The delivery of quality health care requires a sound working relationship between patient and provider, but this can be difficult to achieve even in the best of circumstances. Differences in treatment goals, expectations, time constraints, and educational background form substantial barriers to effective patient-provider communication. Important in any situation, this relationship is especially critical when treating a poorly understood, difficult to diagnose, and inadequately controlled condition like fibromyalgia syndrome.

Patients and physicians are often too personally vested in their roles to recognize these potential pitfalls, and the result is an unpleasant and dissatisfactory encounter for both patient and provider. To understand how this happens, it is constructive to look at the differences in how each party perceives this sometimes contentious relationship.

Fibromyalgia patients are typically looking for two things when they first visit their doctor. They want someone to listen and understand, and they want to feel better. Reasonable desires, certainly, but not without the potential to create problems, either.

As modern citizens, we have been conditioned to think of our doctor as we would our auto mechanic. When something breaks we have it diagnosed, repaired, and continue as before, and this is actually a pretty good analogy most of the time. If we get a respiratory infection, we get it diagnosed, take our antibiotics, and in a week our metaphorical motors are running as smoothly as ever.

This is the expectation many fibromyalgia patients bring to their first office visit… and it is likely very different from the approach their physician will take. Of course, physicians are fond of the auto mechanic analogy, too. Given their choice, most would probably choose to see patients with definable, structural illnesses that can be treated with a high probability of success. Unfortunately, fibromyalgia syndrome does not fit this model. The fact that fibromyalgia symptoms are so diverse and the pain so generalized immediately presents treatment problems for the physician.

Providers tend to be cautious anytime a patient presents with idiopathic pain. Legal and ethical responsibilities require the provider to prescribe pain medications for medical purposes only, and subjective pain with no definable cause is a favorite ruse for individuals attempting to illegally divert drugs. It is unfortunate for suffering patients that fibromyalgia syndrome presents in this manner, leaving physicians immediately faced with a dilemma, especially when the patient is unfamiliar.

This is not intended as an indictment of physicians or their training. Quite the opposite, this cautious approach is exactly what should be expected from a competent physician. Suffering fibromyalgia patients are not likely to have this idea foremost in their minds, though.

By the time they reach the doctor’s office, most fibromyalgia patients have already dealt with a barrage of skepticism about their invisible illness. Spouses, employers, friends, and co-workers likely will have expressed some level of incredulity about their condition at some point, and it is natural for fibromyalgia patients to eventually assume a defensive attitude about their health. Combined with a provider’s professional skepticism, this defensiveness sets the stage for potential patient-provider conflicts.

Even when these initial difficulties are overcome, the nature of fibromyalgia creates other problems. The lack of quantifiable testing leaves the diagnosis of fibromyalgia open for debate, and inaccurate diagnosis of fibromyalgia is relatively common. Medically unexplained symptoms and bodily dysfunctions are common complaints in primary care settings, and differences in the assessment of these symptoms can create a relationship challenge between the provider and patient.⁽¹⁾

Patient reaction to a diagnosis of fibromyalgia syndrome can vary according to expectations, but often follows a predictable pattern which can act to undermine the physician’s treatment plan.⁽²⁾ The typical first reaction is one of denial. As discussed earlier, most fibromyalgia patients are expecting a definable illness that can be adequately controlled, if not completely cured. A diagnosis of fibromyalgia syndrome usually offers neither of these desired outcomes.

Even if the diagnosis is accepted, patients still tend to seek out second opinions, both medical and non-medical, in an attempt to find a more suitable outcome. Many times this is done without the diagnosing physician’s knowledge and may lead to non-compliance with prescribed therapy serving to further undermine the patient-provider relationship. Physicians tend to see this activity as subversive and may come to view their fibromyalgia patients as difficult, demanding or illness-focused.⁽³⁾ As a result of these attitudes, patients may have their pain and frustrations discounted by health care providers.

These tensions tend to be self-reinforcing as patients become more frustrated with redundant testing, poorly treated symptoms, and condescending attitudes. Health care providers may begin spending less time with these patients (viewing them as having unrealistically high expectations) or come to see their illness as primarily psychosomatic.⁽⁴⁾⁽⁵⁾ Obviously, this situation does nothing to improve patient outcomes, and leaves both patient and provider emotionally drained.

