October 23, 2019

Commonly Prescribed Fibromyalgia Meds Work only 20% of the Time Study Says

ScienceDaily.com reports on a recent medical study conducted in Germany which shows that two medications commonly prescribed for fibromyalgia offer benefit to only about 1 out of every 5 patients.

The study looked at testing conducted on 6,000 adults – mostly middle aged females – who were prescribed duloxetine (Cymbalta), milnacipran or a placebo.  Study participants were asked to rate these drugs on a “quality of life” scale.  Only 22% of participants reported significant improvement, while 21% discontinued using medications because of side effects.

A future study will evaluate pregabalin (Lyrica) later this year.

“The medical field does poorly with the treatment of fibromyalgia in general,” says Brian Walitt, M.D., M.P.H., a co-author of the review and an expert in pain syndromes at Washington Hospital Center in Washington, D.C. “Chasing [a cure] with medicine doesn’t seem to work.”

This relative ineffectiveness of prescription medication should not be a surprise to Social Security disability claimants who are applying for benefits due to chronic pain, cognitive decline and fatigue associated with fibromyalgia.   Obviously individuals who allege that the are disabled are not benefiting from medications, and claimant’s attorneys often note symptoms of depression due to the absence of any viable treatment options.

If you have been prescribed Cymbalta, Lyrica or any other prescription medication by your doctor, it is important that you make every effort to remain complaint with recommended treatment.   Social Security judges are often not very understanding if a claimant decides to stop taking a medication on his or her own, even if that medication does not seem to be working.

At the very least, report to your doctors any concerns about the effectiveness and side effects of medications so that your medical record will reflect what you have experienced.  Judges will use non-compliance as a basis for denying claims and this is especially true for cases involving a condition that arises from symptoms that are inherently subjective and self -reported.

 

Mind-Body Approach to Healing – Zero Pain Now

Neuro-Linguistic Programming practitioner Adam Heller has written a book entitled Zero Pain Now in which he describes a “mind-body” approach to healing fibromyalgia pain.  Mr. Heller argues that fibromyalgia causes physical changes in the brain that can be reversed without the use of narcotic pain mediations.  Take a look at Mr. Heller’ s video.  If you have had experience with Zero Pain Now – either positive or negative, please let us know.

Fibromyalgia from Adam Heller on Vimeo.

Fibromyalgia Patients: Avoid Accidental Overdosing on Tylenol

Many fibromyalgia patients use Tylenol, either in conjunction with other pain medications (such as tramadol) or as over-the-counter pain relief for mild-symptom days. But a recent study warns that even the tiniest overdose of acetaminophen can result in death.

Researchers from the University of Edinburgh (Scotland) reported that their study found that taking even a little too much acetaminophen over time is more dangerous, in fact, than taking a single much-too-large dose.

Dr. Kenneth Simpson of the University of Edinburgh, the study’s lead author, stated in a press release accompanying the study’s publication:

They haven’t taken the sort of single-moment, one-off massive overdoses taken by people who try to commit suicide, but over time the damage builds up, and the effect can be fatal . . . Staggered overdoses or patients presenting late after an overdose need to be closely monitored and considered for the (acetaminophen) antidote, N-acetylcysteine, irrespective of the concentration of (acetaminophen) in their blood. [Read more…]

So What if Your Social Security Judge Calls Fibromyalgia a Mental Health Condition!

Social Security judges often call psychologists to testify as expert witnesses in fibromyalgia disability cases because there is medical literature that characterizes fibromyalgia as a mental health condition that produces physical symptoms.

However, if you mention cognitive behavioral therapy to fibromyalgia advocates and you’re sure to get a passionate response.

Cognitive behavioral therapy or CBT is a term that covers a wide variety of psychological treatment approaches in which focus is placed on the role of the patient’s thoughts in controlling and impacting behavior and choices.

Some advocates and patients assert that focusing on CBT merely perpetuates unproven myths that the patient’s pain is “all in the head” – i.e., purely a mental issue. Others assert that CBT has been proven to lessen symptoms of fibromyalgia and should be a central part of treatment.

