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Your Fibromyalgia Treatment Guide

Treating Fibromyalgia Through the Development, Validation and Utilization of an Individualized Self-Management System.

Brought to you by: Fibromyalgia-Treatment.com

Table of Contents
Introduction ..................................................................................................................................... 5 Chapter 1: Getting Started: From Confusion to Knowledge ...................................................... 10 Associations and Internet Resources .................................................................... 13 Magazines and Journals ........................................................................................ 14 Doctors, Care Providers, and Therapists............................................................... 15 Support Groups ..................................................................................................... 16 Support Groups and Accountability...................................................................... 17 Primary Focus ....................................................................................................... 18 Chapter 2: Reviewing Fibromyalgia ............................................................................................ 19 History and Introduction ....................................................................................... 19 Demographics ....................................................................................................... 20 Symptoms ............................................................................................................. 20 Fibromyalgia Triggers .......................................................................................... 27 Diagnosis............................................................................................................... 27 Causal Theories ..................................................................................................... 29 Chapter 3: Fibromyalgia: The Elusive Fiend .............................................................................. 30 General Confusion ................................................................................................ 30 A Tough Nut to Crack........................................................................................... 32 SymptomCause Interplay and Confusion ........................................................... 32 Negative Feedback Loops ..................................................................................... 33 Medical System ..................................................................................................... 35 "Magic Pill Syndrome" ......................................................................................... 37 Effective Treatment - Overwhelming Options .................................................... 38 Chapter 4: Self-Management: Basis for Effective Treatment...................................................... 40 Taking Responsibility ........................................................................................... 40 Education - Laying the Foundation for Success ................................................... 41 Defining Your Fibromyalgia................................................................................. 42 Building Your Team ............................................................................................. 43 Take Action ........................................................................................................... 44 Setting Goals ......................................................................................................... 45 Become a Problem-Solver .................................................................................... 46 Evaluating Treatment Options .............................................................................. 47 Self-Empowerment ............................................................................................... 49 Self-Management Conclusion............................................................................... 50 Chapter 5: Treating Fibromyalgia: What you need to know ...................................................... 51 Medical Specialists ............................................................................................... 51 Create a Partnership with your Physician ............................................................. 55 FDA-Approved Pharmaceuticals .......................................................................... 57 Antidepressants ..................................................................................................... 59 Prescription Sleep Medications............................................................................. 60 Anti-Anxiety Medications .................................................................................... 60 Pain Management.................................................................................................. 61 Coping Strategies for Pain .................................................................................... 63 Dietary Supplements ............................................................................................. 63

4 Diet ........................................................................................................................ 66 Exercise ................................................................................................................. 67 Therapies ............................................................................................................... 68 Chapter 6: Pulling it all Together: A Systematic Approach ....................................................... 70 Tools ..................................................................................................................... 75 Tracking Symptoms .............................................................................................. 77 Tracking Causal Relationships, Events, and Triggers .......................................... 77 Tracking Your Treatments .................................................................................... 78 Intelligent Trial and Error A Concept and a System ...................................... 79 The Key to Success ............................................................................................... 80 Chapter 7: The Future: "FibroTrack" .......................................................................................... 81 FibroTrack: Internet Enhanced Self-Management............................................... 82 Disclaimer ............................................................................................................. 85

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Introduction
I am not a doctor, nor a research scientist, medical professor, nurse, therapist or medical practitioner in any sense. There are no fancy plaques on my wall that project some aura of authority over me on this subject (my degree is in History.). I do not have fibromyalgia. So why am I writing an ebook on this subject - and why should you pay any attention? Fibromyalgia has undermined my life. It is working to destroy my wife and wreak havoc on the lives of my 2 children. Experts always stress that writers and business people should focus their efforts on something they are passionate about. Am I passionate about fibromyalgia? Absolutely! I passionately hate it, to be precise. I love my wife and I have watched her suffer to extremes as we both fought feelings of helplessness and hopelessness for years. I qualify as an expert in how fibromyalgia can destroy. My wife and I chased a dream together. Not a small dream, not a typical sort of dream but something extraordinary (at least to us). We got it into our heads that we could move our family aboard a sailboat to live full time, home school our kids and live a lifestyle of freedom and discovery spending quality time with each other and our kids. We read, studied, learned and planned and in 2008 we began to make this dream a reality. I purchased a 47' sailboat and poured all that we had into building the boat into a home and restructuring our lives to make this huge change a reality. Through all of this - we fought fibromyalgia. My wife Michele was diagnosed with fibro in 2003 after the birth of our daughter. She exhibited some symptoms before the pregnancy (her 2nd) but it was only after the c-section birth of 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. After being diagnosed with fibromyalgia and learning about the difficulties in treatment, Michele began focusing her attention on researching and implementing treatment options while my focus remained on running our business so we could pay for the expensive treatment efforts she needed. (Self-employed with a very small company - our insurance paid for essentially nothing). We went through many doctors and tried different drugs and combinations of drugs and listened to many specialists. Through it all the fibromyalgia waxed and waned but it was
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always there. At times things got better and we were deluded into believing a corner had been turned only to feel crushed again when things got worse. But - we maintained our dream. Through 2008 as our efforts to make the sailing dream a reality began to pick up steam we also increased the war against fibromyalgia. We began seeing a fibro specialist center, and despite this care being extremely expensive, we went all-in. We both believed that putting forth the effort in a big push to once and for all crush this beast would yield success, and if it didn't, we had a backup plan. The backup plan was simple - If youre going to be in pain, you might as well be in pain in a tropical paradise living aboard a boat. That sounded pretty good at the time. All of the hard work and effort did pay off. Michele felt much better. In late 2009 we moved aboard our boat full time and began to "live the dream". We had problems (the saying "Going cruising is just repairing your boat in exotic locations" is true). We had adventures and we had fibro. After getting away from the "Big Push" medical efforts the fibro began to slowly build back. After we returned from the Bahamas in June of 2010, fibromyalgia flared with a vengeance, raging like I had never seen before and transforming Michele into a complete wreck. We were convinced something more was wrong. This flare was different. The pain was overwhelming but it went beyond that to shaking and convulsions and huge migraines coupled with severe anxiety, bowel pains, horrible leg cramping and other symptoms. Was this MS? Could a brain tumor be in play? What could be causing all these new symptoms and in such severity? We were distraught and confused, but one thing rapidly became clear - the "Cruising Dream" was dead. Michele was in serious trouble. We had to seek medical care at once to find out what was really wrong. This was the worst time of my life. It's bad enough having dreams crushed, but watching my wife suffer was overwhelming. We launched into a whole new endeavor to determine what 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. As we began dealing with fibro on a new level and working to put our lives back in some semblance of order, I began to feel a new sense of mission. I would focus my life on helping my wife overcome this disease and provide my family with the rich
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and productive life that they want and need. I had lots of ideas on what form this might take, but the first step was to make myself an expert on fibromyalgia. I set about this task aggressively reading everything I could find. I read books, studied online, delved deep into research reports, contacted research scientists and in general, did everything I could to figure out how to help my wife. I had every expectation that my efforts would yield a magic combination of treatments that would bring complete success. I no longer have those expectations. Education and knowledge are wonderful things, but in this case, reward was tempered as I began to realize that fighting fibro is a war, not just a single battle. I also understood that determining what treatments would be most effective for Michele would be an individual struggle. I learned that fibromyalgia manifests itself differently in each patient and that developing an effective treatment strategy would require implementing strong systems in order to effectively manage treatment efforts. I needed to be able to not only research what treatment options were possible, but to quantify results and validate the combined treatment approach that we were developing. I learned that the research data indicated a multi-faceted treatment approach. Such an approach consisting of pharmaceuticals, dietary supplements, exercise, diet changes, therapies and alternative medicine was most likely to yield lasting results, but determining what combination would be best for Michele would be an ongoing individual process. The more I learned, the more I began to seek out information about selfmanagement programs. Among the very few things I found consistent among the "experts" on fibromyalgia 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 difficult. I began to seek programs or systems to utilize in this process. Given that there is so much material out there relative to management of illnesses in general, I expected to find structured online programs specifically aimed at assisting those fighting fibromyalgia in their running of an ongoing self-management program. I searched 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, I found nothing in online systems aimed at

facilitating an ongoing process. Its one thing to learn what one may need to do, but it is something else to determine how to actually do it. I found no "how." This need is what has driven both this ebook and the development of the FibroTrack application. My focus is not on telling you specifically what you need to do in order to treat your fibromyalgia. Anyone who purports to tell you what treatments will be effective for you probably does not understand fibromyalgia at its most basic level. The reality is that effective treatment varies from patient to patient and the only way you can tell if any given treatment will be effective for you is to test it. My focus is on this part: the systems and processes required to improve your ability to intelligently test and determine what does work, for you. In effect, I am not trying to tell you what you should do for effective treatment - I am suggesting to you how to proceed toward effective treatment. What is a selfmanagement program? How do you develop, implement, and manage one on an ongoing basis? This ebook answers these questions. The concepts and processes that I present in this book are not new. I have not been engaged in new conceptual research and the processes discussed here are not revolutionary new developments. What I have done is take existing research data and treatment process suggestions from many different experts and combine them into an overall strategy that can be implemented and managed by those struggling with fibromyalgia. I hope this ebook helps you to improve your fight against fibromyalgia. You will find references to the FibroTrack application throughout this ebook and I do firmly believe that FibroTrack can help any patient improve their self-management efforts. But you do not have to utilize FibroTrack in order to put the concepts and systems outlined in this ebook into action. I urge you - please - make the effort to implement what you learn here. Knowledge without action never yields success. Please take what you learn and put it into action. I also need to point out that a great deal of relevant information about fibromyalgia is not in this ebook, but is available on my website. The following 3 main sections of the site have expandable 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 Internet.

Click these links to learn more! What is Fibromyalgia? Fibromyalgia Treatment Fibromyalgia Symptoms Also - Please follow my Blog.

Finally - THANK YOU. Thank you for downloading this ebook and taking the time to read it. I truly value the trust you have placed in me by taking the time to read the information I have put together for you. If you have any suggestions, questions, concerns or problems that you feel I may be able to help with, I urge you to contact me. Email: terrycspringer@yahoo.com

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Chapter 1:

Getting Started: From Confusion to Knowledge

Fibromyalgia for most patients begins with pain and confusion. Pervasive and persistent pain appearing with no apparent cause and not responding to typical treatments can leave the patient and care providers frustrated. Diagnostic parameters of this disorder are poorly defined due to its inherent nature. Diagnosis frequently boils down to the elimination of other possibilities, a process that can be both long and confusing. No specific medical tests apply, and no established set of symptoms exist that provide a definitive diagnosis. Confusion and doubt have been central to fibromyalgia throughout its history. This is our purpose: To develop an individualized treatment approach, confusion must be replaced with understanding so that specific actions can be focused toward the reduction of symptoms. There is no shortage of information about fibromyalgia and its many different treatment options. Books, websites, magazine, associations and organizations abound on this topic. Much of the information available online is, unfortunately, of dubious quality. The problem is so pervasive that it triggered a research study of its own, a study that concluded that the majority of fibromyalgia websites are deeply flawed (Click HERE for an article on this research study). This is one of the primary motivations behind our website at http://www.fibromyalgia-treatment.com. Our goal is provide an online source for definitive research based articles and information related to fibromyalgia - so of course we urge readers to use this resource. In addition to our website, many others provide a wealth of information. We urge those fighting fibromyalgia 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 direction.

Books
There have been hundreds if not thousands of books published on fibromyalgia. Below are brief reviews of 4 favorites:

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The Complete Idiots Guide to Fibromyalgia By: Lynne Matallana with Laurence A. Bradley Ph.D, Stuart Silverman MD, Muhammad Yunus MD This is a great book. It covers a diverse battery of information and stresses the critical importance of developing and implementing a self-management program. This book also covers many treatment options, the building of a care-provider team, and details on actions you can take to move your treatment efforts forward.

From Fatigued to Fantastic By: Jacob Teitelbaum MD This book should be considered a mandatory reference manual. Fair warning - the amount of information presented is massive. Dr. Teitelbaum goes into great detail on a huge variety of possible treatment options, so much so that it can be overwhelming. This is not the kind of book someone is going to sit down and just read; its presentation is complicated and at times the content can be difficult to digest. Teitelbaum does focus on the need to develop an individualized treatment protocol, but while he is overwhelming in detail relative to what options are recommended, he is a bit short in details on the management process. Despite any shortcomings though, this book has a huge amount of detailed reference information.

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Fibromyalgia for Dummies By: Roland Staud, MD with Christine Adamec This is both an excellent starting point for beginners and a great reference manual for the seasoned warrior. Much material is covered relative to different treatment options. Much effort is put forth in explaining the history and background related to fibromyalgia, and the reader gains a solid understanding of the struggles those suffering from fibro have faced in having the syndrome accepted by the medical establishment. One shortcoming in this book is its lack of focus on the need for strong selfmanagement processes. The book documents a wealth of information about treatment options, but it does not delve into discussions about how these efforts should be integrated into an overall plan. Still, it's a worthwhile read and good reference source.

Fibromyalgia & Chronic Myofascial Pain By: Devin Starlanyl and Mary Ellen Copeland This is another book that covers a huge amount of content in a largely textbook style manner. Information about Myofascial pain is covered in detail, and it's very helpful given the level of comorbidity between these two syndromes. This book goes into more detail concerning possible causes and triggers, and it discusses the relationships between causal factors at length. The authors discuss the interactions and complications associated with different treatment approaches and the need for the patient to strive to integrate treatments into a comprehensive management strategy, but little detail is provided on any related processes. Despite this lack, the huge amount of relevant content and excellent supporting graphics are excellent.

