Tap into Dr. Nielson's knowledge, learn from his years of caring for and helping Fibromyalgia patients, learn from his knowldege of research at an institution that has been one of Canada's leaders in FM research.
        Click here to see some of the research underway in London, Ontario.

His bio:
Dr. Warren Nielson is an Associate Professor of Medicine (Rheumatology) and Adjunct Professor of Psychology at the University of Western Ontario. He is also the Clinical Director of the Rheumatology Day Programs at the Arthritis Institute and, St. Joseph’s Health Care London. His research interests are in psychological factors associated with chronic pain, particularly in relation to Rheumatoid Arthritis, Osteoarthritis and Fibromyalgia Syndrome. Current studies focus on predictors of outcome in both multidisciplinary treatment programs. Dr. Nielson was also appointed to both the WSIB Expert Panel on Chronic Pain and the WSIB Expert Translations Committee, Program of Care for Chronic Low Back Pain.

Your Question:

Managing fibromyalgia requires multidisciplinary approaches. Diet, exercise, massage, antidepressant medications, physiotherapy, water therapy, herbal / vitamin supplements, and accupuncture are just some of the approaches that I am aware of. Personally, I have become so overwhelmed and exhausted with fibromyalgia, that I can hardly follow one or two of these treatments. It's about all I can do to take some supplements and walk a little every day. If I decide to go for a massage, I will feel better temporarily, but the energy it takes to get dressed, get out of the house and to the massage therapist's office wears me out for the rest of the day. The temporary good feeling from the massage is worn off by the next day. I then have to find more energy to go somewhere else for some other treatment or make an appointment with a doctor. All this takes time and energy I simply don't have. Considering there are so many people which suffer from FMS, will there ever be a Fibromyalgia Care Facility, where all treatments and practitioners are under one roof?

Dr. Nielson's answer:

It is great to hear that you are aware of the need for a multidisciplinary approach. It is often the case that those with FM are searching for a single curative treatment. While this may happen someday it isn't likely for the foreseeable future. So, at present, multidisciplinary approaches may be the best bet.

I understand your constant battle with fatigue. One of the things we have learned from research into the effectiveness of treatments for FM is that regular exercise is one of the most effective things that people can do to improve their symptoms and the quality of their lives. In our Program we find that patients typically have to start an exercise program at a very low level and gradually increase the length of time that they exercise. Generally, people find that as they increase their level of physical fitness they feel better. People are often afraid of exercise because when they have tried in the past their symptoms increased. Almost always it was a result of doing too much exercise too quickly.

You are correct, it would be better for patients if we had 'one stop shopping' for people with FM. Unfortunately, there are not many health care resources attached specifically to FM care. Some health care practitioners are not part of the Canada Health Act (e.g.,. psychologiists, physiotherapists, massage therapists, occupational therapists). So as hospitals have had to cut services, the services of many of these professionals have been cut severely or eliminated. They are only available if you have private insurance or can pay yourself. I know that this lack of access is a concern that FM-CFS Canada is planning to address.

Your Question:

I also feel like I run into a brick wall sometimes and have no energy to do anything? This happens from time to time. I know stress plays a part but not all the time with me.

I really feel that hormones play a big part in Fibromyalgia with what I have read. I am over 60 years old and can not deal with a lot of juggling like I use to do.. I am always told you are getting older yes I accept that but look at 80 yr. old and how active there are and can't figure old why??

Dr. Nielson's answer:

Feeling like you are older than you are is something I often hear from people with FM. I think that the fatigue, pain and memory problems make people feel that way - especially when they see older people who seem to be able to do more than them! There are two common reasons why this is upsetting. The first is that the person may be feeling a sense of loss or grief. When you have a chronic illness, grief is a normal response because you have lost the person you expected you would be. It is normal and healthy to have those feelings.

The second reason is thinking in an exaggerated way. It might be a good idea to remind yourself that you are not that old even though it feels than way. One of the things that appears to help people with chronic illnesses is Cognitive Therapy (also called Cognitive-Behavioural Therapy).

To be clear, Fibromyalgia is a biological condition and isn't imagined, and there is no cure for FM, including CBT. CBT is one approach of many that people can learn and use to manage their symptoms and improve the quality of their lives. My own belief is that CBT is best used as part of a larger set of FM self-management strategies. Although psychological factors play a role in FM they certainly don't explain everything. It is worth noting that there are 11 randomized, controlled trials of that demonstrate that CBT is beneficial for people with Rheumatoid Arthritis - and I don't think anyone would say that RA is "psychological".

