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Chronic Pain That's Not All in Your Head

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Five little words we women hope we'll never hear again in a doctor's office: It's all in your head. Yet that's exactly what was heard for decades when women reported experiencing widespread pain lasting months and accompanied by sleep disturbances, headache, even mood and memory issues.

Angela Roberts, who saw her share of doctors over the years as she desperately sought a diagnosis for her chronic pain and fatigue, is one of 540,000 adults in Canada trying to cope with this complex yet invisible disability. Chances are, when their doctors did not know what to say or do, some of these people felt defeated and dismissed. Today, that chronic pain condition has not only been given a name but is finally recognized as a legitimate medical condition: Fibromyalgia.

The chronic pain syndrome increases with age and is considerably higher among women than men. Although it is not yet entirely understood, experts now believe that it may be linked to stressful or traumatic physical events such as car accidents or repetitive injuries. Other research is examining its genetic components, potential environmental triggers, and how deficiencies in the hypothalaic-pituitary axis contribute to its development.

Fibromyalgia affects mood and research has also focused on the link between fibromyalgia and depression and fatigue. These affect not only those suffering with the condition but also those around them. One study done by researchers at the University of Missouri found that individuals with fibromyalgia were almost three times more depressed than their spouses. The healthy spouses reported increased levels of marriage instability and said that it was difficult to watch their spouses experience chronic pain.

There is no apparent cure, but there are treatment strategies. For instance, women who exercise regularly have less of a risk of fibromyalgia, and among those who have the condition, regular everyday exercise such as walking, taking the stairs, or even gardening can bring some relief. The problem is that when you have fibromyalgia you can hardly get up off the couch to move. The I-must-exercise-but-am-too-tired-and-in-pain cycle can be a vicious one.

But Angela Roberts found help through a unique program run by Southlake Regional Health Centre in Newmarket, Ontario. That program run by an inter-professional team including rheumatologists, physiotherapists, and social workers covered exercise techniques, medication options, and problem-solving skills to help sufferers attain empowerment and increased emotional well-being -- things that Roberts felt she lost over the years of trying to understand and cope with her illness.

Roberts got the support she needed to re-gain her confidence. Now a patient ambassador for the program, she hopes to raise awareness so that people living with the illness won't feel so isolated: "We have to get over this negative stigma attached to fibromyalgia and just realize that everybody has a bag of hammers, and this is just ours," she concludes.

Toronto naturopath Dr. Louise McCrindle says that fibromyalgia overlaps with various fields including sleep dysfunction, chronic pain and depression. In her view, however, depression does not cause fibromyalgia because "it's normal to be depressed when you have such an isolating and debilitating condition."

Dr. McCrindle, together with Dr. Alison Bested, medical director of the Complex Chronic Diseases Program at BC Women's Hospital in Vancouver, British Columbia, offer common-sense tools to help fibromyalgia patients to improve their quality of life in their book The Complete Fibromyalgia Health, Diet Guide & Cookbook.

Why diet? Diet can have a definite impact, says Dr. McCrindle: "Most of our patients also present with digestive symptoms. A lot of them are not absorbing their nutrients well, so it is important to try to improve their nutrient status." Fibromyalgia is also an inflammatory condition, she says: "In the blood of fibromyalgia patients, inflammation markers are elevated. If you eat more regularly and in a balanced way, if you eat protein and anti-inflammatory foods, you are stabilizing your blood sugars." The anti-fibromyalgia anti-inflammatory diet is balanced, high in protein, low in carbs, organic and Omega-3 rich.

Fibromyalgia cannot be diagnosed by any lab test, but simple blood tests can rule out other possibilities such as hypothyroidism or autoimmune disease. "One of the most debilitating aspects of the condition outside the pain is brain fog," says Dr. McCrindle. "There is often cognitive impairment, memory loss, trouble concentrating, problems in completing tasks." The difference between fibromyalgia and chronic fatigue can be confusing, she admits: "But chronic fatigue is a pathological fatigue with a viral history. Chronic fatigue does not have the pain associated with fibromyalgia."

But just how is it diagnosed? Because not all fibromyalgia patients will see specialists such as a rheumatologist, primary care physicians can now consult the 2012 Canadian Fibromyalgia Guidelines at www.fmguidelines.ca, written to help patients and their health care providers navigate fibromyalgia's murky waters. But according to Montreal Dr. Mary-Ann Fitzcharles, in the absence of abnormal results from laboratory tests, "clinicians must rely on the time-honoured art of medicine to diagnose fibromyalgia."

In a review published last spring in the Canadian Medical Association Journal, Dr. Fitzcharles, Research Institute of the McGill University Health Centre, and her co-authors note that until we know more, "skepticism about the condition will remain." Adds Dr. McCrindle: "There is no magic bullet. It's a slow and steady approach to return to wellness. Regardless of conventional or alternative medicine, you have to go one step at a time to let your body heal."

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