Fibromyalgia? Try Tai Chi

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By Carina Storrs

WEDNESDAY, August 18, 2010 ( — Doctors often recommend exercise for patients with fibromyalgia, but the chronic pain and fatigue associated with the condition can make activities like running and swimming difficult. Tai chi—a slow, meditative martial art—may be an effective alternative, a new study suggests.

Fibromyalgia patients who took tai chi classes twice a week for three months experienced less pain, stiffness, and fatigue than a control group that attended lifestyle education and stretching sessions, according to the study, which was published in the New England Journal of Medicine.

Tai chi involves a series of slow, fluid movements that focus on balance and deep breathing. Although it’s not clear from the study how exactly tai chi might improve fibromyalgia symptoms, both the physical activity and the meditative aspects are likely beneficial, says Chenchen Wang, MD, the lead researcher and an associate professor at the Tufts University School of Medicine, in Boston.

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“Some people need the physical improvement; some people need more mental improvement,” she says. “Tai chi can help with both.”

Previous research has shown that tai chi can help relieve the symptoms of arthritis and other pain conditions, but this study is the first controlled trial to examine its effectiveness as a treatment for fibromyalgia, which affects an estimated 10 million Americans.

The study included 66 fibromyalgia patients who were randomly assigned to take one-hour tai chi classes with an experienced teacher or one-hour classes that taught coping skills, pain-management techniques, and stretching. Participants were also asked to practice tai chi or stretch on their own for 20 minutes each day, depending on which group they were in.

After three months, Dr. Wang and her colleagues asked the patients to rate their pain symptoms, physical functioning, fatigue, and mood, all of which were combined on a single scale ranging from 0 to 100, with higher scores indicating more severe symptoms. (The patients completed the same survey before the study began.)

The average score among the tai chi patients dropped from 63 to 35, while the average for the control group dropped by just nine points, from 68 to 59. Three months after the sessions stopped, the scores had remained roughly the same, which suggests that the benefits of the tai chi were lasting, Dr. Wang says.

Next page: Encouraging results

The results were encouraging, as existing fibromyalgia treatments—including medication, sleep therapy, and aerobic exercise—fail to help many patients. “We need another approach,” says Dr. Wang.

Robert Shmerling, MD, an associate professor at Harvard Medical School and the clinical chief of rheumatology at Beth Israel Deaconess Medical Center, in Boston, says that he often recommends alternative treatments, such as acupuncture and massage, to his fibromyalgia patients, although some of them are skeptical.

“I would certainly put tai chi on the list,” says Dr. Shmerling, who co-wrote an editorial that accompanies the study. “It’s difficult to take something that’s as safe as tai chi and show that it has this dramatic benefit and not be enthusiastic about it.”

The calming style of tai chi used in the study, known as Yang, may be especially effective for fibromyalgia patients, says Kim D. Jones, PhD, an associate professor at the Oregon Health & Science University School of Nursing, in Portland.

“It works more on the parasympathetic nervous system, …the part of the nervous system that helps us feel calm and relaxed,” says Jones, who studies Yang-style tai chi and yoga in fibromyalgia but wasn’t involved in the study.

Jones recommends that fibromyalgia patients find a well-trained instructor rather than trying tai chi on their own. She points out that learning tai chi in a group may have its own therapeutic benefits, by boosting confidence, for instance.

Many community centers offer affordable tai chi classes, but experienced teachers can be expensive and hard to come by. However, if future studies support the benefits of tai chi, insurance companies might start to cover the practice, Dr. Shmerling says.

Yoga Soothes Fibromyalgia Pain

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By Carina StorrsTHURSDAY, October 14 ( — Fibromyalgia patients who aren’t getting relief from prescription drugs and are in too much pain to exercise may want to try yoga, a new study suggests.

A weekly two-hour yoga class reduced fibromyalgia symptoms such as pain, fatigue, and stiffness by 30% in more than half of the people who took it, according to the study, which was published in the journal Pain. A control group of patients who continued their regular treatment regimen reported no change in symptoms.

The yoga program used in the study is a low-impact way for fibromyalgia patients to get moving, and it may even change the way the central nervous system responds to pain, says James Carson, PhD, the lead researcher and a psychologist at the Oregon Health and Science University, in Portland.

“Exercise is often recommended, but many fibromyalgia patients find that exercise is too painful to continue or that the classes aren’t tailored for them,” Carson says.

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Fibromyalgia? Try Tai Chi

Carson and his colleagues adapted elements of the gentle Hatha style of yoga into a program they call “Yoga of Awareness.” In each two-hour session, patients spend 40 minutes working through a series of familiar yoga poses (warrior 1, child’s pose) and another 80 minutes on meditation, breathing exercises, and group discussions about coping with pain.

The activities other than the yoga poses are “major components of [the program]—not just add-ons—in helping patients learn to handle pain and fatigue in a different way,” Carson says.