A recent multi-site clinical trial, the results of which are being reported in Arthritis & Rheumatism, seems to back up the latter group. This study found that CBT lessened depression in teenagers with fibromyalgia and helped them cope with the disease’s symptoms more effectively. [Read more…]

Studies Linking Mouse Retrovirus with Fibromyalgia Appear Flawed

Social Security disability lawyers representing fibromyalgia clients often seen similarities in their clients.  Most fibromyalgia clients are “Type A,” overachieving females between the ages of 30 and 60 who experience a gradual onset of fatigue, myofascial pain, mental confusion, digestive upset and balance issues characteristic of a FM/CFS diagnosis.

Many of these fibromyalgia patients go from doctor to doctor looking for a cure, but, of course, there not only is no cure, but there is no consensus in the medical community as to how to objectively test for this condition.

Medical researchers have been working on this problem and over the past few years there have been a number of studies published that purport to identify unambiguous markers that will enable practitioners to objectively diagnose FM/CFS.

One of the more intriguing medical studies in recent years involved the Whittermore-Peterson Institute and researcher Judy Mikovits.

The fibromyalgia and Chronic Fatigue Syndrome (CFS – also sometimes referred to as “CFS/ME,” where “ME” stands for myalgic encephalomyelitis) community has been roiled by a controversy over the news, reported first in 2009, that a mouse retrovirus might be involved in CFS.  Now, the research group which first asserted the connection between xenotropic murine leukemia virus-related virus (XMRV) and CFS is at the center of another controversy – this one of a decidedly non-medical nature. [Read more…]

Yoga Can Ease Fibromyalgia Pain

For people suffering from fibromyalgia and other chronic pain illnesses, yoga has now been proven both to help ease the pain and cope more efficiently with the pain. Participants report feeling muscles relax that have felt perpetually locked in spasm and a deep sense of relaxation that carries over in daily life from regular participation in restorative yoga.

The study, conducted by researchers from the Oregon Health & Science University in Portland, looked at 53 women diagnosed with fibromyalgia. Twenty-five of these women participated in a “Yoga of Awareness” program once a week (including gentle stretching, mindfulness meditation, breathing techniques, and applying yoga principles to optimal coping); the remaining 28 participants did not take part in the yoga instruction program.

Participants in the study followed a specific routine that introduced them to yoga poses and practice in general, and specific yoga-based pain coping techniques. Classes consisted of a set series of sections or phases, including 40 minutes of gentle “stretch” poses (or asanas, as they’re called in yoga), followed by a 25-minute meditation and a 10-minute session where participants practiced pranayama, or yogic breathing techniques. The yoga classes were followed by lectures and presentations on how to use yoga principles to copy with physical pain and a group discussion geared around how participants could incorporate a home-based yoga practice in their lives.

Three months after the program began, the women who had been assigned to the yoga protocol reported reduced pain and fatigue. They also demonstrated more effective strategies for coping with the pain that they experienced, with less “catastrophizing, self-isolation, and disengagement.”

One of the best resources on the web for yoga is Yoga Journal’s website. You can learn more about this ancient mind-body practice and get instructions on simple asana sequences you can do at home. Another excellent resource is Kelly McGonigal’s Yoga for Pain Relief (available from Amazon).

Fibromyalgia and Post-Traumatic Stress Disorder: Associational Link or Causative Link?

One of the most prevalent sources of confusion in health information and news is the report of one disease having been found “linked to” another disease. But it’s important to understand that just because there’s a correspondence or a certain frequency of occurrence in the general population, that doesn’t mean that one disease causes the other. The relationship between the two illnesses could simply be associational — in other words, these two conditions sometimes occur together.

The question becomes even more confusing when reports suggest a greater occurrence of one disease in patients diagnosed with another illness. Take, for example, the studies suggesting that post-traumatic stress disorder (or PTSD) is more prevalent in fibromyalgia patients. The study linked to in the previous sentence was conducted by Drs. H. Cohen, L. Neumann, and others at the Ben-Gurion University of the Negev, in Israel.

