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.

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.

A study headed up by Selda Bagis, M.D., of Turkey, helps clarify the link between magnesium deficiency, your symptoms, and how supplementation therapy might play a role in fibromyalgia.*

First, Bagis looked at the magnesium levels in the serum (clear liquid fraction of the blood containing nutrients but no cells) and the red blood cells (loaded with oxygen and sugar needed by the muscles). She compared the results of fibromyalgia patients to that of age-matched healthy control subjects. She also checked to see if any symptoms corresponded to the magnesium levels in the serum and red blood cells.

Overall, Bagis found the lower the magnesium level, the greater the fibromyalgia-related symptoms. The symptoms associated with reduced magnesium in the serum and the red blood cells are listed in Table 1 below.

Low serum magnesium levels also corresponded to an increase in sleep disorders and gastric upset. This makes sense because magnesium is involved in the production of the sleep-promoting hormone, melatonin, and it is a known agent for settling the stomach (e.g., Milk of Magnesia). On the other hand, the red blood cells cannot provide oxygen and glucose fuel for powering muscle movements unless ample magnesium is present.  So lower levels of this mineral in red blood cells would likely influence muscle symptoms, such as the number of tender points and the patient’s pain rating.

The second part of Bagis’ study was to compare the effectiveness of three different therapies for treating fibromyalgia (using three groups of 20 patients each): 300 mg of magnesium citrate, 10 mg of amitriptyline (an inexpensive antidepressant that works similar to Cymbalta), and the combination of the two therapies (300 mg of magnesium citrate plus 10 mg of amitriptyline). The trial lasted for eight weeks and all treatments were taken in the evening.

Antidepressants that increase both serotonin and norepinephrine at the nerve junction are often prescribed to treat pain because they supposedly work by bolstering the spinal cord’s pain fighting system. It would be important to know if a commonly prescribed medication eases different symptoms than magnesium or if the combo might work synergistically to reduce the impact of fibromyalgia. Table 2 shows a comparison of the three different treatment approaches.

“We found that magnesium supplementation was effective on reducing muscle tenderness and functional status,” says Bagis. “But amitriptyline plus magnesium supplementation was more effective on all parameters than either treatment alone.”

The sedating effects of amitriptyline likely led to the reported improvements in sleep; in addition to increasing serotonin, it also works like an anti-histamine. In turn, this may have improved next-day energy levels. However, Bagis cautions that this was a short-term study and the drug may lose potency over time. Magnesium, on the other hand, should not lose its effectiveness with continued use.

The use of magnesium at bedtime appears to be able to augment the impact of standard fibromyalgia treatments. In addition, Bagis found magnesium levels are lower in fibro patients compared to healthy controls, and these lower levels appear to be associated with many commonly reported symptoms for this condition.

“All of these findings support the fact that magnesium plays an important role in the development of fibromyalgia,” claims Bagis. Regardless of what your current treatments are, you might talk to your doctor about adding 300 mg per night of magnesium citrate. Although this dose produced minor gastrointestinal irritation in the study participants, keep in mind all fibromyalgia patients are different and you may need to adjust the dose accordingly.

* Bagis S, et al. Rheumatology Int [epub ahead of print] Jan. 22, 2012.

The two most common treatments for musculoskeletal pain used by physical therapists are ultrasound and transcutaneous electrical nerve stimulation (TENS). Ultrasound works by emitting sound waves from a hand-held wand that penetrates between 1 and 2 inches deep into soft tissue, such as your muscles. These sound waves can increase heat and improve circulation in the region, relax muscles, and heal tissues. TENS units work by applying two pads placed on the skin across a painful area. The small unit emits an electric signal believed to ease discomfort by activating the natural opioid pain-relieving system in the spinal cord.

A research team led by Felipe Azevendo Moretti, P.T., of the Universidade Federal in Sao Paulo, has found the combination of both therapies have been somewhat successful at reducing the muscle aches and disturbed sleep of fibromyalgia.* However, that is based on using this combination therapy during 12 sessions over a one month period. Each of the treatments was applied for two minutes at each painful tender point (typically averaging 14 per patient), making this approach very time-consuming. Whereas insurance companies may not approve such frequent visits.

But the real question answered by the Moretti’s recent study is whether there was any difference in effectiveness if sessions were once or twice weekly over a duration of 12 weeks. This means one group of 25 fibromyalgia patients received 12 treatments while the other group received 24 treatments. Moretti looked at their pain, sleep and physical function measures before and after the 12 weeks, and found the effects of combined ultrasound plus TENS was the same regardless of whether it was given once or twice weekly.

Before the current study, patients were asked to rate their level of pain on the first day of the study and over the previous week, as well as their sleep, and overall quality of life. They also noted their number of tender points (one group averaged 15 while the other averaged 14).

