Fibromyalgia, (Have Pain, Fatigue, Brain Fog & Memory Loss), 4 Steps to Success!

This article is a transcribed edited summary of a video Bob and Brad recorded in July of 2021. For the original video go to https://www.youtube.com/watch?v=hCAjFfd_cgo&t=80s.


Brad: Today we are fortunate enough to have Bob off and Chris the Pharmacist on, we've got a very serious subject to cover. The title is “Fibromyalgia, (Have Pain, Fatigue, Brain Fog, Memory Loss)”, those are all typical symptoms. We're going to go through four steps to success to help manage and overcome these problems associated with this syndrome.


Chris: There we go.


Brad: Fibromyalgia is a very painful, debilitating condition and if you have it, you've been diagnosed, you're very well aware of this. It's oftentimes in some specific parts of the body, across, I'm not going to go through the points because I do have them mapped out, the most common locations in the body, but typically the upper back and the chest, around the hips and waist, and I may be missing some that you may be suffering from but it's a chronic condition, it goes on and its really life-changing. So, we have done research on it, we've both had patients over the years that have this and we came up with a four step guide that you can vary from, because everyone does not treat fibromyalgia in the same manners, it's not a cookie cutter thing. Chris, do you want to step in so I can quit talking so much?


Chris: Yeah, fibromyalgia, it's not even really a disease state, it's much more of syndrome. So, when we think about it, it's many, many, different things and oftentimes, when patients have the diagnosis of fibromyalgia, it's arrived almost backhandedly like a process of exclusion. It takes an average of five years just to hit the diagnosis in most cases. And you're talking about, two to three percent of the population, about 70-90% women. Some unique facts about fibromyalgia, oftentimes when they come in they present with pain and they just don't know why, but you know, the doctors try. And, there's not a set test for it either, which makes it so darn frustrating to diagnose as a clinician and it makes it really, really hard on the patient, because they're just waiting for an answer! I think, so many times when we get an answer it's nice to start to turn the page and work on the healing process, and that's what's so darn hard. So, your doctor will rule out other arthritis form conditions, you'll see strange things that pop up like IBS, inflammatory bowel syndrome.


Brad: IBS?


Chris: Inflammatory bowel syndrome. So, basically, constipation, diarrhea-type dominant side effects with a lot of pain in the tummy and with that respect, you know, you're like, “well, are we treating one thing?” I mean, are we looking for an elephant and it should be a giraffe kind of thing, and they just don't know where it goes. Well, I still have these symptoms, but you know, I'm hurting here, hurting there, I'm in pain for every second of the day from the moment I wake up to the point where I go to bed. Your friends and family will be like why are you always hurting all the time? So ultimately when they get the diagnosis, then I think the healing can begin and then I think we have lots of things that we can kind of start to share to try. It's not a hopeless condition, it's something that can go into remission, and we can move forward and have very happy effective lives so there's lots of good things that we can do to help people.


Brad: Right, and that can be the challenging part. I did want to mention, as far as from a therapy standpoint, when I look at it with people, is part of the explanation of the pain is, these muscles will tighten up in these painful areas and when a muscle tightens up, there's less circulation because the muscle's tightened up like a ball, a real knotted area and blood cannot circulate in that near as well as a relaxed muscle, it's like a sponge, it can absorb the blood and the nutrients and the oxygen that fresh blood provides and we want to get rid of the waste products. You may not have heard that term, thinking of in your muscles but the waste products being carbon dioxide, lactic acid, and these things when they build up create that pain in there, so, getting to be able to relax can be a big part of this. We're going to talk about that a little bit more, so again, oh, the point I wanted to bring up, Chris, is this is kind of like back pain, although it's different, in the way that you look normal. I mean, it's not like you have a broken arm, you look healthy, but you've got this pain that the average person is not familiar with it, who's ignorant of fibromyalgia. They don't understand.


