You are on page 1of 85

2

Your Fibromyalgia

Treating Fibromyalgia
Utilization of

Brought

an

to

Through the Development,

Individualized

you

Treatment

by:

Guide

Validation

Self-Management

and

System.

Fibromyalgia-Treatment.com

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Table of Contents
Introduction

Chapter 1: Getting Started:

Associations
Magazines

From Confusion to Knowledge

10

and Internet

13

Resources

and Journals

14

Doctors, Care Providers, and Therapists...............................................................

15

Support

Groups

16

Support

Groups and Accountability......................................................................

17

Primary

Focus

18

Chapter 2: Reviewing

History

Fibromyalgia

19

and Introduction

19

Demographics
Symptoms

Fibromyalgia

Triggers

20
20
27

Diagnosis...............................................................................................................

27

Causal Theories

29

Chapter 3: Fibromyalgia:

The Elusive Fiend

General Confusion

A Tough Nut to Crack...........................................................................................


Interplay

SymptomCause

Negative Feedback

and Confusion

Loops

Medical System

"Magic Pill Syndrome"

Effective Treatment

Chapter 4: Self-Management:

Overwhelming

Options

Basis for Effective Treatment......................................................

Taking Responsibility
Education

- Laying

the Foundation

for Success

30
30
32
32
33
35
37
38
40
40
41

Defining Your Fibromyalgia.................................................................................

42

Building Your Team

43

Take Action

44

Setting Goals

Become

Problem-Solver

Evaluating

Treatment

Options

Self-Empowerment
Self-Management

Conclusion

Chapter 5: Treating Fibromyalgia:

What

you

need to know

Medical Specialists
Create

Partnership

FDA-Approved

with

your

Physician

Pharmaceuticals

45
46
47
49
50
51
51
55
57

Antidepressants

59

Prescription

60

Anti-Anxiety

Sleep Medications.............................................................................

Medications

Pain Management..................................................................................................
Coping Strategies

Dietary

for Pain

Supplements

60
61
63
63

Diet

. . . ..................................................................................................................
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. . . . . . . . . . . . . . . . . . . . . ..................................... ... ... ... ... ... ... ... ...
. . ...........................................................................................
.......................................................

Exercise

Therapies

Chapter 6: Pulling it all Together:

A Systematic

Approach

Tools

Tracking Symptoms

Tracking Causal Relationships,

Events, and Triggers

Tracking Your Treatments


Intelligent

Trial and Error

A Concept and

System

The Key to Success


Chapter 7: The Future:

"FibroTrack"

FibroTrack:

Internet

Enhanced

Disclaimer

Self-Management...............................................

66
67
68
70
75
77
77
78
79
80
81
82
85

--------------------------------------------------

Introduction
Iam not

nor a

research scientist, medical professor, nurse, therapist or


any sense. There are no fancy plaques on my wall that
over me on this subject (my degree is in History.). I
do not have fibromyalgia. So why am Iwriting an ebook on this subject
and why
should you pay any attention?
doctor,

medical practitioner
project

some aura

Fibromyalgia
havoc

on

in

of authority

has undermined

the lives of

my

my

passionate

my

love

about fibromyalgia?

dream but something

our

lifestyle

are

they

for

about. Am I

hate it, to be precise. I

Ipassionately

years.

Iqualify

dream together. Not

extraordinary

family aboard

as we both fought
as an expert in how

feelings

typical sort of

our

heads that

our

we

kids and

spending quality time with each other and

47' sailboat and poured all that

home and restructuring

- we fought

small dream, not

(at least to us). We got it into

sailboat to live full time, home school

of freedom and discovery

reality. Ipurchased

the boat into

wife and wreak

her suffer to extremes

kids. We read, studied, learned and planned and in 2008

dream

my

passionate

destroy.

My wife and Ichased

move our

something

Absolutely!

and hopelessness

can

fibromyalgia

live

on

wife and Ihave watched

of helplessness

could

life. It is working to destroy

2 children. Experts always stress that writers and business

people should focus their efforts

our

we began to make this


we had into building
a reality.

lives to make this huge change

was diagnosed with


some symptoms before
our daughter
that the fibro began its assault in earnest. The diagnostic process was typically
confusing, frustrating and long. We suffered through multiple misdiagnoses, more
medical tests than we can recall and a long list of "treatments"
none of which
really achieved anything more than draining our bank account.
Through all of this

fibro in 2003 after the birth of

the

pregnancy

(her 2nd) but it

fibromyalgia.

our
was

My wife Michele

daughter. She exhibited

only after the c-section birth of

After being diagnosed

with fibromyalgia

and learning about the difficulties

on

treatment, Michele began focusing her attention


treatment options while

pay

for the expensive

- our

my

focus remained

on

researching

running

our

treatment efforts she needed. (Self-employed

small

company

many
many

doctors and tried different

insurance

paid for essentially

so we could
with a very

nothing). We went through

drugs and combinations

specialists. Through it all the fibromyalgia

in

and implementing

business

of drugs and listened to

waxed and waned but it

was

always there. At times things got better and

corner

our

Through 2008

we

as our

efforts to make the sailing dream

also increased

We both believed

simple

tropical paradise

the

war

against fibromyalgia.

care

success,

If youre

up
a fibro
we went all-in.

reality began to pick

expensive,

a big push to once and for all crush


we had a backup plan. The backup
in pain, you might as well be in pain in a

boat. That sounded

our

pay

off. Michele

pretty good at the time.

felt much better. In late 2009

boat full time and began to "live the dream". We had

(the saying "Going cruising is just repairing

locations"

We began seeing

being extremely

going to be

living aboard

moved aboard

problems

- we

and if it didn't,

All of the hard work and effort did

we

But

that putting forth the effort in

this beast would yield

was

worse.

dream.

center, and despite this

specialist

plan

deluded into believing

had been turned only to feel crushed again when things got

maintained

steam

we were

is true).

We had adventures

and

we

your

boat in exotic

had fibro. After getting

away from
we
a vengeance,

the "Big Push" medical efforts the fibro began to slowly build back. After
returned

from the Bahamas

raging like Ihad

never seen

in June of 2010, fibromyalgia


before and transforming

flared with

Michele into

complete

wreck.

We

were

was

convinced

overwhelming

migraines

something

more was wrong.

severe

confused, but

Michele
what

was

new symptoms

one

was

different. The pain

brain tumor be in play? What could be

was

really

the worst time of

were distraught and


Dream" was dead.
care at once to find out

and in such severity? We

thing rapidly became clear

- the "Cruising

in serious trouble. We had to seek medical

was

and huge

anxiety, bowel pains, horrible leg cramping and

other symptoms. Was this MS? Could


causing all these

This flare

but it went beyond that to shaking and convulsions

coupled with

wrong.

my life. It's bad enough having dreams crushed, but


was overwhelming. We launched into a whole new
was wrong. Medical tests flew about like confetti on
New Years Eve. Medical bills flowed in on a scale that was shocking. We saw
every sort of doctor known to man. The end result, other than insane medical bill
totals, was simply this: fibromyalgia.
This

watching

my

endeavor

to determine

wife suffer

what

we began dealing with fibro on a new level and working to put our lives back in
some semblance of order, Ibegan to feel a new sense of mission. Iwould focus my
life on helping my wife overcome this disease and provide my family with the rich
As

was to

might take, but the first step


about this task aggressively

make myself

reading everything

an expert on

my

that

efforts would yield

Ino longer have those expectations.

fibro is

case,

a war, not

Ialso understood
Michele

an

wife. Ihad

every

of treatments

magic combination

are

Education and knowledge

was

reward

just

that

tempered

as

wonderful

Ibegan to realize that fighting

single battle.

that determining

would be

individual

what treatments

would be most effective

struggle. Ilearned that fibromyalgia

an

in each patient and that developing

itself differently

my

and in

success.

would bring complete

things, but in this

Iset

fibromyalgia.

research scientists

Icould to figure out how to help

general, did everything

what form this

Icould find. Iread books, studied

online, delved deep into research reports, contacted

expectation

on

life that they want and need. Ihad lots of ideas

and productive

would require implementing

effective

for

manifests

treatment strategy

strong systems in order to effectively

manage

treatment efforts. Ineeded to be able to not only research what treatment options

were

possible, but to quantify

results and validate the combined

approach that

we were

multi-faceted

treatment approach. Such

dietary supplements,

developing.

Ilearned that the research data indicated

an

approach consisting

exercise, diet changes, therapies

most likely to yield lasting results, but determining


best for Michele

The

more

would be

Ilearned, the

more

ongoing individual

of pharmaceuticals,

and alternative

what combination

medicine

was

would be

process.

Ibegan to seek out information

about self-

very few things Ifound consistent among the


was the call for patients to embrace the concept of selfmanagement. It was clear to me: given the nature of fibromyalgia that a patientdirected, team-focused self-management approach made by far the most sense,
but moving from the conceptual idea to implementation proved to be very
management
"experts"

on

programs.

an

treatment

Among the

fibromyalgia

difficult.

Ibegan to seek

programs or systems to

utilize in this

much material out there relative to management

process.

of illnesses

Given that there is

so

in general, Iexpected

programs specifically aimed at assisting those fighting


fibromyalgia in their running of an ongoing self-management program. Isearched
extensively, but no such program existed. Experts and educational programs exist
that are aimed at convincing you that embracing the concept of self-management is
crucial to treatment success. However, Ifound nothing in online systems aimed at
to find structured

online

an

facilitating

process.

ongoing

Its

else to determine

it is something

one

one may need to


Ifound no "how."

thing to learn what

how to actually do it.

This need is what has driven both this ebook and the development
FibroTrack

application.

to do in order to treat
treatments

on

My focus is not

your

will be effective

you

for

telling

probably

you

is to test it. My

improve

your

ability to intelligently

to

suggesting

management

you

test and determine

what

you

effective

for

to

required

what does work, for

should do for effective

you

treatment

a selfmanage one on an

treatment. What is

you develop, implement,


answers these questions.

How do

This ebook

at

fibromyalgia

treatment varies from patient to

how to proceed toward effective

program?

ongoing basis?

you

you need
you what

what

to tell

way you can tell if any given treatment will be


focus is on this part: the systems and processes

In effect, Iam not trying to tell

am

of the

specifically

does not understand

its most basic level. The reality is that effective


patient and the only

you

Anyone who purports

fibromyalgia.

do, but

and

processes that Ipresent in this book are not new. Ihave not been
new conceptual research and the processes discussed here are not
new developments. What Ihave done is take existing research data
treatment process suggestions from many different experts and combine them
an overall strategy that can be implemented and managed by those struggling

The concepts
engaged

and

in

revolutionary
and
into

with fibromyalgia.

Ihope this ebook helps


find references

efforts. But

you

you to

improve

to the FibroTrack

believe that FibroTrack

can

your

fight against fibromyalgia.

application

help

any

throughout

patient improve

do not have to utilize FibroTrack

systems outlined in this ebook into action. Iurge


implement

success.

what

you

learn here. Knowledge

Please take what

Ialso need to point out that

you

You will

this ebook and Ido firmly

their self-management

in order to put the concepts

you

without

- please - make
action

never

and

the effort to
yields

learn and put it into action.

a great

deal of relevant

information

about fibromyalgia

on my website. The following 3 main sections


menus to the left through which you can navigate to
hundreds of detailed articles, all based on medical research with most including
references to source research materials. My goal for our website is simple: To
provide the largest and most accurate repository of fibromyalgia information on the
is not in this ebook, but is available
of the site have expandable

Internet.

Click these links to learn more!

What is Fibromyalgia?

Also

Finally

Please follow

my

Fibromyalgia

Treatment

Fibromyalgia

Symptoms

Blog.

you for downloading this ebook and taking the


you have placed in me by taking the time to
put together for you.

THANK YOU.

Thank

time to read it. Itruly value the trust


read the information

If

you

have

any

Ihave

questions, concerns or problems


you to contact me. Email:

suggestions,

be able to help with, Iurge

that

you

feel Imay

terrycspringer@yahoo.com

-----------------------------------------------------------

10

1:

Chapter
Fibromyalgia
persistent

pain appearing

treatments

can

parameters
frequently

with

of this disorder

are

poorly defined due to its inherent

boils down to the elimination

exist that provide

central to fibromyalgia

our purpose:

This is

confusion

of other possibilities,

throughout

no
on

shortage

is

concluded

be
of

and doubt have been

its history.

an

individualized

so

treatment

approach,

that specific actions

can

be

of symptoms.

of information

about fibromyalgia

Books, websites, magazine,

and its

associations

many

different

and organizations

this topic.

Much of the information


problem

nature. Diagnosis

a process that can


no established set

diagnosis. Confusion

must be replaced with understanding

treatment options.
abound

definitive

To develop

focused toward the reduction

There is

and

no apparent cause and not responding to typical


care providers frustrated. Diagnostic

leave the patient and

both long and confusing. No specific medical tests apply, and

symptoms

to Knowledge

From Confusion

Getting Started:

for most patients begins with pain and confusion. Pervasive

so

pervasive

available

online is, unfortunately,

that it triggered

that the majority

of dubious quality. The

own, a study that


are deeply flawed (Click
one of the primary motivations

research study of its

of fibromyalgia

websites

an article on this research study). This is


our website at http://www.fibromyalgia-treatment.com. Our goal is provide
source for definitive research based articles and information related to
fibromyalgia
so of course we urge readers to use this resource.
HERE for
behind

an

online

many others provide a wealth of information. We urge


to use the internet as a source of knowledge and a
resource for their own research and education. Step one in any effective treatment
effort is going to be replacing confusion with knowledge. This process will of
course be ongoing, but simply initiating it is a positive action aimed in the right
In addition to

our

website,

those fighting fibromyalgia

direction.

Books
There have been hundreds
Below

are

if not thousands

of books published

on

fibromyalgia.

brief reviews of 4 favorites:

10

11

Idiots Guide to Fibromyalgia

The Complete
By:

Lynne Matallana

Ph.D,

with

Laurence

A. Bradley

MD, Muhammad

Stuart Silverman

Yunus

MD

a great

This is

information

developing

program.

book.

It

covers a

diverse battery of

and stresses the critical importance

This book also

a care-provider team,
you can take to move your

options, the building of


details

on

of

a self-management
covers many treatment

and implementing

actions

and

treatment efforts forward.

From Fatigued
By:

to Fantastic

Jacob Teitelbaum

MD

This book should be considered


reference

information

goes

presented

into great detail

treatment options,
overwhelming.

so

mandatory

- the amount

manual. Fair warning

of

is massive. Dr. Teitelbaum

on a

huge variety of possible

much

so

that it

can

be

This is not the kind of book

someone

is going to sit down and just read; its presentation


and at times the content

complicated

to digest. Teitelbaum
develop

an

does focus

individualized

while he is overwhelming

bit short in details

this book has

on

on

treatment

can

is

be difficult

the need to
protocol, but

are recommended, he is
any shortcomings though,

in detail relative to what options

the management

process.

huge amount of detailed reference

Despite

information.

11

12

Fibromyalgia

for Dummies

By: Roland Staud, MD

an

This is both
beginners
seasoned

excellent

a great

and

with Christine Adamec

starting point for


manual for the

reference

warrior. Much material is covered

relative to different

treatment options. Much

effort is put forth in explaining

the history and

background

related to fibromyalgia,

reader gains

struggles

solid understanding

and the

of the

those suffering from fibro have faced in

having the syndrome


establishment.

accepted

by the medical

One shortcoming

on the need
processes. The

in this book is

its lack of focus

for strong self-

management

book documents

wealth of information
discussions
it's

about treatment

options, but it does not delve into

about how these efforts should be integrated

worthwhile

read and good reference

& Chronic Myofascial

Fibromyalgia

into

an

overall plan. Still,

source.

Pain

By: Devin Starlanyl and Mary Ellen Copeland

This is another book that


of content in
Information

detail, and it's


morbidity

covers a

largely textbook

about Myofascial

very

huge amount

manner.

style

pain is covered in

helpful given the level of

between these two syndromes.

co-

This

goes into more detail concerning possible


causes and triggers, and it discusses the
book

between causal factors at length.

relationships

The authors discuss the interactions


complications
approaches

associated

to integrate treatments
management

on any

and

with different

treatment

and the need for the patient to strive


into

comprehensive

strategy, but little detail is provided

related

processes.

and excellent supporting

Despite this lack, the huge amount of relevant


graphics

are

content

excellent.

12

13

Associations

and Internet

resources are

Considerable

multitude

of information

professional

associations

Fibromyalgia

now

on

and Chronic

organization

sufferers, all of which provide

awareness

to increasing

of

for those who suffer from it. The National

Pain Association

inactive National Fibromyalgia

nonprofit

to fibromyalgia

living with and treating the disease. Several

have devoted themselves

and advocating

fibromyalgia

Resources

available

dedicated

(NFMCPA)

joined forces with the

(NFA) to become the leading

Association

to the support of individuals

with fibromyalgia

and other chronic pain illnesses. Their mission is to educate patients, the medical
the public, government,

community,

timely diagnosis

and appropriate

conditions. NFMCPA

on

information

Fibromyalgia

advocacy

regarding

and members

their website (www.fmcpaware.org),

and overlapping

that

can

with

American

Academy

yearly conference
educational

number of online

provide information

include the American

sufferers

Pain Foundation

of Pain Management

on

pain, known

opportunity

access to a

as

wealth of

including e-newsletters,

conditions,

as

well

forums, general

as

research and

to fibromyalgia

updates. The NFA website also remains available

patients (www.fmaware.org)

resources

still available.

and support to fibromyalgia


(www.painfoundation.org)

(www.aapainmanage.org).

PAINWeek,

for medical professionals

of

and overlapping

have

Pain LIFE magazine, online discussion

fibromyalgia

Other organizations

the importance

treatment for fibromyalgia

is donor-supported,

and Chronic

on

information

and scientists

an

as an

is held each September


who have

and the

In addition,

interest in pain

management.

A number of Internet-based
fibromyalgia.

online

In addition to

resource

fibromyalgia

Co-cure

resources are also available to those who suffer


our website, www.fibromyalgia-treatment.com,

(www.co-cure.org)

and chronic fatigue syndrome

message board, a list of good


online resources. The website
patient education

as

well

patients, including

and

comprehensive

boards and support

Foundation

is

an

the

daily newsletter,

review of additional
industry-sponsored

group

large repository

information.

is the website of well-known

Robert Bennett and colleagues

from

for both

and chronic fatigue syndrome

initiatives. In addition, it contains

as message

Oregon Fibromyalgia

researchers

doctors,

helpful information

www.immunesupport.com

site that donates to fibromyalgia

research and advocacy


articles,

contains

of

Finally, the

fibromyalgia

(www.myalgia.com).

13

14

Magazines

and Journals

In addition to the education


number of magazines
information

magazine

Fibromyalgia

registered

members.

