Fibromyalgia and Exercise: Yes, You Can

 

By Denise Mann

Reviewed by Louise Chang, MD

Exercise eases the pain of fibromyalgia. Getting started may not be easy, but it’s worth it

Fibromyalgia and Exercise: Slow and Steady

“Exercise improves a person’s overall sense of well-being and reduces pain and tenderness over time,” says Lesley M. Arnold, M.D. a psychiatrist and fibromyalgia expert at the University of Cincinnati College of Medicine in Ohio. 

“We try to pace it slowly and make sure that their symptoms of pain and fatigue are under control before we introduce it.”

The first step is typically an assessment of the person’s current fitness level. “We like to start them on a program that is a level or two below their current level, improve their stamina, and build up to 20 to 30 minutes of moderate aerobic activity on most days of the week,” Arnold tells WebMD. “We really encourage them to pace things and set reasonable goals.”

Water Aerobics Soothe and Strengthen

For people with fibromyalgia, low-impact aerobics is the way to go. “We really like an aerobic water class and people tend to go back,” Arnold says.

The research backs her up. A study in Arthritis Research & Therapy found that water aerobics improve health-related quality of life in women with fibromyalgia.

These classes often start in warm-water pools, which can be soothing. What’s more, they are typically group-based, so people can garner support and motivation from other members of the group. 

Holthaun says that this helps people stick to a program. “People with fibromyalgia tend to isolate, but being in a group helps motivation,” she says.

Strength Training and Low-Impact Exercise

What if you don’t have access to a pool? Don’t despair: Walking, biking, and other forms of low-impact aerobic activity also provide benefits. “Grab a buddy, take a class, or look into physical therapy,” Arnold suggests.

And don’t rule out strength training. Although doctors once believed that strength training could worsen pain in people with fibromyalgia, new research suggests that this is not the case. 

In fact, the latest research -- presented at the 2008 annual meeting of the American Society of Anesthesiologists in Orlando -- suggests that strength training can have the same ameliorating effect on pain as aerobic exercise.

Lynne Matallana, president and founder of the National Fibromyalgia Association in Anaheim, Calif., says the benefits of exercise for people with the condition are tremendous. “This has been shown scientifically and anecdotally,” she says.

Matallana’s own experience has shown her that exercise can also soothe the mind. 

A former dancer, she was diagnosed with fibromyalgia in 1995. “I have watched how exercise has improved my symptoms and my overall outlook,” she says. “When I got in water, I could do movements that were almost like dance. That touched my soul again.”

Getting Over the Mental Hurdles

Let’s face it: It may hurt just to think about going from couch potato to marathon runner. To avoid getting overwhelmed, take it in stages.

“If you have fibromyalgia, you have this amplified pain signal telling you that something is wrong,” Mattalana says. 

“It’s a natural instinct to want to protect your body by going to bed, but that actually makes pain worse.”

Try these two tips to get your mind on board:

• Give yourself a pep talk. 
• “Tell yourself that this is going to be beneficial,” Mattalana says. “Say, ‘Today I will do just this amount because I know this will help me feel better.” 
•  
• Set realistic goals. Arnold often prescribes five minutes of walking to start.
•  
•  “People may think that won’t be too difficult, but it can be if you have fibromyalgia,” she says. 
• “We start very slow and build up from there, and emphasize that there is no hurry.”

From Skeptic to Believer

In the beginning, Mattalana scoffed at the thought of doing only three minutes on the treadmill, but it wasn’t as easy as she thought it would be. 

“I slowly got my body conditioned and got to a point where I could add more exercise,” she says. “It is a slow process, but every time you get up, stretch, walk, get into a pool, or take a yoga class, you are one step closer to feeling better.”

“Once you convince people to start exercising, they become believers,” says Daniel J. Clauw, MD, professor of anesthesiology and medicine at the University of Michigan in Ann Arbor. 

“It’s not until they do it and see how much it helps that they embrace it.”

How long does that usually take? 

“Some people will notice changes right away, but for others, it may take a couple of weeks,” he says.

Exercise is not a panacea for fibromyalgia, Clauw says. But, he says, “it works in more people than anything else. I can’t remember an instance where someone got into an exercise program and didn’t notice a significant improvement in symptoms.”

Fibromyalgia and Diet Will changing your diet help you cope with fibromyalgia?