Chris: No, and that's one of the biggest, I think one of the biggest tragedies of fibromyalgia is we all look perfectly normal if we're suffering from it, except for the fact that we're not, because we're feeling so miserable. What we think is that it was probably brought on by a stress event, a traumatic event, so whether it's a car accident, stress, an infection, so we don't really know that nexus event that caused it. We know that it runs in families so we don't really know. But what we think we understand right now is it seems to be nerve transmission is the problem. So, if you think of your nervous system as a series of highways, something's not right with that. When we talk about the pain points, and there's at least 18 of them that they look at pretty routinely but I think there may be others as you alluded to. But what happens is that, let's say we're listening to the radio and we like it loud, we're rocking out, we're driving, it's on ten, well, your pain, if you have fibromyalgia, is easily an 11 or higher, so it goes beyond that and just simple things like if you went in for a massage or you know, you just hit your arm on a door in one of those tender spots, it puts you through the roof. So it's not a normal response, like, for anybody else it's just a little slap and you're like, why did you almost want to drop to your knees or actually have tears in your eyes. You know, and it's a very real pain. I mean, just because it doesn't look bad, it's bad.


Brad: Right.


Chris: And so you know we go through a lot of different things to treat these and we'll jump into those as we go forward.


Brad: I'm not a fibro specialist, so I went to Adriaan Louw. He's a physical therapist, he's got his PhD in pain, he treats people with fibromyalgia on a regular basis and he does research and he has dedicated his life to pain, people with chronic pain. We've had him on our show actually, he lives in Iowa not too far from here.


Chris: Yeah, right down the way.


Brad: Yeah, and he's just a heck of a nice guy, you can just tell he is, life is, you know, this is his passion. So he does have a book specifically for fibromyalgia, he has them for other chronic ailments as well, painful ailments. The name of his book is "Your Fibromyalgia Workbook", it's made for the layperson.


Chris: Yeah, it's made for everybody!


Brad: But one of the things I wanted to bring it down to, and I heard this from him, break it down to the simplest areas to address for pain and so there was sleep.

Chris: Critical.


Brad: Yeah, as opposed to going after this painful condition as a whole, break it down into four. One is sleep, the next one is understand your pain, try to get a better understanding of why it is. People come out after they see the doctor, maybe someone else, they say,” well, they think it's just all in my head,” which is the farthest from the truth. You're not going to progress if you don't understand it a little bit better and he does a really good job of explaining. I've watched some of his videos and talking to him, his way to communicate that to the patient is really good, as opposed to coming across in a real technical manner. He comes across in a personal manner so you can relate to it. And then exercise or motion. I'm going to show you a little, a way to work into movement because most people with fibromyalgia don't want to move because it hurts.


Chris: No, the pain is so extreme.


Brad: Right, exactly, so it's like, “I know I should be moving but it hurts worse,” so there's some ways to work through that. Then we are going to touch also on some diet at the end. We're not dieticians but we can give some good general rules for that.


Chris: Absolutely.


Brad: Did I miss one?


Chris: No, I think, I think we'll start with sleep.


Brad: Yeah, and that's what Dr. Louw said, if you can get your sleep under control that's half the battle right there. And it's not easy, because we have people having problems with sleep without pain because of other issues. Do you want to talk about sleep?


Chris: Well, we can. One of the hallmarks of fibromyalgia is the fatigue. Not only are they in pain all the time but they're always exhausted, I mean, we're talking like just bone weary tiredness. So you're just dragging tail every moment of every day and so how do you fix that when you're sore, painful, tired? It's just a very frustrating point, so one of the things that we can do to try and gravitate towards better sleep, I always call it sleep hygiene, but there's other ways of looking at it. But some basics with sleep, whether you have fibromyalgia or anything else, are just keys to getting a better night's rest. Everything follows through from sleep in a lot of cases, so if we can get the rest, our bodies begin to heal, things calm down, your nervous system seems to settle out, so we'll kind of see that as we talk. The reality of it is to go to bed, you want to have a nice, quiet setting. You want a dark, dark room. You want to be putting away your iPhones, your iPads, your laptops, you probably don't even want to be watching TV. Your phones and your iPads and computers reflect that blue light and that's stimulating to the brain and that keeps us awake to begin. It is kind of strange, because a lot of people, think, “oh, I'm just relaxing, playing a little, you know, keyboard Sudoku or words with friends or whatever.”


Brad: Even on your cell phone, there's enough blue light to affect you?


Chris: Correct, and some of them now have recognized that. I know that with Apple they do have a dimming setting, so it's certainly something that I would encourage to take advantage of even as you're approaching bedtime. But I would still encourage putting all the things away so that you're heading into bed in a quiet, relaxed manner. We want to have same set times. You want to have the same bedtime and you want to try and establish the same wake up time, too.


