Thursday, April 14, 2011

Possible genetic link in FMS/CFS

Two separate research groups have published new findings regarding genetic susceptibility and fibromyalgia.

A Wisconsin group investigated whether a gene mutation called the apolipoprotein E4 (Apo E4) allele is linked to fibromyalgia.  The study found that people with at least one copy of Apo E4 and an environmental factor (such as a car accident) were more likely to have the illness.

However, having fibromyalgia with Apo E4 didn't appear to make the condition worse.

Research from a Texas group looked into the frequency of a particular gene polymorphism (variant of a trait) called Beta (2)-adrenergic receptor, or B(2)AR.

This polymorphism was significantly lower in fibromyalgia participants than in controls, suggesting it also could be a risk factor.  The polymorphism also appeared to be connected to sleep dysfunction.

Researchers also say they demonstrated differences in cellular response that may explain why some subgroups of fibromyalgia react differently than others to adrenergic agonist medications that are frequently prescribed for the condition.

The discoveries in both of these studies offer additional biological evidence that fibromyalgia is a physiological illness and they may someday help doctors identify who is at risk.

Many researchers have long believed fibromyalgia involves a genetic predisposition because it frequently runs in families.

Help with Chronic Pain

When I first went to Kern Pain Management Program, I wasn't ready.  I still thought I had a pretty good handle on my chronic pain condition, and I honestly didn't think anyone could help me beyond what I was doing for myself.  A couple of years later, and some significant defeats in my physical and emotional life, I was there again.  This time, I said, "I'm whipped."  And I was.  I was beaten down by my disorder to the point where I was willing to take whatever help I could get.  And this time it worked.

I learned a great deal about how my body and my brain deal with pain signals, ways to distract myself from constantly thinking about my pain, and ways to take advantage of the brief reprieves that I was fortunate enough to have.  I learned to recognize those reprieves for what they were--breaks in the cycle of pain that I could build on by becoming more aware of them.

Kern Pain Management Program is a benefit of Kaiser Permanente of Southern California.  I don't know how many other programs there are out there like it, but it was of great benefit to me.  I would suggest that anyone suffering from a chronic pain condition try to find such a program and take advantage of what it has to offer.  I think for me it was a little like Alcoholics Anonymous.  I had to "hit bottom" before I reached a point where I could truly take advantage of it.  I hope that others out there are able to take advantage of such a program before they get to that low point in their lives.

I spent a lot of time believing that no one really understood my problems with pain.  Part of this was because I had negative responses from doctors who really didn't understand.  I'm glad I finally found a doctor who did.  He is the one who referred me to Kern Pain Management Program.  There I found a team of people who really understand what pain is all about.  I am not cured, and I still have a lot of bad days when my pain prevents me from enjoying my life.  However, I now have days where I do enjoy my life, something I didn't have before.  My pain isn't all there is to me anymore, and that is a blessing I didn't have before.

Monday, April 11, 2011

SHINE program

By Jacob E Teitelbaum MD
Jacob E Teitelbaum MD

The “perfect storm” for Fibromyalgia, CFS/ME, and fatigue in general is preparing to hit.

A combination of poor nutrition, decreasing sleep, increasing stress and environmental toxins has created a human energy crisis of unprecedented proportions. Over the past 10 years, the incidence of Chronic Fatigue Syndrome (CFS) and Fibromyalgia (FMS) has exploded by 400 to 1000 percent, as documented in five separate studies.

The numbers for those with CFS in the U.S., previously estimated at 500,000, are now being re-tallied at closer to 1- 2.5 million. Previous estimates placed the number of Americans with FMS at 6 million. Studies worldwide suggest this has likely gone up in the last decade to ~ 12-24 million Americans! Meanwhile, ¼ of Americans suffer with chronic pain and most are fatigued.

So what does the research show? 

