Researchers from the University of Edinburgh (Scotland) reported that their study found that taking even a little too much acetaminophen over time is more dangerous, in fact, than taking a single much-too-large dose.

Dr. Kenneth Simpson of the University of Edinburgh, the study’s lead author, stated in a press release accompanying the study’s publication:

They haven’t taken the sort of single-moment, one-off massive overdoses taken by people who try to commit suicide, but over time the damage builds up, and the effect can be fatal . . . Staggered overdoses or patients presenting late after an overdose need to be closely monitored and considered for the (acetaminophen) antidote, N-acetylcysteine, irrespective of the concentration of (acetaminophen) in their blood.

(In the UK and other countries, acetaminophen is known as “paracetamol.”)

Additionally, patients who take some opioid pain medications along with acetaminophen should exercise even greater caution with their Tylenol doses, as many commonly-prescribed opioid medications contain acetaminophen as well, making the risk of an unwitting overdose even greater.

The FDA states that the maximum safe daily dose of acetaminophen is 4000 mg, and has taken steps to have manufacturers lower the per-unit dosage to 325 mg in an attempt to reduce the risk of accidental overdose.

Triggered by greater-than-average activity, post-exertional flare-ups may arise more frequently during the hectic lead-up to the holidays. Shopping, family meal preparations, home decoration projects, and a more active social schedule can all take a toll.

It’s a good idea to spend some time thinking about ways you can prepare for the eventuality of a flare-up and to minimize the chances you’ll have one ahead of time.

Some suggestions:

• Delegate whatever you can. Spouses and children can share the burden of décor and cleaning chores; children especially will enjoy putting up the decorations and this will help you avoid painful reaching and stretching.
• Consider outsourcing and simplifying meals wherever possible. One-pot recipes, casseroles, and the occasional delivered pizza can reduce the physical stress that comes with cooking.
• Make family meal gatherings a “pot-luck.” Everyone brings a dish, and that means you only provide the space and the necessary accessories (plates, flatware, glasses, drinks, ice, etc.). Cooking complicated menus can wreak havoc on painful muscles.
• Lower your expectations. The house doesn’t have to be spotless all over; the meal doesn’t have to be perfect; your neighbors will appreciate store-bought goodies just as much as the ones you slaved for hours to bake yourself.
• Seek out an active fibromyalgia support community, either online or in your hometown. Just knowing that others are having similar experiences can reduce emotional stress greatly, which can thus increase your ability to cope with the symptoms.

Finally, remember the real meaning of the holidays and consider cutting back on the whole endeavor this year. Celebrating the holidays doesn’t necessarily mean you have to go “all out.” Maybe this is a good year to take a breather and just enjoy your family and loved ones.

However, if you mention cognitive behavioral therapy to fibromyalgia advocates and you’re sure to get a passionate response.

Cognitive behavioral therapy or CBT is a term that covers a wide variety of psychological treatment approaches in which focus is placed on the role of the patient’s thoughts in controlling and impacting behavior and choices.

Some advocates and patients assert that focusing on CBT merely perpetuates unproven myths that the patient’s pain is “all in the head” – i.e., purely a mental issue. Others assert that CBT has been proven to lessen symptoms of fibromyalgia and should be a central part of treatment.

A recent multi-site clinical trial, the results of which are being reported in Arthritis & Rheumatism, seems to back up the latter group. This study found that CBT lessened depression in teenagers with fibromyalgia and helped them cope with the disease’s symptoms more effectively.

The study looked at 114 teenagers who had been diagnosed with juvenile fibromyalgia. The subjects were divided into groups which received either CBT or fibromyalgia education. Those in the CBT group experienced a reported 37% improvement in disability and depression compared to 12% of the education-only group.

While CBT and other forms of therapy might be useful in fibromyalgia treatment, and patients should consider any treatment that might be effective in managing the debilitating pain associated with fibromyalgia, care should be taken not to infer a reverse correlation. The mere fact that psychiatric treatment models may help a patient develop better coping skills does not mean that the disease is a psychiatric disorder.

On the other hand, if you are applying for Social Security disability, your goal is to win.  If the judge wants to consider your fibromyalgia as a mental condition there is no practical reason to object if if he finds in your favor.

Many of these fibromyalgia patients go from doctor to doctor looking for a cure, but, of course, there not only is no cure, but there is no consensus in the medical community as to how to objectively test for this condition.

Medical researchers have been working on this problem and over the past few years there have been a number of studies published that purport to identify unambiguous markers that will enable practitioners to objectively diagnose FM/CFS.

One of the more intriguing medical studies in recent years involved the Whittermore-Peterson Institute and researcher Judy Mikovits.