After 12 weeks of treatment to tender points, patients’ scores in all areas dropped dramatically. Those receiving treatment once a week reported pain in half as many tender points, and pain scores fell from 7.6 (on 10 a point scale where 10 represents worst possible pain) to 3.1. Pain experienced over the first seven days compared to the last seven days of the study dropped from 9.5 to 3.3. Sleep problems and quality of life scores also improved at least 35%. Similar changes in scores were obtained by the twice weekly study group.

“Based on these results, we can observe that the combined therapy was effective not just in the improvement of the musculoskeletal symptoms, but also helped the patients with sleep and quality of life,” said Moretti. “Once the patients have a reduction in the number of tender points, the subjective feeling of pain is diminished.”

A greater than 50% drop in painful symptoms of fibromyalgia for patients not taking any medications or using other treatments is substantial. In addition, none of the patients experienced intolerable side effects, which can be a turnoff when trying a new drug or other approaches.

Moretti believes this combination therapy along with medications and other forms of treatment, such as water exercise or walking, can be added to each patient’s care to create more substantial benefits. How long the combo ultrasound plus TENS therapy lasts beyond the three-month treatment was not determined by this study. Regardless of its lasting effects, this approach can certainly help patients increase activity levels while minimizing the potential for added discomfort.

“This study helps professionals who work with fibromyalgia patients know that it is possible to obtain symptom improvement with only one weekly application of the ultrasound and TENS therapies,” said the physical therapist. “Clearly, it is important to offer the most efficient treatment solution for the least amount of money.”

* Moretti FA, et al. Physiother Res Int Nov 24, 2011, doi: 10.1002/pri.525. [Epub ahead of print]

(Keep in mind this is a research study to show the effectiveness of TENS. Understandably, 12 PT treatments could be costly, but a therapist can help you with the proper use of a TENS unit that can be purchased and applied as needed. Units range from $40 to $70.)

Low-intensity exercise is often recommended to people with fibromyalgia to help maintain mobility. But the thought of starting an activity, overdoing it, stopping, and starting all over again is a frustrating and discouraging cycle.

Two researchers in Spain have come up with a therapeutic exercise program that fibromyalgia patients seem to be able to stick with while improving their overall health.* The study included 44 fibromyalgia patients divided into two groups. One formed the control group that received educational literature on fibromyalgia health and simply resumed their normal lifestyle. The actual study group received an exercise program that included deep water running in a warm water pool with the aid of a floatation device.

The eight-week program consisted of five minutes of gentle stretching, 15 minutes of mobility and flexibility exercises, 15 minutes of moderate muscle strengthening, 20 minutes of deep water running with a flotation device, followed by a five-minute relaxing, cool-down period. In total, the participants did this one-hour routine three times a week.

Before and after the eight-week program, both groups were given a fibromyalgia symptom questionnaire to evaluate the treatment effects. In addition, the study group was given a heart-rate activity test to determine at what point they were pushing themselves beyond a moderate threshold. This information was used to individualize each study participant’s exercise treatment program.

During the first two weeks, patients in the deep water running group were instructed to keep a fairly low heart rate. Then they should attempt to exercise with an increased heart rate that produced a moderate water running pace based on their prior testing. This part of the study was done in six feet of 81-degree water (the deep end of a pool). Participants wore a floatation belt that kept their head above water, and they were instructed to mimic a running motion. No participants dropped out of the study.

The test group reported a 20% reduction in most of their fibromyalgia symptoms. Significantly noted was less pain, fatigue, and morning stiffness. Improvements were also made in physical function, anxiety, depression, sleep, and overall quality of life. The control group showed no improvement.

“It is difficult to separate the effectiveness of the deep water running from the other activities,” said Antonio I. Cuesta-Vargas, Ph.D. “But previous studies of exercise show worsening of symptoms and high drop-out levels. Here, there were no reported adverse effects confirming that patients with fibromyalgia can undergo physical training without damage and increased muscle soreness, and the deep water running may be a useful addition to treatment.”

A 20% improvement is relatively small, but keep in mind that this is just one aspect of treatment. Cuesta-Vargas is now seeking to incorporate this combination of physical activity into a complete program for fibromyalgia patients that includes diagnosis, activity and counseling, and pain management.

* Cuesta-Vargas AI, Adams N. Clin Rheumatol [Epub ahead of print] Aug 25, 2011.

Note: Looking for a flotation device that’s easy to use? See a variety available online at the following locations:

• Aqua jogger and water running flotation devices: Amazon.com, $28.74 and up.
• Flotation belt by WaterGym, Watergym.com, $33.95
• Water jogging belts: SwimOutlet.com, starting at $25.95.