Fibromyalgia

covers

and advocacy

and newsletters

and support to

and Chronic

are

Back issues

Network,

The NFMCPA

journal (Fibromyalgia

an

alternative

fibromyalgia

are

Network

devoted

Fibromyalgia

Health, which provides


of interest to

providing

Fibromyalgia

sufferers.

Alternative

causes

to exploring the underlying

quarterly

News is
of

non-

by the

Other periodicals

suffers include magazines

such

as

that

Womens

on health, fitness, nutrition, and beauty issues


as Prevention magazine. Prevention focuses on
consumers to help them lead a healthy lifestyle and

information

women, as

information

that

both

eNews pertaining

and chronic fatigue syndrome

Coalition International.

be of interest to fibromyalgia

for free to

their website. The


organization

Journal) and monthly

and chronic fatigue syndrome, and is published

profit organization

may

on

for download

patient-advocacy

all free of advertisements.

health magazine

their bi-monthly

research and treatments, publishes

to topics of interest for both fibromyalgia


These publications

are a

provide, there

publishes

Pain LIFE, which is available


available

member-supported

the latest fibromyalgia-related

quarterly

these organizations

that provide fibromyalgia-specific

consumers.

well

for

prevent disease.

In the academic

world,

fibromyalgia-related

number of scientific

information

journals

regularly

publish

and research. Although fibromyalgia

form of arthritis and does not arise due to joint

or

muscle inflammation

is not

(like

causes chronic pain and fatigue very similar to arthritis,


and therefore Rheumatologists are often involved in the diagnosis and treatment of
fibromyalgia. As such, many Rheumatology-focused medical journals publish
fibromyalgia-related research findings on a regular basis. Arthritis & Rheumatism
rheumatic

diseases

do), it

is the official monthly

covers

information

journal of the American

Rheumatology,

fibromyalgia.

and

diseases. Other journals include The Journal of

Clinical Rheumatology,

Clinical and Experimental

pain management

College of Rheumatology,

related to diagnosis, treatment, research, and socioeconomic

issues that relate to all rheumatic

regularly

Journal of Clinical Rheumatology,

Rheumatology.

In addition, several journals

publish findings

These include publications

related to the treatment

such

as

and

focused

on

of

Pain and The Journal of Pain.

14

15

Doctors, Care Providers,


is not

Fibromyalgia

are

rheumatologists

commonly

or

rheumatic

consulted

the symptoms

diagnosis. This is because


rheumatoid

and Therapists

form of arthritis

during

must be ruled out. A rheumatologist


In addition to rheumatologists,

of fibromyalgia

as a

condition)

continues

physicians

can

can

neurological

one

are an

and Depression

becoming

and treat fibromyalgia.

part of

important

occur
manage the

an

effort to increase

In addition, psychotherapists

psychological

mobility. Physical therapists

to administer
providers

difficulty

licensed

normal activities

as acupuncture,
supplements,
depression,

to fit

healthcare

therapeutic

are

in

trained

specifically

healthcare

and independence

who suffer from fibromyalgia,

is most often achieved

massage

by

needs.

through

and alternative

an

integrated

therapies

therapy), dietary modifications

(such

and

and regular exercise. For those patients who suffer from anxiety and

tailored psychotherapy

is also crucial.

about Doctors and Care Providers

discussions

your

more

be of great
exercise

massage,

also licensed

More detailed information

Learn

and

and injuries. They help patients who have

therapy, complementary
and

providers

therapists

to regain functioning

patients

and treatment

chiropractic,

can

therapists

electrical stimulation

to note that for most individuals

management

system of pharmaceutical

of the disease.

training related to the physical and

of illnesses

ramifications

the environment

It is important
effective

are

these therapies. Occupational

performing

modifying

plan.

and these specialists

components

and strength, reduce pain, and improve overall

who receive specialized

psychological

care

patients

fibromyalgia

patients. Physical therapy combines

flexibility

understanding

rheumatological

with fibromyalgia,

with other modalities, including ultrasound,

more

and internal medicine

In addition to medical doctors, physical and occupational


benefit to fibromyalgia

to do

specialist

increasingly

as our

of fibromyalgia,

condition (rather than

commonly

help patients address and

similar to those of

of exclusion, these conditions

are

to evolve. General practitioners

also diagnose

and psychologists

is

quest to achieve

are

of the muscular-skeletal

is often the most appropriate


neurologists

and management

involved in the diagnosis

Anxiety

disease in general, however,


patients

arthritis and other chronic pain conditions

system. Since the diagnosis of fibromyalgia

so.

of fibromyalgia

about building

about

individual

Medical Specialists

care team

is covered in

in Chapters

in the treatment

4 and 5.

of Fibromyalgia.

15

16

Support

Groups

Participation
be of

groups, whether online or in person, can


groups offer an opportunity for fibromyalgia

support

in fibromyalgia

benefit to patients. Support

also

patients to connect with others who have the disease and gain valuable insight that

can

overcome

help

changes

challenges

that result from

strategies, and provide


often feel neglected,

fibromyalgia.

Others

may

that not all support


pervasive

unevenly

focus

on

distribute

related

environment

ostracized, and misunderstood

of the lifestyle

groups

Support

of information

safe and understanding

in tone, with

discouraging

their understanding

of fibromyalgia.

the exchange

to understand

It is important

and improve

diagnosis

emotional support, facilitate

also offer

to treatment

for patients who

can

by the medical community.

groups are

the

the negative

member

same.

Some

may

be

aspects of

participation,

with

one or

the meetings and the focus of the group. Therefore, it


you to choose the support group that is best for you and your
fibromyalgia. Make sure you choose one that reinforces the positive factors in your
life, is constructive and caring, and encourages participation from all members.
You may need to try out a few different groups before you find the right fit for
you. You may prefer a live support group, or you may wish to test the waters with
an online support group first. For some people, using a combination of the two
may be most beneficial.

two individuals
is important

dominating

for

A few examples

of the

numerous

online support communities

available

include:

www.dailystrength.org

www.mdjunction.com/fibromyalgia

www.fibrotalk.com

www.livingwithfibro.org

The Arthritis

across
support

Foundation

sponsors
can

the United States. You

group

The NFCPA

directory

fibromyalgia
find

website also offers

directory

(www.fmcpaware.org/support-groups),

interested

groups in many locations


groups by visiting their online

support

of these

of support

organized

groups

by state. Individuals

who

a support group of their own can also visit the NFCPA


and resources to assist in the startup process, as
new support groups with the NFCPA directory.

are

in starting

website to find information

to register

one

at their website, www.arthritis.org.

well

as

16

17

Groups and Accountability

Support

Support

groups can

provide camaraderie

should not be viewed

as mere

for fibromyalgia

motivated

patients, however

convene to

where patients

clubs

about how terrible they feel. Effective support

groups

they

commiserate

will consist of highly

who strive to help each other through the decision making

individuals

processes that are required to progress


groups should enable members to help

toward achieving

treatment goals. Support

each other with goal-setting,

treatment ideas, obtain feedback and opinions

on

collective

during bad times. The KEY to

that all members

maintain their accountability

foxhole, support

group

members

are

review

symptoms, and

group
to each other. Like soldiers in a
war against fibromyalgia together.
They should hold each other accountable, as accountability has demonstrated
effectiveness in helping people achieve a variety of goals, and it can also help
patients progress toward reducing fibromyalgia symptoms as well.
maintain motivation

support

successful

is

in this

The FibroTrack
online self-

management
includes
focused

system

many tools
on assisting

those with
in

fibromyalgia

building and
participating

an

in

effective,
meaningful

support
includes

online

group.
a

sophisticated

This

system

for matching potential support

(age, geographic
symptoms).
networking

group

members

also facilitates

support

on

based

location, work situation, comorbid

FibroTrack

their demographic

conditions

group

functions, contact sharing and rating, symptoms

sharing, private messaging

and forums. The FibroTrack

from the ground

up to promote

The information

presented

these topics. Please visit


detailed information,

and support effective

in this ebook is merely

our

an

data

and Fibromyalgia

interaction

with social

and treatment

program

system has been designed

support

groups.

overview

of the highlights

website, www.fibromyalgia-treatment.com

of

more
more.

for

including blogs, articles, webinars, and much, much

17

18

Primary

Focus

Our primary focus at www.fibromyalgia-treatment.com

is all about the How

to

fibromyalgia, and so many treatment options are


can be confusing and conflicting if you dont have a
trustworthy source to guide you through it all. Our website can help you pull it all
together, create a plan based on your specific needs, and then execute that plan to
work toward successful management of your fibromyalgia. The tools available to
you on our website will allow you to develop and implement an individual
fibromyalgia self-management program, a system, designed BY you (and your
team) FOR you (and your team), that is specifically targeted at treating
fibromyalgia as is manifests itself in your body and your life.

do it! Information
available

Step 1:

abounds

on

that the information

Learn.

Knowledge

is the foundation

on our website can


you started:

articles

following

required

to get

Current

Diagnostic

The Diagnostic

Criteria

Process

of effective

provide the foundation

Diagnostic

History

Multiple Diagnosis

action.

The

of knowledge

of Fibromyalgia

and Fibromyalgia

Fibromyalgia

Medical Tests

Keys for the Newly Diagnosed

Fibromyalgia

Causal Theories

Brain Chemical

Fibromyalgia

and Genetics

Anxiety

Abnormalities

and Fibromyalgia

Stress and Fibromyalgia

Fibromyalgia

Widespread

Demographics

Fibromyalgia

Myths

of Fibromyalgia

Pain

The Great Pretender

Life with Fibro- A Woman's

Nothing Easy About It

Online Self-Management

Symptoms

Internet

Online

vs

Overview

Offline Treatment

Enhanced Treatment

Treatment

Focus: Symptoms

Perspective

Efforts

or

Causes?

18

19

2:

Chapter

History

Reviewing

Fibromyalgia

and Introduction

First observed

and fibrositis

muscular

rheumatism.

syndrome. It later

pain

across

referred to

(such

as

is diagnosed

areas on

19 specific

symptoms

associated

was

Dr. Philip Hench coined the term fibromyalgia

the disease in 1976. Fibromyalgia


patients

was originally referred to as


as fibromyositis and

century, fibromyalgia

in the nineteenth

fibrositis

by examining

as

the body,

sleeping difficulty, cognitive

to refer to

the severity of each

as

well

the severity of their

dysfunction,

and

fatigue).

years,

Over the

has carried

fibromyalgia

realms of the medical community.


illness,

many

clinicians

believed

combination

addition, other clinicians


considering

it

an

in the absence of
community

psychosomatic

simply imagined

was not a

have refused to acknowledge

condition and simply treating each specific symptom

formal diagnosis. This lack of acceptance

definitive

finally received

by the medical

has also made it difficult

diagnostic

for patients to explain their

the credibility

in 1990, the disease

criteria for fibromyalgia

it deserved

and

gave

patients the

still refused to accept that fibromyalgia

clinicians

to insist that its symptoms


simply psychological
medical community,

were

is

a true

has become

more

care

they

or
some in
as a true

from

so

the

desperately

greatly deserve.

For far greater detail relative to defining and understand


fibromyalgia,

please refer to

our

and Fibromyalgia

the

many aspects

of

website www.fibromyalgia-treatment.com.

in the primary header labeled What

Treatment

some

condition

resistance

widely accepted

medical diagnosis, thereby enabling patients to get the

so

criteria,

condition and continued

the result of another physiologic

in nature. Despite the continuing


fibromyalgia

ability to receive

true diagnosis. However, despite the existence of these diagnostic

sections

disease,

the disease altogether,

to family and friends. When the American College of Rheumatology

established

need and

singular

of related conditions. In

has made patients feel ostracized, confused, and frustrated. In addition,

this lack of acceptance

symptoms

itself

a group

from

many

stigma within

as a

disregarded

that fibromyalgia

of symptoms

illegitimate

legacy of negative

that people with fibromyalgia

their symptoms. Others believed


but rather

Originally

Symptoms

related to all aspects of fibromyalgia.

is Fibromyalgia?,

contain comprehensive

You will find individual

The

Fibromyalgia
information

articles detailing

19

20

specific treatment

and alternative

options, from various pharmaceutical

drugs to complementary

such as acupuncture and yoga. There you can also read


many symptoms associated with fibromyalgia, such as
as well as find summaries of

therapies

detailed articles

on

the

anxiety, depression,

fatigue, and morning stiffness,

the latest research surrounding

fibromyalgia.

Demographics
Although fibromyalgia
discriminate.

survey

by

a team

were

were

female and 91.5%

moderately

incomes

overweight.

men, can get

Caucasian. The

Half of all respondents

between $20,000 and $80,000. Click HERE

research study into the demographics

researchers,

in conjunction

found that of the 2,569 respondents,

Association,

were

it does not

the disease. A 2005 Internet-based

of leading fibromyalgia

with the National Fibromyalgia

96.8%

women,

most often affects Caucasian

Anyone, including

conducted

average age was 47 and most


had average household
for a full article on this

of fibromyalgia.

Symptoms
Pain

The most

common symptom

widespread

as

associated

with fibromyalgia

as

pain. The pain is often described

pain in the connective

tissues (myofascial

by far is chronic,

being deep, muscular

pain).

pain

as

Individual descriptions

well
of

vary among fibromyalgia patients, with some describing it as


throbbing, or sharp/shooting. Others describe it more as a burning or

pain sensations
aching,

tingling sensation.

The pain associated


"Tender

Points

on

causes
may continue to
may feel constantly

with fibromyalgia
the body

patient tries, and muscles

sufferers

to ache all

ache regardless
overworked.

over.

Certain

of the therapies

The pain of

can concentrate around the joints of the neck, back, shoulders, and
hips, which can make sleeping difficult and restrict mobility. Furthermore,
fibromyalgia pain is frequently made worse by changes in weather, temperature,
loss of sleep, fatigue, excessive physical activity or lack thereof, and stress/anxiety.
fibromyalgia

Fibromyalgia
resolves

pain differs from acute pain (that which originates

over a

period of time, such

as

with

suddenly

and

broken bone), in that it is chronic,

persistent, and ongoing.

20

21

Living with the pain of fibromyalgia


problematic

and interacts

severely

sleep deprivation

Chronic

and daytime
maintain

with

an

pain

difficult. It makes relaxation

ability to sleep restfully.

individuals

results in increased

fatigue. Fibromyalgia

an

is extremely

can

pain and aching, morning stiffness,

also make it difficult

to

for sufferers

and lead to social isolation, depression,

active lifestyle

and anxiety.

Fatigue

In addition to widespread

can

patients and

muscle pain and aching, chronic persistent

symptom of fibromyalgia.

another hallmark

so severe

be

It

occurs

in

as many as

that it leads to isolation, depression,

fatigue is

90% of

and anxiety.

sufferers describe their fatigue as being similar to that which


occurs with the flu, truly debilitating and exhausting. Fatigue may wax and wane
as symptoms worsen or improve, however it continues to be problematic and made
worse by the sleep disturbances most fibromyalgia patients also experience.

Many fibromyalgia

Some researchers

fatigue

seen

and physicians

in fibromyalgia

have observed

strong similarities

between the

patients and the condition called chronic fatigue

a disorder marked by persistent, extreme fatigue that does


not improve, even after a person rests. In addition, a number of other symptoms are
commonly seen in CFS, including muscle pain, impaired memory, headache, sleep
problems, and painful lymph nodes. It also occurs most often in women in their
syndrome

(CFS). CFS is

forties and fifties. Due to the strikingly

occurrence in women, CFS


other or diagnosed together

similar symptoms

and fibromyalgia
in the

same

are

and the high rate of

often miss-diagnosed

as

each

patient.

Sleep Impairment

Impaired

- 90%

groggy

sleep is another defining symptom of fibromyalgia,

of patients reporting insomnia

and un-refreshed

difficulty

initiating

excessive

daytime

or

Fibromyalgia

an

individual

a state

disrupt sleep and


which culminate

85%

or

of

poor

report

quality, and

sudden bursts of brain

of deep sleep. These bursts of activity prevent

apnea

is also

stops breathing while asleep. These

cause a shift
in poor sleep

as many as
frequently

which mimic being awake when in

from having deep, restful sleep. Sleep

results when

with

sleep. Patients feel


sufferers

sleep, sleep that is light

Some patients experience

alpha EEG anomalies

fact the brain should be in

individuals

and non-restorative

awakening.

maintaining

sleepiness.

as

activity known

upon

common, and it
pauses in breathing

from deep sleep into lighter sleep phases, all of

quality and

feeling of fatigue and tiredness the

next day.

21

22

Morning Stiffness

Between 70% and 90% of individuals


increased
feel

as

pain, tenderness,

report waking

with fibromyalgia

becoming

can

fully mobile. This obviously

activity, making

even

up or

the most simple tasks such

of morning stiffness

particularly

as

for fibromyalgia

patients.

upon awakening,
range of motion in

include muscle tightness

in the hands, fingers, feet and toes, limited

your

may

and limit

getting out of bed,

difficult

joints (for example, being unable to fully extend


stiffness

with

warm up before

with mobility

interfere

showering, and driving into work incredibly


Symptoms

up

muscle aches, and stiffness in the morning. They

if it takes several hours for their bodies to loosen

stiffness

the

leg), and generalized

in the back, neck and head.

Tender Points

one

Historically,

receive

diagnosis

was

fibromyalgia

presence

of the

criteria to

required

of

the

of at least 11 of

18 specific tender points.


These 18 anatomic

sites

cluster around the neck,


shoulders, chest, hips,
knees, and elbows. In
order to evaluate
tender points,

will apply light

these
physician

pressure

to the surface of the


muscles

throughout

the

body. While most


individuals

will feel only

pressure,

light

patients

with fibromyalgia
feel increased

pressure
The

may

that is disproportionate

to the amount of

that is applied.

presence

diagnosis

pain and tenderness

of myofascial

of fibromyalgia.

trigger

points

can

sometimes

complicate

the

The term fascia refers to the dense fibrous connective

22

23

tissue surrounding

are

as

known

up and creates what

muscles. When fascia is injured, it knots

are very painful


areas. The chronic

trigger points. When touched, these trigger points

and the pain radiates throughout

the muscle and surrounding

as
can

muscle pain that results from these trigger points is known


syndrome. The pain is persistent,

negative

significant

worsens over

sleeping. Much like fibromyalgia,

difficulty

impact

result of their overlapping

misdiagnosed

as

on an

individuals

fibromyalgia

tender points in fibromyalgia.

and vice

versa.

times

Trigger points

pain syndrome, whereas

diagnostic

underlying

requirement

point. Tender points have extreme

pressure

is applied, but

no

hard muscular

may

be

to understand,

are not the same as


cause of

are a

defining symptom and at

Tender points do not present

present in

myofascial

and disproportionate

knots

and

have

the underlying

is typically

tenderness

pain

can

active lifestyle. As

What is important
pain syndrome

are

tender points

as

an

pain syndrome

for fibromyalgia.

hard knot of muscle tissue

myofascial

result in stiffness

pain syndrome

ability to live

features, myofascial

however, is that trigger points for myofascial

myofascial

time, and

myofascial

an

trigger

pain when

are present.

