FDA Approves Cymbalta For Fibromyalgia Syndrome (FMS)

Cymbalta is the First Antidepressant Approved to Treat Fibromyalgia

The FDA has approved the drug Cymbalta to treat fibromyalgia.

That makes Cymbalta the first antidepressant approved to treat fibromyalgia, which is a chronic disorder of the muscles and related soft tissue, including ligaments and tendons. Its main symptoms are muscle pain, fatigue, sleep disturbances, and tender points at certain points of the body.

Besides fibromyalgia and depression, Cymbalta is also approved to treat generalized anxiety disorder and diabetic peripheral neuropathic pain, a diabetes-related pain condition, in adults.

Cymbalta belongs to a class of drugs called serotonin and norepinephrine reuptake inhibitors (SNRIs).

The FDA approved Cymbalta for fibromyalgia based on two clinical trials that together included 874 fibromyalgia patients, according to Lilly.

For three months, the patients either took Cymbalta or a placebo. Cymbalta trumped the placebo at pain reduction and overall improvement.

Compared to patients taking the placebo, Cymbalta patients were more likely to experience nausea, dry mouth, constipation, decreased appetite, sleepiness, increased sweating, and agitation.

Cymbalta is the second drug approved by the FDA to treat fibromyalgia. Nearly a year ago, the FDA approved Lyrica as the first drug treatment for fibromyalgia. Lyrica also treats nerve pain caused by shingles and diabetes, as well as reducing some forms of epileptic seizures.

By Miranda Hitti
WebMD Health News

Reviewed by Louise Chang, MD

Article found at WebMD

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Treatment Option For Fibromyalgia, Chronic Back Pain, and Migraines

 

Research is showing that meditation can significantly reduce the pain of certain chronic conditions.

Meditation can help with chronic pain and the anxiety and depression that often accompanies it. It isn’t a cure-all that eliminates the need for medication, but it can help you manage your pain, and it may indeed reduce your need for medication.

“You have to be ready for meditation, and there’s no one more ready than people who are suffering from pain,” says Jon Kabat-Zinn, PhD, former executive director of the Center for Mindfulness in Medicine, Health Care, and Society at the University of Massachusetts Medical School, in Worcester, Mass. Some research and patient experience suggests that meditation may be particularly helpful to people who suffer from the following.

Chronic back pain
Many studies show that meditation not only relaxes the body and helps patients manage pain, but that it can also improve the brain’s response to pain. A 2005 study at the Duke University Medical Center, in Durham, N.C., found that chronic back pain sufferers showed significant improvements in pain and psychological distress after practicing a form of meditation that focuses on releasing anger.

Fibromyalgia
In 2007, researchers at the University of Basel Hospital, in Switzerland, concluded that mindfulness-based stress reduction helped fibromyalgia patients in several ways, including coping with pain, anxiety, and depression. A three-year follow-up found that patients who continued to use some form of mindfulness meditation kept seeing the benefits.

Migraine
Jan Lewis Brandes, MD, assistant clinical professor of neurology at Vanderbilt University School of Medicine, in Nashville, Tenn., and a specialist in migraine management, has seen many patients benefit from meditation and other relaxation techniques along with preventive medication for migraine. “Some people who have anxiety that triggers migraine can use meditation, yoga, and breathing techniques to avoid an attack,” explains Dr. Brandes. “It can give them an edge that medication can’t.”

“Patients will finish a meditation or mindfulness-based stress-reduction program, and their pain may still be a six out of 10, but they sleep better, have better coping skills, and less depression and anxiety,” says Robert Bonakdar, MD, director of pain management at the Scripps Center for Integrative Medicine in San Diego.

Lead writer: Sharon Kay

Article found at Health.com

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Fibromyalgia Syndrome: Tips For Living With Chronic Pain

1. Learn deep breathing or meditation to help with chronic pain relief.

These are techniques that help your body relax, which eases pain. Tension and tightness seep from muscles as they receive a quiet message to relax.

The soothing power of repetition is at the heart of meditation. Focusing on the breath, ignoring thoughts, and repeating a word or phrase — a mantra — causes the body to relax. While you can learn meditation on your own, it helps to take a class.

Deep breathing is also a relaxation technique. Find a quiet location, a comfortable body position, and block out distracting thoughts. Then, imagine a spot just below your navel. Breathe into that spot, filling your abdomen with air. Let the air fill you from the abdomen up, then let it out, like deflating a balloon.

2. Reduce stress in your life. Stress intensifies chronic pain.

Negative emotions like depression, anxiety, stress, and anger can increase the body’s sensitivity to pain. By learning to take control of stress, you can find chronic pain relief.

Several techniques can help reduce stress and promote relaxation. Listening to soothing, calming music can lift your mood — and make living with chronic pain more bearable. There are even specially designed relaxation tapes or CDs for this. Mental imagery relaxation (also called guided imagery) is a form of mental escape that can help you feel peaceful. It involves creating calming, peaceful images in your mind. Progressive muscle relaxation is another technique that promotes relaxation.

3. Boost chronic pain relief with the natural endorphins from exercise.

Endorphins are brain chemicals that help improve your mood while also blocking pain signals. Exercise has another pain-reducing effect — it strengthens muscles, helping prevent reinjury and further pain. Plus, exercise can help keep your weight down, reduce heart disease risk, and control blood glucose levels — especially important if you have diabetes. Ask your doctor for an exercise routine that is right for you. If you have certain health conditions, like diabetic neuropathy, you will need to be careful about the types of activities you engage in; your doctor can advise you on the best physical activities for you.

4. Cut back on alcohol, which can worsen sleep problems.

Pain makes sleep difficult, and alcohol can make sleep problems worse. If you’re living with chronic pain, drinking less or no alcohol can improve your quality of life.

5. Join a support group. Meet others living with chronic pain.

When you’re with people who understand what you’re going through, you feel less alone. You also benefit from their wisdom in coping with the pain.

Also, consider meeting with a mental health professional. Anyone can develop depression if they’re living with chronic pain. Getting counseling can help you learn to cope better and help you avoid negative thoughts that make pain worse — so you have a healthier attitude. Asking for help is a sign of strength, not weakness.

6. Don’t smoke.

Smoking can worsen painful circulation problems and increase risk of heart disease.

7. Track your pain level and activities every day.

To effectively treat your pain, your doctor needs to know how you’ve been feeling between visits. Keeping a log or journal of your daily “pain score” will help you track your pain. At the end of each day, note your pain level on the 1 to 10 pain scale. Also, note what activities you did that day. Take this log book to every doctor visit — to give your doctor a good understanding of how you’re living with chronic pain and your physical functioning level.

8. Learn biofeedback to decrease pain severity.

Through biofeedback, it’s possible to consciously control various body functions. It may sound like science fiction, but there is good evidence that biofeedback works — and that it’s not hard to master.