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Associations and Internet Resources

Considerable resources are available to fibromyalgia sufferers, all of which provide a multitude of information on living with and treating the disease. Several professional associations have devoted themselves to increasing awareness of fibromyalgia and advocating for those who suffer from it. The National Fibromyalgia and Chronic Pain Association (NFMCPA) joined forces with the now inactive National Fibromyalgia Association (NFA) to become the leading nonprofit organization dedicated to the support of individuals with fibromyalgia and other chronic pain illnesses. Their mission is to educate patients, the medical community, the public, government, and scientists regarding the importance of timely diagnosis and appropriate treatment for fibromyalgia and overlapping conditions. NFMCPA is donor-supported, and members have access to a wealth of information on their website (www.fmcpaware.org), including e-newsletters, Fibromyalgia and Chronic Pain LIFE magazine, online discussion forums, general information on fibromyalgia and overlapping conditions, as well as research and advocacy updates. The NFA website also remains available to fibromyalgia patients (www.fmaware.org) with a number of online resources still available. Other organizations that can provide information and support to fibromyalgia sufferers include the American Pain Foundation (www.painfoundation.org) and the American Academy of Pain Management (www.aapainmanage.org). In addition, a yearly conference on pain, known as PAINWeek, is held each September as an educational opportunity for medical professionals who have an interest in pain management. A number of Internet-based resources are also available to those who suffer from fibromyalgia. In addition to our website, www.fibromyalgia-treatment.com, the online resource Co-cure (www.co-cure.org) contains helpful information for both fibromyalgia and chronic fatigue syndrome patients, including a daily newsletter, a message board, a list of good doctors, and a comprehensive review of additional online resources. The website www.immunesupport.com is an industry-sponsored patient education site that donates to fibromyalgia and chronic fatigue syndrome research and advocacy initiatives. In addition, it contains a large repository of articles, as well as message boards and support group information. Finally, the Oregon Fibromyalgia Foundation is the website of well-known fibromyalgia researchers Robert Bennett and colleagues (www.myalgia.com).

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Magazines and Journals

In addition to the education and advocacy these organizations provide, there are a number of magazines and newsletters that provide fibromyalgia-specific information and support to consumers. The NFMCPA publishes their bi-monthly magazine Fibromyalgia and Chronic Pain LIFE, which is available for free to registered members. Back issues are available for download on their website. The Fibromyalgia Network, a member-supported patient-advocacy organization that covers the latest fibromyalgia-related research and treatments, publishes both a quarterly journal (Fibromyalgia Network Journal) and monthly eNews pertaining to topics of interest for both fibromyalgia and chronic fatigue syndrome sufferers. These publications are all free of advertisements. Fibromyalgia Alternative News is an alternative health magazine devoted to exploring the underlying causes of fibromyalgia and chronic fatigue syndrome, and is published quarterly by the nonprofit organization Fibromyalgia Coalition International. Other periodicals that may be of interest to fibromyalgia suffers include magazines such as Womens Health, which provides information on health, fitness, nutrition, and beauty issues of interest to women, as well as Prevention magazine. Prevention focuses on providing information for consumers to help them lead a healthy lifestyle and prevent disease. In the academic world, a number of scientific journals regularly publish fibromyalgia-related information and research. Although fibromyalgia is not a form of arthritis and does not arise due to joint or muscle inflammation (like rheumatic diseases do), it 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 is the official monthly journal of the American College of Rheumatology, and covers information related to diagnosis, treatment, research, and socioeconomic issues that relate to all rheumatic diseases. Other journals include The Journal of Rheumatology, Clinical Rheumatology, Journal of Clinical Rheumatology, and Clinical and Experimental Rheumatology. In addition, several journals focused on pain management regularly publish findings related to the treatment of fibromyalgia. These include publications such as Pain and The Journal of Pain.

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Doctors, Care Providers, and Therapists

Fibromyalgia is not a form of arthritis or rheumatic disease in general, however, rheumatologists are commonly consulted during a patients quest to achieve a diagnosis. This is because the symptoms of fibromyalgia are similar to those of rheumatoid arthritis and other chronic pain conditions of the muscular-skeletal system. Since the diagnosis of fibromyalgia is one of exclusion, these conditions must be ruled out. A rheumatologist is often the most appropriate specialist to do so. In addition to rheumatologists, neurologists are becoming increasingly more involved in the diagnosis and management of fibromyalgia, as our understanding of fibromyalgia as a neurological condition (rather than a rheumatological condition) continues to evolve. General practitioners and internal medicine physicians can also diagnose and treat fibromyalgia. In addition, psychotherapists and psychologists are an important part of a fibromyalgia patients care plan. Anxiety and Depression commonly occur with fibromyalgia, and these specialists can help patients address and manage the psychological components of the disease. In addition to medical doctors, physical and occupational therapists can be of great benefit to fibromyalgia patients. Physical therapy combines therapeutic exercise with other modalities, including ultrasound, electrical stimulation and massage, in an effort to increase flexibility and strength, reduce pain, and improve overall mobility. Physical therapists are licensed healthcare providers specifically trained to administer these therapies. Occupational therapists are also licensed healthcare providers who receive specialized training related to the physical and psychological ramifications of illnesses and injuries. They help patients who have difficulty performing normal activities to regain functioning and independence by modifying the environment to fit a patients needs. It is important to note that for most individuals who suffer from fibromyalgia, effective management and treatment is most often achieved through an integrated system of pharmaceutical therapy, complementary and alternative therapies (such as acupuncture, chiropractic, and massage therapy), dietary modifications and supplements, and regular exercise. For those patients who suffer from anxiety and depression, tailored psychotherapy is also crucial. More detailed information about Doctors and Care Providers is covered in discussions about building your individual care team in Chapters 4 and 5. Learn more about - Medical Specialists in the treatment of Fibromyalgia.

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Support Groups
Participation in fibromyalgia support groups, whether online or in person, can also be of benefit to patients. Support groups offer an opportunity for fibromyalgia patients to connect with others who have the disease and gain valuable insight that can help overcome challenges and improve their understanding of the lifestyle changes that result from a diagnosis of fibromyalgia. Support groups also offer emotional support, facilitate the exchange of information related to treatment strategies, and provide a safe and understanding environment for patients who can often feel neglected, ostracized, and misunderstood by the medical community. It is important to understand that not all support groups are the same. Some may be discouraging in tone, with a pervasive focus on the negative aspects of fibromyalgia. Others may unevenly distribute member participation, with one or two individuals dominating the meetings and the focus of the group. Therefore, it is important for 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. 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 Foundation sponsors fibromyalgia support groups in many locations across the United States. You can find one of these groups by visiting their online support group directory at their website, www.arthritis.org. The NFCPA website also offers a directory of support groups (www.fmcpaware.org/support-groups), organized by state. Individuals who are interested in starting a support group of their own can also visit the NFCPA website to find information and resources to assist in the startup process, as well as to register new support groups with the NFCPA directory.

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Support Groups and Accountability

Support groups can provide camaraderie for fibromyalgia patients, however they should not be viewed as mere clubs where patients convene to commiserate about how terrible they feel. Effective support groups will consist of highly motivated individuals who strive to help each other through the decision making processes that are required to progress toward achieving treatment goals. Support groups should enable members to help each other with goal-setting, review treatment ideas, obtain feedback and opinions on collective symptoms, and maintain motivation during bad times. The KEY to a successful support group is that all members maintain their accountability to each other. Like soldiers in a foxhole, support group members are in this 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. The FibroTrack online selfmanagement system includes many tools focused on assisting those with fibromyalgia in building and participating in an effective, meaningful online support group. This includes a sophisticated system for matching potential support group members based on their demographic data (age, geographic location, work situation, comorbid conditions and Fibromyalgia symptoms). FibroTrack also facilitates support group interaction with social networking functions, contact sharing and rating, symptoms and treatment program sharing, private messaging and forums. The FibroTrack system has been designed from the ground up to promote and support effective support groups. The information presented in this ebook is merely an overview of the highlights of these topics. Please visit our website, www.fibromyalgia-treatment.com for more detailed information, including blogs, articles, webinars, and much, much more.
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Primary Focus
Our primary focus at www.fibromyalgia-treatment.com is all about the How to do it! Information abounds on fibromyalgia, and so many treatment options are available that the information 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. Step 1: Learn. Knowledge is the foundation of effective action. The following articles on our website can provide the foundation of knowledge required to get you started: Current Diagnostic Criteria The Diagnostic Process Fibromyalgia Medical Tests Fibromyalgia Causal Theories Fibromyalgia and Genetics Stress and Fibromyalgia Demographics of Fibromyalgia The Great Pretender Nothing Easy About It Symptoms Overview Online vs Offline Treatment Diagnostic History of Fibromyalgia Multiple Diagnosis and Fibromyalgia Keys for the Newly Diagnosed Brain Chemical Abnormalities Anxiety and Fibromyalgia Fibromyalgia Widespread Pain Fibromyalgia Myths Life with Fibro- A Woman's Perspective Online Self-Management Internet Enhanced Treatment Efforts Treatment Focus: Symptoms or Causes?

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Chapter 2:

Reviewing Fibromyalgia

History and Introduction

First observed in the nineteenth century, fibromyalgia was originally referred to as fibrositis and fibrositis syndrome. It later was referred to as fibromyositis and muscular rheumatism. Dr. Philip Hench coined the term fibromyalgia to refer to the disease in 1976. Fibromyalgia is diagnosed by examining the severity of each patients pain across 19 specific areas on the body, as well as the severity of their associated symptoms (such as sleeping difficulty, cognitive dysfunction, and fatigue). Over the years, fibromyalgia has carried a legacy of negative stigma within many realms of the medical community. Originally disregarded as a psychosomatic illness, many clinicians believed that people with fibromyalgia simply imagined their symptoms. Others believed that fibromyalgia itself was not a singular disease, but rather a combination of symptoms from a group of related conditions. In addition, other clinicians have refused to acknowledge the disease altogether, considering it an illegitimate condition and simply treating each specific symptom in the absence of a formal diagnosis. This lack of acceptance by the medical community has made patients feel ostracized, confused, and frustrated. In addition, this lack of acceptance has also made it difficult for patients to explain their symptoms to family and friends. When the American College of Rheumatology established definitive diagnostic criteria for fibromyalgia in 1990, the disease finally received the credibility it deserved and gave patients the ability to receive a true diagnosis. However, despite the existence of these diagnostic criteria, some clinicians still refused to accept that fibromyalgia is a true condition and continued to insist that its symptoms were the result of another physiologic condition or simply psychological in nature. Despite the continuing resistance from some in the medical community, fibromyalgia has become more widely accepted as a true medical diagnosis, thereby enabling patients to get the care they so desperately need and so greatly deserve. For far greater detail relative to defining and understand the many aspects of fibromyalgia, please refer to our website www.fibromyalgia-treatment.com. The sections in the primary header labeled What is Fibromyalgia?, Fibromyalgia Treatment and Fibromyalgia Symptoms contain comprehensive information related to all aspects of fibromyalgia. You will find individual articles detailing
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specific treatment options, from various pharmaceutical drugs to complementary and alternative therapies such as acupuncture and yoga. There you can also read detailed articles on the many symptoms associated with fibromyalgia, such as anxiety, depression, fatigue, and morning stiffness, as well as find summaries of the latest research surrounding fibromyalgia.

Demographics
Although fibromyalgia most often affects Caucasian women, it does not discriminate. Anyone, including men, can get the disease. A 2005 Internet-based survey conducted by a team of leading fibromyalgia researchers, in conjunction with the National Fibromyalgia Association, found that of the 2,569 respondents, 96.8% were female and 91.5% were Caucasian. The average age was 47 and most were moderately overweight. Half of all respondents had average household incomes between $20,000 and $80,000. Click HERE for a full article on this research study into the demographics of fibromyalgia.

Symptoms
Pain The most common symptom associated with fibromyalgia by far is chronic, widespread pain. The pain is often described as being deep, muscular pain as well as pain in the connective tissues (myofascial pain). Individual descriptions of pain sensations vary among fibromyalgia patients, with some describing it as aching, throbbing, or sharp/shooting. Others describe it more as a burning or tingling sensation. The pain associated with fibromyalgia causes sufferers to ache all over. Certain "Tender Points on the body may continue to ache regardless of the therapies a patient tries, and muscles may feel constantly overworked. The pain of fibromyalgia 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 pain differs from acute pain (that which originates suddenly and resolves over a period of time, such as with a broken bone), in that it is chronic, persistent, and ongoing.

