My therapist visit

Discussion in 'Fibromyalgia Main Forum' started by gymmbabe, Sep 22, 2006.

  1. gymmbabe

    gymmbabe New Member

    Hello FMS friends,

    Well, had my first therapist visit yesterday to deal with the depression and pain. When I explained to the therapist that I have FM; he said, "Fibromyalgia is a hodge podge diagnosis that doctors make when they can't find anything wrong."

    I cried. All I want is some help in dealing with this stupid illnes. How can I get help from someone that doesn't believe in the illness?? I'm so frustrated.

    He does believe that I am in pain and depressed. He wants to teach me some meditation and relaxation techniques. I am going back in a couple of weeks. He also referred me to a psychologist...Any one else seeing a psychologist for FMS??

    Dawn
  2. PVLady

    PVLady New Member

    I mentioned this before but will say it again... it is a good idea to see three different therapists before settling on one you will stick with.

    This is a example why...someone who does not even believe in your illness is not going to gain your trust.

    Is it possible for you to see two more therapists and then decide who you will see permanently?
  3. Redwillow

    Redwillow New Member

    I understand your frustration. I have had these comments too. From doctors, therapists, chiropractors... It is like they all have to let you know they aren't convinced yet!

    Fibromyalgia is very real! Whether it is a mixture of several different conditions or not shouldn't be the issue here!

    But these comments put us on the defensive. It attacks our credibility and it makes me very angry. It took me 30 years to get a diagnosis and I am still hitting walls with people in the medical community!

    Your question about therapy is important though. I was involved with Cognitive Behavioural Therapy for 2 1/2 years. It was the best thing that happened to me. At the same time I had quit my job, hadn't been diagnosed yet and was dealing with a lot of anger and stress with my family.

    CBT addresses our feelings and our emotions and how we deal with stressful situations in our life. We have to do the work to change the way we think and the way we react and it isn't always easy. But for me it was very rewarding.

    Mediation and relaxation techniques can be good. Be careful with relaxation techniques where you are required to tense your muscles and then relax them. This didn't work for me. My muscles won't relax when I tense them and this put me in even more pain. Our muscles are already tense and tightning them up even more just makes it worse. Someone else on this board (sorry can't remember the name) said the same thing.

    hugs Marion (Redwillow)
  4. gymmbabe

    gymmbabe New Member

    Thank you Redwillow, Prickles, Hayleycole and PVLady for your replies. I'm sorry it took a little while to get back to you. I live in KY and all of our phone lines/cable lines/internet lines were down due to the weather.

    Thanks to you all, I am not as nervous about seeing a psycologist. This person I saw was a "therapist." There are several more in the office, maybe I will inquire about them. If none of them believe in FM...I am taking Hayley's advice and RUNNING!

    I know I need some help dealing with this. Bipolar does run in my family (mom & sister). Maybe this is part of my problem?? We'll see.

    Thanks again and I will keep you all up to date.

    Dawn
  5. carebelle

    carebelle New Member

    I would ask to see someone that is up to date on FM/CFS this person is not.

    If he starts out by telling you that he doesnt believe in it then why waste your time? Hes made up his and you are not the one to educate him.

    I see a psychologist but it is for other problems not my FM/CFS. He knows I have them but he doesnt treat them .
  6. lenasvn

    lenasvn New Member

    from Devin Starlanyl about FM for mental health workers. Give it to him and get a new counselor!!

    What Your Mental Health Worker Should Know
    About FMS and CMP


    by Devin J. Starlanyl

    This information may be freely copied and distributed only if unaltered,
    with complete original content including: © Devin Starlanyl, 2003.

    Please read “What Everyone on Your Health Care Team Should Know.”

