In attendance: Donna, Doreen, Ruchi & Nancy (facilitator)
Topics: QiGong, Pain Management, Fibromyalgia, Service and Therapy Dogs
We went around the room doing the usual check in. Topics of conversation that followed were: QiGong, sleep deprivation, inflammation, acupuncture and doctors of rheumatology.
Below are the documents that elaborate on the above topics.
QiGong: (info taken from the Internet)
Go to: https://taichifoundation.org for a free video demonstration
You Tube demonstrations and background videos:
What are the benefits?
Qigong practice has profound effects on the health of body, mind, spirit and heart. It improves the Qi flow in the body and helps prevent illness, improve overall health and support recovery from illness and injury. Medical Qigong and Healing Qigong are used in many clinics, rehab centers, addiction clinics, and mental health clinics to support the healing process of patients. Scientific research from Eastern and Western scientists affirm the following effects:
· Increase vitality and enhance longevity
· Balance and strengthen the body
· Strengthen the immune system
· Support cancer treatment
· Improve cardiovascular, respiratory, and lymphatic functions
· Balance the hormonal systems
· Regulate the nervous system
· Strengthen the organs
· Improve bone density
· Improve insomnia and sleeping problems
· Improve headache, chronic pain, asthma
· Help with chronic fatigue, fibromyalgia, arthritis
· Regulate blood pressure
· Prevent injuries from falling
SERVICE AND THERAPY DOGS (article taken from the Internet)
Some of the most unsung heroes in our world are animals. Therapy animals provide their human friends with multiple benefits at all kinds of facilities — schools, nursing homes, hospitals, etc. After tragedies such as natural disasters and school shootings, a therapy animal is there to comfort children as well as adults who have been traumatized. They are not just regular household pets, and their relationships with patients are beneficial to both them and humans. The most common therapy pets are dogs and cats, but they are not the only medical professionals you can work with — there are therapy llamas, pigs, and even birds! In this article, we will focus on all the things you need to know about therapy dogs specifically.
The Difference Between Therapy Dogs and Service Dogs
Many people use the terms “therapy animal” and “service animal” interchangeably, but they are two completely different things. The official website for the Americans with Disabilities Act (ADA) states, “service animals are defined as dogs that are individually trained to do work or perform tasks for people with disabilities. Examples of such work or tasks include guiding people who are blind, alerting people who are deaf, pulling a wheelchair, alerting and protecting a person who is having a seizure, reminding a person with mental illness to take prescribed medications, calming a person with Post Traumatic Stress Disorder (PTSD) during an anxiety attack, or performing other duties. Service animals are working animals, not pets. The work or task a dog has been trained to provide must be directly related to the person’s disability. Dogs whose sole function is to provide comfort or emotional support do not qualify as service animals under the ADA.”
Unlike service animals, therapy animals are not supported under the ADA, meaning that they may not be allowed at certain public venues or in living situations in which the landlord has a no-animal policy. Therapy dogs are trained but not as rigorously or for the same tasks as service dogs. Their main responsibilities are to provide psychological and physiological therapy to people other than their handlers in times of stress. They have good temperaments and calm, easy-going personalities. Whereas service dogs are not supposed to interact with or be touched by anyone but their handler, patients are encouraged to interact with therapy dogs while they are on-duty.
The Duties of Therapy Dogs
Dogs make such effective therapy animals because of their sensitivities to human emotion. They have been proven time and time again to show sympathy and empathy by nuzzling or whining when they sense a human is sad or in general emotional distress. Therapy dogs often visit places with vulnerable populations of people such as nursing homes, hospitals, and college campuses to soothe stressed patients and students. Therapy dogs are even being brought into the corporate workplace, where they make employees feel less stressed and more productive. Their roles vary from actively participating in physical rehabilitation therapy to giving children with learning disabilities the confidence to read aloud and improve reading skills. Some work exclusively in one field, such as one particular campus or building.
