Who Should Be Managing your Fibro?

Primary Care Physicians are inundated with Fibromyalgia and Chronic Fatigue cases. In the current climate of managed care,  an ill patient receives an average of 10-15 minutes of attention from the well-meaning doctor, and leaves with a prescription or a referral. A person with Fibro often gets bounced around to a number of specialists, including rheumatologists, neurologists and orthopedists before returning to the PCP without answers or solutions. This causes a great deal of frustration for both doctor and patient, and that frustration often leads to less attentive care rather than more.

Many physicians are now prepared to offer a diagnosis of Fibromyalgia based on the presence of pain points, following a reasonable diagnostic process of elimination of other conditions. This does represent progress as compared to ten years ago, when there was less understanding of the condition and therefore, less compassionate, less comprehensive care. However, there has not been as much progress in the area of management of care. People with Fibro require a certain touch, and that is often outside of the availability and skill set of the PCP.

According to the most current information available, the largest number of people with Fibro benefit the most from a multimodal treatment approach. Some combination of medications, alternative treatments, nutrition and exercise seems to offer the most consistent relief for chronic pain and other symptoms of Fibro, and success of these treatments is augmented significantly by the addition of cognitive behavioural therapy. However, in most cases the primary care physician is not in a position to manage such an array of treatments and has neither the time nor attention to manage the needs of these patients effectively.

As an alternative, the job of management could be transferred to the cognitive behavioural therapist, who is not only more versed in treatments available, but is uniquely suited to assist the patient in managing day to day functioning, and this greatly increases the likelihood the patient will comply with the treatments recommended by the physician and/or psychiatrist.

Fibromyalgia is painful and debilitating. Effective treatment requires innovation, focus and perseverance, and we can get there.

Sara Halevi Kalech is a Cognitive Behavioral Therapist specializing in the treatment of Fibromyalgia and CFS. She will be presenting a series of training courses on this topic for physicians, psychiatrists and mental health professionals in Israel in May and June. For more information visit http://gethelpisrael.com.

Why are Teenagers Getting Fibro?

There are many things that are unique about adolescence. It is a developmentally tumultuous time that involves many physical and emotional systems. When a teenager is having a normal day, they are inundated with hormones, physical growth, emotional confusion and intensive brain activity. Introduce stress and sometimes the balance is tipped a bit too much. Teenagers are suffering from stress-related and stress-induced illnesses like never before. Recent studies suggest that seven percent of all teens suffer from chronic illnesses like Fibromyalgia or Chronic Fatigue Syndrome. While these illnesses have traditionally been far more common among women and girls than men or boys, this is beginning to shift. There is no known cause for Fibro, and as of yet, no known cure. There are many treatment options, but unfortunately no one treatment helps everyone.

One thing we do know, however, is that stress is a huge factor in the onset of chronic illness, and Fibromyalgia has been gaining popularity among teenagers at an alarming rate. Defined as a collection of pain points throughout the body, Fibromyalgia is a debilitating, intractable and mysterious condition. It is a long and arduous process to diagnose in adults, and even more so in teens. If you believe your teenager might have Fibromyalgia, it is essential that your doctor eliminate as many other possible conditions that may be life threatening. Fibro is annoying and hard to live with, but not fatal.

So, why are teenagers coming down with Fibro? There are a number of possible explanations. The most obvious is stress. Teenagers are under incredible amounts of stress while they juggle their insecurities and shortcomings in a competitive and success-driven adult world. They are inundated with information and flooded by constant communication without end. They are less physically active than ever, yet more stimulated than ever.

I heard a theory this week that people are stressed because of the lack of face-to-face contact, as so much of our social interaction is done online. The natural triggers for the parasympathetic nervous system, the part responsible for calming, are less available when we are communicating remotely. All of these things combined make for a stressed out teen population.

I worked with a teenage girl a few years ago who climbed into bed with a virus and didn't get up for three months. She is doing great now, but had to work very hard to find her way out of the fog. There were a few things about her case that were uniquely teen: One, she was torn between pleasing her parents and doing what seemed right for her. Two, she enjoyed being at home with her mom while she was ill.

During the course of our work together, she used the tools of CBT to shift her thinking enough to get well and stay that way. The good news is that teens are naturally flexible in their minds and are more responsive to treatment than most adults.

So, if your teen has unexplained chronic pain and fatigue, speak to your doctor about Fibromyalgia as a possible diagnosis.

Sara Halevi Kalech, MA CBT is now available by Skype, anywhere in the world. Email her at sarahalevi@gmail.com and get help today.

How Fear Makes Pain Worse

Everyone experiences pain. There are no exceptions to this. In graduate school I often heard a well-worn phrase, "everyone's pain hurts." That was brought to teach us not to judge our clients, to accept that everyone has a different ability to tolerate pain, and so we should never think we would tolerate someone else's pain better than they do. One difference in the various degrees to which people tolerate pain seems to be the amount of fear the client engages in response to the pain.

This is a sophisticated partnership. As soon as the brain receives the pain signal, the fear instinct kicks in. This is a beautiful thing, as the signal for pain tells the primitive basic survival instinct that the body is in danger. The fear reflex brings with it a series of mechanisms that assist the fight or flight instinct, many of which are recognisable: muscles tense, breathing becomes rapid and shallow in order to increase oxygen flow to the muscles, and the mind shifts its focus to become hyper aware of the painful sensations it wants to avoid.

The problem with allowing the fear reflex to take over is that it prepares us for something that never comes. The experience of pain that is not being induced by a lion's jaw clamping down on our thighs is exacerbated by the stress reaction. In other words, once the fear kicks in, bringing a host of physical and psychological responses with it, all of that preparedness just sits there, making us anxious. And, this makes the pain even worse!

So, what do we do if the body is NOT in danger?

We can stop the pain-fear reflex from happening.With mindfulness and other meditation techniques, we can unlearn this primal pattern of pain-fear and undo the process of gearing up for fight or flight. We can learn to talk ourselves down from the hyper-alert readiness state, and relax our bodies. Once we unwrap all the layers of fear and stress, an amazing thing happens: The pain hurts less.

As it turns out, fear is far more painful than just pain. The pain we experience with Fibro will not do us any actual harm. We have nothing to fear from this pain. It's just pain. It's not dangerous. When we allow this message into our deeper being, we hurt less. I encourage you to try it.

Need help managing your chronic pain or illness? Contact me to set up a Skype counselling session. Email me Sarahalevi@gmail.com