The lead article published in an issue of the Journal of Chronic Fatigue Syndrome is titled "Effective Treatment of Chronic Fatigue Syndrome and Fibromyalgia -- the Results of a Randomized, Double-Blind, Placebo-Controlled Study"! After decades of hard work by hundreds of researchers in the field, we have progressed to the point where effective treatment is now available for these illnesses! In our study, 91 percent of patients improved with treatment.

In the average patient, after two years of treatment, the average improvement in quality of life was 90 percent. Pain decreased by over 50 percent on average. Many patients no longer even qualified for the diagnosis of CFS or fibromyalgia after treatment! Interestingly, many of the same principles for treating fibromyalgia also apply to myofascial pain syndrome

That the vast majority of patients improved significantly in the active group while there was minimal improvement in the placebo group proves two very important things. The first is that these are very treatable diseases. The second is that anyone who now says that these illnesses are not real or are all in your head are clearly both wrong and unscientific.

A new day is dawning in how CFS/fibromyalgia/MPS will be treated. In support of our work, an editorial in the April, 2002 journal of a major multidisciplinary medical society for pain management in United States noted " the comprehensive and aggressive metabolic approach to treatment detailed in the Teitelbaum study are all highly successful approaches and make fibromyalgia a very treatment responsive disorder. The study by Dr. Teitelbaum et al. and years of clinical experience make this approach an excellent and powerfully effective part of the standard of practice for treatment of people who suffer from fibromyalgia and myofascial pain syndrome”.

It is important to recognize that these syndromes can be caused and aggravated by a large number of different triggers. When all these different contributing factors are looked for, and treated effectively, patients improved significantly and often get well!

What is causing these illnesses?

As we noted above, CFS/FMS/MPS is not a single illness. Our study has shown that it is a mix of many different processes that can be triggered by many causes. Some of you had your illness caused by any of a number of infections. In this situation, you can often give the time that your illness began almost to the day.

This is also the case in those of you who had an injury (sometimes very mild) that was enough to disrupt your sleep and trigger this process. In others the illness had a more gradual onset. This may have been associated with hormonal deficiencies (e.g. low thyroid, estrogen, testosterone, cortisone, etc.) despite normal blood tests. In others, it may be associated with chronic stress, antibiotic use with secondary yeast overgrowth, and/or nutritional deficiencies. Indeed, we have found well over 100 common causes of, and factors that contribute to, these syndromes.

What these processes have in common is that most of them can suppress a major control center in your brain called the hypothalamus. This center controls sleep, your hormonal system, temperature, and blood flow / blood pressure. When you don't sleep deeply, your immune system also stops working properly and you'll be in pain. When we realized this, the myriad symptoms seen in CFS/fibromyalgia suddenly made sense. It also gave us a way to effectively treat you!

The “SHINE Protocol”- Five main categories of problems need to be treated.

A half-century of work by Dr. Janet Travell, the White House physician for Presidents Kennedy and Johnson and author of the Trigger Point Manual showed that the same problems caused by hypothalamic suppression resulted in muscles getting stuck in the shortened position. Chronic muscle shortening then causes myofascial and fibromyalgia pain, with chronic pain then being amplified in the brain (called Central Sensitization). As she laid the groundwork for effective treatments these processes, our research team dedicated our published study to her memory. These are the five key areas that need to be treated for Chronic Fatigue syndrome, fibromyalgia and muscle pain to resolve:

1- Sleep. Most patients with these illnesses find that they are unable to get 7-8 hours of deep sleep a night without taking medications. In part, this occurs because hypothalamic function is critical to deep sleep. Unfortunately, many of the most common sleep medications actually aggravate the sleep problems by decreasing the amount of time spent in deep sleep. For patients to get well, it is critical that they take enough of the correct sleep medications to get 8 to 9 hours sleep at night! These medications include Ambien, Desyrel, Neurontin, Klonopin, and, if you don't have Restless Leg Syndrome, Flexeril and/or Elavil. In addition, natural remedies can help sleep. An excellent one (which I developed –the Revitalizing Sleep Formula by Enzymatic Therapy -- 100 percent of my royalty for all products I develop is donated to charity) includes theanine, Jamaican Dogwood, wild lettuce, valerian, passionflower, and hops. Other natural sleep aids include magnesium (250-500 mg of the Jigsaw Health sustained release magnesium would be an excellent choice), and melatonin (3/10-1mg). In the first six months of treatment, it is not uncommon to sometimes need to take even six to eight different products simultaneously to get 8 hours of sleep at night. After 6-18 months of feeling well, most people can come off of most sleep (and other) medications. I'm starting to believe that, to offer a margin for safety during periods of stress, it may be wise to stay on 1/2 to 1 tablet of a sleep medication for the rest of your life.

