Factors that Affect FM Symptoms


Experts offer their clinical advice on what factors, outside of clinical therapies, may mitigate symptoms of fibromyalgia (FM).


Wendy Wright, DNP, ANP-BC, FNP-BC, FAANP, FAAN, FNAP: I'm wondering, we're going to talk about medicines in a little bit, but what are some of the factors in patients with fibromyalgia that can worsen their fibromyalgia, and what are some factors that can make it better other than medicine?

Benjamin Natelson, MD: Well, Dan, you've already talked about CBD. I believe there's a role for CBD in any illness, heart failure, COPD. Coping with chronic illness is a whole set of different things. And then there's CBD as Dan mentioned for poor sleep also. That's certainly very helpful as an adjunct. And the other thing that's helpful as an adjunct is what I call gentle physical conditioning. I think that walking is the least prescribed and probably most important self-help tool that patients have. What happens is, at least patients with chronic fatigue syndrome and fibromyalgia is the severity of their illness have made them cut back on their activities. They must rest a lot. And as you rest, especially if you rest lying down, you have significant amounts of deconditioning, which can be combated first by vertical position if you can be in the vertical position, and then a gentle physical conditioning, which in my practice has to be hand tailored for each patient. You can't just tell someone to go out and walk for 20 minutes because for some it may be trivial, in others it may be impossible. But doing that does two things for the patient. It gives the patient a sense of being in control in an illness where they really don't know what's going on, their doctors don't know what's going on. And it also combats the deconditioning produced by the need to rest.

Wendy Wright, DNP, ANP-BC, FNP-BC, FAANP, FAAN, FNAP: I'm glad you brought that up because one of the things we talk about in any patient with chronic pain is, and I just say to them, just move. You've got to move. But we know that patients with fibromyalgia, some of them walking for ten minutes, puts them in bed for the next two days, whereas others walking for 20 minutes is what puts them in bed. You're right, gently tailoring it to them, but to get them to move because the less they move, the worse their pain perception in my opinion.

Daniel Clauw, MD: Don't use the word exercise to a fibromyalgia patient. They'll look at you like you're stupid. Use activity or move as how you really describe to people what you want to do. Because just getting people to move around their house or to get up for five minutes every hour, and the symptom that's more rapidly impacted when people start moving is not pain, it's fatigue. I think most of us learned during COVID that you get tired if you just sit all day and you don't do anything. But if you use the word exercise, people will just turn and tune off. They'll just say, 'I can't do that.'

Benjamin Natelson, MD: Sure. And what you were explaining, Wendy, where people do too much and then pay for it the next day is the Sinequan of chronic fatigue syndrome. It's called post-exertional malaise. And that's where the 2 overlap usually the FM. The FM patient who has fatigue and post-exertional malaise and cognitive complaints will fulfill criteria for chronic fatigue syndrome. And of course, then the treating physician has to determine with the patient what's worse, the fatigue or the pain, and treat accordingly.

Kostas Botsoglou, MD: I like to remind my patients motion is lotion. So, I agree. If you mention the word exercise, they may look at you funny. But low impact aerobic activities such as stretching or gentle strength training can really make a difference.

Wendy Wright, DNP, ANP-BC, FNP-BC, FAANP, FAAN, FNAP: I love that statement. Motion is lotion. That's a good one. Thank you for that. That's a great pearl.

Transcript edited for clarity.

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