 

By Jen Uscher
WebMD Feature

Reviewed by Melinda Ratini, DO, MS

 

If you have fibromyalgia, you've probably wondered if there are ways to modify your diet to improve symptoms such as fatigue and muscle pain.

Research hasn't shown that there are specific foods that all fibromyalgia patients should avoid or add to their diets. But it may still be worthwhile to take a closer look at how foods impact the way you feel.

"There aren't many good studies that have looked at how diet can affect fibromyalgia symptoms. But I think we can gather a lot from anecdotal evidence -- from what patients tell us," says Ginevra Liptan, MD, medical director of the Frida Center for Fibromyalgia in Portland, Ore., and author of Figuring Out Fibromyalgia: Current Science and the Most Effective Treatments.

Here are some of the ways doctors say food can play a role in fibromyalgia and tips on how you can tweak your diet to support your overall health.

Pay Attention to How Food Makes You Feel

"A lot of people with fibromyalgia have sensitivities to particular foods, but it varies from person to person," Liptan tells WebMD.

"They might be sensitive to MSG, certain preservatives, eggs, gluten, dairy, or other common allergens."

In fact, in a survey published in the journal Clinical Rheumatology, 42% of fibromyalgia patients said their symptoms worsened after eating certain foods.

A good way to start identifying the foods that may aggravate your symptoms, Liptan and other experts say, is keeping a daily food journal.

"I have some patients keep a food journal for two weeks," says James McKoy, MD, chief of pain medicine, director of complementary medicine, and staff rheumatologist at Kaiser Permanente in Honolulu.

"They write down the foods they ate each day and whether they had symptoms like headaches, indigestion, or fatigue. It can be very helpful, because sometimes we see, for instance, that they have more fatigue when they eat a particular food."

Try Eliminating Certain Foods

If a fibromyalgia patient has a lot of irritable bowel symptoms, Liptan often recommends they try an elimination challenge diet.

They stop eating a certain food they suspect they're sensitive to for six to eight weeks. Then they add it back to their diet and see how they feel.

 Liptan's patients most often try eliminating dairy products or foods containing gluten.

"When you discover you're sensitive to a food and then eliminate it from your diet, it can make a huge difference," Liptan says. "Some people get a lot of benefit in terms of reduction of pain, but more often we see a reduction in fatigue and an improvement in irritable bowel symptoms like bloating and constipation."

If you think you might have food sensitivities or allergies, talk with your doctor.
In some cases, they may refer you to an allergist for food allergy testing.

You may also want to consult a dietitian to make sure you don't miss out on essential nutrients when you eliminate certain foods from your diet.

Make It Easier to Eat Healthfully

It makes sense for people with fibromyalgia -- just like everyone else -- to try to eat a diet high in fruits, vegetables, whole grains, and lean protein.

A well-balanced diet can give you more energy to stay physically active and can potentially improve your overall health.

If you're struggling with pain and exhaustion, however, it's hard to cook nutritious meals. Liptan says she encourages her patients to make it easier on themselves by seeking out healthy foods that don't require much preparation.

"Buy vegetables that are pre-washed and cut up," she suggests. "If you have a health food store nearby, go to the deli section and buy small portions of pre-prepared foods like beet salad or quinoa to vary your diet."

Use Food to Help Fight Fatigue

Choosing the right foods may help you keep your energy level more consistent and prevent fatigue.

"We know anecdotally that certain dietary choices -- like eating small meals frequently throughout the day -- can help energy levels," says Ann Vincent, MD, assistant professor of medicine and medical director of Mayo Clinic's Fibromyalgia Clinic in Rochester, Minn.

"It can help to eat a snack with a little protein, for example, when you're feeling tired at three in the afternoon," she says.

Make sure you eat breakfast, which should include some protein and whole grains, says Christine Gerbstadt, MD, RD, MPH, a spokeswoman for the Academy of Nutrition and Dietetics and a registered dietician and practicing physician in Sarasota, Fla.

"You could try eating a boiled egg and some oatmeal," Gerbstadt says. "That will prevent your blood sugar from spiking and will give you the right kind of energy to get you going through the morning, even if your body is aching and you're feeling tired."

Of course, diet is not the only factor in how much energy you have. Getting enough sleep and being active during the day can also help.