Here’s how it works: You wear sensors that let you “hear” or “see” certain bodily functions like pulse, digestion, body temperature, and muscle tension. The squiggly lines and/or beeps on the attached monitors reflect what’s going on inside your body. Then you learn to control those squiggles and beeps. After a few sessions, your mind has trained your biological system to learn the skills.

9. Get a massage for chronic pain relief.

Massage can help reduce stress and relieve tension — and is being used by people living with all sorts of chronic pain, including back and neck pain.

10. Eat a healthy diet if you’re living with chronic pain.

A well-balanced diet is important in many ways — aiding your digestive process, reducing heart disease risk, keeping weight under control, and improving blood sugar levels. To eat a low-fat, low-sodium diet, choose from these: fresh fruits and vegetables; cooked dried beans and peas; whole-grain breads and cereals; low-fat cheese, milk, and yogurt; and lean meats.

11. Find ways to distract yourself so you enjoy life more.

When you focus on pain, it makes it worse rather than better. Instead, find something you like doing — an activity that keeps you busy and thinking about things besides your pain. You might not be able to avoid pain, but you can take control of your life.

Article found at WebMD

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Fibromyalgia Pain Management Option: Hydrotherapy

Summary

Hydrotherapy can refer to any treatment that uses water. Several types of hydrotherapy are used in pain management. 

Hydrotherapy performed in pools or tanks allows patients to exercise with less stress on their joints. In other situations, warm or pulsating water may relieve pain by massaging the body, relaxing tight muscles and increasing circulation. This can help relieve conditions including back pain, other joint pain, arthritis, fibromyalgia or spasticity following spinal cord injuries. Hydrotherapy is also used for wound care.

Hydrotherapy can be performed with swimming pools, whirlpools, showers, saunas, compresses, foot baths, body wraps, immersion tanks and other techniques. It often employs heat (thermotherapy), cold (cryotherapy) or both.

Though hydrotherapy is beneficial for treating many disorders, there are conditions and situations where it is not recommended. Patients should consult their physician before beginning hydrotherapy.

About Hydrotherapy

Hydrotherapy is treatment using water to relieve pain or help wounds heal. Swimming pools, whirlpools and Hubbard tanks (tanks that allow patients to immerse their entire body in water) are all used to perform hydrotherapy. Benefits of hydrotherapy may include:

• Decreased pain and stiffness
• Increased muscle relaxation
• Greater ease when performing exercises and daily activities
• Increased healing

Hydrotherapy is often used in arthritis patients to help them exercise joints. The buoyancy of the water counteracts the effects of gravity, allowing patients to exercise with less stress on their joints. Exercise is important for patients with arthritis, because it helps them to retain their maximal range of motion and strength in joints, tendons, ligaments and muscles.

Hydrotherapy is also used to reduce the pain that some patients feel. The water may be heated or cooled to relieve painful acute or chronic conditions such as back pain, neck pain, other joint pain, arthritis, fibromyalgia or spasticity following spinal cord injuries. It can help maintain joint mobility in diseases that restrict range of motion, such as muscular dystrophy.

Physical therapists and other health professionals use hydrotherapy to help wounds heal. Whirlpool treatments assist in debridement (removal of dead tissue and foreign matter).

Though hydrotherapy is beneficial to treating many conditions, there are conditions and situations where it is not advised. For example, people with open wounds may be referred to whirlpool therapy for wound care, but instructed not to use swimming pools. Patients should always consult with their physician before beginning any hydrotherapy treatment plan.

Holistic and alternative health facilities and spas promote many forms of hydrotherapy, such as damp body wraps and facial douches. Such techniques are sometimes advertised as complementary and alternative treatments for everything from varicose veins to migraines, often without scientific backing. Colon hydrotherapy (also known as a high colonic, high enema or colonic irrigation) has been marketed as a treatment for many conditions. However, organizations such as the American Cancer Society caution that colon hydrotherapy is not supported by scientific evidence and can pose dangers such as spreading infections. 

Types and Differences of Hydrotherapy

There are many types of hydrotherapy. They include:

• Pool. Swimming pools can be used to perform pain–relieving therapy. Therapy in a pool – which may or may not involve swimming – is beneficial to many patients because the buoyancy of water supports the body’s weight and removes the effects of gravity. This allows patients suffering from pain to perform low–impact exercises that are less stressful to the joints of the spine, legs and feet.

The support of the water also allows patients to move through their full range of motion more easily. At the same time, the water provides resistance that can help build strength and endurance.

A physician may recommend aquatic exercise therapy for patients who cannot tolerate high-impact activities. Research has shown that water aerobics can also relieve back pain and pelvic pain in pregnant women.

• Hubbard tank. These allow patients to immerse their entire body in water. Convection heating may be used to increase water temperature, facilitating range-of-motion exercises and easing conditions such as arm pain, shoulder pain, leg pain or back pain. Heating can cause blood vessels to dilate, increasing circulation. Therapy in a Hubbard tank can be particularly useful for burn patients, because temperature can be regulated and electrolytes can be added to the water.
• Whirlpool. This form of therapy involves heated, churning water that can help ease muscle sprains, chronic spinal conditions and wound debridement (excision of dead, devitalized or contaminated tissue). Jet nozzles in whirlpools release a mixture of warm water and air that massages the body and helps relax tight muscles.
• Sitz bath. The individual sits in a small tub with water covering the hips. Sitz baths may be advised for conditions such as lumbar pain, pelvic pain, prostatitis or testicular/scrotal pain.
• Saunas and steam baths. A physician may recommend these to ease conditions such as back strain or to relieve stress.
• Damp hot packs or cold packs. These types of thermotherapy and cryotherapy may be part of a physical therapy treatment plan. Moist compresses can be applied at home to ease conditions including migraines, facial pain and herniated discs. 

Some patients can obtain the benefits of water therapy at home by installing a pool or spa or using less expensive techniques, such as foot baths and damp compresses. However, home treatments must be performed correctly to be safe and effective. Patients must be sure that home pools can be entered and exited safely, and that thermometers are available to accurately measure water temperature. Patients should consult with their physician about details such as proper water temperature, suggested exercise routines and length of treatment sessions.

Potential Risks With Hydrotherapy

Hydrotherapy is generally safe when conducted under the supervision or guidance of a physician, but it does carry some risks: 

• Pool. In some cases, an inappropriate water temperature may produce unwanted effects in the body. Patients who are unable to swim need to wear a life vest or other flotation device (or receive supervision) to avoid the potential for drowning. Pool therapy should not be undertaken by patients who have bowel or bladder incontinence, open wounds or sensitivity to certain chemicals.

In addition, exercise performed in a pool is not weight-bearing. This means that patients who exercise in pools are not building bone mass, which is critical to helping protect against conditions such as osteoporosis, a bone-thinning disorder that is most common in women after menopause.

