Monthly Archives: May 2023

Fibromyalgia and Trigger Point Injections

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When I was attending the pain clinic, I spoke to the pain specialist doctor who recommended trigger point injections to help ease pain in specific areas. If you have not heard of trigger point injections – the injections often contain lidocaine and corticosteroids. The lidocaine helps block pain receptors in the muscles and the steroids helps reduce inflammation in the muscle and connective tissues surrounding the nerves. The injection is inserted into a muscle knot found in the trigger point injection sites. A muscle knot is tense muscle fibers – which prevents the muscle from relaxing. The knots cause the affected muscles to remain tense even when the muscle is at rest. The following picture shows several trigger point injection sites.

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While I was attending the pain clinic a nurse practitioner had evaluated me to see if I qualified for trigger point injections. A quick physical exam on my upper back revealed several knots in my neck and upper back had formed. Fibromyalgia pain seems to attack these knotted muscles twice as hard ( in my case). The pain in these areas are always steady and worse when I am in a flare.

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Trigger point injections are supposed to be a safe treatment option ( pain relief) for those with fibromyalgia. Fibromyalgia causes tense muscles and knots can form. The injections can help relax the muscles and allow your muscles to work properly. The relaxed muscles decreases tension thus reducing nerve pain. The trigger point injections may be more painful because fibromyalgia can make you extra sensitive to pain. I was always encouraged to try trigger point injections, but due to the fact it contains corticosteroids – I was unable to even consider it after researching the procedure further. I do know several people who do get the injections done for fibromyalgia pain. What they have all stated is the injection does relieve pain but does not last long enough before they can get another round.

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I decided to opt out of trigger point injections for several reasons. One of my main reasons was due to the fact that the pain specialist doctor could not seem to provide me any information about the trigger point injection procedure. When I asked how the injection provided relief, I got told ” We don’t actually know! It just does.” The doctor did not even want to provide me with information of what was in the injection itself. These are need to know information before I allow any procedure to be done. I was also not given any time to think about it or have my questions clarified. The doctor wanted to just begin injections five minutes into what I thought was just a consultation appointment.

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I am glad I choose to decline the trigger point injections. I later found out the injection contains lidocaine and a corticosteroid. My body is sensitive to many corticosteroids – leaving me feeling like I have bugs crawling under my skin. Corticosteroids have been marked on my medical file for years – not to be administered to me due to possible allergy/sensitivity. I am someone who can’t even use prednisone. I was shocked that this doctor did not review my file to be sure it was safe to administer trigger point injections before hand.

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When I researched trigger point injections I also found many sites that state these injections can have a possible side effect of damaging the muscles and nerves. However, I do not know the prevalence of possible damage caused by these injections. If you consider using this treatment route – I would speak to your doctor about this concern. The muscle damage is called myonecrosis – which appears to be treatable.

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Read more information about trigger point injections at the following websites:

1. https://www.onehealthcare.co.uk/treatments/trigger-point-injections/#:~:text=A%20more%20serious%20side%20effect,if%20symptoms%20continue%20beyond%20this.

2. https://www.thefibroclinic.com/trigger-point-injections-patient-questions-answered-part-ii/

3. https://www.medicalnewstoday.com/articles/327384

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Progressive muscle relaxation and fibromyalgia

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Progressive muscle relaxation is a technique used to help decrease muscles tension. It focuses on one part of your body at a time with a goal of relaxing that part. Believe it or not this technique focuses on slowly tensing and releasing each muscle group at a time. You might be discouraged as soon as you read tensing up your muscles, but the technique states to stop tensing before you feel pain!

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I actually read about this technique in a book I have in regards to PTSD. I decided to research more about progressive muscle relaxation and came across articles stating this technique may be used to help fibromyalgia. There are also many other benefits to using this technique – it helps reduce anxiety, stress, lowers blood pressure, helps migraines, improves sleep issues and lowers pain levels. These are just a few benefits to using progressive relaxation techniques!

