Dry Mouth and Fibromyalgia: How to Overcome It

Many of us with fibromyalgia (FM) also know what it is like to live with dry mucous membranes. Despite it being a common complaint among fibromyalgia patients, it’s not something that’s often discussed in articles or online groups and forums, but it’s frustrating, nonetheless.

In this article, I want to review the consequences of chronic dry mouth, in particular. We will consider possible causes, its relationship to fibromyalgia, the effects on our gastrointestinal tract, and ways to manage it.

What is Dry Mouth?

Chronic dry mouth, xerostomia (pronounced zero-stO-mEa), is the result of insufficient saliva secretion. This is important because saliva washes away food debris, buffers digestive acids that can cause tooth decay, reduces the formation of plaque, and begins the digestive process.

In 2002, one study reported that salivary gland dysfunction could be exacerbated by several factors, including medications, autoimmune diseases, cancer of the head or neck, neurological conditions, hormonal fluctuations and more. Additionally, a 2018 study provides insights into the mechanisms by which saliva acts as protector and how it relates to taste, chewing, formation of food blockages in the esophagus, enzymatic digestion and swallowing.

Those of us who live with fibromyalgia symptoms should be on the lookout for conditions that can aggravate chronic dry mouth.

Causes of dry mouth

Let’s take a more in-depth look at the myriad of things can act as causes of dry mouth, such as:

  • Mouth breathing
  • Poor diet
  • Dehydration
  • Chemotherapy
  • Radiation
  • Central and peripheral nerve damage that affects salivary glands
  • Small fiber neuropathy
  • Removal of salivary glands (such as seen in oral cancer)
  • Medication side effects
  • Medical conditions like Sjögren’s, thyroid disease, diabetes, and Lupus)

Furthermore, chronic dry mouth is also one symptom of Sicca syndrome. Sicca is collection of symptoms characterized by unusually dry eyes, mouth, throat, nose, and other mucous membranes. Sicca symptoms are commonly associated with the autoimmune disease called Sjögren’s. Some people interchange the two, and others see Sicca syndrome and Sjögren’s Syndrome quite differently. My own rheumatologist sees Sicca as Sjögren’s without the presence of tissue specific antibodies.

Herein lays the connection between dry mouth and fibromyalgia. In another 2018 study, researchers concluded about 1/3 of fibromyalgia patients tested positive for Sjögren’s-related biomarkers. Plus, the majority of the testing population had the presence of other autoimmune antibodies, lending further credence to the idea that autoimmunity and fibromyalgia are connected.

The Consequences of Dry Mouth

Chronically thick and stringy saliva, a horse or dry throat, a tongue that is grooved or coated white, or sticky surfaces in the mouth suggests the presence of chronic dry mouth. This can contribute to:

  • Difficulty speaking
  • Difficulty chewing, swallowing, and tasting
  • Insufficient digestive enzyme production
  • Increased risk of bacterial and fungal infections (which can travel out of the mouth into the body’s circulation)
  • Burning mouth syndrome
  • Bad breath
  • Mouth sores
  • Dental cavities
  • Gum disease
  • Malabsorption of nutrients
  • Gastrointestinal dysfunction

If left untreated or unmanaged, complications related to dry mouth can affect our overall health.

Things We Can Do to Help Chronic Dry Mouth

One of the first things I learned in nursing school was the importance of oral care. Keeping a patient’s mouth moist with glycerine swabs and treating their lips with oral moisturizers is a significant nursing intervention to maintain oral health as well as the health of the body. Other things we can do include:

  • Address lifestyle issues, such as stress, diet, tobacco use.
  • Consider contributing factors, such as sleep apnea or other airway obstructions (i.e. deviated septum), teeth grinding, TMJ, etc.
  • Practice good oral hygiene as recommended by the American Dental Association. Brush teeth twice a day with fluoride toothpaste, clean between teeth daily, limit sugary beverages and snacks, see a dentist regularly.
  • Avoid overuse of caffeine, carbonated beverages, and alcohol, which are dehydrating.
  • Avoid sugar.
  • Sip on water frequently.
  • Rinse mouth frequently.
  • Don’t use mouthwash that contains alcohol.
  • Use oral lubricants and saliva substitutes.
  • Suck on sugar-free hard candy or chew sugar-free gum to stimulate saliva production. (Discuss these options with your dentist.)
  • Use a humidifier.
  • Talk to your dentist about a mouthwash that increases saliva.
  • Talk with your doctor or pharmacist about medication side effects. (i.e., antihistamines or other medication used in fibromyalgia treatments).
  • Talk with your doctor about prescription medications that can increase saliva production.

Chronic dry mouth is complicated; it’s far more than having periodic cotton mouth.  And, while we may not always know what causes it, there are things we can do to minimize the effects, and in the process, have an effect on our overall health.

This article was first published on ProHealth.com on February 6, 2019 and was updated on September 17, 2019.

Celeste Cooper, RN, is a frequent contributor to ProHealth.  She is an advocate, writer and published author, and a person living with chronic pain. Celeste is lead author of Integrative Therapies for Fibromyalgia, Chronic Fatigue Syndrome, and Myofascial Pain and Broken Body, Wounded Spirit, and Balancing the See Saw of Chronic Pain (a four-book series). She spends her time enjoying her family and the rewards she receives from interacting with nature through her writing and photography. You can learn more about Celeste’s writing, advocacy work, helpful tips, and social network connections at CelesteCooper.com.