• Hubbard tank, whirlpool and sitz bath. Inappropriate water temperature can cause unwanted side effects in the body. For example, too much time spent in hot water can increase blood pressure. In addition, researchers have found that many recreational whirlpools have bacteria that can cause conditions such as urinary tract infections, skin infections and pneumonia.
• Sauna and steam bath. Use can be dangerous or inappropriate for many individuals, such as those with heart conditions, impaired circulation or sensation (e.g., from diabetes), acute rheumatoid arthritis, acute infections or sexually transmitted diseases.
• Damp hot packs. Improper use can cause burns.

Questions For Your Doctor On Hydrotherapy

Preparing questions in advance can help patients have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions about hydrotherapy:

1. How can hydrotherapy help relieve my pain?
2. Do you recommend hydrotherapy for me?
3. Which types of hydrotherapy can help me?
4. Are there any types of hydrotherapy that can harm me?
5. Where will my treatments take place?
6. I’m concerned about infections. What sort of tank disinfecting and water testing is performed at this facility to ensure cleanliness?
7. What will my treatment involve? Will it include exercises?
8. How often will I be treated and for how long?
9. Do any of my conditions rule out any forms of hydrotherapy?
10. Can I safely perform hydrotherapy at home? What types of home hydrotherapy do you recommend?
11. Does hydrotherapy pose any risks for me?

Reviewed By:
David Slotnick, M.D.

Article found at ivillage

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Fibromyalgia Syndrome & Connection To Myofascial Pain Syndrome (MPS)

Myofascial Pain Syndrome (MPS) is a painful musculoskeletal condition, a common cause of musculoskeletal pain. MPS is characterized by the development of Myofascial trigger points (TrPs) that are locally tender when active, and refer pain through specific patterns to other areas of the body. A trigger point or sensitive, painful area in the muscle or the junction of the muscle and fascia (hence, myofascial pain) develops due to any number of causes. Trigger points are usually associated with a taut band, a ropey thickening of the muscle tissue. Typically a trigger point, when pressed upon, will cause the pain to be felt elsewhere. This is what is considered “referred pain”.

These factors can cause trigger points:

•Sudden trauma to musculoskeletal tissues (muscles, ligaments, tendons, bursae)
•Injury to intervertebral discs
•Generalize fatigue (fibromyalgia is a perpetuating factor of MPS, perhaps chronic fatigue syndrome may produce trigger points as well)
•Repetative motions; Excessive exercise; Muscle strain due to over activity
•Systemic conditions (eg, gall bladder inflammation, heart attack, appendicitis, stomach irritation)
•Lack of activity (eg, a broken arm in a sling)
•Nutritional deficiencies
•Hormonal changes (eg, trigger point development during PMS or menopause)
•Nervous tension or stress
•Chilling of areas of the body (eg, sitting under an air conditioning duct; sleeping in front of an air conditioner)

The fascia is a tough connective tissue which spreads throughout the body in a three dimensional web from head to foot without interruption. The fascia surrounds every muscle, bone, nerve, blood vessel and organ of the body, all the way down to the cellular level. Therefore, malfunction of the fascial system due to trauma, posture, or inflammation can create a binding down of the fascia, resulting in abnormal pressure on nerves, muscles, bones or organs.

This can create pain or malfunction throughout the body, sometimes with bizarre side effects and seemingly unrelated symptoms. It is thought that an extremely high percentage of people suffering with pain and/or lack of motion may be having myofascial problems; but most go undiagnosed, as the importance of fascia is just now being recognized.

Many of the standard tests, such as x-rays, myelograms, CAT scans, eletromyography, etc., do not show the fascia. (John Barnes, P.T., 1992)

Occassionally, trigger points produce autonomic nervous system changes such as flushing of the skin, hypersensitivity of areas of the skin, sweating in areas, or even “goose bumps.” The trigger points cause localized pain, although TrPs can involve the whole body.

In three studies, the prevalence of myofascial TrPs among patients complaining of pain anywhere in the body ranged from 30% to 93%; (among patients with chronic craniofacial pain, 55%; and for lumbogluteal pain, 21%.)

The characteristic electrical activity of myofascial TrPs most likely originates at dysfunctional endplates of extrafusal muscle fibers. This dysfunction appears to play a key role in the pathophysiology of TrPs. (Simons 1996)

Subjective shortness of breath can be part of the myofascial pain syndrome of the levator scapulae muscle. In one study, 75 patients who reported neck pain & shortness of breath were examined. Trigger points were located and inactivated with acupuncture needles (dry needling). 68 of the 75 patients in the study reported that their shortness of breath and soreness were abolished immediately after inactivation of the TrPs. The other 7 patients needed a second trial of inactivation. Eliminating the trigger points eliminated the symptoms. (Journal of Muskuloskeletal Pain, 1996)

Like fibromyalgia, Myofascial Pain syndrome is an often misunderstood condition. Even today, some doctors either don’t believe that MPS exists or they don’t understand its symptoms and treatment.

Treatment of MPS can only begin after an accurate diagnosis is accomplished. Methods for managing this painful condition:

• Trigger Point Therapy {Myofascial release therapy, myotherapy, massotherapy (medical massage therapy)}
• Spray and Stretch technique (stretching of the muscles involved with a vapocoolant spray - a coolant is sprayed on the trigger point to lessen the pain and then the muscle is stretched. this is often done by a physical therapist.)
• Trigger Point Injections (local anesthetic,such as lidocaine, injected directly into the trigger points)
• Dry Needling (the use of a needle without injecting anything)
[TrP injections and dry needling mechanically disrupt the tirgger point. The use of lidocaine is no more effective, but it reduces the soreness afer injection. For MPS there is no role for injected steroids]
• Chiropractic or Osteopathic manipulation treatment
• Craniosacral Therapy
• Physical Therapy (hands-on)
• Exercise
• Improvement of nutrition
• Changing sleeping habits
• The use of tricyclic antidepressants in low doses
• Elimination of stress; Biofeedback; Counseling for depression that may result from this painful condition

An active trigger point when treated well or with rest will become latent (quiet, or not causing active symptoms). It can often resurface after trauma after acute overload or fatigue, or even sudden exposure to cold. Conversely, new trigger points may arise elsewhere, or at least become more sinificant as others become latent.

For MPS, you should see a doctor knowledgeable in chronic pain such as a physical medicine doctor (a physiatrist), or a neurologist. The diagnosis is made by the history and physical exam. There is no lab test nor imaging studies to confirm the diagnosis. A history of acute trauma or chronic overuse should be looked for.. On exam, there is typically restricted motion with pain of the affected muscle. Other medical problems need to be ruled out with imaging or other studies. For instance, if a patient presents with back pain, disc and other problems need to be ruled out.