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A 2022 study (small study) put progressive muscle relaxation to the test to see how people with fibromyalgia were effected. Thirty seven people with fibromyalgia were randomly selected along with a control group of people without fibromyalgia. The group with fibromyalgia took part in progressive muscle relaxation twice a week for eight weeks. The results of the study showed pain and fatigue among the fibromyalgia group significantly decreased. Perceived stress, blood pressure and pulse rate also decreased.

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Conclusion.

According to the study progressive muscle relaxation is a feasible treatment route to help improve pain, fatigue, and stress symptoms in people with fibromyalgia. Of course this is just a small study completed, I feel a wider study should be completed to verify the findings. To read the study visit here.

Here is a basic progressive relaxation sequence.

Taken from the book “The PTSD Workbook” third edition
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Taken from the book “The PTSD Workbook” third edition
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There are many other examples online if you look up progressive relaxation techniques. The above sequence is just one example. I have not personally tried this technique, but I think I will trial it for a few weeks to see how my body reacts.

For more information on progressive muscle relaxation visit the following websites.

1. https://www.healthline.com/health/progressive-muscle-relaxation#about-pmr

2. https://www.anxietycanada.com/articles/how-to-do-progressive-muscle-relaxation/

Do doctors know how to diagnose fibromyalgia properly? Do they know the fibromyalgia diagnostic criteria?

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As we know, fibromyalgia is a difficult condition to diagnose. With no specific test to help diagnose fibromyalgia it can become complicated and time consuming for the doctor. There is specific criteria that must be met to be diagnosed with fibromyalgia and also ruling out many other conditions. However are doctors familiar with the diagnosis criteria?! Over the years, the diagnosis criteria has changed and altered.

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An article I read explained that a doctor and his colleagues distributed a 37 item questionnaire which tested physician’s knowledge on the 1990 fibromyalgia criteria and the 2010 diagnostic criteria. I was rather shocked at the findings.

Overall, 12% of the respondents used only the 1990 criteria in their practice, 27% used the 2010 criteria, 12% used both, and 49% used no criteria. Therefore, only 51% of respondents adhered to these sets of criteria in diagnosing fibromyalgia.

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The results did show that specialists were more familiar with the diagnostic criteria, but did not have in depth knowledge. Even doctors who had the “most specialist training” only showed having 55.4% knowledge on the 1990 fibromyalgia diagnostic criteria and 72.4% on the 2010 diagnostic criteria. I believe the latest fibromyalgia diagnostic criteria was updated in 2016. It makes me wonder if doctors even know of the update as this article only lists the 1990/2010 diagnostic criteria.

For more information visit here.

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In addition (my personal thoughts)….

Many doctors are reluctant to begin testing early for fibromyalgia ( ruling out other conditions). In order to be diagnosed with fibromyalgia, symptoms must be present at a similar level for at least three consecutive months. Do doctors wait to see if symptoms last that long before beginning to rule out other conditions? My doctor began ruling out other conditions as soon as he suspected fibromyalgia. The waiting game is one of the hardest parts of fibromyalgia. We wait to see doctors or specialists, we wait for specific tests to be completed – then we wait some more for the results and repeat this process for months to come ( in some cases years).

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I won’t mention all the tests doctors may decide to run, but it is very time consuming. My doctor ruled out many other conditions then had a rheumatologist verify his fibromyalgia diagnosis. The rheumatologist agreed 100% on the diagnosis stating I meet all the diagnosis criteria listed.

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Another difficult aspect about a doctor evaluating fibromyalgia is that it is also diagnosed by self reporting. Doctors are often left trying to decipher if the patient is telling the truth to the many questions asked during the assessment. I understand their side of it as well – some people do try to play the system and fake fibromyalgia as there is not a test to diagnose. Sadly, those of us who are being honest and truthful when self reporting our symptoms often feel the backlash of not being believed.

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Doctors and other healthcare providers should be informed about diagnostic changes to the fibromyalgia criteria. If they are informed and educated about fibromyalgia more – it would save a lot of frustration all around. The first question I ask doctors is what they know about fibromyalgia and if they believe in the diagnosis. If they can’t answer these questions I know the frustration will soon set in on both sides.

Fibromyalgia – Are opioid medications used to treat fibromyalgia pain?

