NJ Fibromyalgia Treatment of FMS in New Jersey

Fibromyalgia: Flares and Stress

There is a sad and disturbing observation I have made over the past few months that I felt I needed to share with all my readers. Lately I have been witnessing many people having severe flares of their Fibromyalgia. I have seen this not only in my office but also in the blogs and messages I get on my new Facebook cause “The International Fibromyalgia Awareness Campaign”. There are now close to 2000 members supporting that cause, whose ultimate goal is to raise public awareness though the main stream media. Many are writing to me and complaining about increased pain and fatigue. They are describing what can only be considered a severe “Fibro Flare”. People that were doing extremely well managing their conditions are now having major exacerbations. On this website and also at IFAC I am getting daily emails from people that are expressing discouragement because they feel they are taking a step backwards in their healing. It is difficult to pinpoint exactly why this is occurring but I do have some theories as to the general “uptick” in flares. I also have suggestions for those of you that are presently experiencing a flare so that you can get back on track and feel some relief.

So, what is happening and why so many flares? I have heard some people saying that maybe it is the weather. We did have an unusually hot summer and the humidity has been extremely high. Now, the fall seems to be starting very wet and cool. Many researchers have defined a definite link between climate and body chemistry so that may be one cause. If the neurotransmitters are disrupted due to environmental factors, then it will obviously bring on a flare. Also with the severe heat that we had, especially up in the North East and Mid Atlantic states, many people decided to not be as active as they once were. Hot and humid conditions, kept them inside in air conditioning and lack of exercise exacerbated many of the myofascial trigger points. We then had a brief period of some really nice mild weather and it is possible that this brought on a sort of backlash because people sometimes make up for lost time. I have patients that were relatively inactive over the summer that then suddenly got outside and started doing all sorts of heavy yard work when the heat finally broke. They were exerting muscles that definitely aren’t ready for that type of workload. It’s a strange but typical type of backlash. Now the weather has been cool and damp. The change in barometric pressure makes us feel stiff. Both trigger points and tender points act up as the cold constricts blood vessels and tightens muscles. So the weather is likely one factor to flares but I believe there is a much more obvious and apparent reason.

My belief based on personal observation and experience is that the largest percentage of flares I am now witnessing is arising from stress. We are being bombarded daily with news concerning the situations our country is facing. Many people are out of work and many more are in financial trouble with their debt beyond control. We have millions of people that are upside down in their mortgages and even more that have lost hope of ever being able to pull out of the spiral they feel themselves in. Every week, I have 2 or 3 more patients telling me that they were let go from a job that they have had for 20 years. People are extremely concerned about the economy and this worry seems to be creeping into every aspect of their lives. Even those that are fortunate enough to have not been hit personally by this mess often have a loved one that is going through it and they worry about them.

I have patients that were managing their Fibromyalgia very well with a combination of techniques and therapies such as exercise, manual body work, chiropractic manipulation, acupuncture and nutritional supplementation. Now because of finances, they are unable to continue with many of these therapeutic modalities unless, as in the case of chiropractic, they are covered by their health insurance. The gains they had made bringing their body back into balance and finding relief has been slipping away. If you combine that with the fear of where they are headed with their accruing debt, you have a significant problem brewing. Stress plus a major change in lifestyle and therapeutic modalities equals a flare. Patients that were doing terrific and that I hadn’t seen in months or some cases even years have been calling for appointments. Most of them, when questioned, are expressing that they are under extreme stress. I have had patients say to me that they feel like they are in a “pressure cooker”. It is obvious that the mind body connection in these cases is the key.

I want to emphasize now that just because I am saying there is a stress factor responsible for many of the recent flares I am seeing does not mean that Fibromyalgia is a psychological or emotional condition. Fibro is not “in the mind” but it certainly is “in the brain”. It is partly a condition of neurotransmitter imbalance that can be greatly exacerbated when stress comes into play. An expression I often use in the office “psychology becomes physiology” describes this phenomenon really well. When we are stressed, especially for extended periods of time, the body reacts and chemical changes occur. Most of us have heard of “fight or flight” where the adrenal glands release adrenaline in a sudden burst due to a severe stressor. The story that comes to mind is of that little woman who lifted the car off of her son when the jack slipped and he became trapped. That adrenaline release can give someone the extra boost needed to run faster, and temporarily become stronger or perform better. It is protective and the body’s way of dealing with a dangerous situation. The problem arises when the stress factors that alert the adrenals and other glands become chronic and don’t go away. It is then that the chemicals produced by the body get out of control and turn from productive to destructive. These chemicals do even more damage when there is no release for them and no way for them to burn off or balance out.

