Book by Jenny Fransen, R.N. and I. Jon Russell, M.D., Ph.D. (1996: Smith House Press, St. Paul, MN. $18.95. )
Thanks to its expert authors, this comprehensive yet utterly readable text is perhaps the most authoritative book on fibromyalgia in print: Fransen is a rheumatology nurse clinician and director of the Arthritis Care Program and Fibromyalgia Treatment Program at Abbott Northwestern Hospital in Minneapolis, MN. The editor of The Journal of Musculoskeletal Pain and author of over seventy original publications and numerous chapters in medical textbooks, Dr. Russell is an internationally recognized researcher and clinical practitioner caring for patients with musculoskeletal pain disorders. In addition, Russell is Associate Professor of Medicine at the University of Texas Health Science Center in San Antonio.
Fibromyalgia Syndrome (FMS) is a mysterious and complex disorder which causes chronic widespread muscle pain, stiffness, insomnia, fatigue, memory problems, lack of concentration and numerous other debilitations. According to Fransen and Russell, fibromyalgia afflicts over 5 million people in the United States and about 1.5 percent of the general population in nearly every country where it has been studied. Fransen’s and Russell’s sympathy for those afflicted with the widespread body pain and disabling power of fibromyalgia is expressed throughout the book. Noting how the pain and other symptoms of FMS are not only intense, chronic and “invisible,” the authors understand how healthy people may fail to believe that the syndrome exists. Because Fransen and Russell know all too well how alienating, angering and overwhelming FMS can be for the patient, their book outlines detailed practical strategies, tools and ideas for taking control and effectively managing this illness. Fransen’s and Russell’s profoundly heartening attitude is based on their many years of patient care and clinical research; it also serves as a valuable example to any health care professionals who may read this book.
Fransen and Russell validate the physical and psychological suffering of FMS patients by explaining how until recently, the medical community believed that fibromyalgia was a physical manifestation of psychiatric disease, or some kind of psychological disorder with no physical abnormalities and no abnormal laboratory tests to authenticate its existence. Now, a simple physical examination is used by doctors to diagnose FMS. Although its origin has eluded M.D.’s for years, fibromyalgia now appears to be a complex disorder of the neuroendocrine system, involving blood and brain chemicals which regulate how pain is perceived by the body. While this evidence holds implications for understanding the cause and effects of FMS, it also influences how doctors devise treatment strategies.
Operating under the premise that FMS “patienthood” is a full-time job, the authors aim to empower patients so that they can control fibromyalgia, rather than have the illness control them. This book functions rather like a support group on paper: it tells patients what they need to know about what fibromyalgia is and is not, discusses apparent causes of the illness, how to get the diagnosis, and how to interview prospective physicians and find a knowledgeable one. Also discussed are how to find a support group in your area.
A chapter on medical management of the illness instructs patients how to embark on a FMS self-education program and which resources they can contact. Medications for sleep, pain and depression are explored here, including a complete medication guide. Perhaps one of the most helpful chapters is the one on how to achieve better quality sleep: included here are dietary strategies, exercise tips, meditation and breathing instructions, as well as information on sleep disorder clinics.
A chapter devoted to fibromyalgia in children discusses common regions of FMS pain in children, the preferred strategies for treating these, such as physical therapy and muscle relaxants such as Flexeril. Guidelines on how to help the child play an active role in his or her illness are presented alongside of suggestions on how the child’s physician should explain FMS to school officials and ensure that the child can keep up with school work during periods of bedrest.
Because FMS is a shape-shifting illness whose course may dramatically change from day to day or from one week to the next, a section on creative medication management may be especially useful for patients and health care professionals. The relative merit of psychiatric treatment is covered here, as is combination drug therapy. Patients will especially benefit from a checklist in this section which helps identify situations where increasing medication for a specified period might prevent a flare-up and improve overall quality of life.
The authors repeatedly stress how the patient must become the mastermind and key player in a multi-modal self-rehabilitation program. While willfully creating and maintaining a positive and solution-oriented attitude is necessary for the patient to manage (and triumph over) this illness, so is being open to new psychological coping strategies. These can not only positively “re-program” patients’ minds, but help them solve day-to-day problems and conquer flare-ups. Self-evaluation checklists throughout the book help the patient pinpoint their core feelings, urgent needs and areas they need to focus on the most in order to manage their mental and physical symptoms. A chapter on building a relationship with a physician provides step-by-step guidance and realistic insights into how much a patient should expect of his or her doctor; which questions to ask, how to ask them, what to say and do in follow-up visits, and how to know when to sever a relationship with a doctor.
Along with confronting the more intense psychological issues of the illness, such as loss of control, stages of loss and grief, denial, anger, depression and conquering helplessness, the authors explore the value of physical therapy, relaxation and meditation training. These sections are some of the most motivational in the book, as is the chapter on developing an exercise program. A chapter summarizing the key findings of fibromyalgia research provides a substantial yet easily grasped overview of this persistently baffling illness. This section also spreads hope by forecasting how more research and medical knowledge will help improve the quality of life for people with FMS.
A bibliography on research studies, papers and books published on various aspects of fibromyalgia will help readers further their understanding of the illness. Guidelines on how to start a support group and a directory of North American Fibromyalgia Organizations will help readers obtain the assistance they need; United States Arthritis Foundation Chapters and chapters of the Arthritis Society of Canada are also listed in the Resources chapter of the book. Because of the association between FMS and many other related conditions, a directory of other helpful organizations, such as the American College of Rheumatology and the National Headache Foundation is also included. A list of hospitals around the world where clinical research is being conducted may be of special interest to health care providers. The directory of adaptive equipment resources and relaxation and guided imagery tapes provides various self-help tools that both doctors and patients can benefit from knowing about or using.
To order “The Fibromyalgia Help Book” direct from its publisher, Smith House Press, phone toll free, 1-888-220-5402, 9 a.m. to 5 p.m. Central time Monday through Friday in the U.S. and Canada only. (U.S. orders are shipped by Priority Mail; other North American orders are shipped by Air Mail. First book costs $4.00 in shipping and $6.00 if going elsewhere in North America. Each additional book costs $2.00 in shipping and $3.00 if going to Canada.) Purchases may be made via check, money order, Visa, Master Card or Discover card. If ordering from Minnesota, please include state tax.
Toll-free fax orders can be made from the U.S. or Canada only: dial 1-888-220-5401. To fax an order from abroad, dial 1-612-490-9359. Overseas orders must be made via credit card, in U.S. funds only. Shipping is via global priority mail; $4.00 fee.
Should you wish to order through the mail, the Smith House Press address is 2700 Rice Street, St. Paul, MN. 55113-2261.
Another company stocking the book is Fibromyalgia Information Resources. To order, send a stamped, self-addressed envelope to them at P.O. Box 690402, San Antonio, TX. 78269.