Continue reading “Dry Mouth and Fibromyalgia: How to Overcome It”

A Doctor’s Perspective: Why Did I Write a Book about Chronic Pain?

Editor’s Note: As a specialist in pain medicine, David Nagel, MD, discusses his thoughts on the current state of pain management in the U.S. Like many aspects of chronic pain, patients often find that their fibromyalgia pain is dismissed by many healthcare professionals. Through his writing, Nagel explores his own biases in the hopes of improving fibromyalgia treatment options and advocating for those in need of care. 

I was honored when I was asked me to write something for ProHealth. Over the course of time, I would like to share my thoughts about chronic pain and public policy in a variety of settings. First, though, I’d like you to get to know me. Specifically, why I wrote a book about pain (Needless Suffering: How Society Fails Those with Chronic Pain), and who I am.

The reason why I wrote a book about pain is simple: I was angry, and I wanted to make a difference in the lives of fibromyalgia patients and others struggling with chronic pain.

I could no longer tolerate seeing those suffering from pain being ostracized, stigmatized, and blamed for their infirmities by social institutions, which were supposed to be caring for and supporting them, in the process, aggravating their suffering. When I began the process of writing  Needless Suffering, I had practiced pain management for 18 years. I cared for thousands of patients on a 24/7/365 basis, rarely receiving the support I needed from my colleagues. In addition to my clinical work, I worked to create public policies to help those in pain, frequently finding road blocks which limited access to compassionate care.

Chronic Pain and The Final Straw

The final straw for me came in two simultaneous incidents in 2003. I was brought before our state’s medical board in what turned out to be a one-year investigation of my pain practice. While I knew I had done nothing wrong, which was later proved to be the case, the stress created an unnecessary burden to an already challenging life. The second came when my partners “asked” me to give up my pain practice to focus on the more lucrative practice of “interventional pain management.”  They were no longer willing to support what I viewed as my calling.

In the midst of all of this tumult, I became angry with myself. I referred to myself as a coward, a hypocrite who would not stand up for his beliefs when the pressure became too great. I accused myself of the same ignorance I accused others of when, in my journey, I realized that I was blind to the effects of pain in my own world. My mother valiantly suffered with incapacitating pain her whole life, and I never saw it when it mattered most.

I felt backed into a corner with nowhere to turn and nobody to help. When I am hurt, angry, or frustrated, I write. And so I did. I sat at my laptop and wrote four short stories, all dealing with individual aspects of pain in America. As I saw the relationship of those in pain to the medical system as akin to that of the poor to society as a whole, the first story had to do with my first experience with homelessness. That story was entitled Poor Man. The rest of the stories were related to this one. The original title of the collection was Poor Man, Pained Man.

As I often do, I shared the work with a friend, a woman who suffers from fibromyalgia symptoms and other painful conditions. She is also a writer. She called me a day later and told me that I must publish this. “You are writing for us!” she told me quite emphatically.

I was simultaneously honored and overwhelmed by her request. I had written dozens of short stories but never for the purpose of publication. They were merely therapeutic for me. We both realized these stories could not stand alone. They were too abstract to make meaningful social change. It took me several years to figure out how I wished to share my message in a more productive, concrete form, without losing the stories. I finally came to see what I was writing was a play, a tragedy, and that part of any play is the final critique of the characters. What was missing was the critique. I chose to take a broad sociological look at the phenomenon of pain in America. With the golden rule as a standard of measurement, “do unto others as you would have them do to you,” I looked at twelve social entities in our culture, each which proclaims proudly how they are there to serve. I looked at what they say they are going to do, what they really do, and the gap in between, and how, through creative public policy, we, as a collective whole, can close that gap and minimize the suffering of those in need and avoid creating “needless suffering.”

The book begins and ends with the most difficult task of all. I asked the question, “Am I a coward?”  The question is posed in the first chapter and answered in the last one. With the biblical story of the Good Samaritan from the Gospel of Luke as a reference, I came to my own conclusions, which I leave to the reader to judge.

The original title of the book was You Do Have to Suffer, Just not as Much as We Make You. The editors wanted something shorter, but I was able to still use the original as a chapter title. I was thrilled when the publisher and the editors took great pains to preserve as many stories as possible. Unfortunately, Poor Man did not make the final cut. That was hard for me because that story revealed a lot about who I am, and I thought it was important for me to share that with the reader. In the future, we’re likely to release that as a short story entitled The Missing Chapter; Ellen, a Man in Despair, and too Many in Pain.

My only goal in life is to make a difference. In that way, I choose to emulate my mother. Despite her broken body, she practiced something I call “kitchen table advocacy.”  Armed with a phone and a desire to help others, she continually put the needs of others second to her own and, in doing so, she will always be my most important hero. Since publishing Needless Suffering, I have had the honor of meeting wonderful people all over the country, from all walks of life, and from all stations who do live up to my mom’s ideals. We can learn so much from each other. I am so thankful for these opportunities. My purpose is to advocate for those in need and for those who help them.

Thank you for reading. I look forward to our journey together. Together, we can make this a better, more caring place.

