Saturday, August 23, 2008

Does it Hurt Yet?

I’ll say it straight out, I think the vast majority of chronic pain and chronic fatigue disorders are BS. They’re the modern equivalent of having the vapors. As such, I strongly recommend a course of sea air (in a nice tropical clime) and daily hysterical paroxysms (most effective if administered by the hot pool boy).

I’ve researched a good deal about fibromyalgia lately, as I know several people claiming to be debilitated by it. According to Dr. Google about 1% of the population suffers from this horrible disorder. That’s not a terribly insignificant number of folks, especially due to the notion that one may be completely laid up and unable to work or function in any way due to their terrible pain.

Here’s the wikipedia entry on Fibromyalgia for your edification, with a description of symptoms, etc.

I have my own personal theory of this disorder. For the record, unless I acquire a reader with money they need to launder through funding of an amateur research undertaking, this is me talking from a reasonably unscientific compilation of experience and medical research reading.

As an aside, I strongly recommend that anyone interested in any particular disorder skip any website written for laymen about that problem, and go directly to the research. It’s not easy, research papers are boring and require at least a basic comfort level with statistics, but the information therein is 150% better than anything you’ll get on “Jane’s Gallbladder Cancer and Demonic Possession Blog.”

In my opinion fibromyalgia is simply a combination of three factors:

1. Hypochondriasis secondary to availability of tremendous amounts of medical information available on the internet, with gigantic gaps in reliability of source.

2. Societal focus on continuous introspection, with the medical system generally validating self-perception of any symptom with over-testing to protect themselves from lawsuits. Essentially you think: “Why would they be putting me through this test if my itchy thumb wasn’t serious.” But they’re thinking: “Man, I better run that allergy test even though they have no clinical presentation, or if they do have that 0.000001% occurring syndrome they’ll sue me for the GDP of India.”

3. The low level of physical fitness in the general population (also the rising levels of overfat and obese individuals) contributing to a growing number of people who have bodies that do not function correctly, and who do not understand how their bodies work or respond to varying situations.

Please note: I am not at all saying that people with fibromyalgia do not experience symptoms. I do think they are feeling pain. However, I think they are not experiencing as much pain as they think they are, and many of the models for diagnosis and treatment actually lead away from the easiest cure of all. I think this is primarily a disorder of perception, rather than a physical problem. I’m sure this isn’t what some people want to hear, but a perception problem is just as serious as a physical disorder. However it may be easier to fix.

To tie everything together I’m going to veer off for a bit into my experiences with pain. I’ve always thought I had a fairly high pain threshold. I have lots of tattoos, I have cavities drilled without Novocain, when I had appendicitis I could never realistically rate my pain above a 3 on a 1-10 scale. I get migraines infrequently, complete with visual auras and all kinds of fun stuff, and am able to control the pain through breathing techniques I taught myself when I was a kid.

Turns out I really had no idea, and am actually in recovery from being somewhat of a huge wimp.

January of this year I started martial arts training in a small dojo in a bid to improve my fitness. I practice Aikido Yoshinkan which is considered a “hard” form of aikido. Unusually though, our instructor is a former national-class track athlete, and believes strongly in overall fitness and strength training. Our “warm-up” lasts 30-45 minutes, and often leaves pools of sweat on the mat and me staggering. After that we start really training. For example, we did “33’s” to warm up a week ago, that when done properly will have you complete a total of 90 push-ups in about 15 minutes while having a medicine ball flung at your head every 3 push-ups.

Point is, it’s not easy, and I’ve put on more muscle in the last six months than I thought I’d be able to acquire in my life. And it has all been painful. In Yoshinkan we do a lot of falling, rolling and joint locking. All of which hurts when done poorly, and with the joint locking, hurts when done correctly. Very realistically, I probably experience more pain and discomfort in one 2-hour lesson (which I have 3 days a week) than most people experience in a year. In fact, learning to tolerate some of the extreme discomfort of being in a good arm lock or a strangulation hold is part of our training, so we can learn to do the technique, and learn to escape from it.