Altered Pain Perception Accompanies MPS: A Danish study indicates that people with chronic myofascial pain perceive and transmit pain differently than people without the syndrome. As many as 72 percent of people with fibromyalgia may have trigger points associated with myofascial pain.
Source: “Qualitatively altered nociception in chronic myofascial pain,” by L. Bendtsen, R. Jensen, and J. Olesen, Pain, 65 (1996), pages 259-264

 

Fibromyalgia or Myofascial Pain Syndrome or both?

 

Differential features of Fibromyalgia & Myofascial Pain Syndrome

Feature	FMS	MPS
Pain	Diffuse	Local
Fatigue	Common	Uncommon
AM Stiffness	Common	Uncommon
Tender Points	X
Trigger Points		X
Prognosis	Chronic	Resolves with treatment

Article found at AOL

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Fibromyalgia Syndrome: General Anesthesia Can Increase Post-Op Pain

“The choice of anesthetic appears to be an important determinant of post-operative pain.” – Gerard Ahern, PhD, Georgetown University Dept. of Pharmacology  

Washington, D.C. - The general anesthesia that puts patients into unconscious sleep so they do not feel surgical pain can increase the discomfort they feel once they wake up, say researchers from Georgetown University Medical Center. They say their findings, the first to scientifically explain what has been anecdotally observed in the clinic, may lead to wider use of the few anesthetics that don’t have this side effect, or to the development of new ones. 

In the June 24 issue of the Proceedings of the National Academy of Sciences (PNAS)¹ the scientists report that “noxious” anesthesia drugs - which most of these general anesthetics are - activate and then sensitize specific receptors on neurons in the peripheral nervous system. These are the sensory nerves in the inflammation and pain pathway that are not affected by general anesthesia drugs that target the central nervous system – the brain and the spinal cord. 

“The choice of anesthetic appears to be an important determinant of post-operative pain,” says the study’s lead investigator, Gerard Ahern, PhD, an assistant professor in the Department of Pharmacology at Georgetown University Medical Center. “We hope these findings are ultimately helpful in providing more comfort to patients.”

• It has long been known that general anesthetics cause irritation at the infusion site or in the airways when inhaled, Dr. Ahern says. 
• And investigators have also known that while they suppress the central nervous system, they can activate so-called “pain-sensing” or nociceptive nerve cells on the peripheral nervous system. 
• In fact, anesthesiologists often first use a drug to suppress inflammation and pain before delivering the anesthesia to put the patient to sleep. 
• But what has not been understood is the specific mechanism by which anesthetics affect sensory neurons, or that they can continue to cause pain and inflammation even as they are being used during surgery, Dr. Ahern says.

The Hypothesis

The researchers tested the hypothesis that two specific receptors on the nerve cells (TRPV1 and TRPA1) which are often expressed together and which also react to other irritants, such as garlic and wasabi, were the ones activated by the noxious drugs. 

“Plants produce chemicals such as capsaicin, mustard and garlic that were meant to stop animals from eating them. When they are eaten, the two main receptors that react to them are TRPV1 and TRPA1,” Dr. Ahern says. In fact, TRPA1 is more commonly known as the mustard-oil receptor, and is a principal receptor in the pain pathway, he says.

The Findings

Experiments showed that general anesthetics appear to regulate TRPA1 in a direct fashion, and are thus responsible for the acute noxious effects of the drugs. Perhaps the strongest evidence is that mice bred without TRPA1 genes demonstrate no pain when the drugs are administered and used, Ahern says. 

“Most general anesthetics activate the mustard oil receptor, and animals that don’t have the receptor don’t have irritation,” he says. 

The research team also found that nerve-mediated inflammation was greater when pungent (chemical irritants) versus non-pungent inhaled general anesthetics were used. 

The Implications

What both findings suggest is that sensory nerve stimulation throughout the body just before and during surgery adds to the pain that is felt after the patient is awake, Ahern says. 

“This is a provocative finding in terms of the clinical setting, because it was not really recognized that use of these drugs results in release of lots of chemicals that recruit immune cells to the nerves, which causes more pain or inflammation.” 

Some general anesthetics do not activate the mustard-oil receptor, but they may not be as effective in other ways, Ahern says. “This tells us that there is room for improvement in these drugs.” 

The study was funded by National Institutes of Health and the National Multiple Sclerosis Society. Co-authors include José Matta, PhD, Paul Cornett, PhD, Rosa Miyares, BA, Ken Abe, PhD, and Niaz Sahibzada, PhD, from Georgetown University.

____
1. See “General anesthetics activate a nociceptive ion channel to enhance pain and inflammation,” PNAS (Proceedings of the National Academy of Sciences) June 24; 105:8784-8789. PMID: 18574153, by Ahern GP, Matta JA, et al. [E-mail: Gerard P Ahern gpa3@georgetown.edu]

Source: Georgetown University Medical Center news release, June 23, 2008

Note: This information has not been evaluated by the FDA. It is generic and is not meant to prevent, diagnose, treat or cure any disease. It is very important that you make no change in your healthcare plan without researching and discussing it in collaboration with your professional healthcare team.

Article found at ImmuneSupport.com

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Fibromyalgia Disability Application Issues

Without hard lab test data to measure how sick you are, you can still provide objective evidence of how it affects your life.

FM & ME/CFS specialist Richard Podell, MD* - a clinical professor at New Jersey’s Robert Wood Johnson Medical School - has served as a Fibromyalgia disability medical expert witness on behalf of both insurance companies and patients, and lectures legal professionals on the process of disability litigation. Though this advice applies specifically to claims in New Jersey, much of it will be useful in general.

_______________________

For someone with Fibromyalgia, it’s a difficult step to apply for disability. That’s true…throughout the country. How upsetting it then feels if an insurance company representative appears not to believe that you are actually very ill. But don’t be put off. You can improve your Fibromyalgia disability claim, if you imagine yourself in the insurance examiner’s place. 

Medical Expert Witness Issue #1
Your insurance company isn’t allowed to assume that you are telling the truth just because you say so. 

Insurance companies have learned by hard experience with other forms of illness that a few individuals exaggerate their symptoms. Therefore, a disability insurance company has not only the right, but an obligation to satisfy themselves that the claims they pay are, in fact, valid.

Expert Medical Witness Issue #2
Fibromyalgia pain is, by definition, subjective. No one can just look and tell for sure how you feel. In contrast, most illnesses that disability companies are used to display “objective” abnormalities that anyone can see.

People with bad backs have trouble bending; people with bad knees may limp. People with heart or lung disease can’t walk very far. EKG or chest X-ray may show damage. However, Fibromyalgia disability is different. You may look fairly normal. So, how can the insurance agent know for sure that you’re truthful?