    The combination of fibromyalgia syndrome (FMS) and chronic myofascial pain
    (CMP) can cause diagnostic confusion and complicate treatment. Central
    sensitization of FMS may be maintained by peripheral stimulation such as
    myofascial TrPs (Staud, Smitherman 2002; Borg-Stein 2002). Myofascial TrPs may
    be more painful due to the central sensitization of FMS. It is important that both
    conditions are addressed so that the cycle is interrupted. “The most aggressive
    challenges of the FMS concept have been from legal defenses of insurance carriers
    motivated by economic concerns. Other forms of critique have presented as
    psychiatric dogma, uninformed posturing, suspicion of malingering, ignorance of
    nociceptive physiology, and occasionally have resulted from honest misunderstanding” (Rau, Russell 2000). Fibromyalgia is real. Your patient may have
    multiple hormonal and autonomic imbalances, leading to profound physiological
    and clinical consequences (Adler, Manfredsdottir, Creskoff 2002). It should not be
    taken lightly. It’s associated with dysautonomia (Raj, Bruillard, Simpson 2000).
    “Chronic imbalance of the autonomic nervous system is a prevalent and potent risk
    factor for adverse cardiovascular events, including mortality”(Curtis, O’Keefe
    2002).

    Myofascial trigger points (TrPs) are associated with autonomic concomitants, as
    well as proprioceptive disturbances (Simons, Travell, Simons 1999), and these and
    other TrP symptoms such as eye-twitching may be mistaken as psychogenic. Ask
    your patients about restricted range of motion with pain at the end of the motion,
    and the presence of nodules or painful lumps and ropy bands in their muscles.
    Some TrP symptoms mimic neurological disorders (Simons, Travell, Simons 1999),
    and FMS symptoms can as well. Patients with specific patterns of referred pain,
    indication of nerve, lymph, or blood vessel TrP entrapment, or proprioceptive
    disturbances should be evaluated for CMP. Patients with diffuse body wide aches of
    long duration, and with allodynia and/or hyperalgesia should be evaluated for FMS
    (Starlanyl, Copeland 2001).

    Think about how you would feel if you were no longer able to practice your
    profession . . . if you lost the ability to control your muscles, and sometimes even
    to think clearly . . . if you couldn’t function in your family role . . . if you were in
    severe pain, and your ankles were buckling, and you couldn’t even pick up a glass
    of water without spilling it, and yet your family, your friends and even your doctors
    thought you were crazy because you looked okay. This is what life is like for many

    What Your Mental Health Worker Should Know About FMS and CMP
    by Devin J. Starlanyl © 2003 Page 1


    people with FMS and CMP. Acute pain that diminishes in the course of healing is
    something most of us can endure. Recurrent or persistent pain, especially when
    its cause is not recognized, can be intolerable (Gritchnik and Ferrante 1991;
    Hitchcock, Ferrell and McCaffery 1994). It can lead to frustration, depression, and
    progressive disability. There is no specific personality type for patients with CMP
    (Nelson, Novy 1996) or FMS (Johannson 1993). These and many other studies
    indicate that “emotional disturbance in pain patients is more likely to be a
    consequence than a cause of chronic pain”(Gamsa 1990).

    Cognitive complaints are common in many chronic pain states. In FMS, these
    deficits are often called “fibrofog” and have been documented (Park, Glass, Minear
    et al. 2001). Free-floating anxiety, panic attacks, rapid mood swings, irritability
    without known cause, difficulty concentrating, inability to recognize familiar
    surroundings can all part of fibrofog and may be due to neurotransmitter
    imbalance, but may be complicated by many factors. Pain processing eats up
    thought processing networks and thus interferes with thinking, reasoning, and
    remembering (Grisart and Plaghki, 1999). Pain can disrupt cognitive performances
    that depend on intact speed and capacity of information processing (Grigsby,
    Rosenberg, Busenbark 1995). Fibromyalgia can cause slowed psychomotor speed
    in tasks that require sustained effort (Landro, Stiles, Sletvold 1997). “Sensory
    overload” is what I call the sense that information and other stimuli are coming so
    fast the brain can’t handle it. Some patients may go into a fugue state at this
    point, staring into space until the brain integrates the information. This can even
    happen during a conversation, mid-sentence. Simple tasks such as putting on
    socks can be interrupted by fugues, but the patient can often be taught to
    recognize them and push a mental reset button to resume activities or learn to
    close down some sensory input such as shutting off the radio or avoiding crowds
    and cities.

    Patients may forget to do tasks they require to minimize physical symptoms. That,
    plus the additional stress brought about by fibrofog, can lead to flare. Although
    flare is part of FMS, myofascial TrPs can be activated or new ones can form at this
    time. Existing symptoms worsen, new symptoms may appear, and patients may
    require extra support, including bodywork and medication, until the central
    nervous system calms down. Perpetuating factors must be identified and brought
    under control. Confusional states may be compounded by coexisting reactive
    hypoglycemia (RHG) (Hvidberg, Fanelli, Hershey, et al. 1996; Blackman, Towle,
    Lewis, et al. 1990; McCrimmon, Deary, Huntly, et al. 1996), a common
    perpetuator of both FMS and CMP. Chronic stimulation of the HPA axis, usually
    part of FMS, may contribute to the development of insulin resistance (Farias-Silva,
    Sampaio-Barros, Amaral et al. 2002). Check for the possible presence of RHG,
    insulin resistance or metabolic syndrome by asking about your patient’s diet and
    response to carbohydrates. If present, these conditions require immediate diet
    modification. In these cases, ensure sufficient protein intake and avoidance of
    excess carbohydrates in all meals and snacks.

    What Your Mental Health Worker Should Know About FMS and CMP
    by Devin J. Starlanyl © 2003 Page 2


    Fibrofog frustration can be doubly difficult for your patient because under its
    influence, the art of self-expression may be lost or damaged. Difficulty getting out
    known words, especially nouns and pronouns, difficulty distinguishing right from
    left and/or difficulty finding places or following directions and sequencing are
    common, as well as difficulty multitasking. Myofascial TrPs in the laryngeal
    muscles can create a slow, “halted” speech pattern, or garble sounds. Activation
    of other TrPs can cause the patient to appear clumsy, drop objects, or even fall
    down.

    If your patient doesn’t show up on time for an appointment, it doesn’t necessarily
    signify that s/he is noncompliant. Your patient may simply be in a confusional
    state. Try to schedule appointments at the best time of day for the patient, and
    the same time every time, and teach patients with timing difficulties some memory
    aids. Patients experiencing fibrofog often take a hefty amount of abuse from
    people who are unaware of the reason behind their confused state of mind.
    Neurotransmitters are imbalanced in FMS (Russell 1996) and in the endocrine
    system as well (Pillemer, Bradley, Crofford, et al. 1997). Too little serotonin may
    cause depression, but there may be many neurotransmitters, hormones and other
    informational substances imbalanced in FMS, and each of them can affect many
    others. Many of these informational imbalances may cause symptoms that appear
    psychological, and this may be part of the picture, but they may have a physiological basis as well.

    Many patients with FMS and/or CMP have had repetitive trauma. Emotional
    symptoms as well as brain function may be affected whenever the cervical spine
    has been injured (Radanov, Bicik, Dvorak et al.1999). It doesn’t take a major auto
    accident to cause significant damage. Some brain-disconnects are a consequence
    of the trauma and not psychological at all (Radanov, Begre, Sturzeneggar et al.
    1996).

    Some researchers believe that impaired mental function in FMS is daytime
    sleepiness causing fatigue, in addition to the distraction of persistent pain (Cote,
    Moldofsky, 1997). Waking up feeling tired and unrefreshed may be a symptom of
    fragmented sleep disorder, which is common in FMS (Drewes, Gade, Nielsen et
    al.1995). Sleep deficit can further imbalance the HPA axis stress response
    (Meerlo, Koehl, van der Borght et al. 2002), so it is vital that this perpetuating
    factor be addressed. It is not enough that your patients spend eight hours in bed.
    When they wake, they need to have experienced restorative sleep. Question your
    patients carefully about sleep quality as well as quantity. They may need
    medication to regain restorative sleep, and it may take a while to find the right
    combination of medications, good sleep hygiene and diet that will allow this.

    Stress glucocorticoids affect memory acquisition and consolidation processes, as
    well as memory retrieval mechanisms (de Quervain, Roozendaal, and McGaugh,
    1998). As the stress level goes up, fibrofog may rise. A few days of high cortisol
    levels at concentrations associated with physical and psychological stress can

    What Your Mental Health Worker Should Know About FMS and CMP
    by Devin J. Starlanyl © 2003 Page 3


    reversibly affect specific kinds of memory performance in even healthy individuals
    (Newcomer, Selke, Melson et al.1999). Stress itself can be a major perpetuating
    factor for both FMS and CMP. Ask about over-the-counter supplements as well as
    prescribed medication, as they may have a profound psychological impact. For
    example, inositol may be of benefit for people with FMS and thyroid resistance but
    should not be taken patients who also have bipolar disorder because it will reverse
    the actions of lithium, carbamazepine and valproic acid (Williams, Cheng, Mudge et
    al. 2002).

