By Ginevra Liptan, MD * Links may generate a commission for this site Adrenal burnout is common in fibromyalgia and can really worsen fatigue and fog. Adrenal burnout (also referred to as adrenal fatigue) stems from overworked adrenal glands. The hyperactive stress response in fibromyalgia causes the adrenal glands to work hard—all the time. The continual bombardment of stress response on the adrenals in fibromyalgia forces them to try to pump out cortisol at a high rate continuously. This results in overworked adrenal glands that never get a “rest” period until they “burn out” and start secr ..read more

by Ginevra Liptan, MD *Links may generate a commission for this site I often get asked about pregnancy and fibromyalgia, here are some FAQ on this important topic based on my clinical experience and review of the medical literature. Does fibromyalgia affect fertility?  Clinically my patients with fibromyalgia seem to have more fertility issues, and I think there are a few reasons for this 1) higher levels of inflammation 2) hormone alterations caused by the chronic fight-or flight response and 3) myofascial restrictions around the uterus and fallopian tubes. All of these factors can have ..read more

by Ginevra Liptan, MD *Links may generate a commission for this site Before I tried Pilates for myself I had always thought of it as a fibro-unfriendly form of exercise since several of my patients had injured themselves in Pilates classes. But it turns out there are ways to make Pilates work really well for the fibromyalgia body, especially since it is a mind-body exercise that matches breathing and flowing movement to build strength and body awareness. I call it “enforced mindfulness” because when I am doing Pilates I can literally only focus on my body and breathing, there is no mental spac ..read more

By Ginevra Liptan, MD *Links may generate a commission for this site I learned so much attending PainWeek this year, the largest conference for pain providers in the US! CBD was a hot topic, as you can imagine, and the results of 3 interesting studies were presented that I wanted to share with you. The first two were surveys of pain clinic patients, and 14-37% reported trying a CBD product. Most reported some benefit for their condition, with few side effects. The other study, also at a pain clinic, followed patients taking CBD capsules for ten months, and noted really impressive reduction of ..read more

Rates of addiction among those taking opioids for chronic pain By Ginevra Liptan, MD *Links may generate a commission for this site The hysteria around opioid use for chronic pain is wrong and not supported by the facts. Studies show that among people who are prescribed opioids, addiction is relatively uncommon. According to a brilliant article by Dr. Sally Satel, “the percentage of patients who become addicted after taking opioids for chronic pain is measured in the single digits; studies show an incidence from less than 1 percent to 8 percent.” It is important here to clarify the difference ..read more

By Ginevra Liptan, MD *Links may generate a commission for this site I was relieved to to read the headline “A Mea Culpa on CDC Opioid Guideline” in a recent edition of Pain Medicine News. Mea Culpa means a formal acknowledgement of fault or error, and gives me hope that the pendulum on opioids may be moving closer back to center. The 2016 CDC guidelines really cemented the medical hysteria around opioids (see timeline for further exploration) and rapid adoption of their strict opioid dosage ceilings and duration limits has resulted in widespread undertreatment of chronic pain. Even though stu ..read more

By Ginevra Liptan, MD *Links may generate a commission for this site Opioids are important, but imperfect, tools to manage chronic pain. Part of their imperfection is due to the physical dependence they cause with chronic use that can make getting off opioids such a miserable experience. Remember that physical dependence does not indicate addiction, it simply means that withdrawal symptoms will occur if the medications are stopped abruptly. Opioid withdrawal symptoms usually occur within 24-48 hours of the last dose and continue for 4-10 days. The symptoms can include:  Nausea, vom ..read more

By Ginevra Liptan, MD *Links may generate a commission for this site Inflammation (immune system activation) plays a big role in causing certain types of pain, especially arthritis and joint pain. This is why anti-inflammatory medications like ibuprofen and prednisone can help so much. However they also have significant side effects including gastric ulcers and GI bleeding, and there are some herbal alternatives with better safety profiles. Four plants that can lower pain by reducing inflammation are: Turmeric, Devil’s Claw, Boswellia, and White Willow. Clinically I have seen the most success ..read more

By Ginevra Liptan, MD *Links may generate a commission for this site Kratom Mitragyna speciosa Kratom Mitragyna speciosa Let me start talking about kratom by clarifying that I am not against it (my prior blogs and videos on this topic generated many strong feelings!).  Kratom definitely has medicinal properties and many people in chronic report it is helpful for pain. But a wise consumer needs to know all the potential risks along with potential benefits of any medicine or supplement.  My biggest concerns about kratom are that because it is so widely available over the cou ..read more

By Ginevra Liptan, MD *Links may generate a commission for this site Papaver somniferum Opium Poppy Papaver somniferum First and foremost on the list of herbs that relieve pain is the opium poppy which contains powerful medicinal alkaloids such as morphine and has been used since ancient times as an analgesic. Hippocrates recommended medicinal use of “poppy juice” in 400 BCE.  Almost all prescription opioids available today share a common lineage beginning with the opium poppy.  Opioids are only legally accessible in the US via a prescription, and have fallen into disfavor ..read more