Medical Expert Witness Issue #3
With Fibromyalgia, when you physically push through your limits the expected flare-up of symptoms might not occur right away. 

Often the flare-up is delayed for hours or even a day. This pattern of Fibromyalgia disability is very different from that of most other illnesses. Insurance industry representatives - and indeed many physicians - don’t yet understand this very basic fact. 

Consider the Functional Capacity Evaluation (FCE), the insurance industry’s standard “test.” A physical or occupational therapist observes a claimant’s ability to bend, crawl, push, and pull things during a single session of two hours or so. 

That’s fine if the key problems are muscle weakness or stiff joints, where the symptom flare-up occurs quickly. 

But it misses the point for Fibromyalgia, since the expected flare-up often does not occur. Current FCE protocols make no provision for follow-up; so these delayed reactions are missed.

Expert Medical Witness Issue #4
Physically pushing through your limits for just one day might cause only a minor flare-up. But repeating the same effort - for two, three, four or five days in a row –will usually cause a flare-up that’s much more severe.  Current FCE protocols test for just one or two days. But real world work occurs five days every week. FCE testing therefore is not a realistic test of the Fibromyalgia patient’s ability to actually keep at work. 

Practical “Tests” To Substantiate Your Fibromyalgia Disability
We don’t yet have an “objective” lab test to measure how sick you are. However, you can “objectively” document how your fibromyalgia disability has affected how you live. 

Test #1: Keep a diary of how you feel each day, how you spend your time, when you were too tired to undertake a normal task, and how your symptoms were affected when you tried to do too much. It’s easy to dismiss as self-serving an essay you write the day you apply for disability, but a six to twelve month long diary should be taken seriously. That’s how you can serve as your own “expert medical witness”. 

Test #2: Obtain written statements from friends, clergy, employers, neighbors, even family - who know how your illness has affected or limited your life. This “objective” testimony is impossible to ignore. 

Test #3: Be sure your physician actually writes down in his or her office notes the specific ways that your illness limits your life style and activities. Your doctor’s office notes may be your most important medical expert witness. 

Test #4: Ask your physician to document ALL your fibromyalgia related complaints, not just your muscle pain. For example: poor stamina and fatigue, prolonged exacerbation of pain and/or fatigue after modest activity, muscle pain, poor sleep and cognitive difficulties may be as important as fatigue for affecting your ability to work. 

Note: Many people with Fibromyalgia disability also satisfy the diagnostic criteria for Chronic Fatigue Syndrome. In other settings such as social security, the standards for proving disability due to chronic fatigue syndrome are clearer than they are for fibromyalgia. However, in other settings it’s the opposite. As a practical matter, if you qualify for both diagnoses, it may be best to present them both. 

Test #5: Consult at least one physician who has special expertise, sympathy and experience with fibromyalgia.   

Check with your local fibromyalgia support groups for a read on which local doctors are both knowledgeable and sympathetic. 

Test #6: You, your physician and your attorney should discuss the pro’s and con’s of accepting your disability insurance company’s invitation to undergo functional capacity evaluation (FCE) testing. 

As currently performed – on a single day, without attention to the typical delayed symptom flare-up, the FCE is a misleading test of your ability to function in the workplace on an on-going basis. And, if you are very ill, the physical effort involved in the FCE testing, might make you worse for many weeks or for months. 

Test #7: Consider obtaining a formal evaluation by a psychologist or a psychiatrist. If depression or anxiety have developed, it’s best that you recognize and treat it. 

Once that’s been done, your psychologist or psychiatrist can attest that the physical aspects of your illness are the main reasons why you are not able to work. Without this support a skeptic might dismiss your claimed impairment as mainly “psychological.” 

Test #8: If a major part of your disability claim relates to mental concentration difficulties, consider formal neuropsychological testing. 

This entails several hours of standardized pencil and paper testing, and is expensive. But it’s the most objective way to document cognitive impairment. However, the cognitive defects we can measure can be fairly subtle. So be sure the neuropsychologist you see has experience as an expert medical witness testing people with severe fibromyalgia and/or ME/CFS. 

Full article found at FibromyalgiaSupport.com

For hundreds of additional articles about Fibromaylgia and how to reduce its impact on every aspect of your life, please visit the FibroFocalPoints section of FibroFighters.com today!

As always, stand tall and let the world know you’re: “Not taking it lying down™!”

Please click on the link below to join the fight today!

Fibromyalgia Syndrome: Tips For Combatting Tiredness!

22 ways to tackle life’s biggest energy zappers.

Every day, 2.2 million Americans complain of being tired. Most of us chalk it up to having too much to do and not enough time to do it in, especially during extra-busy periods. But often the true culprits are our everyday habits: what we eat, how we sleep, and how we cope emotionally. Read on for some simple, recharging changes that can help you tackle all of the energy stealers in your life.

Energize Your Diet

Why is it that filling up on pasta or Chinese food for lunch leaves us snacky and sleepy an hour later? Or that falling short on fluids makes us forgetful and foggy? Fact is, eating habits play a powerful role in how well we function on every level. Below, six top fatigue-fighting nutrition strategies to chew on.