Headaches

The majority

of people with fibromyalgia

experience

headaches. Migraine

are common, as are tension headaches. Migraines cause severe


throbbing or pulsing in one area of the head, and may also be accompanied by
nausea, vomiting, and sensitivity to sound and/or light. Migraines may last in
duration for hours or even days. Tension headaches are typically widespread and
moderately painful, and they are the most common type of headache. They are
commonly experienced as dull, aching pain, or a sensation of tightness or pressure
along the forehead, sides, or back of the head. Tension headaches can range in
duration from as short as 30 minutes to as long as a week. For individuals with
fibromyalgia, headaches often arise for no apparent reason. They often do not
headaches

respond well to traditional

Cognitive

Impairment

Individuals

headache

/ Fibro

medicines.

Fog

who suffer from fibromyalgia

impairment,
characterized

a symptom so prevalent
by memory loss (both

frequently

report substantial cognitive

is has been coined Fibro


short- and long-term),

Fog. Fibro fog is

difficulty

maintaining

focus and paying attention, and trouble locating the right words to speak while

talking. In addition to the cognitive


experience

impairments,

dizziness, feelings of lightheadedness,

fibromyalgia

patients

and disorientation.

may

also

These

23

24

cognitive

difficulties

are

very

all

troubling for fibromyalgia

patients and

can

fuel

feelings of anxiety and depression.

& Anxiety

Depression

While

many

people will experience

part by the constant widespread

may

depression

fibromyalgia,

disturbances,

up to

goes

often

some

point during their lives,

- actions

activity

hand-in-hand

fatigue associated

by constant

can

in fibromyalgia

and fibromyalgia

excessive

it

can

and sustained,

it

can

fibromyalgia

as a
that

very severe

result, including self-imposed

can

with depression.

when

symptoms

no
also

elevated

stimulus

social

feed the syndrome.

a natural response of
occurs under normal

Anxiety is

become

debilitating

disorder that prevents

anxiety disorder

levels of anxiety, excessive

many

condition

worrying, and tension,

is there to trigger such symptoms. Certain physical

accompany

muscle aches, difficulty

and

quality

to the body; however, when anxiety becomes

patients also suffer from generalized

marked by sustained

generalized

swallowing,

anxiety, including fatigue, headache,

and irritability. Those who suffer from

anxiety often suffer from panic attacks and unexplained

Irritable

with
sleep

from carrying out normal daily activities. In addition to depression,

sufferers

even

be beneficial

be

have decreased

the human body to stress, both good and bad. When anxiety
circumstances

headaches,

30% of patients at the time of diagnosis. Those

of life and often modify their behaviors

Anxiety

at

heavy burden of the illness. Driven in

also be exaggerated

patients who suffer from both depression

isolation and decreased

pain and overwhelming

and muscle pain. Depression

to be present in

is estimated

depression

patients often must deal with

fibromyalgia

feelings of inadequacy.

Bowel Syndrome

bowel syndrome (IBS) is characterized by severe abdominal cramping,


in bowel movements, along with a host of other symptoms. The cause of
cases of IBS is not known, however some cases may result from an intestinal
infection or be triggered by a nerve problem. Like fibromyalgia, research has
shown that IBS may start following a stressful life event or result from the bodys
impaired ability to process pain. IBS is common and affects one out of six people
in the United States, with women affected more often than men at a rate of two to
one. The primary symptoms of IBS include abdominal pain, a sense of fullness,
gas, and bloating, and can range in intensity from mild to severe.
Irritable
changes

most

24

25

When compared

to the rate of IBS in the general population (10%-15%),

an increased incidence of the condition. Some


as many as 70% of fibromyalgia patients have IBS.
may also have fibromyalgia. Despite their
common co-occurrence, it is unknown if the two conditions are causally related or
if they merely occur together as a coincidence. Those who have both conditions
usually have more severe symptoms and a poorer overall quality of life than those
who suffer from either fibromyalgia or IBS alone.
patients experience

fibromyalgia

researchers

have estimated

Up to two-thirds

that

of all IBS patients

Interstitial

Cystitis

Interstitial

cystitis (IC) is

condition that is marked by frequent

vary

in the bladder and pelvis. Symptoms


in intensity

as

from

person to person

pain
and

or discomfort
may increase

the bladder fills with urine, and after it is emptied. In addition to

may also
may worsen during

pain, people with IC

feel the frequent

symptoms

menstrual

urge to urinate. For women, their


or vaginal intercourse. The cause

periods

many women who suffer from IC also have other


as fibromyalgia or IBS, some researchers think that IC is merely
response to a more generalized condition elsewhere in the body. The
frequent co-occurrence of fibromyalgia and IC in many patients may be due to
malfunctioning nerve signals. The fact that both conditions are much more
common in women than in men also suggests that certain genetic and/or hormonal
factors may contribute to their development.
of IC is not known. But since

conditions

such

the bladders

Secondary

symptoms

of Fibromyalgia

A number of secondary
from patient to patient

comprehensive

symptoms

so

are

associated

with fibromyalgia.

much that it is nearly impossible

list. An abbreviated

list of

some

of the

They

to provide

vary

more common symptoms

is

below:

Temporomandibular
and tenderness
TMJ

can

Joint Disorder (TMJ):

in the jaw joint,

also manifest

itself

as

chewing, facial pain, difficulty

on

TMJ is characterized

by pain

each side of the head just below the

dull, aching pain in the

ear,

ears.

difficulty

opening and closing the mouth,

or as a

clicking sensation while chewing. TMJ affects nearly 35 million people in

the Unites States, most of them

are women

Restless

RLS is characterized

Leg Syndrome (RLS):

urge to move

between the

the legs in order to stop unpleasant

ages

of 30 and 50.

by the uncontrollable

sensations. The sensations

25

26

occur

generally

arms may
describe

between the knee and ankle, although the

also be affected. Individuals

the sensations

and usually experience

eyes:

Dry mouth and

as

aching,

used by

many

are

Skin rashes and irritations:

patients,

Abnormally

Many fibromyalgia

make sleeping

side effects to medications

some

patients experience

as

well

as

even more

increase

difficult

than it already is for

pain.

difficult and increased PMS and menstrual period pain:

Women who suffer from fibromyalgia


menstrual

as

experienced

eyes

directly related to the

symptoms, including dry and itchy skin and rashes.

can

These symptoms
fibromyalgia

are

diuretics, and opiate pain medication.

sort of skin-related

tingling

report dry

sufferers, including antihistamines,

fibromyalgia

antidepressants,

or

crawling,

with fibromyalgia

these symptoms

condition itself, but often they

or

at night while lying down.

Many individuals

and dry mouth. Sometimes

leg, feet,

who suffer from RLS generally

creeping,

their symptoms

upper

problems

are more

likely to have greater

than those who do not have fibromyalgia.

Increased

are all symptoms of PMS and


occur at higher rates and with great intensity in women with fibromyalgia.
Due to their increased sensitivity to pain, women with fibromyalgia also
moodiness,

irritability, fatigue, and cramping

greater pain with their menstrual periods, including pain in the

experience

lower abdomen and back.

Vulvodynia:
which is

Many

throbbing. It

can

women

with fibromyalgia

condition characterized

pain is generally

described

can

be constant,

Endometriosis:

as

also be marked by

or

it

can come

and

Women with endometriosis

that lines the uterus

grows

vulvodynia,

condition in which the tissue

in other parts of the abdominal

likely to suffer from fibromyalgia,


the immune

also experience

area. This type of


soreness, stinging, rawness, or
itching or painful intercourse. The pain
go, and it can last for months or years.

by pain in the genital

burning,

cavity

are more

chronic fatigue syndrome, and diseases

causes severe

system. Endometriosis

pelvic pain and

of

may cause

infertility.

Hypoglycemia:

Many individuals

hypoglycemia,

or

sugar

low blood

with fibromyalgia

sugar.

include intense cravings

panic attacks, lightheadedness,

The symptoms

also experience
associated

with low blood

for sweet foods, tremors/trembling,


confusion, headaches,

sweating,

and heart palpitations.

26

27

Fibromyalgia
The exact
potential

Triggers

cause
causes

development

have been suggested.

as

of fibromyalgia,

families. In addition,

many

may

Genetic factors

play

indicate

are

individuals

causal association

report having been under

with fibromyalgia

potential triggers

obese,

an

many

observation

people with

may

which also

No definitive

evidence

In

as

number of events have been suggested

that result in the development

individuals.

number of

role in the

between body weight and/or diet and fibromyalgia.

causes, a

addition to these potential

predisposed

or

often overweight

to cluster in

the disease has been observed

extreme stress prior to the onset of symptoms. Furthermore,


fibromyalgia

has yet to be identified, however

of fibromyalgia

among

of fibromyalgia

exists, however, which links them

to the onset of the disease. These potential triggers

include: accidents

that result

in physical trauma, physical and/or sexual abuse, illness, high stress levels,
childbirth, and others.

Diagnosis

Fibromyalgia
diagnosis
rule out

is

very

difficult

through the

process

condition that is

is often achieved

number of conditions

fatigue syndrome, myofascial


confusion

and frustration

and undergo

multiple

to diagnose. In reality, its


Doctors must first

of elimination.

that closely mimic the disease, including chronic

pain syndrome, and others. This often results in

for patients,

as

they shuffle from

tests and diagnostic

one

to another

specialist

procedures.

are no laboratory tests that can be used, therefore the diagnosis of


can only be achieved by physical examination, patient history, and
presence of other similar conditions. Rheumatic diseases, such as
rheumatoid arthritis and lupus can easily be ruled out by the presence of definitive
There

fibromyalgia

ruling

out the

clinical

features

rheumatoid

generalized

experience

in particular
and

to

characteristic

arthritis

abnormalities

widespread

blood

each

joint

condition.

swelling,

tests. Patients

inflammation,

presence of certain
as many fibromyalgia

tests. Ruling out the

more

difficult,

findings

is easily done,

when evaluated

in the diagnosis

as most

when

report

and

with

specific

with

in specific

rashes,
blood

can prove to

feeling

the exclusion

patients

neurological

occurs

patients

present

conditions

may

ultimately

fibromyalgia

using standard

of fibromyalgia

example,
deformities,

abnormalities

neurological
patients

tingling, and burning sensations. However,


conditions

and

For

joint

with lupus

be

numbness,

of neurological

do not show

any

abnormal

testing. The greatest difficulty

attempting

to distinguish

it from

27

28

other

chronic
in

pain

functional

syndrome.

fatigue

as many as

patients

also

as

diagnosis,
physician

80%

have

of

such

may vary,

interpretation

and Smythe proposed

minimum

symptoms: decreased

as

swelling, and/or numbness.

These included

well

presence

much-needed

are very

70%

to diagnose

one

of

of mis-

subjective

and

disease

criteria for fibromyalgia

presence

revised,

more

in

formal set

aching, pain, and stiffness

for

of at least five tender points. In

response to symptoms,

weather-related

symptom aggravation, sleep


irritable bowel syndrome,

Finally, in 1990, the American


official diagnostic

of chronic widespread

recognition

co-occur

of at least 12 of 14 tender points and

to fibromyalgia

College of

criteria for fibromyalgia.


pain and

18 tender points. In addition, the attention and endorsement

gave

differently.

anxiety, headaches,

(ACR) established

the

the

to

fibromyalgia

40%

high frequency

physicians

which required

as

is

of

and

patients to have at least three of the following

stress/anxiety-related

fatigue/tiredness,

Rheumatology

presence

physical activity in

symptom aggravation,
disturbances,

some

symptoms

the first diagnostic

fibromyalgia,

of three months

addition, Yunus et al. required

70%

with these disorders

leading

syndrome,

have been estimated

Approximately

sleep. In 1981, Yunus et al. proposed

of criteria to diagnose

bowel

approximately

syndrome.

associated

1977. These criteria included 1) the

irritable

also have TMJ. As such, there

the symptoms

2) non-refreshing

TMJ,

whereas

bowel

when another might view the patients

Moldofsky

as

CFS and fibromyalgia

patients,

irritable

patients

fibromyalgia

disorders,

as an

minimum

of 11 of

by the ACR finally

official clinical diagnosis.

were recently updated in 2010, in an


diagnosis of the disease and ensure that
same process to make a diagnosis. With this update, the
tender point test was replaced with a widespread pain index and a measurement of
symptom severity, known as the symptoms severity scale. The pain index is
determined by counting the number of areas on the body where the patient felt pain
within the previous week, and the checklist includes 19 specific areas. The
symptom severity score is determined by patients rating the severity of three
common symptoms fatigue, waking unrefreshed, and cognitive symptoms on a
scale of zero to three (with three being the most severe). Additional points can be
added for the presence of other symptoms, with a final score ranging from zero to
12. Under the new criteria, in order to receive a diagnosis of fibromyalgia, a patient
would need to have seven or more pain areas and a symptom severity score of five
or more; or, three to six pain areas and a symptom severity score of nine or greater.
The ACR diagnostic

criteria for fibromyalgia

effort to standardize

the symptom-based

physicians

are

using the

28

29

In addition to the 2010 ACR diagnostic


Questionnaire

It

was

worded in

a way

patients, and it failed to include important

are

on an

based

11-point numeric

worst. The FIQR is organized


fibromyalgia,

on a

in 1991 and has

originally

used

assessments

was

100 millimeter-long
the questionnaire

that made unfair assumptions

sensitivity. In 2010, the FIQ


creating the FIQR.

deficiencies,

slash

of their symptoms. Unfortunately,

indicate the magnitude

score.

patients to place

fibromyalgia

first published

into 14 languages. The questionnaire

analog scale that required

environmental

was

in the late 1980s, the FIQ

since been translated

to

Impact

(FIQ) has often been used to help doctors evaluate

patients. Developed

difficult

criteria, the Fibromyalgia

visual
line to

was

about

of cognition, balance, and

revised to correct these

The FIQR consists of 21 questions, all of which


rating scale from 0 to 10, with 10 being the

to evaluate functioning, overall impact of

and symptoms.

Causal Theories

One of the main

fact that despite

reasons
years of

that fibromyalgia

transmits

and

processes

is

so

difficult to treat effectively

cause

research, the definitive

remain unknown. Advances

is the

(or causes) of fibromyalgia

in research and understanding

of how the human body

pain signals has led to the prevailing

theory that

are unable to process pain signals normally.


may be the result of various chemical abnormalities in
the brain. These chemicals, known as neurotransmitters, carry pain signals from
one nerve cell to the next. When the body has excess neurotransmitters, it is easier
individuals

with fibromyalgia

Research suggests

that this

for pain signals to reach the brain, which then relays the painful sensation

the body. Recent research studies have shown that fibromyalgia


disproportionate

levels of pain-regulating

researchers

to hypothesize

individuals

may

of people with fibromyalgia

develop the syndrome


of

studies in fibromyalgia

genetic

cause

genome

involved in the development


ability to transmit

are

for clues

some

eight times

more

likely to

on

observational

relatives, researchers

have turned

as to

Based

gene, or genes, may be


genes that regulate
neurotransmitters are of particular

of fibromyalgia.

pain signals via

for

in the brain.

family history of it, which is

for fibromyalgia.

and their first-degree

their sights to the human

brains

no

than those who have

possible

back to

patients have

This has led

that perhaps the origin of fibromyalgia

be related to these chemical abnormalities

In addition, relatives

suggestive

neurotransmitters.

what

In particular,

the

interest to researchers.

29

30

3:

Chapter

Fibromyalgia:

leaving

you

is relentless. It

can

The Elusive Fiend

body with pain and drain your energy


physically and mentally. The ever-changing way in which
can confuse not only you but your doctors as well, leading to
frustration and a sense of helplessness. Fibromyalgia takes a toll on all involved
you, your friends, and your family. It can destroy relationships, careers, and bank
accounts. Fibromyalgia is indeed a fiend, and an elusive one at that, as effective
treatment can be very difficult in light of the fact that there is no known definitive
cause to target.
Fibromyalgia

wrack

your

exhausted

it manifests

itself

presents

Fibromyalgia

the extreme difficulties

serious problem, and this chapter is devoted to discussing


relative to its diagnosis, reputation

posed by fibromyalgia

within the medical community,

and struggles

with regard to the most effective

treatment approach. This chapter will also touch


health

care

on

our

perceptions

Americans

fails to conform with what

and how fibromyalgia

expect in terms of treatment from

we

have

of

come to

medical system.

General Confusion
Fibromyalgia

symptoms

years,

to both define and diagnose, given the wide spectrum of

is difficult

and co-morbid

is often misdiagnosed

conditions

the medical community

discounting

patients

that

with other diseases


considered

symptoms

accompany

it. In addition, fibromyalgia

that add to the confusion. For

many

a whiners
was all in the

head.

fibromyalgia

and suggesting

to be

their pain

disease,
(that

may prove to be true research has demonstrated differences in the


chemical processes in the brains of fibromyalgia patients relative to how pain
signals are amplified and processed) Unfortunately, despite the formal recognition
of fibromyalgia as a diagnosable condition by the American College of
Rheumatology and the International Classification of Diseases, many providers
continue to doubt its legitimacy as a true pathological condition.
ironically

Adding to the confusion


of fibromyalgia

Treatment

and confounding

the medical communitys

is the lack of easily defined and effective

of fibromyalgia

is highly individualized;

understanding

treatment strategies.

there is

no

Magic

Pill that

everyone. What works for one patient may be totally ineffective for
may even make that patients symptoms worse. Unfortunately, those
are helped to a great extent by a particular therapy may celebrate the relief of

will work for


another, and
who

30

31

their symptoms

by telling others about their cure,

The general lack of understanding

surrounding

stigma about the disease and perpetuates


suffer from it. People tend to doubt

in the

case

of fibromyalgia,

doubtful, harsh, and


frequent

symptoms

friends, co-workers,

crushing and

can

even

peoples

creates

negative

toward those who

toward those with the disease

Given that anxiety and depression

with fibromyalgia,

negative

attitudes

fear things they do not understand,

attitudes

family members, and

new

fibromyalgia

negative

or even

condescending.

associated

trigger

perpetuating

treatments.

about effective

confusion

unintentionally

even

feedback

this kind of hard feedback

health

care

providers

can

and

can
are

be

from

be

loops.

31

32

A Tough Nut to Crack

The reality of fibromyalgia

stop individuals

is that there is

no cure.