Fibromyalgia research has shown the importance of specific endocrine glands and the hormones they release with the overall neurotransmitter balance of the body. The 3 endocrine glands that Fibro patients should be most interested in are the Adrenals, Pituitary and Hypothalamus. This is better known as the HPA axis and is directly related to the secretion of numerous chemicals that control the transmission of nerve impulses along with many other bodily functions. When stress throws these glands into and imbalance the result is often severe dysfunction of the autonomic nervous system causing an array of symptoms. This is the main connection between stress and Fibromyalgia and why the stress component needs to be addressed.

OK so what can we do for the stresses that we are facing? Well, for some of the stresses, there may be no immediate fix. Certainly, if someone is facing bankruptcy or losing their home, a cure to their financial mess may not be fast or easy. Although the situation may persist and may not be immediately remediable, there are still techniques we can use to help balance out the overall levels of stress hormones. Meditation is a very valuable tool that most everyone can do. Even those people that feel that they have no clue how to perform meditation can purchase CDs and listen to some guided imagery and meditative programs. There are countless meditative CDs available online at sites such as Amazon and in some websites people can even listen to samples before buying. There are also classes in yoga offered at most YMCAs and local health clubs that can offer a great form of not only relaxation but also stretching. A light easy walk for 20 minutes can also help to reduce stress and help reverse the downward spiral caused by a cascading imbalance of neurochemicals. Even the simplest act of playing soothing music throughout the day can help reduce stress. Other stress reducing techniques should also be considered and can greatly help keep your stress hormones under control. They include techniques and practices such as Ti Chi, Chi Gong and of course prayer.

When the overall situation we face can’t be immediately solved then we need to look at ways to offset or balance the stress with relaxation techniques. By doing so, the stress we face will become more manageable and subsequently the chemical fluctuations will be less dramatic. I have witnessed many patients turn their health around and improve the overall quality of their lives through simple meditative or relaxation techniques. For me, personally, it has been one of the most important factors to find balance and wellness. Please remember that flares will occur. We can’t have control over everything that happens in our lives. We can, however, control how we respond to them. Please don’t look at a flare as defeat. It is really a temporary condition and can be reversed much faster if we learn how to control our emotional response to it.

7 Comments

  • Bonnie Laniohan
    Posted May 13, 2011 at 6:32 am | Permalink

    It’s past 3am, can’t sleep as usual. I found your web site and found it interesting, and since I
    have been in a chronic fllare for the last 11months, I am constantly trying to find answers as to why so long a flare up. (OR AT LEAST THIS IS WHAT MY DR IS CALLING IT)
    I was told 5 years ago I had Fibro (I’m Sure it was much longer than that.) I’ve hurt but not like this…..My two shoulders are effected along with my arms. I can no longer dress myself completely w/o help. Can’t lower myself into a bathtub, can’t raise my arms over my head,or put them behind my back. I have NOT been pain free for 11 months

    My Dr just recently put me on Nortripyline ….she stopped at 50MG She said it would help with pain. (I have been on it for 5 weeks and can tell no difference) I’ was given percocet.

    WITHI ALL THE TESTING MY DR. HAS DONE..ALL INDICATIONS POINT TO FIBRO,but I’M still not coniv

    Thank you
    (From one that doesn’t

  • Posted May 13, 2011 at 12:59 pm | Permalink

    Hi Bonnie, I am sorry that you are having so much pain. Often when someone has fibromyalgia they have other problems or conditions that coexist. I rather simple analogy of this would be someone having chronic lung disease and then also developing a upper respiratory infection of top of it. We call that co-morbidity and we often see it with fibro patients. Fibromyalgia does not exist in it’s own vacuum and many times patients have other problems along with it. Obviously I can’t properly diagnose you, because you are not my patient, but it is possible that you have separate shoulder issues along with your fibro. People can develop rotator cuff disorders because of the trigger points that they develop with the fibro. I would suggest you discuss this further with your treating doctor and maybe ask for some additional testing to see if you have some mechanical problems with the shoulders that can be easily fixed. The proper treatment may not fix your original fibro diagnosis but surely ease the local pain in your shoulders. Also, please remember that those of us with fibro have imbalances of certain neurotransmitters and that makes us feel pain at a much higher level. So, even a mild should issue can result in a lot of pain. I hope you feel better.
    Good Luck
    Dr. Mark

  • Karen Rickard
    Posted August 9, 2012 at 11:44 am | Permalink

    I was diagnosed with Fibro in 1999. Had it for years before diagnosis. I too have been in the longest flare I have ever experienced. I also can’t lift my arms, and the fibro has flared through out my arms and shoulders and neck. My doctor found that I have bursitis, complicated by fibro. I had steroid shot in my bursa, which calmed the bursitis down. but the fibro persisted and the changing weather brought the bursitis back. If I try to exercise the pain is so tremendous I can’t handle it. I have refused for years to take pain medication but now find it completely necessary. I can only pray we have an early fall and some temperate weather. If the weather varies more than 20 degrees in an 24 hour period I flare, and this has been documented. I am the absolute best in knowing when weather will change. If I had my rather’s, I would rather not be a weather forecaster……praying for an end to chronic conditions.