With primary care facing a shortage crisis in the U.S., the need for more healthcare options is crucial. In research by Thomas Bodenheimer, M.D., M.P.H., today’s medical students are more reluctant to go into primary care because of higher workloads and lower incomes compared to specialty medicine.¹ And with healthcare reform expected to increase access to primary care for 32 million more Americans in the next few years, only 7% of fourth-year medical students in a 2010 survey plan to go into this field.

“NPs are well positioned to be part of the solution to issues of access to primary care,” said Joanne M. Pohl, Ph.D. and Board Certified NP, in an article written by Laura A. Stokowski, R.N., M.S., for Medscape News.² “Forty years of evidence confirm that NPs provide high-quality, cost-effective care and can contribute significantly to narrowing the primary care gap. There is no place for limitations on practice or other regulations that are not based on evidence.”

Research led by Marielle E. Kroese, M.Sc., provides evidence that supports specialized nurses in primary care.³ Her team in the Netherlands did a study of 193 patients suspected of having fibromyalgia who were referred for diagnosis and treatment to a rheumatology clinic. Patients in the study were randomly divided and assigned to see either specialized rheumatology nurses or a rheumatologists (M.D.). The researchers wanted to compare patient satisfaction and costs between the care providers.

Initially, patients were able to get an appointment with the nurses within three weeks compared to three months for the rheumatologists. Actually, eight patients assigned to the rheumatologists dropped out of the study because of the long wait time.

Patients were seen one week after their first consultation, at three weeks, six weeks, and nine months later. About 75% of patients seen by a rheumatologist and 92% of those seen by the nurses were diagnosed with fibro. (All patients confirmed by the nurses with fibro were seen and received further confirmation from a rheumatologist.) Regardless of diagnosis, all the patients filled out questionnaires every two weeks during the study concerning their health, treatments, satisfaction with their care provider, and ability to function. Patients were also required to maintain a record of medical expenses.

After nine months, both patient groups reported to be in similar heath. However, the patients seeing the nurses were more satisfied and had better functionality with less cost throughout the study. Specifically, patients rated the nurses better in all nine patient-satisfaction categories including: taken seriously, understanding, time spent with nurse, paying attention to the social aspects of the illness, and giving clear information and advice. The research estimates that the average costs including medical and loss of productivity at work and home amounted to $5,595 per patient seen by a nurse compared to $7,690 per rheumatology patient. Some of this difference is accounted for by the patients who reported not being productive in the three months they had to wait for their initial appointment with the rheumatologist.

“The nurse-led diagnostic process can be recommended from a healthcare and societal perspective,” said Kroese. “Patients in the nurse group were significantly more satisfied. Total healthcare costs and patient and family costs were significantly lower in the nurse group. Also costs from a societal perspective including absenteeism from work were lower.”

Where do you go from here? Check your insurance list of providers for nurse practitioners. If none are listed, don’t dismay. You may need to print the list of nearby primary care providers and call around to find out if an NP works in the doctor’s office. The M.D.’s name may be on the door (and on the billing paperwork), but research shows that an NP may be your best option for fibromyalgia care.

1. Bodenheimer T, Hoangmai PH. Health Aff 29(5) 799-805, 2010.
2. Stokowski L. Medscape Ask the Experts The Nurse Practitioner Will See you Now, June 29, 2010.
3. Kroese ME, et al. J Rheumatol [Epub ahead of print] April 2011.

Regular sun exposure causes your skin to produce vitamin D, which does more than maintain healthy bones and build strong muscles. This essential vitamin is known for its immune system effects on relieving pain and inflammation. Making sure you get adequate sun exposure should lead to greater vitamin D levels and less fibromyalgia pain … at least in theory.

A team in Israel put this theory to the test. Their study included 60 chronic pain patients, primarily those with fibromyalgia, but also patients with osteoarthritis and rheumatoid arthritis. All subjects sun-bathed briefly each day for three weeks under medical supervision. Pain levels, disease severity, and serum vitamin D were measured before and after the three-week period.

Vitamin D increased by 25%, regardless of whether the patient had fibromyalgia or arthritis. Greater changes in vitamin levels correlated with the degree of improvements in pain and disease severity. The research team comments that their findings “support the hypothesis that increased serum vitamin D may reduce musculoskeletal pain.”

Minimize Risks

Exposure to sun places people at risk for skin cancer.³ Dermatologists Steven Feldman, M.D., Ph.D., and Sarah Taylor, M.D., at Wake Forest University, offer the following advice for FM patients who find the sun helpful:

• Short, controlled increments (less than 15 minutes), 2-3 times a week, are best.
• Cover your neck with a cloth and wear a hat that shades your face. These are the most common areas for skin cancer.
• Wear a cover-up if the warmth of the sun reduces your pain, and wear sun screen.

