EXERCISE: Virtual reality exposure therapy as treatment for pain catastrophizing in fibromyalgia patients: proof-of-concept study

Author: Linzette MorrisKaren Grimmer-SomersBruce SpottiswoodeQuinette Louw
Credits/Source: BMC Musculoskeletal Disorders 2011, 12:85

Albeit exercise is currently advocated as one of the most effective management strategies for fibromyalgia syndrome (FMS); the implementation of exercise as a FMS treatment in reality is significantly hampered by patients'poor compliance. The inference that pain catastrophizing is a key predictor of poor compliance in FMS patients, justifies considering the alteration of pain catastrophizing in improving compliance towards exercises in FMS patients.
The aim of this study is to provide proof-of-concept for the development and testing of a novel virtual reality exposure therapy (VRET) program as treatment for exercise-related pain catastrophizing in FMS patients.

Methods:
Two interlinked experimental studies will be conducted. Study 1 aims to objectively ascertain if neurophysiological changes occur in the functional brain areas associated with pain catastrophizing, when catastrophizing FMS subjects are exposed to visuals of exercise activities.
Study 2 aims to ascertain the preliminary efficacy and feasibility of exposure to visuals of exercise activities as a treatment for exercise-related pain catastrophizing in FMS subjects. Twenty subjects will be selected from a group of FMS patients attending the Tygerberg Hospital in Cape Town, South Africa and randomly allocated to either the VRET (intervention) group or waiting list (control) group.
Baseline neurophysiological activity for subjects will be collected in study 1 using functional magnetic resonance imaging (fMRI). In study 2, clinical improvement in pain catastrophizing will be measured using fMRI (objective) and the pain catastrophizing scale (subjective).DiscussionThe premise is if exposing FMS patients to visuals of various exercise activities trigger the functional brain areas associated with pain catastrophizing; then as a treatment, repeated exposure to visuals of the exercise activities using a VRET program could possibly decrease exercise-related pain catastrophizing in FMS patients.
Proof-of-concept will either be established or negated. The results of this project are envisaged to revolutionize FMS and pain catastrophizing research and in the future, assist health professionals and FMS patients in reducing despondency regarding FMS management.
Trial registration: PACTR201011000264179
http://7thspace.com/headlines/380906/virtual_reality_exposure_therapy_as_treatment_for_pain_catastrophizing_in_fibromyalgia_patients_proof_of_concept_study_study_protocol.html

United States Court of Appeals

 Argued and Submitted March 9, 2011 — Seattle, Washington.

Cynthia Coleman seeks disability insurance benefits from the Commissioner of Social Security ("Commissioner"). The administrative law judge ("ALJ") determined that Coleman has the residual functional capacity to perform sedentary or light work, so long as she can switch between sitting, standing, and walking at least briefly every hour. Based on testimony provided by a vocational expert ("VE") that Coleman could perform three specified occupations, the ALJ then held that Coleman could perform work that exists in significant numbers in the economy. He therefore denied benefits.

Coleman filed suit in district court, contending that the ALJ erred in two ways. First, Coleman faulted the ALJ for disbelieving her testimony of severe pain on the grounds that her fibromyalgia did not result in certain physical symptoms and that Coleman failed to lose weight as treatment for her obesity.

1. The ALJ relied on the absence of objective physical symptoms of severe pain as a basis for disbelieving Coleman's testimony regarding her symptoms. He erred insofar as Coleman's pain is related to her fibromyalgia, which is a "disease that eludes [objective] measurement."  He also erred by holding, in the middle of a discussion of Coleman's obesity, that her "failure to lose weight reflects on her credibility."

Although we find these errors troubling, we conclude that they were harmless. "[T]here remains substantial evidence supporting the ALJ's conclusions on credibility,"  including Coleman's failure to follow repeated medical recommendations that she treat her pain with exercise and increased activity levels. The ALJ's errors therefore "do not negate the validity of [his] ultimate credibility conclusion" or his resulting determination of Coleman's residual functional capacity.

http://www.leagle.com/xmlResult.aspx?xmldoc=In%20FCO%2020110324179.xml&docbase=CSLWAR3-2007-CURR