Therapy dogs can come in all breeds, shapes, and sizes, and they all share a common purpose — to provide physically- and mentally disabled people with comfort and companionship. They play a key role in recovery and stress management because of their non-judgmental natures and willingness to interact with people no matter their physical or emotional states. However, not every dog is meant to be for therapy dog certification. Therapy dogs must enjoy meeting people of all ages and comfortable with being touched anywhere on their bodies, including their ears and tail. They must know basic obedience, such as walking on a leash, sitting, and staying, and cannot be bothered by sudden movements and hovering or loud sounds like crying and yelling. When a therapy dog is in the room, you can pet it, play with it, let it sit in your lap, simply look at it–whatever makes you feel comfortable and less stressed.
The Value of Therapy Dogs
Just the presence of a therapy dog will help take a person’s mind off of all their worries, physical or emotional pains, and anxieties. The simple act of petting a dog has been proven to provide a human with multiple mental and physical health benefits. When human pets and animals, hormones such as serotonin, prolactin, and oxytocin, which play a role in elevating moods, are released in the brain. Animal-assisted therapy also lowers anxiety to help patients relax, provides comfort, reduces loneliness, increases mental stimulation, and provides an escape or happy distraction. Physically, the presence of and interaction with therapy animals can help lower blood pressure, reduce the number of medications that people need, diminish overall physical discomfort or pain, motivate people to exercise, and help children with autism in the departments of language and social interaction.
It’s no wonder that you can walk onto a college campus during finals week and witness students playing with the university’s therapy dog to relieve stress or into a bustling hospital where a dog is roaming from room to room making sure the patients are comfortable. Their presence and unconditional love are therapeutic, calming, and mood-boosting. To learn more about the joy-spreading abilities of therapy dogs, join the Alliance of Therapy Dogs, or browse the website!
Chronic Pain: It's More Than Mechanical
Shifting healthcare explanations from cause-based to mindbody management by
Laura Baehr, PT (taken from her article on the internet)
How do we get to the point where our pain prevents us from feeling normal? How can we get back to feeling functional?
These are the questions that motivate individuals with chronic pain to seek healthcare providers’ expertise. Unfortunately, many people leave their appointments more confused than confident. As the field of chronic pain expands, outdated treatment practices expire. However, many healthcare providers continue to offer explanations for chronic pain which do not serve their patients and clients.
Mechanical dysfunction is by far the most commonly cited explanation for chronic pain used by healthcare providers. Perhaps you’ve heard that the wear and tear on your joints is the issue, or that your hips are out of alignment thereby causing tension. Historically, this is how the medical system quantified the pain experience. It was believed that the source of pain resides at the site of the symptoms. Therefore, if you “fix” the area that hurts, the pain will decrease. Here’s the truth – humans are not cars. We are more complicated than our individual parts, and sometimes replacing them does not make us feel as good as new. What’s worse is that these mechanical justifications for physical discomfort are both reductive and problematic for the person seeking support to manage their chronic pain.
For an example, let’s use arthritis. Arthritis is a natural aging process whereby the support structures in our joints thin and become less pliable. In fact, most people have some amount of arthritis starting in their twenties! So how can we begin to understand that two people of the same age can both have arthritis in their knees, yet one has debilitating pain and the other runs three times a week without symptoms? Perhaps we can begin to make sense of this difference by explaining how our body “normally” processes sensations. To do this, we must acknowledge an extremely important piece of the pain puzzle: the brain.
The Connection Between Mind, Brain and Body
The brain and body do not function separately. In fact, they are in constant communication. Your body senses the world, and that information is transmitted through our nervous system to and from the brain.
The "mind" comprises all of those experiences, thoughts and memories that are not made up of brain tissue, but are stored in the brain nevertheless. To use technology as an example, our brain is the hardware (the computer) and our mind is the software (the program we “run” on our brain). Human minds are complicated, each with our own beliefs, emotions, and behavioral responses that shape our personal experience of the world. In other words, we all run different versions of software.
For example, you may feel a light brush across your arm as you walk down the street, so you turn your head to see if you’ve bumped into something or if a leaf fell on your shoulder. In that brief moment, your body alerted your mind to a stimulus and your brain instructed your body to check out what it might be... and perhaps do something about it. In a person without chronic pain, it is perceived as non-threatening. If there was a leaf, you’d brush it off. If you bumped a stranger, you’d say “excuse me.”
