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PTSD and Fibromyalgia Connection


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Interesting Study (though old. . .2004)


Posttraumatic Stress, Fibromyalgia Linked
Chronic Pain Condition Seen in Half of Veterans With PTSD

"A consistent relationship has been seen between PTSD and chronic pain conditions like fibromyalgia," says psychologist John D. Otis, PhD, who is also studying the link in veterans. "The fact that the pain is often independent of the traumatic event leads us to believe that there is something else going on."

Pain and Trauma

While the cause of fibromyalgia remains unknown, the condition often occurs following physical trauma -- such as an illness or injury -- which may act as a trigger. In 1990, the American College of Rheumatology developed a standardized diagnostic evaluation for fibromyalgia, which includes a history of widespread pain for a minimum of three months and pressure-associated pain at 11 of 18 specific sites on the body.

The ACR standards were used in the Israeli study to evaluate 55 war veterans with severe PTSD, along with 20 veterans with major depression and 49 veterans with neither condition.

About half -- 49% -- of the PTSD patients met the criteria for fibromyalgia, but only 5% of the patients with major depression did. None of the men who had neither condition had fibromyalgia.
In his presentation to the European League Against Rheumatism, lead investigator Howard Amital, MD, notes the fibromyalgia-PTSD link was much stronger than that for PTSD and major depression, despite the fact that the severity of the two psychiatric conditions was similar.

"Psychiatric illness is (not) necessarily correlated with fibromyalgia, but PTSD certainly is," he notes. "The symptoms may overlap, but the degree and the intensity of these disorders are so closely related that it cannot be just a coincidence."

Integrating Treatment

What's freaky is that a relatively common injury, e.g. a foot-sprain (maybe prior injuries there, but a "final straw" injury), can cause sudden-onset osteoarthritis and that can activate fibromyalgia, additional chronic dis-ease conditions. 

I'm screwed, my situation (relevant, only perhaps re: already released veterans, no documentation of service related injuries).  I've suffered chronic, disabling, severe ptsd for many years, without access to treatment, programs, etc.  I can't get basic medical care to handle acute pain symptoms, no meds, no orthotics, no specialists-- that's the state of Ontario/OHIP and provincial disability (underhanded, sneaky changes by provincial government brought into effect January 2013).  I've had some months of lost mobility (from foot to knee, walk with cane, re-injured, lose days of functioning-- extreme fatigue, push against that, most systemic pain and more intense fatigue).  Pain disrupts sleep.  So, I'm left with self-diagnosing; research and 'scientific method' to try to figure out what can work, with very limited budget.

New drug policy by Ontario, response to control abuse of things like oxycontins.  I had to fight with my GP to give me my small amount of Ativans-- 5 sublinguals to last 3 months (and suppose to cut them in half?), but I've resisted taking them, even letting the prescription go to 6 months (but I find they are necessary for extreme triggering, fight/flight and prolonged numb to break the cycle up and only after patiently trying to apply and re-apply coping skills).  So I won't get 'muscle relaxants', so I can sleep, stop the pain from spreading and waking me up, or making it hard to get to sleep.  So self-medication options, I guess it's alcohol as the only legal choice (I'm also experimenting with Valerian root?).  I need relief from acute symptoms, before I can re-connect to relaxation techniques-- I guess the major stressor was loss of mobility-- anxiety to get over with CBT technique.  I feel in crisis at times with it all, very stressed, irritated (and ptsd on top, been to some 'places', but not in me to give up-- tested and re-tested many times-- I consider one family member, I do hang on for).

Not good advice to others.  I managed to avoid alcohol addiction, knowing bad family history.  But maybe I'll just monitor it (keep a log, my notes, 'scientific method' what works)- glass of whiskey before bed, make sure to re-hydrate (and pee) before bed.  Focus on getting orthotic help for fallen arch in injured foot, to stop knee damage-- worthwhile investment (and at least get it assessed) prevent re-injury cycle.

I'm not a good example, only a warning.  Yes, there's consequences to self-neglect and maladaptive coping (like smoking lots when heavily triggered); like not managing meds which damaged metabolism, causing weight gain (even 5 pounds over can cause stress on joints-- I've got 20-30 to lose to get back to healthy weight for my height)-- walking was free, but that's not an option atm (damaged by sports injuries though); like withdrawal, depression, not being active enough (agoroaphobia periods, assault traumas); and good nutrition (more veggies/fruits)-- catching up to me in my early 40s.  Then the unmanaged chronic, severe PTSD on my nervous system, seizing me, re-living hellish times, not knowing how to stop/prevent it (which could have limited more permanent damage by chronic stress condition).  Lots I did not know nor think was important vs. more immediate 'crisis'/fatigued states.