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If you are one who suffers from chronic pain you know too well the debilitating deep down pains we are having to live with. We often make several trips back and forth to the doctor for a prescription to help alleviate even a small fraction of the pain. Often times the use of opioids to help with pain is asked. Most doctors will not prescribe opioids for fibromyalgia pain. Why are opioids not recommended for the treatment of fibromyalgia?

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My doctor actually did have me on an opioid in combination with a medication for nerve pain, however I stopped taking it as I noticed no change to my pain levels while using it. I had a pain specialist explain to me that opioids don’t usually work for fibromyalgia pain when I mentioned I found no change of pain levels while in use. I started to do my own research and soon enough realized opioids are not the best choice for chronic pain management – at least when it comes down to fibromyalgia pain.

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What many of us don’t understand is opioid drugs are made to be used short term. We all know fibromyalgia is not a short term kind of condition. With many medications our body adjusts and begins to build up a tolerance level to the prescribed dose. Once that tolerance level is hit, higher doses are needed for the same effect to take place. Prolonged use of opioid use is associated with significant risk of addiction. Opioids are very addictive medications. The higher the dose, the higher the chance of addiction. I think this is a concern of many doctors – so they try everything possible before prescribing an opioid medication.

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A 2007 study revealed that people with fibromyalgia were found to have reduced binding ability of a receptor in the brain that is the target for opioid painkiller drugs. To simplify the findings – when these medications cannot bind to the receptors in the brain and spinal cord like they should, they cannot alleviate a person’s pain. If this is true, it could be why many people find opioids unsuccessful to treat fibromyalgia. You can read about the study here.

“These findings could explain why opioids are anecdotally thought to be ineffective in people with fibromyalgia,”

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Furthermore, frequent use and using opioids for too long are known to increase pain levels. You are probably thinking how can a medication increase pain when it is being used to decrease pain? This is known as opioid induced hyperalgesia. Read more information on OIH here.

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Sometimes opioids are prescribed for fibromyalgia. Depends on the doctor and circumstances. For myself, I stay away from them as the majority of research findings and reports state opioids are often unsuccessful in treatment for fibromyalgia. I was on a mild opioid – which caused further fatigue as opioids often have a side effect of sedative effects. You may be one of the people who finds pain relieve from these medications. My advice is to weigh your pros and cons when considering opioid medication for fibromyalgia pain.

What are some common fibromyalgia treatment routes?

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1. Medication.

Various medications out there that have been FDA approved to treat fibromyalgia. Doctors often will prescribe anti depressants or anti convulsive medications as they are known to help fibromyalgia pain. There are other medications that your doctor may prescribe. My doctor has me on venlafaxine as many of the other medications had too many side effects or did not work for me. Please note that everyone responds differently to medications. Some people may find medications help while others do not find any improvement. With use of medications, there are also side effects to deal with. Weigh the pros and cons of using medications – speak to your doctor if you have any concerns.

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2. Exercise

I have always had a hard time accepting this as a treatment for fibromyalgia. I used to be such a physically active person before fibromyalgia set in. To be told by health care professionals to add exercise begins to become so redundant and frustrating. Don’t get me wrong exercise is important whether you have fibromyalgia or not. What I have learned, exercise looks much different with fibromyalgia then to someone without fibromyalgia. Fibromyalgia requires gentle exercise.

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3. Stress management.

I never could understand why health care providers kept telling me to practice mindfulness skills or meditation – until now. Before I always rolled my eyes at the thought because I would think ” meditation will not fix fibromyalgia!” It won’t fix it, but it can help control stress. By controlling stress in our lives, fibromyalgia symptoms may ease. Stress releases cortisol into our body. High cortisol levels in the body can cause muscle tension. Muscle tension causes higher chronic pain levels.

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4. Education on fibromyalgia.

As I always say arm yourself with knowledge about fibromyalgia. Do NOT rely on health care providers to do it for you. As the saying goes “Knowledge is power!” Take your health into your own hands since fibromyalgia is often misunderstood by many! We have access to the internet which can be a wealth of information if you use the right sources to research.

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5. Alternative treatments – acupuncture, massage therapy, dry needling, physiotherapy, counselling etc.