That said, when you have a chronic illness it is easy to begin to "catastrophize" or have overly negative thoughts such as "I can't do ANYTHING anymore" or "things are just going to get worse and worse" or even "I am always falling apart". In addition to making you feel worse emotionally, such thoughts can even increase your experience of pain (and likely fatigue). If you find yourself thinking in a way that you feel is overly negative, try challenging those thoughts and ask yourself whether there is a more helpful, less upsetting way to think about the situation.

I hope that is helpful.

Your Question:

Can you please tell me.
Is there anything a person with FM AND CFS can do to help the MEMORY part since the short term memory is not working too well.
Thank you,

Dr. Nielson's answer:

As far as I know, there are no specific treatments for memory problems in FM. We don't even know exactly why people with FM have memory problems -even though we suspect that lack of restorative sleep, stress, depression, fatigue and the distracting effect of chronic pain are likely factors. The implication is that if you can get better control of your FM symptoms, your memory may also improve.

Using memory aid may be helpful. There are self-help books for that describe such strategies e.g., Your Memory : How It Works and How to Improve It by Kenneth L. Higbee. The other thing is not to worry about memory problems too much - worrying likely magnifies them.

Your Question:

Assuming that some of your patients are not employed when they come to you, do you find that your multidisciplinary care is able to help people get back to work? If so, what appears to be the reason - is it many reasons fitting together, is there one more than the others? Are there noticeable reasons why some do not get a benefit?

Dr. Nielson's answer:

Disability and FM is an area of great debate and controversy among health care professionals. The debate can continue because disability cannot be objectively determined. Functional abilities evaluations are often conducted but symptoms like pain and fatigue are subjective experiences and are what limits functioning in those with FMS. How much FM or fatigue is enough to warrant disability? In my experience, whether someone can return to work is determined by multiple factors such as: The physical and psychological demands of the job, the willingness of the employer to provide work modifications, the motivation of the person with FM to return to work and the severity of FM symptoms. In our Program, those who were working at the time of admission are more likely to return to work. The longer they have been off, the less like it is they will return. Psychological factors such as fear of movement and depression may also have an effect. Those who work in jobs where the employer is willing to and/or can make accommodations are more likely to go back. If the job involves repetitvive or heavy physical demands e.g., assembly work in a factory, it seems that people often don't return. The work environment also can effect whether they return. If the person has poor relationships at work and a history of conflicts with coworkers or supervisors that can also be a factor. Severity of pain and fatigue is also different from person to person. If they have other committments (e.g., mother of young children) that can be very important. Whether a particular person returns to work is a combination of such factors. I don't know if one factor tends to be more important than the other, on average. Averages don't help too much because it still comes down to the factors involved for an individual.

Your Question:

I would like to pose a question for your online Question and Answer sessions with the Fibromyalgia and Chronic Fatigue Syndrome researchers. I belong to the M.E. Victoria Assoc. supporting people with CFS/ME in and around Victoria, BC. Several members have express frustration with the response from doctors, employers and occupational health representatives that research shows that is best for people with CFS to remain at work. I do not know what piece of research they are quoting but the consistent piece that is repeated is that it is better for one's self-esteem, the implication being that it guards against depression. However in my, and others, experience it is used to pressure employees to work more than is healthy for them leading them to bigger crashes when they finally cannot work any longer. Some report that it has resulted in repetitive failed return to work trials which understandably undermines their self-esteem. I have been cautioned individually by doctors to not "push myself" but is there research to support the failing employees need to cut back on work? I am hoping that there is research that can either counter and give balance to this older research or give clearer defining guidelines for how much someone with CFS should "push" themselves to remain at work. Thank You for considering this and others questions.

Dr. Nielson's answer:

I think my last response about disability and FM may at least partially address this question. I more familiar with the FM literature than that for CFS. In general, I would agree that those who are able to continue work would do better emotionally. For many people, work is a highly valued aspect of their life and if they aren't able to continue it is a significant loss and can lead to depression. When valued activites are removed from people's lives, their risk of depression increases. I don't know of any research that directly answers your question. Most research of the type you describe is correlational rather than experimental. What this means is that there may be an association between staying at work and self-esteem but no proof that staying at work actually causes better self-esteem. It may be that those who stay at work do so because they have less fatigue which, it turn, makes them less depressed. But I would have to see the study that they refer to in order to make an informed comment. By the way, if someone quotes a study, ask for the reference so you can look it up. If they can't give you the reference, I would be skeptical.