Could Your Depression and Pain Really Be Fibromyalgia?

Monica’s Story

Since her early 20’s, Monica struggled with reoccurring bouts of flu-like symptoms of extreme fatigue, physical weakness and incapacitating pain in her joints and muscles, especially in her arms, hips and legs. These bouts of illness seemed to come out of nowhere, until she began to notice a connection between physical activity and a flare-up of her symptoms. A late night out with friends, strenuous yoga class, eating junk food, walks with her pet, cleaning the house, or a busy workweek was enough to knock her off her feet and send her to bed for several days.

During a physical flare-up of symptoms, even lifting herself out of bed was difficult. Literally, she couldn’t move at these times, let alone drag herself out of bed to eat. Monica was so physically, mentally and emotionally wiped out that she wondered if she had cancer, multiple sclerosis, Lyme disease, or an autoimmune disorder, like lupus or rheumatoid arthritis. Monica was also extremely depressed during these flare ups, which made medical professionals and her wonder if this was all just depression or a bipolar disorder.

Antidepressants, anti-inflammatory medications, strong antibiotics (Cipro) and anti-viral medications (Acyclovir) managed her symptoms for years. But, not without taking a toll on her body, mind and spirit. She hated the “sick” role and did all she could to avoid it throughout the years. Monica interacted with no one during physical flare-ups and only reappeared when she felt well, so that no one except family really knew how sick she really was. No one saw the real Monica who had to drag her aching, tired and depressed self out of bed each morning, as if she were a very old woman.

By her 40’s, Monica became more housebound. All she could physically manage was working and occasional outings with friends. But, the good news was that after years of medical tests and treatments, there was finally a name for her disorder; Monica had fibromyalgia, a chronic, muscular and skeletal physical pain syndrome characterized by symptoms of widespread joint and muscle pain, fatigue, disturbance of sleep and mood and cognitive difficulties that include slowed processing of information, motor responses, and attention problems.

Persons with fibromyalgia often get misdiagnosed as being primarily depressed with physical symptoms as a response to major depression or bipolar disorder, rather than the other way around. This isn’t surprising, as studies show there is a moderate to strong relationship (73%) between fibromyalgia and the depressive disorders. Prior to the newest version of the main diagnostic manual in psychiatry (DSM V), the pain disorders (somatoform disorders) that include fibromyalgia were distinguished as separate health conditions that have psychological features. The jury was still out in terms of the biological cause of such disorders. To assure diagnostic accuracy, a number of physical and pain related symptoms had to be present for patients to meet the diagnosis of a somatoform disorder that alerted practitioners to the strong medical-nature of the problem and the need for a holistic approach to treatment.

Unfortunately, this has changed. Although there’s a growing body of research showing the genetic, rheumatologic and viral connections to fibromyalgia, and new blood tests to detect molecules in the blood specific to fibromyalgia syndrome (Faster, Simpler Diagnosis for Fibromyalgia on The Way), it seems the psychiatric profession has taken a step backward to its treatment of this serious health disorder. Fibromyalgia along with the other pain disorders will now be lumped into a diagnostic category called somatic symptom disorder that requires patients present with only one physical complaint that distresses or disrupts their daily lives to receive this diagnosis. It’s easy to see how pain-related health disorders, such as fibromyalgia, will continue to be misdiagnosed as psychiatrically-based with this new change of category (Mislabeling Medical Illness:

Just the Facts, Mam!

fibromyalgia_cycleFibromyalgia affects approximately 5 million people in the United States alone, affecting more women (3.4%) than men (.05%) in the general population. Gender differences may speak to the interaction of female hormones with the genetic, stress, pain, immune and viral pathways of the disease.

Heredity may be a factor in fibromyalgia.

The odds of having fibromyalgia are several times higher in the immediate families of people with fibromyalgia than in families in which no one has the disease . Genetic studies have turned up a number of genes specific to fibromyalgia, some of which are also associated with tendencies toward depression and anxiety. This may explain the high rates of depression in persons who have fibromyalgia and also why antidepressants help to treat some of its symptoms.

Fibromyalgia was originally thought to be a disease in the arthritis family because of its widespread muscular and skeletal pain. But, recent studies show that the body pain found in the disorder extends well beyond the central nervous system. Researchers are now looking at the role the immune system plays in the onset of the disorder. Specifically, they are studying the relationship between fibromyalgia and the common herpes simplex virus that takes up residence in the nerves.

Importantly, when the immune system gets compromised by too much physical, hormonal or emotional stress and trauma (common triggers for fibromyalgia), it can no longer contain the herpes virus. Breakouts of the herpes virus causes flare-ups of fibromyalgia in which symptoms across many body systems appear (Herpes Simplex Virus and Fibromyalgia: Devil is in the Details: Causes of Fibromyalgia). 

Fight Fibromyalgia In Every Area of Life

Fibromyalgia affects almost every system of the body. Stress in one area of our lives (physical, hormonal, viral or emotional) can be just enough to cause a fibromyalgia flare-up. Minimizing stress across all body systems that include mental health reduces a fibromyalgia flare up of symptoms and wear and tear on the body, mind and spirit.