2--Hormonal deficiencies. The hypothalamus is the main control center for most of the glands in your body. Most of the normal ranges for our blood tests were not developed in the context of hypothalamic suppression or these syndromes. Because of this (and for a number of other reasons) it is usually necessary, albeit controversial, to treat with thyroid, adrenal (very low dose cortef; DHEA), and ovarian and testicular hormones -- despite normal blood tests! These hormones have been found to be reasonably safe when used in low doses.

3--Infections. Many studies have shown immune system dysfunction in FMS/CFS. Although there are many causes of this, I suspect that poor sleep is a major contributor. The immune dysfunction can result in many unusual infections. These include viral infections (e.g. –XMRV, HHV-6, CMV, and EBV), parasites and other bowel infections, infections sensitive to long-term treatment with the antibiotics Cipro and Doxycycline (e.g. mycoplasma, chlamydia, Lyme’s, etc) and fungal infections. Avoiding sweets (stevia is OK) and taking Acidophilus Pearls (healthy milk bacteria –2 pearls twice a day for 5 months) can be very helpful. We often also add prescription antifungals as well.

4--Nutritional supplementation. Because the western diet has been highly processed, nutritional deficiencies are a common problem. In addition, bowel infections can cause poor absorption, and the illness itself can cause increased nutritional needs. The most important nutrients include: a) vitamins -- especially the B vitamins (most at 25-50 mg/day), vitamin B12 (50-3000mcg/day), antioxidants (e.g. -- vitamin C and E). b) Minerals -- especially magnesium, zinc, and selenium and c) amino acids (proteins).

In addition, a new nutrient discovery called Ribose (Corvalen by Bioenergy) is looking like the most exciting discovery of the decade in energy research. Two studies using it in ~ 300 CFS/FMS patients at 53 medical centers have shown it increased energy an average of ~60% after only 3 weeks! Take 5 grams (1 scoop) 3 x day for 3 weeks, then twice a day. For “day to day” fatigue, even lower doses are helpful (I take 1 scoop each morning mixed in with the vitamin powder).

5- Exercise as tolerated. In the beginning, walk as much as you can so that you feel “good tired” after and better the next day. Because you do not yet have the energy to condition, do not push beyond what is comfortable. Otherwise, you’re likely to crash. After 10 weeks on the program, your energy production will increase, and then you’ll be able to condition by increasing your walking by one minute a day as able. When you get to 1 hour a day, you can increase the intensity of your exercise.

There are many other treatments available as well. Although space does not allow for a full discussion of these in this article, I discuss them at length in my book “From Fatigued to Fantastic! “ and at my website. Our free short online “ symptom analysis program” on my web site can simplify this process markedly. It can analyze your symptoms and labs to tell you what the likely causes are of your Chronic Fatigue or Fibromyalgia, and even of day to day fatigue, and tailor a treatment protocol to your specific case!

Effective treatment is now available. It’s time for people to get well!