CF to me seems to have a lot of smarts.  Physical health upkeep is not only important for Universality of Service, but also for further protection from health complications which could arise from untreated, prolongued PTSD and/or maladaptive coping, lifestyle issues.  I've seen good OSI-lectures on the net.  I go to military-resourced info because bulk of my ptsd stems from combat-type damage (even without formal training, pre-occupied with physical safety, self/others for a long time-- which I got through, without full ptsd), prolonged and later acute exposures which got to the point of no-return in my nervous system.  Also traumatic losses, visually not good, close people (complicated grief, survival guilt, etc.).  Most research is produced through the military, but many wounds go back to early years, predisposition to delayed onsets which nailed me at a bad time in my life, medical coverage-wise (but no time is good time for ptsd, it sucks, literally, everything).

I hang on because I'm also a problem-solver, just that it does become impaired regularly.  There's a symptom reproted in the fibromyalgia literature, called "brain fog", which also seems similar e.g. to what ptsd-dissociation/overwhelment can do.  Getting "attacked" by pain suddenly (and/or losing mobility), bothers me not unlike being "attacked" by ptsd-re-experiencing symptoms-- it's unwanted, tired of unwanted recall, sensations, silly-startle responses [which can come an dgo, but too much in a day causes irritation and I think that's biochemical/physiolgical vs. mind/annoyance -- using CBT/mindfulness on it, and I try to remember to breath, relax my system), etc.  The aspect of chronic re-experiencing, and chronic pain, fatigue is draining and hard on the spirit at times, re: hope in recovery and also the challenges presented by limited health care access (and the bad state that's all at, in these times. . .).  When I lose hope, I remind myself to find it again, take small actions, smaller goals, try to manage something, one thing of the lot of it all.  Simplify, as necessary geared to energy and severity of ptsd-symptoms/SUDS.

I've challenged fatigue, but pushing forward anyway, but that resulted in further physical disability, so that doesn't work, not simple "mind over matter".  Probably a running theme in my life, is not working within my own limitations, but over-doing it, not respecting my self/needs enough, causing tire-spin out, not being realistic with my self.  Humbly, I need to learn and accept these sorts of things (hmm, what not managing excessive hyperviglance has done to me, not being self-aware, not stopping, grounding, lacking psychotherapeutic insight for so long-- survival guilt-baggage, not realizing how that was running so much of the 'show' [and not having access to that treatment --obviously too expensive for public health care and no political will nor public backing for such care because of "bad childhoods'-- not taken seriously, regardless of manifestations into severe, physical- ptsd). . .?).

Anyway, there's other research re: fibromylagia and excess of protein-types.  There's research on PTSD causing changes to DNA-structures.  All sorts of stuff.  I'm just trying to work through my own stuff, share studies as I come across which could benefit people here.  Being aware of things can help settle some anxiety, move to acceptance when trying to figure out wtf is going on with me.  Then seek possible solutions, catch-all ones and symptom-specific ones.

While you do have the medical coverage make full use of it (and self-advocqate, get help advocacy help, fight as needed), don't neglect your self (regarldess of limitations, roadblocks in health care that you may encounter)-- the payback is a bi*tch, more complicated health issues.  Nothing seems certain in health care, nor pensions-- take what you need while it's there.  Put away extra personal savings, as back-up for medical, just in case. . . if Rome is burning. . . What's happening in public health care (speaking of Ontario-case) is a disaster, getting worse-- and that intel is relevant for release situations, re: undocumented injuries, if you have to fall back on public health care or NVC-generation, care when you age.  Get PTSD/OSI treated early (especially if starting nightmares, flashbacks and they're sticking-- because over time that's potentially very damaging to your body, not just mind).  Preaching to the choir, but reminding just in case. . .  If Rome is burning. . . and you guys are already carrying extra injuries from service, and the download of federal responsibilities of care to the chaotic mismanagement of the provinces. . . take care out there. . .

