Thursday, 19 December 2013

T’was the Pain before Christmas (An ode to those with fibromyalgia)

T’was the night before Christmas, and all through my body
Not a thing isn’t hurting. How I need a hot toddy!
The stockings I’d put on my feet with such care…
They now chafe my skin, I feel so raw and rare.

I’ve spent almost all of this day in my bed
With this merciless migraine pounding my head.
I just feel so tired, all energy sapped.
How I wish I could sleep — please — just a half hour nap!

When down in my gut, I can hear such a clatter:
I’m just not quite sure — Is it bowels? Is it bladder?
Away to the bathroom, I crawl like a slug
And sigh when I spy in the mirror… my mug.

My face seems as white as the new fallen snow.
And so are my hands — I’ve Raynaud’s, you know.
When what to my wandering eyes should appear
But a toy that my grandchild has somehow left here.

She’s a beautiful grandchild — so lively and quick.
Right now she’ll be dreaming of good ol’ Saint Nick.
The rest of my family, well, they’ll do the same.
If only I could remember their names.

There’s Stacey and Thomas and… Sarah, I’m thinking.
I hate when my mind’s like I’ve spent all day drinking.
Whatever their names or size, big or small,
Come Christmas morning, they’ll all come to call.

They know not to come too much before noon.
They know I’ll be useless if they come too soon.
But then in their Honda they’ll park in my drive.
And suddenly sprout like a busy beehive.

They’ll rush to my door bearing goodies and such.
Mostly for them though… I can’t eat too much.
They know not to hug me too hard, lest I scream
And spend all day smelling like a deep-heating cream.

My grandchild will be at the centre of things.
But that is the magic that each Christmas brings.
The day will seem long for me; yes, that is so.
But Christmas comes just once a year, don’t you know.

And if I stay careful, and limit myself
To no more than what I can handle, or else,
I CAN enjoy Christmas, and all of the cheer
And then be so thankful it’s just once a year.

So if you are hurting like me, might I say
I hope you too tolerate this Christmas Day
And more than just that, I hope that you find
Some joy and some love and some true peace of mind.

And though we’re in pain, to start things off right
I say Merry Christmas... and to all a good night!

Copyright © Dec. 18, 2013, Kevin P White, MD, PhD
Kevin P White, MD, PhD
5-Time Award Winning Author of

Thursday, 3 October 2013

Cranial Electrical Stimulation (CES) for Fibromyalgia

I recently was contacted by Linda Horncastle, an Occupational Therapist who lives and works in the United Kingdom. She wanted to know my opinions regarding the use of cranial electrical stimulation (CES) for the treatment of fibromyalgia. My first response was wise and confident: I told her I hadn't even heard of it. But then, not wanting to come across as more of an idiot than I already seemed, I told her I would look into it and get back to her.So here I am, getting back to her (and you) regarding my thoughts on CES, having done some reading about it.

To begin with, cranial electrical stimulation is just what it sounds like: it is low-level pulsed electrical stimulation of the brain, typically administered via little clips attached to the ears (see below).
The treatment has been approved by the US Food and Drug Administration (FDA) for the treatment of depression, anxiety and insomnia. Usually, CES is administered for between 20 minutes and one hour per treatment; and some patients receive several treatments per week over weeks. 

Recently, several have been using it also for the treatment of pain. The question that Ms. Horncastle had for me was: do I believe it works? To answer her, I have done a search of the medical scientific literature to see what I might find. I hadn't expected to find a whole lot; but I was somewhat surprised, in that at least two well-designed, randomized, sham-controlled, double-blinded studies have been conducted and reported.  By randomized, sham controlled and double-blinded, what I mean is that a number of patients with fibromyalgia were randomly assigned either to receive real treatment (real CES) or a mock treatment, in that ear clips were applied, but didn't administer any electrical currents.  Since patients don't actually feel the real currents (it isn't like sticking your finger in a light socket; there is no shock), the patients in these two studies truly did not know if they were receiving the real CES or fake CES.  