We have a new adult student who took a bad roll on his shoulder last Thursday, and decided he was too sore to continue being thrown for the remainder of the class. This morning, Saturday, he was still concerned about being injured, though he has full range of motion. I took a poor roll on Thursday too, and stuck my shoulder into the mat so hard that the instructor heard it from across the classroom. I had a good bit of soreness, and the imprint of my gi fabric weave in my shoulder in welts that night. I suspect that I and my fellow classmate are suffering about the same amount of pain. However, I shook it out a little, tested my motion, and knew from experience that I was hurt but I was not injured and continued with business as usual. The other student will learn this in time.

As I’ve trained, both my body and my neurological system have changed. My pain threshold has substantially increased, and I’m getting better at physically reacting in an controlled manner even when in pain or exhausted. Even better, my internal perception of the pain status in my body has changed.

For example, if you asked me right now what my pain level is, I’d say it’s a 0 on the 1-10 scale. No significant pain whatsoever, just normal body feelings. However, if I sit here and carefully examine myself I find that I actually have a bit of a sinus headache, my upper arms and thighs have quite a good deal of muscle soreness, my neck is a stiff and tight, and I have an abrasion on my left knee that burns. My knees and ankles are also pretty stiff as we did seated techniques this morning. My shoulder is still good and bashed up, and I can feel that as well. I’ve learned though, to differentiate between pain that means that I’m injured and need immediate attention, and background pain that signifies nothing. This background pain I can easily dismiss, and don’t notice it much more than I notice wearing a watch.

Looking back at my completely sedentary self of last year, I can see now that I objectively felt much less bodily pain than I do now, but I perceived it as much more! I was laid low by pain that I can easily ignore today. What I have done neurologically is raise my baseline of pain at which my body tries to interrupt my mind with messages of impending doom. Basically the lights and sirens used to go off at 10 psi in the pipes, now they only go off around 5000 psi.

What I believe happens in disorders like fibromyalgia is that a person starts to notice their “background pain” or other relatively normal bodily feelings, and becomes concerned that they signify a major problem. Because this person is pretty sedentary and doesn’t have recent or continuing physical experience as to what constitutes pain that signifies an injury, rather than just noise, they start getting the aforementioned lights and sirens telling them there’s something wrong. They also might be a bit overweight or have little muscle tone, so they really do feel some musculoskeletal and joint pain. This person is pretty responsible, and doesn’t want to go to the doctor frivolously, and fires up old Doc Google to see if what they’re feeling is a symptom of something. They are immediately overwhelmed by myriad sites telling them they have a symptom of everything from fribro to MS to chronic lyme disease to parasites to colon impaction to, well.. you name it.

Now they’re worried. God, this must be bad. They start doing more research and reading more sites. They see that fatigue is an element of many disorders, and realize, yeah they’ve been feeling pretty sluggish lately, and maybe even depressed. Man, they think, as they read hundreds of pages of questionable information, I have a LOT of these symptoms. As they think more about it they focus more on their internal bodily feelings, and to a legitimately concerned person, each feeling can grow in their mind into a symptom. The more they focus, the more they feel, and the more it physically bothers them. For instance, you can feel your watch and clothes if you sit there and concentrate, and they might even start to feel annoying, even if they’ve been comfortable all day.

They eventually go to their doctor and tell them they’re having all this muscle pain and they’re fatigued and can’t concentrate and can’t something be done. The doc orders a bunch of CYA tests, which confirms to our hapless person that there really must be something wrong (or why would they order all the tests). Mr. Doc doesn’t find anything conclusive, but the person (now officially having undergone the transition from person to “patient”) still feels the sensations they felt before, and just knows *something* must be wrong. Someone like me can generally say, “Well, OK, I’m fine, cool, seeya later,” but another person may decide to get a second opinion. They may have also read on the internet that doctors don’t know about this mystery disorder, or that there’s even a medical conspiracy to suppress knowledge about this problem. So they go from doc to doc, maybe one tries a painkiller or an anti-inflammatory prescription, because though I love doctors - but when your tool is a hammer (medicine) sometimes every problem becomes like a nail (medical diagnosis and medication). Maybe they get to a doctor who believes in this internet affluent disorder, and gives them the diagnosis they think they need and a bunch of meds. Or maybe they meet a less than ethical doctor who is willing to prescribe serious pain medications at the drop of a hat and does so.