There are many alternative treatments that may help alleviate fibromyalgia symptoms. If you have insurance, many of these treatments have some coverage per year, but not enough coverage that is needed for maintenance treatment for fibromyalgia. For example, I get $700 a year for physiotherapy, but when each session is $70-$100 you max out the coverage very quickly. Many people do not have insurance coverage at all – leaving them having to pay out of pocket for each session. Many of the recommended alternative treatments that help improve fibromyalgia cost us money and are often not utilized for this reason alone.

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6. Learning to pace

Learning to slow down and pace yourself is essential. Sadly, not everyone is always given the choice to slow down as life gets busy with family obligations such as kids. If you are able to pace yourself, it can help lower fibromyalgia symptoms and flare ups. It does take time to learn how to pace. For more information of pacing visit my previous blog here.

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There may be more treatment routes out there that doctors may suggest or even a pain clinic. I have just listed the most recommended/used treatment options in this article. Whatever route you choose to explore – remember it takes time and commitment. I hope you find the right combination of strategies that work for you!

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Fibromyalgia – What causes fibromyalgia?

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The cause of fibromyalgia remains unknown, but there are many possible theories to what cause fibromyalgia to develop. Please keep in mind these are just six possible causes and there are likely more not listed in my article . For my article I am just listing the most talked about causes.

1. Hereditary.

Believe it or not fibromyalgia can be hereditary. If there is a family history of fibromyalgia, you have a higher chance of developing it. However, little is known about the genetic basis of fibromyalgia. More research is needed. A 2014 study suggests that a person is 8.5 times more likely to get diagnosed with fibromyalgia if a first degree relative has fibromyalgia.

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2. Physical trauma

Any form of physical trauma is believed to possibly trigger fibromyalgia. It could be trauma from an injury from being in a vehicle accident or even an injury such as a broken bone. I often tell health care providers I think my fibromyalgia began from a knee injury. The spring of 2019, I tore the meniscus and MCL in my knee. Shortly after it “healed” fibromyalgia symptoms began to surface. Keep in mind there are many forms of physical trauma – a vehicle accident to an abusive relationship.

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3. Emotional trauma

Experts believe that emotional trauma can also be a cause of fibromyalgia. Emotional trauma can happen in many situations. Dealing with the loss of someone you were close to can possibly cause fibromyalgia. I was also told by a doctor in 2015, he believed I had fibromyalgia symptoms after I lost my father to cancer. I shrugged it off because the symptoms were so minor back then and only affected me in the fall for a few weeks. Again, abusive relationships also cause emotional trauma. There are many other examples, but for my article I am only listing these two.

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4. Built up toxins in the body/gut

There are theories out there that the build up of toxins in your body are the root cause of fibromyalgia. I have not done much research on this specific theory, so I won’t comment/explain any further. I will say this though…the body removes toxins and waste from our bodies while we sleep. Many of us with fibromyalgia suffer from insomnia or sleep issues. Since this removal takes place while we sleep, can inconsistent sleep cause our body to not properly filter toxins and waste – resulting in toxicity and causing fibromyalgia to form? I don’t have the answer! Just food for thought!

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5. Stress

I personally believe being exposed to high amounts of stress can cause fibromyalgia. There is also a lot of research stating stress can trigger fibromyalgia to develop! Any form of stress! We all know that extreme amounts of stress is not good for our body – eventually our body says enough and respond in one way or another. Maybe for those of us with fibromyalgia that was our body’s response – developed fibromyalgia while others may respond with just getting sick with a cold.

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6. Illness

When we are sick with anything our body is put under stress. Could contracting a certain virus/ bug contribute to fibromyalgia developing? I know a few who contacted the Epstein Barr virus and later got diagnosed with fibromyalgia. Some viral infections have been linked to the development of fibromyalgia. When I attended an online fibro summit, a speaker spoke about seeing an increase in fibromyalgia diagnosis’s for those who had contracted covid19. Is it really fibromyalgia or long-covid symptoms?! Once again, I do not have the answer.

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In the future, researchers may eventually be able to pinpoint what causes fibromyalgia to develop in some people and not others. More research is needed!