• Have breakfast… even if you don’t feel hungry. You’ll be a lot perkier: Studies show that people who eat breakfast feel better both mentally and physically than those who skip their morning meal. British researchers at Cardiff University even found that spooning up a bowl of breakfast cereal every morning is associated with lower levels of the stress hormone cortisol.
• Eat every three to four hours. Having three smallish meals and two snacks throughout the day can keep your blood sugar and energy levels stable all day long, says Roberta Anding, R.D., a spokesperson for the American Dietetic Association (ADA). Note the word “smallish.” Supersized meals demand more of your energy to digest, which can leave you feeling lethargic. At each mini-meal, get a mix of carbohydrates (which the body uses for energy), protein (which helps sustain energy if needed), and healthy fats like those found in fish, nuts, and olives — these fats and protein contribute to meal satisfaction, so you don’t go hunting for sweets an hour later and wind up with a short-lived sugar high and subsequent crash. A few meal ideas: a low-fat yogurt parfait with berries and a couple of tablespoons of whole-grain granola; salmon over mixed greens with whole-grain crackers; and beef tenderloin with a baked sweet potato and asparagus.
• Fill up on more fiber. Fiber has a time-releasing effect on carbs, so they enter your bloodstream at a slow and steady pace, giving your energy staying power, says Anding. When choosing your mini-meals (see above), include fiber-filled options that add up to the daily recommended 25 to 30 grams of fiber (the average person gets only between 10 and 15 grams). Some suggestions: a bowl of raisin bran (5 grams of fiber per cup); black beans and cheese wrapped in a multigrain tortilla (beans have 7.5 grams per 1/2 cup; one tortilla has 5 grams); air-popped popcorn (3.6 grams per 3 cups); an apple with the skin (3.3 grams); and whole-wheat spaghetti (6.3 grams per cup).
• Fuel your brain with omega-3s. Found in fatty fish (such as tuna and salmon), walnuts, and canola oil, these essential fatty acids play a role in keeping brain cells healthy and helping you feel mentally alert. Another potential bonus: Omega-3s encourage the body to store carbs as glycogen — the storage form of glucose (blood sugar) and the body’s main source of stored fuel — rather than as fat.
• Stay hydrated. Water makes up the majority of your blood and other body fluids, and even mild dehydration can cause blood to thicken, forcing the heart to pump harder to carry blood to your cells and organs and resulting in fatigue. Also, ample fluids keep energy-fueling nutrients flowing throughout the body, says Nancy Clark, R.D., author of Nancy Clark’s Sports Nutrition Guidebook. To gauge your hydration, Clark recommends monitoring how often you urinate. You should be going every two to four hours, and your urine should be clear or pale yellow in color. Tip: Besides drinking more, you can also consume foods that naturally contain water, such as yogurt, broccoli, carrots, and juicy fruits, like watermelons, oranges, and grapefruits.
• Watch caffeine intake after noon. Typically, consuming a moderate amount of caffeine — 200 to 300 mg, the amount found in two to three cups of coffee — can make you more energetic and alert in the hours following, says Anthony L. Komaroff, M.D., a professor of medicine at Harvard Medical School. But when caffeine is consumed in large quantities — or anytime in the afternoon or evening — the quality of your sleep that night can take a nosedive, leaving you with heavy eyelids the next day. One caution for those who are highly sensitive to caffeine: Although switching to a decaf latte in the afternoon sounds like the answer, researchers at the University of Florida found that out of 22 decaffeinated coffee beverages tested, all but one contained some caffeine.

Energize Your Spirit

• We’re all familiar with physical exhaustion, but mental strain — sadness, boredom, worry, anger, and general stress (the biggie) — can take an even heavier toll on vitality, completely wearing you out. Life happens, and these difficult emotions will, too. But if you react wisely, your brain and body will rebound — along with your vim and vigor.
• Splash some water on your face or take a shower when you’re feeling burned-out. Some 55 percent of study participants reported using these types of “water therapy” to successfully increase their energy, according to findings in the Journal of Personality and Social Psychology. Apparently, a little H ₂ O refresher can instantly help take the edge off when you’re feeling overwhelmed.
• Suit up in a “power” outfit to beat the blahs. Fight the tendency to throw on sweats when you’re feeling sluggish. Although it may seem counterintuitive to slip into the skirt you save for special occasions, it helps to look in the mirror and see an energizing image — not a deflating one that confirms and reinforces your internal state, says Alice D. Domar, Ph.D., founder and executive director of the Domar Center for Complementary Healthcare in Waltham, MA. Dressing for success will give you a big mental boost every time you catch sight of your reflection (or receive a compliment) throughout the day.
• Vent your feelings. Keeping fear, anxiety, and stress pent up inside may seem like a grown-up way to deal with these emotions. But discussing negative feelings with another person can ease them far better than keeping them bottled up; by airing them, you reduce their ability to sap your stamina, says Komaroff, who is also the editor-in-chief of the Harvard Health Letter.
• Turn on some tunes. Listening to music is one of the most effective ways to change a bad mood, decrease tension, and increase energy. Consider this: Runners in one study who listened to music while on the treadmill ran faster than those who jogged in silence — no matter how loud the volume or how fast the tempo, according to new findings in the journal Ergonomics. Other research suggests that music effectively distracts you from feeling fatigue. Try burning a CD of your favorite songs and playing it anytime you need a pick-me-up. (If you exercise, so much the better — but the music will move you either way.)
• Let go of grudges. Nursing a grudge prompts your mind and body to react as if they’re under chronic stress, increasing your heart rate and blood pressure and potentially resulting in an impaired immune system and exhaustion over time, according to a study in the journal Psychological Science. On the other hand, practicing empathy and forgiveness after you’ve been wronged makes you feel as if you’re back in control, which keeps the body’s stress responses in check. The next time you find yourself harboring ill feelings, repeat a stress-relieving mantra to yourself, such as, “Forgiveness makes me a happier and stronger person.”
• Take belly breaths. When we’re under stress, we’re prone to take “chest breaths” — short, shallow ones, says Domar. Chest breathing brings less air into the lungs and reduces the supply of energizing oxygen to the body and brain, leaving you physically and mentally drained. The goal is deep, diaphragmatic breathing — like that of a sleeping infant: When you breathe in, your belly should round and fill like a balloon; on an exhale, your belly should slowly deflate. Of course, remembering to practice deep breathing isn’t the first thing on your mind when you’re under the gun, so as a visual reminder, try posting a tranquil picture (such as a pool of water or your kids smiling) with the word “breathe” next to your computer, or anywhere you tend to feel on edge.
• De-clutter a corner. Go through that teetering pile of papers or overflowing closet and clear it out. Clutter can make you feel out of control and overwhelmed, especially when you’re already feeling stressed or down. Plus, simply accomplishing a goal, no matter how seemingly minor, can be energizing, says Domar.
• Do some good. Acts of altruism can lend a little pep to your step. In fact, one study in the Journal of Health and Social Behavior found that volunteer work can boost your energy in six ways: It enhances happiness, life satisfaction, self-esteem, sense of control over life, physical health, and mood. Find short- and long-term volunteer opportunities at volunteermatch.org and charityguide.org.

Get a Restorative Rest

When you have a lot to do (um…always), usually the first thing to get squeezed off your agenda is sleep. But miss out on shut-eye and your energy, positivity, productivity, and memory are sure to suffer. And nearly a quarter of American adults aren’t getting enough rest, which has led to an epidemic of daytime sleepiness, according to a poll by the National Sleep Foundation. The key to bucking this trend is to brush up on sleep hygiene. Try these steps for starters.