Unfortunately,

are

fibromyalgia

are

diagnosed

Additionally,

this does not

from claiming to have found one! In addition, misdiagnosis

rampant, both for those with and without fibromyalgia.


often diagnosed

with fibromyalgia
there is

clinical conditions

is

with true

Many individuals

as having a different disorder, while others who


may in fact suffer from something quite different.

a very high incidence of comorbid (having additional


same time as the primary) conditions with fibromyalgia,
to an already complicated situation.

at the

adding further complexity

In addition, there is

no

driven by the fact that

on a

recognized

even

percentage

significant

and accepted

single best treatment

the most effective treatments

have

of those who try them. The following

negative

reality

impact

point cannot be

enough: What may work for one patient may not work for another,
may in fact make the other patient feel worse! This reality makes the Elusive
a moving target, and the weapons for fighting him inconsistent from one

emphasized
and

Fiend

warrior to another.

SymptomCause

Interplay

Many causal symptoms


the symptoms

are

and Confusion

with fibromyalgia. In other words, many


appear to function in a causal role, i.e., they can
or appear after the onset of fibromyalgia. For example,
associated

of

of fibromyalgia

both trigger fibromyalgia

can cause
can cause

depression

anxiety. Fatigue
depression.

Sleep problems

can cause

fatigue. Deep,

persistent

pain

can cause

sleep problems. All of these


things

can

be both caused

can cause
occur. These

by stress and

stress to

symptoms

come

and

wane,

also frequently

go, or

fibromyalgia

pinpoint

wax and

in seemingly

fashion. As the

what

random

course

came

of

over

unfolds

time, it often becomes

first in different

and the egg scenario

develops

symptom /

which

can

extremely

cause

difficult

for patients to

loops. In effect,

make determining

effective

chicken

approaches

32

33

can

to treatment difficult. This


in the overall negative

to understand.

can

They

Determining

the patients

by

be

extremely

side effects, chemical sensitivities,

the relationship

more

complicated

The

manner

are no

there

complicated

and difficult

cycle, weather,

and environmental

between primary and secondary


environmental

than calculating

clinical standards;

in which these factors interplay

are

factors.

symptoms

and life factors

rocket trajectory

mission. At least with NASA, the laws of physics


fibromyalgia,

and further escalations

wide variety of factors, including stress,

exercise, obesity, menstrual

causal factors and negatively-impactful

prove to

confusion

life.

are

relationships

be impacted

diet, vitamin deficiencies,


pharmaceutical

on

impact

All of these symptom-cause

lead to increased

the

everyones

same

for

NASA

often

moon

for everyone! In

fibromyalgia

will be different

key

can

for

you

is unique.
than it is for

others.

Learn

more

about these frequent

Anxiety

Stress

Negative

Feedback

causal symptoms

Depression

Fatigue

Sleep

Loops

Many symptoms
associated

with

fibromyalgia

are not

isolated. They interact


with each other, feeding
off of each other in

negative

manner.

known

as a

This

type of relationship

is

negative

feedback

loop. Negative

feedback

can best be
as a cycle in

described
which

an event

leads to

another event, which


leads to another event,
which leads back to the
original event and

so on.

The cycle continues

until something

happens

to make it stop. For example,

an

33

34

individual

may

with fibromyalgia

sleep adequately

aggravates

suffer from sleep impairment.

results in excessive

the persistent

daytime fatigue. This excessive

pain that the individual

Due to the worsening

fibromyalgia.

experiences

pain, the individual

to

This inability
fatigue

from their

may not

be able to sleep

an example of a negative feedback loop, and will not cease until


occurs to disrupt it. That something might be a new treatment regime
massage therapy, which addresses both the fatigue and relieves

well. This cycle is


something

that incorporates
the

excess

pain, thereby improving

Causal symptoms

sleep quality.

interact both with other symptoms

negative

loops

feedback

Furthermore,

the interaction

to overlapping

scenario

of negative

may cause
a

NOT by definition

symptoms
debilitating

can,

downward

to

worsen over

is

in frequency

fibromyalgia

time. Fibromyalgia

and untreated, lead to

negative

loops

feedback

can

so

loops will

generalizations

reason

between patients, just

discouragement,

both of which

are.

than they already

feedback

loops

progress,

they

can

lead to the formation

environmental
opposite

can

often with

factors

can

also

so

trigger

symptoms, such

as

can

serve

the

lead to increased

pain and

poor

hard to pin down is that

or

amplify secondary

of additional

effect. Take Seasonal Affective

Affective Disorder

negative

will. This makes


of

confusion

related to treatment

make decisions

lead

lies in the

and

even more

Again, the Elusive Fiend at work.

fact that makes fibromyalgia

may

as symptoms

relative to the overall syndrome

next to impossible. In addition, this increases patients

fibromyalgia

in turn

vary

and precise definitions

can

to define. All of this

elusive? One

function simultaneously,

shared causal factors. In addition, the form and function of symptomatic

Another

is

and causal factors is multi-layered,

and intensity, and difficult

to ask: why is the Fiend

sufferers

fact that multiple

difficult

lead

decline in the quality of life for the

between symptoms

The relationship

feedback

can
that

downward

disease, however the causal impact of

if left unrecognized

spiral and

loops and causal factors

loops with shared symptoms

patient.

fibromyalgia

inconsistent

or

result of these interactions

syndrome

fibromyalgia

degenerative

and triggers

vicious circle is created.

feedback

loops, loops within loops,

impact other symptoms. The ultimate


spiral that

in which

and other causal factors. As is

creates, fosters, and strengthens

illustrated in the above example, this interaction

same

negative

as

negative

symptoms, which

feedback

loops. Certain

function though at times have the

Disorder (SAD) for example. Seasonal


depression

sleep; however,

as

that feeds into other


the

seasons

change and spring

34

35

brings with it improved

weather and sunshine, it

thus foster improvements

criteria associated

observed

phenomenon.

linked conditions
negative

more

with Fibromyalgia,

Significant

does provide

are not

by definition

are a

but rather

commonly

research relative to causal factors related to

some

research evidence

loops and their function

feedback

lessen the impact of SAD and

in pain and sleep quality.

to note that negative feedback loops

It is important
diagnostic

can

as an

to support the concept of

amplifier

in Fibromyalgia

but

specific research is needed.

Medical System

The U.S. medical system is highly fragmented

to effectively

diagnose

fibromyalgia.

As the diagnosis

the

presence

approaches

they

may

diagnosis

of fibromyalgia

if

may
a

altogether

of doctors lack

approach, i.e., throwing

partially

are

as

practitioner

as a true

is in

diagnosis,

in favor of treating each

an

in-depth understanding

it

can serve to

pills at it. This approach is not


make things

often effective; however,

alleviated. Improvement

supplemented
Another

such

by excluding

take different

particular

of fibromyalgia

the most effective options for treating it. This frequently

options

syndrome

symptom.

A large percentage

frequently

only be achieved

of other conditions, different physicians

to reach their diagnosis. Furthermore,

bypass

individual

can

of fibromyalgia

the school of those who doubt the legitimacy

simply not designed

and therefore

and treat patients who suffer from

with other treatment

of fibromyalgia

leads to

a cure,

and

generic

worse for the patient. Pharmaceutical


even in the best case, symptoms are only
if the pharmaceutical drugs can

is maximized

be

options.

aspect of the U.S. medical system that often precludes

seeking certain treatments

however, and

is health insurance. Many insurance

grant approval for certain treatments, such

as

chiropractic

individuals
providers

or massage

from

do not

therapy, and

even certain medications may not be covered by some insurance plans. Therefore,
if a particular treatment approach is not approved by a patients insurance
company it may never be discussed as an option for the patient. This can have huge
ramifications for patients who may actually receive benefit from those treatments.
A massive

problem is created when insurance

drive treatment

restrictions

options, rather than the fibromyalgia

and required

patient and their

approvals

care team.

35

36

Admittedly,

insurance

companies

face

an

system for the treatment of fibromyalgia


patient and viable within their business

manage

of trying to

the treatment

of whom require individualized

insurers want to be effective

fibromyalgia

are

approaches

expanding

alternative

to

manage

their availability

treatments

patients

of patients, all

no

question that
they do.

for fibromyalgia;

standpoint, but also from

proven treatment

approaches

for

in nature, and health insurance

companies

are

some

this kind of approach. Although

insurers

to included complementary

of covered services

and

such

of insurers. Furthermore,

recent economic

financial factors have resulted in


of their insurance

Without

must deal with the reality


with millions

as acupuncture, chiropractic, and nutritional therapy,


are not universal and are by no means standard across the broad

therapies,

these offerings

scope

that is both effective for the

and therapies. There is

the most effective

multi-disciplinary

simply not structured

range

a manner

when approving

cost standpoint. Unfortunately,

are

in

model. Insurers

and costs associated

treatment is not only prudent from

Effective

uphill battle when trying to structure

plans.

many

downturns

and other personal

having to scale back

individuals

Some people forego health insurance

health insurance, affording good-quality,

comprehensive

on

the

altogether.

care

health

in the

U.S. is almost impossible.

Insurance

issues aside, doctors

suitable, it is nearly impossible


guiding and managing

are

an

in

untenable

approach to the treatment

multi-disciplinary

for

patients

any

position. Due to the fact that

of fibromyalgia

is typically

the most

care provider to be effective in


treatment on a long-term basis. To expect

single health

overall

single doctor to be capable of this is to simply ignore the realities of both

fibromyalgia

and the medical system. No doctor

medicine, chiropractic,
behavioral

massage

focused medicine

play into treating fibromyalgia.


the best in all of the different
Fibromyalgia

will want

take responsibility

on

can

medical specialties

that

a team

nightmare

individualistic

difficult

one

medicine,

that

can

that

to be

individual

fighting

drives the reality of why

treatment. The patient must

the efforts of all of their

symptoms

care

and the

nature of the disease itself, fibromyalgia

treatment, the need for treatments

extremely

in general

approach.

for the medical system. The lack of

insurance, and the relentless

for

someone

the most effective

be imagined, when coupled with the variable

overwhelmingly

an expert

possible

their team. This scenario

is

be

other medical specialties

for directing and coordinating

providers. Self-Management

As

many

It is not physically

approach provides

self-management

can

therapy, dietary nutrition, alternative

and all of the

are not

one-size-fits-all

is

approach to

often covered by routine health

nature of the disease itself makes fibromyalgia

to both endure and to

manage.

36

37

"Magic Pill Syndrome"

and patients have been led to be believe and have

Consumers

that there is

phenomenon

as

unfortunate,

many
sense

cure

every

almost

come to expect

ailment out there. This cultural

it gives

individuals

false

of security and

inaccurate

Pill to

Magic

is

an

understanding

of how medicine

truly

works. The unfortunate


reality is that medical

are
as advanced nor as
as most

science and doctors


neither
capable

believe them to

Americans

be. This is not

on

failure

the part of the medical

a failure of expectations to remain aligned


doctors on TV can cure anything (and have good hair while
my doctor should be able to make me feel better.
community;

it is

This is particularly

case

the

for fibromyalgia.

only treatments

fibromyalgia

of those treatments

are

patients. Magic Pill Syndrome


medication
exists.

or

depression

among

even more

condition in order to

no

known

one

for

many
a percentage of

particular

cure for their disease when

no

such

cure

expectations,

feeds

to the frequent confusion and lack of

manage

for all fibromyalgia

move

cure

in only

family members. These false expectations

to

The

- so surely

its symptoms, and

effective

leads patients to believe that

result in

complicated

It is vitally important

or

doing it)

patients, this belief drives unrealistic

to people with fibromyalgia,

major hindrance

disease

can

effective,

and anxiety, and contributes

understanding

therapy

For fibromyalgia

There is

geared toward addressing

only partially

with reality.

and make

a very

are a

big issue and

complicated

effectively.

patients to accept the reality of their

forward with effective

treatment. There is

no

magic

pill.

The U.S. Food and Drug Administration


for the treatment

of fibromyalgia.

For

(FDA) recently

many

Americans

approved
who do

the drug Lyrica

cursory

research

37

38

with regard to treatment, they

may

this FDA approval as meaning that the U.S. government has certified
as a cure and thus it is the magic pill they are seeking. Unfortunately,
case. Lyrica is not a cure for fibromyalgia, and for those patients in

this

and depend solely

upon

their doctors

guidance

interpret
Lyrica

is not the

whom it is most effective, it only decreases

may

In other words, Lyrica

There

Treatment

Effective

are many

patient. These variations


conditions

extremely

help, but it is certainly

Overwhelming

causes

suspected

symptoms

fibromyalgia

not

pill.

magic

Options

of fibromyalgia,

make the identification

and they

vary

and evaluation

given the time constraints

difficult

by about 40%.

from patient to
of overlapping

on

modern realities place

the medical profession.

Among the theories surrounding


perhaps the most consistent
likely to yield sustainable

combination

however, that what works for

care

provider is going to be

options present interaction

or

dietary supplements.

metabolizes

and

uses

various treatments.
effective

for

one

has

may not necessarily


a large number of

in all of them. Finally,

challenges.

Dietary factors

Certain drugs

may

the drugs themselves.

may

Determining

particular

agree

approach is most

and research

have

an

may

alternative

to note,

work for another.

no
many treatment
options and

single

interact with other drugs

impact

on

how the body

In addition, personal factors, such

also play

role in the effectiveness

the combination

patient involves

patients will

therapy, dietary supplements,

patient

an expert

body weight and mental status

multifaceted

and regular exercise. It is important

each aspect of treatment

Furthermore,

treatment for fibromyalgia

of pharmaceutical

therapies, dietary modification,

is that

results. Most experts

tends to support that the most effective


involve

treatment strategies for fibromyalgia,

effective

among experts

long-term

of treatments

of

as

the

that is most

patience, dedication, and

a process

of

trial-and-error.

38

39

As noted in the
diagram to the
left

- multiple

negative
loops

feedback

may

function

simultaneously
feeding

an

ongoing decline
in overall health
that drives

worsening

of

fibromyalgia

symptoms.

Patients should
utilize diagrams
like this to chart
and document
how
fibromyalgia

is

playing out in
their

own

bodies. Nothing
fancy is required

- crude

diagrams

can
same
a

hand-drawn

serve
purpose as

fancy computer

comprehensive
presented

in

generated

base of understanding

your

individual

graphics. The important

the

thing is to build

relative to exactly how fibromyalgia

is being

case.

39

40

4:

Chapter
are

Self-Management:

Basis for Effective Treatment

your fibromyalgia. In fact, no one else will ever be capable


of understanding how your fibromyalgia manifests itself in your body and life as
well as you can. You are the only one who is able to effectively evaluate and
manage the treatment of your fibromyalgia, and your motivation to get better will
never be matched by anyone else. Remember: you are your own best advocate,
your own hero, and your own boss!
You

There

1.

unique. So is

are two

choices when it

Learn to effectively

comes to

manage

managing

fibromyalgia:

it yourself

OR

2. Option #2 is

see

years

option #1. No other worthwhile

option exists.

you will find a magic cure. Do not expect that your


doctors will have all the answers for you. In fact, dont expect anyone to have all
the answers, including you, because for fibromyalgia there are few certainties. But
that is ok; many times even an intelligent guess can have great outcomes for you.
Do not waste

thinking

Taking Responsibility
for managing your own fibromyalgia. Taking
a decision; it is an action. It means taking control. The
move from a path of dependence, confusion, hopelessness,

You must take responsibility


is not just

responsibility

so

step in doing
and fear to

is to

path of knowledge,

hope, challenge, and most importantly,

you
you act upon

or concept in history, it
means accepting the

The action part is key. Even if

have the greatest idea

worth nothing unless

it. Taking responsibility

reality that action is required

This

can

be

may

one

has

one

feel capable of

and trust their

people,

is

who must do it.

as some may not

can

many

the

one is better equipped or prepared than


better motivation, and no one will ever be in a position to better
and manage your fibromyalgia than you.

instincts. Nonsense. You

observe, evaluate,

you are

doubt their ability to take responsibility

breaking point for

taking action. They

YOU. No

and that

first

action.

do it! No

40

41

- Laying

Education

you

the Foundation

is the cornerstone

Education

know, the better armed

Knowledge

is

primary

management for fibromyalgia. The more


you are to tackle the many challenges you will face.
weapon in this fight. It is important to understand how
conditions, the treatment

functions, its associated

fibromyalgia

you,

your

for Success

of successful

and the types of doctors

you

need to

engage

in

options available

to

your care.

reality is that a large number of comorbid conditions and


are an integral part of fibromyalgia. It is important to focus your
on those symptoms that are specific to you, in addition to learning
all you can about the general nature of fibromyalgia. Learning all you can about
these co-occurring conditions is key to developing an individual and effective
The unfortunate

symptoms

learning efforts

treatment strategy.
As mentioned
magazines,

in chapter

newsletters

one

understanding
such

as

on

and Chronic

The National Fibromyalgia


Pain Foundation

Furthermore,
information

care

providers, such

about fibromyalgia.

Make it

as a

up to

date

as

well

of Pain Management,

as

all

and/or chronic pain.

that also provide comprehensive

as

therapists,

nurses,

on your

ASK for their ongoing

pharmacists,

and

journey to understand

point to ask questions

Seek out the input of these individuals

relationship.

you with a
your

and pain management.

medical specialists, should also be consulted

can

provide

individual. Magazines

Pain Association,

Academy

have websites

related to fibromyalgia

Doctors and other

and Chronic

and American

related to fibromyalgia

these organizations

can

you as an

strategies, research, and tips for living with

the American

publish newsletters

number of journals,

and facilitate

Pain LIFE provide regular,

the newest management

fibromyalgia.

regularly

that

regarding fibromyalgia

of the disease and how it affects

Fibromyalgia

information

are a

of this ebook, there

and national organizations

wealth of trusted information

and

engage

and make the time to cultivate

help and assistance,

all

you

in dialogue.

and for them to function

sounding board when needed.

The Internet, while


notoriously

fibromyalgia

proven

an

found

on

research tool and

you

read

source

of information,

the wide availability

is

of low

the Internet. That said, keep the reality of

in mind when sourcing information

best treatment

patient. If

indispensable

inaccurate. Research has corroborated

quality information

method! Fibromyalgia
testimony

from the Internet: there is

manifests

online that treatment

itself differently

X worked for

no one

in each

one person,

be

41

42

that treatment

skeptical and understand


educating

may not

work for

is to learn about the options that

yourself

sure to

great place for this, but be

you

The

purpose

of

have. The Internet is

validate the information.

In contrast to the Internet, face-to-face

support

groups

is playing out in the lives of others who

fibromyalgia

you.

groups are

you to see

allow

are

how

suffering with the

who are
of the same trials and obstacles that you are, they can help you
your own fibromyalgia and allow you to evaluate different
treatments in context. Support groups also increase the pace of learning, as you are
able to share things with other group members.
disease.

support

Since fibromyalgia

comprised

of individuals

many

going through

to better understand

Your Fibromyalgia

Defining

Your fibromyalgia

is unique. It manifests

your

other patients. From


negative

your

loops and

feedback

your

possible

response to treatments

you

than it does in

even your

triggers,

all of these things define

and set it apart from the fibromyalgia

fibromyalgia

in

itself differently

causal factors, to

other patients experience.