But what if your brain was running chronic pain software? What if you had shoulder pain for a number of years and so had a whole filing cabinet of experiences reinforcing that sensation at your shoulder really hurt? This brush then might elicit discomfort, so you wince or grab your arm. In other words, some chronic pain can be described as the experience of otherwise non-threatening stimuli being perceived by your nervous system as dangerous.
So how do we increase body tolerance to these perceived threats?
Ultimately, it is not by telling people that their knees are crumbling from the inside. When healthcare providers use mechanical explanations for chronic pain, it only perpetuates misconceptions and worse, leaves the patient feeling helpless.
By healthcare providers using a mind-body approach to chronic pain education, the client is set up to feel supported in managing their pain experience. They receive concrete strategies that emphasize autonomy such as deep breathing, guided meditation, or graduated return to movement. Lifestyle changes such as improving sleep quality, increasing physical activity, and promoting good nutritional habits also go a long way towards balancing the nervous system.
If our mind shapes our response to pain, then we can alter our input to help reformat our reaction to discomfort. It is a steep slope to reach the ultimate goal of pain-free function. It is the healthcare provider’s responsibility to provide a walking stick on this journey rather than pummel the client with an avalanche of explanations that hinder their climb.
About Laura Baehr, PT
Laura Baehr is a physical therapist, scientist, and dance artist who melds her interdisciplinary training in order to inspire strength, confidence, and quality of life through movement. She earned her clinical doctorate in physical therapy from Temple University and her undergraduate training includes a dual degree in dance and neuroscience from Muhlenberg College. Laura is currently pursuing her PhD examining the biopsychosocial contributions to the development of chronic pain following neurological injury. She hopes to contribute to the field of rehabilitation sciences through her clinical and research background in order to shift healthcare and community perspectives on the importance of healthful movement in the management of pain and wellness. In addition to her scientific interests, Laura is a professional dance artist, movement teacher, and Pilates instructor in Philadelphia.
Please note: This article is made available for educational purposes only, not to provide medical advice. The views expressed in this article are those of the author, which do not necessarily represent those of Curable or other contributors to the Curable site.
Fibromyalgia is a long-term (chronic) condition. It causes:
pain in the muscles and bones (musculoskeletal pain)
areas of tenderness
sleep and cognitive disturbances
This condition can be hard to understand, even for healthcare professionals. Its symptoms mimic those of other conditions, and there aren’t any real tests to confirm the diagnosis. As a result, fibromyalgia is often misdiagnosed.
In the past, some healthcare professionals even questioned whether fibromyalgia was real. Today, it’s much better understood. Some of the stigma that used to surround it has eased.
Fibromyalgia can still be challenging to treat. But medications, therapy, and lifestyle changes can help you to manage your symptoms and to improve your quality of life.
Sex and gender exist on a spectrum. This article uses the terms “male” and “female” to refer to sex assigned at birth. Learn more about sex and gender.
Fibromyalgia causes what’s now referred to as “regions of pain.” Some of these regions overlap with what was previously referred to as areas of tenderness called “trigger points” or “tender points.” But some of these previously noted areas of tenderness have been excluded.
The pain in these regions feels like a consistent dull ache. Your healthcare professional will consider a diagnosis of fibromyalgia if you’ve experienced musculoskeletal pain in 4 out of the 5 regions of pain outlined in the 2016 revisions to the fibromyalgia diagnostic criteria.
This diagnostic protocol is referred to as “multisite pain.” It’s in contrast to the 1990 fibromyalgia diagnostic criteria definition for “chronic widespread pain.”
This process of diagnosis focuses on the areas of musculoskeletal pain and severity of pain as opposed to an emphasis on pain duration, which was previously the focal criteria for a fibromyalgia diagnosis.