This article was first published on ProHealth.com on March 6, 2019 and was updated on September 10, 2019.

Dr. David Nagel is a physiatrist who, for the past 30 years, has specialized in pain management in Concord, New Hampshire. His special interests include doctor-patient communication and advocacy and social justice for those who live with chronic pain. He is the author of the book Needless Suffering:  How Society Fails Those with Chronic Pain.

Described as a “self-help book for society” with the potential to change the way we talk about pain in America, Needless Suffering offers a broad sociological look at how we, as a culture, treat those who suffer, too often needlessly, and how, through public policy and personal behavior, we can do much better. Dr. Nagel is a member of the US Pain Foundation and the Pain Connection, both patient advocacy groups, and the NFL Players’ Association Pain Committee.


Podcast Featuring Fibromyalgia Treatments, Experts, and Lifestyle Advice

In March 2019, Tami Stackelhouse, fibromyalgia coach, author, and founder of the International Fibromyalgia Coaching Institute, launched her first episode of The Fibromyalgia Podcast. During her show, Stackelhouse tackles subjects like fibromyalgia treatment, symptoms, self-care, natural therapies, and more. In this intriguing interview with Stackelhouse, Melissa Swanson explores the ideas behind the podcast. If you experience fibromyalgia pain, fatigue, sleep probelms, or other fibromyalgia symptoms, this podcast may offer you encouragement and hope.

Podcast Featuring Fibromyalgia Treatments and More

Who is Tami Stackelhouse, and what is your fibro story?

I’m a fibromyalgia patient myself. I was diagnosed over 10 years ago, in 2006. My fibromyalgia eventually got so bad that I ended up filing for social security disability in 2008. At the end of that year, my doctor introduced me to a health coach and everything changed. I started feeling better, having more energy, and less pain.

In 2009, I became a health coach myself because I wanted to pass along to other fibromyalgia patients the gift I’d been given. Today, I almost never have fibromyalgia pain and have enough energy to do the things I want to do.

What is a Podcast and how does it work?

Podcasts are basically just talk radio shows that you can listen to anytime, anywhere, on any device. People can listen through an app on their smartphone, or on The Fibromyalgia Podcast website from the comfort of their own home — maybe even in their pajamas!

Why do a Podcast?

This podcast was born because two things happened:

Over the last decade, as I’ve done interviews, taught classes, and spoken at events, people have always said I should do more, teach more, speak more. Dr. Ginevra Liptan, author of The FibroManual and medical director of The Frida Center for Fibromyalgia, has been telling me for about two years now that I specifically should do a podcast. I’ve always had a lot on my plate, so I always just smiled and laughed, and set the idea aside.

After a particularly insistent conversation with Dr. Liptan, I decided to see if anyone would actually be interested in listening to a podcast from me. I put a post out on my Facebook page asking if anyone would listen.

And, wow! The response was overwhelmingly, yes. I did a bit of research and found there was very little out there in terms of good quality educational podcasts on fibromyalgia. Most were patient stories, an audio diary of one patient’s journey, or a few episodes here and there from folks like the Mayo Clinic. But nothing 100% devoted to fibromyalgia education, featuring our top doctors, researchers, and advocates.

What will be different with your Podcast?

In this podcast, I’ll be interviewing our top doctors, researchers, experts, coaches, and patient advocates in the fibromyalgia community. I’ll be talking with experts like Dr. Ginevra Liptan on the current science and understanding of fibromyalgia.

Every 10 episodes, I’ll do a special “Ask the Coach” episode where I will answer questions sent in by listeners. The whole purpose of this podcast is to encourage hope and educate on ways you can improve your fibromyalgia symptoms.

What can listeners learn?

I’ll also cover topics such as the role we have as patients in our own healthcare, why your body isn’t actually the enemy, what a fibromyalgia coach is and does, and how self-care isn’t really about the things you do.

What about those of us with fibro fog and aren’t always able to remember what we hear?

Since I know all about Fibro fog, I will have full show notes for each episode at FibromyalgiaPodcast.com, including any links and resources mentioned on the show, so you don’t have to worry about taking notes or trying to remember.

I also plan to post each episode on YouTube for those of you who prefer to watch instead of listen.

“Your world doesn’t have to revolve around your illness;
it can revolve around your healing.”

So, how do you hear the podcast?

If you have fibromyalgia, deal with chronic pain, and feel like a prisoner in your own body, be sure to subscribe on iTunes, Apple Podcasts, or wherever you listen. Join Stackelhouse as she explores a variety of fibromyalgia treatments and solutions to help you create a life you love that supports you feeling your best.

You can go to FibromyalgiaPodcast.com to sign up to be notified when the podcasts goes live.

This article was first published on ProHealth.com on March 11, 2019 and was updated on July 10, 2019.

melissa-swanson.jpgMelissa Swanson is a chronic pain patient, advocate, and author of Ravyn’s Doll:  How to Explain Fibromyalgia to Your Child. Through her Facebook page, she offers positive encouragement, medical information, resources, and support to 20,000+ fibromyalgia and chronic pain patients. In addition to her own blog, Melissa has been published in “Living Well with Fibromyalgia” and the NFMCPA “Advocate Voice.” She also works with the International Support Fibromyalgia Network.