The fibromyalgia and Chronic Fatigue Syndrome (CFS – also sometimes referred to as “CFS/ME,” where “ME” stands for myalgic encephalomyelitis) community has been roiled by a controversy over the news, reported first in 2009, that a mouse retrovirus might be involved in CFS.  Now, the research group which first asserted the connection between xenotropic murine leukemia virus-related virus (XMRV) and CFS is at the center of another controversy – this one of a decidedly non-medical nature.

The Whittemore Peterson Institute in Nevada was “ground zero” for the XMRV/CFS news, and the name most frequently associated with the potential link is Judy Mikovits, one of the Institute’s lead researchers. In late September 2011, the Institute fired Mikovits, and a little over a month later, the Institute made headlines again by filing suit against her.

The suit, filed in a Nevada state court, focuses mainly on notebooks and other documents the Institute claims Mikovits removed unlawfully following her termination. Mikovits, through her attorney, rebutted the charges and said she wasn’t even in the Institute’s facility on the grounds of the University of Nevada when she received notice of her termination, and never returned to the facility after that point. Thus, Mikovits’ attorney asserted, she could not be responsible for the allegedly missing notebooks and research materials.

The Institute also secured a restraining order against Mikovits barring her from destroying or altering any of the missing files.

However, the lawsuit was just the beginning of the controversy.  A few weeks later came word that Mikovits was taken into custody on a fugitive warrant related to the civil lawsuit.

Mikovits and the Institute first announced they had found evidence of XMRV in the blood of over 60% of a sample of CFS patients back in 2009.   Subsequent studies, however, failed to demonstrate anything resembling that strong of a correlation or link, and one study’s results caused its authors to posit XMRV could not be transmitted to humans at all.

The study, conducted by researchers from the Oregon Health & Science University in Portland, looked at 53 women diagnosed with fibromyalgia. Twenty-five of these women participated in a “Yoga of Awareness” program once a week (including gentle stretching, mindfulness meditation, breathing techniques, and applying yoga principles to optimal coping); the remaining 28 participants did not take part in the yoga instruction program.

Participants in the study followed a specific routine that introduced them to yoga poses and practice in general, and specific yoga-based pain coping techniques. Classes consisted of a set series of sections or phases, including 40 minutes of gentle “stretch” poses (or asanas, as they’re called in yoga), followed by a 25-minute meditation and a 10-minute session where participants practiced pranayama, or yogic breathing techniques. The yoga classes were followed by lectures and presentations on how to use yoga principles to copy with physical pain and a group discussion geared around how participants could incorporate a home-based yoga practice in their lives.

Three months after the program began, the women who had been assigned to the yoga protocol reported reduced pain and fatigue. They also demonstrated more effective strategies for coping with the pain that they experienced, with less “catastrophizing, self-isolation, and disengagement.”

One of the best resources on the web for yoga is Yoga Journal’s website. You can learn more about this ancient mind-body practice and get instructions on simple asana sequences you can do at home. Another excellent resource is Kelly McGonigal’s Yoga for Pain Relief (available from Amazon).

But even if the fibromyalgia sufferer is willing to file the application and go through that potentially lengthy process, it’s far from a certainty that the application process will result in approval. For this reason, many applicants entertain serious doubts about the process, including the fear that they’ll somehow be asked to prove that their pain is real.

And in some ways, they are right to be concerned. A successful disability claim — for any illness — does depend significantly on adequate medical documentation and proof of both the diagnosis and the disease’s impact on the applicant’s ability to work. For that reason, getting professional functional capacity evaluations tests and opinions is a crucial step in the disability application process.

Focusing on the actual limitations that fibromyalgia imposes on the  applicant means that the application process revolves around the true purpose of Social Security Disability: finding out whether the patient/applicant is capable of working, and to what extent. Coupled with sufficient medical evidence of the several facts we do know about fibromyalgia — that it appears to be a neural disorder, for instance, and that it is characterized by cortical or sub-cortical augmentation of pain processes — a thorough FCE can help support the disability applicant with objective, demonstrable proof of physical limitations.

The question becomes even more confusing when reports suggest a greater occurrence of one disease in patients diagnosed with another illness. Take, for example, the studies suggesting that post-traumatic stress disorder (or PTSD) is more prevalent in fibromyalgia patients. The study linked to in the previous sentence was conducted by Drs. H. Cohen, L. Neumann, and others at the Ben-Gurion University of the Negev, in Israel.