The findings of this study indicate that a statistically significant portion of the fibromyalgia population studied also had PTSD. From the study’s abstract:

57% of the FM sample had clinically significant levels of PTSD symptoms. The FM patients with PTSD reported significantly greater levels of avoidance, hyperarousal, reexperiencing, anxiety, and depression than did the patients without clinically significant levels of PTSD symptoms. The prevalence of PTSD among the FM patients in this study was significantly higher than in the general population. Women with FM and PTSD reported a greater number of past traumatic events than did their male counterparts.

CONCLUSIONS: The results represent the first comprehensive study applying structured clinical assessment of trauma exposure and PTSD to a group of FM patients. This study shows a significant overlap between FM and PTSD, according to the currently accepted diagnostic criteria for each.

But does that mean that fibromyalgia is “caused by” or somehow “triggered by” PTSD? The study found nothing of the sort, of course, but these findings have been cited in news articles that can present misleading suggestions of some causative connection that hasn’t been proven yet.

Another study from the same institution looked at whether PTSD and fibromyalgia were really the same illness. While they do share some symptoms in common, it is generally thought that fibromyalgia results from actual neurological changes as opposed to some psychological trauma. It could be that in many cases, an initiating physical trauma causes both PTSD and fibromyalgia.

Yet a lazy researcher could well take that association as grounds for concluding that fibromyalgia is “all in your head” — which is clearly not the case. And given that fibromyalgia is too often relegated to some behavioral issue, as opposed to a systemic or neurological malfunction, that’s unfortunate.

It’s important for fibromyalgia patients to educate and inform themselves, but it’s also important to keep an objective view of studies that are reported in the press.

Finding the Right Fibromyalgia Doctor

I recently ran across an interesting article on a blog published by the North Carolina disability law firm Hardison & Associates called “Fibromyalgia: Searching for the Right Doctor.”   This article raises several issues that I regularly face in my own disability practice – many physicians do not understand how to diagnose fibromyalgia and can damage your disability case by offhand comments in your medical record.

Some doctors incorrectly see fibromyalgia as a “garbage can” diagnosis, meaning that any pain symptoms that cannot otherwise be explained end up with the fibro label.  The problem with this approach is that Social Security judges are increasingly familiar with the American College of Rheumatology’s diagnostic classifications for the disease and judges will discount or ignore a physician diagnosis that does not refer to the American College diagnostic criteria.

Some doctors – thankfully fewer and fewer – do not accept that fibromyalgia exists at all.  Often the medical records from these doctors will contain suggestions that the patient has psychiatric problems, or worse, that the patient is a malingerer or drug seeker. [Read more…]

FDA Panel Rejects Xyrem as Fibromyalgia Treatment

WebMD reports that the United States Food and Drug Administration has rejected a drug called Xyrem as a treatment for fibromyalgia.  Although public comments (primarily from users testing the drug as part of the manufacturer’s trials) supported approval, and the FDA physicians acknowledge that the drug can reduce pain, the FDA advisory panel rejected the drug because of its similarity to GHB – the so-called “date rape” drug.

According to the FDA, Xyrem, or sodium oxybate, “is much better than the stuff you get on the street, and that is the problem.  Approving it for such a large patient population — 5 million people are estimated to suffer from fibromyalgia — would risk flooding the streets with a pharmaceutical-grade version of the highly controlled substance.

Xyrem is currently available for the treatment of narcolepsy.  It is a central nervous system depressant.

Can Tai Chi Ease the Symtoms of Fibromyalgia?

A recent issue of the New England Journal of Medicine contains a study suggesting that Tai Chi may ease the pain and discomfort associated with fibromyalgia.    Tai Chi, the ancient practice of slow movement, breathing and meditation may reduce pain because of its focus on the mind-body connection.

The NEJM study looked at a small group of trial participants and focused on only one type of Tai Chi – researchers are planning larger scale trials and evaluations of different schools of Tai Chi.

Still, this study offers promising hope that this ancient and inexpensive therapy may improve the lives of thousands of fibromyalgia sufferers.