I Don't Like to Exercise

Ellen Greenlaw: Reviewed by Louise Chang, MD

Fibromyalgia specialists often recommend exercise as a way to help improve fibromyalgia symptoms. But what happens if you don’t like to exercise? Or when exercise only seems to bring on more pain and no relief from fibromyalgia symptoms? This is the case for one member of WebMD’s fibromyalgia community. She says that she feels really sore after movement and just wants to sleep. “Everything I read says I MUST exercise, and I just do not feel like it. So, any ideas?”
One man laments that he can’t exercise the way he used to. But he says that mild stretching is helpful. He tells her to stretch “just to the point where you start to feel the pull, then hold it there and release.” And if she feels sore after stretching, he suggests a taking a hot bath to help relieve the pain. His routine is to soak in a hot tub for 30 to 60 minutes right before bed. “Most of the time by the next morning, I’m nearly human again,” he says.
Another fibromyalgia community member also finds hot water helpful to ease aches and pains. “I actually found that a hot shower in the morning before I go for my walk with my dog helps loosen me up a bit,” she says. She stretches in the shower and uses the hottest water she can stand. Then she takes another short shower when she returns from the walk and takes short walks every two to three hours throughout the day. “It helps to keep me loose to help get through the day. But take it one day at a time…do what you can and be happy with what you can accomplish,” she says.
Another woman reports that swimming has helped ease her fibromyalgia pain . “I started floating around in the pool for a few days, and then doing half laps,” she says.  Once she was swimming laps regularly, she also started doing easy exercises at home. “I started with the easiest one I could find. Then after a week or so I add another very easy exercise to my program,” she says. “There are days that I feel I only can do one exercise, and that is okay -- at least I’m moving.” Getting exercise really does make her feel better, she adds.
Another  fibromyalgia community member tried using a Wii Fit interactive video game. Although some of the balance exercises were too difficult, she found one she could do. It involved just sitting on the board and being still. “I’ve found it’s a great way to be aware of my muscles and it’s an easy way to start out,” she says. She also tried the yoga deep breathing and very mild stretching with the Wii and found them helpful. “I’m still dealing with the frustration of what I used to be able to do vs. now, but I suppose I will come to terms with it in time,” she says.
One other community member suggests isometrics or tai chi. “Slow, tight movements contract the muscles and help strengthen them,” she says.
http://www.webmd.com/fibromyalgia/features/i-dont-like-exercise

Dr. Ranchhodbhai Chaudhary, MD - Internal Medicine Physician

January 12, 2011

Q: What is the treatment for Fibromyalgia?

A: The goal of treatment for fibromyalgia is a multimodal approach to reduce fatigue and to allow appropriate sleep and activity routine. It includes both pharmacologic and non-pharmacologic treatments that are individualized for patients. Non-pharmacologic treatments are exercise, cognitive behavioral therapy, and psychotherapy. Educating patients that fibromyalgia is not a life-threatening disorder, not associated with deformity or with increased mortality or early death is critical to optimal management and improves the outcome. Light aerobic exercise appropriately titrated to an individual’s aerobic threshold, is as effective as any medication. Patients should stay away from narcotics to prevent further fatigue.

Treating Fibromyalgia in Teens and Children

A team of specialists works together to treat fibromyalgia in children and teens. This team can include a:

• Pediatric rheumatologist (a doctor who specializes in treating children with arthritis and other rheumatologic diseases)
• Psychologist
• Physical therapist

Though there currently is no cure for fibromyalgia in children (or adults), several good treatments are available to help manage its symptoms, including:
Coping strategies.One of the most effective ways to treat fibromyalgia in teens and children is by using coping strategies to manage the pain. A technique called cognitive behavioral therapy helps children with fibromyalgia learn what triggers their pain and how to deal with it. It's very helpful for improving kids' ability to function, and relieving their depression. Other behavior-based approaches to treating fibromyalgia include muscle relaxation and stress-relieving techniques (such as deep breathing or meditation).
Medication. Medications may be used to treat adults with fibromyalgia. Rheumatologists may try some of these same medicines in children. However, the safety and effectiveness of fibromyalgia drugs isn't as well studied in children as in adults.
Exercise. Exercise is an important part of fibromyalgia treatment. Children with fibromyalgia who stay active tend to have less intense pain and less depression. A physical therapist can show kids the best exercises for fibromyalgia and can teach them how to ease into an exercise program gradually so they don't get injured.
Physical therapy. Physical therapy and massage can ease some of the muscle soreness that children with fibromyalgia experience.
For teens and children who are struggling with fibromyalgia, these treatments can bring help and hope. Getting enough rest and exercise and relieving stress can help control fibromyalgia so that kids with the condition can stay symptom-free over the long term.
http://www.webmd.com/fibromyalgia/guide/fibromyalgia-in-children-and-teens?page=2

Fibromyalgia Home Remedies

 Experiencing muscular pain all over your body? When you are signaled with myriad of signs and symptoms of fibromyalgia, you should not leave yourself unprotected, especially if you are ready and capable to follow a daily exercise regimen that will target those problematic body locations.