Other symptoms of fibromyalgia include:
sleeping for long periods of time without feeling rested (nonrestorative sleep)
trouble focusing or paying attention
pain or a dull ache in the lower belly
bladder problems, like interstitial cystitis
In people with fibromyalgia, the brain and nerves may misinterpret or overreact to normal pain signals. This may be due to a chemical imbalance in the brain or abnormality in the dorsal root ganglionTrusted Source affecting central pain (brain) sensitization.
Fibromyalgia can also affect your emotions and energy level.
Learn which of its symptoms could have the biggest impact on your life.
Fibromyalgia fog – also known as “fibro fog” or “brain fog” – is a term some people use to describe the fuzzy feeling they get. Signs of fibro fog include:
trouble staying alert
According to a 2015 studyTrusted Source published in Rheumatology International, some people find mental fogginess from fibromyalgia more upsetting than pain.
Fibromyalgia symptoms in females
Fibromyalgia symptoms have generally been more severe in female people than in male people. Female people have more widespread pain, IBS symptoms, and morning fatigue than male people. Painful periods are also common.
But when the 2016 revisions to the diagnostic criteria are applied, more male people are being diagnosed with fibromyalgia, which may reduce the degree of distinction between the pain levels that males and females experience. More research needs to be done to further evaluate that distinction.
The transition to menopause could make fibromyalgia worse. Complicating things is the fact that some symptoms of menopause and fibromyalgia look almost identical.
Fibromyalgia in males
Male people also get fibromyalgia. Yet, they may remain undiagnosed because it’s seen as a predominantly female disease. But current statistics show that as the 2016 diagnostic protocol is more readily applied, more male people are being diagnosed.
Male people also have severe pain and emotional symptoms from fibromyalgia. The condition affects the quality of life, career, and relationships of men, according to a 2018 survey published in the American Journal of Public Health.
Part of the stigma and difficulty in getting diagnosed stems from society’s expectation that men who are in pain should “suck it up.” Male people who do venture in to see a doctor can face embarrassment, and the chance that their complaints won’t be taken seriously.
Fibromyalgia trigger points
In the past, people were diagnosed with fibromyalgia if they had widespread pain and tenderness in at least 11 out of 18 specific trigger points around their body. Healthcare professionals would check to see how many of these points were painful by pressing firmly on them.
Common trigger points included the:
back of the head
tops of the shoulders
For the most part, trigger points are no longer a part of the diagnostic process.
Instead, healthcare professionals may diagnose fibromyalgia if you’ve had pain in 4 out of the 5 areas of pain as defined by the 2016 revised diagnostic criteria, and you have no other diagnosable medical condition that could explain the pain.
Pain is the hallmark fibromyalgia symptom. You’ll feel it in various muscles and other soft tissues around your body.
The pain can range from a mild achiness to an intense and almost unbearable discomfort. Its severity could dictate how well you cope day to day.
Fibromyalgia appears to stem from an abnormal nervous system response. Your body overreacts to things that shouldn’t normally be painful. And you may feel the pain in more than one area of your body.
But available research still doesn’t pinpoint an exact cause for fibromyalgia. Research continues to evolve in better understanding this condition and its origin.
When fibromyalgia pain is in your chest, it can feel frighteningly similar to the pain of a heart attack.
Chest pain in fibromyalgia is actually centered in the cartilage that connects your ribs to your breastbone. The pain may radiate to your shoulders and arms.
Fibromyalgia chest pain may feel:
like a burning sensation
Similar to a heart attack, it can also make you struggle to catch your breath.
Your back is one of the most common places to feel pain. Most Americans have low back pain at some point in their lives. If your back hurts, it may not be clear whether fibromyalgia is to blame, or another condition like arthritis or a pulled muscle.
Other symptoms like brain fog and fatigue can help pinpoint fibromyalgia as the cause. It’s also possible to have a combination of fibromyalgia and arthritis.
The same medications you take to relieve your other fibromyalgia symptoms can also help with back pain. Stretching and strengthening exercises can help provide support to the muscles and other soft tissues of your back.
You can also feel fibromyalgia pain in the muscles and soft tissues of your legs. Leg pain can feel similar to the soreness of a pulled muscle or the stiffness of arthritis. It can be:
Sometimes fibromyalgia in the legs feels like numbness or tingling. You may have a “creepy, crawling” sensation. An uncontrollable urge to move your legs is a sign of restless legs syndrome (RLS), which can overlap with fibromyalgia.