You can find Melissa at:

Facebook: www.facebook.com/survivingfibro

Blog: www.fibrowarriorslivinglife.com

Twitter: @Fibrowarriors

Wishing you sun-filled days & rest-filled nights.

A Brain Under Seize: A Look at Centralization, Chronic Pain, and Fibromyalgia

I ask myself, how does something others find pleasant, like a cool breeze blowing over their body on a hot summer day, cause me such discomfort? How can my brain’s pathways and messengers be so dysfunctional? Do others experience similar fibromyalgia (FM) symptoms? As it turns out, even though changes in the brain are visible on imaging, researchers don’t have answers either. There are no diagnostic criteria for a nervous system that is hyperaroused or overly reactive to painful stimuli, a term some may refer to as “centralization,” though chronic pain is apparent. The nervous system has two components:

  • Central nervous system (CNS) = the brain and spinal cord
  • Peripheral nervous system (PNS) = the nervous system outside the brain and spinal cord

Centralization of Pain in Fibromyalgia

Centralized pain syndromes in fibromyalgia, pain originating somewhere in the central nervous system, usually occur from some type of injury or disease within the brain or spinal cord. “Centralization of pain” or “central sensitization” results from cellular and molecular changes. These and other changes in the CNS result from abnormal pain signal processing between the peripheral nervous system (PNS) and the CNS.

For instance, messages from the PNS become distorted because of detours or derailments and dysfunctional neuro-messengers; the messages containing information on the content, character, and intensity of a problem leave the periphery just fine, but it doesn’t reach the brain that way.

Why Doesn’t Centralization of Pain Occur in Everyone with Fibromyalgia Symptoms?

In an interview with my pain doctor, Dr. Hurst-Wicker, he had this to say: “The transition from acute to chronic pain has a variety of contributing factors. Sometimes the underlying problem can’t be fixed, like a bad joint that can’t be replaced because the patient is too sick for surgery. In other cases, people with chronic pain can develop changes in the CNS that lead to central sensitization, thus perpetuating pain even after the initial problem is fixed. Some studies indicate genetic factors may explain why some people experience chronic pain and others don’t. Other studies indicate certain pain medications could initiate the process of central sensitization. We don’t know why.”

In short, many factors are at play in chronic, fibromyalgia pain. The pathways, signals, and other influencers are not operating correctly, but the dysfunction isn’t the same for all chronic pain, and no two of us are alike. I expect neuroscientists, those who study how the nervous system develops, its structure, and what it does, will continue to seek answers to our questions, because current evidence is too compelling.

Contributing Factors to Centralization of Pain in Fibromyalgia

Those of us with fibromyalgia know stress and dysfunctional sleep contribute to our pain levels. In part, that’s because we have abnormal stress hormone levels that amplify our pain. We also have abnormal sleep patterns that interrupt the circadian rhythm responsible for micro-healing and restoration of our brain and body. And, imaging in one study found the size of the hippocampus is reduced in FM patients. That’s the part of our brain responsible for memory and spatial awareness.

This leads us to another study I found quite interesting to this equation. Researchers showed the pain experience during low intensity stimulation is more closely related to attention, memory, and executive functions in those of us with FM. This evidence suggests central sensitization (abnormally amplified pain) influences our cognitive problems. I couldn’t agree more — this is a primary complaint for those of use who seek fibromyalgia treatments.

It remains unclear if all people with chronic pain experience altered cognitive processing because, unlike the promising fibromyalgia test, there aren’t any diagnostic criteria for chronic pain as a disease or syndrome on the horizon.

In conclusion

Chronic pain usually results from injury or it can be triggered by hormonal or metabolic changes; however, some chronic pain doesn’t have an identifiable cause. Regardless, constant, unrelenting pain can cause structural and processing changes in our brain and/or spinal cord. I found a new imaging technique reported on in Stanford’s Scope Blog, The beating brain, quite interesting. One day it may be used to diagnose abnormal brain structure.

It’s important to remember that our brain also allows us to do things that we know reduces stress on our CNS. The impact of something as simple as deep breathing can have a profound effect. Ask any mother about the value of deep breathing in labor. Findings in neuroimaging demonstrate there is evidence that mindful exercises affect activity in a positive way. Our head is indeed a valuable piece of real estate in the state of pain.

Let’s raise awareness that chronic pain is more than subjective. Chronic pain is real, and everyone deserves access to treatments and medications without bias or recrimination. Share the evidence and your thoughts with your legislators and others. I have compiled resources on Facebook in The Advocate’s Corner. 

This article was first published on ProHealth.com on September 25, 2018 and was updated on July 02, 2019

Celeste Cooper, RN, is a frequent contributor to ProHealth.  She is an advocate, writer and published author, and a person living with chronic pain. Celeste is lead author of Integrative Therapies for Fibromyalgia, Chronic Fatigue Syndrome, and Myofascial Pain and Broken Body, Wounded Spirit, and Balancing the See Saw of Chronic Pain (a four-book series). She spends her time enjoying her family and the rewards she receives from interacting with nature through her writing and photography. You can learn more about Celeste’s writing, advocacy work, helpful tips, and social network connections at CelesteCooper.com.