Dr. Teitelbaum is a board certified internist and Medical Director of the ”Fibromyalgia and Fatigue Centers” nationally. Having suffered with and overcome Chronic Fatigue Syndrome (CFS ) and Fibromyalgia in 1975, he spent the next 30 years creating, researching, and teaching about effective therapies for fatigue and pain. He is the senior author of the landmark studies "Effective Treatment of Chronic Fatigue Syndrome and Fibromyalgia -- a Placebo-controlled Study" & “Effective Treatment of CFS & Fibromyalgia with D-Ribose”. He lectures internationally. He is also the author of the best-selling book” From Fatigued to Fantastic!” (3rd ed-Penguin/Avery Oct 2007), “Pain Free 1-2-3- A Proven Program to Get YOU Pain Free! “ “Beat Sugar Addiction NOW”, and the free iPhone and Android application “Cures A-Z”. His web site can be found at:

Sunday, April 10, 2011

Memory loss and fibromyalgia

Memory loss and disorientation are two of the most challenging symptoms of fibromyalgia. Suddenly not knowing where you are can lead to embarrassment or even panic. Here are 6 expert-recommended tips for preventing fibro fog…

We all sometimes forget grocery items or loved ones’ birthdays, but for people with fibromyalgia, memory lapses happen more frequently and can be more severe.

The chronic pain disorder triggers a sudden forgetfulness known as “fibro fog” or “brain fog.” It changes cognitive functioning and leads to memory loss or other thought-processing problems, says Jacob Teitelbaum, M.D., fibromyalgia expert and author of From Fatigued to Fantastic! (Avery Trade).

Actual brain loss may be a cause, some researchers believe. Fibromyalgia patients showed 10 times the gray matter loss than those aging normally, according to a 2007 study by Montreal’s McGill Centre for Research on Pain.

Fibro fog can also cause episodic disorientation – 30-90 seconds of suddenly not knowing where you are or where you’re going, says Teitelbaum. That happens in a third of women with fibromyalgia, often when they’re turning onto a freeway exit or shopping at the grocery store.

These cognitive problems may make fibromyalgia patients fear they’re developing Alzheimer’s disease, but the two aren’t related, Teitelbaum says.

“Fibro brain fog can make you lose your keys,” he explains. “Alzheimer’s makes you forget how to use a key.”

More good news: You can ease symptoms of brain fog. Here are 6 tips from fibromyalgia experts:

1. Fibro fog lifter: Get enough sleep.
Fibro patients often start the day exhausted. They struggle to fall and stay asleep and often suffer from a variety of sleep disorders.

Daily fatigue triggers cognitive problems, says Roland Staud, M.D., professor of medicine at the University of Florida’s rheumatology department. So the more sleep-deprived you are, the more symptoms of fibromyalgia fog you’ll suffer.

Try it: Treatment depends on the cause of your sleep issues. So work with your doctor to find out what’s keeping you awake, advises Teitelbaum.

If it’s restless leg syndrome (RLS), a common fibromyalgia symptom, your doctor may prescribe dopamine agonists, anti-anxiety drugs or anticonvulsants.

If you’re wired from anxiety and depression, ask your physician about taking a combination of melatonin and the antidepressant fluoxetine, which eased sleep problems for participants in a 2010 study published in the Journal of Pineal Research.

Keeping healthy sleep habits can also help you rest better. Teitelbaum offers these tips:

* Put the bedroom clock out of arm’s reach and facing away from you so you can’t see it.

* Take a hot bath before bed.

* Don’t drink alcohol near bedtime.

* Skip caffeine after 4 p.m.

(Get more sleep tips for people with fibromyalgia in our article Losing Sleep Over Fibromyalgia?)

2. Fibro fog lifter: Take ribose supplements.
Ribose, a natural simple sugar, plays a key role in metabolism. And “anything that improves energy production in the cells helps brain cells,” Teitelbaum says.

Specifically, ribose is a component of adenosine triphosphate (ATP), considered the body’s energy molecule. ATP helps the body use key nutrients, such as vitamin B1, that are necessary for proper brain function, says Teitelbaum.

Ribose improved mental clarity an average of 30% in a 2006 study published in the Journal of Alternative and Complementary Medicine. It also increased energy an average of 61%, says Teitelbaum, one of the study’s lead researchers.

Try it: Take 5 grams (g) of ribose, three times a day (15 grams total) for three weeks.

Then drop it to 5 g twice a day, “although you may find that 3 g twice a day is enough to prevent mental cloudiness,” Teitelbaum says.