Inspect What You Expect

Before

condition

can

be effectively

to detail how fibromyalgia

causes,

possible

possible

will change

fibromyalgia

ongoing, however

You

are

over

your

your

it must be defined. It is important

life, including

time and therefore

condition

source
on a daily

of information

basis and

you

emotional impact. Only through self-observation

true inventory

of

your

about

your

is playing out in your


easy access to your notes

it. Focus

on

inspecting

you

life and track what

facilitates

and deeper evaluation.

up.

the

your

fibromyalgia.

You

can you take


impact on your life

closely how
find in

a manner

that

Baseline

In order to effectively
ground

of

will be

and self-awareness

Fibromyalgia

process

know its true physical and

condition its symptoms, complications,

and well being, and what improves

Laying Down

your symptoms,

the evaluation

starting point must be established.

the most important

live with

managed,

is present in

triggers, and potential patterns. The definition

Note all of

evaluate

your

your

fibromyalgia,

it is important

to begin from the

primary symptoms. Keep track of each symptoms

severity and write down descriptive

details for each. Do not try at this stage to

42

43

detail

history for how

your

you are

played out in the past;

fibromyalgia

now. Focus on what fibromyalgia is for you right


your life. Make note of things you know for sure,
you have tried in the past relative to treatment and what impact it
had on you. If you have noticed that certain dietary changes seemed to help, make
note of those. If your spiritual practice helps you relax on days when symptoms are
at their worst, make note of that. If adhering to a regular schedule of both rest
periods and periods of activity reduce your fatigue, make note of that.
establishing

now,

starting point right

and how it is impacting

including what

Note things that confuse


drafting

some

you
or

basic charts

and

any

questions

diagrams

that

you have. You may consider


you define how you perceive

to try and help

your body and mind. Formalize this


journal; take your time and be thorough. It may not
process is actually a therapy in and of itself, and this
baseline information will form a foundation from which you can begin to measure
your ongoing progress and the effects of your treatment efforts.
fibromyalgia

to be currently working in

material into

an

seem

organized

like much, but this

Building

Your Team

mean isolated self-management! It is


a team, and you are the boss. Never
forget this and NEVER relinquish the role. This is not a job from which you can be
fired. Even if your team includes someone with advanced medical degrees, an
office full of awards, a high salary, and a hospital full of professionals reporting to
them, it will not change the fact that they work for you! You are the boss, and only
you.
Fibromyalgia

that

CEOs of large corporations

order for their

company to

you

will need

are not experts

in

unified whole. This unified whole is far

members

working alone. Good government

because of
foremost

every skill and job that is required


are experts at finding and

lack of leadership

economic

more

skills. The President

from those experts

any of the team


same way or fails

capable than

works in much the

expert, military commander,

scientist, Constitutional

of the U.S. is not the worlds

expert, research

environmental

lawyer, and social worker all wrapped

up

into

one.

as

being

a great

expert at finding each of those (and

many

more) and pulling them together

he is to be recognized

by history

recognize

where

is all about. When it

your

strengths

comes to

lie. Acknowledge

But, if

President, then he must be

team that is effective at solving massive problems and achieving


is what leadership

in

succeed. Rather, they

experts, and then applying the skills and knowledge

managing
into

does not

self-management

to understand

important

managing

your

your

primary

an

into

lofty goals. This


fibromyalgia,

skills, research

43

44

are required to best


you can to assist you.

what skills and knowledge


seek the best individuals

address

your

fibromyalgia,

and then

Take Action

Once

you

your

have defined

you need to work on building your


your primary care physician, several
group members. Examples of
to have on your team are described in detail

fibromyalgia,

team. An effective team will usually include


specialists, selected
specialists

who

you

friends, family, and support

might find useful

in Chapter 5 of this ebook.

a support group is also an important component of your fibromyalgia


a successful support group is having a two-way relationship
your support group members; this give-and-take offers you the value of
accountability and allows you to gain insight from each other through the sharing
of your experiences.
Having

treatment. The key to


with

friends and family members may (or may not!) be important


your team. If you are fortunate to have family members who are
to your fibromyalgia, their involvement and support can make all the
difference when it comes to successfully managing your fibromyalgia.
If you do
not have a reliable and/or understanding family support system, it might be in your

Finally, selected
elements

of

sympathetic

best interest to exclude


those individuals

your
you are

from

team. Remember,

the boss and it is ultimately

up to you to determine
you need and who can
provide it to you.
One

way to

maximize

what
best

the

of the role

effectiveness

your friends and family


in your fibromyalgia

play

treatment is to place each


member

in

specific role.

For example, if

partner,

or a

genuinely

your spouse,

close friend is

good at listening

and providing

comforting

44

45

guidance, rely

on

that individual

support and objective input. If

for emotional

you

someone who is able to assist you with running errands, transportation for
you or your children, and housekeeping, solicit their help for those activities. For
times when you need to relax or find a distraction from your symptoms on a bad
day, have someone you can rely on to go out with you for coffee or lunch, or to a
movie or museum. Everyones needs are different, and you may find that you dont
need many people to assist you; other individuals may require even more
have

assistance

that

to distribute the

than that listed here. The point is that it is important

you require of your team across a number


no one person feels overburdened or suffers burnout.

responsibilities

of different

people,

so

you will occasionally make mistakes, and that


some team members will not work out. Use those times as opportunities to learn
and move on; it is ok. You should periodically evaluate the performance of your
team members. If a particular member is not contributing, replace them. Managing
your fibromyalgia is not about making friends. Note that friends were not listed as
being critical team members. This is because if you find that a team member is not
providing value to you, and is not helping you move forward toward your goals,
you need to replace them. Obviously, this is an issue that is best avoided when it
comes to friends! Remember always that your first obligation is to yourself and
your family, so assemble the best team that you can!
Also, be mindful of the fact that

Setting Goals

It is important
fibromyalgia.

to targetable
put

you on

to focus

projects

As

Consider

you

efforts

detailed look at

are as

your

what goals

complicated

management

as

of

on

specific aspects of

fibromyalgia,

you set

any

is! Specific

complicated

tracking down and stomping

goals, remember

your

and boil it down

for yourself and help

to meet these goals. If

have to know where there

in the successful

you set your

associated

self-management

the path to defining the strategies

from here to there,

paramount

your

Step back, take

aspects. This will determine

you want to get


are

goals

venture, and few

on

the Elusive Fiend!

to be specific and to set goals that

can

be

with actions.

the following

examples:

This is not a
a concrete outcome

"I Want to Get Better."

not clearly define

specific goal. It is

vague

and the steps required

and does

to achieve it.

45

46

"I want to improve


improvement

My Sleep."

to make it

more

room

This is better, but there is

actionable

for

and specific.

up less during the night" and


more refreshed in the mornings"
This is a group of five specific
These goals can be reviewed in the

"I want to get to sleep faster" and "Wake


"Sleep longer each night" and "Feel

and "Reduce

my

morning stiffness.

goals to which actions

can

be tied.

context of specific treatment options.

comes to

When it

establishing

leading to incremental
expectations

one

and chasing goals, fibromyalgia

achievement

of instant gratification,

the hard reality is that

you can

that will take time. One of the best things

success can

and

be achieved

These small steps will build


achieve

even more

upon

in small, specific and measurable

The best

you

way to
a

address problems
systematic,

your

Once

some problems may have


may be the most appropriate

fight against fibromyalgia

you

have identified

is to

problem

to consider all possible solutions.

multiple

causes,

therefore

approach to addressing

combination

them.

a specific symptom or grouping of symptoms, research


options and evaluate the pro's and con's of each. When you feel
one or more of the options move forward with an action plan including
methods you will use to evaluate results. Sometimes, you may not be able to fully
understand or determine your best options. In those cases, it is important to solicit
input from the most relevant members of your team.
Once

you

manner.

it is important

that

of solutions

fall

would be to try for 30 minutes using

that arise in

defined

feel must be addressed,

Recognize

and

Problem-Solver

attack them in
that

steps.

empower you to establish


takes you one hour to
on your part, you improve that time to 45

a goal has been met! Your next step


same or a modified approach.

be

each other and

minutes,

Become

can

goals. For example, if it normally

asleep and through actions taken

the

above

fight, and

is accept this

do for yourself

reality, plan for it, and expect it. Each if the goals mentioned
measured,

requires small steps

easy to have
this is a tough

of goals. Although it is

have identified

potential treatment
ready to try

As

you try out one or two

effectiveness.

may

Recognize

be achieved

through

possible

solutions, be

that the ultimate

combination

sure

solution to

and evaluate

your

their

some cases
one solution.

problem in

of solutions, rather than just

46

47

Evaluating

Treatment

Your symptoms

Options

your

and

causal factors should drive

NOT let the pharmaceutical

treatment decisions for

can gauge

factors and

Eliminating

When

you

you

what

the severity of

evaluate

you are

may
my

particular

can

team! Review

members

who

potentially
what

are most

not let

a team

members

It is also important

you.

is

decisions. DO

industry

make

Treatment

who understands
better

is not

your

should be

your

specific

specific factor;

specific factor.

treatment option, make specific notes about what

areas

where it

your fibromyalgia you expect to


may have an impact and evaluate
sure to use

affect other symptoms. In addition, be

you are

evaluating

appropriate

and input, but always remember

one

work best. Feeling


insomnia

improve. Make note of multiple

your

the only

hope to get out of it and which aspects of

how this impact

your treatment

dietary supplement

allow them to influence

at specific factors, and

targeted

or

industry

you, or

and considering

for that particular

with the team

goal. Ask for their opinion

to ask WHY they have their particular

personal bias influence

your

opinion. Do

decision-making.

to ask yourself the following questions:

What

are

What

potential side effects should

What

possible

the negative

negative

possibilities?

interactions

you

be watching out for?

with other treatments

should Ibe

on

the

lookout for?

How likely

are

these and what is the worst

How might this impact

my

case

scenario?

life overall?

"How much is this going to cost?"

"What

are my

specific goals relative to outcomes

associated

with this

option?"

47

48

Case Studies

Fred has been diagnosed


that

means.

with fibromyalgia

Fred is prescribed

though he knows little about what

care

Lyrica by his primary

physician

because

that is what the doctor has read should be effective, he has little actual
experience

with either the drug

or

muscular

pain and cognitive

disorientation.
and dizziness

is largely defined by

impairment

Among the most

including

common
severe

truck driver,

it, and he immediately

Double Ooooops.

Fred

be in for

it to

his

fatigue, deep

and

are

drowsiness

if present in Fred given his

he begins taking Lyrica the

doctor prescribed

may

severe

dizziness

side effects of Lyrica

things likely to be

symptoms. Fred is

or
cure

Fred does not ask why

accepts it and takes it expecting

question this, but rather happily

symptoms. Fred's fibromyalgia

fibromyalgia.

heads out

some

on a

same

day his

long haul truck trip.

problems!

OR

Mary has evaluated


physician

her fibromyalgia

and sleep specialists


plus 3 members

therapist
pervasive

as a

sleep impairment

fatigue and dizziness

key causal symptom

combination

or

approach

(though

she

caffeine

she is doing water walking

as a

her primary
and

potentially

medications

may test

any

she is planning to take

problems

journal all of her symptoms

are

she experiences.

in Marys

her fibromyalgia,

manage

to test different

so

she

can

be

side effects of

aware

of what

She is tracking in her pain

and keeping notes relative to how her exercise

evaluated

his treatment

fact work out great for Fred and Mary

are

in

progressing.

Fred has not properly

the odds

now

at night to improve her sleep including melatonin, kava-

the dietary supplements

and diet efforts

for

to increase her

safe exercise, she is eliminating

kava, and passion flower. Mary has written down the possible

be causing

driving her

Lyrica in the future).

in the mornings

and most gluten from her diet. She is also beginning

dietary supplements

may

care

massage

She has identified

and tender point pain. Mary

other prescription

She is utilizing Ribose and Acytel-L-Carnitine

energy,

group.

along with her depression

had decided to forego Lyrica


favor of

at length, consulted

along with her nutritionist

of her online support

favor

over

may

the long

options

have

run.

- Mary

has. Lyrica

may

in

bad reaction to Kava. However,

This is because Mary understands

the options available to her, and she is using her knowledge

her approach to treatment. Fred is unconsciously

abdicating

to

the

48

49

management

to

of his fibromyalgia

victim to magic

someone

else his doctor and is falling

pill syndrome.

Self-Empowerment

we have defined so far


you to set goals for yourself

steps

All of the self-management

empowerment.

and

prerequisite

are

but they

can

They enable

lead to selfand take educated

steps toward achieving those goals. These steps

calculated

also

for developing

positive

and managing

an

loop and embody

feedback

are not

effective

an

only

and

necessity

treatment approach,

effective treatment. You

think of it like this:

symptoms

less anxiety reduced stress reduced

less depression

Empowerment

Success Demonstrated

Empowerment

Or:

+ Education + Care

Responsibility

Team

Goals

+ Treatment

Evaluation

Empowerment.

When

you are empowered, you minimize the negative impact


upon a systematic self-management approach that

by relying

and feelings of hopelessness.


that

you can do this! Not


are major factors

to do it

your

goals. Without

empowerment

that

knowing
that

can

or

your

what

approach

systematic

and

reassurance

to do and how

ability to take action to achieve

action, nothing is possible. Self-management

through implementing
that not

every treatment

of causal emotions

reduces confusion

self-encouragement

fully understanding

undermine

every treatment
most initiatives will yield no

to understand
(in fact

It also provides

drives

approach. While it is important

approach is going to yield positive


results at all) it is equally

will yield data, and data compiled

important

over

results,

to know

time yields

success. You should understand that failure is


expected and is part of the systematic process you must use to address your
fibromyalgia. Remember
a baseball player who is a complete failure with the bat
7 out of 10 times he tries to hit the ball has a future in the "Hall of Fame" if he can
fail this consistently over a long career!
knowledge,

which ultimately

drives

49

50

Self-Management

Successful

Conclusion

self-management

only for successful

managing

your

important

systematic

approach is

approach. This is true not

role that self-management

is key; however, always remember

systematic

You MUST HAVE

upon a

militaries, and rulers, but for the Elusive Fiend

the critically

treating fibromyalgia
without

must rely

companies,

well. Understanding

well-defined

self-management

as

plays in

that self-management

half-measure.

and supported

program.

system for executing and

(Chapter

6)

50

51

5:

Chapter

Treating Fibromyalgia:

This chapter is devoted to


available

you.

to

comprehensive,

discussion

It is important

to understand

definitive, and exhaustive

you

need to know

with

listing of all treatment

options

options available;

you in the right


are numerous, and the
are the most effective for you
will be as individual as your fibromyalgia. As you read through these pages,
understand that this is nothing more than a summary, meant to serve as a primary
guide to help start you on your journey of learning about the treatment options
available. It is well beyond the scope of this eBook to dig deeply into all of the
possible treatment approaches. You can visit our website, www.fibromyalgiatreatment.com for a much more information on this.
it is merely meant to provide

you

What

core aspects of treatment


that this is by no means a

about the

starting point and steer

direction. The truth is that potential treatment

process

of elimination

options

to determine which one(s)

Medical Specialists

to assist with your


one or more medical specialists.
one who is compatible with your
needs, and who is also sympathetic toward and understanding of fibromyalgia may
seem like a daunting task. Fortunately, there are resources available to assist you
with your search. One way that you can start the process is to talk with fellow
fibromyalgia patients; support groups are a great resource for this. Examples of
online support groups as well as websites that contain directories of local support
groups can be found in Chapter 1. In addition, some local chapters of the Arthritis
It is important

to assemble

well-rounded

treatment. Your team will invariably


With

so many

Foundation
following

physicians

offer physician

are

additional

team of individuals

include

out there, searching for

referral lists for patients with fibromyalgia.

resources

Doctors list at Co-Cure:

Good

The FMS Community

The

for locating physicians:

www.co-cure.org/Good-Doc.htm

website:

http://fmscommunity.org/findingadoctor.htm

www.sover.net/~devstar/provider.htm

FibroTrack

Care Provider

Database

In order to build the most effective


interview
contribute

potential members

to

your team,

to

with patient reviews and ratings.

team, it will be important

ensure

for

you to screen

and

that they have not only the right skills to

but the right attitude and understanding

about

51

52

When

fibromyalgia.

examples

of

success

you meet

with

medical specialist,

and what the outcomes

etc.). Be

a new care

such

patient feedback,

to accept

you as an

but to also consider


engaged

in discussions

about

your

why they recommend

different

you

feedback

must be

relative to

a two way

your

opinions

their

your own

engage

doctors

Make

sure

the logic and research behind

treatment options. Make it clear that

not only benefit from their expertise through their

evaluation

that

their general

and active leader of

approach to self management.

willing to take the time to explain to

their providing

therapies

as acupuncture,

provider team. Take the time and make the specific effort to

are

additional

provider, it is critical to not only evaluate

relative to treating fibromyalgia,

and specialists
they

any

and chiropractic.

attitude and willingness

care

whom they have

treatment options they have used,


along with

(side effects, tolerability,

in relation to fibromyalgia

When getting to know


knowledge

way

ask for

ask them what they think of the various alternative

have been researched


aromatherapy,

were,

of those treatments

they made along the

sure to

sure to

stories of former patients with fibromyalgia

treated. In addition, ask them to discuss different

observations

be

own

you

wish to

opinions, but also through

and ideas. Communication

and

channel.

that should be included on your team is a primary care


can be an internal medicine doctor or a family medicine doctor.
a primary care physician, it is vitally important that you find
someone who is willing to listen to your concerns, ideas, and opinions, and who
will take your input seriously. They must accept that you are the leader of your
fibromyalgia management team. Be sure and choose a primary care physician who
One medical specialist

physician. This
When choosing

has experience

to

manage

with fibromyalgia

breakthrough

The following
wish to include

patients, and who is knowledgeable

of strategies

pain.

a non-exhaustive list of other medical specialists who you may


on your team, along with a description of what they treat and
that they may be helpful in managing.

is

various aspects of fibromyalgia

Rheumatologist:

Rheumatologists

have received additional


and other diseases

arthritis, autoimmune
individuals

internal medicine

physicians

and treatment

diseases, pain disorders, and osteoporosis.

with fibromyalgia

of their diagnosis

are

training in the diagnosis

may see a

rheumatologist

who

of arthritis

of the muscles, joints, and bones. They commonly

treat

Many

early in the

course

in order to rule out arthritis and other musculoskeletal

disorders. Since rheumatologists

are

specially

pain

trained to treat patients who

52

53

have chronic pain conditions, they


patients

fibromyalgia

Psychiatrist:

effects of mental illness

are

on

pressure.

and high blood

Psychologist:

of mental illness. They also monitor the

are

Psychiatrists

well-trained

that

are

may

cognitive

can

Psychologists

specialists who have received extensive


diagnosis, treatment, and

trigger

be instrumental

or worsen

fibromyalgia

Neurologist:

their depression,

of

process
a

and

their

fibromyalgia

processes

patients

with

part

in the

that affect the

often

of

is that it results from the bodys

inability

nerves are the means by which the


neurologists are often integral members

medical doctors, however


training in

chiropractic

Chiropractic

pain, and headaches.


chiropractic

care

pain,

team.