Fibromyalgia is a condition affecting mostly women (usually in the age group of 35 to 60) compared with men, in which intense pain is experienced emanating from the muscles, joints, tendons and ligaments which is also accompanied by tiredness and lethargy. It can hinder productivity and get in the way of safe and cool life. What actually could be the right treatment of cure for this fibromyalgia? Of course, keeping in view the emergence of everyday new side effects, home remedies are the ultimate complete cure for this physical pain. The natural remedies can further be segregated into two segments – Regular Exercise and Home Remedies.  

Regular Exercise for Fibromyalgia Fibromyalgia patients generally take therapeutic exercise sessions in healthcare institutions, where they can be overviewed by trained medical staff. People grappling with fibromyalgia can also take this exercise regimen in the comforts of their own homes, or enroll in an aerobic or gym class wherein they can receive the guidance of a personal trainer.

• Studies and case studies have also shown that people having fibromyalgia can simmer down their pain and keep a check of their health & wellness by complying with a regular exercise program. Exercise for fibromyalgia can include running a treadmill, riding a bicycle, aquatic exercises, or even strength building, (generally under the supervision of a trainer) and of course yoga also. 
• Yoga is known to soothe the mind and soul while strengthening and balancing a person. In a way, yoga enables a person displaying the signs & symptoms of fibromyalgia keep a track of his/her health, more so as the condition generated some sort of hindrance in the way the body is able to process pain. Persons suffering with the arthritis-related disorder experience decreased blood pressure to a few areas of the brain which generally helps in letting the body handle pain.
• Opting for a natural treatment like exercise in lieu of medication to soothe the pain, inflammation, and in most of instances, depression accompanying fibromyalgia can be fruitful. People's bodies, usually, react in several ways. A right exercise for fibromyalgia for one person may not be at all suitable for another.
• One exercise which has been considered as evergreen and effective even for the old people is water aerobics. It develops stamina while offering comfort and relief to the symptoms and effects of fibromyalgia. Water aerobics also generates motivational strength for patients who join a group class/activity.
• Although there are myriad of medication available for fibromyalgia, the best medication for fibromyalgia is still believed to be the natural home remedy. In the long run, natural pain relief is better as it is easier to administer. Natural treatment is also considered to be better as there are generally no noticeable side effects witnessed.

Whatever form of exercise the person suffering with fibromyalgia undergoes, it's imperative to keep in mind that the results may not come quickly. The positive effects may take more time compared with medicines and drugs.  

Fibromyalgia Home Remedies 

• To several person's surprise, a lot of the components that can be facilitated to deal with this kind of pain are mostly found at home - in our daily diet. 
• Honey and lemon have many powerful healing substances, and in addition to being used for cooking, they can also be used to treat fibromyalgia pain. A few teaspoons of lemon and honey blend with a glass of warm water and if taken twice a day, work wonders. Not only does it help treating the fibromyalgia, it also has other healing agents for the body. If small quantity of turmeric is also incorporated, it becomes a very strong cocktail. Turmeric is a very strong antiseptic with healing properties. The only drawback is the pungent taste of turmeric. 
• Don’t use white flour, white sugar and salt. If you can cut down your sugar intake, it would not only alleviate your fibromyalgia pain, but would also heal your body in general. For those who have a sweet tooth, start using brown or raw cane sugar. White flour is not advisable for you to consume. You must totally rely on whole grain flour. And also keep the silent killer salt at bay as much as possible.
• Scrubbing warm vinegar on your aching muscles and joints is yet another very effective home treatment. Vinegar and its components have been used for years to cure chronic joint and muscular pain. This product could not catch much eye balls as people just don't believe that such a simple substance can have medicinal properties.
• The most prominent hidden factor behind all this is the faith in what you are doing. Don't just administer vinegar on your joints and aches just because you got information through some article and you are simply trying it out to ward off the pain. Believe in what you are doing and its results. When you consume something or apply an ointment or take a drug that is meant for relieving you from pain, alert your subconscious mind that what you are applying or doing will ultimately cure your trouble.

The best way to take natural remedies into your stride is to take one small step at a time, or in different stages, and then to retain and sustain the physical activity.

http://www.altiusdirectory.com/Lifestyle/fibromyalgia-home-remedies.html

Pregabalin was the first drug approved for prescription by the US FDA for the treatment of fibromyalgia

Your constant head pain can be fibromyalgia!

 December 9, 2010,

KUALA LUMPUR: “It is just a pain in your head, just ignore it,” a doctor once told Mary Gaspar, 54, when she consulted him for the continuous pain she had been suffering from.