After a while this persistent patient is still feeling the same sensations, and maybe some side-effects of medication they might be on. They might have a label, as in this person suffers from X Disorder, which for better or worse, comes with a ration of sympathy and ability to make life just a little more flexible: “Don’t bother mommy now, she’s laying down with breakthrough pain (rather than going to work at a crappy office for 10 hours, then driving pell-mell across town to pick up Suzy to get her to ballet and Johnny to guitar and doing all the grocery shopping in 20 minutes flat, picking everyone up, making dinner, helping with homework, writing the bills, cleaning up, herding everyone to bed, trying to figure out whether to file a claim on the roof leak, finishing extra office paperwork, reading a book for 5 minutes and getting to bed 3 hours later than intended).”

Whatever anyone says, there are some benefits to being “sick,” see above for illustration.

Now they still have the sensations which they focus on more and more so they can try to tell if treatments are working, they have reams of medical files, prescriptions, and diagnoses, and all this tells them something MUST BE WRONG!

And we end up with a bunch of folks with the vapors.

My opinion here is backed up by a bit of research. The Journal of Clinical Rheumatology published a paper in 2004 which found that the incidence of fibromyalgia in college athletes is significantly less than the general population. 0.16% compared to 0.5%-10%. Out of 641 athletes they could only find one that met the criteria for a diagnosis. Link to Paper.

Also, it’s been fairly consistently found that exercise cures fibromyalgia. Gee, I could have told you that, and for less money. Link to Paper.

From 1996

This one advocates exercise and agrees with me on source as well.

Oh, just Google fibromyalgia and exercise, you’ll get the picture.

So anyhow, in parting – the solution to your problems is to get off your ass and exercise. It’s a solution to a great many problems, of course it’s not as easy as taking a pill or complaining, wish it were – I’d be able to do more pushups.

Let me reiterate my basic theory for the record: Fibromyalgia is a disorder of perception. Pain is actually felt, but the cure is a neurologic adjustment, not a physical one.

The problem is that the way to change the neurology is to reduce the perception of pain through physical training, which will initially be very uncomfortable. Here's the cure:

--Serious exercise (I'm talking weightlifting, strength training, etc. under the guidance of an experienced trainer, not just a jog at the gym every few days, no pink 2lbs weights).

-- Cognative behavior therapy with the intent of training the mind to refocus away from constant bodily introspection.

-- Additional treament of underlying comorbidity like obesity or overfatness, depression, lack of stress coping skills, or other condition that would interfere with parts 1 and 2.

I am exremely confident if a fibro sufferer commits, I mean REALLY COMMITS, not just takes a stab, feels some pain and gives up (I'm talking at least six months of hardcore commitment), to something like this they will feel better.

I would write a book but I don't think it will sell. People don't want to hear that they need to take responsibility and do something difficult and uncomfortable to be fixed. It has amused me in the past that I've heard fibro sufferers swear they would "do anything" to feel better, but have all kinds of excuses to not exercise, not lose weight, and not start thinking in a productive manner.

Important Note: I'm also conducting an informal study regarding the co-morbidity of fibromyalgia and acute blogcommentum textwallitus. Please be aware that if you write me a six-page essay about your fibroI will:
A) Include you in my study, with or without your permission,
B) Know you probably didn't read my entire post, and
C) Find you really amusing (especially if you have fibro and are also overfat, depressed, bipolar, and/or suffering from Morgellons, chronic fatigue, intestinal parasites, colon impaction, OTC pain med allergies, Aspergers, hypoglycemia, MCS, or you use the ER to treat breakthrough pain, or think the medical establishment refuses to acknowledge your rare disorder so that they can profit from you in an unspecified manner).
D) Please be aware - if you have ever called an ambulance to treat your fibro pain and choose to tell me about it, I will repost your comment in an extremely unflattering manner.


Another Fine Quote

"It is the fool's metric which declares that unless you are perfect, you aren't good."

From this WATN post on patriotism.

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