3. Fibro fog lifter: Exercise.
Working out can physically grow your brain. Exercise increases the right and left sides of the hippocampus, the part of the brain involved in memory, according to a 2011 University of Illinois study.

And “the increased blood flow that occurs when our heart pumps faster enhances concentration, learning and memory,” says Marie Palinski, staff neurologist at Massachusetts General Hospital, faculty member at Harvard Medical School and author of Beautiful Brain, Beautiful You (Hyperion).

Try it: The American College of Sports Medicine recommends 30 minutes of activity on most days of the week for adults. Low-impact activities, such as swimming, are usually recommended for people with fibromyalgia, but check with your doctor or a physical therapist before starting a new workout.

It’s also important to stay active throughout the day too.

“Revving up your heart rate by taking the stairs instead of the elevator, walking faster, or standing during phone calls improves mental clarity,” Palinski says.

And cut back on TV time, as hard as that may be when you’re achy and exhausted. Too much TV drains you of energy and makes you even more tired and foggy.

“Numerous studies have found that excessive TV watching is associated with depression, lower cognitive function and a decline in overall physical health,” Palinski says.

4. Fibro fog lifter: Change your routine.
A new daily routine challenges both your mind and body.

“When stuck in a rut, we’re constantly treading the same brain pathways,” Palinski says. “Engaging in a new activity literally wakes up our brains.”

That’s because the brain has to lay new neural pathways to process new information.

Try it: Trade the treadmill for a stationary bike, shop at a different store, take an alternate route home, or try a new recipe.

And go outside your social comfort zone, Palinski advises. The next time you’re in the supermarket checkout line, start chatting with a stranger. Meeting new people and engaging in conversation forces your brain to pay attention.

5. Fibro fog lifter: Commune with nature.
Our multi-tasking modern lives – with computers, TV, texting, tweeting, emails and cell phone calls all going at once – can overstimulate the brain and increase stress levels.

“Our brains can only hold one thought at a time,” Palinski says. Constant interruptions disrupt our ability to focus, concentrate and retain information.

Try it: Nature has a calming effect. So walk in the park, take the scenic route home, stop to watch the sunset, or just gaze at evening stars.

People who walked through a wooded park for 15 minutes significantly improved their performance on an attention test, according to a 2008 University of Michigan study. Those who walked on noisy city streets before testing stayed the same.

“The beauty of nature will give your prefrontal cortex – the area of your brain that helps you focus – an opportunity to recharge,” Palinski says.

6. Fibro fog lifter: Practice yoga, tai chi or mindfulness meditation.
Relaxing activities such as yoga, tai chi and meditation can improve problems with sleep, fatigue, poor memory and anxiety – all of which are linked to brain fog, according to many studies.

For example, women with fibromyalgia on an eight-week program of meditation and gentle yoga poses had a 42% drop in depression and 30% decline in fatigue, according to a 2010 Oregon Health and Science University study.

Yoga also reduces inflammation, which can trigger fibro fog, a 2010 Ohio State University study found. Researchers discovered that the ancient Indian practice lowered the levels of cytokine interleukin-6 and IL-6 – two inflammatory markers – in the blood.

Try it: Sign up for yoga classes at your local gym or YWCA or rent instructional DVDs from the library.

If possible, practice outside, advises Teitelbaum. “The combination of exercise with sunshine and fresh air can help reduce brain fog.”

For more from this author, see the link below:

People with Fibromyalgia often think they're alone in pain, and no one understands. People in pain suffer the burden of feeling that no one believes them.

Dr. Keith Lynch understands, and has put together a vital video highlighting the ways in which people with Fibromyalgia can find solutions to their ailments. Dr. Lynch has been treating people successfully for over 13 years.

Fibromyalgia sufferers find poor sleep, chronic pain, irritable bowels, anxiety, depression, brain fog and fatigue burdening them. Many of these symptoms can be addressed by a new protocol offered by Dr. Lynch at his Charlottesville Virginia location.