What happened? Interestingly, both studies demonstrated a greater reduction in pain with real CES treatment than with the fake treatment, but the reduction in pain was small. In one study, the reduction in pain was just over 10%; while in the other study, there was a 27% reduction in pain and a 28% reduction in tender point scores.  These results are not earth-shattering; but they are reductions nonetheless.  In the most recent study, functional MRI scans of the brain were done that showed that the CES treatment resulted in significant reductions in the activation of the pain-regulating center of the brain, suggesting that this was a true pain reduction, and not merely a reduction in depression or anxiety related to pain.

CES may have more benefit for other manifestations of fibromyalgia than pain, however. In the sham-controlled study published in 2001, for example, the percentage of patients who rated their sleep as poor dropped from 60% to 5% in those who received active CES, while the sleep of patients who received the sham treatment actually worsened. Those receiving real CES also noticed a significant improvement in overall quality of life. Interestingly, when patients who received either the sham treatment were later given real CES, many responded.

How good were these studies?  From a scientist's point of view, two positive studies are not definitive. However both studies noted above were well-designed, in that they were randomized, sham-controlled and double-blinded. What this means is that neither patients nor doctors could falsely bias the results. In this regard, the studies were good.  However, one study only involved three weeks of treatment and the other eight weeks.

More recently, a Cochrane database review has been published  assessing the effects of CES and other forms of non-invasive brain stimulation that include repetitive transcranial magnetic stimulation (rTMS), cranial electrotherapy stimulation (CES), and transcranial direct current stimulation (tDCS). Overall, a 15% reduction in pain was noted between active and sham treatments over 33 studies.

So... to answer Ms. Horncastle:   I think that there is certainly reason to believe that CES can be helpful in some fibromyalgia patients, but the effects regarding pain reduction will usually be small, in the order of 10 to 30%.  However, greater improvements might be observed in sleep and other symptoms, resulting in an overall improvement in quality of life.

Are CES and other forms of non-invasive brain stimulation safe?  That question is harder to answer. The FDA considers them so. What might happen twenty and thirty years down the line, no one can be sure. For years, scientists have been trying to determine if society's now rampant use of cell phones and other hand-held electrical devices will result in increased rates of brain cancer. So far, no significant increases have been identified. But again, what will happen in 20 or 30 years?  Time will tell.  I suggest, however, that the risk of CES devices used in the short-term will likely be very low.  Note also that we don't know the long-term risks of many other things, including some of the newer drugs now being used for fibro.

The bottom line:  Would I recommend that CES be used in a fibro patient?  I believe that, if you have a therapist who is knowledgeable and judicious in its use, and you have symptoms that are interfering significantly with your quality of life, CES would be reasonable to try. It might especially help your sleep. And I think life always seems much more tolerable after a good night's sleep.


Kevin White, MD, PhD, multiple award-winning researcher, author, teacher & speaker

Monday, 30 September 2013

Novel about Autism Wins International Book Award

Just thought I'd let everyone know that another one of my novels has won an international book award. The book is called Puck, and I am really excited about it. It is the story of an autistic boy who learns to play hockey.

Told from the perspective of the boy's father, the book describes the ups and downs the young family has, from the first realization that something is wrong, to the day autism is diagnosed, to the many struggles and successes that follow.

It is called 'Puck' because that is the very first word the boy says, when he is eight years old... and that one word changes everything.

Readers Favorite Review wrote:

“Puck” by Kevin White is the beautiful, heart-warming and heart-wrenching story of Kathy and Jason and their autistic young son Luke. It is a great story that Kevin White wrote with feeling, understanding and a lot of love. I felt all of the pain and joy along with Jason and Kathy. I cheered for Luke and became emotionally attached to him. The final chapters tore at my heart and made me proud too at the same time. I was really sad to leave my new friends behind when I got to the last page. Kevin White has written a winner that can easily hold its own as the top best seller for many weeks. It would make a fantastic movie as well. My hope is that there is a follow-up so that we can see where life takes Luke next. Kevin White is a five star writer who has left me wanting more.