Chiropractors

treating musculoskeletal

some

ways to cope

vitally important

painful stimuli correctly. Since

Chiropractor:

exams.

are

events that

nervous system. Like


one of the first specialists seen by
quest for a diagnosis, as certain neurologic

are

among many experts

body transmits

be

must be excluded. In addition, the current understanding

fibromyalgia

to

can

medical doctors who specialize

of diseases

on

techniques.

regimen of patients who

and by identifying

psychologists

neurologists

patients

fibromyalgia

care

care team.
are

Neurologists

rheumatologists,

diseases

patients

and treatment

diagnosis

in the

to prescribe medication,

including talk therapy,

modification

and anxiety by helping them recognize

symptoms. Like psychiatrists,


of

means,

therapy, and behavior

suffering from depression

can

symptoms.

treat patients through other

behavioral

extremely

be useful to fibromyalgia

prevention of mental disorders. While not permitted


psychologists

are

patients. As medical doctors, psychiatrists

in the assessment,

education

to help patients who

and anxiety, both of which

their depressive

Psychologists

post-graduate

medical doctors who specialize in the

for medications

patients in managing

integral part of

other physical conditions, including heart disease

are suffering from depression


common among fibromyalgia
write prescriptions

an

often

treatment team.

Psychiatrists

diagnosis, and treatment

prevention,

are

and

are

specially

trained practitioners

nervous system

they must complete


college and
is commonly

pass

four

years

on

are not

of post-graduate

both national and state licensing

used to treat back and neck pain, joint

Although research surrounding

care as a treatment

for fibromyalgia

patients do find that chiropractic

who focus

disorders. Chiropractors

care

the usefulness

symptoms

improves

of

is conflicting,

their symptoms.

53

54

Massage therapist:
who

use

therapeutic

are

Massage therapists

pressure

touch and

anxiety and depression.

For fibromyalgia

useful to help reduce pain and promote

depression

patients,

in order to relieve

relaxation

massage therapy may


in an effort to improve

be

and anxiety.

therapist:

Occupational
licensed

specially trained practitioners

applied to muscles

injuries, reduce stress, provide relaxation, and relieve

pain, rehabilitate

healthcare

are

therapists

Occupational

providers

who assist individuals

specially trained,
who

are

experiencing

with activities of daily living. They receive detailed training

difficulty

related to the physical and psychological

on

peoples

therapists

modify

and the effects that these have


activities. Occupational

can

their changing needs. This

are

patients, who

result of the persistent

physical limitations

an

individuals

be beneficial

way

therapists

can
the

they face, which

can

to fit

environment

to fibromyalgia
in which they live

their homes to better accommodate

pain they endure. Occupational

patients modify

fibromyalgia

obviously

with illness

ability to perform everyday

forced to change the

frequently

associated

difficulties

result in improved

as a

help

symptom

control.

Dietitian:
principles

Registered

dieticians

are

healthcare professionals

degrees that include studies in biochemistry,

anatomy, and physiology. They

are

exams. Dietitians can be useful to


many common co-existing symptoms

national board
suffer from

irritable

who

are

trained in the diagnosis

are

healthcare

of movement

the bodys

reducing pain, and preventing

disability. Since fibromyalgia

suffer from decreased

widespread

pain and stiffness,

patients how to

Naturopath:

overcome

Naturopathic
naturopathic
basic sciences

as

physicians

functioning

as a

doctors focus

well

as

on

by restoring

mobility,

patients

can

be helpful in teaching

the holistic and proactive

years

medical school, during which they

as

professionals

disorders. They

they face.

comprehensive

(N.D.) attend four

as

result of their chronic

physical therapist

physical challenges

Naturopathic

prevention of disease,

mobility

pass

patients who

cystitis.

licensed

and treatment

to

required

and diseases, such

work with patients to improve

frequently

Physical therapists

are

fibromyalgia

bowel syndrome, obesity, and interstitial

Physical therapist:

They hold

human

to complete dietetic

also required

of at least 900 hours. In addition, dietitians

internships

who apply

of food and nutrition to health and human functioning.

nutrition-related

diagnosis

and treatment.

of post-graduate

are

educated

in all of the

medical doctors (M.D.); however, their studies also include

54

55

education
emphasis

related to holistic and nontoxic

on

disease prevention

also required

to complete four

acupuncture,

homeopathic

and the optimization

years

may

person

of the whole

conventional

with

of wellness. They

board

exams.

Holistic medicine focuses

therapies

in

an

and

Naturopathic

treatment team.

patients

on

body, mind and spirit. It integrates

and alternative

an
are

of training in clinical nutrition,

pass professional
of a fibromyalgia

be useful members

Holistic medicine practitioner:

care

approaches,

medicine, botanical medicine, psychology

counseling, and they must also


doctors

therapeutic

addressing
both

effort to foster optimal health

are
on patient care in terms
a one-size-fits-all
viewed as a partnership

and wellbeing, and to prevent disease. Holistic medicine practitioners


useful to fibromyalgia

patients because they focus

of

the unique needs of the patient, rather than through


approach. The practitioner-patient
that

relationship

is

encourages patient input and needs. This individualized, attentive


can be of great benefit to fibromyalgia patients, as the disease
on the individual-level and requires a patient-directed

relationship

itself is unique

approach to treatment.

no means a comprehensive list of medical specialists.


are many other medical disciplines. It is important to approach the building
of your team with a receptive and inquisitive mind. Talk to others, get input and
advice, and get creative. Fibromyalgia is an unique disease that requires a unique
approach to treatment; have an open mind!
As stated above, this is by
There

Create

When

you

Partnership

have found

good fit for

or

your team,

with

underscore

Below

are a

schedules,

Physician

who meets

it is important

her. The time limitations

overloaded

your

physician

many

your needs and


a productive

to develop

high patient-to-physician

the need for

you to

few tips to help

you

who

you

feel is

relationship

with him

doctors face when seeing patients due to

be

as

prepared

accomplish

ratios, and other limited

as you can at

resources

each appointment.

that:

55

56

1. Prepare

an

agenda before

your

accomplish

at that particular

explanation

of

paperwork

appointment.

appointment.

symptom?

Do

you

Know what

Do

you

need

need medication?

you want to
diagnosis or an
Do you need

signed by the doctor.

2. Rehearse

a new

brief but comprehensive

you

situation before
getting his

or

visit the doctor

of your symptoms and


you waste no precious time
your journals and notes
Take your journals and notes

description

so

her input and assistance.

that

Review

prepare which sections need to be shared.


you so your care provider can review them.

and
with

an active role in your appointment. Describe your symptoms and


concerns quickly and articulately. For example, you might say Dr. Mills, I
am here today because Ive noticed my fatigue worsening. Im worried that
my exercise regimen may be affecting it, however my pain is much

3. Take

since Ibegan exercising. Iwould like to discuss what options I

improved

my

might have to address

the pain relief Iget

fatigue without sacrificing

from exercise.

4. Present to
initiatives
specifics

your
that

doctor

express

ideas and theories about

new treatment

you have researched and are interested in


you wish to try, why it appeals to you,

of what

done into possible


thoughts

your

effectiveness,

trying. Discuss the


research

you

have

side effects, risks and problems. Share the

care team members about your ideas. Make sure to


you place on your doctors thoughts relative to your own

from other

the value

treatment ideas.

you converse with your doctor, be sure to leave the appointment with
some concrete answers to key questions. Ask, "what is your diagnosis (i.e.,
whats wrong?); what is your prognosis (i.e., what is the outlook?); what
tests (if any) are needed; what treatments (both medical and behavioral) are
advisable, and when you should return for a follow-up visit?"

5. As

6. To make certain that


back to him

or

you

might repeat back that


break

up your

understand

all that

your

her they key points they have told

exercise

rather than exercising

you

understand

that the doctor

regimen into three 15-minute


for 45 minutes at

you, repeat
you
recommends you

doctor has told

you.

For example,

increments

each day,

time.

56

57

FDA-Approved

Pharmaceuticals

Three prescription

drugs have

now

been approved

(FDA) to treat the symptoms

Administration

by the U.S. Food and Drug

associated

with fibromyalgia:

Savella, and Cymbalta. This next section will briefly describe

for

more

on

detailed information

each, please refer to

our

Lyrica,

these medications;

website,

www.fibromyalgia-treatment.com

Lyrica
Lyrica (pregabalin)

treat neuropathic

is manufactured

as

epilepsy. The

understood,

means

however

pain. It

seen

improvements

as a

Lyrica is taken

450mg

per

headache,

dry mouth,

or

rare.

individuals

common side
nausea, vomiting,

arms

patients

per

day, usually at

gas,

constipation,

concentrating,

dose of 300 to

bloating, elevated

confusion, forgetfulness,

twitching, increased

mood,

anxiety, loss

appetite and/or weight gain,

are also possible,


are pregnant or nursing,
pressure should use

reactions

women

who have diabetes,

who

to treat high blood

certain medications

effects of Lyrica include dizziness,

and legs, and back pain. Allergic

Individuals

on

nerves.

many

with fibromyalgia,

capsule two to three times

of balance and/or coordination,

although

everyone

such

is not

that it works by calming overactive

day. The most

swelling of the

nerves), pain due to

be also used to treat seizure disorders

in pain, sleep quality, and overall functioning.

speaking, difficulty

difficulty

can

by which Lyrica works to treat fibromyalgia

it is believed

Although Lyrica does not work for


have

by the FDA to

by Pfizer, Inc. and is approved

pain (pain that results from damaged

shingles, and fibromyalgia

caution when taking Lyrica.

Savella
Savella (milnacipran)

is manufactured

another FDA approved


functioning

fibromyalgia,

improvements

Savella

by Forest Pharmaceuticals,

drug for treating fibromyalgia

in fibromyalgia

may

help

some

individuals

inhibitors,

used to treat depression,

or

everyone

overall

with

feel less pain and

achieve

in overall functions.

Although it is not used to treat depression,


commonly

Inc. and is

pain and improving

patients. While it cannot help

it is in

as

known

class of medications

selective

that help stop the transmission


changes

in mood, particularly

understand

that that

your

mental health

in

may

younger

patients,

change in

are

the amount of chemicals

of pain signals in the brain. SSRIs

unexpected

that

serotonin reuptake

SSRIs. As such, Savella works by increasing

an

so

can cause
it is important

unexpected

way

to

when

57

58

you

to communicate

begin taking the drug. It is important


and to make

doctor immediately,

aware

your

any

to

changes

family and other support

group

your

members

of this potential risk.

once or

Savella is taken in tablet form

twice

minimize

the risk of stomach upset. The most

Savella is

nausea,

however

other side effects

dizziness, insomnia, hot flushes, excessive


increased

day, preferably

sweating, vomiting, heart palpitations,

heart rate, dry mouth, and high blood

need to be monitored

by

your

doctor

on a

Savella should not be taken by individuals

with food to

common side effect associated with


may include headache, constipation,
pressure.

Your blood

pressure

will

regular basis while taking Savella.


who

are

currently

taking medications

as MAOIs, or by those who have uncontrolled glaucoma (increased


pressure in the eye). It is also important to let your doctor know if you have high
blood pressure or any heart disease, liver or kidney problems, current or previous
manic episodes or seizures, bleeding disorders, or are pregnant or nursing.
known

Cymbalta
Cymbalta

(duloxetine)

generalized

for the treatment

is FDA approved

anxiety disorders, diabetic neuropathy

nerve damage),
or muscle pain

and fibromyalgia
from conditions

SSRI and therefore

pain. It
such

osteoarthritis.

Cymbalta

capsule. It is important

that

nausea,

may not

be felt for

vomiting, constipation,

appetite, dry mouth, increased


and/or tiredness, drowsiness,

up to

and

with diabetic

is taken

you

bone

Like Savella, Cymbalta

is

an

of pain signals in the brain.

once a

day

as a

do not crush, split,

capsule; it must be taken whole. In addition, Cymbalta


the full benefit

of depression

(pain associated

also be used to treat persistent

works by blocking the transmission

When taken to treat fibromyalgia,


(delayed-release)

as

can

long-acting

or

chew the

takes time to take effect,

so

four weeks. Common side effects include

diarrhea, heartburn, stomach pain, decreased


urination, sweating, dizziness, headache,

changes

shaking. Like Savella, individuals

in sexual desire

or

weakness

ability, and uncontrollable

who take MAOIs should not take Cymbalta.

certain blood thinners, antidepressants, diuretics and a variety of


can also interfere with Cymbalta, so it is crucial that you tell
every medication and nutritional supplement you are taking or plan to
tell your doctor if you are pregnant or plan to become pregnant, as
can have adverse effects on the fetus.

Furthermore,

other medications

your

doctor

take. Also
Cymbalta

58

59

Antidepressants

is

Antidepressants

to treat depression,

known

as

neurotransmitters.

on

brain and have effects

There

are

broad term used to describe

class of drugs commonly

used

anxiety, mood disorders, bipolar disorder, and other mental

health problems. They work by increasing

the bodys

These chemicals

both emotions

production

transmit

nerve

of chemicals

signals within the

and pain reception.

four main types of antidepressants:

Tricyclic antidepressants
treat depressive

not used

typically

target two specific

in the brain: norepinephrine

effective, they tend to

as a

cause a

used to

Among the first antidepressants

(TCAs):

disorders, they primarily

neurotransmitters

considerable

and serotonin.

Although

are

number of side effects and

first line of treatment. Examples

of

common

TCAs

include Anafranil, Elavil, and Tofranil. Common side effects include dry
mouth, vision disturbances,
constipation,

increased

fatigue, weight gain, tremors,

bladder problems, daytime

sleepiness,

heart rate, and

increased

sexual problems.

Monoamine

oxidase inhibitors (MAOIs):

antidepressants,

they

are most

MAOIs interact with substances

considerable
MAOIs

are

examples

nausea

in

to other treatments. Unfortunately,

many

foods and beverages,

number of other medications.

As

limited to strict diets and medication

as

as a

well

result, patients who take


regimens. Common

of MAOIs include Parnate, Nardil, and Marplan. Side effects

be serious and include headache,

racing heartbeat,

neurotransmitter

must also be avoided to

interactions.

Selective serotonin reuptake inhibitors


antidepressants

can

chest pain, neck stiffness,

and vomiting. Certain foods and medications

prevent dangerous

Another early class of

effective when used to treat people with

who have not responded

depression

(SSRIs):

and they work by modifying

These

are a newer

the available

serotonin in the brain. Some of the

class of

amount of the

more common

examples

of SSRIs include Prozac, Zoloft, Paxil, Lexapro, and Celexa. Many patients

treated with these medications

sex

drive

or

inability

will experience

to orgasm), however such problems

Other side effects include dizziness,


jittery

sexual problems

headache,

nausea,

are

(such

as

low

reversible.

insomnia, and

feeling.

59

60

Serotonin and norepinephrine


class of antidepressants,
norepinephrine

reuptake inhibitors (SNRIs):

SNRIs increase

in the brain. Examples

the availability

and Cymbalta. Common side effects include drowsiness,

strange dreams, constipation,

feeling lightheaded,

headache,

Prescription

such

as

or

falling

sleep medications

that if

can

symptom of insomnia

There

as

sleep medications

may

asleep easier, and those that help

(ramelteon),

you

for individuals

who have

insomnia). However, it is

be much

more effective. Unfortunately


can at times be difficult to

commonly

Eurodin (estazolam),

that

In such instances,

be of benefit.

you

sleeping pills: those that help

remain asleep for

Sonata (zaleplon),

prescribed

to help

Lunesta (eszopiclone),

you stay

you

fall

longer period of time.

fall asleep include Lunesta (eszopiclone),

Halcion (triazolam),

are

Drugs that

as

the Elusive Fiend

two types of prescription

generally

Drugs that help

available

condition is causing the insomnia

making restful sleep next to impossible.

therefore

are

underlying

ultimately

cannot always be achieved,

prescription

an

treating that condition itself rather than treating the

fibromyalgia

manage,

are

staying asleep (a condition known

to understand

important

blurred vision,

nausea.

Sleep Medications

A number of prescription
difficulty

a newer

fever and/or chills,

in appetite, tremors, dry mouth, and

changes

Also

of serotonin and

of SNRIs include Effexor, Remeron,

Rozerem

and Ambien (zolpidem).


asleep include ProSom /

Restoril (temazepam),

Ambien CR

many of these drugs may interact


or can become less effective with
prolonged use. Each drug has specific nuances that may make it a better choice for
one person over another, so it is important to discuss each option with your doctor
and decide which, if any, is best for you.
(zolpidem),

and Silenor (doxepin). In general,

with other medications,

Anti-Anxiety

The most

Medications

common

benzodiazepines.

situations
that

are

or

in

class of anti-anxiety

While antidepressants

medications

are

generally

those drugs known


used

over a

as

long period of

can
more quickly and therefore are ideal for short-term use in specific
response to symptomatic episodes. Examples of benzodiazepines

time to continuously
begin working

be habit forming,

commonly

treat and control depression and anxiety, benzodiazepines

used to treat anxiety include Klonopin (clonazepam),

Ativan

60

61

(lorazepam),

and Xanax (alprazolam).

common

side effects of

include upset stomach, blurred vision, headache,

benzodiazepines
grogginess,

The most

confusion,

and nightmares.

Pain Management

Analgesic
There

wide variety of prescription

management
overview

any

is the medical term used to describe

are a

in fibromyalgia

of selected

analgesic

drug that is used to relieve pain.


medications

available

and other pain disorders. The following

is

for pain

brief

examples:

The most

Narcotics:

powerful type of pain-

relieving medication

a
as

is

class of drugs known


narcotics. Narcotics
decrease

nerve

on

pain by working

pain receptors

found

on

the

cells themselves.

Common examples

narcotics

of

include Tylenol

with codeine, Lorcet,


Lortab, Vicodin, Morphine,
Roxicodone,

OxyContin,

use

and Percocet. Excessive


of narcotics

with other pain medications

example, Tylenol)

can

be

very

can

habit-forming,

dry mouth, and difficulty

Anticonvulsants:
seizure disorders
have analgesic
Neurontin
Topamax

as

properties

(gabapentin),
(topiramate).

anticonvulsants

in addition to causing constipation,

are

medications

drowsiness,

generally used to treat

epilepsy. However, several have been shown to

as

well, including Tegretol (carbamazepine),

Trileptal (oxcarbazepine),
Scientists

Lyrica (pregabalin),

do not fully understand

and

how these

work to reduce chronic pain, but it is thought that they

actually disrupt the transmission

common

(for

urinating.

