Episode 5: Forget the pharmaceuticals! Movement is medicine!
Perhaps that claim is hyperbole. Perhaps. When it comes to fibromyalgia, though I have been prescribed pregabalin, the most promising answer for pain that I have experienced which fits into my belief system and my bodies functionality is movement.
Before I go any further, let me make this clear: This blog does not provide medical advice. This is for informational purposes only. No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. With that said and understood, read on...
Although movement is known to alleviate symptoms of fibromyalgia, I am not categorically opposed to western medicine's intervention. I am not opposed to using medicine to help alleviate or cure disease. I prefer not to use medicines because I never know which, if any, of the side effects are going to become a part of the story. But, let it be known, for example, that although I would rather ingest ginger to help with stomach problems, I know that Alka-Seltzer will quickly and easily work as well, perhaps even better at relieving the acute pain and discomfort of eating greasy, nasty food or a drinking too much alcohol. As for fibromyalgia, first, let's look at what I fear most about the commonly prescribed drugs, and then let's look I why I prefer to use movement as medicine.
The Drugs
If you read my journal, you know that I recently spent 6 hours digging into and perseverating over academic studies and reviews of literature about prescription drugs used in the treatment of fibromyalgia. I got scared. The side effects and drug interactions sound troubling to say the least. Sadly, A review of pharmacological studies showed that only a small minority of patients taking the 3 most common drugs prescribed and approved by the FDA for fibromyalgia: pregabalin (Lyrica), duloxetine (Cymbalta), and milnacipran (Savella), will experience significant relief from symptoms.
Side Effects:
According to the Mayo Clinic, the side effects from these drugs are numerous. For pregabalin, blurred vision, mental confusion, and weight gain are common - along with more than 30 other common side effects. For duloxetine, body aches and pains, muscle aches, and trouble sleeping are listed among the most common side effect - as well as over 15 more. As for milnacipran, the Mayo clinic lists 20 common side effect including, body aches or pain, fast, irregular, pounding, or racing heartbeat or pulse, and unusual tiredness or weakness. For people living with fibromyalgia, many of these side effects are common symptoms of the disorder that they experience
every day. It is true that many of these side effects may not present themselves. But, considering that a minority of people will reap substantial benefits of these drugs when prescribed, I wonder if tolerating the side effects is worth it.
Interactions:
Besides the side effects, interactions with other drugs are numerous for all three of these drugs. For pregabalin alone, there are over 140 interactions with other drugs that doctors need to be aware of before prescribing it to patients. And if 140 doesn't freak you out, try 576 drugs known to interact with duloxetine. But this is according to Drugs.com - which is maybe not the most "reliable" source (as an English teacher, I would send my students back to the library if they tried to use that as a source!). But, if I was just trying to see what my doctor was prescribing for me, and I came across this information, I would definitely have some questions. Though the drug interactions with milnacipran are not as numerous as for duloxetine, we are still talking about over 195 drugs that need to be cross for interactions before prescribing this medicine. With so many drug to drug interactions with these FDA approved drugs prescribed for fibromyalgia, it is daunting to consider which one and for what reason, or in what combination a doctor will prescribe them for their patients.
My Doctor Prescribed Pregabalin:
My doctor prescribed pregabalin. Interestingly, I have yet to find a paper, report, or study that explains exactly what pregabalin does for fibromyalgia. It is good for neuropathic pain and inflammatory injuries but, in the article Pregabalin in Acute and Chronic Pain the authors conclude, "Higher rates of the substantial benefit were found in postherpetic neuralgia and painful diabetic neuropathy, but not in central neuropathic pain or fibromyalgia". So why did I agree to take it? The answer is that I may be one of the few who will benefit from the pain relief it promises. The product website boasts: "In clinical studies, some patients taking LYRICA had significant fibromyalgia pain relief compared with those taking a placebo, so they felt better and could do more*". The Asterisk is for a tiny print warning that "individual results may vary". And if we remember back at the beginning of this blog, it was noted that only a small minority of patients will experience significant relief. Perhaps I will be one of the lucky few.
Considering I take no other medication except vitamins, with much trepidation but careful consideration of the possible benefits and the side effects, I am taking it as prescribed with titration up to a therapeutic dose. I started at 25mg and I am currently at 150mg. I am not sure what dosage will be therapeutic for me, but generally "therapeutic" starts at 300mg. So far, with each increase, I feel a slight elevation in mood and some pain relief. The pain relief isn't like the pain in my body is gone, it's more like I don't think about it as much. I don't seem to have any other side effects yet, except the elevation in mood, but I am not sure if that is considered a "side effect".
When my doctor prescribed the medication, it almost sounded as if he is throwing stuff at the wall to see what would stick. He gave me options and said "if it doesn't work, we'll try something else". I mean... OK but... that seems a bit cavalier. However, he was also honest about how difficult it is to treat fibromyalgia because everybody's symptoms are different, everybody responds differently to medication, and that it is kind of "hit or miss" with treatment options. But he was also willing to suggest alternative treatments such as: chiropractics, acupuncture, massage therapy, and physical and movement therapy. What impressed me most was his insistence that I see a physical therapist who works with fibromyalgia patients. This physical therapist has knowledge of the disorder and knows how to work with the all over body pain. So far, my physical therapist has prescribed a series of movements to help with specific joints and muscles to help not only relieve the pain but work on strengthening weaknesses in my body. A-HA! Here we go! Movement as Medicine!