Brad: Sure, some consistency.


Chris: So that you're getting a nice, round-the-clock chronologically, you just want to have that same set time. Ideally seven or eight hours. Some people need a little bit more. You know your body and you know what you need. But you want that quiet time. I think white noise is actually important for a lot of people. What is white noise, well it's not a color, but it's like a fan. A gentle whooshing.


Brad: That's what we use, we just use a fan.


Chris: There's lots of studies outside of this, what we're talking about, that actually shows that white noise just relaxes the brain and when you look at the brain waves and the delta waves and all the things that they're looking at with sleep, specifically, you just get a deeper level of sleep. So it does help to promote that healthier sleep. And you know, you want kind of a cool room, you don't want it real hot, so your body, as the temperature slows down, heart rate slows down, you promote deeper sleep so we head into REM, which is actually one of the restorative parts for our brain but also our body, we're learning. So, there's a lot of fascinating things with sleep that oftentimes we take for granted.


Brad: I just want to say, I just read a book a few months ago by Sean Stevenson, and it's about sleep. If you look up the author, Shawn Stevenson, it’s called “Sleep Smarter.” The whole book talks about things, one of the things, he was so specific on having a dark room is if you need light to be able to see your time, get it in red, if you need a nightlight, get a red nightlight so you don't trip over. There's something about red that does not produce the same, is it the melatonin in the brain?


Chris: Blue is stimulating and red, red actually doesn't throw off a lot of effect, so if your partner is there too it doesn't annoy them. It just doesn't reflect, so that's why the military uses to read their maps and things. Lots of studies on those wavelengths.


Brad: Ah, I want to get to the next number, understanding, some understanding of the pain, but before we do that, medication for sleep, that's your specialty?


Chris: I dispense it, it's not my specialty, but I can tell you a lot about them. The reality of it is, is that sleep does not come easily to millions and millions of Americans and when you're talking about three to five million Americans with fibromyalgia, sleep is one of the things that's a challenge to achieve. So there's a lot of different ways that we can approach falling asleep. We've talked about some of the basic mechanistic things that we can do but sometimes we need pharmaceutical help. Not always, I mean, sometimes it can be something as simple as melatonin. For some people, you can get it through foods like raspberries or pineapple or cherries. Some people like that because it also gives you other healthful nutrients, and it also helps to stimulate that sleep about 30 minutes before you want to lay down. Otherwise, we have to use medication so something like trazadone which is an old-school anti-depressant, which isn't much of an anti-depressant, but interesting with fibromyalgia, it has unique capabilities because it works on some of those neurotransmitters which we talk about fibromyalgia as being a kind of a highway disorder where the nerves are firing improperly, it raises serotonin and some dopamine and norepinephrine levels to try and help to improve transmission. The benefit for people who can't sleep is that it just makes you doggone tired. So it helps you to sleep and get more fitful sleep. But there's other drugs that we can use, like the Z drugs, which we did a video about awhile back, so you talk about zolpidem is probably one of the more common ones, but also zopiclone.


Brad: So, the big picture, pharmaceuticals for sleep is not going to be a long-term fix.


Chris: No, we hope that you can naturally do it on your own because there's really no substitute for it. When it comes down to pharmaceuticals, yeah, America is a society of better living through chemistry, but if we can do it without, it's best. And I'm telling you that as a pharmacist. But if you can, you can, but if you can't, you can't, and those of you that know that you just can't sleep, you understand it and you realize the need for these medications, obviously your doctors do and they do a very good job of trying to diagnose and they'll try and mitigate where they can. It depends on the circumstance; everybody's case of fibromyalgia specifically is different. So, if you had it and I had it, we'd have two totally different stories.


Brad: Yeah, I should have said that if sleep quality is not one of your biggest problems, you could probably skip this section, but it's probably part of it.


Chris: No, but everything stems from that well, fitful night of rest. And that's one of the things that is hard to achieve. That's why you want to go into a pattern and that's why it's so important going forward, that if we have this diagnosis of fibromyalgia that we learn to make some of these lifestyle changes so that we can go forward.