• Cut back on TV and computer time after 8 p.m. If you’re already a night owl (you go to bed late and sleep in on weekends), the bright light emitted from television and computer screens can make falling asleep at a decent hour even harder. The reason: Light suppresses the production of melatonin, a hormone secreted at sunset that tells the brain that it’s nighttime, explains John Herman, Ph.D., director of the training program in sleep medicine at the University of Texas Southwestern Medical School at Dallas. And when melatonin levels are low, your brain is fooled into thinking that it’s still daytime — and remains raring to go. Whenever possible, wait until the next morning to tune in and/or log on. If you must use light-emitting technology at night, try to turn it off an hour or two before hitting the sack.
• Hide your alarm clock. Watching the clock to see how long it’s taking you to drift off or how much time you have left before your alarm goes off can result in a poor night’s sleep, says Kelly A. Carden, M.D., medical director of the Sleep Health Center Affiliated with Hallmark Health at Medford in Medford, MA. This hypervigilance keeps the brain awake and alert and prevents you from slipping into deep, restorative sleep. The easy fix: Set your alarm clock, then either face the numbers away from you or put it on the floor, in a drawer, or across the room.
• Give your pet his own separate sleeping space. At night, pets snore, jiggle their tags, move around a lot, and even hog the covers and bed space. It’s no wonder that 53 percent of pet owners who sleep with their pets in the bedroom have some type of disrupted sleep every night, according to a study from the Mayo Clinic Sleep Disorders Center in Rochester, MN. Consider relocating your furry friend’s sleeping quarters to another area, even if it’s just his own bed in your bedroom.
• Lower the thermostat. For a good night’s sleep, make sure your room is comfortably cool — enough so that you need a light blanket. This ensures that your environment is in sync with your body’s internal temperature, which naturally drops during the night, according to the National Sleep Foundation. Studies suggest the ideal sleeping temperature is between 54 and 75 degrees; anything cooler or warmer may cause you to wake up.
• Skip the nightcap. Alcohol depresses the nervous system — the system of cells, tissues, nerves, and organs that controls the body’s responses to internal and external stimuli. So while sipping a glass of wine before bed may help you nod off, the sedative effects wear off as your body metabolizes the alcohol, which may cause you to wake up in the middle of the night and have trouble falling back to sleep. Alcohol has also been shown to interfere with the body’s natural 24-hour biorhythms, causing blood pressure to rise and heart rate to race at night when it’s normally calm and relaxed. You don’t have to give up that evening cocktail entirely to achieve sound sleep — just try to avoid alcohol within two to three hours of bedtime.
• Get your exercise. While scientists don’t yet understand why, aerobic exercise has been proved to help you fall asleep faster at bedtime, spend more hours in deep sleep, and wake up less often throughout the night, says Komaroff. At the same time, vigorous exercise can act like a stimulant (which is a great daytime energizer), so schedule your workouts in the morning or afternoon, when you need a boost the most.
• Follow the 15-minute rule. If you can’t fall asleep, or if you wake up and can’t get back to sleep within about 15 minutes, get out of bed and do something relaxing that will help clear your head, such as reading, meditating, or knitting (but not watching TV or surfing the Web). Then, once you feel sleepy again, go back to bed. If you stay put and fret about being awake, you’ll only make yourself more anxious — and less likely to catch the z’s you need.
• Write down your worries. During the day, jot down any stressors that are weighing on you, says Carden. Then, do some mental problem-solving before your head hits the pillow — or, if you’re falling short on solutions, tuck your list away and resolve to brainstorm ideas during your morning shower or commute to work. Just knowing you’ve established a plan for tackling your to-do’s will make you feel like you’ve made some progress, allowing you to relax, drift off — and wake up the next morning ready to take on the day.

WebMD Feature from “Redbook” Magazine

By Nancy Rones

Article found at WebMD

For hundreds of additional articles about Fibromaylgia and how to reduce its impact on every aspect of your life, please visit the FibroFocalPoints section of FibroFighters.com today!

As always, stand tall and let the world know you’re: “Not taking it lying down™!”

Please click on the link below to join the fight today!

Fibromyalgia Syndrome: Free or Low-Cost Treatment For Depression

Perhaps the only thing worse than depression is having depression and not being able to afford treatment. I frequently get letters from those of you who are in just this predicament. I’ve collected here all of the free and low-cost resources and ideas that I have come across in the past couple of years. I will continue to add more as I find them.

LOW COST MEDS

Pill Splitting - An article in the September 1999 issue of Clinical Psychiatry News reports that you may be able to purchase a higher dose pill at a cost only slightly more than the dose you’re currently on and split them in half. In a presentation to the APA, it was reported that patients can save an average of 37% off their current medication costs by pill splitting. A list of the medications surveyed included popular antidepressants.

FREE MEDS

Needy Meds - According to their website: “NeedyMeds is a 501(3)(c) non-profit with the mission of helping people who cannot afford medicine or healthcare costs. The information at NeedyMeds is available anonymously and free of charge.”

The Medicine Program - The Medicine Program’s free services include: a prescription plan, a 24-hour nurse hotline, a dental plan, a medical plan, a vision plan and medical records storage. Their benefits are subsidized by running Google ads on their site.

Free Samples - Often pharmaceutical companies provide physicians with free samples. Ask your doctor is he/she has any samples on hand of your medication. I used to get all my Buspar this way.

ALTERNATIVES TO PRESCRIPTION MEDS

There are several herbals and nutraceuticals on the market that are reputed to work well as antidepressants and anti-anxiety treatments. They are inexpensive and do not require a prescription. St. John’s Wort, melatonin, Kava Kava and Valerian have all been very effective for me personally.

St. John’s Wort (depression)

Evening Primrose Oil (PMS, PMDD)

5-HTP (depression)

SAM-e (depression)

Vitamins and Minerals (depression)

Kava Kava (anxiety)

Valerian (anxiety and sleep)

Melatonin (sleep)

LOW COST TREATMENT

Sliding Scale Fees - Some providers may have sliding-scale fees. Based on your income, the provider will reduce his or her fees.

Negotiate a Lower Fee with Your Doctor - Other providers, if they are aware of your financial limitations, may be willing to negotiate a payment plan that you can afford or to lower their rates according to what your insurance plan pays.

Community Mental Health Centers - Many communities have community mental health centers (CMHCs). These centers offer a range of mental health treatment and counseling services, usually at a reduced rate for low-income people. CMHCs generally require that you have a private insurance plan or be a recipient of public assistance.

For more information about Community Mental Health Centers:

National Council for Community Behavioral Health Care

12300 Twinbrook Parkway, Suite 320

Rockville, MD 20850

voice: 301-984-6200

fax: 301-881-7159

Email: Communications@thenationalcouncil.org

http://www.nccbh.org/

Pastoral Counseling Programs - Your church or synagogue can put you in touch with a pastoral counseling program. Certified pastoral counselors, who are ministers in a recognized religious body, have advanced degrees in pastoral counseling, as well as professional counseling experience. Pastoral counseling is often provided on a sliding-scale fee.

For more information about Pastoral Counseling Programs:

American Association of Pastoral Counselors

9504-A Lee Highway

Fairfax, VA 22031-2303

voice: 703-385-6967

fax: 703-352-7725

http://www.aapc.org/

e-mail: info@aapc.org

SELF-HELP AND SUPPORT GROUPS

Another option is to join a self-help or support group. These groups give people a chance to talk about and work on their common problems-such as alcoholism, substance abuse, depression, family issues, and relationships. Self-help groups are generally free and can be found in most communities. You may also join an online support group.