The findings of this study indicate that a statistically significant portion of the fibromyalgia population studied also had PTSD. From the study’s abstract:

57% of the FM sample had clinically significant levels of PTSD symptoms. The FM patients with PTSD reported significantly greater levels of avoidance, hyperarousal, reexperiencing, anxiety, and depression than did the patients without clinically significant levels of PTSD symptoms. The prevalence of PTSD among the FM patients in this study was significantly higher than in the general population. Women with FM and PTSD reported a greater number of past traumatic events than did their male counterparts.

CONCLUSIONS: The results represent the first comprehensive study applying structured clinical assessment of trauma exposure and PTSD to a group of FM patients. This study shows a significant overlap between FM and PTSD, according to the currently accepted diagnostic criteria for each.

But does that mean that fibromyalgia is “caused by” or somehow “triggered by” PTSD? The study found nothing of the sort, of course, but these findings have been cited in news articles that can present misleading suggestions of some causative connection that hasn’t been proven yet. Another study from the same institution looked at whether PTSD and fibromyalgia were really the same illness. While they do share some symptoms in common, it is generally thought that fibromyalgia results from actual neurological changes as opposed to some psychological trauma. It could be that in many cases, an initiating physical trauma causes both PTSD and fibromyalgia.

Yet a lazy researcher could well take that association as grounds for concluding that fibromyalgia is “all in your head” — which is clearly not the case. And given that fibromyalgia is too often relegated to some behavioral issue, as opposed to a systemic or neurological malfunction, that’s unfortunate.

It’s important for fibromyalgia patients to educate and inform themselves, but it’s also important to keep an objective view of studies that are reported in the press.

Some doctors incorrectly see fibromyalgia as a “garbage can” diagnosis, meaning that any pain symptoms that cannot otherwise be explained end up with the fibro label.  The problem with this approach is that Social Security judges are increasingly familiar with the American College of Rheumatology’s diagnostic classifications for the disease and judges will discount or ignore a physician diagnosis that does not refer to the American College diagnostic criteria.

Some doctors – thankfully fewer and fewer – do not accept that fibromyalgia exists at all.  Often the medical records from these doctors will contain suggestions that the patient has psychiatric problems, or worse, that the patient is a malingerer or drug seeker.The Hardison law post quotes from a National Fibromyalgia Association publication that offers the following questions that a fibro patient should ask his doctor:

• Are you comfortable with diagnosing and treating fibromyalgia?
• How many fibromyalgia patients have you treated?
• Are you familiar with my other conditions?
• What medications do you usually prescribe for fibromyalgia? Do you have a problem with the medications I am currently taking?
• What do you feel is adequate pain control?
• Can you treat depression or must I see a specialist?
• Are you familiar with alternatives therapies? What therapies do you recommend?
• How can you and I communicate best?

In this era of soaring medical costs and lower reimbursements, patients must serve as their own advocates.  Changes in health care law will discourage treatment of conditions that cannot be objectively observed on x-rays or MRI scans.   Fibromyalgia patients will therefore need to assert the legitimacy of their condition and their rights to treatment.

Successful claimants need treating doctors who fully support the claim.  The “classic” fibromyalgia treatment record is usually voluminous as the suffering patient goes from one doctor to another seeking relief.  The symptoms that the patient suffers also change over time.  A good record will contain discussions from either a primary care doctor or a pain doctor that explains how the claimant is seeking relief and that her symptoms are changing and resistant to treatment.

Less compelling cases, by contrast, usually contain a medical record that is conspicuous for what it does not say.  The treating doctor may talk about the claimant’s complaints and how those complaints do not seem consistent with any particular diagnosis.  Hints of drug seeking behavior may appear in the record.   The treating doctor will report the symptoms but make it clear that these symptoms are self reported, with nothing said about whether the doctor believes his patient.

Judges reading these records will “read between the lines” and will recognize that the doctor has come to the conclusion that his patient has multiple complaints but that no medical treatment of any type is going to help.  Judges often translate this resignation on the part of both the doctor and the patient as the dreaded “attitude of entitlement.”

I recently posted a case study on my Georgia Social Security disability web site describing a hearing in a fibro case I tried that the judge will likely deny.  My client is a pleasant person and she undoubtedly experiences fatigue and discomfort but the record in her case will not support a claim for disability.  Compare this case study to the case studies on this web site that describe winning cases.

According to the FDA, Xyrem, or sodium oxybate, “is much better than the stuff you get on the street, and that is the problem.  Approving it for such a large patient population — 5 million people are estimated to suffer from fibromyalgia — would risk flooding the streets with a pharmaceutical-grade version of the highly controlled substance.

Xyrem is currently available for the treatment of narcolepsy.  It is a central nervous system depressant.