Table of Contents for FM and Chronic Pain Owner’s Manual
...... Introduction
why did i write this book...... 22
who did i write this book for...... 22
Chapter 1...... my personal story
my story...... 23
applying for disability benefits is exhausting...... 24
not everyone is supportive...... 24
applying for disability benefits while trying to get well...... 24
believe in those who apply for benefits...... 24
chapter 2...... My journey towards wellness
Self-Knowledge is the beginning of recovery ...... 25
NS Arthritis Society first to offer help ...... 25
Self-Management is the key to health ...... 25
NS Environmental health centre - angels...... 26
NS environmental health centre - employer...... 26
Returning to work was scary ...... 27
how did i know how to treat fibromyalgia and chronic pain...... 28
Introducing the Adams Functional Classification...... 29
private practice for chronic pain and fibromyalgia clients...... 30
private practice physiotherapy for home care clients...... 31
The 4 M’s Map for Recovery...... 32
Chapter 3...... My Philosophy of Care
Introduction...... 33
The 3 Key areas of treatment focus for fibromyalgia and chronic pain.34
Recovery Phase #1
AWARENESS of the disease and Rx
Awareness of the disease itself...... 36
chapter 4...... Fibromyalgia 101
what is fibromyalgia...... 38
how is fibromyalgia diagnosed...... 39
the old way to diagnose fibromyalgia...... 39
the new way to diagnose fibromyalgia...... 39
could you have fibromyalgia...... 42
what are the possible causes of fibromyalgia:...... 43
top 10 myths about fibromyalgia:...... 44
treatment includes debunking the myths about fibromyalgia:...... 45
inventory checklist to discuss with your pt or doctor...... 48
physical impairments in fibromyalgia...... 49
top 20 physical impairments in fibromyalgia...... 50
when i flare up, is it the fibromyalgia pain or muscle / joint pain?...57
i’m dizzy…especially when tired. Is vertigo a part of fibromyalgia?...57
chapter 5...... Work and the FCE for Fibromyalgia
what’s the problem...... 58
possible causes...... 58
can you work with fibromyalgia...... 59
what predicts pain and function in a fm client over time...... 60
the independent medical evaluator (ime)...... 60
the functional capacity evaluation an option besides the ime...... 61
problems using the functional capacity evaluation for fibromyalgia..61
why do fm patients get sent for an fce when the canadian fm guidelines say
that these tests aren’t always appropriate...... 62
why do some doctors seem to treat you with less than the usual respect 63
why don’t some doctors seem to want to help those with fm...... 64
why do cognitive tests not show that i have trouble thinking...... 65
chapter 5...... Work and the FCE for Fibromyalgia
how does a doctor know if you have the physical ability to work....67
how do we get health professionals to take us seriously...... 67
do i tell my employer that i have fibromyalgia...... 68
my boss won’t help me stay at work...... 68
should i hire a lawyer if i am applying for disability benefits...... 70
what steps should i take if i am considering or being asked to go to work 71
stages of recovery from chronic pain...... 72
when you are ready to return to work you will need to negotiate...73
inventory checklist to discuss with your pt or doctor...... 74
chapter 6...... physiotherapy assessment of fm
the interview…what will happen at your first few pt sessions ...... 75
a complete fce for fibromyalgia or chronic pain patients ...... 76
traditional functional capacity evaluation ...... 77
physiotherapy treatment for fibromyalgia patients ...... 79
can you predict which injured worker will get back to work ...... 80
chapter 7...... Chronic pain 101
what is acute pain and what is chronic pain...... 81
what is the biggest difference between acute and chronic pain.....83
what is neuropathic pain ...... 84
why do I have pain when i feel like I haven’t even done anything ...84
what factors lead to the development of chronic pain ...... 85
how do you treat chronic pain ...... 86
self-treatment for predisposing, precipitating & perpetuating issues .88
inventory checklist to discuss with your pt or doctor ...... 89
what is the second biggest difference between acute & chronic pain .90
what are the 2 key pain rules and what is the pain gate...... 91
what is recovery anyway...... 94
chapter 8...... Pain treatment resources