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Living with the pain of fibromyalgia is extremely difficult. It makes relaxation problematic and interacts severely with an individuals ability to sleep restfully. Chronic sleep deprivation results in increased pain and aching, morning stiffness, and daytime fatigue. Fibromyalgia pain can also make it difficult for sufferers to maintain an active lifestyle and lead to social isolation, depression, and anxiety. Fatigue In addition to widespread muscle pain and aching, chronic persistent fatigue is another hallmark symptom of fibromyalgia. It occurs in as many as 90% of patients and can be so severe that it leads to isolation, depression, and anxiety. Many fibromyalgia 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. Some researchers and physicians have observed strong similarities between the fatigue seen in fibromyalgia patients and the condition called chronic fatigue syndrome (CFS). CFS is 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 forties and fifties. Due to the strikingly similar symptoms and the high rate of occurrence in women, CFS and fibromyalgia are often miss-diagnosed as each other or diagnosed together in the same patient. Sleep Impairment Impaired sleep is another defining symptom of fibromyalgia, with as many as 85% - 90% of patients reporting insomnia and non-restorative sleep. Patients feel groggy and un-refreshed upon awakening. Fibromyalgia sufferers frequently report difficulty initiating or maintaining sleep, sleep that is light or of poor quality, and excessive daytime sleepiness. Some patients experience sudden bursts of brain activity known as alpha EEG anomalies which mimic being awake when in fact the brain should be in a state of deep sleep. These bursts of activity prevent individuals from having deep, restful sleep. Sleep apnea is also common, and it results when an individual stops breathing while asleep. These pauses in breathing disrupt sleep and cause a shift from deep sleep into lighter sleep phases, all of which culminate in poor sleep quality and a feeling of fatigue and tiredness the next day.
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Morning Stiffness Between 70% and 90% of individuals with fibromyalgia report waking up with increased pain, tenderness, muscle aches, and stiffness in the morning. They may feel as if it takes several hours for their bodies to loosen up or warm up before becoming fully mobile. This obviously can interfere with mobility and limit activity, making even the most simple tasks such as getting out of bed, showering, and driving into work incredibly difficult for fibromyalgia patients. Symptoms of morning stiffness include muscle tightness upon awakening, stiffness particularly in the hands, fingers, feet and toes, limited range of motion in the joints (for example, being unable to fully extend your leg), and generalized stiffness in the back, neck and head. Tender Points Historically, one of the required criteria to receive a diagnosis of fibromyalgia was the presence 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 these tender points, a physician will apply light pressure to the surface of the muscles throughout the body. While most individuals will feel only light pressure, patients with fibromyalgia may feel increased pain and tenderness that is disproportionate to the amount of pressure that is applied. The presence of myofascial trigger points can sometimes complicate the diagnosis of fibromyalgia. The term fascia refers to the dense fibrous connective
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tissue surrounding muscles. When fascia is injured, it knots up and creates what are known as trigger points. When touched, these trigger points are very painful and the pain radiates throughout the muscle and surrounding areas. The chronic muscle pain that results from these trigger points is known as myofascial pain syndrome. The pain is persistent, worsens over time, and can result in stiffness and difficulty sleeping. Much like fibromyalgia, myofascial pain syndrome can have a significant negative impact on an individuals ability to live an active lifestyle. As a result of their overlapping features, myofascial pain syndrome may be misdiagnosed as fibromyalgia and vice versa. What is important to understand, however, is that trigger points for myofascial pain syndrome are not the same as tender points in fibromyalgia. Trigger points are the underlying cause of myofascial pain syndrome, whereas tender points are a defining symptom and at times a diagnostic requirement for fibromyalgia. Tender points do not present an underlying hard knot of muscle tissue as is typically present in a myofascial trigger point. Tender points have extreme tenderness and disproportionate pain when pressure is applied, but no hard muscular knots are present. Headaches The majority of people with fibromyalgia experience headaches. Migraine headaches 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 respond well to traditional headache medicines. Cognitive Impairment / Fibro Fog Individuals who suffer from fibromyalgia frequently report substantial cognitive impairment, a symptom so prevalent is has been coined Fibro Fog. Fibro fog is characterized by memory loss (both short- and long-term), difficulty maintaining focus and paying attention, and trouble locating the right words to speak while talking. In addition to the cognitive impairments, fibromyalgia patients may also experience dizziness, feelings of lightheadedness, and disorientation. These

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cognitive difficulties are all very troubling for fibromyalgia patients and can fuel feelings of anxiety and depression. Depression & Anxiety While many people will experience depression at some point during their lives, fibromyalgia patients often must deal with a heavy burden of the illness. Driven in part by the constant widespread pain and overwhelming fatigue associated with fibromyalgia, depression may also be exaggerated by constant headaches, sleep disturbances, and muscle pain. Depression in fibromyalgia can be very severe and is estimated to be present in up to 30% of patients at the time of diagnosis. Those patients who suffer from both depression and fibromyalgia have decreased quality of life and often modify their behaviors as a result, including self-imposed social isolation and decreased activity - actions that can feed the syndrome. Anxiety often goes hand-in-hand with depression. Anxiety is a natural response of the human body to stress, both good and bad. When anxiety occurs under normal circumstances it can be beneficial to the body; however, when anxiety becomes excessive and sustained, it can become a debilitating disorder that prevents sufferers from carrying out normal daily activities. In addition to depression, many fibromyalgia patients also suffer from generalized anxiety disorder a condition marked by sustained elevated levels of anxiety, excessive worrying, and tension, even when no stimulus is there to trigger such symptoms. Certain physical symptoms also accompany generalized anxiety, including fatigue, headache, muscle aches, difficulty swallowing, and irritability. Those who suffer from anxiety often suffer from panic attacks and unexplained feelings of inadequacy. Irritable Bowel Syndrome Irritable bowel syndrome (IBS) is characterized by severe abdominal cramping, changes in bowel movements, along with a host of other symptoms. The cause of most 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.

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When compared to the rate of IBS in the general population (10%-15%), fibromyalgia patients experience an increased incidence of the condition. Some researchers have estimated that as many as 70% of fibromyalgia patients have IBS. Up to two-thirds of all IBS patients 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. Interstitial Cystitis Interstitial cystitis (IC) is a condition that is marked by frequent pain or discomfort in the bladder and pelvis. Symptoms vary from person to person and may increase in intensity as the bladder fills with urine, and after it is emptied. In addition to pain, people with IC may also feel the frequent urge to urinate. For women, their symptoms may worsen during menstrual periods or vaginal intercourse. The cause of IC is not known. But since many women who suffer from IC also have other conditions such as fibromyalgia or IBS, some researchers think that IC is merely the bladders 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. Secondary symptoms of Fibromyalgia A number of secondary symptoms are associated with fibromyalgia. They vary from patient to patient so much that it is nearly impossible to provide a comprehensive list. An abbreviated list of some of the more common symptoms is below: Temporomandibular Joint Disorder (TMJ): TMJ is characterized by pain and tenderness in the jaw joint, on each side of the head just below the ears. TMJ can also manifest itself as dull, aching pain in the ear, difficulty chewing, facial pain, 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 between the ages of 30 and 50. Restless Leg Syndrome (RLS): RLS is characterized by the uncontrollable urge to move the legs in order to stop unpleasant sensations. The sensations

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generally occur between the knee and ankle, although the upper leg, feet, or arms may also be affected. Individuals who suffer from RLS generally describe the sensations as aching, creeping, crawling, or tingling and usually experience their symptoms at night while lying down. Dry mouth and eyes: Many individuals with fibromyalgia report dry eyes and dry mouth. Sometimes these symptoms are directly related to the condition itself, but often they are experienced as side effects to medications used by many fibromyalgia sufferers, including antihistamines, antidepressants, diuretics, and opiate pain medication. Skin rashes and irritations: Many fibromyalgia patients experience some sort of skin-related symptoms, including dry and itchy skin and rashes. These symptoms can make sleeping even more difficult than it already is for fibromyalgia patients, as well as increase pain. Abnormally difficult and increased PMS and menstrual period pain: Women who suffer from fibromyalgia are more likely to have greater menstrual problems than those who do not have fibromyalgia. Increased moodiness, irritability, fatigue, and cramping 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 experience greater pain with their menstrual periods, including pain in the lower abdomen and back. Vulvodynia: Many women with fibromyalgia also experience vulvodynia, which is a condition characterized by pain in the genital area. This type of pain is generally described as burning, soreness, stinging, rawness, or throbbing. It can also be marked by itching or painful intercourse. The pain can be constant, or it can come and go, and it can last for months or years. Endometriosis: Women with endometriosis a condition in which the tissue that lines the uterus grows in other parts of the abdominal cavity are more likely to suffer from fibromyalgia, chronic fatigue syndrome, and diseases of the immune system. Endometriosis causes severe pelvic pain and may cause infertility.

Hypoglycemia: Many individuals with fibromyalgia also experience

hypoglycemia, or low blood sugar. The symptoms associated with low blood sugar include intense cravings for sweet foods, tremors/trembling, sweating, panic attacks, lightheadedness, confusion, headaches, and heart palpitations.

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Fibromyalgia Triggers
The exact cause of fibromyalgia has yet to be identified, however a number of potential causes have been suggested. Genetic factors may play a role in the development of fibromyalgia, as the disease has been observed to cluster in families. In addition, many individuals with fibromyalgia report having been under extreme stress prior to the onset of symptoms. Furthermore, many people with fibromyalgia are often overweight or obese, an observation which also may indicate a causal association between body weight and/or diet and fibromyalgia. In addition to these potential causes, a number of events have been suggested as potential triggers that result in the development of fibromyalgia among predisposed individuals. No definitive evidence 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 is a condition that is very difficult to diagnose. In reality, its diagnosis is often achieved through the process of elimination. Doctors must first rule out a number of conditions that closely mimic the disease, including chronic fatigue syndrome, myofascial pain syndrome, and others. This often results in confusion and frustration for patients, as they shuffle from one specialist to another and undergo multiple tests and diagnostic procedures. There are no laboratory tests that can be used, therefore the diagnosis of fibromyalgia can only be achieved by physical examination, patient history, and ruling out the presence of other similar conditions. Rheumatic diseases, such as rheumatoid arthritis and lupus can easily be ruled out by the presence of definitive clinical features characteristic to each condition. For example, patients with rheumatoid arthritis experience joint swelling, joint deformities, and specific abnormalities in particular blood tests. Patients with lupus present with rashes, generalized and widespread inflammation, and abnormalities in specific blood tests. Ruling out the presence of certain neurological conditions can prove to be more difficult, as many fibromyalgia patients may report feeling numbness, tingling, and burning sensations. However, ultimately the exclusion of neurological conditions is easily done, as most fibromyalgia patients do not show any abnormal findings when evaluated using standard neurological testing. The greatest difficulty in the diagnosis of fibromyalgia occurs when attempting to distinguish it from

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other functional pain disorders, such as TMJ, irritable bowel syndrome, and chronic fatigue syndrome. CFS and fibromyalgia have been estimated to co-occur in as many as 80% of patients, whereas approximately 70% of fibromyalgia patients also have irritable bowel syndrome. Approximately 40% - 70% of fibromyalgia patients also have TMJ. As such, there is a high frequency of misdiagnosis, as the symptoms associated with these disorders are very subjective and physician interpretation may vary, leading some physicians to diagnose one disease when another might view the patients symptoms differently. Moldofsky and Smythe proposed the first diagnostic criteria for fibromyalgia in 1977. These criteria included 1) the presence of at least 12 of 14 tender points and 2) non-refreshing sleep. In 1981, Yunus et al. proposed a revised, more formal set of criteria to diagnose fibromyalgia, which required aching, pain, and stiffness for a minimum of three months as well as the presence of at least five tender points. In addition, Yunus et al. required patients to have at least three of the following symptoms: decreased physical activity in response to symptoms, weather-related symptom aggravation, stress/anxiety-related symptom aggravation, sleep disturbances, fatigue/tiredness, anxiety, headaches, irritable bowel syndrome, swelling, and/or numbness. Finally, in 1990, the American College of Rheumatology (ACR) established official diagnostic criteria for fibromyalgia. These included the presence of chronic widespread pain and a minimum of 11 of 18 tender points. In addition, the attention and endorsement by the ACR finally gave much-needed recognition to fibromyalgia as an official clinical diagnosis. The ACR diagnostic criteria for fibromyalgia were recently updated in 2010, in an effort to standardize the symptom-based diagnosis of the disease and ensure that physicians are using the 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.

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In addition to the 2010 ACR diagnostic criteria, the Fibromyalgia Impact Questionnaire (FIQ) has often been used to help doctors evaluate fibromyalgia patients. Developed in the late 1980s, the FIQ was first published in 1991 and has since been translated into 14 languages. The questionnaire originally used a visual analog scale that required patients to place a slash on a 100 millimeter-long line to indicate the magnitude of their symptoms. Unfortunately, the questionnaire was difficult to score. It was worded in a way that made unfair assumptions about patients, and it failed to include important assessments of cognition, balance, and environmental sensitivity. In 2010, the FIQ was revised to correct these deficiencies, creating the FIQR. The FIQR consists of 21 questions, all of which are based on an 11-point numeric rating scale from 0 to 10, with 10 being the worst. The FIQR is organized to evaluate functioning, overall impact of fibromyalgia, and symptoms.

Causal Theories
One of the main reasons that fibromyalgia is so difficult to treat effectively is the fact that despite years of research, the definitive cause (or causes) of fibromyalgia remain unknown. Advances in research and understanding of how the human body transmits and processes pain signals has led to the prevailing theory that individuals with fibromyalgia are unable to process pain signals normally. Research suggests that this 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 for pain signals to reach the brain, which then relays the painful sensation back to the body. Recent research studies have shown that fibromyalgia patients have disproportionate levels of pain-regulating neurotransmitters. This has led researchers to hypothesize that perhaps the origin of fibromyalgia for some individuals may be related to these chemical abnormalities in the brain. In addition, relatives of people with fibromyalgia are eight times more likely to develop the syndrome than those who have no family history of it, which is suggestive of a possible genetic cause for fibromyalgia. Based on observational studies in fibromyalgia and their first-degree relatives, researchers have turned their sights to the human genome for clues as to what gene, or genes, may be involved in the development of fibromyalgia. In particular, genes that regulate the brains ability to transmit pain signals via neurotransmitters are of particular interest to researchers.

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Chapter 3:

Fibromyalgia: The Elusive Fiend

Fibromyalgia is relentless. It can wrack your body with pain and drain your energy leaving you exhausted physically and mentally. The ever-changing way in which it manifests itself 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 presents a serious problem, and this chapter is devoted to discussing the extreme difficulties posed by fibromyalgia relative to its diagnosis, reputation within the medical community, and struggles with regard to the most effective treatment approach. This chapter will also touch on Americans perceptions of health care and how fibromyalgia fails to conform with what we have come to expect in terms of treatment from our medical system.

General Confusion
Fibromyalgia is difficult to both define and diagnose, given the wide spectrum of symptoms and co-morbid conditions that accompany it. In addition, fibromyalgia is often misdiagnosed with other diseases that add to the confusion. For many years, the medical community considered fibromyalgia to be a whiners disease, discounting patients symptoms and suggesting their pain was all in the head. (that ironically 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. Adding to the confusion and confounding the medical communitys understanding of fibromyalgia is the lack of easily defined and effective treatment strategies. Treatment of fibromyalgia is highly individualized; there is no Magic Pill that will work for everyone. What works for one patient may be totally ineffective for another, and may even make that patients symptoms worse. Unfortunately, those who are helped to a great extent by a particular therapy may celebrate the relief of

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their symptoms by telling others about their cure, unintentionally perpetuating confusion about effective treatments. The general lack of understanding surrounding fibromyalgia creates a negative stigma about the disease and perpetuates negative attitudes toward those who suffer from it. People tend to doubt or even fear things they do not understand, and in the case of fibromyalgia, peoples attitudes toward those with the disease can be doubtful, harsh, and even condescending. Given that anxiety and depression are frequent symptoms associated with fibromyalgia, this kind of hard feedback from friends, co-workers, family members, and even health care providers can be crushing and can trigger new negative feedback loops.

