Esp 207:433-9, 2007.

If you are a man with fibro, there is a terrific site just for you: www.menwithfibro.com.

Indeed, 90% of the fibromyalgia patients in the Fibromyalgia Network’s recent survey of Fibro Over Time endorsed significant problems with morning stiffness. But what do most doctors think of your stiffness? Bennett says they “generally regard it as a minor symptom,” or a sign of inflammation unrelated to the fibromyalgia.

When doctors think of stiffness, they conjure up rheumatoid arthritis and other inflammation-related joint diseases that make it harder for these patients to get going in the morning. Yet studies in fibromyalgia patients also show stiffness is usually worse in the morning and Bennett points out, “morning stiffness has been rated as more severe in fibromyalgia than rheumatoid arthritis.” He says people with both conditions have worse stiffness than those with fibro alone. But why would fibromyalgia patients be troubled by stiffness?

As people age, they get arthritis, become less active, and expect a little morning stiffness. However, this does not explain why 25 or 45-year-old fibromyalgia patients showed signs of joint stiffness on a test involving the ankle.² A detailed report was provided in our February 2011 eNews Alert, but suffice it to say, fibro patients showed twice as much stiffness as age-matched healthy controls.

Stiffness sometimes correlates with pain, and since Cymbalta is FDA-approved to treat the pain of fibromyalgia, Bennett and colleagues thought it might relieve the symptom of stiffness. The study was supported by Eli Lilly, the maker of Cymbalta, to see if the drug could help with this symptom. Stiffness did improve, but only by a tiny amount of 10%. This compares closely to the 13% benefit found in the trials of Lyrica.

If the pain of fibro was solely related to the stiffness, the FDA-approved drugs should be able to produce significant improvement in this symptom. Yet they don’t.

Fibromyalgia is a rather “messy” multi-system condition. There is the central nervous system component involved in processing pain, an area all three FDA-approved drugs work on (Cymbalta, Lyrica and Savella). People with fibro also have trigger points or knots in their muscles, which cause serious pain and restrictive movement.³ In addition, one has to remember the circulatory system, and fibromyalgia patients have increased arterial stiffness.⁴

Your arteries should be flexible, but studies show a reduction of the elastic-like qualities in fibro patients compared to age-matched controls. An overly active sympathetic nervous system is thought to be partly to blame.

Therapies to relax your sympathetic nerves, such as a hot shower and many other approaches, often ease morning stiffness. One of the three FDA-approved drugs may even help, but just don’t expect too much from them.

1. Bennett R, et al. Clin Ther  34(4):824-37, 2012.
2. Dierick F, et al. Eur J Appl Physiol 111:2163-71, 2011.
3. Ge HY, et al. Arthritis Res Ther 13(2):R48, Mar 22, 2011.
4. Cho KI, et al. Clin Rheumatol 30:647-54, 2011.

People can grasp how back pain interferes with one’s ability to put on their shoes, bending for household chores, or yard maintenance tasks. Even the difficulties of sitting in a chair or standing for prolonged periods of time with a sore back might be something the average person can relate to.

At any given time, roughly 72% of fibromyalgia patients have objective evidence of painful muscular knots in their low back region.¹ This means most people with fibro have low back pain with the added discomfort of their widespread symptoms. On the flip side, a recent study found 28% of women with chronic low back pain also met the criteria for fibromyalgia.²

The purpose of the above study was to examine the impact fibromyalgia had on people already burdened with chronic low back pain, compared to those who only had the back pain. By itself, low back pain produced serious consequences for the 130 people in the study. Many objective findings such as handgrip strength, walking speed, and work disability were combined with validated questionnaires to assess the impact of the chronic painful conditions.

As to be expected, chronic low back pain seriously affected patients in the study regardless of whether they also had the widespread symptoms of fibromyalgia. However, patients with both pain conditions were clearly more burdened. So if the people in your life (partner, friend or coworker) understand how back pain interferes with function, this study might help explain why your fibro symptoms further limit your abilities.

“The back pain plus fibromyalgia group showed significantly more severe impairments in body functions, more severe activity limitations, and participation restrictions,” writes the lead author Lena Nordeman, Ph.D., RPT. She adds, “Less social support and lower healthy-related quality of life” was also found in the patients with both conditions compared to those with low back pain.

More specifically, the reduced speed of walking and handgrip strength in the fibro group was nearly the same as that reported for healthy people 15 years older. Many patients with fibromyalgia state they feel much older than they really are, and the measurements from this study offer confirmation. However, it is not just a state of mind, as neither patient group (low back or fibro) met the criteria for clinical depression or anxiety.

Physical function and vitality were both significantly lowered in the fibromyalgia group versus the low back pain group. This likely reflects the more systemic and fatiguing effects of the widespread symptoms of fibro versus the more regional back pain syndrome.

If anyone questions your limitations, you might start by asking if they have ever had a severe back ache because most people have. Then explain how fibromyalgia further impacts your function on a daily basis.

1. Ge HY, et al. Arthritis Res Ther 13(2):R48, Mar 22, 2011.
2. Nordeman L, et al. Clin J Pain 28:65-72, 2012.