I sincerely hope that some of my blog fans will go to amazon and pick it up as an eBook (just 99 cents), read it, and then comment on it.  If you'd prefer a printed copy, the book is in its final editing stage and should be available through amazon as a printed book within a month. Proceeds from all my books go to a variety of charities. And, by the way, October is International Autism Month.



Kevin White, MD, PhD, multiple award-winning researcher, author, teacher & speaker

Thursday, 15 August 2013

Fibromyalgia and Myofascial Pain Syndrome: Similarities & Differences

I just read a comment to one of my many YouTube videos, one called
Fibromyalgia: The Disease Where Even Hugs Hurt, in which the writer asked me if fibromyalgia and myofascial pain syndrome are the same. I'd like to respond to that question here.

To begin with, let me say that the two conditions are alike in many ways. Both are associated with chronic (i.e., long-standing) muscle pain. In both conditions, that pain can be anywhere from mild and merely annoying to severe and disabling. And both conditions are poorly understood by most doctors.

But this is how they are different. Myofascial pain syndrome (MPS) refers to chronic muscle pain in a localized area... for example, your shoulder or hip.  Fibromyalgia (FM), on the other hand, refers to generalized pain. In fact, about half of patients with fibromyalgia say they hurt everywhere. This doesn't mean that they hurt everywhere all the time or even every day. But if you ask them to colour in where they've had pain in the last month on a pain diagram like the one below, most will colour in at least half of it. Meanwhile, the person with MPS will just colour in their shoulder and areas next to it (possibly their upper back and chest on the same side; maybe their neck on the same side; potentially even that same arm).  That is not to say that people with MPS can't have MPS in more than one place. Having MPS in your shoulder doesn't prevent you from getting it in your hip.  Theoretically, if you had MPS in enough places, you could have widespread pain that is virtually indistinguishable from the pain of fibro. But there is one major difference: MPS generally is pain; fibro is pain PLUS a host of other symptoms (Read below) 

Pain Diagram: Patients are asked to colour in where they have pain.
If you ask people with MPS what their worst symptom is, almost all will say that it is their pain. Some may be extremely tired because the pain keeps them from sleeping. Some may have severe headaches if their MPS affects their neck. Some may be very depressed about everything. But pain is GENERALLY the #1 worst symptom they have. Among those with fibro, however, pain is the worst symptom in only about half. The remainder will rank fatigue, or sleeplessness, or headaches, or problems with memory and concentration (the so called fibro fog), or irritable bowel syndrome as #1. That, more than the localized versus generalized distribution of the pain, is the #1 difference between these two conditions.

That being said, can MPS and FM co-exist? Most certainly. In fact, they commonly do.  I have met relatively few patients with fibro who don't have one area that is always painful, that is their worst area. Most also have an area that is so tender that pushing on it causes pain to shoot elsewhere. This last phenomenon - where pushing on someone's upper back on the right side causes pain to shoot all the way down their right arm - is called triggering; and locating trigger points is a major way doctors diagnose MPS. 

Similarly, many people with FM once started with pain that was localized to one area. In other words, they started with MPS that then spread to become generalized pain associated with numerous other symptoms. Their MPS spread to become fibro.

Are there differences in the way MPS and FM are treated? Yes and No. If someone has localized pain only, treatment generally should be geared locally, for example with physiotherapy directed to that affected shoulder or hip, or with local injection(s) of anesthetic +/- a steroid to reduce pain +/- inflammation. However, if someone with fibro has one really bad area, localized treatment of that area also may be helpful. 

If someone asked me which I'd rather have, MPS or fibro, I wouldn't hesitate a second: I'd rather have MPS because treatment IS more localized and there is a reasonably good chance that the pain can ultimately be made to go away or, at least, be significantly reduced. That is not to belittle MPS, as for some it is a nightmare. But MPS usually does NOT become fibro, and most patients ultimately do well.  That being stated, MPS must be treated aggressively and as soon as possible, so that the pain doesn't spread and other symptoms develop. 

Developing FM on top of MPS is a real pain.

Kevin White, MD, PhD, multiple award-winning researcher, author, teacher & speaker
Multiple award-winning author of Breaking Thru the Fibro Fog: Scientific Proof Fibromyalgia Is Real