Anticonvulsants
such

that contain acetaminophen

result in serious liver damage. In addition, narcotics

may

of pain signals in the brain. The most

side effects of anticonvulsant

medications

dizziness, drowsiness,

fatigue, confusion, skin rash,

of appetite, abdominal

pain, weight gain

or

include headache,

nausea,

vomiting, loss

loss, and swelling of the feet.

61

62

Muscle relaxants:

are

Muscle relaxants

medications

that control muscle

spasms by depressing the central nervous system. They have a sedative


effect on the body. In addition to calming muscle spasms, they can also
relieve pain in some people. Examples of muscle relaxants include Soma
(carisoprodol),

Flexeril (cyclobenzaprine),

(metaxalone),
for

use

or

of depression

drowsiness,

women,

older adults,

drug/alcohol

used only

on a

short-term

many
as

treat chronic pain,

depression.

such

caused by arthritis,

nerve

results. The most effective

group,

(imipramine),
Norpramin

history

muscle relaxants should be

are commonly used to treat chronic


even when the patient does not have

have been shown to work best for pain that is

way

shingles, migraine,

in which

with these conditions

is not

takes several weeks to achieve maximum

group

of antidepressants

which includes

(desipramine).

or

pain resulting from diabetes

drugs such

Anafranil (clomipramine),

these medications
constipation,

with

antidepressants
fibromyalgia

and it generally

the tricyclic

dependence,

treat the pain associated

antidepressants

Skelaxin

recommended

addiction, dry mouth, and urinary retention.

low back pain, and pelvic pain. The

fibromyalgia,

are not

basis.

Antidepressants

understood,

They

those individuals

Although they have not been approved by the FDA to

Anti-depressants:
pain conditions,

or

addiction. Common side effects include

dizziness, possible

To avoid the risk of developing

Valium (diazepam),

and Robaxin (methocarbamol).

by pregnant

as

Pamelor

Side effects commonly

associated

is

Tofranil

(nortriptyline),

include blurred vision, drowsiness,

weight gain, difficulty

purpose

used for this

Amitriptyline,

and

with the

use

of

dry mouth,

urinating, and changes

in blood

pressure.

Over-the-counter

options:

pain medications,

such

Aleve (naproxen),
fibromyalgia,

headache

but

as

Common over-the-counter
Tylenol (acetaminophen),

and aspirin. These

can

are not

(non-prescription)
Advil (ibuprofen),

specifically

designed

to treat

symptoms, such as
naproxen, and aspirin can cause stomach
of aspirin) can interfere with blood

be used to treat associated

and joint pain. Ibuprofen,

upset, and all (with the exception


thinning medications.

62

63

for Pain

Coping Strategies

pain associated

so

will

your

to have

It is important

your

variety of tools under

with fibromyalgia.

As

your

belt to help

pain changes

from

to be flexible and

coping strategies. It is important

you cope with the


one day to the next,
open to a variety of

you better manage your pain. It is also important to remain positive


use your support network friends, family, doctors, whoever you feel is the
person at that time to lean on. Ask for help when you need it.

options to help
and

most appropriate

Distractions

that divert

your

attention

away

from

your symptoms are

important

a
a hobby you
you can do
without aggravating your symptoms), or taking a slow,
easy walk in a nice park. In addition, relaxation techniques can also be of
coping mechanisms.

Examples

funny movie, reading

a
so

enjoy (if

of distracting

tremendous

help. Deep-breathing

meditation,

yoga,

exercises,

can

and visualization

As with all aspects of fibromyalgia


work for

everyone,

willing to explore

your

mainstays

Dietary

therefore

activities

might include watching

short book, visiting with friends, engaging in

progressive

muscle relaxation,

all be beneficial.

management,

it is important

every

not

coping strategy will

to remain open-minded, patient, and

variety of options while searching

for those that will become

for coping.

Supplements

A number of dietary supplements

symptoms

associated

as potential treatments for


proven to be more effective
(i.e., what may be highly

have been investigated

with fibromyalgia.

than others, and effectiveness

Some have

varies between individuals

one individual may have no noticeable effect in another). It is


may adversely interact with
you are taking, so be sure and tell your doctor if you plan to use a
supplement so that you can be aware of any potential risks.

effective

important

for

to note too that dietary supplements

medications
dietary

The list provided


supplements

below is meant to provide

commonly

investigated

an

overview

and associated

of the main dietary

with the treatment

of

no means exhaustive, as there are literally hundreds of


possible supplements one could try. It is beyond the scope of this eBook to provide
detailed, in-depth information about each one. Also, more detailed information on
these and other supplements can be found on our website, www.fibromyalgiafibromyalgia.

It is by

treatment.com.

63

64

5HTP:

5-HTP (5-

hydroxytryptophan;

L-5

hydroxytryptophan)

is

chemical naturally

as a

produced in the body


by-product

of the amino

acid L-tryptophan.

can

It

also be produced
synthetically

from the

seeds of the African plant


known

as

Griffonia

5-HTP

simplicifolia.

works by increasing
serotonin. 5HTP is

to treat

variety

fibromyalgia,

the bodys

production

widely available

of symptoms

of

including sleep disturbances,

migraine, and chronic widespread

chemical known

dietary supplement

and conditions

as

that has been used

that affect individuals

depression

with

and anxiety,

pain. However, the National Institutes of

consumers to refrain from using 5HTP until more is known


as it has been linked to serious side effect known as
eosinophilia-myalgia syndrome, or EMS. EMS is characterized by severe
Health advises

about the supplement,

muscle tenderness

and increased levels of white blood cells. Other potential

side effects of 5HTP include heartburn, stomach pain, vomiting,


diarrhea, drowsiness,

Ribose:

Ribose is

supplement
improve

nausea,

and sexual problems.

kind of

sugar

naturally produced by the body. In its

form, it has been used to increase

athletic performance,

recovery,
energy stores. It has

muscle function

and replenish muscle

also been used to help prevent muscle cramping, pain, and stiffness
patients with various disorders

some

of the musculoskeletal

as a treatment
to support its use for

people have used it

research available
demonstrated

to corroborate

purposes. One study has


per day, can improve energy,
more research is needed

however

these findings.

Acetyl-L-carnitine:

Acetyl-L-carnitine

that helps the body produce


mental disorders, such
alcoholism,

there is little

such

that ribose, taken three times

sleep, and decrease pain in fibromyalgia,

in

system. Although

for fibromyalgia,

as

energy.

and thought problems

is

naturally-occurring

It has historically

Alzheimers

disease,

amino acid

been used to treat

memory

loss, depression,

related to Lyme disease. There is limited

64

65

available

information

symptoms

associated

regarding

generally

taking

can

It

odor. Acetyl-L-carnitine

fishy

as

blood thinner such

to treat the

of acetyl-L-carnitine

however

for those who suffer from

fog) and anxiety/depression,

(fibro

are

vomiting, and restlessness.

use

with fibromyalgia,

cognitive dysfunction
benefit. Side effects

the

may

it

be of

mild and include stomach upset,


also

cause

nausea,

urine, breath, and sweat to have

should NOT be taken while concurrently

Coumadin

or

(warfarin)

Sintrom

(acenocoumarol).

Magnesium

/ Malic Acid: Magnesium

body and is found predominantly

over

is the most abundant mineral in the

in the bones. Magnesium

is required

for

among which include


nerve function. Magnesium supplements
have been used for a wide variety of purposes, ranging from digestive health
to cardiovascular health, as well as anxiety, chronic fatigue syndrome,
300 biochemical

maintaining

reactions in the body,

normal muscle and

also supports

restless leg syndrome, and urinary problems. Some evidence


the

use

of oral magnesium

supplements,

SAMe:

as

cramping,

SAMe,

or

chemical reactions

the neurotransmitters
fibromyalgia

may

occur

use

dopamine

increased

synthetic form of

and serotonin. This

worse.

may

compound

many

the availability

of

be of benefit for

Individuals

who have

In addition, two clinical trials

with placebo (sugar pill), SAMe


in fibromyalgia

sugar,

can result in
common
nausea, skin

symptoms. The most

dry mouth, blood in the stool, excessive

urination, headache,

hyperactivity,

coenzyme

side

thirst,

anxiety, and insomnia.

that have been investigated

include alpha hydroxy

(GHB), ascorbigen,

with SAMe include digestive difficulties,

Other dietary supplements

treatments

is

SAMe with caution and consult their doctor before taking

improvements

rash, low blood

and

in the body. A number of studies have found

make anxious symptoms

effects associated

pain and

include diarrhea

kidney failure.

at treating depression by increasing

have shown that compared


significant

as

patients who suffer from depression.

anxiety should
it

well

in the body. It is believed to be involved in

that

that SAMe is effective

as

taken along with malic acid

treatment for fibromyalgia-related

S-adenosylmethionine,

that is found naturally

it,

supplements,

effective

Side effects of taking too much magnesium

tenderness.
abdominal

as an

as

possible

fibromyalgia

acids, capsicum, gamma-hydroxybutyrate

Q10, ginkgo, chlorella, and melatonin.

65

66

Diet

there is

Unfortunately,

and fibromyalgia.
in,

your

lack of good research investigating

However, this does not

diet cannot be of benefit to

mean

certain symptoms, which is

the link between diet

that changes to,

your

in managing

cannot treat the fibromyalgia

Dietary modifications
improve

you

or

improvements

symptoms.

fibromyalgia

may

itself, but they

be able to

good thing!

you can do as part of your self-management is to pay


your diet affects your symptoms and how you feel. By being
cognizant of what you eat and relating it to symptoms you experience, you may
uncover that you have particular sensitivities to certain foods. Many individuals
may be sensitive to certain preservatives, dairy products, gluten, or other common
food allergens. The best way to identify these sensitivities (and their associations to
your symptoms) is to maintain a daily food journal. By recording what you eat as
well as recording any symptoms you experience each day you can begin to see
patterns emerge. For example, you may notice that on days when you eat a lot of
dairy, you have more fatigue. By identifying these associations and patterns, you
can better manage your symptoms.
One of the best things

attention to how

Some evidence

suggests that eating vegetarian and

vegan

may

diets

help improve

the symptoms

associated

and decreased

flexibility. However, only three studies have been done to evaluate

with fibromyalgia,

the link between vegetarian

larger and

Celiac Disease is

damaged,

diets and fibromyalgia,

pain, mobility, sleep quality,

and they

were

limited by small

and design flaws. In order to better explore this potential

numbers of subjects
association,

including

more

specifically

designed

studies will be needed.

condition in which the lining of the small intestine becomes

preventing

it from absorbing

nutrients

from the food

you consume. The


rye, and oatcan develop

damage results from eating gluten, which is found in wheat, barley,


containing

at

any

products. The

of celiac disease is not known, and it

point during the lifespan, from infancy to adulthood. Much like

fibromyalgia,

makes

cause

the symptoms

an accurate

diagnosis

of celiac disease

can vary

between individuals,

pain, bloating,

to the nutritional deficiencies


bruising, depression

symptoms

difficult. Common gastrointestinal

gas, indigestion, constipation,


diarrhea, lactose intolerance, nausea and vomiting, stool
unexplained weight loss. Additional symptoms that may
abdominal

changes

irregularities,
arise

which
include

in appetite,

over

and

time

are

related

that result from celiac disease and include easily

and anxiety, fatigue, delayed growth (children), hair loss,

66

67

itchy skin, missed menstrual


numbness

in the hands and feet. Muscle and joint pain

may

symptoms, fibromyalgia

overlapping

versa. In
at the same

commonly

disease and vice

addition, individuals

celiac disease

time. Celiac disease

special blood test and by examining


for microscopic

changes

that

or

periods, mouth ulcers, seizures, and tingling

are

may

also be present. Due to

be misdiagnosed

may

with fibromyalgia

can

generally

as

celiac

also have

be diagnosed

by

biopsy (tissue sample) of the small intestine

characteristic

of the condition.

Exercise

Research supports

the positive

impact of exercise

treatment approach for fibromyalgia.


scientific

obese. Furthermore,

and reliable

effective

more
are primary causal
are overweight or
increases, so does the
has

One of the most important

fibromyalgia,

symptoms

of patients

symptoms.

things to understand

however, is that

inactive lifestyle

over 65%
that as weight

symptoms. Therefore, exercise is key in reducing body

weight and thus improving

no matter

as an

other treatment

of fibromyalgia;

studies have shown

severity of fibromyalgia

an

no

backing than exercise. Obesity and being overweight

factors in the development

led

In fact,

your

care must

entire life

exercise must be introduced


the circumstances,

with regard to exercise

be taken. Regardless

or
or

just recently
reintroduced

and

of whether

you have
your

due to the onset of

slowly and carefully. But

it must be done. Start slowly, and consistently

strive

that there is a fine line: too


any noticeable benefit, whereas too much may
worsen your symptoms. Also be aware that initiating an exercise program may
temporarily increase symptoms of tenderness and pain as the body increases its
level of conditioning and fitness. Therefore, be sure that you choose a physical
fitness regimen that is tailored to your individual fitness level and conditioning, as
well as to your pain threshold and fatigue level. There is no one size fits all
approach when it comes to exercise and fibromyalgia.

to achieve longer durations of activity. Also remember


little exercise

Examples

may not

of exercises

include Tai-Chi,

yoga,

provide

modalities

that have shown benefit to fibromyalgia

water-based

initiate, it has shown


information

regarding

proven

very

effectiveness

these exercise

patients

exercise, stretching, strength training, and

walking. Of these strength training is

important. Although it

can

to

be difficult

at reducing pain and fatigue. Additional

regimens

can

be found

on our

website,

www.fibromyalgia-treatment.com.

67

68

Therapies

A number of additional

many

therapeutic

people with fibromyalgia.

commonly

and alternative

Below is

are also
some of

treatments

brief overview

of

Balneotherapy:

Balneotherapy

including increasing

body temperature

It is thought to improve
improve

metabolism,

use

is the therapeutic

is thought to work through

disease. Balneotherapy

of water to heal

germs

(to kill harmful

blood circulation

improve endocrine

and

means,

number of

oxygen

and viruses).

delivery

to cells,

gland function, improve

system function, and improve mental well-being by promoting

used by
the most

used therapies:

Chiropractic:

Chiropractic

musculoskeletal
these disorders

and
have

focuses

nervous systems
on overall health

hands-on approach that involves

care

Chiropractic

on

is frequently

immune

relaxation.

treating disorders of the

within the body, and the impact that


and wellbeing. It utilizes

examination,

drug-free,

diagnosis, and treatment.

used to treat ailments such

pain, and pain in the elbows, knees, and hips. It

can

as

back and neck

also be used to treat

headaches.

Massage therapy:

pressure

Massage therapy is the therapeutic

applied to muscles

use

of touch and

in order to relieve pain, rehabilitate

injuries,

reduce stress, provide relaxation, and relieve anxiety and depression.

Trigger point therapy (also known

uses

connective

myofascial release therapy):

a subset of massage therapy in


pressure in order to release tightness

release therapy is

Myofascial

therapist

as

sustained

which the
in the fascia,

or

tissues, between muscles.

Aromatherapy:

Aromatherapy

involves the

use

of essential oils from

as therapy to improve physical health and wellare scented liquids that are removed from plants by
or pressure. They contain the chemicals that naturally give the
essence, or fragrance. Aromatherapy is administered in different

flowers, herbs, and trees

being. Essential oils


using steam
plant its

ways,

including

inhalation
various

lotions/creams
providing

inhalation

is believed

organs

and direct application

to have psychological

to the skin. Direct

effects that stimulate

within the body. Direct skin application,

or massage, are

psychological

or

sedate

either through

to work by inducing relaxation and

benefits.

Cognitive behavioral therapy:


therapy that is commonly

believed

Cognitive behavioral

therapy is

used to treat anxiety and depression,

number of other mental disorders

and psychological

a type

of talk

as

as a

well

symptoms. It is based

68

69

on

the premise that by understanding

influence their behaviors, patients


modifications

Reflexology:
the application

that ultimately

Reflexology

is

pressure to

of

can

how their thoughts


make deliberate

and feelings

behavior

result in symptom improvement.

an

alternative therapeutic

practice that involves

the feet and hands using specific thumb, finger,

cream, or lotion. It is based on a


system of zones within the feet that reflect an image of the body. The
premise is that applying pressure to certain zones will results in physical
changes in the corresponding areas of the body.
and hand techniques

You should understand

in the absence of oil,

that the above-described

the surface of all the complementary

treatment of fibromyalgia
provide

can
can

comprehensive

be found
also learn

Alternative

alternative

and alternative

review of all the modalities

therapies

therapies

symptoms. It is beyond the

scope

barely

available

scrape

for the

of this eBook to

available. More information

on our website, www.fibromyalgia-treatment.com In addition, you


more by visiting the National Center for Complementary and

Medicine, at www.nccam.nih.gov.

69

70

6:

Chapter
across

Experts

reputable

associations

you are

track what

fibromyalgia.

that: provide
maximize

you

have

with the how to tools

your

with regard to

experience

gone
you

fibromyalgia

authors to

your

into great detail about the

purpose

need to take ownership


self-management.

and this chapter will provide

you

processes

of this chapter is to do just


of and

You need to inspect

with the information

required

to

of the tools that you will need, consider this


When you are sick and
you visit your doctor. As your doctor evaluates you, they go
through a defined process to determine the course of action they choose to
recommend. First, they ask you questions about your signs and symptoms. Then
they record this information in your medical record for reference back to it at a
later point in time. Next, based on what you have told them, they use all of the
Before

we

none

Approach

have noted the need to effectively

the how to part. The

the potential of

you expect,
so.

what

you

doing and what

A Systematic

world from prominent

to devoted researchers

Unfortunately,

that should be used

do

Pulling it all Together:

all realms of the fibromyalgia

example

begin with the discussion

to help put the whole concept into perspective:

need treatment,

tools at their disposal their medical knowledge,


their understanding
recommend

a course

done is collected
analyzed
(i.e.,

relevant

of how the illness is manifesting

a treatment.
you questions

of action, i.e.,

data (by asking

clinical guidelines, and

itself in

Essentially,
about

your

to

you as a

body to

your

doctor has

signs and symptoms),

that data using various tools, and then recommended

treatment)

your

what

a course

of action

result of their data collection and analysis. If

you

leave their office and return two weeks later, having tried the treatment and found
it unsuccessful,

the doctor will repeat the

action recommendation.

By using

illness, the doctor does his best to

process

of data collection, analysis, and

a defined, repeatable system to evaluate your


ensure that the correct steps are always followed.

