Primer on Fibromyalgia and Other Painful Syndromes
Pedro Gismondi M.D.
FIBROMYALGIA is a condition usually
associated with generalized muscle aches and pains and fatigue. It can
be debilitating and, in fact, cause true disability so that some
patients can no longer be gainfully employed.
The purpose of this article is to outline in
some detail the usual approach to treatment. But before
beginning that discussion, I would like to review the origin
of this kind of chronic pain. In most patients
this is unknown. In a few, the origin or cause is some other problem
like a chronic infection, or a hidden cancer,
or perhaps depression. Your primary care physician is
the source of any care associated with the discovery of these hidden
problems, and your role in this is most important because you
will be the one to make your doctor aware when a physical exam (rectal,
breast, etc) is due. Your next step is to see a Rheumatologist who will
attempt to discover if a rheumatic disease like lupus
or inflammatory arthritis is present. This kind of
association is unusual but not rare.
There are many sources of
information about this syndrome (see below) but this is meant to be a
simple outline of the usual approach to treat such patients.
“Treatment” brings to mind the idea that we
are talking about a cure. However, the response to management
is not uniform. The speed of improvement is impossible to predict
because people, their personality, their job, their circumstances,
their way to deal with stress, are all different and none of these
will change with a pill. We will come back to this below.
Management has three main elements:
1. Treat the sleep disturbance. People invariably say, “I can’t sleep”
because I hurt”. The answer always is, “You hurt because you don’t
sleep” or don’t sleep deep enough to allow your body and your mind real
REST. We can produce fibromyalgia in a perfectly normal individual by
depriving him/her of sleep. Tricyclic antidepressants (Elavil,
Sinequan, desipramine) produce the right kind of sleep. If the dose
is too small you may have vivid dreams, even nightmares. So if
this happens, your doctor will ask you to take a little more medicine
for deeper sleep. If you are too sleepy in the morning, you have two
choices, either lower the dose a little or, even better, take the
medicine a lot earlier, i.e., with supper. If you have restless legs at
night or sleep apnea, or if you are a loud snorer. Ask your doctor. He
may have to order a sleep study.
It is hard to acquire
a new habit but you must start. No matter how much you hurt you will
find water exercise, what is called aquatherapy, to be a good solution. I tell my
patients to find a very warm pool somewhere in town and go there 3 or 4
times a week for 30 to 45 minutes. Please start very slowly and
build to aerobic level over 3 to 6 months. Ask your doctor if there are
cardiovascular considerations or limits for you. Once in the water
choose the deeper side of the pool (you will need a floating belt) so
your feet will not touch the bottom of the pool. Respect pain. When you
hurt too much you tense up and make the pain worse. There are
exercise types you should not do. Do not sign contracts for a year
in any spa until you have tried whatever exercise they offer for a few
weeks – without pain. There are gentle, slow toning tables you could
try. Be very careful and wise. Again, this
is not a "3 week treatment" but a lifelong endeavor. Always avoid
movements that cause enough pain to make you tense up. "Tensing up" is
the enemy. Always breathe easy while doing any exercise.
3. Stress Management. Take
an inventory of your life style, your daily activities, and driving
habits. Stay below the speed limit. Take it easy. Do not resist the
idea of counseling if you or your mate see this as a possible way to
solve personal or relationship conflicts. This does not mean you need a
psychiatrist, but perhaps you need a wise counselor. Your pastor or
priest, or even a good friend can help to clear up foggy thinking, and
sort through difficult circumstances or situations. The aim of “stress management” is that
at the conclusion of this effort you should be able to say, “I am at
peace with God, with the world, and with myself.”
Here is a pearl of insight you need to take
to heart. In regard to pain after an injury, there are
two kinds of patients: The tense and the
loose. No offense.
When a person has a motor vehicle
accident, or slips and falls, or slips and braces, the loose will usually recover after a
while – mend the bones, heal the muscle, darn the ligament, etc. The tense
will tense up some more and continue to boil inside and outside, except
a little harder because now there is pain and someone to blame. Now you
are probably angry at me for saying this, and in fact this may not
really apply to you because there are always exceptions. But the
pattern is very common.
Here is another look at the problem of
chronic tension. Mr. A is a very impatient, tense, angry fellow. He
drives aggressively, presses his left leg to the car door while driving
with one foot on the brake and the other on the accelerator. He rear
ended a brand new Cadillac and tried to blame the old gentleman who
drove “too slow” for the highway traffic, and screamed at the poor old
chap because he was going to cause his insurance rates to rise. He
fumed all day and evening and would “rehearse” very frequently the
“stupid” affair in his mind. He carried old grudges, smoked to “relax”
– quite a bit, and when in bed his brain was always in high gear and
would not slow down enough to allow restful sleep.
Mr. B has had a bad break in his recent life,
a truly heartbreaking emotional reverse. He started to lose sleep
because of it. He has a good buddy who lent an ear and suggested an
herbal remedy to relax enough to sleep. He decided to slow down his
life a little, quit his second job, and instead of driving on the busy
highway at rush hour to go home, he began taking the longer route by
the lake and learned to enjoy the wonderful, colorful skies of the Oklahoma sunsets.
Now, you are to guess which one, Mr. A or Mr.
B will really recover, perhaps even be cured.
Take stock of your life. See if it needs some
order, some peaceful times, some forgiveness, some counsel, some
drinking of the cup of the beauty of creation, some relating to the
There are no specific drugs to
treat FM, but Magnesium maleate has been found to help some patients.
There are some medicines that can be helpful. Your doctor may want to
refer you to a Rheumatologist who does treat FM (Some do not). Some
Physiatrists (Physical Medicine and Rehab doctors) also treat FM. If
you have sharp pains in a buttock or a limb, you may also have
Dr. Gismondi was trained in Internal
Medicine at the Mayo Clinic in Rochester, MN. He later completed
Fellowships in Rheumatology at Indiana University and the Emory Clinic
in Atlanta, Georgia. Dr. Gismondi was born in Peru, South America, and
married a Georgia “peach”, Glenda. They live in northwest Oklahoma
They have three grown children, Mark and his wife Tammy, Michael, and
Dr. Gismondi has developed Classic Rub to help anyone suffering
from pain including those experiencing the pain of fibomyalgia.
For more information concerning the Classic Rub click