Continue reading “A Brain Under Seize: A Look at Centralization, Chronic Pain, and Fibromyalgia”

Lessons From Dogs… Take Time For Naps

Remember the good old days in kindergarten when we got to lie down on our mats after lunch and have a little rest and quiet time? Wouldn’t that be wonderful to do at work every day? I distinctly remember the feeling of “calm” I felt as we were allowed to get up and put our mats away. The entire room had changed, the energy was soft and quiet… I liked that feeling!

Every morning after I feed my dogs, they go outside for a potty break, play for about 10-15 minutes and then go to their favorite spot on the couch or one of the doggie beds and are fast asleep within minutes. Mind you, they have been awake for less than two hours at this point after sleeping all night (and hogging the bed). This is their routine every day, like clockwork, unless some major excitement or disruption emerges in our household.

I got the opportunity to see this pattern as I was home with them almost every day for four months last spring while recovering from a broken leg and surgery. I found myself settling in right with them every morning on the couch as I lay there with my leg elevated and iced. We would sleep for almost two hours every day while I recovered. Just like in kindergarten, when I awoke each morning from our nap… I LIKED THAT FEELING! I felt rested and calm, yet energized. I allowed myself to surrender and listened to what my body needed, which was a lot of extra sleep to heal from the trauma.

Dogs don’t sleep the way we do; they take a lot of short naps throughout the day. As predators, they are genetically designed this way. These short bursts of sleep help them recharge their energy quickly, so they can be ready to get up and go again. Dogs in the wild have to hunt for their food and this is strenuous work. They also must be ready to protect their territory and pack from other predators at any moment. Their genes have developed according to these needs.

It should come as no surprise that our dog’s sleep patterns are very different from our own. For instance, although people can nap, it’s not a need. Humans sleep in long intervals. Most people need a solid eight hours of sleep a night. Dogs, on the other hand, get their sleep in short bursts, spending most of their time napping.

Dogs and humans alike experience REM—or rapid eye movement—sleep cycles. These are the deepest sleep cycles, necessary for the brain to process information. Because dogs sleep for short periods of time, they need to sleep more often to get enough REM sleep and be able to keep their brains in top working condition. It takes humans 90 minutes to reach REM sleep stage; dogs are able to reach REM in as little as 15 minutes! This allows them to wake and go back to sleep—and be back in that vital REM sleep quickly to adapt to their environment and energy needs.

Quality sleep provides a lot of health benefits such as better heart function, hormonal maintenance, and cell repair and boosts memory and improves cognitive function. Sleeping gives your body a chance to process and sort through everything that happened during the day as well as repair itself and reset for tomorrow.

A body which is deprived of sleep actually harms us in multiple ways such as an increase in inflammation and interruption of hormone function. Yet, one of the most obvious and bothersome harms is that we have trouble focusing when sleep deprived.

Studies of napping have shown improvement in cognitive function, creative thinking and memory performance. We are naturally designed to have two sleeps per day according to our circadian rhythm. Professor Jim Horne from Loughborough University says that “we’re naturally designed to have two sleeps a day: a long one at night and another one in the early afternoon. Early afternoon is when our energy naturally dips lower than usual and we have a harder time focusing.” Because of the natural cycles of our circadian rhythms, we are at our most tired twice during a 24-hour period. One peak of sleepiness is usually in the middle of the night, so the other, 12 hours later, falls smack-dab in the middle of the afternoon. If you have ever traveled to Spain or Mexico, you’ll know that most businesses close during this time for “siesta” which means afternoon rest or nap. The world’s population sleeps in a variety of ways and at different times of the day. Millions of Chinese workers will put their heads on their desks for an hour or so for a nap after lunch. Daytime napping is also common in countries such as India and Italy.

In one study of 23,681 Greek men over a six-year period, the participants who napped three times per week had a 37% lower risk of dying from heart disease.

Sleep experts are finding that daytime naps can help our body in many ways such as increased alertness, boost in creativity, reduction of stress, improved perception and stamina. Naps improve motor skills and accuracy, enhance your sex life, aid in weight loss, reduce the risk of heart attack, brighten your mood and boost memory.

Sleep prepares the brain like a dry sponge to soak up new information as it processes and files away memories from the day. The left side of our brain takes some time off to relax during sleep, but the right side remains active as it clears out our temporary storage areas. As we sleep, the right brain is pushing information into long-term storage and solidifying memories from the day (learning and cognition).

The amount of time a person naps is very individual, as are their levels of physical and mental activity. Typically, napping longer than 90-minutes is not beneficial or refreshing as you will only begin another sleep cycle. Also, if you take a snooze too late in the day, it will contain too much slow-wave sleep leaving you sluggish and groggy.

A body that is fatigued, or struggling to function related to illness, injury or disease will need more sleep to restore and repair damaged tissue. In such instances, naps are key to healing and recovery. As you might imagine, a body which is exposed to chronic stress such as excess work/school difficulties, mental and/or emotional upset and chronic pain or physical disabilities may often experience burnout. Burnout is a sign that indicates you are unable to take in or process more information in your brain until you have had sleep. Unfortunately, a reality in our country is that far too many people try to work on a regular basis while in this state. Excessive stress and lack of sleep lead to chronic inflammation as our body does not get a regular opportunity to regenerate and repair cells. Chronic inflammation leads to disease, and it is no surprise to see how 90% of disease in this country is STRESS related.