1. Taylor SL, et al. J Alt Complement Med 15:15-23, 2009.
2. Harari M, et al. Isr Med Assoc J 13:12-15, 2011.
3. Feldman SR, et al. Pediatric Derm 22(6):501-12, 2005.

Too many demands placed on an individual from multiple roles may cause strain and be detrimental to overall well-being. On the other hand, multiple commitments to job and family can be rewarding and improve quality of life. If you are wondering how other fibromyalgia patients fare with juggling work and family life, a new study by Zettel-Watson at California State University in Fullerton, addresses these issues.*

Employment status, caregiving roles, and health-related measures were examined for a group of 70 middle-aged fibromyalgia patients and compared to a control group of 76 middle-aged adults that did not have fibro. People in the non-fibro group were not in perfect health; they represented adults in the community who are bound to have some aches and pains, but without the widespread pain of fibromyalgia.

More than half of the fibro group and 75% of the non-fibro group held college or graduate degrees. In addition, both groups resided in southern California where wages ranged from $50,000 to $75,000 annually, due to the high cost of living. Please keep these two factors in mind as you read the study results.

Health status, quality of life, physical functioning, and level of depression were all substantially worse for the fibromyalgia group compared to the non-fibro group, regardless of the number or type of roles engaged in. This finding reinforces what patients already know, that living with fibromyalgia is definitely not easy, even if one has a college education.

Although fibro patients struggle with many symptoms and health-related factors, employment and caregiving commitments tended to produce a favorable impact. Both health status and general quality of life improved when fibro patients fulfilled one role (job or caregiver). When patients were committed to two or more roles, these benefits declined slightly but remained above the level for those patients who were not involved in any roles.

Physical functioning and depression scores both showed improvement when fibro patients were involved in at least one role. This benefit was slightly greater for patients committed to multiple roles.

The results for the non-fibro group were nearly the opposite of those for the fibro group. As the number of roles increased, health status and general quality of life declined. Depression scores and level of physical functioning remained the same regardless of the number of committed roles for the non-fibro subjects.

Could the type of role played by fibro patients (employment versus caregiver) influence their health status? “Differences may exist between people with fibromyalgia who have an employment role versus those with a caregiving role,” writes Zettel-Watson, but her study did not detect any differences. She adds that this could be due to the small size of her study.

“Research has demonstrated the potential benefits of employment for physical health and quality of life,” writes Zettel-Watson. “Despite the problems that may accompany the caregiving role, the current results suggest that this role also may enhance the well-being of those with fibromyalgia.”

Being involved in any role (work or caregiving) can be a source of motivation, build self-esteem, and keep patients exercising their bodies and minds, even if the roles are performed out of obligation, according to Zettel-Watson. While commitments to any role created added strain for the non-fibro group, people with fibro benefitted from being involved in at least one role.

Future studies need to take a closer look at the impact of more than one role on people with fibromyalgia. Based on the results of this study, Zettel-Watson says, “it is possible that participation in one role is beneficial but addition of other roles starts to strain or overburden those with fibro.”

Although fibromyalgia clearly impairs quality of life, your overall well-being and function may improve if you are able to remain employed or elect to become involved in a regular commitment such as caregiving.

* Zettel-Watson L, et al. Impact of Employment and Caregiving Roles on the Well-Being of People with Fibromyalgia Syndrome. J Musculoskel Pain 19(1):8-17, 2011.

A research team in Turkey divided 56 fibromyalgia patients into three different treatment groups that all received standard physical therapy (i.e., TENS, ultrasound and infrared laser). In addition, two of the groups also received a form of water therapy. One consisted of hydrotherapy, similar to a whirlpool with jets, with lukewarm tap water. The other involved warm water containing minerals, but lacking the jets used in the hydrotherapy group.

All patients in the study were treated daily for three weeks, with the exception of Sundays. Pain scores and lung function tests were measured before the start of the study, after three weeks of treatment, and then at a follow-up period six months later.

Physical therapy by itself, and when combined with the two different types of water therapy, all led to improvements in pain scores at the end of three weeks. However, lung function tests and the perceived ease of breathing were only improved in the two water therapy groups.

The greatest treatment benefits were achieved in the warm mineral water group in which fibromyalgia patients continued to show improved lung function up to six months after the therapy ended. Only short-term (not long-term) benefits were observed in the hydrotherapy group when it came to enhancing lung function and reducing the strain of breathing.

If you are always struggling to catch your breath, especially during the winter cold and flu season, take comfort in knowing that you do not need a fancy whirlpool to ease your breathing difficulties. Soak in warm water for 20 minutes each day, perhaps using Epsom salt if you wish to simulate the mineral water used in this study. Within three weeks you should reap the benefits of easier breathing and significantly reduced fibro pain.

* Kesiktas N, et al. J Back Musculoskel Rehabil 24:57-65, 2011.