a health care team support is essential to your recovery ...... 95
meet your health care team (employer, case manager, co-worker)..95
what is duty to accommodate, 25% of FM clients receive disability benefits 98
Recovery phase #2
Acceptance of the challenges
acceptance of the challenges you face...... 101
client symptom log...... 103
client medical condition log...... 104
Client medication list...... 105
Chapter 9...... food and weight
introduction...... 105
top 10 foods that can increase your pain level ...... 107
inventory checklist to discuss with your pt or doctor ...... 108
chapter 10...... sleep issues
to sleep, perchance to dream…what are the Issues ...... 109
sleep impacts movement and movement Impacts sleep ...... 110
causes, functional tests and self-management strategies...... 111
inventory checklist to discuss with your pt or doctor ...... 112
physiotherapy assessment of sleep problems...... 113
possible causes of sleep disorders...... 114
physiotherapy Intervention may include any or all of these: ...... 114
chapter 11...... family relationships
introduction...... 115
self-disclosure can be therapeutic or a family stressor ...... 116
what to say to your partner and family about what is wrong with you 116
top 10 tips for family members of chronic pain patients ...... 117
parenting challenges and strategies when you have chronic pain...118
what special challenges do parents with chronic pain face? ...... 118
top 10 challenges for parents who have chronic pain ...... 119
top 10 benefits of having parents who have chronic pain ...... 119
chapter 12...... housework
introduction...... 120
the top 10 hardest activities of daily living ...... 120
causes...... 121
what are physical demand capacities? ...... 122
functional tests...... 123
self-management strategies...... 123
break each hour into three – 20 minute units ...... 124
computer use challenges require special strategies ...... 125
inventory checklist to discuss with your pt or doctor ...... 126
chapter 13...... Medication
introduction...... 127
medications for chronic pain and fibromyalgia patients ...... 128
don’t get upset if your doctor prescribes an anti-depressant...... 128
what drug treatments are helpful for people with fibromyalgia? ..129
medication options for treating pain ...... 130
alcohol and marijuana use for pain control ...... 131
excellent list of most commonly prescribed medication for fm ....132
medicinal marijuana ...... 133
a unique way of knowing if your medication is Helping you ...... 134
what we want is immediate and complete pain relief ...... 134
what we most often get is a gradual recovery...... 135
chapter 14...... psychosocial risk factors
introduction...... 136
causes...... 137
progressive goal attainment program or PGAP © ...... 138
treating psychosocial risk factors takes professional help ...... 139
volunteering helps reduce your psychosocial risk factors ...... 140
a gradual return to work reduces fears of triggering a relapse .....140
chapter 15...... psychological support
introduction...... 141
how do you talk to your family, friends & coworkers about fm? ...141
how do you cope with having a chronic illness? ...... 142
5 stages of grief...... 142
Chapter 16...... Sex issues and strategies
marriage and partner relationships can be difficult...... 144
the partner (family) of a chronic pain patient is hurting too! ...... 145
great sex advice from the husband of a fibromyalgia client ...... 146
why does sex hurt and what can you do for the pain ...... 146
chapter 17...... memory loss and brain fog
description...... 147
possible causes...... 147
self – management strategies: ...... 148
inventory checklist to discuss with your pt or doctor ...... 149
physiotherapy assessment of memory problems ...... 150
subjective reports ...... 150
physiotherapy evaluation ...... 151
additional allied health care evaluation and management:...... 151
physiotherapy Intervention may include any or all of these: ...... 151
how to deal with memory difficulties! ...... 152
how to deal with concentration difficulties ...... 153
Recovery phase #3
Actions THAT BRING ABOUT RECOVERY
chapter 18...... electrotherapy
when not to use these tens devices...... 157
TENS transcutaneous electrical nerve stimulation...... 158
IFC interferential current therapy...... 158
SCENAR self-controlled energo neuro adaptive response...... 159
TENS machine versus Interferential machine vs scenar chart ...... 160
inventory checklist to discuss with your pt or doctor ...... 161
do you need a doctor’s prescription to buy a tens devices? ...... 162
how to use a tens device at home...... 162
chapter 19...... eXERCISE PRINCIPLES
if exercise were a pill it would be...... 163
exercise principles and options ...... 164
possible reasons for not wanting to exercise: ...... 164
general exercise principles for those with chronic pain & fm ...... 165
inventory checklist to discuss with your pt or doctor ...... 166
how often do you need to exercise ...... 167
tips to help keep you motivated...... 167
exercising safely means...... 168
choosing an exercise is like choosing a bra…it needs to be a good fit 168
your physiotherapist is the ideal person to help ...... 168
what is the best exercise to do...... 169
details about the various types of exercise to choose from ...... 170
what is your current fitness level ...... 176
figure out your FITT score ...... 178
chapter 20...... exercise challenges & side effects
introduction...... 178
exercise challenges...... 179
exercise side effects...... 179
most common exercise side effects for fm & chronic pain patients .180
other exercise side effects for fm & chronic pain patients ...... 181
even more exercise side effects for fm & chronic pain patients ....182
still more exercise side effects for fm & chronic pain patients .....183
possible causes...... 184
self-management strategies...... 189
what symptoms flare up with exercise ...... 189
how bad do you flare up with exercise ...... 189
the simple way to know if you did too much exercise ...... 191
the scientific way to know if you did too much exercise ...... 191
physiotherapy training covers every function of the body ...... 192
the good news...... 192
what is taught to health professionals about fibromyalgia? ...... 192
what is available on the Internet about fibromyalgia?...... 192
why do I flare up when I have a physiotherapy assessment? ...... 193
what is a physiotherapist really testing ...... 194
the questions everyone wants answered...... 194
chapter 21.....ADAMS FUNCTIONAL CLASSIFICATION
introduction...... 194
what’s normal...... 194
treatment principles based on the classification chart...... 194
fce needs to be enhanced for fm an chronic pain patients ...... 195
adams functional classification for clients with chronic pain & fm..195
confidence in both subjective & objective reports is important....196
benefits of testing over several sessions Instead of on only 1 day ..196
drawbacks to doing fce testing all on one day ...... 197
development of the adams functional classification chart ...... 198
adams version of the fce tests signs & symptoms not normally assessed with a traditional fce 198
how to read and use the adams functional classification chart ....199
Category 1 (Step count range of 7000 to 13000 steps per day) .....200
Category 2 (Step count range of 6000 to 8000 steps per day) ....201
Category 3 (Step count range of 4000 to 6000 steps per day) ....202
Category 4 (Step count range of 3000 to 5000 steps per day) ....203
Category 5 (Step count range of 2000 to 4000 steps per day) ....204
Adams Functional Classification Chart FOR CHRONIC PAIN and
FIBROMYALGIA © (step count & subjective reports)...... 205
Adams Functional Classification Chart FOR CHRONIC Pain &
fibromyalgia (objective outcome measure tests)...... 206
Adams Functional Classification Chart Explanation – subjective tests 207
Adams Functional Classification Chart explanation – objective tests .208
Adams Functional Classification Chart used for exercise prescription 209
chapter 22...... posture
treatment protocol to improve your posture ...... 210
treatment stages for categories 1 to 5...... 211
chapter 23...... PEDOMETER THERAPY
introduction...... 213
the most powerful health care tool in the world is the Pedometer ..214
the pedometer is like your mileage gauge ...... 214
pedometer program presented here is based on years of Research .214
step count ranges ...... 214
what is a normal step count for healthy active adults ...... 215
what is a normal step count for seniors and children...... 215
what is a typical step count for those with chronic illness or disability 215
step count ranges...... 215
on average Fibromyalgia clients function at about 60% ...... 216
step count ranges ...... 216
for accurate step count, don’t wear a pedometer when...... 217
why do you need to wear a pedometer for 14 days ...... 217
how to check the accuracy of your pedometer...... 217
how to use a pedometer to do a 14 day diary ...... 218
how to fill out a pedometer diary...... 218
14 day pedometer diary and report...... 219
understanding pedometer diary score averages & results ...... 220
what is a pedometer report ...... 220
understanding your flare up line...... 220
sample pedometer report ...... 221
analysis of the pedometer report look for high and low days first ..221
kara’s pedometer diary ...... 222
the Importance of pacing ...... 223
pacing & exercise do’s and don’ts ...... 223
chapter 24...... pacer pusher spectrum
introduction...... 224
if you are a pusher you will be a crasher...... 224
causes...... 225
when you push to get things done, it will look like this: ...... 225
what does a pusher look like? ...... 225
pacer pusher spectrum...... 226
where are you on the Pacer Pusher Spectrum? ...... 226
chapter 25...... PAIN AND FATIGUE FLARE UP LINE
introduction...... 227
calculating the pain and fatigue flare up line © ...... 228
understanding how to PACE using your FLARE UP LINE ...... 229
chapter...... OVER EXERTION CRASH PATTERN
chapter 26...... the over-exertion crash pattern
introduction...... 230
understanding crash days and recovery response time ...... 231
what is over-exertion...... 232
how do you stop over – exerting ...... 232
over – exertion crash (flare up line) summary chart ...... 232
over – exertion crash pattern step count summary chart ...... 233
understanding flare ups & recovery response time ...... 233
recovery time can vary from a few hours to 7 to 10 days! ...... 234
cfs study on the impact of pacing walking & recovery time ...... 234
how do you speed up your relapse recovery time? ...... 234
inventory checklist to discuss with your pt or doctor ...... 235
the physiotherapy assessment of the over –exertion crash pattern .236
physiotherapy assessment of the push crash pattern ...... 237
physiotherapy intervention to reduce flare ups may include: .....237
your flare up line is going to go up (take more steps to FLARE): ....237
top 10 symptoms of over-exertion triggered flare ups ...... 238
you can improve your flare up line and step count average by: ....238
top 10 statements you make when you have done too much: .....239
identifying 20 activities that trigger an increase in pain...... 240
chapter 27....PAIN CAUSES FALLS & FALLS CAUSE PAIN
causes: muscle weakness and joint stiffness cause falls ...... 244
causes: vision issues and vestibular function loss cause falls .....245
70% of your balance comes from your vision ...... 245
20% of your balance comes from somatosensory feedback ...... 245
10% of your balance comes from vestibular system ...... 245
treatment of chronic pain involves the treatment of balance and treatment of balance loss involves the treatment of pain 246
chapter 28...... STATIC BALANCE
introduction...... 249
what kind of balance problems do fibromyalgia and chronic pain
patients have ...... 250
research into balance problems...... 251
a physiotherapy assessment of static balance – subjective tests....252
a physiotherapy assessment of static balance – objective tests....253
berg balance test...... 253
functional reach test...... 254
tandem stance and sharpened rhomberg...... 255
single limb stance time (slst)...... 256
modified clinical test of sensory integration and balance (mod ctsib)257
research showed static balance made worse after walking ...... 258
static balance treatment protocols ...... 259
balance treatment starts with safety first, second & third ...... 260
safety rules to follow while working on your balance ...... 260
a complete physiotherapy treatment protocol includes: ...... 261
standing on one foot treatment protocol client handout part 1 & 2.262
standing on one foot treatment protocol – tips ...... 263
modified clinical test for sensory Integration and balance treatment protocol client handout - part 1 & 2 264
top 10 balance exercises client handout ...... 265
chapter 29...... dynamic gait
introduction...... 269
how do you know if you have difficulty walking?...... 270
what specific skills should we be able to do while walking? ...... 270
the dynamic gait index ...... 271
the dynamic gait index treatment protocol handout...... 272
chapter 30...... canes, walkers & nordic poles
introduction and inventory checklist...... 273
physiotherapy prescription of gait aids or nordic poles ...... 275
additional allied health care evaluation and management: ...... 276
possible reasons why people don’t use mobility aids:...... 277
chapter 31...... MOTION SENSITIVITY & chronic pain
introduction...... 278
inventory checklist to discuss with your pt or doctor ...... 279
physiotherapy assessment of motion sensitivity ...... 280
possible causes: ...... 281
pt treatment guidelines for motion sensitivity ...... 282
chapter 32...... Dizziness & Chronic Pain
introduction...... 283
there are many ways to describe dizziness:...... 284
possible causes: ...... 285
the assessment of dizziness is very complicated and takes special physiotherapy training 285
physiotherapy treatment of dizziness...... 285
chapter 33...... Blurry Vision & Gaze stability
introduction...... 286
difficulty focusing the eyes often results in...... 286
why does having trouble focusing the eyes result in a stiff neck ...287
physiotherapy assessment guidelines for gaze instability (blurry vision) 288
physiotherapy treatment of gaze instability ...... 289
once gaze Issues are evaluated do gaze stability exercises ...... 289
chapter 34...... LIFTING CHALLENGES
introduction...... 291
all clients with fibromyalgia or chronic pain have trouble lifting ...291
physiotherapy assessment guidelines for lifting ability ...... 292
physiotherapy treatment guidelines for lifting ability: ...... 292
chapter 35...... AUTONOMIC NERVOUS SYSTEM
introduction...... 293
research into autonomic nervous system problems ...... 294
percentage change in ans response from baseline (resting) ...... 295
physiotherapy treatment guidelines...... 296
recommend a safe heart rate range during exercise: ...... 296
recommend a safe systolic and diastolic bp change: ...... 297
physiotherapy treatment recommendations for ans dysfunction: .298
chapter 36...... paces exercise program
PACES exercise program...... 299
paced breathing protocol...... 301
abdominal exercise protocol...... 304
cardiovascular exercise protocol...... 307
treadmill exercise treatment programs ...... 310
aerobic exercise guide summary chart using step count and flare up recovery time 312
aerobic exercise guide summary chart case study 1...... 314
aerobic exercise guide summary chart case study 2...... 315
aerobic exercise guide summary chart case study 3...... 316
aerobic exercise guide summary chart case study 4...... 317
exercise guide summary chart using step count and flare up
recovery time ...... 318
exercise treatment program for very low FUNCTIONING CLIENTS ..319
12 level treadmill walking program for chronic pain and fibromyalgia Clients 321
treadmill walking programs for chronic pain and fm clients – 1- 4 ..322
treadmill walking programs for chronic pain and fm clients – 5- 6...323
treadmill walking programs for chronic pain and fm clients – 7- 8...324
treadmill walking programs for chronic pain and fm clients – 9-10..325
treadmill walking programs for chronic pain and fm clients – 11-12.326
endurance exercise protocol...... 327
strength exercise protocol...... 330
stretch exercise protocol...... 332
10 level PACES exercise program and Daily exercise log...... 344
chapter 37...... Sauna therapy
sauna and exercise therapy treatment protocol...... 349
physiotherapy treatment protocol - sauna and exercise therapy treatment protocol 350
chapter 38...... Multiple Chemical Sensitivities
introduction...... 354
physiotherapy treatment protocol - Sauna and Exercise Therapy treatment protocol 356
chapter 39...... chronic fatigue syndrome
introduction...... 362
for more information on cfs ...... 363
help your doctor help you ...... 364
Chapter 40...... The final word
what to say to someone next time they ask you what’s wrong with you 370
self-management is the key to long term health ...... 371
the value of self – disclosure...... 372
self – disclosure and paces exercise program research study ...... 372
References...... Research Articles
list of research articles on chronic pain and fibromyalgia ...... 376
Appendix...... Feedback welcome, courses offered
feedback is always welcome and courses offered ...... 388
an inspirational message from fog off owner tim henneberry .....390
managing chronic pain is a 3 phase process ...... 391