Mary had been working in a bank before she suffered the unexplained pain since 2005.
“I was told much later, I could have suffered from fibromyalgia or FM in short, since 2005.
“It made me go through a tough state of depression. I was not able to walk and sleep. All these made me cry day and night,” Mary explained further.
That would be the one advice a patient should not take seriously from their doctors but instead, seek a second opinion.
“The pain they feel is real. With the right help, it can be effectively managed,” Dr Mary Suma Cardosa, Consultant Anaesthesiologist at Selayang Hospital as well as the president elect of Malaysian Medical Association (MMA) told attendees to an afternoon session of revelations by South East Asia Fibromyalgia Awareness, Concerns and Trends Survey (Seafacts), recently.
The press conference was organised by Pfizer Inc and it opened the eyes of many who were not aware of such disease.
What causes fibromyalgia or this FM syndrome? Professor Ramani Vijayan, the President of Malaysian Association for the Study of Pain, noted: “There is no scientific consensus as to the cause of this disease.
“It could have developed in individuals with certain vulnerability elements. It may arise from biological factors such as genetics, age, trauma, gender or a tissue injury.
“Depression, anxiety, a person’s belief about pain and coping strategies are just as important.
“Two to five per cent of the people are affected by this debilitating and chronic pain condition.
“It is occurring more often in the young to middle aged females.
“It is characterised by musculoskeletal pain and tenderness in the up, down, left and right regions of the body,” Ramani added.
FM is said to be seven to nine times more common in females.
People with FM are actually suffering from a significant disability and reduced quality of life.
The most vulnerable age group suffering this most common pain condition is between 30 and 65 years of age.
Patients suffering from fibromyalgia will experience symptoms like stiffness, muscle cramps, fatigue and depression.
The severity of pain felt is widespread thus this chronic though not life threatening condition should not be misunderstood.
However, FM has yet to record cases affecting children and those below the age of 20.
According to survey results, one out of five Malaysian patients found their quality of life and ability to participate in hobbies have been strongly impacted by this disease.
And four out of 10 FM sufferers or 38 per cent, agreed that FM had caused their quality of work to deteriorate.
“Three quarters of GPs and almost all specialists surveyed agreed that fibromyalgia is not well understood among many physicians.
“Education, training and support from physicians are the keys to enabling them to help manage FM patients,” said Dr Mary Cardosa.
Most FM patients have to wait between 3.3 to 15.4 months, with an average of two physician visits before receiving an accurate diagnosis.
FM sufferers worldwide, also have to endure tenderness at almost eleven different points — top or bottom, left and right.
Treatment and management of FM involves a multi-faceted approach.
It includes exercise, behavioural management and lastly the approved medication.
Patients suffering from FM are dependent on complete medication reliance until they feel better or learn to manage their fibromyalgia, coping with the management procedures.
Sadly, there are no available laboratory tests to diagnose the symptoms of FM.
Forty million people suffer from this chronic pain disease worldwide.
“A total of 506 people took the survey in South East Asia. A total of 941 physicians were also asked about their understanding on fibromyalgia.
“The outcome proved that the disease is poorly understood by both quarters.
“The survey also revealed that this negatively impactful disease can cause people experiencing the chronic condition to suffer serious financial consequences, from the condition, including the inability to work,” said Professor Ramani, also shared when the Seafact Survey results were revealed.
Pregabalin was the first drug approved for prescription by the US FDA for the treatment of fibromyalgia.
The drug was effective, it reduced symptoms of pain, disturbed sleeps and fatigue.
Patients and physicians from Indonesia, Malaysia, Philippines, Singapore and Thailand took part in this Seafact survey, held from June right through August 2009.
Currently there are no short cuts to relieving an FM sufferer of pain.
Drugs alone will not take the debilitating pains away but they will ease one’s suffering if the medications; as prescribed by a physician or upon referrals to a specialist, is taken with a consistent exercise session, done after sufficient knowledge had been acquired.
“I had to learn how to manage my pain. I exposed myself to the standing and sitting tolerance to extend pain endurance.
“I cannot and must not lift anything as it would exert more pressure on the pain I felt.
“I began to think positively and that had helped me to cope better,” said Mary Gaspar, accompanied throughout the afternoon session by her supportive husband.
Seeking the doctor’s advice even if the pain felt was at one isolated area only, is a must do.
Mary insists that exercising is the main key towards managing one’s FM pain.
“Having an FM support group is another option to expedite the know-your-disease factor.
“Informing the patients and their family members at home on the hypersensitivity to pain conditions suffered, is very essential.
“It would help patients feel less awkward talking about the pain they feel and possible home remedies to try on,” Dr Mary also recommended.
Fibromyalgia is not an imaginary pain.
It is a disease that has yet to set its clinical practice guidelines for physicians to follow through.
If you feel pain and tenderness upon self pain examination, reach out for help and visit a physician for the next positive step forward.
http://www.theborneopost.com/?p=79486