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A Tough Nut to Crack

The reality of fibromyalgia is that there is no cure. Unfortunately, this does not stop individuals from claiming to have found one! In addition, misdiagnosis is rampant, both for those with and without fibromyalgia. Many individuals with true fibromyalgia are often diagnosed as having a different disorder, while others who are diagnosed with fibromyalgia may in fact suffer from something quite different. Additionally, there is a very high incidence of comorbid (having additional clinical conditions at the same time as the primary) conditions with fibromyalgia, adding further complexity to an already complicated situation. In addition, there is no recognized and accepted single best treatment a reality driven by the fact that even the most effective treatments have a negative impact on a significant percentage of those who try them. The following point cannot be emphasized enough: What may work for one patient may not work for another, and may in fact make the other patient feel worse! This reality makes the Elusive Fiend a moving target, and the weapons for fighting him inconsistent from one warrior to another.

SymptomCause Interplay and Confusion

Many causal symptoms are associated with fibromyalgia. In other words, many of the symptoms of fibromyalgia appear to function in a causal role, i.e., they can both trigger fibromyalgia or appear after the onset of fibromyalgia. For example, depression can cause anxiety. Fatigue can cause depression. Sleep problems can cause fatigue. Deep, persistent pain can cause sleep problems. All of these things can be both caused by stress and can cause stress to occur. These symptoms also frequently come and go, or wax and wane, in seemingly random fashion. As the course of fibromyalgia unfolds over time, it often becomes extremely difficult for patients to pinpoint what came first in different symptom / cause loops. In effect, a chicken and the egg scenario develops which can make determining effective approaches
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to treatment difficult. This can lead to increased confusion and further escalations in the overall negative impact on the patients life. All of these symptom-cause relationships are extremely complicated and difficult to understand. They can be impacted by a wide variety of factors, including stress, diet, vitamin deficiencies, exercise, obesity, menstrual cycle, weather, pharmaceutical side effects, chemical sensitivities, and environmental factors. Determining the relationship between primary and secondary symptoms key causal factors and negatively-impactful environmental and life factors can often prove to be more complicated than calculating rocket trajectory for a NASA moon mission. At least with NASA, the laws of physics are the same for everyone! In fibromyalgia, there are no clinical standards; everyones fibromyalgia is unique. The manner in which these factors interplay will be different for you than it is for others. Learn more about these frequent causal symptoms Anxiety Stress Depression Fatigue Sleep

Negative Feedback Loops

Many symptoms associated with fibromyalgia are not isolated. They interact with each other, feeding off of each other in a negative manner. This type of relationship is known as a negative feedback loop. Negative feedback can best be described as a cycle in 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
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individual with fibromyalgia may suffer from sleep impairment. This inability to sleep adequately results in excessive daytime fatigue. This excessive fatigue aggravates the persistent pain that the individual experiences from their fibromyalgia. Due to the worsening pain, the individual may not be able to sleep well. This cycle is an example of a negative feedback loop, and will not cease until something occurs to disrupt it. That something might be a new treatment regime that incorporates massage therapy, which addresses both the fatigue and relieves the excess pain, thereby improving sleep quality. Causal symptoms interact both with other symptoms and other causal factors. As is illustrated in the above example, this interaction creates, fosters, and strengthens negative feedback loops a scenario in which a vicious circle is created. Furthermore, the interaction of negative feedback loops and causal factors can lead to overlapping loops, loops within loops, or loops with shared symptoms that impact other symptoms. The ultimate result of these interactions is a downward spiral that may cause fibromyalgia syndrome to worsen over time. Fibromyalgia is NOT by definition a degenerative disease, however the causal impact of symptoms and triggers can, if left unrecognized and untreated, lead to a debilitating downward spiral and a decline in the quality of life for the fibromyalgia patient. The relationship between symptoms and causal factors is multi-layered, inconsistent in frequency and intensity, and difficult to define. All of this can lead fibromyalgia sufferers to ask: why is the Fiend so elusive? One reason lies in the fact that multiple negative feedback loops can function simultaneously, often with shared causal factors. In addition, the form and function of symptomatic negative feedback loops will vary between patients, just as symptoms will. This makes generalizations and precise definitions relative to the overall syndrome of fibromyalgia next to impossible. In addition, this increases patients confusion and discouragement, both of which can make decisions related to treatment even more difficult than they already are. Again, the Elusive Fiend at work. Another fact that makes fibromyalgia so hard to pin down is that as negative feedback loops progress, they can trigger or amplify secondary symptoms, which in turn may lead to the formation of additional negative feedback loops. Certain environmental factors can also serve the same function though at times have the opposite effect. Take Seasonal Affective Disorder (SAD) for example. Seasonal Affective Disorder can lead to increased depression that feeds into other symptoms, such as pain and poor sleep; however, as the seasons change and spring

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brings with it improved weather and sunshine, it can lessen the impact of SAD and thus foster improvements in pain and sleep quality. It is important to note that negative feedback loops are not by definition a diagnostic criteria associated with Fibromyalgia, but rather are a commonly observed phenomenon. Significant research relative to causal factors related to linked conditions does provide some research evidence to support the concept of negative feedback loops and their function as an amplifier in Fibromyalgia but more specific research is needed.

Medical System
The U.S. medical system is highly fragmented and therefore simply not designed to effectively diagnose and treat patients who suffer from a syndrome such as fibromyalgia. As the diagnosis of fibromyalgia can only be achieved by excluding the presence of other conditions, different physicians may take different approaches to reach their diagnosis. Furthermore, if a particular practitioner is in the school of those who doubt the legitimacy of fibromyalgia as a true diagnosis, they may bypass a diagnosis of fibromyalgia altogether in favor of treating each individual symptom. A large percentage of doctors lack an in-depth understanding of fibromyalgia and the most effective options for treating it. This frequently leads to a generic approach, i.e., throwing pills at it. This approach is not a cure, however, and frequently it can serve to make things worse for the patient. Pharmaceutical options are often effective; however, even in the best case, symptoms are only partially alleviated. Improvement is maximized if the pharmaceutical drugs can be supplemented with other treatment options. Another aspect of the U.S. medical system that often precludes individuals from seeking certain treatments is health insurance. Many insurance providers do not grant approval for certain treatments, such as chiropractic or massage 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 restrictions and required approvals drive treatment options, rather than the fibromyalgia patient and their care team.

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Admittedly, insurance companies face an uphill battle when trying to structure a system for the treatment of fibromyalgia in a manner that is both effective for the patient and viable within their business model. Insurers must deal with the reality of trying to manage the treatment and costs associated with millions of patients, all of whom require individualized approaches and therapies. There is no question that insurers want to be effective when approving treatments for fibromyalgia; they do. Effective treatment is not only prudent from a patients standpoint, but also from a cost standpoint. Unfortunately, the most effective proven treatment approaches for fibromyalgia are multi-disciplinary in nature, and health insurance companies are simply not structured to manage this kind of approach. Although some insurers are expanding their availability of covered services to included complementary and alternative therapies, such as acupuncture, chiropractic, and nutritional therapy, these offerings are not universal and are by no means standard across the broad range of insurers. Furthermore, recent economic downturns and other personal financial factors have resulted in many individuals having to scale back on the scope of their insurance plans. Some people forego health insurance altogether. Without health insurance, affording good-quality, comprehensive health care in the U.S. is almost impossible. Insurance issues aside, doctors are in an untenable position. Due to the fact that a multi-disciplinary approach to the treatment of fibromyalgia is typically the most suitable, it is nearly impossible for any single health care provider to be effective in guiding and managing a patients overall treatment on a long-term basis. To expect a single doctor to be capable of this is to simply ignore the realities of both fibromyalgia and the medical system. No doctor can be an expert in general medicine, chiropractic, massage therapy, dietary nutrition, alternative medicine, behavioral focused medicine and all of the many other medical specialties that can play into treating fibromyalgia. It is not physically possible for one individual to be the best in all of the different medical specialties that someone fighting Fibromyalgia will want on their team. This scenario drives the reality of why a self-management approach provides the most effective treatment. The patient must take responsibility for directing and coordinating the efforts of all of their care providers. Self-Management is a team approach. As can be imagined, when coupled with the variable symptoms and the overwhelmingly individualistic nature of the disease itself, fibromyalgia is a nightmare for the medical system. The lack of a one-size-fits-all approach to treatment, the need for treatments that are not often covered by routine health insurance, and the relentless nature of the disease itself makes fibromyalgia extremely difficult to both endure and to manage.
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"Magic Pill Syndrome"

Consumers and patients have been led to be believe and have come to expect that there is a Magic Pill to cure almost every ailment out there. This cultural phenomenon is unfortunate, as it gives many individuals a false sense of security and an inaccurate understanding of how medicine truly works. The unfortunate reality is that medical science and doctors are neither as advanced nor as capable as most Americans believe them to be. This is not a failure on the part of the medical community; it is a failure of expectations to remain aligned with reality. The doctors on TV can cure anything (and have good hair while doing it) - so surely my doctor should be able to make me feel better. This is particularly the case for fibromyalgia. There is no known cure for fibromyalgia only treatments geared toward addressing its symptoms, and many of those treatments are only partially effective, or effective in only a percentage of patients. Magic Pill Syndrome leads patients to believe that one particular medication or therapy can result in a cure for their disease when no such cure exists. For fibromyalgia patients, this belief drives unrealistic expectations, feeds depression and anxiety, and contributes to the frequent confusion and lack of understanding among family members. These false expectations are a big issue and a major hindrance to people with fibromyalgia, and make a very complicated disease even more complicated to manage effectively. It is vitally important for all fibromyalgia patients to accept the reality of their condition in order to move forward with effective treatment. There is no magic pill. The U.S. Food and Drug Administration (FDA) recently approved the drug Lyrica for the treatment of fibromyalgia. For many Americans who do cursory research

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and depend solely upon their doctors guidance with regard to treatment, they may interpret this FDA approval as meaning that the U.S. government has certified Lyrica as a cure and thus it is the magic pill they are seeking. Unfortunately, this is not the case. Lyrica is not a cure for fibromyalgia, and for those patients in whom it is most effective, it only decreases fibromyalgia symptoms by about 40%. In other words, Lyrica may help, but it is certainly not a magic pill.

Effective Treatment - Overwhelming Options

There are many suspected causes of fibromyalgia, and they vary from patient to patient. These variations make the identification and evaluation of overlapping conditions extremely difficult given the time constraints modern realities place on the medical profession. Among the theories surrounding effective treatment strategies for fibromyalgia, perhaps the most consistent among experts is that a multifaceted approach is most likely to yield sustainable long-term results. Most experts agree and research tends to support that the most effective treatment for fibromyalgia patients will involve a combination of pharmaceutical therapy, dietary supplements, alternative therapies, dietary modification, and regular exercise. It is important to note, however, that what works for one patient may not necessarily work for another. Furthermore, each aspect of treatment has a large number of options and no single care provider is going to be an expert in all of them. Finally, many treatment options present interaction challenges. Certain drugs may interact with other drugs or dietary supplements. Dietary factors may have an impact on how the body metabolizes and uses the drugs themselves. In addition, personal factors, such as body weight and mental status may also play a role in the effectiveness of the various treatments. Determining the combination of treatments that is most effective for a particular patient involves patience, dedication, and a process of trial-and-error.

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As noted in the diagram to the left - multiple negative feedback loops may function simultaneously feeding an ongoing decline in overall health that drives a 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 hand-drawn can serve the same purpose as fancy computer generated graphics. The important thing is to build a comprehensive base of understanding relative to exactly how fibromyalgia is being presented in your individual case.

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Chapter 4: Self-Management: Basis for Effective Treatment

You are unique. So is 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! There are two choices when it comes to managing fibromyalgia: 1. Learn to effectively manage it yourself
OR

2. Option #2 is see option #1. No other worthwhile option exists. Do not waste years thinking 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.

Taking Responsibility
You must take responsibility for managing your own fibromyalgia. Taking responsibility is not just a decision; it is an action. It means taking control. The first step in doing so is to move from a path of dependence, confusion, hopelessness, and fear to a path of knowledge, hope, challenge, and most importantly, action. The action part is key. Even if you have the greatest idea or concept in history, it is worth nothing unless you act upon it. Taking responsibility means accepting the reality that action is required and that you are the one who must do it. This can be a breaking point for many people, as some may not feel capable of taking action. They may doubt their ability to take responsibility and trust their instincts. Nonsense. You can do it! No one is better equipped or prepared than YOU. No one has better motivation, and no one will ever be in a position to better observe, evaluate, and manage your fibromyalgia than you.