The good news is that solutions to this problem have been identified, but they require the commitment of both patient and provider in order to be effective. Shared decision-making, in which the patient plays an active role in selecting appropriate therapy, has been shown to make both a qualitative and quantitative difference in patient outcomes.⁽⁶⁾ Including family members in the treatment plan also tends to enhance improvement.

“One size fits all” therapy does not work well in treating fibromyalgia syndrome, and an interdisciplinary approach often achieves better results.⁽²⁾ Providers who consult with allied health team members report better results and less stressful patient interaction when treating fibromyalgia patients.

Above all, successful treatment of fibromyalgia requires a hopeful attitude from the patient. Patience, encouragement, and motivation are, then, necessary components of any treatment plan. Cultivating this cooperative partnership early in treatment helps avoid many of the pitfalls that can eventually poison the patient-provider relationship.

Learn more about fibromyalgia at: www.myalganex.com

1. Fitzcharles MA, Boulos P. Inaccuracy in the diagnosis of fibromyalgia syndrome: analysis of referrals. Rheumatology. 2003 Feb;42(2):263-7. [↩]
2. Alghalyini B. That sinking feeling: a patient-doctor dialogue about rescuing patients from fibromyalgia culture. Can Fam Physician. 2008 Nov;54(11):1576-7. [↩] [↩]
3. Asbring P, Närvänen AL. Ideal versus reality: physicians perspectives on patients with chronic fatigue syndrome (CFS) and fibromyalgia. Soc Sci Med. 2003 Aug;57(4):711-20. [↩]
4. Stutts LA, Robinson ME, McCulloch RC, Banou E, Waxenberg LB, Gremillion HA, Staud R. Patient-centered outcome criteria for successful treatment of facial pain and fibromyalgia. J Orofac Pain. 2009 Winter;23(1):47-53. [↩]
5. Robinson ME, Brown JL, George SZ, Edwards PS, Atchison JW, Hirsh AT, Waxenberg LB, Wittmer V, Fillingim RB. Multidimensional success criteria and expectations for treatment of chronic pain: the patient perspective. Pain Med. 2005 Sep-Oct;6(5):336-45. [↩]
6. Bieber C, Müller KG, Blumenstiel K, Schneider A, Richter A, Wilke S, Hartmann M, Eich W. Long-term effects of a shared decision-making intervention on physician-patient interaction and outcome in fibromyalgia. A qualitative and quantitative 1 year follow-up of a randomized controlled trial. Patient Educ Couns. 2006 Nov;63(3):357-66. [↩]

Fibromyalgia is pervasive. If you or a loved one are afflicted, you already know this. Left unmanaged, it can take control of your daily activities, your thoughts, your sleep, and even your interactions with other people. Since fibromyalgia is a long-term chronic disease, most patients eventually come to the realization that it is better to be proactive than to allow further erosion in the quality of their lives. With that in mind, here are 10 things you can do today to start getting your life back in order.

1. Take Back Your Sleep Cycle

Set up a regular routine for sleeping by going to bed and getting up at the same time each day, and make sure your bedroom has an atmosphere that is conducive to sleeping. This means not watching TV or spending time on the computer while in bed. Keep your bedroom dark, quite and cool. Try to avoid spicy foods or too many beverages before going to bed, and never underestimate the value of a good pillow.

2. Eat Right

This is a lot easier said than done, but it is possible. Look around the web and you’ll find a lot of advice about fibromyalgia and diet, but the advice is often contradictory and confusing. What works for one patient may not work for the next. Fibromyalgia is a perplexing syndrome. It’s a diverse disease that doesn’t present the same way in every patient. This doesn’t mean that you have to give up on eating right, though. You just have to do a little trial-and-error first.

Experience has shown that a few foods seem to cause problems for most fibromyalgia patients, so eliminating them is a good place to start. These include coffee, carbonated beverages, alcohol, and foods high in fat. It is important to realize that there is no “Fibromyalgia Diet” suitable for all patients. It will take time and effort discern the most appropriate diet for you. A journal of your dietary habits can really help speed this process.

3. Keep A Journal

 Journals aren’t just good for remembering what you had for dinner. Keeping a brief journal of your activities should become an important part of your daily routine. This doesn’t have to be extremely detailed or time-consuming, though detailed journals are usually more effective. As a minimum, list your day’s basic activities, any pain experienced and the approximate time of onset. Eventually, correlations between what you are doing and how you are feeling will become evident. This does require some diligence, but remember that greater effort will mean faster rewards.