Fatigue sometimes manifests in the legs. Your limbs can feel heavy, as if they’re held down by weights.
Healthcare professionals and researchers don’t know what causes fibromyalgia.
According to the latest research, the cause appears to be a multiple-hit theory that involves genetic disposition (hereditary characteristics) complemented by a trigger, or a set of triggers, like infection, trauma, and stress.
Let’s take a closer look at these potential factors and several more that may influence why people develop fibromyalgia.
A past illness could trigger fibromyalgia or make its symptoms worse. The flu, pneumonia, GI infections, like those caused by Salmonella and Shigella bacteria, and the Epstein-Barr virus all have possible links to fibromyalgia.
Fibromyalgia often runs in families. If you have a family member with this condition, you’re at higher risk for developing it.
Researchers think certain gene mutations may play a role. They’ve identified a few possible genes that affect the transmission of chemical pain signals between nerve cells.
People who go through a severe physical or emotional trauma may develop fibromyalgia. The condition has been linkedTrusted Source to post-traumatic stress disorder (PTSD).
Like trauma, stress can leave long-lasting effects on your body. Stress has been linked to hormonal changes that could contribute to fibromyalgia.
Healthcare professionals don’t fully understand what causes the chronic widespread nature of fibromyalgia pain. One theory is that the brain lowers the pain threshold. Sensations that weren’t painful before become very painful over time.
Another theory is that the nerves overreact to pain signals. They become more sensitive, to the point where they cause unnecessary or exaggerated pain.
Fibromyalgia and autoimmunity
In autoimmune diseases like rheumatoid arthritis (RA) or multiple sclerosis (MS), the body mistakenly targets its own tissues with proteins called autoantibodies. Just like it would normally attack viruses or bacteria, the immune system instead attacks the joints or other healthy tissues.
Fibromyalgia symptoms look very similar to those of autoimmune disorders. These symptom overlaps have led to the theory that fibromyalgia could be an autoimmune condition.
This claim has been hard to prove, in part because fibromyalgia doesn’t cause inflammation, and because reproducing autoantibodies haven’t been found to-date.
It’s possible to have an autoimmune disease and fibromyalgia simultaneously.
Fibromyalgia risk factors
Fibromyalgia flare-ups can be the result of:
an illness, like the flu
An imbalance in brain chemicals may cause the brain and nervous system to misinterpret or overreact to normal pain signals.
Other factors that increase your risk of developing fibromyalgia include:
Gender. Most fibromyalgia cases are currently diagnosed in women, although the reason for this gender disparity isn’t clear.
Age. You’re most likely to be diagnosed in middle age, and your risk increases as you get older. But children can develop fibromyalgia, too.
Family history. If you have close family members with fibromyalgia, you may be at greater risk for developing it.
Disease. Although fibromyalgia isn’t a form of arthritis, having lupus or RA may increase your risk of also having fibromyalgia.
Your healthcare professional may diagnose you with fibromyalgia if you’ve had widespread pain for 3 months or longer. “Widespread” means the pain is on both sides of your body, and you feel it above and below your waist.
After a thorough examination, your healthcare professional must conclude that no other condition is causing your pain.
No lab test or imaging scan can detect fibromyalgia. Your healthcare professional may use these tests to help rule out other possible causes of your chronic pain.
Fibromyalgia can be hard for healthcare professionals to distinguish from autoimmune diseases because the symptoms often overlap. Some research has pointed to a link between fibromyalgia and autoimmune diseases like Sjogren’s syndrome.
Currently, there isn’t a cure for fibromyalgia.
Instead, treatment focuses on reducing symptoms and improving quality of life with:
Medications can relieve pain and help you sleep better. Physical and occupational therapy improve your strength and reduce stress on your body. Exercise and stress-reduction techniques can help you feel better, both mentally and physically.
In addition, you may wish to seek out support and guidance. This may involve seeing a therapist or joining a support group.
Find support for fibromyalgia.