Exercise and Fibromyalgia
Low impact aerobic exercise, strength training, and stretching are all components of a good exercise regimen for people living with fibromyalgia.
But, for a person with fibromyalgia, exercise is sometimes last thing they may want to do. Experts say exercise, strength training, and stretching can reduce pain and help manage this disorder. However, according to the Harvard Health Publishing blog, as with any exercise program, start slow. Jumping into it (like I tend to do) and going too hard, too fast, could cause "Post-Exertional-Malaise", or PEM, sometimes called "push and crash" (something I am well-acquainted with), which leaves the body exhausted and unable to recover for days, weeks, or in severe cases even months. PEM is often referred to as a FIBRO-CRASH. The way to avoid the crash is pacing. A good physical therapist should be able to help you ward off such crashes and assist you in creating an exercise protocol and pacing strategies that work for you.
Dance Therapy
My favorite! My first career was dance, so the idea of dance as therapy is exciting to me. Dance has been shown to lead to a significant reduction in pain. Why? Because dance releases endorphins which interact with the same receptors as opioid medications and because of this, dance is "a natural pain reliever". Not only is dance therapy good for pain reduction, it is good for mental health. According to Álvaro Murillo-García et al., "physical exercise is the non-pharmacological therapy with the highest level of evidence to reduce fibromyalgia symptoms...[and] dance has emerged as a relevant therapy to improve quality of life". Move that body! Finally, dance has a social-emotional component that may lead to a better overall sense of well-being.
Yoga and Fibromyalgia
Yoga is another practice that can be incorporated into a movement regimen to relieve pain, reduce fatigue, strengthen muscles, and improve sleep. Yoga engages the parasympathetic nervous system which is responsible for slowing the body's systems down, conserving energy, and countering the "flight or fight" response of the sympathetic nervous system. Yoga helps decrease sympathetic activation. In times of extreme stress the sympathetic nervous system can be activated for too long and, according to the Franklin Cardiovascular Autonomic Dysfunction and POTS Center, "excessive sympathetic activity may make pain more amplified and make one's reaction to simple stimuli appear excessive". Yoga helps the parasympathetic nervous system counter this activity, and helps reduce musculoskeletal pain, stiffness, fatigue, along with improving mobility, strength, flexibility and sleep quality, all of which plague the person living with fibromyalgia. This is more evidence that movement is medicine.
My Routine: QUIT THE GYM
First of all, I quit the gym. I loved it, but it perpetuated my cycle of PUSH and CRASH. I had a dream of being strong and powerful and invincible. I was getting strong, but I also was having bouts of inactivity because of acute fatigue. After a good run of about 7 weeks, I would have to stop for 3 weeks or more to recover. My husband remarked, and rightfully so, that it was expensive and I wasn't getting my money's worth. His solution was Apple Fitness, an app on my iPhone with which I could tailor my fitness needs. I love it! and it is cheap! I have created a fitness routine with 5 different short 5-10 minute fitness classes all taught by people with REAL bodies - some are CUT, some are CURVY and, important to me, ALL are women!
5 Flows: 45 Minutes
I start with a 5 minute meditation - to set my intention for the work out.
I do a 10 minute Yoga flow - to get my body warmed up, opened up and released.
I move on to 10 minute easy HIIT (High Intensity Interval Training) with low impact modifications - to get my heart rate up.
I then do 10 minutes of strength training for arms and/or core - either with light dumbbells or body weight.
I end with a 10 minute fascia focused cool down - to stretch and lower the heart rate.
This training is perfectly tailored to me and physical therapist approved. It is something I can easily do 3-5 times a week at home along with meeting my 10,000 steps at work. I can cut something out if I need to, or add something if I feel like I need more. There are no grunting weightlifters, nor pushy trainers in my face. It's just me, doing my thing in my living room practicing healthy fitness without throwing myself into PEM.
I am not a fan popping pills and I believe in the end, movement is the medicine that I will depend on for the rest of my life. Right now, as I try to mitigate the pain and navigate this disorder, I will lean into a combination of medication and movement with hopes of seeing, perhaps, significant pain relief.
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Karen Palmen, EdD is a veteran educator in Saint Paul, Mn. She teaches Dance and English at Saint Paul Central High School. She has an active TikTok page that features humorous, political, mental health, and educational content (kickin it with karen). And a a dormant YOUTUBE channel with the same name, featuring fermented foods and other cooking oddities.
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The information, including but not limited to, text, graphics, images and other material contained on this website are for informational purposes only. No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition or treatment and before undertaking a new health care regimen, and never disregard professional medical advice or delay in seeking it because of something you have read on this blog.
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