In the study, the researchers randomly assigned 53 women who had lived with fibromyalgia for at least a year to maintain their existing treatment regimen or to take a weekly Yoga of Awareness class (in addition to their current medication and treatment). Patients in the yoga group also received instructional DVDs and were encouraged to practice on their own every day.

At the beginning of the study, the participants rated the severity of their fibromyalgia symptoms—including pain, fatigue, stiffness, poor sleep, and anxiety—on a scale from 0 to 100 using a standard questionnaire. After two months, the average score of the women who completed the yoga program decreased from 48 to 35, while the average score in the control group (49) didn’t budge.

Next page: More research needed

Though promising, these results need to be borne out by studies with a larger and more diverse group, including men, who make up 10% to 25% of fibromyalgia patients, says Robert Shmerling, MD, an associate professor at Harvard Medical School and the clinical chief of rheumatology at Beth Israel Deaconess Medical Center, in Boston.

Future studies will also need to test the yoga program against other types of interventions, rather than the participants’ existing treatment. Carson and his colleagues couldn’t rule out the possibility that participating in the yoga classes caused a response, similar to the placebo effect, that improved symptoms over and above the effects of the yoga itself.

Still, the study adds to a growing body of evidence that suggests that gentle exercise could be a valuable treatment for fibromyalgia. Yoga reduced the symptoms of fibromyalgia patients in a 2007 study, and in August of this year, a study in the New England Journal of Medicine found that tai chi similarly eased symptoms.

The yoga and tai chi studies could help build interest in alternative therapies for fibromyalgia, Dr. Shmerling says. “They will get the neutral doctors and even the doubters into the camp of, ‘Why not try this?'”

Most physicians are interested in prescribing a combination of medication and alternative therapies for fibromyalgia, although a new crop of prescription drugs that are expected to become available in the coming years may temporarily shift attention back to medical treatments, Dr. Shmerling adds.

Carson is planning a larger study that will use sensory tests to explore how exactly yoga might improve fibromyalgia. “We believe that it probably changes [central nervous system] responses to pain signals,” he says.

Fibromyalgia patients who are interested in trying yoga should look for a class that focuses on low-impact poses and an instructor who has experience working with pain patients, Carson says. And because classes that incorporate other coping strategies are hard to find, he recommends complementing yoga with a meditation course at a community or health center.

To the Brain, Being Burned and Getting Dumped Feel the Same

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By Matt McMillen

MONDAY, March 28, 2011 ( — Science has finally confirmed what anyone who’s ever been in love already knows: Heartbreak really does hurt.

In a new study using functional magnetic resonance imaging (fMRI), researchers have found that the same brain networks that are activated when you’re burned by hot coffee also light up when you think about a lover who has spurned you.

In other words, the brain doesn’t appear to firmly distinguish between physical pain and intense emotional pain. Heartache and painful breakups are “more than just metaphors,” says Ethan Kross, Ph.D., the lead researcher and an assistant professor of psychology at the University of Michigan, in Ann Arbor.

The study, which was published in the journal Proceedings of the National Academy of Sciences, illuminates the role that feelings of rejection and other emotional trauma can play in the development of chronic pain disorders such as fibromyalgia, Kross says. And, he adds, it raises interesting questions about whether treating physical pain can help to relieve emotional pain, and vice versa.

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“What’s exciting about these findings,” he says, “is that they outline the direct way in which emotional experiences can be linked to the body.”

Kross and his colleagues recruited 21 women and 19 men who had no history of chronic pain or mental illness but who had all been dumped by a romantic partner within the previous six months. The volunteers underwent fMRI scans—which measure brain activity by tracking changes in blood flow—during two painful tasks.

In the first, a heat source strapped to each subject’s left arm created physical pain akin to “holding a hot cup of coffee without the sleeve,” Kross says. In the second, the volunteers were asked to look at photos of their lost loves and were prompted to remember specific experiences they shared with that person.

Other fMRI research has examined how social rejection manifests in the brain, but this study was the first to show that rejection can elicit a response in two brain areas associated with physical pain: the secondary somatosensory cortex and the dorsal posterior insula. Those brain regions may have lit up in this study but not others because the rejection his volunteers experienced was unusually intense, Kross says.

Although Kross stresses that the study is “very much a first step” in understanding the connection between physical and emotional pain, the findings may help chronic pain patients grasp that emotions can affect their physical condition, says psychologist Judith Scheman, Ph.D., director of the chronic pain rehabilitation program at the Cleveland Clinic.

Past traumas can make people more sensitive to pain and thus more susceptible to disorders like fibromyalgia, which causes both chronic pain and fatigue, Scheman says. She and her staff encourage pain patients to “explore their emotional trauma and baggage,” but many are reluctant to do so.

“As a clinician, I like studies like this because patients often don’t understand why they have to do painful emotional work,” Scheman continues. “Showing them something like this helps them understand that there is science behind what I am asking them to do.”