4. Know Your Triggers

You may already know some of the factors that cause your fibromyalgia to flare, and your journal will help you discover more. Be cognizant of these triggers, even going so far as to write them down. Learn to recognize and avoid them even when you may be preoccupied. Fibromyalgia is different for everyone; it pays to know your fibromyalgia.

5. Educate Yourself

Fibromyalgia is personal, varying widely from individual to individual. No one knows your condition better than you (not even your doctor), so it is important that you empower yourself with knowledge. A standard treatment protocol does not exist for fibromyalgia. Because of it’s nature, your fibromyalgia must be managed by you.

6. Exercise

This goes against the natural tendencies of most fibromyalgia patients. After all, who wants to exercise while sleep deprived, with sore joints and a migraine headache? It may be counterintuitive, but exercise does benefit most fibromyalgia patients. The key to a successful exercise program is to start slowly, always being careful not to overexert yourself. Strength training, flexibility exercise, and aerobic activities are of particular value to fibromyalgia patients.

7. Start Cognitive Behavioral Therapy

This form of psychotherapy utilizes rational analysis to influence our thought processes and ultimately our behaviors. It has proved itself particularly useful for fibromyalgia patients, and best of all, you can do it all by yourself. A quick web search should point you in the right direction to get started.

8. Communicate

Let the people you care about know how you are feeling. Tell them in advance when you are in pain, stressed, or feel your patience waning. Do not hold your feelings inside until you feel compelled to release them in anger or frustration. Your family members want to help you. Remember to let them know important they are to you.

9. Accept Your Limitations

Fibromyalgia is a chronic disease and it is not likely to leave you. It may limit the quantity of what you can accomplish, but doesn’t have to limit the quality. Focus on those things that you can do, and pace yourself so as not to become exhausted or frustrated.

10. Congratulate Yourself

Fibromyalgia patients endure a lot, suffering in silence most of the time, but they also accomplish some amazing things in light of their condition. Raising a family, going to work, walking the dog… all of these things take extra effort for the fibromyalgia patient, yet everyday they get done. So, give yourself a pat on the back occasionally. You deserve it.

Learn more about fibromyalgia at: www.myalganex.com

Whether via prescription medications, dietary supplements, or even processed foods, most fibromyalgia patients regularly ingest the often misunderstood chemical compounds known as excipients. Excipients are substances other than the active ingredient which are included in the manufacturing process or are contained in a finished dosage form. Many of us have read the fine print on our vitamin label and having found ingredients like magnesium stearate, EDTA, and hydroxy-propyl-methylcellulose, wondered, “What are these things, really? And, do they really need to be in my fibromyalgia supplements?”

It turns out that defining the purpose of a given excipient is a lot easier than determining whether or not it needs to be in your vitamins. This is due primarily to the broad range of purposes served by excipients. Some excipients, like disintegrants, are an essential part of a dosage form. Others, like sweeteners and shellacs, are intended solely to make a dosage form more palatable and the perceived value of these excipients likely would vary from patient to patient.

More controversial still are excipients such as lubricants and glidants whose lone purpose is to aid in the manufacturing process. These additives ensure the smooth functioning of the manufacturing machinery, ultimately leading to a lower market price, but they provide  no real health benefit. Many fibromyalgia patients, especially those who experience extreme chemical sensitivities, choose to minimize exposure to these “nonessential” excipients.

Finally, there are excipients that are used as marketing aids. These are things like artificial colors and printing inks which are intended to help the manufacturer sell more product. Most fibromyalgia patients try to avoid these types of excipients.

Let’s look in more detail at the major classifications of excipients, categorize them by how “essential” they are, and examine some of the more commonly used compounds.

 Essential: Excipients Integral to Dosage Formulation 

• Binders hold the tablet ingredients together in a stable form which makes them essential for obvious reasons.
• Disintegrants, conversely, are used to break apart tablets in the digestive tract thereby releasing the active ingredients for absorption into the blood stream.
• Fillers (diluents) are used to add volume to the dosage form so that it can be handled by the patient. Without fillers, some dosage forms would be too tiny to see!
• Suspensing/dispersing agents are used to prevent settling or clumping in suspensions and are necessary to ensure that each dose has the proper amount of active ingredient.