Those of us who struggle to get a full 8 hours of sleep at night on a regular basis or who have chronic stresses affecting our life in one form or another may need naps more often to allow our immune system and brain to re-charge. Those who get regular sleep at night my still consider the amazing benefits of napping simply to improve our cognitive function and memory!

Here are more wonderful reasons to add napping to your wellness regimen:

  • Your immune system releases cytokines. While you sleep, your immune system releases small proteins called cytokines which help the body to fight inflammation, infection and trauma. Just as my body needed naps during my recovery.
  • Cortisol (often called the stress hormone) levels lower during the first few hours of sleep.
  • Your brain sorts and processes the day’s information and is actually quite busy while you sleep. This is important for creating long term memory and learning.
  • Hormones flood your body during sleep. Melatonin is released by the pineal gland and controls your sleep patterns. Growth hormone is released by the pituitary gland which helps your body to grow and repair tissue and bone.
  • Your sympathetic nervous system chills out! This is what controls our fight or flight response, and when we sleep, it gets a chance to relax. When we are deprived of sleep, sympathetic nervous system activity increases as the body thinks it is being threatened, and blood pressure and muscle tension remain elevated. Scientists studying coronary disease are investigating whether there is a relationship between decreased sleep duration and an increased risk of heart disease.

This LESSON FROM DOGS tells us to listen to our body and quiet our ego. When you “feel” tired or sleepy….REST! We are actually much less productive and less efficient with our time and energy when we are tired and fatigued. Never pass up the opportunity to snuggle up for a restorative nap with your pack!


Lisa Adams is nurse, Health and Wellness Coach and Certified Flowtrition Practitioner.  She has combined over 25 years of experience as a registered nurse with training in Flowtrition and health education to provide her clients with the most comprehensive and holistic approach to preventive healthcare and wellness. Lisa believes that wellness starts from within and that if we trust in our body’s ability to heal as it is designed, amazing things happen. She also believes that optimal health is achieved in a multi-system approach that includes not only physical wellbeing, but also mental and emotional wellbeing. Lisa’s passion and objective in coaching is to increase awareness in individuals about the way their body functions and especially how it responds to stress.

The body cannot begin to heal
while in a constant state of tension.”
~ Lisa Adams ~

Spirit of Namaste
Health and Wellness Center


Video: Fibromyalgia and Exercise

This is a safe, total body strength workout for anyone with Fibromyalgia or chronic pain.

Start slowly, focusing first on breath and posture, and then moving to this gentle exercise and strengthening program.

When performing the strengthening exercises, start with 8 repetitions and only one set 2 days a week. Make sure to do the exercises on non-consecutive days.

Have you tried an exercise program for your fibromyalgia pain?  Tell us about your experience in the comments below.


Opportunities to speak up for the pain community at the federal level are rare. As individuals who live with pain, it is important to make the most of them.

Don’t miss out on the opportunity to submit your feedback today on the Pain Management Best Practices Inter-Agency Task Force Draft Report, which offers a number of recommendations for improving pain care in America.

Why does the draft report matter?
This draft report is incredibly important because it has the potential to change pain care across the nation. Once finalized, it will be submitted to Congress, at which point we hope the recommendations will be funded and implemented.

It’s important to note that the draft report was developed out of a task force at the Department of Health and Human Services, which oversees a number of other health agencies, like the Food and Drug Administration and the Centers for Disease Control and Prevention. Because it was created at the highest levels of government, it’s vital the draft report and its recommendations reflect the patient perspective.

Comment Now
The deadline to submit feedback is April 1 at 11:59 pm EST. That’s less than one week away!

To make an individual comment, consider telling your story and how the recommendations made (or not) in the Draft Report can help you and/or suggest revisions to make them stronger. A list of statement prompts is attached. It is most helpful to the reviewers of all the comments if you cite which specific portion of the report you refer to.

For example, someone might write:

Thank you for recognizing the realities of the 100 million Americans who live with chronic pain. I am one of those millions, living with fibromaylgia. Chronic pain is present every day in my life. Some days, it is better; other days, worse. My healthcare team includes my primary care physician, a pain management specialist, a low dose of Tramadol, physical therapy when I can afford it (which isn’t often), mindfulness and an exercise program.

I also attend a monthly education/advocacy meeting, where I learn about communication, advocacy, and elements of integrative pain management. This activity has given me a voice, a voice that was long silent partly because of the stigma of chronic pain and especially because of the conflation between chronic pain and opioids.

Re: 3.1 Stigma I have not told my supervisor the full extent of my pain experience and treatment plan because I fear that it might jeopardize my job. Because of the conflation of the opioid crisis with the chronic pain epidemic, I fear my boss and colleagues may treat me differently, maybe even thinking that I’m an addict because I use an opioid as part of my treatment plan.

I believe if the general public better understood the commonalities and the differences between these two public health issues (substance use disorder and chronic pain), my fear and the stigma around both issues would be lessened.

Therefore, I support all of the Recommendations included and specifically suggest that the Task Force engage with pain patient advocacy groups and support groups to implement Recommendations 1a, 1b, and 1c, as well as 2a.

This is just an example – make it YOUR story.