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Education - Laying the Foundation for Success

Education is the cornerstone of successful management for fibromyalgia. The more you know, the better armed you are to tackle the many challenges you will face. Knowledge is your primary weapon in this fight. It is important to understand how fibromyalgia functions, its associated conditions, the treatment options available to you, and the types of doctors you need to engage in your care. The unfortunate reality is that a large number of comorbid conditions and symptoms are an integral part of fibromyalgia. It is important to focus your learning efforts 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 treatment strategy. As mentioned in chapter one of this ebook, there are a number of journals, magazines, newsletters and national organizations that can provide you with a wealth of trusted information regarding fibromyalgia and facilitate your understanding of the disease and how it affects you as an individual. Magazines such as Fibromyalgia and Chronic Pain LIFE provide regular, up to date information on the newest management strategies, research, and tips for living with fibromyalgia. The National Fibromyalgia and Chronic Pain Association, as well as the American Pain Foundation and American Academy of Pain Management, all regularly publish newsletters related to fibromyalgia and/or chronic pain. Furthermore, these organizations have websites that also provide comprehensive information related to fibromyalgia and pain management. Doctors and other care providers, such as therapists, nurses, pharmacists, and medical specialists, should also be consulted on your journey to understand all you can about fibromyalgia. Make it a point to ask questions and engage in dialogue. Seek out the input of these individuals and make the time to cultivate a relationship. ASK for their ongoing help and assistance, and for them to function as a sounding board when needed. The Internet, while an indispensable research tool and source of information, is notoriously inaccurate. Research has corroborated the wide availability of low quality information found on the Internet. That said, keep the reality of fibromyalgia in mind when sourcing information from the Internet: there is no one proven best treatment method! Fibromyalgia manifests itself differently in each patient. If you read a testimony online that treatment X worked for one person, be
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skeptical and understand that treatment X may not work for you. The purpose of educating yourself is to learn about the options that you have. The Internet is a great place for this, but be sure to validate the information. In contrast to the Internet, face-to-face support groups allow you to see how fibromyalgia is playing out in the lives of others who are suffering with the disease. Since fibromyalgia support groups are comprised of individuals who are going through many of the same trials and obstacles that you are, they can help you to better understand 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.

Defining Your Fibromyalgia

Your fibromyalgia is unique. It manifests itself differently in you than it does in other patients. From your causal factors, to your possible triggers, even your negative feedback loops and response to treatments all of these things define your fibromyalgia and set it apart from the fibromyalgia other patients experience. Inspect What You Expect Before a condition can be effectively managed, it must be defined. It is important to detail how fibromyalgia is present in your life, including your symptoms, the possible causes, possible triggers, and potential patterns. The definition of your fibromyalgia will change over time and therefore the evaluation process will be ongoing, however a starting point must be established. You are the most important source of information about your fibromyalgia. You live with your condition on a daily basis and you know its true physical and emotional impact. Only through self-observation and self-awareness can you take true inventory of your condition its symptoms, complications, impact on your life and well being, and what improves it. Focus on inspecting closely how Fibromyalgia is playing out in your life and track what you find in a manner that facilitates easy access to your notes and deeper evaluation. Laying Down a Baseline In order to effectively evaluate your fibromyalgia, it is important to begin from the ground up. Note all of your primary symptoms. Keep track of each symptoms severity and write down descriptive details for each. Do not try at this stage to
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detail a history for how your fibromyalgia played out in the past; you are establishing a starting point right now. Focus on what fibromyalgia is for you right now, and how it is impacting your life. Make note of things you know for sure, including what 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. Note things that confuse you and any questions that you have. You may consider drafting some basic charts or diagrams to try and help you define how you perceive fibromyalgia to be currently working in your body and mind. Formalize this material into an organized journal; take your time and be thorough. It may not seem like much, but this 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.

Building Your Team

Fibromyalgia self-management does not mean isolated self-management! It is important to understand that you will need 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. CEOs of large corporations are not experts in every skill and job that is required in order for their company to succeed. Rather, they are experts at finding and managing experts, and then applying the skills and knowledge from those experts into a unified whole. This unified whole is far more capable than any of the team members working alone. Good government works in much the same way or fails because of a lack of leadership skills. The President of the U.S. is not the worlds foremost economic expert, military commander, environmental expert, research scientist, Constitutional lawyer, and social worker all wrapped up into one. But, if he is to be recognized by history as being a great President, then he must be an expert at finding each of those (and many more) and pulling them together into a team that is effective at solving massive problems and achieving lofty goals. This is what leadership is all about. When it comes to managing your fibromyalgia, recognize where your strengths lie. Acknowledge your primary skills, research
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what skills and knowledge are required to best address your fibromyalgia, and then seek the best individuals you can to assist you.

Take Action
Once you have defined your fibromyalgia, you need to work on building your team. An effective team will usually include your primary care physician, several specialists, selected friends, family, and support group members. Examples of specialists who you might find useful to have on your team are described in detail in Chapter 5 of this ebook. Having a support group is also an important component of your fibromyalgia treatment. The key to a successful support group is having a two-way relationship with 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. Finally, selected friends and family members may (or may not!) be important elements of your team. If you are fortunate to have family members who are sympathetic 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 best interest to exclude those individuals from your team. Remember, you are the boss and it is ultimately up to you to determine what you need and who can best provide it to you. One way to maximize the effectiveness of the role your friends and family play in your fibromyalgia treatment is to place each member in a specific role. For example, if your spouse, partner, or a close friend is genuinely good at listening and providing comforting
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guidance, rely on that individual for emotional support and objective input. If you have 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 assistance than that listed here. The point is that it is important to distribute the responsibilities you require of your team across a number of different people, so that no one person feels overburdened or suffers burnout. Also, be mindful of the fact that 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!

Setting Goals
It is important to focus your self-management efforts on specific aspects of your fibromyalgia. Step back, take a detailed look at your fibromyalgia, and boil it down to targetable aspects. This will determine what goals you set for yourself and help put you on the path to defining the strategies to meet these goals. If you want to get from here to there, you have to know where there is! Specific goals are paramount in the successful management of any complicated venture, and few projects are as complicated as tracking down and stomping on the Elusive Fiend! As you set your goals, remember to be specific and to set goals that can be associated with actions. Consider the following examples: "I Want to Get Better." This is not a specific goal. It is vague and does not clearly define a concrete outcome and the steps required to achieve it.

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"I want to improve My Sleep." This is better, but there is room for improvement to make it more actionable and specific. "I want to get to sleep faster" and "Wake up less during the night" and "Sleep longer each night" and "Feel more refreshed in the mornings" and "Reduce my morning stiffness. This is a group of five specific goals to which actions can be tied. These goals can be reviewed in the context of specific treatment options. When it comes to establishing and chasing goals, fibromyalgia requires small steps leading to incremental achievement of goals. Although it is easy to have expectations of instant gratification, the hard reality is that this is a tough fight, and one that will take time. One of the best things you can do for yourself is accept this reality, plan for it, and expect it. Each if the goals mentioned above can be measured, and success can be achieved in small, specific and measurable steps. These small steps will build upon each other and empower you to establish and achieve even more goals. For example, if it normally takes you one hour to fall asleep and through actions taken on your part, you improve that time to 45 minutes, a goal has been met! Your next step would be to try for 30 minutes using the same or a modified approach.

Become a Problem-Solver
The best way to address problems that arise in your fight against fibromyalgia is to attack them in a systematic, defined manner. Once you have identified a problem that you feel must be addressed, it is important to consider all possible solutions. Recognize that some problems may have multiple causes, therefore a combination of solutions may be the most appropriate approach to addressing them. Once you have identified a specific symptom or grouping of symptoms, research potential treatment options and evaluate the pro's and con's of each. When you feel ready to try 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. As you try out one or two possible solutions, be sure and evaluate their effectiveness. Recognize that the ultimate solution to your problem in some cases may be achieved through a combination of solutions, rather than just one solution.

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Evaluating Treatment Options

Your symptoms and your causal factors should drive your treatment decisions. DO NOT let the pharmaceutical industry or dietary supplement industry make your treatment decisions for you, or allow them to influence you. Treatment should be targeted at specific factors, and you are the only one who understands your specific factors and can gauge what may work best. Feeling better is not a specific factor; Eliminating the severity of my insomnia is a specific factor. When you evaluate a particular treatment option, make specific notes about what you hope to get out of it and which aspects of your fibromyalgia you expect to improve. Make note of multiple areas where it may have an impact and evaluate how this impact can potentially affect other symptoms. In addition, be sure to use your team! Review what you are evaluating and considering with the team members who are most appropriate for that particular goal. Ask for their opinion and input, but always remember to ask WHY they have their particular opinion. Do not let a team members personal bias influence your decision-making. It is also important to ask yourself the following questions: What are the negative possibilities? What potential side effects should you be watching out for? What possible negative interactions with other treatments should I be on the lookout for? How likely are these and what is the worst case scenario? How might this impact my life overall? "How much is this going to cost?" "What are my specific goals relative to outcomes associated with this option?"

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Case Studies Fred has been diagnosed with fibromyalgia though he knows little about what that means. Fred is prescribed Lyrica by his primary care physician because that is what the doctor has read should be effective, he has little actual experience with either the drug or fibromyalgia. Fred does not ask why or question this, but rather happily accepts it and takes it expecting it to cure his symptoms. Fred's fibromyalgia is largely defined by severe fatigue, deep muscular pain and cognitive impairment including dizziness and disorientation. Among the most common side effects of Lyrica are drowsiness and dizziness - things likely to be severe if present in Fred given his symptoms. Fred is a truck driver, he begins taking Lyrica the same day his doctor prescribed it, and he immediately heads out on a long haul truck trip. Double Ooooops. Fred may be in for some problems!
OR

Mary has evaluated her fibromyalgia at length, consulted her primary care physician and sleep specialists along with her nutritionist and massage therapist plus 3 members of her online support group. She has identified pervasive sleep impairment as a key causal symptom potentially driving her fatigue and dizziness along with her depression and tender point pain. Mary had decided to forego Lyrica or other prescription medications for now in favor of a combination approach (though she may test Lyrica in the future). She is utilizing Ribose and Acytel-L-Carnitine in the mornings to increase her energy, she is doing water walking as a safe exercise, she is eliminating caffeine and most gluten from her diet. She is also beginning to test different dietary supplements at night to improve her sleep including melatonin, kavakava, and passion flower. Mary has written down the possible side effects of the dietary supplements she is planning to take so she can be aware of what may be causing any problems she experiences. She is tracking in her pain journal all of her symptoms and keeping notes relative to how her exercise and diet efforts are progressing. Fred has not properly evaluated his treatment options - Mary has. Lyrica may in fact work out great for Fred and Mary may have a bad reaction to Kava. However, the odds are in Marys favor over the long run. This is because Mary understands her fibromyalgia, the options available to her, and she is using her knowledge to manage her approach to treatment. Fred is unconsciously abdicating the

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management of his fibromyalgia to someone else his doctor and is falling victim to magic pill syndrome.

Self-Empowerment
All of the self-management steps we have defined so far lead to selfempowerment. They enable you to set goals for yourself and take educated and calculated steps toward achieving those goals. These steps are not only a necessity and a prerequisite for developing and managing an effective treatment approach, but they are also a positive feedback loop and embody an effective treatment. You can think of it like this: Empowerment less depression less anxiety reduced stress reduced symptoms Success Demonstrated Empowerment
Or:

Responsibility + Education + Care Team + Goals + Treatment Evaluation = Empowerment. When you are empowered, you minimize the negative impact of causal emotions by relying upon a systematic self-management approach that reduces confusion and feelings of hopelessness. It also provides self-encouragement and reassurance that you can do this! Not knowing or fully understanding what to do and how to do it are major factors that can undermine your ability to take action to achieve your goals. Without action, nothing is possible. Self-management drives empowerment through implementing a systematic approach. While it is important to understand that not every treatment approach is going to yield positive results, (in fact - most initiatives will yield no results at all) it is equally important to know that every treatment approach will yield data, and data compiled over time yields knowledge, which ultimately drives 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!

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Self-Management Conclusion
Successful self-management must rely upon a systematic approach. This is true not only for successful companies, militaries, and rulers, but for the Elusive Fiend as well. Understanding the critically important role that self-management plays in treating fibromyalgia is key; however, always remember that self-management without a systematic approach is a half-measure. You MUST HAVE a well-defined and supported system for executing and managing your self-management program. (Chapter 6)

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Chapter 5: Treating Fibromyalgia:

What you need to know

This chapter is devoted to a discussion about the core aspects of treatment options available to you. It is important to understand that this is by no means a comprehensive, definitive, and exhaustive listing of all treatment options available; it is merely meant to provide you with a starting point and steer you in the right direction. The truth is that potential treatment options are numerous, and the process of elimination to determine which one(s) 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.

Medical Specialists
It is important to assemble a well-rounded team of individuals to assist with your treatment. Your team will invariably include one or more medical specialists. With so many physicians out there, searching for 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 Foundation offer physician referral lists for patients with fibromyalgia. The following are additional resources for locating physicians: Good Doctors list at Co-Cure: www.co-cure.org/Good-Doc.htm The FMS Community website: http://fmscommunity.org/findingadoctor.htm www.sover.net/~devstar/provider.htm FibroTrack Care Provider Database with patient reviews and ratings. In order to build the most effective team, it will be important for you to screen and interview potential members to ensure that they have not only the right skills to contribute to your team, but the right attitude and understanding about
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fibromyalgia. When you meet with a medical specialist, be sure to ask for examples of success stories of former patients with fibromyalgia whom they have treated. In addition, ask them to discuss different treatment options they have used, and what the outcomes of those treatments were, along with any additional observations they made along the way (side effects, tolerability, patient feedback, etc.). Be sure to ask them what they think of the various alternative therapies that have been researched in relation to fibromyalgia such as acupuncture, aromatherapy, and chiropractic. When getting to know a new care provider, it is critical to not only evaluate their knowledge relative to treating fibromyalgia, but to also consider their general attitude and willingness to accept you as an engaged and active leader of your own care provider team. Take the time and make the specific effort to engage doctors and specialists in discussions about your approach to self management. Make sure they are willing to take the time to explain to you the logic and research behind why they recommend different treatment options. Make it clear that you wish to not only benefit from their expertise through their own opinions, but also through their providing feedback relative to your opinions and ideas. Communication and evaluation must be a two way channel. One medical specialist that should be included on your team is a primary care physician. This can be an internal medicine doctor or a family medicine doctor. When choosing 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 has experience with fibromyalgia patients, and who is knowledgeable of strategies to manage breakthrough pain. The following is a non-exhaustive list of other medical specialists who you may wish to include on your team, along with a description of what they treat and various aspects of fibromyalgia that they may be helpful in managing.