Check on Your Supplements

Always tell your health care providers about any supplements you're taking to treat your fibromyalgia. Some supplements, such as SAMe, can have significant side effects and may interact with medications, Vincent says.

In addition to checking on any possible interactions, your doctor should also be able to help you gauge any claims you might read about what supplements can, or cannot, do for your health.

Focus on Your Overall Well-Being

As you make changes to your diet, keep in mind that people with fibromyalgia tend to benefit most from taking a variety of approaches to managing their symptoms.

Along with leading a healthy lifestyle (including a nutritious diet) and taking any medications your doctor may prescribe for pain or other symptoms, there are many other therapies worth exploring.

"Look into trying things like yoga, massage, and deep-breathing exercises," says Gerbstadt. "Each individual with fibromyalgia has different symptoms and will need different solutions to get the best possible quality of life."

Lidocaine Injection May Help Treat Fibromyalgia

By Mary Elizabeth Dallas

HealthDay Reporter

TUESDAY, Aug. 5, 2014 (HealthDay News) -- The pain of fibromyalgia might be eased with injections of the painkiller lidocaine, a new study suggests.

People with fibromyalgia complain of chronic pain throughout their body as well as an increased sensitivity to pain. Doctors often have trouble treating this pain because it's unclear what causes it, the study authors noted.

In the new study, injecting lidocaine into peripheral tissues -- such as the muscles in the shoulders or buttocks -- effectively reduced pain sensitivity, the researchers found.

"We hypothesized that if pain comes from the peripheral tissues, and we can take this pain away by injecting local anesthetics, then this would be indirect proof of the importance of peripheral tissues for the clinical pain of these individuals," study lead author Dr. Roland Staud, a professor of medicine at the University of Florida College of Medicine, said in a university news release.

"Over-the-counter medications and [narcotic] prescriptions such as opiates aren't really effective for controlling chronic pain conditions," he added. But with the new therapy, "we are able to explain the pain of chronic patients better and manage it better," Staud said. "We are making progress but it will take time."

The study involved 62 women with fibromyalgia. Each woman received four injections: two in certain muscles in their shoulders and two more in their buttocks. Some of the women received lidocaine injections, while a "control group" received saline injections.

Right before the injections were given and 30 minutes afterwards, the women received mild pain stimulations delivered through mechanical means or through heat.

Compared to "dummy" saline injections, the lidocaine significantly eased the women's sensitivity to pain, according to the study published recently in the European Journal of Pain.

The researchers noted, however, that both lidocaine and the placebo resulted in a 38 percent reduction in pain at or near the point of injury.

But chronic pain affects the body differently than a specific injury, like a broken leg, the study authors pointed out. Chronic pain, they explained, actually alters nerve function along the spinal cord.

"The best way to treat chronic pain conditions is . . . [by] looking at emotional, sensory and tissue damage," 

Michael Robinson, director of the University of Florida Center for Pain Research and Behavioral Health, said in a university news release. "We know there are central and peripheral and social and behavioral components to someone saying, 'Ow, it hurts.'"

Cancer survivors who experience pain, for example, may associate it with their disease and fears about their prognosis -- even if it's been treated and in remission.

"That sensation may well feel more painful than if they just thought it was a tweaked muscle," Robinson explained.

Two experts in fibromyalgia were unsure about the significance of the findings, however.

"There was no significant difference between the pain reduction in the placebo versus the treatment group -- this signifies that it does not matter what the injection product is, but the act of injection itself might be the cause of pain reduction," said Dr. Waseem Mir, a rheumatologist at Lenox Hill Hospital in New York City.

"One can then argue that the pain reduction was placebo," he said. "To examine the placebo point, another arm in the experiment might need to be introduced where patients are not getting injected but taking a placebo pill."

Dr. Houman Danesh is director of integrative pain management at Mount Sinai Hospital in New York City. He said that "fibromyalgia is a complex disorder where patients are more sensitive to pain. 

It is mainly diagnosed by a rheumatologist by touching 18 diagnostic pressure points, and if 11 of them are sensitive, then the diagnosis is made," he explained.

"This study offers insight as to a potential contributor to fibromyalgia and a possible treatment," Danesh said. 

"It is interesting to note that the points which were used were acupuncture points, therefore suggesting acupuncture as a possible treatment to help patients with fibromyalgia."