A recent article in www.medscape.com by Alice Goodman summarised an overview of research on fibromyalgia treatment that was presented at the Paris 2014 European League Against Rheumatism Congress.
Winfried Häuser MD, from Technische Universität Munchen is an expert in the field of fibromyalgia. He believes that treatment for people with fibromyalgia should be individualised and include non pharmacalogical approaches , as these are often more effective than drugs. He explained that aerobic exercise is the most effective ‘weapon’ that we have and both healthy people and people with fibromyalgia benefit from continuous physical exercise.
He and his colleagues recently published a network meta-analysis which was an indirect comparison of all available therapies for fibromyalgia. They were unable to find any significant differences in effectiveness between drug and non-drug therapies. While the effects of drugs are lost once the patient stops taking them, the effects of aerobic exercise and multicomponent therapy are sustained but declining at 1 or 2 years.
Dr Häuser advocates a graduated approach to treating fibromyalgia.
Mild fibromyalgia : can be managed with reassurance from the doctor and encouragement to engage in regular physical and mental activities.
Moderate fibromyalgia: should be managed with aerobic exercise and the temporary limited use of drugs.
Severe fibromyalgia: can be managed with aerobic exercise, drugs and the psychological and/or psychopharmalogic treatment of mental comorbidities.
Dr Mary-Ann Fitzcharles, a rheumatologist at McGill University in Montreal who treats people with fibromyalgia, agreed with the patient-tailored approach outlined by Dr Häuser. She cautioned about overmedicating people, and keeping them on continued medications which have side effects. Non Pharmalocological therapies have no risks, she explained.
Dr Fitzcharles went on to say that non pharmacologic therapies are probably the most important ones for people with fibromyalgia. In her experience, every person with fibromyalgia should be managed with exercise, promotion of an internal locus of control and education.
Activity pacing is the key, in order to not overdo or avoid exercise.
Non Pharmacological therapies include:
Pharmacologic / drug therapies include:
Ann Rheum Dis 2013; 72:955-962 doi:10.1136/annrheumdis-2011-201249
I recently visited an elderly woman in her home, in my community therapy role. So much had been happening in her world. During the weeks since my last visit she had experienced some serious health challenges, and her brother had died.
How could I be surprised that she had not managed to continue with the exercise and walking programme we had started?
She was tired, heartbroken and wracked with guilt, describing herself as “full of self-pity” because she was mourning the loss of her dear brother. This had also reminded her of the grief she experienced when her sister died a year previously.
I sat and listened with my Whole Heart.
I was not there to offer solutions, to slap a band-aid over her aching heart, to make light of her feelings. I told her I believed it was good, right and proper to feel such acute loss and to express it. How else do we recover from our deep wounds?
She told me about her family, her ancestors who had migrated to New Zealand from an Eastern European country, just before the time of the Depression. She spoke of a grandfather who worked many menial jobs to provide for his family of seven children. Her parents also worked hard to raise her and her many siblings – a labour of love which she reflected on with great gratitude. She spoke of one of her sisters who had endured many trials and tribulations only to finally triumph – and she now lives overseas. She spoke with love of her own children – their successes and challenges.
In the telling, she called all of her Ancestors into that small lounge. I could feel them standing around her. I told her that I believed that talking about our Loved ones brings them close.
I can recognise the entrenched belief that being occupied fully, being accountable for every minute spent at the expense of any form of pure relaxation, has been ingrained in our psyches. No wonder, then, that this dear soul believed she was “full of self-pity” because her thoughts kept turning to those she loved dearly who were no longer here, in physical form. Because she could not do it for herself, I offered her the gift of my time, so that she could express what her heart was longing to share.
When it was time for me to leave, she hugged me tightly and thanked me for “just listening”. I feel I was the recipient of the greater gift. I heard her heart sing!
Do you feel taking time to grieve is selfish? Do you believe it is a form of self-pity?
I welcome your comments.
You are going to win! With these words spurring me on, how could I not be a winner!
This morning I set out on my morning run, and it was hot already. Along the way, I passed and greeted a mum on her early morning walk, pushing her two small children in their stroller. The older child called out to me as I passed them, “you are going to win!”. How could I not honour that proclamation? How could I even consider feeling tired or discouraged with those beautiful words ringing in my ears?
This set me thinking about the many times I feel discouraged, as if I am wading through sludge. I have a strong work ethic, and set myself tasks and deadlines. This works for me when I have a good idea about a desired outcome, because it keeps me on track and I can measure my progress. But what happens when I am not sure about what I want to pursue or produce?
I am marooned in indecision, in not knowing, what my ‘next step’ is. Do you experience this too?
Business and personal coaching works wonders in helping one to define a pathway, helping to break down goals into manageable steps, in order to reach the defined outcome. This supposes that one already KNOWS or at least has an idea of the desired outcome.
One beautiful practice I was invited to participate in, invited us each to choose a Word to define a theme to focus on through the new year ahead, and to choose four Supporting Words to cushion or supplement the Word.
I have chosen SURRENDER.
Nothing works easily when I am pushing uphill, trying to do it all alone. I am not giving up, just practising being present in the moment, experimenting with ‘flowing’ rather than being rigid.
My supporting words are Grace, Gratitude, Courage and Insight – all qualities I will need to call on and include in my daily living.
Which brings me back to the proclamation “You are going to win!” We are all winners when we focus on what inspires us, what gives us meaning, and practice living in the present moment. And when we have others cheering us on!
“You are going to win!” – how does that make YOU feel?�
I have a heavy heart moving into this new year. Endings and more endings, because I am grieving the loss of two people dear to me.
My sister Anne has dementia and she is sliding further into the space between here and there. While she is still physically present, I miss her intellect, her sharp wit, her full presence. She is my older sister. I have known her my whole life. I never imagined that I would not be with her ‘fully’. She was the drawcard for my move to live in Christchurch.
She always looked after my younger brother and I; we looked up to her and trusted her guidance. As the eldest child, she copped the authority of our parents, and she fought hard for her independence. She is super intelligent, and my brother and I had a hard time following after her at school. She chose her own path, and with her husband travelled to places I have only ever dreamt of.
Now, I call on all my parenting and therapy skills as I navigate our relationship. She can’t remember what she ate two minutes ago, or whether she has eaten at all. She can’t dress herself. Her spatial awareness is impaired – steps are a challenge, and she doesn’t recognise familiar objects. Loud noises and busyness upset her, and her tolerance levels are reduced. Soon, she will need to be placed into full time care, which seems like a jail sentence. Excepting, there is no parole to look forwards to.
My heart is breaking. How did her Soul choose this challenge in this Lifetime?