I'm okay, I  have some resilience to frustrations with bad health care, not as shocking (but it still shocks, not just my case, but when I look around to others in same boat).  Bad luck for me, but I'll cope.  It's just a mess out there and I recognize the predisposition of multiple injury risks for you guys.  I fully support the necessity to protect and strengthen veteran rights to good premium health care, poverty-prevention/decent, liveable pensions.  I didn't serve my Country as you guys have, I've just survived stuff that ultimately was not good for my health in the long-run.  We are fortunate for those who have risked all and so much for the good of Canada, unconscionable to not honour that seriously and by actions to support your health, and wellness and wellness of your families. :salute:  Hopefully some things turn around.  I'm going to try my MPP, Health Ministry to see what I can do for my own situation.  "Put life-perserver on myself before I seek to rescue others", less easy to forget that now, that's a good thing I suppose. ;D  Karma, it all catches up. . . take care of your health.  Neglecting health to save the system $, only hurts you and doesn't stop what's happening to the system-- figure some soldiers may need that reminder. . .

NB:  I'm probably going to lose internet, for a bit anyways (to the relief of a few members ;-) ), but it helped me out a lot and I'm grateful for that.  I'm stronger because of it, better foundation moving forward (despite physical footing ;-) and challenges).  I learnt from all examples, including really great ones here, of which there are many and not found just 'anywhere', IME.  :salute:

So with that . . .

"So long, and thanks for the fish."  ;D (Hitchhikers Guide to the Galaxy)  Appreciated.  :salute:
I don't know about anyone else here, but I had to look Fibromyalgia up:

Fibromyalgia (FM or FMS) is a psychosomatic disorder[1] characterized by chronic widespread pain and allodynia (a heightened and painful response to pressure).[2] Fibromyalgia symptoms are not restricted to pain, leading to the use of the alternative term fibromyalgia syndrome for the condition. Other symptoms include debilitating fatigue, sleep disturbance, and joint stiffness. Some patients[3] also report difficulty with swallowing,[4] bowel and bladder abnormalities,[5] numbness and tingling,[6] and cognitive dysfunction.[7] Fibromyalgia is frequently comorbid with psychiatric conditions such as depression and anxiety and stress-related disorders such as posttraumatic stress disorder.[8][9] Not all fibromyalgia patients experience all associated symptoms.[10] Fibromyalgia is estimated to affect 2–4% of the population,[8] with a female to male incidence ratio of approximately 9:1.[11] The term "fibromyalgia" derives from new Latin, fibro-, meaning "fibrous tissues", Greek myo-, "muscle", and Greek algos-, "pain"; thus the term literally means "muscle and connective tissue pain".

The brains of fibromyalgia patients show functional and structural differences from those of healthy individuals, but it is unclear whether the brain anomalies cause fibromyalgia symptoms or are the product of an unknown underlying common cause. Some research suggests that these brain anomalies may be the result of childhood stress, or prolonged or severe stress.[9]

There is controversy as to whether fibromyalgia should be considered a rheumatological or neuropsychiatric disorder. There is no cure for fibromyalgia, albeit controlled clinical trials have demonstrated various modalities capable of symptom improvement; in particular, anti-depressant medication, such as tricyclic antidepressants, possess the best evidence, though behavioral interventions, patient education, and exercise have also been documented as treatment alternatives.[12][13][14][15][16][17] The most recent approach of a diagnosis of fibromyalgia involves pain index and a measure of key symptoms and severity.[18]

Fibromyalgia has been recognized as a diagnosable disorder by the US National Institutes of Health and the American College of Rheumatology.[19][20] Fibromyalgia, a central nervous system disorder, is described as a 'central sensitization syndrome' caused by neurobiological abnormalities which act to produce physiological pain and cognitive impairments as well as neuro-psychological symptomatology.[21] Despite this, some health care providers remain skeptical about fibromyalgia as a disease because of a lack of abnormalities on physical examination and an absence of objective diagnostic tests.[22][23]