Fibromyalgia is a high-maintenance disease that requires full-attention to manage it well. Poor nutrition, insufficient sleep or exercise, excess alcohol or drug use, smoking, or too much physical and mental stress can increase flare-ups of fibromyalgia symptoms, weaken health, and reduce quality of life.

With fibromyalgia, it’s very important to see a Rheumatologist to manage the symptoms of pain and other medical aspects of the disease. They are very knowledgeable in the pain (Lyrica), viral (acyclovir) and anti-depressant medications (Cymbalta) that treat fibromyalgia symptoms.

But, medication alone is not enough to treat the widespread symptoms of fibromyalgia. “Pain medications only reduce the pain felt in fibromyalgia patients by about 50% at best.”

fibro warriorTo reduce fibromyalgia flare-ups and to strengthen quality of life ~ you have to fight fibromyalgia across every body system and area of living.  Health Psychologists and Psychiatrists and holistic health professionals, such as Acupuncturists, Oriental Medical Doctors and Licensed Massage therapists can help you to manage physical pain and also to learn how to cope efficiently with the disease.

But, perhaps the most important thing you can do to treat fibromyalgia is in your own hands. Nutrition, exercise and rest and relaxation are vital to keeping flare-ups at a minimum and to securing health.

fibromyalgia_foods to avoid1. Nutrition: Fibromyalgia patients have to eat a healthy diet of the right foods if they wish to get better and to keep flare-ups at bay. The following recommendations are vital to reducing physical and mental stress, strengthening the body, and lowering the inflammation that causes physical pain.

Toxins and additives cause stress on the body and can contribute to fibromyalgia flare-up of symptoms. It’s important to be on a clean” diet that consists of little to no processed or manufactured food in which chemicals are added and good nutrients are removed.

It’s also very helpful to avoid fast-food that is high in saturated, hydrogenated fat, sugar, preservatives, sodium, and high fructose corn syrup–all of which increase cellular inflammation and PAIN. Eating a diet that is high in fruits and vegetables, lean protein, whole grains, and healthy fats (essential fatty acids: omega 3’s) reduces body and brain inflammation and pain.

Once you are eating clean, as they say, you want to experiment with eating smaller meals, six times per day that are balanced in protein, carbohydrates, and good fats. This is better than eating three, large meals per day that are more apt to over-work the body organs (pancreas and liver) responsible for turning food into blood sugar.

Also, research is clear that sugar stresses the body. You want to keep sugary treats at a low, to reduce fibromyalgia symptoms. Sugar stresses the pancreas and liver and causes the body hormone insulin to chronically circulate through the body to store excess levels of blood sugar. Insulin increases inflammation throughout the body and brain and slows one down physically and mentally. This slowing of brain processes that causes memory lapses, problems remembering names for things, mental confusion and concentration difficulties in fibromyalgia is referred to as fibro fog

Also, foods in the night-shade vegetable category (potatoes, bell peppers, and eggplant) have a chemical called solanin that causes pain. To reduce physical pain, it’s best to avoid these foods on a regular basis.

Fibromyalgia patients often have multiple food and chemical sensitivities. While these may not be the cause of the disease, allergies stress the body enough to cause a flare-up of fibromyalgia symptoms. An important part to fighting the disease is becoming aware of food and chemical sensitivities and then avoiding them.

2. Exercise: Although exercise may be the last thing on your mind when you are in physical pain, it’s one of the best things you can do for treating fibromyalgia. Stretching the muscles brings oxygen and blood flow back to the muscles and reduces pain. But, remember, fibromyalgia may have a viral component to it. Too much physical exercise of any kind can unleash the herpes virus and cause a fibro flare-up. Gentle, low impact exercise for short periods of time, a few days a week, like taking daily walks, stretching, swimming, yoga, tai chi, or pilates can lower physical stress and keep you fit in spite of having fibromyalgia.

3. Rest and Relaxation: Last, but certainly not least, is getting enough rest and relaxation to heal the body and mind. Deep breathing and relaxation techniques, meditation, yoga and sleep counteract stress and will help to keep fibromyalgia flare-ups at bay.

At this point, there’s no cure for fibromyalgia; there’s only management of this complex, high maintenance disease. Still, there’s much we can do to treat and manage the disease, as mentioned in today’s post. If you think you may have fibromyalgia, let today’s post be the start of learning all you can about the disease. Become a fibromyalgia warrior. There’s a wealth of information on the Internet on fibromyalgia. Let today’s post stimulate you to search out the information you need to best manage the disease.

I hope you liked today’s post and took away some useful information for your life. Please let me know by selecting the Like icon that immediately follows. You can also Tweet and Google+1 today’s post to let family and friends know about it. Take good care of yourself. Warm regards Deborah.



3 Responses to “Could Your Depression and Pain Really Be Fibromyalgia?”

  1. avatar Anabelle Fernandez says:

    Excellent and informative article on Fibromyalgia Dr. Khoshaba!

  2. avatar pete says:

    Good day Dr
    I need to answer the following question can you please advise me.
    I must Id a few concepts or theories on psychology and write down them and apply them to his of her personal life.
    I will appreciate it if you can assist


    • avatar Dr. Deborah Khoshaba says:

      Hello Pete, do you mind explaining what you need to me a little more? I’m unsure exactly how I can help but will be happy to do so if you can say a little more. Take care. Warm regards Deborah.


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