Rheumatologist: Rheumatologists are internal medicine physicians who have received additional training in the diagnosis and treatment of arthritis and other diseases of the muscles, joints, and bones. They commonly treat arthritis, autoimmune diseases, pain disorders, and osteoporosis. Many individuals with fibromyalgia may see a rheumatologist early in the course of their diagnosis in order to rule out arthritis and other musculoskeletal pain disorders. Since rheumatologists are specially trained to treat patients who
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have chronic pain conditions, they are often an integral part of a fibromyalgia patients treatment team. Psychiatrist: Psychiatrists are medical doctors who specialize in the prevention, diagnosis, and treatment of mental illness. They also monitor the effects of mental illness on other physical conditions, including heart disease and high blood pressure. Psychiatrists are well-trained to help patients who are suffering from depression and anxiety, both of which are extremely common among fibromyalgia patients. As medical doctors, psychiatrists can write prescriptions for medications that may be useful to fibromyalgia patients in managing their depressive symptoms. Psychologist: Psychologists are specialists who have received extensive post-graduate education in the assessment, diagnosis, treatment, and prevention of mental disorders. While not permitted to prescribe medication, psychologists treat patients through other means, including talk therapy, cognitive behavioral therapy, and behavior modification techniques. Psychologists can be instrumental in the care regimen of patients who are suffering from depression and anxiety by helping them recognize events that trigger or worsen their depression, and by identifying ways to cope with symptoms. Like psychiatrists, psychologists can be a vitally important part of a fibromyalgia patients care team.

Neurologist: Neurologists are medical doctors who specialize in the diagnosis and treatment of diseases that affect the nervous system. Like rheumatologists, neurologists are often one of the first specialists seen by fibromyalgia patients on their quest for a diagnosis, as certain neurologic diseases must be excluded. In addition, the current understanding of fibromyalgia among many experts is that it results from the bodys inability to process painful stimuli correctly. Since nerves are the means by which the body transmits and processes pain, neurologists are often integral members of a fibromyalgia patients team.

Chiropractor: Chiropractors are specially trained practitioners who focus on treating musculoskeletal and nervous system disorders. Chiropractors are not medical doctors, however they must complete four years of post-graduate training in a chiropractic college and pass both national and state licensing exams. Chiropractic care is commonly used to treat back and neck pain, joint pain, and headaches. Although research surrounding the usefulness of chiropractic care as a treatment for fibromyalgia symptoms is conflicting, some patients do find that chiropractic care improves their symptoms.

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Massage therapist: Massage therapists are specially trained practitioners who use therapeutic touch and pressure applied to muscles in order to relieve pain, rehabilitate injuries, reduce stress, provide relaxation, and relieve anxiety and depression. For fibromyalgia patients, massage therapy may be useful to help reduce pain and promote relaxation in an effort to improve depression and anxiety. Occupational therapist: Occupational therapists are specially trained, licensed healthcare providers who assist individuals who are experiencing difficulty with activities of daily living. They receive detailed training related to the physical and psychological difficulties associated with illness and the effects that these have on peoples ability to perform everyday activities. Occupational therapists modify an individuals environment to fit their changing needs. This can obviously be beneficial to fibromyalgia patients, who are frequently forced to change the way in which they live as a result of the persistent pain they endure. Occupational therapists can help fibromyalgia patients modify their homes to better accommodate the physical limitations they face, which can result in improved symptom control. Dietitian: Registered dieticians are healthcare professionals who apply principles of food and nutrition to health and human functioning. They hold nutrition-related degrees that include studies in biochemistry, human anatomy, and physiology. They are also required to complete dietetic internships of at least 900 hours. In addition, dietitians are required to pass national board exams. Dietitians can be useful to fibromyalgia patients who suffer from many common co-existing symptoms and diseases, such as irritable bowel syndrome, obesity, and interstitial cystitis.

Physical therapist: Physical therapists are licensed healthcare professionals who are trained in the diagnosis and treatment of movement disorders. They work with patients to improve the bodys functioning by restoring mobility, reducing pain, and preventing disability. Since fibromyalgia patients frequently suffer from decreased mobility as a result of their chronic widespread pain and stiffness, a physical therapist can be helpful in teaching patients how to overcome physical challenges they face.

Naturopath: Naturopathic doctors focus on the holistic and proactive prevention of disease, as well as comprehensive diagnosis and treatment. Naturopathic physicians (N.D.) attend four years of post-graduate naturopathic medical school, during which they are educated in all of the basic sciences as medical doctors (M.D.); however, their studies also include
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education related to holistic and nontoxic therapeutic approaches, with an emphasis on disease prevention and the optimization of wellness. They are also required to complete four years of training in clinical nutrition, acupuncture, homeopathic medicine, botanical medicine, psychology and counseling, and they must also pass professional board exams. Naturopathic doctors may be useful members of a fibromyalgia patients treatment team. Holistic medicine practitioner: Holistic medicine focuses on addressing care of the whole person body, mind and spirit. It integrates both conventional and alternative therapies in an effort to foster optimal health and wellbeing, and to prevent disease. Holistic medicine practitioners are useful to fibromyalgia patients because they focus on patient care in terms of the unique needs of the patient, rather than through a one-size-fits-all approach. The practitioner-patient relationship is viewed as a partnership that encourages patient input and needs. This individualized, attentive relationship can be of great benefit to fibromyalgia patients, as the disease itself is unique on the individual-level and requires a patient-directed approach to treatment. As stated above, this is by no means a comprehensive list of medical specialists. There 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!

Create a Partnership with your Physician

When you have found a physician who meets your needs and who you feel is a good fit for your team, it is important to develop a productive relationship with him or her. The time limitations many doctors face when seeing patients due to overloaded schedules, high patient-to-physician ratios, and other limited resources underscore the need for you to be as prepared as you can at each appointment.

Below are a few tips to help you accomplish that:

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1. Prepare an agenda before your appointment. Know what you want to accomplish at that particular appointment. Do you need a diagnosis or an explanation of a new symptom? Do you need medication? Do you need paperwork signed by the doctor. 2. Rehearse a brief but comprehensive description of your symptoms and situation before you visit the doctor so that you waste no precious time getting his or her input and assistance. Review your journals and notes and prepare which sections need to be shared. Take your journals and notes with you so your care provider can review them. 3. Take 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 improved since I began exercising. I would like to discuss what options I might have to address my fatigue without sacrificing the pain relief I get from exercise. 4. Present to your doctor your ideas and theories about new treatment initiatives that you have researched and are interested in trying. Discuss the specifics of what you wish to try, why it appeals to you, research you have done into possible effectiveness, side effects, risks and problems. Share the thoughts from other care team members about your ideas. Make sure to express the value you place on your doctors thoughts relative to your own treatment ideas. 5. As 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?" 6. To make certain that you understand all that your doctor has told you, repeat back to him or her they key points they have told you. For example, you might repeat back that you understand that the doctor recommends you break up your exercise regimen into three 15-minute increments each day, rather than exercising for 45 minutes at a time.

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FDA-Approved Pharmaceuticals
Three prescription drugs have now been approved by the U.S. Food and Drug Administration (FDA) to treat the symptoms associated with fibromyalgia: Lyrica, Savella, and Cymbalta. This next section will briefly describe these medications; for more detailed information on each, please refer to our website, www.fibromyalgia-treatment.com Lyrica Lyrica (pregabalin) is manufactured by Pfizer, Inc. and is approved by the FDA to treat neuropathic pain (pain that results from damaged nerves), pain due to shingles, and fibromyalgia pain. It can be also used to treat seizure disorders such as epilepsy. The means by which Lyrica works to treat fibromyalgia is not understood, however it is believed that it works by calming overactive nerves. Although Lyrica does not work for everyone with fibromyalgia, many patients have seen improvements in pain, sleep quality, and overall functioning. Lyrica is taken as a capsule two to three times per day, usually at a dose of 300 to 450mg per day. The most common side effects of Lyrica include dizziness, headache, dry mouth, nausea, vomiting, constipation, gas, bloating, elevated mood, difficulty speaking, difficulty concentrating, confusion, forgetfulness, anxiety, loss of balance and/or coordination, twitching, increased appetite and/or weight gain, swelling of the arms and legs, and back pain. Allergic reactions are also possible, although rare. Individuals who have diabetes, women who are pregnant or nursing, or individuals on certain medications to treat high blood pressure should use caution when taking Lyrica. Savella Savella (milnacipran) is manufactured by Forest Pharmaceuticals, Inc. and is another FDA approved drug for treating fibromyalgia pain and improving overall functioning in fibromyalgia patients. While it cannot help everyone with fibromyalgia, Savella may help some individuals feel less pain and achieve improvements in overall functions. Although it is not used to treat depression, it is in a class of medications that are commonly used to treat depression, known as selective serotonin reuptake inhibitors, or SSRIs. As such, Savella works by increasing the amount of chemicals that help stop the transmission of pain signals in the brain. SSRIs can cause unexpected changes in mood, particularly in younger patients, so it is important to understand that that your mental health may change in an unexpected way when
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you begin taking the drug. It is important to communicate any changes to your doctor immediately, and to make your family and other support group members aware of this potential risk. Savella is taken in tablet form once or twice a day, preferably with food to minimize the risk of stomach upset. The most common side effect associated with Savella is nausea, however other side effects may include headache, constipation, dizziness, insomnia, hot flushes, excessive sweating, vomiting, heart palpitations, increased heart rate, dry mouth, and high blood pressure. Your blood pressure will need to be monitored by your doctor on a regular basis while taking Savella. Savella should not be taken by individuals who are currently taking medications known 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. Cymbalta Cymbalta (duloxetine) is FDA approved for the treatment of depression and generalized anxiety disorders, diabetic neuropathy (pain associated with diabetic nerve damage), and fibromyalgia pain. It can also be used to treat persistent bone or muscle pain from conditions such as osteoarthritis. Like Savella, Cymbalta is an SSRI and therefore works by blocking the transmission of pain signals in the brain. When taken to treat fibromyalgia, Cymbalta is taken once a day as a long-acting (delayed-release) capsule. It is important that you do not crush, split, or chew the capsule; it must be taken whole. In addition, Cymbalta takes time to take effect, so the full benefit may not be felt for up to four weeks. Common side effects include nausea, vomiting, constipation, diarrhea, heartburn, stomach pain, decreased appetite, dry mouth, increased urination, sweating, dizziness, headache, weakness and/or tiredness, drowsiness, changes in sexual desire or ability, and uncontrollable shaking. Like Savella, individuals who take MAOIs should not take Cymbalta. Furthermore, certain blood thinners, antidepressants, diuretics and a variety of other medications can also interfere with Cymbalta, so it is crucial that you tell your doctor every medication and nutritional supplement you are taking or plan to take. Also tell your doctor if you are pregnant or plan to become pregnant, as Cymbalta can have adverse effects on the fetus.

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Antidepressants
Antidepressants is a broad term used to describe a class of drugs commonly used to treat depression, anxiety, mood disorders, bipolar disorder, and other mental health problems. They work by increasing the bodys production of chemicals known as neurotransmitters. These chemicals transmit nerve signals within the brain and have effects on both emotions and pain reception. There are four main types of antidepressants: Tricyclic antidepressants (TCAs): Among the first antidepressants used to treat depressive disorders, they primarily target two specific neurotransmitters in the brain: norepinephrine and serotonin. Although effective, they tend to cause a considerable number of side effects and are typically not used as a first line of treatment. Examples of common TCAs include Anafranil, Elavil, and Tofranil. Common side effects include dry mouth, vision disturbances, increased fatigue, weight gain, tremors, constipation, bladder problems, daytime sleepiness, increased heart rate, and sexual problems. Monoamine oxidase inhibitors (MAOIs): Another early class of antidepressants, they are most effective when used to treat people with depression who have not responded to other treatments. Unfortunately, MAOIs interact with substances in many foods and beverages, as well as a considerable number of other medications. As a result, patients who take MAOIs are limited to strict diets and medication regimens. Common examples of MAOIs include Parnate, Nardil, and Marplan. Side effects can be serious and include headache, racing heartbeat, chest pain, neck stiffness, nausea and vomiting. Certain foods and medications must also be avoided to prevent dangerous interactions. Selective serotonin reuptake inhibitors (SSRIs): These are a newer class of antidepressants and they work by modifying the available amount of the neurotransmitter serotonin in the brain. Some of the more common examples of SSRIs include Prozac, Zoloft, Paxil, Lexapro, and Celexa. Many patients treated with these medications will experience sexual problems (such as low sex drive or inability to orgasm), however such problems are reversible. Other side effects include dizziness, headache, nausea, insomnia, and a jittery feeling.

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Serotonin and norepinephrine reuptake inhibitors (SNRIs): Also a newer class of antidepressants, SNRIs increase the availability of serotonin and norepinephrine in the brain. Examples of SNRIs include Effexor, Remeron, and Cymbalta. Common side effects include drowsiness, blurred vision, feeling lightheaded, strange dreams, constipation, fever and/or chills, headache, changes in appetite, tremors, dry mouth, and nausea.

Prescription Sleep Medications

A number of prescription sleep medications are available for individuals who have difficulty falling or staying asleep (a condition known as insomnia). However, it is important to understand that if an underlying condition is causing the insomnia such as fibromyalgia treating that condition itself rather than treating the symptom of insomnia can ultimately be much more effective. Unfortunately that cannot always be achieved, as the Elusive Fiend can at times be difficult to manage, therefore making restful sleep next to impossible. In such instances, prescription sleep medications may be of benefit. There are generally two types of prescription sleeping pills: those that help you fall asleep easier, and those that help you remain asleep for a longer period of time. Drugs that help you fall asleep include Lunesta (eszopiclone), Rozerem (ramelteon), Halcion (triazolam), Sonata (zaleplon), and Ambien (zolpidem). Drugs that are commonly prescribed to help you stay asleep include ProSom / Eurodin (estazolam), Lunesta (eszopiclone), Restoril (temazepam), Ambien CR (zolpidem), and Silenor (doxepin). In general, many of these drugs may interact with other medications, be habit forming, 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.

Anti-Anxiety Medications
The most common class of anti-anxiety medications those drugs known as benzodiazepines. While antidepressants are generally used over a long period of time to continuously treat and control depression and anxiety, benzodiazepines can begin working more quickly and therefore are ideal for short-term use in specific situations or in response to symptomatic episodes. Examples of benzodiazepines that are commonly used to treat anxiety include Klonopin (clonazepam), Ativan
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(lorazepam), and Xanax (alprazolam). The most common side effects of benzodiazepines include upset stomach, blurred vision, headache, confusion, grogginess, and nightmares.

Pain Management
Analgesic is the medical term used to describe any drug that is used to relieve pain. There are a wide variety of prescription analgesic medications available for pain management in fibromyalgia and other pain disorders. The following is a brief overview of selected examples: Narcotics: The most powerful type of painrelieving medication is a class of drugs known as narcotics. Narcotics decrease pain by working on pain receptors found on the nerve cells themselves. Common examples of narcotics include Tylenol with codeine, Lorcet, Lortab, Vicodin, Morphine, OxyContin, Roxicodone, and Percocet. Excessive use of narcotics with other pain medications that contain acetaminophen (for example, Tylenol) can result in serious liver damage. In addition, narcotics can be very habit-forming, in addition to causing constipation, drowsiness, dry mouth, and difficulty urinating. Anticonvulsants: Anticonvulsants are medications generally used to treat seizure disorders such as epilepsy. However, several have been shown to have analgesic properties as well, including Tegretol (carbamazepine), Neurontin (gabapentin), Trileptal (oxcarbazepine), Lyrica (pregabalin), and Topamax (topiramate). Scientists do not fully understand how these anticonvulsants work to reduce chronic pain, but it is thought that they may actually disrupt the transmission of pain signals in the brain. The most common side effects of anticonvulsant medications include headache, dizziness, drowsiness, fatigue, confusion, skin rash, nausea, vomiting, loss of appetite, abdominal pain, weight gain or loss, and swelling of the feet.
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Muscle relaxants: Muscle relaxants are 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), Valium (diazepam), Skelaxin (metaxalone), and Robaxin (methocarbamol). They are not recommended for use by pregnant women, older adults, or those individuals with a history of depression or drug/alcohol addiction. Common side effects include drowsiness, dizziness, possible addiction, dry mouth, and urinary retention. To avoid the risk of developing dependence, muscle relaxants should be used only on a short-term basis. Anti-depressants: Although they have not been approved by the FDA to treat chronic pain, many antidepressants are commonly used to treat chronic pain conditions, such as fibromyalgia even when the patient does not have depression. Antidepressants have been shown to work best for pain that is caused by arthritis, nerve pain resulting from diabetes or shingles, migraine, fibromyalgia, low back pain, and pelvic pain. The way in which antidepressants treat the pain associated with these conditions is not understood, and it generally takes several weeks to achieve maximum results. The most effective group of antidepressants used for this purpose is the tricyclic group, which includes drugs such as Amitriptyline, Tofranil (imipramine), Anafranil (clomipramine), Pamelor (nortriptyline), and Norpramin (desipramine). Side effects commonly associated with the use of these medications include blurred vision, drowsiness, dry mouth, constipation, weight gain, difficulty urinating, and changes in blood pressure. Over-the-counter options: Common over-the-counter (non-prescription) pain medications, such as Tylenol (acetaminophen), Advil (ibuprofen), Aleve (naproxen), and aspirin. These are not specifically designed to treat fibromyalgia, but can be used to treat associated symptoms, such as headache and joint pain. Ibuprofen, naproxen, and aspirin can cause stomach upset, and all (with the exception of aspirin) can interfere with blood thinning medications.

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Coping Strategies for Pain

It is important to have a variety of tools under your belt to help you cope with the pain associated with fibromyalgia. As your pain changes from one day to the next, so will your coping strategies. It is important to be flexible and open to a variety of options to help you better manage your pain. It is also important to remain positive and use your support network friends, family, doctors, whoever you feel is the most appropriate person at that time to lean on. Ask for help when you need it. Distractions that divert your attention away from your symptoms are important coping mechanisms. Examples of distracting activities might include watching a funny movie, reading a short book, visiting with friends, engaging in a hobby you enjoy (if you can do so without aggravating your symptoms), or taking a slow, easy walk in a nice park. In addition, relaxation techniques can also be of tremendous help. Deep-breathing exercises, progressive muscle relaxation, meditation, yoga, and visualization can all be beneficial. As with all aspects of fibromyalgia management, not every coping strategy will work for everyone, therefore it is important to remain open-minded, patient, and willing to explore a variety of options while searching for those that will become your mainstays for coping.

Dietary Supplements
A number of dietary supplements have been investigated as potential treatments for symptoms associated with fibromyalgia. Some have proven to be more effective than others, and effectiveness varies between individuals (i.e., what may be highly effective for one individual may have no noticeable effect in another). It is important to note too that dietary supplements may adversely interact with medications you are taking, so be sure and tell your doctor if you plan to use a dietary supplement so that you can be aware of any potential risks. The list provided below is meant to provide an overview of the main dietary supplements commonly investigated and associated with the treatment of fibromyalgia. It is by 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.fibromyalgiatreatment.com.

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5HTP: 5-HTP (5hydroxytryptophan; L-5 hydroxytryptophan) is a chemical naturally produced in the body as a by-product of the amino acid L-tryptophan. It can also be produced synthetically from the seeds of the African plant known as Griffonia simplicifolia. 5-HTP works by increasing the bodys production of a chemical known as serotonin. 5HTP is a widely available dietary supplement that has been used to treat a variety of symptoms and conditions that affect individuals with fibromyalgia, including sleep disturbances, depression and anxiety, migraine, and chronic widespread pain. However, the National Institutes of Health advises consumers to refrain from using 5HTP until more is known about the supplement, as it has been linked to serious side effect known as eosinophilia-myalgia syndrome, or EMS. EMS is characterized by severe muscle tenderness and increased levels of white blood cells. Other potential side effects of 5HTP include heartburn, stomach pain, vomiting, nausea, diarrhea, drowsiness, and sexual problems. Ribose: Ribose is a kind of sugar naturally produced by the body. In its supplement form, it has been used to increase muscle function recovery, improve athletic performance, and replenish muscle energy stores. It has also been used to help prevent muscle cramping, pain, and stiffness in patients with various disorders of the musculoskeletal system. Although some people have used it as a treatment for fibromyalgia, there is little research available to support its use for such purposes. One study has demonstrated that ribose, taken three times per day, can improve energy, sleep, and decrease pain in fibromyalgia, however more research is needed to corroborate these findings. Acetyl-L-carnitine: Acetyl-L-carnitine is a naturally-occurring amino acid that helps the body produce energy. It has historically been used to treat mental disorders, such as Alzheimers disease, memory loss, depression, alcoholism, and thought problems related to Lyme disease. There is limited

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information available regarding the use of acetyl-L-carnitine to treat the symptoms associated with fibromyalgia, however for those who suffer from cognitive dysfunction (fibro fog) and anxiety/depression, it may be of benefit. Side effects are generally mild and include stomach upset, nausea, vomiting, and restlessness. It can also cause urine, breath, and sweat to have a fishy odor. Acetyl-L-carnitine should NOT be taken while concurrently taking a blood thinner such as Coumadin (warfarin) or Sintrom (acenocoumarol). Magnesium / Malic Acid: Magnesium is the most abundant mineral in the body and is found predominantly in the bones. Magnesium is required for over 300 biochemical reactions in the body, among which include maintaining normal muscle and 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, restless leg syndrome, and urinary problems. Some evidence also supports the use of oral magnesium supplements, taken along with malic acid supplements, as an effective treatment for fibromyalgia-related pain and tenderness. Side effects of taking too much magnesium include diarrhea and abdominal cramping, as well as kidney failure. SAMe: SAMe, or S-adenosylmethionine, is a synthetic form of a compound that is found naturally in the body. It is believed to be involved in many chemical reactions that occur in the body. A number of studies have found that SAMe is effective at treating depression by increasing the availability of the neurotransmitters dopamine and serotonin. This may be of benefit for fibromyalgia patients who suffer from depression. Individuals who have anxiety should use SAMe with caution and consult their doctor before taking it, as it may make anxious symptoms worse. In addition, two clinical trials have shown that compared with placebo (sugar pill), SAMe can result in significant improvements in fibromyalgia symptoms. The most common side effects associated with SAMe include digestive difficulties, nausea, skin rash, low blood sugar, dry mouth, blood in the stool, excessive thirst, increased urination, headache, hyperactivity, anxiety, and insomnia. Other dietary supplements that have been investigated as possible fibromyalgia treatments include alpha hydroxy acids, capsicum, gamma-hydroxybutyrate (GHB), ascorbigen, coenzyme Q10, ginkgo, chlorella, and melatonin.

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Diet
Unfortunately, there is a lack of good research investigating the link between diet and fibromyalgia. However, this does not mean that changes to, or improvements in, your diet cannot be of benefit to you in managing your fibromyalgia symptoms. Dietary modifications cannot treat the fibromyalgia itself, but they may be able to improve certain symptoms, which is a good thing! One of the best things you can do as part of your self-management is to pay attention to how 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. Some evidence suggests that eating vegetarian and vegan diets may help improve the symptoms associated with fibromyalgia, including pain, mobility, sleep quality, and decreased flexibility. However, only three studies have been done to evaluate the link between vegetarian diets and fibromyalgia, and they were limited by small numbers of subjects and design flaws. In order to better explore this potential association, larger and more specifically designed studies will be needed. Celiac Disease is a condition in which the lining of the small intestine becomes damaged, preventing it from absorbing nutrients from the food you consume. The damage results from eating gluten, which is found in wheat, barley, rye, and oatcontaining products. The cause of celiac disease is not known, and it can develop at any point during the lifespan, from infancy to adulthood. Much like fibromyalgia, the symptoms of celiac disease can vary between individuals, which makes an accurate diagnosis difficult. Common gastrointestinal symptoms include abdominal pain, bloating, gas, indigestion, constipation, changes in appetite, diarrhea, lactose intolerance, nausea and vomiting, stool irregularities, and unexplained weight loss. Additional symptoms that may arise over time are related to the nutritional deficiencies that result from celiac disease and include easily bruising, depression and anxiety, fatigue, delayed growth (children), hair loss,

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itchy skin, missed menstrual periods, mouth ulcers, seizures, and tingling or numbness in the hands and feet. Muscle and joint pain may also be present. Due to overlapping symptoms, fibromyalgia may commonly be misdiagnosed as celiac disease and vice versa. In addition, individuals with fibromyalgia may also have celiac disease at the same time. Celiac disease can generally be diagnosed by a special blood test and by examining a biopsy (tissue sample) of the small intestine for microscopic changes that are characteristic of the condition.

Exercise
Research supports the positive impact of exercise as an effective and reliable treatment approach for fibromyalgia. In fact, no other treatment has more scientific backing than exercise. Obesity and being overweight are primary causal factors in the development of fibromyalgia; over 65% of patients are overweight or obese. Furthermore, studies have shown that as weight increases, so does the severity of fibromyalgia symptoms. Therefore, exercise is key in reducing body weight and thus improving symptoms. One of the most important things to understand with regard to exercise and fibromyalgia, however, is that care must be taken. Regardless of whether you have led an inactive lifestyle your entire life or just recently due to the onset of your symptoms exercise must be introduced or reintroduced slowly and carefully. But no matter the circumstances, it must be done. Start slowly, and consistently strive to achieve longer durations of activity. Also remember that there is a fine line: too little exercise may not provide 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. Examples of exercises modalities that have shown benefit to fibromyalgia patients include Tai-Chi, yoga, water-based exercise, stretching, strength training, and walking. Of these strength training is very important. Although it can be difficult to initiate, it has shown proven effectiveness at reducing pain and fatigue. Additional information regarding these exercise regimens can be found on our website, www.fibromyalgia-treatment.com.

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Therapies
A number of additional therapeutic and alternative treatments are also used by many people with fibromyalgia. Below is a brief overview of some of the most commonly used therapies: Balneotherapy: Balneotherapy is the therapeutic use of water to heal disease. Balneotherapy is thought to work through a number of means, including increasing body temperature (to kill harmful germs and viruses). It is thought to improve blood circulation and oxygen delivery to cells, improve metabolism, improve endocrine gland function, improve immune system function, and improve mental well-being by promoting relaxation. Chiropractic: Chiropractic focuses on treating disorders of the musculoskeletal and nervous systems within the body, and the impact that these disorders have on overall health and wellbeing. It utilizes a drug-free, hands-on approach that involves examination, diagnosis, and treatment. Chiropractic care is frequently used to treat ailments such as back and neck pain, and pain in the elbows, knees, and hips. It can also be used to treat headaches. Massage therapy: Massage therapy is the therapeutic use of touch and pressure applied to muscles in order to relieve pain, rehabilitate injuries, reduce stress, provide relaxation, and relieve anxiety and depression. Trigger point therapy (also known as myofascial release therapy): Myofascial release therapy is a subset of massage therapy in which the therapist uses sustained pressure in order to release tightness in the fascia, or connective tissues, between muscles. Aromatherapy: Aromatherapy involves the use of essential oils from flowers, herbs, and trees as therapy to improve physical health and wellbeing. Essential oils are scented liquids that are removed from plants by using steam or pressure. They contain the chemicals that naturally give the plant its essence, or fragrance. Aromatherapy is administered in different ways, including inhalation and direct application to the skin. Direct inhalation is believed to have psychological effects that stimulate or sedate various organs within the body. Direct skin application, either through lotions/creams or massage, are believed to work by inducing relaxation and providing psychological benefits. Cognitive behavioral therapy: Cognitive behavioral therapy is a type of talk therapy that is commonly used to treat anxiety and depression, as well as a number of other mental disorders and psychological symptoms. It is based
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on the premise that by understanding how their thoughts and feelings influence their behaviors, patients can make deliberate behavior modifications that ultimately result in symptom improvement. Reflexology: Reflexology is an alternative therapeutic practice that involves the application of pressure to the feet and hands using specific thumb, finger, and hand techniques in the absence of oil, 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. You should understand that the above-described alternative therapies barely scrape the surface of all the complementary and alternative therapies available for the treatment of fibromyalgia symptoms. It is beyond the scope of this eBook to provide a comprehensive review of all the modalities available. More information can be found on our website, www.fibromyalgia-treatment.com. In addition, you can also learn more by visiting the National Center for Complementary and Alternative Medicine, at www.nccam.nih.gov.

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Chapter 6:

Pulling it all Together: A Systematic Approach

Experts across all realms of the fibromyalgia world from prominent authors to reputable associations to devoted researchers have noted the need to effectively track what you are doing and what you experience with regard to your fibromyalgia. Unfortunately, none have gone into great detail about the processes that should be used - the how to part. The purpose of this chapter is to do just that: provide you with the how to tools you need to take ownership of and maximize the potential of your fibromyalgia self-management. You need to inspect what you expect, and this chapter will provide you with the information required to do so.

Before we begin with the discussion of the tools that you will need, consider this example to help put the whole concept into perspective: When you are sick and need treatment, 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 tools at their disposal their medical knowledge, relevant clinical guidelines, and their understanding of how the illness is manifesting itself in your body to recommend a course of action, i.e., a treatment. Essentially, what your doctor has done is collected data (by asking you questions about your signs and symptoms), analyzed that data using various tools, and then recommended a course of action (i.e., a treatment) to you as a 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 process of data collection, analysis, and action recommendation. By using a defined, repeatable system to evaluate your illness, the doctor does his best to ensure that the correct steps are always followed.

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You are not a doctor, however you should still approach the self-management of your fibromyalgia with a defined, systematic approach that is firmly rooted in data collection and data analysis. Do not let this concept frighten you; it is easily achievable and anyone can do it. You can do it! You must inspect what you expect. Step 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 two: Analyze - EVERYTHING you track. Analyze the data you record; your symptoms, your treatments, their effects on your body, your life, your overall well being. By having tracked everything and recorded it, you will have a wealth of information at your fingertips to analyze and to share with your care team and support group. You might see your fibromyalgia in a different light when it is laid out before 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. Step three: Utilize - Using your newfound understanding of your fibromyalgia its patterns, nuances, and effects on your life evaluate your available courses of action (i.e., treatments) based on your analysis. Only through analysis and evaluation can you truly decide which courses of action will be best for you. It is important to remember that this is an ongoing process. Tracking, recording, and analyzing 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 scenario is unrealistic in light of the elusive nature of fibromyalgia. You will need to rely on your system of data collection, analysis, and evaluation as you try new actions based 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!

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Tools
Recording your signs and symptoms on a regular basis "collecting your data will require effort. It will require more than just jotting down a few notes here and there on a scrap piece of paper. You need an organized system. What works best for one person may not work best for another, but the overall premise is the same for everyone. Find the system that works best for you so that you can inspect what you expect. You could approach your system the old-fashioned way, with journals, forms, notebooks or 3-ring binders, photographs and/or video, a tape recorder or voice recorder, and file folders. Although such a paper-based system may work for some people, it is terribly inefficient and compartmentalizes your data. You may have symptoms logged in one notebook, attempted treatments logged in another, and a free-written diary of your personal thoughts and feelings in yet another notebook. The information in these notebooks may be augmented with voice memos you record on a voice or tape recorder, however those recordings are filed away elsewhere, unable to be viewed in context with the written notes. Finally, you may misplace or misfile a journal or paper, losing valuable data that may make the difference for you in the evaluation of your fibromyalgia.

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How do you analyze data that is spread out across a bunch of journals and binders? How do you identify patterns and causal relationships when your data is poorly organized and difficult to review as a whole? How do you turn hand written notes scattered 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! Admittedly, using a more traditional paper-based system is far better than doing nothing; FAR BETTER. However, even in the best case scenario, such a system leaves you managing your efforts as if it were the 1950s. The Elusive Fiend is a tough adversary and you need to bring your best game: put technology to work. Yes, use your computer. Odds are, if you are reading this, you have one! Here are a few preliminary tips that can be of great benefit to get you started on your path toward successful self-management of the Elusive Fiend: Create directories and folders on your computer specifically dedicated to storing all of your fibromyalgia-related information. Do not mix your fibromyalgia files in with other files. Consider using file sharing services such as Drop Box to enable sharing data with your care team and support group. Obtain copies of your medical reports, charts, and related documents scan them and store the scanned copies on your computer. Remember, these documents contain YOUR health information, and as the leader of your team, you have a right to see and possess it and to determine with whom you wish to share it.

Create a template document to use for recording notes for each doctor or care provider you visit. Use this template to note questions and issues you have prior to your visit, to serve as a reminder for yourself and to keep your provider in the loop as it pertains to your overall goals.

Spreadsheets. These are the most important tool you can have (unless your using FibroTrack, in which case the complete system is provided for you). Use spreadsheets to track EVERYTHING. Use them also to keep a journal and any special notes you wish to record. Spreadsheets offer the key analysis tools you need such as charts and graphs. Good data collection is easily reduced in value by poor analysis abilities.

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If 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.

Tracking Symptoms
There are many methods that you can use to track symptoms. You could use a handwritten journal, however as previously stated, a much better option would be to use a spreadsheet (the best option would be to use our interactive FibroTrack system). Regardless of which method you choose, there are a few things to keep in mind and remember to always do. As you evaluate and begin to define your fibromyalgia, note ALL of your symptoms. All means ALL. This includes even minor ones that you may brush off as being insignificant or even unrelated. As new symptoms pop up during ongoing treatment, note these and add them to your tracking log. Doing so can be key in identifying the things that may be side effects from drugs or supplements you are using. It is extremely important to track everything in a consistent, systemized manner. Rate all of your symptoms on a scale from 1 to 10, with 10 being the worse. If you cannot 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.

Tracking Causal Relationships, Events, and Triggers

As you track the causal relationships, events, and triggers that you observe, do so using the same type of system used to track your symptoms. Track your sleep; break it down into such categories as how long 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, relationships, body weight, depression, anxiety, PMS, menstrual pain, and associated conditions.

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Keep track of the visits to your doctor, the medical tests you undergo, any accidents you have (slips, falls, bumps, bruises), the weather, and any abnormal actions or activities you experience. Work hard to collect data that can be evaluated to look for possible causal relationships and patterns, which can then be used to help you structure specific treatment options. ***Understanding how your individuals symptoms and causational triggers and events are impacting each other and interacting in YOUR fibromyalgia is critical to effectively managing your ongoing treatment efforts. You need to turn this information into relevant data that can be evaluated. This is the core of enabling a process of intelligent trial and error.

Tracking Your Treatments

When attempting 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. As 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. It is also important to track what you have done, what you have taken, when you took it, and how much. For exercise, record how long you exercised, the intensity at which you exercised, and what method 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.

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Intelligent Trial and Error A Concept and a System

Determining the most effective treatment(s) for your fibromyalgia will boil down to a simple process of trial and error. The purpose of 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 decisions based the results measured from previous intelligent decisions, all based on collected and analyzed data. In order to make the most of your intelligent trial and error system, implement review systems that enable you to evaluate treatment efforts relative to your symptoms, events, triggers, and other variables. Plan for WHEN you will conduct reviews, and make it a specific task on your fibromyalgia to-do list. Remember from above that data collection relative to symptoms, events, triggers, and treatments is ongoing, and while review should be ongoing as well, make it a separate task and define it as such. Set aside specific time to devote to doing this, including efforts to integrate your care team and support group into the process. If you are using a spreadsheet as is recommended, your spreadsheet can easily generate charts and graphs. Such visual representations may be useful in helping you visualize the impact 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. It is also vitally important to identify YOUR negative feedback loops. The patterns that will emerge during your data review and analysis will help to identify these, which 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 evaluation, pattern observation, identifying causal relationships and triggering factors, you can identify specifically the areas where you need to TARGET your treatment focus!

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In a reverse of the 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. For example, if you undertake exercise as a treatment, you may find that you begin to lose weight. As you lose weight, it may improve your depression. Improvements in your depression may result in further reductions in anxiety and stress, all of which may culminate in improved pain, fatigue and other symptoms. Exercise Weight Loss Less Depression / Anxiety / Stress reduced symptoms.

The Key to Success

The single most important factor when it comes to applying the principals presented here to effectively gain control over your fibromyalgia is to simply take action. Decide on one small piece of a plan to begin actively working to manage your fibro and then start doing it. This can be as simple as grabbing a notebook and writing down your key symptoms. A small start is a start - and getting started is typically the biggest step required. Don't just think about it! Integrate your efforts into your daily planning. Set aside time specific to your fibromyalgia management efforts. Note specific detailed tasks - what you need to do and how, then assign time to it and get it done. One small step at a time, one new treatment initiative at a time - put the principals of Intelligent Trial and Error to work! Understand that this process will be frustrating at times. Expect far more failures than successes. Know that most successes will be small in nature. Remember the magic pill lesson, and anticipate 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.
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Chapter 7: The Future:

"FibroTrack"

Effective systems are the key to an effective management process. Systems are useful because they foster habits and provide channels for taking effective action. As 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 compartmentalize and fragment data, and make it difficult to evaluate in its entirety and in context. Paper-based systems are rudimentary and inefficient, and therefore not ideal for tackling the Elusive Fiend. It is important to recognize that data collection is 90% pointless (the remaining 10% is empowerment) unless you implement a focused system that can allow you to effectively evaluate and convert your data into defined action plans.

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FibroTrack: Internet Enhanced Self-Management

FibroTrack is an intuitive, graphical user interface cloud based system that has been specifically designed from the ground up to facilitate all aspects of managing your fibromyalgia. FibroTrack provides users with a wealth of tools all available at the simple click of a mouse all designed to be integrated into an overall fibromyalgia specific system: Educational resources including hundreds of articles, blogs, Webinars and videos - all accessible online via computer or mobile device. Simple, intuitive symptom tracking in incredible detail including user defined symptoms and treatment options research tools integrated into the symptoms help functions. Treatment Program tools including detailed interfaces to research and create new treatment programs consisting of pharmaceuticals, dietary supplements, diet changes, pain medications, therapy options and exercise. Tracking tools associated with all aspects of your treatment program including life events which impact or are impacted by your fibromyalgia. Natural Products Comprehensive Database alternative treatment data integration - the Internets 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 and communications tools. Data sharing capabilities with healthcare providers including communications tools and shared online reporting Online support groups - with built in "smart-matching" capabilities that link users to others with similar symptoms and profile data

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Social networking functions to enable support groups and easy tracking of general ongoing treatment efforts. Complete user control over all personal medical data with tools to ensure privacy. Users control what data is shared and what is kept totally private. Discussion forums Webinars - ongoing expert interviews and online training seminars on a huge variety of fibromyalgia treatment related topics. Secure server with state of the art data protection capabilities for security.

Much, much more!

Capabilities like FibroTrack were not possible as recently as several years ago. However, technology has fortunately moved in directions that enable treatment approaches previously thought to be ridiculously impossible. Now, we are able to achieve easy data collection from anywhere, receive targeted research, achieve intelligent analysis all of which is facilitated by sophisticated technology and accessible through intuitive graphical interfaces. In other words, analysis capabilities that doctors have never dreamed of are now possible, and in fact accessible in the palm of your hand! While we certainly feel the FibroTrack is by far the best means of building and implementing an effective self-management system, please remember that it is not required. The purpose of this ebook is to educate you relative to how an effective self-management program should be structured and operated. We invite you to visit our website, www.fibromyalgia-treatment.com, where you will find a wealth of useful information. In addition to our fibromyalgia selfmanagement tool (FibroTrack), you will find researched-based articles on a wide variety of fibromyalgia-related topics, including common symptoms, treatments, associated conditions, diagnostic methods, and more. In addition, you can check out our blog, meet other members through online support groups and link-outs to popular social networking sites, and find a variety of other resources to assist you. Remember, knowledge can lead to success but not without action. Take action by sharing our website with others who may have a need for it. Share it with your team members, family, and friends. Use our FibroTrack tool to help manage your
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fibromyalgia; it offers a comprehensive system of symptom and treatment tracking, and does all of the work for you. You have enough on your plate while trying to chase down the Elusive Fiend; let us help you by making your self-management as simple and as streamlined as possible. In addition, we would greatly appreciate your feedback on this ebook, and as with our website, we ask that you share it with others so that they too can benefit from the information 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. Also note - 10% of all net proceeds from FibroTrack go toward funding fibromyalgia awareness and research efforts!

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Disclaimer
The information contained in this ebook guide is for informational purposes only. The author is not a doctor, research scientist, medical practitioner of any sort, lawyer or accountant. Any advice, information, perspectives, ideas or medical opinion expressed in this ebook is nothing more than the authors opinion based on his own personal experience and provided to you for informational and entertainment purposes only. You should always seek the advice of a medical professional before taking any medical related action. Any actions taken on the part of a reader that may have been suggested in this ebook are taken of the readers own free will with the understanding that said actions are in no way sanctioned, approved or in any way related to the author of this ebook. Please understand that there are some links contained in this guide that the author may benefit from financially. The material in this guide may include information, products or services by third parties. Third Party Materials comprise of the products and opinions expressed by their owners. As such, I do not assume responsibility or liability for any Third Party material or opinions. The publication of such Third Party Materials does not constitute my guarantee of any information, instruction, opinion, products or services contained within the Third Party Material. The use of recommended Third Party Material does not guarantee any success on any level related to medical treatment. Publication of such Third Party Material is simply a recommendation and an expression of my own opinion of that material. No part of this publication shall be reproduced, transmitted, or sold in whole or in part in any form, without the prior written consent of the author. All trademarks and registered trademarks appearing in this guide are the property of their respective owners. Users of this guide are advised to do their own due diligence when it comes to making medical decisions and all information, products, services that have been provided should be independently verified by your own qualified professionals. By reading this guide, you agree that myself and my company is not responsible for the success or failure of your medical treatment relating to any information presented in this guide.

Copyright - 2012, Online Awesome LLC - All rights reserved.

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