Turns out I had an undiagnosed MCL injury, that was the main culprit for all the other symptoms, the extreme fatigue, stress-pain, sleeplessness from pain (then messing up the ptsd), etc.  I had to wait a year to get x-rays and MRI-- the MRI confirmed the injury.  I kept getting "well it's really hard to diagnose pain with a stress disorder".  They hypothesized  'osteoarthritis' and to keep walking (which was re-injuring me-- 10 mins of walking with cane, would cost me some days in functioning, lost mobility, extreme fatigue-- and my hip was getting damaged too).  See there's application of the "Ottawa Knee Rules" (for access to x-ray/MRI diagnostics) and I wasn't fitting the category for entitlement to assessment here in Ontario (not by age, etc.-- wonder how safe sports activities are, if have to risk going through this bs [age 20-65]), under OHIP coverage-- and my doctor/interns having difficulty administering McMurray Knee test?  (Staff seemed stressed with 'fiscal responsibilities to the province', policy changes and in that transition, without assessment training in lieu of x-ray/MRI. . . I was falling between the cracks [again]).  Specialists, physiotherapists which may have more skill at administering knee-tests (not necessitating MRI), but not covered by OHIP nor by Provincial Disability for my age category.  So I was pretty much crippled for the year (and frustrated, not being able to get groceries, etc., apparently no big deal to my doctors. . .).  I was also confused because of pain with other injuries (foot, ankle, collarbone, etc.) and stress pain (from cringing lots, I suppose, and with the PTSD-- neck/shoulders), did me in, loss of sleep-- it was under-attack from all directions, it was overwhelming for me and no Dx,  no access to Tx. . . my head felt spun by it, suffering pretty bad, frustrating all round.

Game-changer was finding a program (via internet) offered for free at a local community health centre, 6-Week program called "Living a Healthy Life With Chronic Conditions", based on the Stanford model: http://patienteducation.stanford.edu/programs/cdsmp.html  It was co-facilitated by a nurse, so in a way I had a witness that could improve accountability with my doctor/clinic when I could show them I was participating in this program (other eyes) and I did internet research, showing how the injury happened, why I think it's MCL (which is the exclusion criterion to the restrictions from the "Ottawa Knee-Rules". . .).  From that, I was able to get my Disability worker to also flex a bit, to help me get a proper brace and a bit of flex for a hinged-brace.  I probably have other 'mechanical' problems from the feet, custom orthotics could benefit me (but what will I have go through to achieve that assistance)-- I'm using store-bought inserts; tape to keep my toe from dislocating, and maxi-pads in the boots, lol [toe was self-injury from some years back, the PTSD, a Tantrum and a Concrete Wall [but no witnesses, no-one else got hurt, but stupid, yes-- and I really regret that now. . . :-[ ]).

The program itself gave practical tips for self-advocacy and support through that.  Program gave some self-empowerment, new ideas-- how to exercise in ways that don't re-injure; to do it at moderate levels to reap benefits from aerobic (which releases endorphins, natural pain-killer-- and assists sleep).  Even if one is limited by wheelchair, can still increase aerobic benefits by upper body exercises, and sport, etc.  Holistic approach: stress management, meditation, nutrition, etc. and how that pain-stress-depression-fatigue-sleeplessness-stress cycle goes and good tips for managing it, the pieces-- using multiple strategies in tandem, can help tip the balance from unbearable, frustration to manageable, to also significant improvements over time. . . having 6 week focus on it, goal-setting to try new strategies out and to assess them-- it helped me get a handle on what I needed to do (shift from from being overwhelmed by all of it, too much with the ptsd overlay too).

I started with cycling.  I'm now able to walk with brace, go an hour (provided my rest has been good), without negative effects on sleep, pain-- and that reduces my stress in a big way.  I'm doing physio exercises (off the internet), I can rehab most of it on my own (stability exercises I don't feel ready to attempt).

At the worst of it, I felt at wits end, super-frustrated by both pain/immobility, the other stressors, ptsd, poverty (incl. hunger-stress); intensely irritated, making me at higher risk for worse accident, so I can get help, qualify for treatment. . . but glad I hung in there (I have a conscience, I don't want to give others/drivers ptsd-- that's what held me back-- that one intervening thought between actions. . .).

Anyway, those programs are being offered across Canada [and in the US as well], free of charge, there are some side-benefits for PTSD management/improvement.  It might be fit well to assist others in wait on medical release (e.g. at JPSU/IPSU) and e.g. if they're not transferring directly into a new career or education path.  The self-empowerment focus of that can be a helpful counter-weight to the stressors of release, medical issues, the 'system-stressors' there, the uncertainties. . .-- start with the smaller things one can have control over and do make a difference in quality of life.  Completion of the program also gains one the opportunity to get free-training to become a facilitator, it's a pay-it-forward kind of opportunity; it is potentially an additional practical-oriented, direct-support way for veterans helping fellow veterans out. . .  plus benefits of community-building, positive focus, positive changes, reducing isolation/increasing support . . .  :yellow: