Eyes and Fibromyalgia

 As I write this about the eyes and if fibromyalgia affects them I have noticeably dry eyes. It will probably take me a few sittings to finish this article due to my own eye symptoms which also include blurry eyes. I always need the font to be larger and I hope this helps you too.

Of course there are many reasons for eye symptoms such as dryness which include Sjogren's syndrome and some medications. 

I wanted to write this article as people often do not think that their eye concerns could be related to them having fibromyalgia. So here I will include all the research I have found about fibro and the eyes specifically from studies that have been done and also some suggestions for coping with these eye conditions.

Dry Eye Syndrome Risks in Patients With Fibromyalgia: A National Retrospective Cohort Study 2016. In this large Taiwanese study they found that the risk of Dry Eye Syndrome (DES) in Fibromyalgia (FM) patients was significant and that the risk was greater among men than woman, which was consistence with the findings of a previous study. They also found that FM patients were getting DES at an earlier age than the people without FM. 

•  The overall incidence rate of DES was 7.37/10,000 in the FM population, and 4.81/10,000 in the control group. 
• The age-specific incidence rate was highest among those 50 to 64 years in the FM population. 
• The incidence rate was highest among those aged 65 years and older in the control group.

Discordant Dry Eye Disease (An American Ophthalmological Society Thesis) Discordant, in this context, means having dry eye symptoms but a normal eye examination. 

In addition to having widespread pain and other somatic symptoms, individuals with FM and other centralized pain conditions have significant ocular symptoms, often in the absence of clinical signs of ocular surface dryness. Recent studies that examined this phenomenon found that patients with FM have more dry eye symptoms than healthy controls. Interestingly, these individuals were found to have reduced corneal sensitivity as compared to controls, so we measured both corneal and systemic sensitivity in this study. The results of this in depth study showed that people with discordant dry eye had substantial similarities to patients with FM.  There was a lack of ocular surface changes on examination in some who complain of dry eyes, as Central Nervous System processes are responsible for much of the discordance between the severity of symptoms and the degree of ocular surface damage. 

Fibromyalgia syndrome and the eye - A review states that:

Fibromyalgia can be associated with ocular symptoms (foreign body sensation, irritation) and visual disturbances (blurred vision), coexisting with dry eye syndrome and reduced corneal sensitivity.

It also says that research shows that there are changes that can be seen in the eyes of people with FM which include the choroid being significantly thinner. The choroid is part of the vascular layer of the eye, and contains connective tissues, and lies between the retina and the sclera. 

What other eye symptoms may be seen in Fibromyalgia?

"Patients can commonly experience symptoms of eye pain, sensitivity to light, blurred vision and fluctuating visual clarity, difficulty focusing, visual overload and dry eyes," Dr Mark Pellegrino explains. 

Experiencing eye issues can be very disconcerting especially after having eye tests and being told nothing is wrong at all. Following are some strategies for treating eye issues.

Dry eyes ~ For relief from dry eyes, try:

• artificial tears which you can purchase over the counter (Try preservative free ones
• wear glasses instead of contact lenses which dry the eye surface
• punctal plugs 
• assess medications that you are taking with your doctor to see if any are causing dry eyes
• use humidifiers for extra moisture in the air
• blinking more frequently
• dietary supplementation with omega-3 fatty acids such as flaxseeds
• read more information about dry eyes

Blurred vision

• check your glasses prescription more frequently 
• look to the long distance more frequently to rest your eyes
• when reading you may find a different font size that suits you better eg some prefer to read large font books available from libraries 
• Try audible books available from libraries and online

Eye pain 

• have your neck and spine assesed as tension and problems in these may cause referred eye pain and headaches

Light Sensitivity

• wear sunglasses and a hat when outside 
• wear sunglasses if driving
• reduce night driving
• do not watch screen shows with flashing lights
• be aware of what lighting suits you
• have block out blinds or block out curtains in the bedroom
• investigate coloured lenses in prescrition glasses. Some people find that adding a coloured lens helps eye strain. An eye specialist will help you decide which ones help your vision

Of course in general, all fibromyalgia symptoms may be reduced by finding the right level and kind of exercise for you, finding ways to improve your sleep and finding an activity that helps you calm your nervous system by reducing stress. 

For myself my refered exercise is hydro therapy and I have written about it here. I force myself to go to bed at the same time each night and find that I sleep better on the nights I have exercised. I take melatonin ten mg at night and also magnesium. A hot shower before bed often is also very soothing. Breathing exercises are my go to for reducing stress. 

I hope this helps you with understanding a bit more about fibromyalgia symptoms and especially that fibromyalgia can affect the eyes. 

Do you have any suggestions for reducing eye concerns in Fibromyalgia? Please leave your suggestion in the comments below. 

You might be interested in how fibromyalgia affects other parts of the body. Try:

• Fibromyalgia and foot pain 
• Fibromyalgia brain study
• Fibromyalgia and hand skills

Effects of lacto-vegetarian diet and stabilization core exercises on body composition and pain in women with fibromyalgia

This was a small randomized control study done in 2018 through the University of Alicante in Spain. A randomized controlled study is one in which people are allocated at random to receive one of several interventions. This means that the treatments can be compared more fairly. 

Background: fibromyalgia is a disease of unknown origin characterized by chronic muscular pain. The lack of knowledge about this disease is one of the main causes that makes it complex to make a diagnosis and an appropriate treatment.

Objective: the main objective of this study was to know the effectiveness of physiotherapy treatment combined with a lacto-vegetarian dietary-nutritional intervention, on low back pain and body composition in women with fibromyalgia.

Methods: twenty-one women were randomly divided into three groups: 

A (core stabilization exercises + lacto-vegetarian diet), 

B (placebo + lacto-vegetarian diet) and 

C (control). 

A lacto-vegetarian diet avoids animal products and eggs but does include dairy products.

The intervention lasted 4 weeks. Pain assessments (EVA scale) and body composition (bioimpedance) were performed at the beginning and at the end of the intervention.

The core is the group of muscles that surround the spine and midsection. Muscles in the midsection, glutes, hips, along the spine, and others work together to uphold the stability of the spine.

Results: group A showed significant changes in pain reduction and body composition at the end of the intervention, increasing muscle mass and decreasing fat mass. In addition, this group significantly improved outcomes compared to groups B and C. The correlations showed a relationship between muscle mass and pain reduction referred to at the end of the study in patients in group A.

Conclusions: the four-week intervention program contributed to both pain reduction and improved body composition. The program combined core stabilization exercises plus lacto-vegetarian diet in patients with fibromyalgia who had low back pain. 

Implications for those of us with fibromyalgia this gives us hope that combining these 2 strategies can provide us with reduced symptoms of pain and specifically low back pain. 

I have written to the researchers and hope to get some more specifics on the diet and exercises that were done and obviously they will be shared here when they are received. 

DIETARY NUTRITIONAL PROGRAM INFORMATION FROM THE STUDY
The recommended daily amount of micronutrients for the Spanish population, was planned by a registered dietician-nutritionist. 

Before the start of the study all participants began a prior nutritional education program so that they could follow the dietary program
during the intervention without any problem. 

• Protein consumption was around 1.2-1.4 g/kg (< 20% of total calories) of body weight; 
• Carbohydrate intake was 5-8 g/kg (50-60% of total calories) of body weight
• Lipids around 1 g/kg (20-30% of total calories) of body weight.

REHABILITATION PROGRAM WITH CORE EXERCISES

The proposed exercises consisted of keeping the spine in a neutral position while maintaining the physiological curvatures when it is subjected to internal or external forces that test its stability

The patients performed a 30-minute exercise program twice a week,

always at the same time.

The intervention lasted 4 weeks where the exercises progressively increased their difficulty based on the technical execution and intensity of the exercise. The intensity of the exercise was evaluated using the scale of perceived effort for

women with fibromyalgia.

The participants began the first sessions with basic lumbo pelvic stabilization exercises focused on the movement of anteversion and retroversion of the pelvis. 

Exercises examples were bridges where the pelvis had to be kept against the force of gravity without resting on the floor,

or “pointing dog” and “dead bug”, in which the patients

kept the spine in a neutral position against forces caused by the movement of their limbs.

The exercise protocol consisted of performing 10 basic core exercises. There were exercises more difficult variables for patients with better physical condition. 

The number of sets and repetitions depended on the previous physical condition of each patient, starting with 1 set of 5 to 10 repetitions for each exercise and following the recommendations of the exercise guidelines published by the American College of Sport Medicine.

All exercises were performed in a controlled and progressive manner, without causing muscle discomfort, pain or causing excessive fatigue. The last 5 minutes of the session were used to perform a series of simple stretches to end the session.

SOURCE: MARTÍNEZ-RODRÍGUEZ A, LEYVA-VELA B, MARTÍNEZ-GARCÍA A, NADAL-NICOLÁS Y: [Effects of lacto-vegetarian diet and stabilization core exercises on body composition and pain in women with fibromyalgia: randomized controlled trial]. Nutr Hosp 2018; 35:392-9

Interesting health articles I am reading this week

 As a person who has been living with chronic pain, in a variety of forms, I often read the latest health articles and wanted to share what I have been reading with you too...

Exploring the Role of Gut Inflammation in Depression

Addressing gut health can have a profound impact on brain function, depression, mood, energy levels, and motivation—factors that antidepressants do not address.

This interesting article includes Fixing the Gut: More Than Just Taking a Probiotic and ways to improve gut health and how a a sedentary lifestyle and junk food have roles in depression.

Clinical strategies to dampen gut inflammation and improve gut health include:

• Adopting a whole-food diet similar to what our pre-industrial ancestors ate.
• Identifying and addressing food sensitivities.
• Improving gut microbiome health and diversity.

Read full article at The Epoch Times by Datis Kharrazian, Ph.D., DHSc, DC, MS, MMSc, FACN, a Harvard Medical School trained, award-winning clinical research scientist, academic professor, and world-renowned functional medicine health care provider.

How Fat Affects Fibromyalgia

Excess weight leads to more pain and fatigue and lower quality of life. 

Many of us with fibromyalgia have unwanted weight gain and struggle to lose weight. This article explains the facts about why fat causes more pain. 

Fibromyalgia hurts more when you’re overweight. Having too much body fat and too little muscle also increases fatigue and worsens many other symptoms. Studies show that losing weight and exercising help dial down the pain while improving daily function. 

Read full article at Arthritis Foundation

Life hacks for living with chronic pain

This article give strategies to cope when living with pain ~ little things to make each day just that bit easier.

5. Inflatable Pillow & Fold-Up Chair

Keep a folding or deck chair in your car, as well as an inflatable pillow and blanket. Many travel pillows are compact in size and will fit in your purse. There are also lightweight, portable back supports for chairs, that you can easily transfer from the car to any chair.

Read full article at  The U.S. Pain Foundation by Amy Orr is a U.S. Pain Foundation Junior Ambassador and author. Her new book, Taming Chronic Pain: A Management Guide for a More Enjoyable Life, has hundreds of tips just like these.

Are You Making This Common Vitamin D Mistake?

Many clinicians and patients now know that vitamin D plays an important role in immune health, bone health and brain health.

However, most physicians and patients are unaware that vitamin D can create some problems.

This article recommends a regular intake of vitamin K2 with vitamin D and suggests the foods that supply it. 

Read full article at the official website of Terry Wahls MD

A Tension Myositis Syndrome breakthrough.

To be clear, this post is on the topic of Tension Myositis Syndrome (TMS) and the related approach that is useful for treating chronic pain and other conditions.

This article explains Helen’s experience with TMS. 

It was devised by Dr John Sarno who spent years being rebuffed by mainstream science whilst he touted his theory that the mind-body connection lay at the root of most if not all unresolved healing, especially from chronic pain and other chronic conditions that defy conventional approaches.

Read full article at Living Whole by Helen White, who came down with Myalgic Encephamialitis / Chronic Fatigue Syndrome (ME/CFS) and Fibromyalgia back in 2005. 

Free Pain Clinics in Australia

I am slowly adding information here about Pain Clinics around Australia that can help with Fibromyalgia and other chronic pain conditions. 

As you probably know Fibro is a condition that we are often told requires a multidiscilinary approach and this is what these clinics offer.

SOUTH AUSTRALIA

The Living Well with Persistent Pain program is offered to patients at no cost, and utilises local primary health care workforce to support patients in their pain management in the community. It provides a holistic self-management course, case coordination, group sessions and one-on-one allied health services.

Northern region — Living well and persistent pain program

Telephone: (08) 8354 9800
Email: painprogramnorth@adelaidephn.com.au

Central western region — Living well with persistent pain program

Telephone: 0450 539 733
Email: painprogramwest@adelaidephn.com.au

Services:

• Individual support services
• Group pain management programs.

Staff:

• GPs
• physiotherapists
• dieticians
• pharmacists
• pain educators
• psychologists.
• exercise physiologist.

Public hospital services

Central Adelaide Local Health Network Pain Management Unit

Address: Level 2B North-East Building, Queen Elizabeth Hospital 28 Woodville Road, Woodville South SA 5011
Telephone: (08) 8222 7826
Email: calhnpainunit@sa.gov.au

Southern Adelaide Local Health Network Pain Management Unit

Address: Flinders Drive, Bedford Park SA 5042
Telephone: (08) 8204 5499
Email: fmcpmu@sa.gov.au

Northern Adelaide Local Health Network Pain Rehabilitation Service

Address: C/- the Specialist Ambulatory Rehabilitation Centre, Cnr Smart Road and Hatheleigh Ave Modbury 5092
Telephone: (08) 7321 4133
Email: health.NorthernPainRehabService@sa.gov.au

Women’s and Children’s Hospital Paediatric Chronic Pain Service

Address: Level 1 General Outpatient Clinic, Women’s and Children’s Hospital, 72 King William Street North Adelaide 5006
Telephone: 0481 900 577
Email: Health.PaediatricChronicPainService@sa.gov.au

ONLINE COURSES  AUSTRALIA WIDE

Chronic Conditions Course is a new free, 8 week, online and internet-delivered education program, run through eCentreClinic, Macquarie University. It is designed to provide good information and teach practical skills for managing the impact of chronic health conditions on day-to-day activities and emotional wellbeing. Register here 

The MindSpot Chronic Pain Course is five lessons over an eight-week period. It provides the information and practical skills you would normally receive from a mental health professional if you attended a specialist pain management clinic. You can choose to receive weekly therapist support during the course, or you can choose to contact us when you need to. Do the assessment to enrol here.

Overactive bladder and fibromyalgia

What is Overactive Bladder? It may also be called sensory bladder or Urgency or Irritable Bladder or neurogenic bladder. These are terms used to describe a bladder condition that causes more frequent and urgent urination. 

Find out more about the connection between Fibromyalgia and the bladder including what is an overactive bladder, the causes and first line treatments.

This need to urinate originates as a sensation in the bladder when the bladder fills. 

Many people who have fibromyalgia, and other chronic illnesses, do not get these messages.

The fibromyalgia connection with overactive bladder.

In July 2023 we did a Poll on irritable bladder in our Fibromyalgia group asking Do you get increase in urinary urgency or frequency (irritable bladder)? 33 said yes and 3 said no.

In this large 2012 study of 920 people they found overactive bladder (OAB) is associated with Fibromyalgia (FMS). Moreover FMS increases with severity of OAB.

This systematic controlled study in 2021 confirms that fibromyalgia is associated with overactive bladder symptoms. The relatively high prevalence of 93% indicates that overactive bladder is an important urological association of fibromyalgia and should be routinely assessed in these patients.

What goes wrong in Overactive bladder

Several muscles and nerves need to work together for our bladders to hold urine. Nerve muscles go back and forth between the brain and the muscles. If the nerves are damaged the muscles may not get the messages to relax or tighten at the right times. 

While this was not a large survey it does say that irritable bladder is experienced by a large percentage of people with Fibromyalgia.

Causes of Overactive Bladder.

There are many causes and you may have a combination of them:

• Hormonal changes during menopause
• Enlarged prostrate
• Some medications
• Kidney problems
• Herniated disc
• Neurological conditions
• Multiple pregnancies
• Vitamin D deficiency
• Aging
• Diabetes
• Extra weight
• Back or pelvic issues

What you should do if you have symptoms of Overactive bladder.

there are many treatment options so you should ask your doctor for a referal to a urologist if they cannot hel you. Below is an example of what would be the first options for treatment but there are also medications and surgical procedures. 

The following information is from The Urology Group which was founded in 1924, and provides Northern Virginia and Greater Washington area with the most up-to-date urologic care available.

First line treatments: Behavioral Therapy for Overactive Bladder

• Fluids: Normal intake is 64 ounces (two liters) daily.
• Avoid bladder irritants: Trial of Frequency/Urgency Diet, which includes caffeine, alcohol, spicy foods, acidic foods, carbonated beverages. Quit smoking.
• Weight loss: Weight loss of 8% decreases incontinence episodes in half.
• Bladder retraining: Training your bladder to hold urine for longer and learning how to suppress the urge.
• Pelvic Floor Physical Therapy: Four to six week course of therapy to identify and strengthen pelvic floor muscles. This often includes electrical stimulation of the muscles.
• 
  

RESOURCES:

Overactive bladder patient guide PDF from Urology Care Foundation

Overactive bladder assessment tool PDF

Overactive bladder diary PDF

Managing OAB at work and on the go Fact Sheet

SOURCES:

FIBRO CONNECT Facebook group poll.

The association between overactive bladder and fibromyalgia syndrome: a community survey.

The Urology Group First Line Treatments

Urology Care Foundation

What's going on in the Fibromyalgia Brain and Nervous System?

 In 'Key Milestones Contributing to the Understanding of the Mechanisms Underlying Fibromyalgia' two Australian researchers give a fascinating overview of what they consider to be the breakthrough findings in FM.

• Three nerves that transmit pain signals to the spinal cord have been found to be overactive in FM.

• Nerves should calm down and adjust to repeated stimulation, but in a process called windup the pain nerves that get activated in FM stay activated. They also respond more quickly to a stimulus and are apt to fire off spontaneously more.

• Twitchy nerves leading from around the spinal column could explain some of the upper body pain common in FM and the problems with bending, moving etc.

• Two neurotransmitters associated with pain, substance P and glutamate, have been found elevated in FM patients’ brains.

• The brain exerts enormous influence over the amount of pain we feel through a pain inhibition process which can reach all the way down the spinal cord.

• When one part of the body is exposed to pain, our sensitivity to pain in other parts of the body actually reduces. This process – called controlled pain modulation – is due to a pain inhibition process which begins in the brain.

• This process has been shown many times not to be working well in many, but not all, people with FM. Interestingly, although it’s not clear why, the low heart rate variability found in FM is associated with reduced pain inhibition. Mestinon is one drug that has proved helpful for some people with ME/CFS.

• Pain signals are believed to need to pass through a series of checkpoints or gates in order to make it to the brain. Those gates are believed to be opened wider than usual in FM.

• Some researchers, though, think that the pain inhibition process in FM is working just fine. They believe its signals are being overridden by a constant stream of pain signals emanating from the body.

• Brain scans show more problems. Blood flows to various parts of the brain are altered. The pain processing areas of the brain are hyperactive. Even when the brain is resting, it still maintains its tight connection to those areas.

• The authors of this study believe that widespread neuroinflammation could explain all the symptoms in FM.

• With so many validated issues in just the brain and nervous systems of FM patients, it seems incredible that any doctor worth his or her salt could dismiss this disease.

Thank you so much to Cort Johnson at Health Rising for all he does to help people with fibromyalgia, ME and CFS understand the scientific side of things. The above is the gist of one of his great articles so if you want to read the full explanation of this 2020 research please visit Cort's site. His article is called 'Wound up, Overheated and Tweaked: A Look at the Fibromyalgia Brain and Nervous System.'

Blood biomarkers in patients with fibromyalgia

Fibromyalgia is a complex chronic pain condition. Because its symptoms are nonspecific it is difficult to diagnose.

There have been talks of a blood test for diagnosing fibromyalgia but unfortunately, the final stages of the clinical trials were never completed and the test is surrounded by controversy. Many people who do research into fibromyalgia dismiss the blood test. I have reached out to a few but at this point have had no responses.

According to the research study I am reporting today no objective test exists to confirm its diagnosis. This is of January 2, 2022. 

One potential diagnostic measure could be a blood test that showed biomarkers. This would be a way of detecting if someone had fibromyalgia through a blood test. This would provide an objective medical sign as opposed to how a person feels. Having a biomarker for Fibromyalgia would be a major step forward in both its diagnosis and acceptance. 

AIMS OF THE STUDY: This systematic review and meta-analysis aimed to review studies assessing blood biomarkers’ levels in patients with FM compared with a healthy control group. 

METHODS: 

• A systematic search of the PubMed, MEDLINE, EMBASE, and PsycINFO databases.
• Fifty-four studies reporting the levels of biomarkers in blood in patients with FM were included. 
• Data were extracted, and the methodological quality of the studies was assessed independently by 2 researchers.
• 40 of these studies were analyzed using a random-effects model. The rest were not included as they were not comparable given differences in methods and other reasons.

RESULTS: 

The meta-analysis showed that patients with FM had significantly different levels of certain blood markers compared with the healthy control groups:

• lower levels of interleukin-1 β 
• higher levels of IL-6, IL-8, tumor necrosis factor-alpha, interferon-gamma, C-reactive protein, and brain-derived neurotrophic factor. 

CONCLUSION: The researchers could not support the notion that these blood biomarkers are specific biomarkers of FM. Our literature review, however, revealed that these same individual biomarkers may have the potential role of identifying underlying pathologies or other conditions that often coexist with FM. Future research is needed to evaluate the potential clinical value for these biomarkers while controlling for the various confounding variables.

MY OPINION: I am pleased that there is continued research into Fibromyalgia and also many clinical trials are being conducted, even during the last two years. Research moves slowly but at least this is heading in the right direction. 

You can read some of the other research, into fibromyalgia, I have reported on here.

SOURCE: 

Potential role of blood biomarkers in patients with fibromyalgia: a systematic review with meta-analysis.

By Dinesh Kumbhare, Samah Hassan, Dion Diep, Felipe C K Duarte, Jasper Hung, Sreekant Damodara, Daniel W D West, P Ravi Selvaganapathy. Jan 3, 2022