Brad: Sure, yep. Okay, so let's go on to the next topic, understanding why you hurt. I know, from my point of view, my understanding as far as the physical part where I talked about tight muscles, we need to get them relaxed, so we get the blood flow, I'm going to show you an exercise warm-up that actually you could do before you go to bed. It may help you relax so you can sleep better. But I think my best advice is to go to an author like Adriaan Louw, read some of his information. Search YouTube for his name, see and listen to how they talk about these experts that have studied it and dedicated their life to it. I know one of the analogies he talks about is, and it's a lot better coming from him, but he talks about pain, you know it's there and it's so painful and he relates that to a lion coming into the room. Like if you get tapped and you have that pain, he says, there's that big lion and there's that fear response and if you can work it out so that that big lion coming in and getting that fight or flight response, if you can get that big lion down into a little cub. So that that fight or flight response settles down as well, and that's one of those things that is easier said than done. Again, that's why from an expert it's going to make more sense than from me.


Chris: Well, I think that's why his workbook is so important for a lot of people. I think it gives nice easy-to-read steps that are going to allow them to relate to their day-to-day activities. One of the things that they talk about also is cognitive behavioral therapy, and it’s kind of an understanding of the condition and I think the more we know, the more we can cope with things more effectively. Whether it's more of a CBT kind of, cognitive behavioral therapy thing where we reach out and we get that understanding for why we're hurting, when we understand the why, and whether it's writing down some things within what Adriaan has done with the workbook, it definitely helps us. When we have that understanding it allows us to accept it, make it become part of us and so we can face it more easily without the fear and the frustration that is associated with it.


Brad: I do want to also mention, you said there was a patient of yours that had chronic low back pain.


Chris: This was a chronic pain, but yes.


Brad: But he used one of Adriaan’s books.


Chris: One of his workbooks, specifically, and he completely is opioid free close to eight years now. Then he was a strong, strong opioid user and he just knew that he was to a point in his life where he couldn’t keep doing that, and he was actually having other subsequent side effects as a result of that.


Brad: Sure.


Chris: Which, you know, just to briefly touch on for fibromyalgia, there's a lot of drug therapies that we do. Over my career, I've been doing this for 26 years, fibromyalgia just kind of came out in the mid-90s when I started coming out of school and one of the things doctors just figured out, well, we got this thing, let's put this label on it, it's fibromyalgia and its pain, it's chronic pain, so what do we do? Well, we treat them with opioids. Well, we found out that that is the last thing on Earth you want to do simply because they're addictive and the reality of it is, is what do pain medications do, they just make you not care about the pain. The pain is still there. So when we're treating FM patients, a lot of it's going to come down to sleeping well, we're going to talk about exercise and things like that shortly, but the medications that we rely on are going to be anti-depressants and maybe muscle relaxants. So those are the things that help to bridge and improve neuronal transmission, that highway, so things like pre-gabalin, things like Sevala, which is menilsopram, any of the antidepressants but duloxetine, or Cymbalta, specifically, are indicated directly for FM.



Brad: Should we jump right into the exercises?


Chris: Yeah, let's go to the exercises.


Brad: So, exercise, and Chris, we've talked about this, as a pharmacist, you're saying exercise seems to be the way to go versus drugs.


Chris: Absolutely.


Brad: And again, we talked about the pain gets worse with exercise, so why do I want to exercise? So I want to show you, this is from a fibromyalgia patient, she was actually a doctor, and I kind of modified it a little bit for my therapist background. Before you exercise, and I'm talking about exercise as simple as a mild walk, which, that can really be uncomfortable, do the warm-up. This is one thing I do with my back in the morning, I’ve got spondylosthesis. If I try to warm up in a standing, weight-bearing position, it is uncomfortable, it's not fun at all. So I lie down on my back, your muscles are much more relaxed.


Chris: You don’t have to fight gravity.


Brad: Yep, exactly. So, you're going to lie down, you can do this on your bed. It might be better on a carpeted floor; it depends on how you feel about getting down onto the floor or not. You're going to start out with a deep breath, everything should be quiet, you're not going to have your dog licking your face or the kids running around.


Chris: That's going to make a problem.


Brad: Yeah, just take a deep breath; two or three deep breaths, in your nose and out your mouth. They talk about meditation, if you can meditate, anything to allow the nervous system to settle down and relax. We're going to start with the feet and probably shoes off, I'm not going to take mine off, you can do it with your shoes on. You're going to do, five to ten ankle pumps. Yo