  • Posted August 9, 2012 at 12:06 pm | Permalink

    I agree that there is so much stress all around us. Being able to cope with pain is something I deal with on a daily basis. Even though I exercise and do everything I can to manage the symptoms, I still deal with a level 5 pain on a daily basis. Actually, level 5 is a pretty good day. I can’t remember being pain free. I take supplements and limit the amount of medication that I’m prescribed. For example I have to take tinzanidine for the muscle spasms in my legs and I take 5 mg. of oxycodone when I have to take the edge off of the pain. I’ve resigned myself to the pain and just try to keep it manageable. I am a typical type A personality but I also have tried to manage that as well….I mean…it really doesn’t matter if my DVD’s are in alphabetical order does it?

    Any thoughts on other coping strategies or mechanisms? I do write a blog (I’ve included the website) and try to keep up on the latest info..

    Thanks,
    Rosemary

  • Posted August 9, 2012 at 12:28 pm | Permalink

    Dr Mark, Well written article that offers a glimpse at the layers of this disease. I agree with everything you’ve written and agree this is a complex syndrome. I would add that patients must work at teasing apart emotional pain over their lifetime from physical pain in the present. My experience is that they immesh. To effectively manage pain in the present I traveled to places I never thought I would find myself seeking skills and coping mechinisms I never knew existed. I almost ran out in the first classes thinking I don’t belong here. But, persevering I gained meaningful and useful skills. I also found swimming and equalling th epressure on my body helped. I loved sitting on the bottom of the pool being engulfed by the pressure all over. I swam until my jaw and cervical spine would not let me continue. Even becoming a lifeguard because I could do in the water that which I couldn’t do on land. It allowed me a freedom of movement I had lost when I could no longer ride a bike because of balance issues. I was left in a flare and again seeking remedies adjusting diet and environmental toxins. Next yoga revived me from flare and took me to a new level of fitness and wellnessover 2 yrs. I was able to teach at the local cacner center and this lasted over 2 years. Until the tumors in my feet and hands started to limit my ability to practice on the floor. Taking my mat practice little by little, the to a chair then to the breath work only. Stress has played a role in my setbacks and I cut life and those stressors back little by little. Social engagemnets get cancelled last minite mostly to weather factor I have no control over. I digress,,,, What works for a time may not always remain the solution. Why is it General Practicing MD’s have little working understanding of the limbic, lymphatic and nervous system? Or is that an illusion? Do you need to get a referral to an Endocronologist for this to be a meaningful conversation?

  • Posted August 9, 2012 at 5:48 pm | Permalink

    Great site! Great blog!
    I am an advanced health and fitness specialist who focuses on pain management. Many of my clients have fibromyalgia and I am seeing the same increase in flares. I absolutely agree that stress is a trigger for flare-ups.

    One common trait I see in many people with fibromyalgia is the need to “be in control” and when times are stressful and they feel out of control, they tend to tighten up muscles in an effort to regain control. I call the muscles that tighten up the “bully muscles” and trigger points often develop on these muscles. One trick I teach my clients is the “freeze game”: While you are going about your normal activities, tell yourself to freeze and hold your position exactly as is. Notice your personal tension areas and relax those muscles. Common tension areas are the neck, the lower back, the shoulder hunchers and mini-hunchers, the rearend, the feet, the hands, and the jaw. Then breath slow deep breaths, repeat the phrase “let go,” and release these areas (for example, drop your shoulders) before going on with your activity. This will help you discover where you tighten up when you are trying to control things. If you play this game regularly, you will be able to sense when you are going into control mode and be able to stop it sooner. It’s amazing how well it works!

    You are providing a valuable service. Keep up the great work!
    Cindy Killip

  • Linda Marie
    Posted December 24, 2012 at 2:04 pm | Permalink

    Hello,

    I was recently diagnosed this year w/ Fibromyalgia. I also have herniated discs in lower back, IBS, EBV, hypothroidism and mild hypoglycemia. I have never felt so exhausted, anxious and depressed as this past year. I started a new job approx one year ago and it is slowly killing me. It is a struggle getting up in the morning and commuting and by 3pm, I feel like going home. My job is mentally exhausting. I have tried going to a chiropractor for years, Physical Therapy and medications. I am sensitive to many meds and cannot tolerate any antidepressants. Recently I started taking Savella and hopefully this will help me w/ the Fibro. I am also on Oxycodone for the back pain. Any advice or suggestions would be very much appreciated. Thanks!

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