70

71

You

are not a

your

fibromyalgia

doctor, however
with

you

should still approach the self-management

defined, systematic

approach that is firmly rooted in data

and data analysis. Do not let this concept frighten

collection
achievable

and

anyone can

can

do it. You

of

you;

it is easily

do it! You must inspect what

you expect.

one:
Collect
Track EVERYTHING associated with your fibromyalgia.
This is a crucial first step. Think of it as the data collection process that allows
you to take inventory of and record your signs and symptoms. Record how you
feel each day, the symptoms you experience, possible triggers for those symptoms,
what treatments you are trying, and how those treatments are impacting your life.
Also note relevant factors such as sleep, stress, work pressures, family issues,
anxiety and physical or emotional happenings. You are looking to build a record of
how fibromyalgia is impacting and being impacted by your life.
Step

Step two:

symptoms,

Analyze

- EVERYTHING

your treatments,

you track.
on your

their effects

being. By having tracked everything

the data you record; your


your life, your overall well
you will have a wealth of
with your care team and

Analyze
body,

and recorded

it,

at your fingertips to analyze and to share


group. You might see your fibromyalgia in a different light when it is laid
you in writing on the table or on the computer screen. Patterns will
emerge that you may not have otherwise noticed. Ideas will present themselves to
you as you observe those patterns. And it will all culminate in providing you with a
much more focused and well-rounded understanding of your medical condition.
information

support

out before

Step three:

Utilize

its patterns,

nuances,

evaluation

can you

your newfound understanding of your fibromyalgia


on your life evaluate your available courses of
on your analysis. Only through analysis and
decide which courses of action will be best for you.

Using

and effects

action (i.e., treatments)

based

truly

that this is an ongoing process. Tracking, recording,


your fibromyalgia signs and symptoms for one week will not lead
you to a treatment that will ultimately get everything in check for you. Such a
It is important

to remember

and analyzing

scenario

is unrealistic

in light of the elusive nature of fibromyalgia.

You will need

on your system of data collection, analysis, and evaluation as you try new
on your findings. As those actions give you benefit or not you
must continue to assess your symptoms by tracking and analyzing them to
determine if more modifications are needed. Remember, this is an ongoing
process. But you can do it! INSPECT what you EXPECT!
to rely

actions based

71

72

72

73

73

74

74

75

Tools

your signs and symptoms on a regular basis "collecting your data


more than just jotting down a few notes here and
on a scrap piece of paper. You need an organized system. What works best
one person may not work best for another, but the overall premise is the same
everyone. Find the system that works best for you so that you can inspect what

Recording

will require effort. It will require


there
for
for

you expect.
your system

You could approach

or

notebooks

the old-fashioned

3-ring binders, photographs

recorder, and file folders. Although such


people, it is terribly inefficient

symptoms

logged in
diary of

free-written

The information
record

on a

one notebook,
your personal

or tape

attempted
thoughts

may

your

treatments

journals, forms,
recorder

may

or

voice

work for

data. You

may

some

have

logged in another, and

and feelings in yet another notebook.

be augmented

recorder, however

system

paper-based

and compartmentalizes

in these notebooks

voice

way, with
a tape

and/or video,

with voice

those recordings

are

memos you
away
you may
may make the

filed

elsewhere, unable to be viewed in context with the written notes. Finally,


misplace
difference

or

misfile

for

you

journal

or paper,

in the evaluation

of

losing valuable

your

data that

fibromyalgia.

75

76

How do

you
you

analyze data that is spread out

across a

bunch of journals

and binders?

identify patterns and causal relationships when your data is poorly


and difficult to review as a whole? How do you turn hand written notes
across multiple 3 ring binders and notebooks into detailed graphs and
charts you can use to conduct professional quality analysis? The answer : you
don't. A paper-based system greatly limits your ability to evaluate your
fibromyalgia in the most beneficial and comprehensive manner. Successful
organizations do not track their key data on paper, and you shouldnt either!

How do

organized
scattered

Admittedly,

a more

using

traditional

system is far better than doing

paper-based

even in the best case scenario, such a system


your efforts as if it were the 1950s. The Elusive Fiend is a
you need to bring your best game: put technology to work.

nothing; FAR BETTER. However,


leaves

you

managing

tough adversary

Yes,

and

use your computer.

few preliminary

can

you are

if

reading this,

be of great benefit to get

and folders

on your computer

storing all of

your

fibromyalgia

files in with other files. Consider

as
group.

fibromyalgia-related

your

team,

you

are a

have one! Here

started

on your

path

dedicated to

Do not mix

your

using file sharing services

your care team

and support

medical reports, charts, and related documents

them and store the scanned


documents

you

specifically

information.

Drop Box to enable sharing data with

Obtain copies of

you

of the Elusive Fiend:

self-management

Create directories

such

are,

Odds

tips that

toward successful

scan

on your computer. Remember, these


and as the leader of your
possess it and to determine with whom you

copies

contain YOUR health information,


have

right to

see

and

wish to share it.

Create

care

template

provider

have prior to
provider

you
your

Use spreadsheets

tools

use

for recording

notes for each doctor

to note questions and issues

serve as a reminder for yourself


pertains to your overall goals.

visit, to

These

using FibroTrack,

to

visit. Use this template

in the loop

Spreadsheets.

and

document

as

it

are

the most important

in which

case

any special notes you wish to


you need such as charts and
poor analysis

reduced in value by

tool

the complete

to track EVERYTHING.

you can

or
you
your

and to keep

have (unless

your

system is provided for you).

Use them also to keep

record. Spreadsheets

journal

offer the key analysis

graphs. Good data collection

is easily

abilities.

76

77

your computer skills are limited and you are uncertain how to create a
template or a spreadsheet
learn! Ask a family member or friend to help
you, or utilize many of the free training videos that are available online.
Resources such as Open Office are great for this and are free.
If

Tracking
There

Symptoms

are many

handwritten

to

use a

methods

that

journal, however

spreadsheet

you can use to track symptoms. You could use a


as previously stated, a much better option would be
use our interactive FibroTrack
method you choose, there are a few things to keep in

(the best option would be to

system). Regardless

of which

mind and remember

to always do.

As

you

evaluate

symptoms. All

as

means

treatment, note these


the things

your

fibromyalgia,

ALL. This includes

or even

being insignificant

identifying

note ALL of your


even minor ones that you may brush off
new symptoms pop up during ongoing
and add them to your tracking log. Doing so can be key in
that may be side effects from drugs or supplements you are

and begin to define

unrelated. As

using.
important to track everything in a consistent, systemized manner.
your symptoms on a scale from 1to 10, with 10 being the worse. If you
use a spreadsheet, create some type of chart that you can note every day. If
you choose to use a spreadsheet, get into detail and make your symptoms specific.
Group your symptoms together by type, using such categories as muscular pain,
tender points, mind/body functioning, internal pain, and so on.
It is extremely
Rate all of

cannot

Tracking

Events, and Triggers

you observe, do so
your symptoms. Track your sleep;
you slept, what time you went to
bed, what time you woke up, and how many times you arose during the night. Rate
the quality of your sleep was it restful? Did you have nightmares? How did you
feel upon waking up? Use the same granular detail when tracking and recording
other causal relationships, events, and triggers, such as fatigue, stress, emotions,
As

you

Causal Relationships,

track the causal relationships,

using the

same type

relationships,
associated

events, and triggers that

of system used to track

break it down into such categories

as

how long

body weight, depression,

anxiety, PMS, menstrual

pain, and

conditions.

77

78

Keep track of the visits to

you

accidents
actions

or

your

doctor, the medical tests

you

undergo,

any

any
abnormal

experience.

can be
can

Work hard to collect data that

and patterns, which

relationships

you

have (slips, falls, bumps, bruises), the weather, and

activities

evaluated

to look for possible causal

then be used to help

you structure

specific

treatment options.
***Understanding

events

are

information

process

individuals

symptoms

and causational

triggers and

each other and interacting in YOUR fibromyalgia

your

managing
into relevant

of intelligent

Tracking

your

how

impacting

to effectively

ongoing treatment

data that

can

is critical

efforts. You need to turn this

be evaluated. This is the

core

of enabling

trial and error.

Your Treatments

new treatments, make limited changes at a time, often only one at


a time. If you commence two separate treatment initiatives at the same time such
as a dietary modification and a dietary supplement
it may be hard to differentiate
which treatment is causing any side effects were you to experience any. This is a
core concept to sound scientific processes testing only single variables at a time.
When attempting

you track your treatments and everything relative to them, divide them into
groups to enable successful management. Examples of these groups might be
drugs, dietary supplements, alternative remedies, therapy programs, exercise, diet,
and so on. Keep records relative to all of these, and note any questions that you
have. Integrate your team, and keep track of questions, answers, and opinions. All
of this information is valuable for integrating data into a bigger picture strategy.
As

you have taken, when you


you exercised, the intensity
you used to exercise (swimming,
walking, etc.). Record therapies in which you have participated, which ones
helped, and why you chose to do it. Documenting the experiences you have with
these efforts can provide you with a wealth of insightful information.
It is also important

to track what

you

have done, what

took it, and how much. For exercise, record how long

at which

you

exercised, and what method

78

79

Intelligent

Determining

A Concept

Trial and Error

the most effective

and

your
purpose of

treatment(s)

for

System

will boil down

fibromyalgia

a simple process of trial and error. The


the efforts you are making in
your self-management focus and data collection is to transform a basic process into
an empowered system that is intelligent
driven by the data you have diligently
collected regarding your symptoms, signs, triggers, treatments and so on. Rather
than taking shots in the dark and hoping for the best, you are making intelligent
to

decisions

on

based the results measured

collected

and analyzed

from previous intelligent

decisions, all based

data.

your
you to

In order to make the most of

intelligent

review systems that enable

evaluate

error system,

trial and

reviews, and make it

specific task

from above that data collection

treatments

as

including efforts to integrate

fibromyalgia

using

you

your

will conduct

to-do list. Remember

relative to symptoms, events, triggers, and

as

well, make it

such. Set aside specific time to devote to doing this,

your care team

and support

group

into the

process.

as is recommended, your spreadsheet can easily


may be useful in helping
your treatments and other efforts are having on the many
variables associated with your fibromyalgia. Another visual aid is to use handwritten diagrams. Often the process of putting these diagrams together (including
the process of throwing away several iterations along the road!) IS evaluation in
and of itself. Review your symptoms charts, treatment effort logs, and personal
notes as to why you have used the treatments you have tried. Relate the answers to
things in your diagram.
If

you are

on your

is ongoing, and while review should be ongoing

separate task and define it

implement

treatment efforts relative to

symptoms, events, triggers, and other variables. Plan for WHEN

spreadsheet

generate charts and graphs. Such visual representations

you

visualize

the impact

It is also vitally important

to identify YOUR negative feedback loops. The patterns

emerge during your data review and analysis will help to identify these,
may not have been visible to you before you began analyzing and reviewing
your fibromyalgia in a focused manner. By identifying these negative feedback
loops and applying strategies to stop them, you can likely make a noticeable
impact on certain variables associated with your fibromyalgia. Through data
that will
which

evaluation, pattern observation,


factors,

you can

identifying

identify specifically

the

causal relationships

areas

where

you

and triggering

need to TARGET

your

treatment focus!

79

80

process, implementing various treatment efforts and gauging


their effect on your fibromyalgia will help to identify the POSITIVE feedback
loops that you are hoping to establish. By determining the intervention strategies
that are most effective, you can begin to slowly choke off causation factors, and
initiate positive feedback loops that can reinforce ongoing treatment efforts.
In

a reverse

of the

you undertake exercise as a treatment, you may find that you begin
you lose weight, it may improve your depression. Improvements
your depression may result in further reductions in anxiety and stress, all of
which may culminate in improved pain, fatigue and other symptoms.
For example, if

to lose weight. As
in

Exercise

Weight Loss Less Depression / Anxiety

/ Stress reduced

symptoms.

The Key to Success


The single most important
presented

on one

action. Decide

your

factor when it

here to effectively

gain control

small piece of

fibro and then start doing it. This

your

writing down

comes to applying the


over your fibromyalgia

can

be

as

simple

key symptoms. A small start is

as

a start

grabbing

- and

the biggest step required. Don't just think about it!

Integrate

your

efforts into

management

your

initiative

at

manage

notebook

and

getting started is

your
you need to
step at a time, one

daily planning. Set aside time specific to

efforts. Note specific detailed tasks

do and how, then assign time to it and get it done. One small

new treatment

is to simply take

plan to begin actively working to

typically

fibromyalgia

principals

time

- put the principals

- what

of Intelligent

Trial and Error

to work!

Understand
than

that this

successes.

process

will be frustrating

Know that most

magic pill lesson, and anticipate

successes

at times. Expect far

more

failures

will be small in nature. Remember

the

that in order to realize the largest reduction in

your symptoms possible, gains will most likely come in small steps. One treatment
initiative may yield a 20% reduction in a symptom. Another later effort may yield
another 15% improvement. Some efforts may make things worse (stop those!).
Over time you will build a treatment regimen that you can document is reducing
your symptoms by a meaningful amount. Even though some symptoms may never
be totally eliminated, the ability to reduce their impact on your life by 50% or more
can be the deciding factor between a full and happy life where your managing your
fibromyalgia and a life of misery where fibro is dictating to you.

80

81

Chapter
Effective

7:

systems

The Future:

are

the key to

an

"FibroTrack"

effective

management

useful because they foster habits and provide channels

process.

Systems

for taking effective

are
action.

we discussed in Chapter 6, there are a variety of systems that can be used to


manage your fibromyalgia from a data collection and analysis standpoint. Old
world systems, such as the use of journals and notebooks have deep inherent
flaws. These systems do not facilitate putting your data to use. They
As

compartmentalize

and fragment

and in context. Paper-based

data, and make it difficult

systems

are

rudimentary

not ideal for tackling the Elusive Fiend. It is important


collection
implement

your

is 90% pointless

(the remaining

focused system that

can

allow

to evaluate in its entirety

and inefficient, and therefore

to recognize that data

10% is empowerment)

you to

effectively

unless

evaluate

you

and convert

data into defined action plans.

81

82

FibroTrack:
FibroTrack

Internet

an

is

been specifically

your

designed

Self-Management

user

cloud

interface

from the ground

up to

facilitate

based

system that has

all aspects of managing

fibromyalgia.

FibroTrack
of

Enhanced

intuitive, graphical

a mouse

provides

users

with

wealth of tools all available

all designed to be integrated

into

an

at the simple click

overall fibromyalgia

specific

system:

videos

resources

Educational

- all accessible

user

and treatment options research tools integrated

into the

help functions.

Treatment

Program tools including detailed interfaces to research and create


consisting

diet changes, pain medications,

Tracking tools associated

with all aspects of

Natural Products Comprehensive


integration

of pharmaceuticals,

- the Internets

dietary supplements,

therapy options and exercise.

including life events which impact

mobile device.

symptoms

new treatment programs

or

Simple, intuitive symptom tracking in incredible detail including


defined symptoms

including hundreds of articles, blogs, Webinars and


online via computer

or are

your treatment program

impacted

by

your

fibromyalgia.

Database alternative treatment data

largest research based repository

of treatment

information.

Comprehensive

reporting and evaluation

tools including

user

defined

reports. Reports include graphs, charts and animations!

Online contact management

Data sharing capabilities


communications

Online support

users to

and communications

tools.

with healthcare providers including

tools and shared online reporting

groups

- with built in "smart-matching"

others with similar symptoms

capabilities

that link

and profile data

82

83

functions to enable support

Social networking

general ongoing treatment

Complete

user

over

control

groups

and

easy

tracking of

efforts.

ensure

all personal medical data with tools to

privacy. Users control what data is shared and what is kept totally private.

Discussion forums
Webinars

- ongoing

expert interviews and online training seminars

server

with state of the art data protection

Secure

Much, much more!

However, technology
approaches

has fortunately

previously

easy

achieve

data collection

analysis

accessible

through intuitive

capabilities

as

in the palm of

recently

huge

as

several

for security.

years ago.

that enable treatment

impossible.

from anywhere, receive targeted

all of which is facilitated

Now,

we are

able to

research, achieve

by sophisticated

technology

and

graphical interfaces. In other words, analysis

that doctors have

accessible

possible

capabilities

moved in directions

thought to be ridiculously

intelligent

never

your

dreamed

of

are now

possible, and in fact

hand!

feel the FibroTrack is by far the best means of building and


an effective self-management system, please remember that it is not
purpose of this ebook is to educate you relative to how an effective
self-management program should be structured and operated.

While

we

were not

like FibroTrack

Capabilities

on a

treatment related topics.

variety of fibromyalgia

certainly

implementing

required. The

We invite
will find

you to

visit

our

website, www.fibromyalgia-treatment.com,

wealth of useful information.

management

variety of fibromyalgia-related
associated

out

our

Remember,

our

knowledge

our

fibromyalgia

articles

where

you

self-

on a

wide

common symptoms, treatments,


more. In addition, you can check
groups and link-outs to
a variety of other resources to assist you.

methods, and

through online support

sites, and find

can

In addition to

will find researched-based

topics, including

conditions, diagnostic

blog, meet other members

popular social networking

sharing

you

tool (FibroTrack),

success but not without action. Take action by


may have a need for it. Share it with your
friends. Use our FibroTrack tool to help manage your
lead to

website with others who

team members, family, and

83

84

fibromyalgia;

it offers

comprehensive

and does all of the work for

you.

chase down the Elusive Fiend; let


simple and

as

streamlined

as

system of symptom and treatment tracking,

You have enough

us

help

you

on your plate while trying to


your self-management as

by making

possible.

we would greatly appreciate your feedback on this ebook, and as with


we ask that you share it with others so that they too can benefit from
contained herein. Finally, if you feel that FibroTrack is the best
system for you to achieve successful self-management of your fibromyalgia, but
you are unable to afford it, please contact us. We do not wish for anyone who
really has a need to be excluded due to costs.
In addition,

our

website,

the information

Also note

- 10%

fibromyalgia

of all net proceeds

awareness

from FibroTrack

go

toward funding

and research efforts!

-----------------------------------------------------------------

84

85

Disclaimer
The information

contained

in this ebook guide is for informational

a doctor,
or accountant. Any

The author is not

research scientist, medical practitioner

lawyer

advice, information,

opinion expressed
his

own

more than
you for

in this ebook is nothing

personal experience

purposes

entertainment

perspectives,

and provided to

purposes only.
any sort,
or medical
opinion based on
of

ideas

the authors

and

informational

only.

a medical professional before taking any


on the part of a reader that may have
are taken of the readers own free will with the
actions are in no way sanctioned, approved or in any way

You should always seek the advice of

medical related action. Any actions taken


been suggested

in this ebook

understanding

that said

related to the author of this ebook.

Please understand

may

that there

or

products

and opinions

services

or

responsibility

The publication

any

are some

expressed

liability for

any

by their

owners.

may

instruction, opinion, products

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guarantee any success on any

include information,

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As such, Ido not

Third Party material

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in this guide that the author

by third parties. Third Party Materials

Third Party Material. The

or

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assume

opinions.

my guarantee

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The material in this guide

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No part of this publication

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and all information,

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you agree that myself and my company is not
your medical treatment relating to any

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By reading this guide,

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85

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