For more information about Self-Help Groups:

American Self-Help Clearinghouse

Northwest Covenant Medical Center

25 Pocono Road

Denville, NJ 07834-2995

voice: 201-625-9565

fax: 201-625-9565

http://mentalhelp.net/selfhelp/

National Mental Health Self-Help Clearinghouse

1211 Chestnut Street, Suite 1000

Philadelphia, PA 19107

800-553-4KEY

PUBLIC ASSISTANCE

People with severe mental illness may be eligible for several forms of public assistance, both to meet basic costs of living and to pay for health care. Such programs include Social Security, Medicare, Medicaid, and disability benefits.

For information about Social Security, Medicare, and disability benefits call:Social Security Administration at 800-772-1213.

SSA Web site: http://www.ssa.gov/

Medicare - Medicare is America’s major Federal health insurance program for people who are 65 or older and for some with disabilities who are under 65. It provides basic protection for the cost of health care. Two programs can help people who have low incomes receive benefits. These are the Qualified Medicare Beneficiary (QMB) and the Specified Low- Income Medicare Beneficiary (SLMB) programs.

Medicaid - Medicaid pays for some health care costs for America’s poorest people. More information about Medicaid and who is eligible for it is available at local welfare and medical assistance offices. Although there are certain Federal requirements, each State has its own rules and regulations for Medicaid. The Medicaid Clearinghouse contains links to information for individual states.

BECOME A RESEARCH SUBJECT

Many research programs for new meds and treatments will provide free treatment for participants. The downside of this is you run the risk of getting a placebo or an unproven treatment, but if you have nothing to lose, this may be better than no treatment at all.

FREE CLINICS

If anyone knows of other free clinics around the country, please email me and I’ll add them to the list.

Haight Ashbury Free Clinic- This free clinic in San Francisco provides services for general health care, HIV, homeless people, mental health care and substance abuse recovery.

Locating Other Free Clinics - The National Free Clinic Directory and A Free Clinic: Starting Out (a manual on how to start free clinics) are published by The Free Clinic Foundation of America and the Bradley Free Clinic of Roanoke, Virginia. You can reach them at:

Free Clinic Foundation of America

1240 Third Street, SW

Roanoke, VA 24016

Phone (540) 344-8242

Fax (540) 342-0220

e-mail: bradleyfc@mailcity.com

http://www.freeclinicfoundation.com/

FURTHER RESOURCES

For more information about paying for mental health care, contact:

Knowledge Exchange Network (KEN)

P.O. Box 42490

Washington, DC 20015

800-789-CMHS (2647)

(866) 889-2647 (tdd)

http://www.mentalhealth.org/

National Alliance for the Mentally Ill (NAMI)

Colonial Place Three

2107 Wilson Blvd., Suite 300

Arlington, VA 22201-3042

voice: 703-524-7600

fax: 703-524-9094

http://www.nami.org/

National Empowerment Center

599 Canal Street

Lawrence, MA 01840

Fax: 978-681-6426

Toll-free: 800-power2u (800-769-372

Outside US: 978-685-1494

Local calls: 978-685-1494

Email: http://www.power2u.org/contact.html

Article found at about.com

For hundreds of additional articles about Fibromaylgia and how to reduce its impact on every aspect of your life, please visit the FibroFocalPoints section of FibroFighters.com today!

As always, stand tall and let the world know you’re: “Not taking it lying down™!”

Please click on the link below to join the fight today!

Fibromyalgia Syndrome (FMS) And The Art Of Resilience

You need to know what resilience is so that you can remember that you have it. Resilience is an emotional muscle that can grow with use and practice — or atrophy if ignored.

Everyone can grow this emotional muscle. Everyone needs to.

You are born with some resilience. You have the choice how to apply it throughout your life. To grow resilience you need fuel, you need challenge and you need lots of practice.

Some people believe that resilience is a trait that is inborn; you either have it or you don’t. But that is not quite accurate. You are born with some component characteristics that aid and abet the development of resilience. For example, there is a contribution that temperament makes to the acquisition of resilience; some people are simply born with less reactivity to stress. It makes them more hardy in the face of adversity and better able to draw on their cognitive abilities in situations that throw others off balance.

Some people are also born with more optimism or are more extraverted. Still others have more courage, are more prone to take risks. All of these qualities, generally thought to be inborn components of personality, influence the ease with which you develop resilience. But determination and practice can help anyone foster resilience. It is, in fact, more a learning process than an inherited gift. What, then, do you do to grow resilience?

* When life hands you a setback, readjust your own identity. Stop thinking of yourself as a victim and start thinking of yourself as a problem-solver.

Flip the switch in your brain. Don’t focus on yourself or your shortcomings, focus on your goal and what you need to do to get there. Ask yourself, How do I solve the problem?

* Always challenge yourself to go just beyond your comfort zone. Risk builds resilience, and it’s OK to take reasonable risks.

The simplest way to go beyond your comfort zone is to learn a new skill. Take up skiing, or snowboarding.

There is no end to the number of areas in which you can go beyond your comfort zone. If you argue a lot with your spouse, don’t give up. Try for an understanding one more time. If you are having trouble with a child, remember how much you love him or her.

The aim is to convert everyday stresses into opportunities for growth. You use them as springboards for developing coping strategies that ensure the survival of self.

* Choose a hero, so that in the face of adversity you can maintain a positive identification. I know men who when facing difficulty summon up images of themselves as Russell Crowe in Gladiator. Women can summon up the story of Joan of Arc. Or think of a grandparent who survived the Holocaust.

* Think of stories of resilience and stars of resilience. Search for models of resilience and study what they did.

You don’t have to go far to find them. The media offer plenty of possibilities: Christopher Reeve, Lance Armstrong, even Hillary Clinton. When, as a new senator, she was told that people don’t like her, she smiled and said, “That’s because they don’t know me.”

* Actively gather information about resilience. Ask people you know how they have handled setbacks.

* Push yourself physically. Regular exercise helps you maintain a positive attitude and breeds feelings of strength. It is in fact a model of strength and what resilience feels like. It’s easy to understand resilience when you experience it organically.

When you run a mile, run a mile and a half. When you lift 10-pound weights, go for 15 pounds. Hold your yoga pose a few seconds longer.

* Teach yourself patience. Resilience requires being more strategic and less impulsive. Give yourself more time before reacting to inflammatory situations.

If someone is rude to you, don’t immediately respond in kind or display contempt. Take three deep breaths before you choose to act. You need to build more space between impulse and action. By definition, when you are less reactive, you become more resilient.

Article found at Yahoo!Health

For hundreds of additional articles about Fibromaylgia and how to reduce its impact on every aspect of your life, please visit the FibroFocalPoints section of FibroFighters.com today!

As always, stand tall and let the world know you’re: “Not taking it lying down™!”

Please click on the link below to join the fight today!