How to Submit Comments

  1. Submit through the Federal eRulemaking Portal at http://www.regulations.gov, Docket Number: HHS-OS-2018-0027 (If Regulations.gov is inoperable, as a secondary option please submit your comments to email noted below.)
  2. Email to: paintaskforce@hhs.gov (Secondary method)
  3. Mail written comments to: U.S. Department of Health and Human Services Office of the Assistant Secretary for Health 200 Independence Avenue, S.W., Room 736E, Attn: Alicia Richmond Scott, Task Force Designated Federal Officer Washington, DC 20201

Let’s walk through the first option:

Click on the Federal eRulemaking Portal at http://www.regulations.gov

Enter HHS-OS-2018-0027 in the Search box, which results in:

Pain Management Task Force Draft Report

Click on Open Docket Folder.

If you want to review the already submitted comments, click on View All (3,201) to the right of Comments. You can search for specific words included in comments if that’s helpful to you.

If you just want to comment without reviewing others’ comments, click on Comment Now!

You can type your comments into the Comment box or you may upload a pdf copy of your comments. You can choose to leave your name and contact information or you can remain anonymous. It is your choice. See the Tips for Submitting Effective Comments.

Remember, your voice matters!

Cindy Leyland is ProHealth’s Fibromyalgia Editor. Cindy also serves as the Director of Program Operations at the Center for Practical Bioethics and the PAINS-KC Project Director. She lives in Kansas City with her husband, enjoys hiking, reading, and being Gramma Cindy.

Video: Pain Relief

Following up on Lisa Adams’ Lesson From Dogs yesterday, this 60-second breathing technique helps to relieve back pain, neck pain, arthritis pain, chronic pain, fibromyalgia, and more.

Using the diaphragm properly relaxes muscles and activates face parasympathetic nervous system; the “rest and digest” system. The diaphragm is also part of the core so it helps to support your body too.

Lessons From Dogs… Breathe Easy!

Have you ever seen your dog or any other pet sit or lie down and take a loud and deep sigh or breath? A LOT is going on in their body and brain during that breath.

Dogs can sigh for a variety of reasons; the main reason they sigh is to signal that they are relaxed. The most common sounds of pleasure we hear from dogs are moans and sighs. They can also use whines and growls to communicate happiness. Low-pitched moans are often a sound puppies make and are signs of contentment.

How often do you find yourself taking such a nice, loud and deep sigh or breath?

Some dog trainers say that dogs generally sigh while resting or when they are ‘resigned.’ These sighs seem to mark a physiological transition into a deeper state of relaxation. In fact, a relaxed, deep breath is a direct message to our (dogs’ and humans’) nervous system to “power down.”. It sends the message to the rest of the body that we are safe and content so all systems should be operating on auto pilot. Our heart rate and blood pressure drop; our breath slows and becomes effortless; and our digestion, sleep patterns, cell regeneration and immune system are fully operational now. This state of rest is our parasympathetic nervous system working.​

The ability to breathe so deeply and powerfully is not limited to a select few or those who have practiced yoga, meditation and mindful breath. This is a skill we are ALL born with but often lies dormant. Reawakening it and feeding your body oxygen while dropping physical tension allows you to tap one of your body’s most important self-healing mechanisms.​

Why does breathing deeply seem difficult or unnatural to so many of us? What I know as a wellness practitioner and a nurse for many years is this: at least 90% of people do not take full, deep breaths, nor do they remember HOW to take deep breaths. One reason may be that our culture often rewards us for stifling strong emotions. I have never seen so many people in my life work so hard at “not feeling.” Girls and women have been historically taught to rein in anger as it is not considered “lady-like” behavior. When my daughter was young, if she heard me swear or get angry, she would always say “mommy….lady-like” to remind me that I was not being a good girl. Boys and men have been historically taught “big boys don’t cry” or that crying is a sign of weakness. The unfortunate reality going on when we hold back tears, stifle anger, tiptoe through a fearful situation, or try to keep pain at bay, is that unconsciously, we hold our breath or take short, shallow breaths. A bunny that tries to cross the road and runs into on-coming cars will freeze and not move to protect himself. As he is doing this, he is barely breathing or even holding his breath – just like we do when stressed! ​

When our body is in fight or flight mode, it does not serve us to breathe loud, deep breaths…what if a tiger were chasing us? This is instinctual for animals and humans to hold or shorten and shallow our breath during an emergency. When we are in such a state, our body goes into preservation mode. Breathing loudly at such a time could allow a predator to find us and hurt us. During such a time our body also wants to conserve energy as much as possible as we may need fuel (oxygen and glucose) to flee a situation or fight for survival. Our reptilian brain responds in such emergent situations, and our sympathetic nervous system is engaged to help save our lives. ​

The unfortunate reality in our current world is that most of us are exposed to constant stress, or perceived stressors, such as work, finances, school, relationships and mental illness. Although these are not real life-threatening situations such as being chased by a tiger, our body responds as if they are. Our nervous system does not differentiate between the type or level of stress; it responds and does its job telling the body to “prepare for battle.” Our muscles tighten up; our heart rate and blood pressure increase; OUR BREATH becomes short and shallow, digestion slows or stops; and our ability to make clear decisions is altered.​

Dogs do not have the ability to think “what if this happens;” they generally live in the present moment. They are not driven by ego and/or fear of the future or past. THIS is why you will see dogs take beautiful, deep breaths many times a day or even many times an hour. If they are tired, they lie down and rest. If they are content and happy, they sigh and breathe and express this. Each time they take such breaths, this is a direct message to the nervous system that says “power down,” all systems are at ease. This message then allows the immune system, cell regeneration and hormonal functions to “carry on as usual.”