The goal of fibromyalgia treatment is to manage pain and improve quality of life. This is often accomplished through a two-pronged approach of self-care and medication.
Common medications for fibromyalgia include:
Over-the-counter pain relievers like ibuprofen (Advil) or acetaminophen (Tylenol) can help with mild pain.
Narcotics, like tramadol (Ultram), which is an opioid, were previously prescribed for pain relief. But research has shown they’re not effective. Also, the dosage for narcotics is typically increased rapidly, which can pose a health risk for those prescribed these drugs.
Most healthcare professionals recommend avoiding narcotics to treat fibromyalgia.
Antidepressants like duloxetine (Cymbalta) and milnacipran HCL (Savella) are sometimes used to treat pain and fatigue from fibromyalgia. These medications may also help improve sleep quality and work on rebalancing neurotransmitters.
Gabapentin (Neurontin) was designed to treat epilepsy, but it may also help reduce symptoms in people with fibromyalgia. Pregabalin (Lyrica), another anti-seizure drug, was the first drug FDA-approved for fibromyalgia. It blocks nerve cells from sending out pain signals.
A few drugs that aren’t FDA-approved to treat fibromyalgia, including antidepressants and sleep aids, can help with symptoms. Muscle relaxants, which were once used, are no longer recommended.
Researchers are also investigating a few experimental treatments that may help people with fibromyalgia in the future.
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Fibromyalgia natural remedies
If the medications your healthcare professional prescribes don’t entirely relieve your fibromyalgia symptoms, you can look for alternatives. Many natural treatments focus on lowering stress and reducing pain. You can use them alone or together with traditional medical treatments.
Natural remedies for fibromyalgia include:
yoga (use with caution if hypermobility is present)
a balanced, healthy diet
Therapy can potentially reduce the stress that triggers fibromyalgia symptoms and depression. Group therapy may be the most affordable option, and it’ll give you a chance to meet others who are going through the same issues.
Cognitive behavioral therapy (CBT) is another option that can help you manage stressful situations. Individual therapy is also available if you prefer one-on-one help.
It’s important to note that most alternative treatments for fibromyalgia haven’t been thoroughly studied or proven effective. Ask your healthcare professional about the benefits and risks before trying any of these treatments.
Fibromyalgia diet recommendations
Some people report that they feel better when they follow a specific diet plan or avoid certain foods. But research hasn’t proven that any one diet improves fibromyalgia symptoms.
If you’ve been diagnosed with fibromyalgia, try to eat a balanced diet overall. Nutrition is important in helping you to keep your body healthy, to prevent symptoms from getting worse, and to provide you with a constant energy supply.
Dietary strategies to keep in mind:
Eat fruits and vegetables, along with whole grains, low-fat dairy, and lean protein.
Drink plenty of water.
Eat more plants than meat.
Reduce the amount of sugar in your diet.
Exercise as often as you can.
Work toward achieving and maintaining your healthy weight.
You may find that certain foods make your symptoms worse, like gluten or MSG. If that’s the case, keep a food diaryTrusted Source where you track what you eat and how you feel after each meal.
Share this diary with your healthcare professional. They can help you identify any foods that aggravate your symptoms. Avoiding these foods can be beneficial in helping you manage your symptoms.
Fibromyalgia pain relief
Fibromyalgia pain can be uncomfortable and consistent enough to interfere with your daily routine. Don’t just settle for pain. Talk with your healthcare professional about ways to manage it.
One option is to take pain relievers like:
These medications can:
help with discomfort
lower pain levels
help you better manage your condition
These medications bring down inflammation. Though inflammation isn’t a primary part of fibromyalgia, it may be present as an overlap with RA or another condition. Pain relievers may help you sleep better.
Please note that non-steroidal anti-inflammatory drugs (NSAIDs) do have side effects. Caution is advised if NSAIDs are used for an extended period of time as is usually the case in managing a chronic pain condition.
Talk with your healthcare professional to create a safe treatment plan that works well in helping you manage your condition.
Antidepressants and anti-seizure drugs are two other medication classes your healthcare professional may prescribe to manage your pain. