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August 15, 2001
ProHealth911: Our guest for this live Internet chat, is Dennis Turk, Ph.D. Dr. Turk is the Director of the Fibromyalgia Research Center and Professor of Anesthesiology and Pain Research at the University of Washington, School of Medicine in Seattle. He currently serves as Treasurer of the American Pain Society and the International Association for the Study of Pain, is on the Practice Guidelines Steering Committee of the American Pain Society, and is a member of the Committee on Publications of the International Association for the Study of Pain, the Executive Council of the Academy of Behavioral Medicine Research and Training Committee of the American Pain Society. Dr. Turk received his PhD in Clinical Psychology from the University of Waterloo in Waterloo, Ontario, Canada.
Question directed to Dr. Turk:
Guest116: Do you believe in antidepressants for fibromyalgia?
DrTurk: Guest 116, yes, antidepressant medication can be quite useful for people who suffer from fibromyalgia.
Question directed to Dr. Turk:
EnglishLady: Hello Dr. Turk. What is your main specialty?
DrTurk: English lady, I am a clinical psychologist and professor of anesthesiology and pain research.
Question directed to Dr. Turk:
dee2: How do I ask my rheumotologist for stronger pain meds without him thinking I'm a druggy?
DrTurk: Dee2, This is an important question and is dependent upon your relationship with your physician. You need to describe the severity of your pain and the impact that it has on your activities. Assuming that he or she increasesyour medication you should make sure that your report back the affect of the medication on both pain and activities.
Question directed to Dr. Turk:
Guest116: It seems that no one knew what fibromyalgia was when I was first diagnosed. Now everyone knows someone who has it. Is it more common or are doctors more aware of this condition?
DrTurk: Guest116, yes, more attention has been given to fibromyalgia as the research has been conducted and more communication has occurred between health care professionals.
Question directed to Dr. Turk:
dee2: Can you tell me about the drug ultram?
DrTurk: Dee2, ultram is an interesting medication. It has some properties of opioid medication and some of anti-depressants. There have been a few small studies reporting on the benefit of ultram for people with fibromyalgia.
Question directed to Dr. Turk:
EnglishLady: Is there anything in your current pain research that looks to be promising for treatment of FM?
DrTurk: Englishlady, yes, we are currently looking at matching of treatment to people's unique characteristics of coping with pain and other symptoms. Previous research has shown that not all people with FM respond to the same treatments. We are trying to identify unique differences and then to see if we can customize treatment to the person.
EnglishLady: That sounds very interesting. Are you able to tell us the most common ways of coping you have found in your studies?
DrTurk: Englishlady, there are a range of techniques including relaxation (both physical and mental), distraction using imagery, as well as other external targets of attention, communication with family and friends, etc.
Question directed to Dr. Turk:
dee2: What do you recommend for stronger pain relief?
DrTurk: Dee2, I think we must be cautious in relying only on medication for pain relief. There are other techniques that can be useful to help people cope with pain and with improved physical conditioning there can be reductions in pain that do not depend on medication alone.
Question directed to Dr. Turk:
dee2: I know but I'd like to know about the different meds out there. Could you please give me a few of them? I've found a good stretching and exercise book that’s helping me with my fibro stiffness but need more help. Not taking any meds right now. Was taking herbs and supplements though. Magnesium with malic acid, B-12, melatonin, and msm.
DrTurk: Dee2, I don't think I can give you sufficient information about medication for pain. You need to trust your physician and discuss the options with him or her.
Question directed to Dr. Turk:
Guest96: What do you think of lidocaine infusions?
DrTurk: Guest96, There have been only very small-scale studies on the benefits of lidocaine infusion. At this point I think it is too early to make and afirm statements with any confidence.
Question directed to Dr. Turk:
dee2: I used to take naproxin and it didn't help at all. What is a good pain med that is stronger that would help? I do special stretches and exercises too for fibromyalgia and need some more help, the pain is really bad. Trying to lose some weight to help ease the pain.
DrTurk: Dee2, I think it would be best to discuss this with your physician as different people with different medical histories and experiences may benefit from alternative treatments. There is not one good medication for everyone
Question directed to Dr. Turk:
patty: What do you think about natural products Dr.? Natural products have helped me better then any medications I have & I've taken plenty.
DrTurk: Patty, the problem with natural products is that it covers too many things. There is no question that people can benefit from some dietary and herbal treatments. This does not mean they will be cured but can gain some benefits. The problem is that so few of these treatments have been subjected to reasonable scientific tests.
patty: There's no side affects with natural products I'm taking.
Question directed to Dr. Turk:
Guest116: I have gained weight by taking elavil, is there anything as helpful for my condition but wouldn't cause the weight gain?
DrTurk: Guest 116, one of the problems with medications is that there are side effects. You should discuss this with your physician.
Question directed to Dr. Turk:
Guest96: Can a person with fibromyalgia end up in a wheelchair or possibly using a cane?
DrTurk: Guest96, physical deconditioning and reduction in activity and diet can create problems with weight, energy, muscle strength and endurance. It is important to stay active and to pace activities so as not to over do it. Rarely should a person with FM need to rely on a wheel chair.
Question directed to Dr. Turk:
Ruthiehib: Dr. Turk, I have FMS, CFS and Myofascial Syndrome with fractures Cervical, Thoracic, Lumbar and have been prescribed Fentanyl, Roxicet. I've been advised to 'detox' and start over with meds. No Medical Facility here in Buffalo, NY. Do you know of programs at Cleveland Clinic or Chicago Rehab Clinic? Are they good?
DrTurk: Ruthiehib, it does sound like you have a number of medical problems that require a comprehensive approach to treatment. Both the Cleveland Clinic and the Rehabilitation Institute of Chicago have excellent programs that may be of particular benefit for someone with the complex nature of problems that you describe.
Ruthiehib: Thanks. Those were the only two I could find that combined Rehab, etc.
Question directed to Dr. Turk:
dee2: What help or advice can you give me in helping me ease my pain? I will ask lots of questions when I see my doc then.
DrTurk: Dee2, keeping active both physically and mentally is important. Getting appropriate sleep is also essential. Some people find that warm baths combined with exercise is helpful. The important thing about exercise is not to overdo things but to gradually build up and pace yourself so that you can be away from days of overdoing it and then being incapacitated.
Question directed to Dr. Turk:
RobertB: Do you treat patients? If so, do you tend to approach diagnosis from a psychological perspective or physical pain management perspective.
DrTurk: RobertB, we treat patients from a biopsychosocial perspective. We do not emphasize a "broken body part" that can be fixed but rather a whole person is has both physical and psychological characteristics that need to be considered in designing the best treatment.
Question directed to Dr. Turk:
Guest96: I have a very physically demanding job, it leaves me no energy when I leave work for the day. What do you suggest?
DrTurk: Guest96, I suggest three things ---Pacing, pacing, pacing. You need to find a way to balance your energy with physical and mental demands of your job. Doing more and pushing yourself on one day may make you less efficient the next. So if you can balance your activities and work should may be able to accomplish just as much.
Question directed to Dr. Turk:
Guest116: My fibromyalgia consists of a lot of symptoms but mostly the pain I have is in my legs. I exercise each day by walking three miles. I have good and bad days. Do you believe that I could be making the problem worse?
DrTurk: Guest116: Yes, you need to pace yourself. Find out what you can do comfortably with out things being worse the next day and start there, you may be able to gradually build up your activity but pushing yourself will not help.
Question directed to Dr. Turk:
dee2: Before or after exercise do I take a warm bath? Is walking a good form of exercise for fibro and is that enough exercise to?
DrTurk: Dee2, yes, it is often helpful to take a warm bath after exercising. Before you exercise you should also do some gentle stretching. You might want to discuss this with your physician or a physical therapist. Walking is a good exercise but swimming is even better if you have access to a warm swimming pool. As I have been noting it is not the specific exercise alone but how you go about doing it that is important. Many people try to push too hard on a "good" day only to find that the next day is miserable. The yo-yo affect is what you want to avoid if possible.
Question directed to Dr. Turk:
jan: I'm stuck. How do you get your Dr. to take you serious about how you are feeling?
DrTurk: Jan, good question. You need to be direct and explain how you are feeling and what impact you pain is having on your activities and life. Try to be unemotional and factual, I know this is hard. Be as specific as possible and not dramatic. Wish I could say more but each physician will respond differently.
Question directed to Dr. Turk:
Guest116: There are so many symptoms to FM, why is bloating and irritable bowel one of them?
DrTurk: Guest116, there are a large number of symptoms experienced by people with FM. We do not completely understand how they are related. One possibility related to the way we process information. Physical symptoms are interpreted and each of us has different thresholds for interpreting information. People with FM may have a lower threshold for many internal stimuli that are related and are very negative.
Question directed to Dr. Turk:
roxy: Dr. Turk, which biopsychosocial treatment would you recommend trying first?
DrTurk: Roxy, Biopsychosocial is not a treatment but rather a way of viewing people as a whole not just a body part or just an emotional part. Any treatment that is geared toward taking you seriously as a whole person would be appropriate. Often going to a treatment program that includes physicians, physical therapists, occupational therapists, nurses, and psychologists would be appropriate. They should work with you to develop a program that integrates all aspects of you as a person not just a patient.
Question directed to chat room:
jan: Does anyone one else have problem's with swelling of the extremities? I am fairly new to this diagnosis even thought I have had the symptoms for about six years.
red: yes jan
jan: Is high blood pressure associated with FM?
red: Yes jan.
Question directed to Dr. Turk:
ladyrose: The only successful med I have taken is oxycontin. Now that this drug has been exploited, I can't get a prescription anymore. Do you know of a doc in Atlanta who is compassionate about FM?
DrTurk: Ladyrose, Emory University has a multidisciplinary pain program that takes a biopsychosocial approach. You might try to speak with someone from that program or ask your physician for a referral.
Question directed to Dr. Turk:
Guest26: I am looking for a doctor within a 50 mile radius from my home encompassing Harrisburg, Hershey, Baltimore, etc. My doctor treats me as if I'm a nut case. Please recommend.
DrTurk: Guest26, Johns Hopkins University has a Pain Management Program and a Behavioral Medicine Program that might be appropriate. The Director of Behavioral Medicine Program is Dr. Jennifer Haythornthwaite. She is very knowledgeable and might have useful recommendations.
Question directed to Dr. Turk:
dee2: Can you recommend a good pain management specialist in the California, Orange County area?
DrTurk: Dee2, I am not familiar with a program in LA but there is a pain program in Kaiser of Southern California. If you are not a member of Kaiser you still might try to contact Kaiser and see if they are familiar with anyone in the area. Sorry I cannot be of more help on this.
ProHealth911: Dr. Turk's time is very valuable. He has only a few more minutes to be with us today, if you have any more questions, please ask now.
Question directed to Dr. Turk:
roxy: For those with no access to integrated programs, what treatments have the best track record for FM pain? Hypnosis, biofeedback, etc.?
DrTurk: Roxy, even without access to integrated programs, it is usually possible to find a physical therapist and physician who can help set up a treatment program and who are familiar with resources in your community.
Question directed to Dr. Turk:
Guest116: I suffer but I cope, what do you think of "mind over matter"?
DrTurk: Guest 116, great to hear that you are coping. Not so happy about the suffering. Psychological methods can be helpful. This does not mean that your pain is all psychological. I think you might be able to find ways to cope better while reducing the amount of suffering. Sometimes we can do that on our own other times we might benefit from learning methods from a psychologist or mental health professional.
DrTurk: Thank you for your questions. Obviously there are many unknown answers. This is why I am involved with research. Trying to find the best ways to help people like you. Let me leave you with one point. Try to view yourself as a person with FM and not an FM patient. That means that you need to find the best way to function despite the limitations caused by symptoms. Pacing activities and keeping a positive attitude are essential. Good luck and best wishes.
ProHealth911: Unfortunately, the live chat with Dr. Dennis Turk must now come to an end. His time is very valuable and we at Pro Health would like to thank him for his expertise in answering your questions today.
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