    Fibromyalgia is a disorder of the central nervous system (CNS). “Treatments for
    FMS should focus on interventions with direct or indirect effects on CNS functions
    that influence pain sensitivity” (Bradley, McKendree-Smith, Alarcon et al. 2002).
    The most intensively studied medications that modulate neurotransmitters are
    psychoactive drugs. This does not mean that the patient’s condition is psychological. Take time to explain this to your patients. A written handout that the
    patient may show family members may be helpful to promote understanding.
    Fibromyalgia patients usually need medication to help do what their bodies are not
    doing by themselves, just as diabetics may need insulin. More central acting
    medications that may be helpful to FMS patients are under development (Suzuki,
    Dickenson 2002). Patients with these conditions are often significantly under
    medicated for pain. The patient may pay for their doctor’s lack of current common
    chronic pain management practice. “Significant knowledge deficits regarding
    currently accepted principles of pain management practice as well as beliefs that
    could interfere with optimal care, mandate a need for educational interventions....
    Unwarranted fear of addiction is a misunderstood and important concept that
    needs to be addressed” ( Lebovits, Florence, Bathina et al.1997).

    Patients with FMS and CMP have symptoms that may be difficult to unravel and
    may take time and patience, but you can make a major impact on their lives. This
    can result in a “take up your bed and walk” phenomenon, and that is a rare
    enough experience in the medical world. Let’s make it more common.

    What Your Mental Health Worker Should Know About FMS and CMP
    by Devin J. Starlanyl © 2003 Page 4


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  7. razorqueen

    razorqueen Member

    that is interesting that you say that a Psychiatrist won't hesitate to precribe Klonopin (clonazapam where I live). When I say the Psych dr this summer he was glad I was weaning off of Clonazapam! He doesn't know that I am staying on it for the time being, as I need it while I recoop, but he doesn't like Benzos.

    He told my GP (in a letter) that he thought I <b>was<b/> depressed, but since nothing has worked for me to stay off. He said some lame remark about my belief system or something, and that if I would try something again I could try Buspar.

    I <B>have</b> tried buspar years ago, and it did NOT work for me! It was awful! Not going there again. Interesting

    Raz
  8. gymmbabe

    gymmbabe New Member

    Hi,

    What do you mean by a mood stabalizer?? I am not familiar with this. I am taking 60 mg of Cymbalta everyday. Along with Requip (for the twitches); calcium with vit D; and Ultram.

    lenasvn: Thanks for the information. i think I will print it out and hand a copy to every nurse, doctor, therapist, etc. I come in contact with! I have a dentist appt. soon, maybe I will give him a copy too.

    Thanks to all that replied...I tried to memorize everyone's name before I hit 'reply' but...I forgot!

    Dawn
  9. carebelle

    carebelle New Member

    I plan to print it also for a handout to Doctors I see.
    I have had such severe pain and I am ready to address this with a better medication.I noticed it states here most of us are underperscribed for our pain.

    Thank you again.
  10. Adl123

    Adl123 New Member

    What a frustrating thing to happen!

    I was seeing a therapist, and making some progress, and then I was diagnosed with CFIDS. When he told me that he didn't believe that it existed, I said "Goodbye", and found another psychologist who did. I figured that the anger and stress caused by dealing with someone who did not believe me regarding the most influential condition that I had, would be too unpleasant, and I just wasn't going to go through that.

    The new psychologist is a wonderful woman, who has a small office . Her visits are very informal, and we sit on the couch and have a cup of tea, while we talk - or rather, talked, as I have moved away. She was a great help to me. Even though she did not prescribe meds., she had an agreement with an M.D. to whom who could refer me if she felt I needed them.

    I found her by asking my friends. this kind of a referral is usually good.

    Good luck in finding someone who can help you.
    Hugs,
    Terry
    [This Message was Edited on 09/25/2006]
  11. gymmbabe

    gymmbabe New Member

    Thank you! You are always so much help. I will be sure to talk to my doctor about this.

    Have a great day...I'm off to work.

    Dawn