Injuries With Fibromyalgia and Chronic Fatigue Syndrome

It almost seems unfair that those of us who have fibromyalgia (FMS) and chronic fatigue syndrome (CFS or ME/CFS) still get injured. It's like life is adding insult to injury ... or maybe injury to insult is more accurate.

One thing that's almost certain when one of us gets hurt, it's going to cause a flare. Our central sensitization makes us feel pain more intensely than other people, and we generally feel it for longer, as well. That means you're going to need more aggressive pain management that someone else with the same injury. If your exercise tolerance is low, you may not be able to handle the physical therapy recommended for recovery without suffering post-exertional malaise.

It's no surprise that how we recover from injury hasn't been a hot topic of research, which means we're pretty much left to figure this out on our own. Here are some things that have worked:

• Early treatment: Take steps right away—ice, anti-inflammatories, rest, pain meds, topical pain creams, whatever is appropriate to the situation. The worse the pain gets, the more likely it is to stir up your symptoms. Also, don't wait to go to the doctor.
• Be clear with your doctor: It's always easier if you have a knowledgeable doctor, but even if you don't, it helps to go in with a game plan. Tell the doctor that your injury is exacerbating certain symptoms and that you need an aggressive treatment regimen (i.e., extra refills on pain meds, massage or physical therapy, etc.) You pay the doctor to perform a service, and it doesn't hurt the doctor to give you a referral, but it could really hurt you not to get it! If you believe something will help, don't ask, tell the doctor what you want.
• Physical/massage therapy: If you get a referral for physical or massage therapy, ask for more visits than would be standard, so you can take things slowly and not make yourself worse. Make sure your therapist understands aspects of your illness including central sensitization and post-exertional malaise.
• Be cautious with drugs: We tend to be sensitive to meds, so if you start a new painkiller or anti-inflammatory, don't jump straight to the full dosage. Take small amounts at first and work up over a few days. If you have a lot of inflammation, try anti-inflammatory foods so you don't need as much of the drug.
• If you have myofascial pain syndrome: MPS is extremely common with FMS. Any time you have a soft tissue injury, you'll want to do whatever you can to keep new trigger points from forming. Massage with myofascial release, spray-and-stretch physical therapy or acupuncture may help. Talk to a knowledgeable therapist to see at what point in your recovery these treatments would be appropriate.
• Give yourself extra time to heal: When your life is structured around managing symptoms, this seems like a no-brainer. The problem is that we get into the habit of trying to do a lot on good days. With FMS or ME/CFS, that approach makes sense. An injury is different, though, and often requires a slow, gradual return to activity—not a "Hey, I feel better! Time to hit the ground running!" approach. If the doctor says your injury should be all better in 6 weeks, plan to be in recovery mode for 9-10.