Cellulose, hydroxypropyl cellulose, methylcellulose, sodium starch glycolate, and crosscarmellose are commonly used examples of this category.

Optional: Excipients Based On Personal Preference

• Sweeteners are used to make ingredients more palatable, typically in liquid dosage forms.
• Preservatives are used to prolong the shelf life of the ingredients.
• Film formers/coatings are used to prolong shelf life and make large or unpleasant-tasting tablets easier to swallow.
• Flavors are used to mask unpleasant tasting active ingredients

Methyl paraben, propyl paraben, sugar and sodium citrate are typically used excipients in this category.

Questionable: Excipients Used To Improve The Manufacturing Process

• Lubricants are used to prevent powders from adhering to manufacturing machinery. They are usually used in conjunction with glidants.
• Glidants (flow enhancers) are also used to promote powder flow through manufacturing machinery, this time by reducing interparticle friction.
• Compression aids are used to compact ingredients prior to tableting.

Talc, magnesium stearate, and stearic acid are examples of this category of excipient.

Avoidable: Excipients Used For Marketing Purposes

• Printing inks are used for identification purposes as well as marketing. Since identifying marks are required on prescription medications, it may not always be possible to avoid ink.
• Colors, likewise, are used for identification and marketing purposes.

The FD&C dyes are the primary excipients in this category.

Because many fibromyalgia patients experience extreme chemical sensitivities they are understandably concerned about the effect pharmaceutical excipients may have on them. A rational strategy for these patients would be to exclude those excipients in the Questionable and Avoidable categories, select only those excipients necessary to ensure compliance from the Optional category, and accept that the excipients in the Essential category are required for the active ingredient to have the desired effect.

Learn more about fibromyalgia and nutritional supplementation at: www.myalganex.com

The nature of fibromyalgia syndrome is such that most patients eventually find themselves taking various nutritional supplements, vitamins, botanicals, and other dietary supplements. As the dosing becomes more frequent, the potential for problems increases and managing one’s therapy can, at times, seem overwhelming. The key to an effective dosing regimen, then, is to first inform yourself and follow up with a little advance planning. 

Over my years of practicing pharmacy, I have consistently noticed the disturbing relationship between the severity of the illness and the probability of a sub-optimal therapeutic outcome. Simply stated, sick people take more medicine and to ensure everything goes as intended special attention needs to be paid to when, and how, dosing is conducted.  Unlike with prescription drugs, however, definitive information about nutritional supplements can be difficult to find, especially for the supplements most preferred by fibromyalgia patients.

Some of these more common fibromyalgia supplements include:

• Malic acid
• Magnesium
• Vitamin D
• Sam-e
• Ginkgo Biloba
• Coenzyme Q10
• 5-HTP
• St. John’s Wort
• Glucosamine
• Chondroitin

So, let’s take a look at how to plan an effective regimen around these supplements.  Our first concern should be to determine if any need to be taken at a particular time of day, say upon waking or at bedtime.  In this case, we see that 5-HTP and, to a lesser extent, St. John’s Wort can cause drowsiness.  The St. John’s Wort dose is usually divided and taken three times daily, so drowsiness is minimized.  If sedation is the desired effect of the 5-HTP then a single large bedtime dose would be required, otherwise splitting the 5-HTP dose, as with the St. John’s Wort, would be advisable.

Next, we need to decide which supplements need to be taken with food and which on an empty stomach.  Our list contains only one item that needs to be taken on an empty stomach, Sam-e (for better absorption).  All the other supplements either need to be taken with food, or else food is irrelevant.

Our third concern, and one for which much research still needs to be conducted, is the potential for adverse interactions between the supplements. In this case, the Sam-e, the St. John’s Wort, and the 5-HTP all have the effect of raising the body’s level of the neurotransmitter, seratonin.  Taking these three together isn’t going to be advisable, so we’ll drop the Sam-e which had the empty stomach requirement, anyway.  By keeping the St. John’s Wort and 5-HTP split into three daily doses we lower to a safe level the potential for interaction between these two (while tidily avoiding our drowsiness side effect, too).

No matter the combination of supplements being taken, this three step process of determining what time of day to dose, whether to dose with or without food, and the potential for interactions, will give you a clear picture of how to achieve optimal outcomes with your nutritional supplementation.

Learn more about fibromyalgia and nutritional supplementation at: www.myalganex.com