Lady Gaga Postponed Her Tour Due to Fibromyalgia. What to Know About the Painful Disorder

Lady Gaga has postponed the European leg of her world tour because she is in “severe physical pain,” according to a statement posted this morning on Twitter. This comes just days after the singer cancelled a performance in Brazil and revealed that she suffers from fibromyalgia—a chronic illness she also addresses in her new documentary, Gaga: Five Foot Two.

The 31-year-old star “remains under the care of expert medical professionals who recommended the postponement earlier today,” today’s statement reads. “She plans to spend the next seven weeks proactively working with her doctors to heal from this and past traumas that still affect her daily life, and result in severe physical pain in her body.”

Gaga also spoke directly to her fans on Twitter, writing that she has to be with her doctors right now “so I can be strong and perform for you for the next 60 years or more.”

While the Super-Bowl headliner may be one of the highest-profile celebs to speak out about a struggle with , she’s certainly not alone. The disorder affects an estimated 5 million adults, according to the National Institutes of Health.

To learn more about the chronic and often debilitating illness, Health spoke with Roland Staud, MD, professor of medicine at the University of Florida’s Center for Musculoskeletal Pain Research. Although Dr. Staud is not involved in Lady Gaga’s care, he has researched fibromyalgia extensively and treated many other patients who suffer from it. Here’s what we learned.

Fibromyalgia involves “amplified” pain signals

“Fibromyalgia is a disorder of disordered sensory processing,” explains Dr. Staud. “Signals in the body, particularly pain signals, are amplified to an extensive degree.” The resulting pain generally affects deep tissues—like the muscles, ligaments, and joints—and is often accompanied by other symptoms including fatigue, sleep problems, and trouble thinking.

Why fibromyalgia occurs is “only partially understood,” says Dr. Staud, but the condition has been linked to stressful or traumatic events, repetitive injuries, illness, and certain diseases. Fibromyalgia can also run in families, and some experts believe that one or multiple genes may play a role, affecting how strongly people react to .

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Diagnosis involves ruling out other conditions

Anyone can get fibromyalgia, but between 80% and 90% of those diagnosed are adult women—most of whom are diagnosed in middle age. There is no test to prove that a person has fibromyalgia, so doctors first have to rule out other conditions that could be causing a person’s symptoms.

In the past, a person could only be diagnosed with fibromyalgia if they met the criteria for a certain number of painful or tender areas on the body. “That’s changed more recently,” says Dr. Staud, “so that now a diagnosis is based not just on abnormalities of pain, but also abnormalities of memory and , as well.”

Hospitalization isn’t usually necessary

When her Brazil show was cancelled last week, Gaga tweeted that she’d been taken to the hospital because she was in so much pain. But Dr. Staud cautions that fibromyalgia pain isn’t something that most people should run to the emergency room for.

“She is probably getting some form of unconventional treatment,” he says. “But it’s important to know that there are really no proven therapies for this condition that need hospital admission.” Instead, he says, patients should work with their doctors to develop long-term treatment plans for managing their pain.

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Medication, behavioral therapy, and lifestyle changes can all help

There are currently three medications approved to treat fibromyalgia pain, which Dr. Staud says have “moderate effectiveness.” Cognitive behavioral therapy should also be part of a fibromyalgia treatment plan, he says, because it can help people learn to respond differently to pain sensations and to stressful situations.

Lifestyle modifications—like taking a break from a busy tour schedule—are also critical, says Dr. Staud. “Getting enough sleep is very important, as is proper nutrition and getting light-intensity, low-impact aerobic exercise several times per week,” he says. “It’s also important to reduce stressful events, because is a consistent problem in fibromyalgia patients that seems to make symptoms worse.”

Patients should ask their doctors about other therapies and alternative remedies that might help with their specific symptoms. In her upcoming documentary, Gaga receives treatments for painful muscle spasms; she’s also shown getting massaged and putting ice on sore muscles during and after rehearsals.

It’s associated with stigma—and often with disbelief

Since fibromyalgia has no obvious cause or visible symptoms—and because there is no test to definitively confirm the disease—those who are diagnosed with it often have to deal with the added challenge of not being taken seriously. Gaga hinted at that in her Twitter message, as well.

“I use the word ‘suffer’ not for pity, or attention, and have been disappointed to see people online suggest I am being dramatic, making this up, or playing the victim to get out of touring,” she wrote. “I use the word not only because trauma and chronic pain have changed my life, but because they are keeping me from living my normal life.”

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More research is desperately needed

Gaga also wrote that she will share more of her story when she feels stronger, and that she hopes to raise awareness and help expand research to help others. That’s good news, says Dr. Staud, because there’s still very much that doctors don’t know about the disorder and how best to treat it. (His lab, in fact, is researching those very questions.)

And more good news, says Dr. Staud, is that many people with fibromyalgia are able to successfully manage their symptoms. “They may have to modify their behavior a bit—maybe they wouldn’t want to play contact sports or anything like that,” he says. “But with medication and the right therapy, many people can live relatively normal lives.”