Unlike humans, dogs live and behave by instinct. They listen to their body and know that relaxation is vital for survival. Humans have learned to by-pass our body’s warning signs to fulfill our ego’s needs. This behavior of constantly reacting to stressors (real or perceived) results in chronic tension patterns. These patterns can be physical, mental, emotional and chemical, or all the above! These chronic tension patterns then create chronic inflammation throughout the body, which then creates DISEASE. ​

This LESSON FROM DOGS is about living in the moment and listening to what your body needs.


Breath allows our immune system to work properly, delivers oxygenated blood to our cells for energy, directs our nervous system to power down and drop tension. An amazing side effect of taking a few deep breaths is that IT FEELS GOOD and brings us back to the present moment. As we breathe, we drop tension; as we drop tension, we prevent chronic tension patterns, which prevents inflammation, and as a result, we PREVENT DISEASE.

  • When you find yourself tensing up or “reacting” to a difficult or stressful situation, look down at your feet, remember what is happening right here and now, and take care of what is right in front of you. Re-group…take three nice, deep breaths in through your nose and let your mouth gently drop open when you exhale. Remember, this is a direct message to your nervous system to “power down.”
  • When you feel tired and/or fatigued….STOP, REST, even if for 5 or 10 minutes; give your body time to recognize that you are safe and not in “fight or flight mode.”
  • If you get good news or feel happy….express it! Smile, sigh like our dogs do, enjoy the moment. This changes our cells and our environment, and we begin to attract MORE GOOD.
  • Practice taking (at least 3 at a time) nice, deep breaths with your loved ones and friends. Children love doing this and recognize that it makes them feel good.

Take a deep breath and pass it on!


Lisa Adams is nurse, Health and Wellness Coach and Certified Flowtrition Practitioner.  She has combined over 25 years of experience as a registered nurse with training in Flowtrition and health education to provide her clients with the most comprehensive and holistic approach to preventive healthcare and wellness. Lisa believes that wellness starts from within and that if we trust in our body’s ability to heal as it is designed, amazing things happen. She also believes that optimal health is achieved in a multi-system approach that includes not only physical wellbeing, but also mental and emotional wellbeing. Lisa’s passion and objective in coaching is to increase awareness in individuals about the way their body functions and especially how it responds to stress.

The body cannot begin to heal
while in a constant state of tension.”
~ Lisa Adams ~

Spirit of Namaste
Health and Wellness Center

Fibromyalgia: Pilates vs. Aerobic Exercise



Fibromyalgia is characterized by chronic generalized pain, fatigue, sleep disorders and other symptoms. Physical exercise is recommended as the first choice of non-pharmacological therapy. Thus, the aim of this study is to evaluate the effectiveness and cost-effectiveness of modified Pilates exercises compared to aerobic exercises in the treatment of patients with fibromyalgia.


In this randomized controlled trial with blinded assessor, 98 patients who meet the fibromyalgia classification criteria of the American College of Rheumatology 2010, aged between 20 and 75 years, and with pain intensity greater than or equal to 3 points in the Pain Numerical Rating Scale, will be randomly divided into Aerobic Group (aerobic exercises on treadmills or stationary bikes) and Pilates Group (modified Pilates exercises), and treated twice a week for eight weeks on the Center for Excellence in Clinical Research in Physical Therapy at Universidade Cidade de São Paulo, Brazil.

The following outcomes will be evaluated by a blinded assessor at baseline, eight weeks, six months, and 12 months after randomization: impact of fibromyalgia assessed by the Fibromyalgia Impact Questionnaire, pain intensity by the Pain Numerical Rating Scale, kinesiophobia by the Tampa Scale of Kinesiophobia, specific disability by the Patient-Specific Functional Scale, functional capacity by the 6-min Walk Test, quality of sleep by the Pittsburgh Sleep Quality Index, and health-related quality of life by EQ-5D-3L and SF-6D questionnaires.


It is expected that the Pilates exercises will be more effective than aerobic exercises in improving clinical outcomes and that this improvement will be maintained over the medium to long term.

This study aims to clarify whether the Pilates method can be incorporated into the clinical practice of physical therapists treating patients with fibromyalgia. The study will also provide information on which exercise will be most cost-effective, information that can be used by insurers and public health systems.

Trial registration

This study was prospectively registered at the Clinical Trials Registry (NCT03050606) in February 2017.

Full text available here.

Source:  Franco KFM, Franco YRDS, Salvador EMES, do Nascimento BCB, Miyamoto GC, Cabral CMN. Effectiveness and cost-effectiveness of the modified Pilates method versus aerobic exercise in the treatment of patients with fibromyalgia: protocol for a randomized controlled trial. BMC Rheumatol. 2019 Jan 18;3:2. doi: 10.1186/s41927-018-0051-6. eCollection 2019.