Dr. Lynch consults with over 1,000 doctors nationwide. Results achieved with patients suffering from fibromyalgia  can be found on the website,

To help more people find relief, Dr. Lynch has also made a free video detailing his treatment program.

Those suffering from this challenging condition can find solutions to their symptoms. There's no reason to continue living in pain.

Free videos on treating people with fibromyalgia are available to all who signup at

Adhesive Capsulitis

This condition is also known as frozen shoulder, and I have been suffering greatly from it for a couple of months now.  I have it in both shoulders.  Here is a graphic showing a normal shoulder:

Here is a graphic showing "frozen" shoulder:


Frozen shoulder is when the shoulder is painful and loses motion because of inflammation.

Of course, some of you may remember my posting this graphic when I was trying to figure out what was going on with my shoulder:

Causes, incidence, and risk factors

The joint capsule of the shoulder joint has ligaments that hold the shoulder bones to each other. When the capsule becomes inflamed, the shoulder bones are unable to move freely in the joint.
Most of the time there is no cause for frozen shoulder. However, risk factors include:


The main symptoms are:
  • Decreased motion of the shoulder
  • Pain
  • Stiffness
Frozen shoulder without any known cause starts with pain. This pain prevents you from moving your arm. The lack of movement leads to stiffness and then even less motion. Over time, you become unable to perform activities such as reaching over your head or behind you.

Signs and tests

The health care provider will make the diagnosis based on your symptoms and an examination of your shoulder. You will have a loss of rotation in your shoulder.
You may have x-rays of the shoulder to make sure there is no other problem, such as arthritis. Sometimes an MRI exam may show inflammation, but there are no specific signs to diagnose frozen shoulder.


Pain is treated with nonsteroidal anti-inflammatory medications (NSAIDs) and steroid injections. Steroid injections plus physical therapy can improve your motion.
It can take a few weeks to see progress, but it may take as long as 6 - 9 months to have a complete recovery. The physical therapy is intense and needs to be done every day.
If nothing is done, the condition should get better by itself within 2 years with little loss of motion.
Any risk factors for frozen shoulder, such as diabetes or thyroid problems should also be treated.
Surgery is recommended if nonsurgical treatment is not effective. This procedure is done under anesthesia. See: Shoulder arthroscopy
Your health care provider will release the scar tissue by bringing the shoulder through a full range of motion. Arthroscopic surgery can also be used to cut the tight ligaments and remove the scar tissue from the shoulder.
Some surgeons may use repeated pain blocks after surgery so you can participate in physical therapy.

Expectations (prognosis)

Treatment with therapy and NSAIDs will usually return the motion and function of the shoulder within a year. Even if left untreated, the frozen shoulder can get better by itself in 24 months.
Even if surgery restores motion, you must continue physical therapy for several weeks or months afterward to prevent the frozen shoulder from returning. Treatment may fail if you cannot tolerate physical therapy.


  • Stiffness and pain continue even with therapy
  • The arm can break if the shoulder is moved forcefully during surgery

Calling your health care provider

If you have shoulder pain and stiffness and suspect you may have a frozen shoulder, contact your health care provider for proper referral and treatment.


The best way to prevent frozen shoulder is to contact your health care provider if you develop shoulder pain that limits your range of motion for an extended period of time. This will allow early treatment and help avoid stiffness.
People who have diabetes will be less likely to get frozen shoulder if they keep their condition under control.


  1. Miller RH, Dlabach JA. Shoulder and elbow injuries. In: Canale ST, Beatty JH, eds. Campbell's Operative Orthopaedics. 11th ed. Philadelphia, Pa: Mosby Elsevier;2007:chap 44.
  2. Krabak BJ, Banks NL. Adhesive capsulitis. In: Frontera WR, Silver JK, eds. Essentials of Physical Medicine and Rehabilitation. 2nd ed. Philadelphia, Pa: Saunders Elsevier;2008:chap 10.

Review Date: 10/31/2010.
Reviewed by: Linda Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington School of Medicine; and C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Dept. of Orthopaedic Surgery. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.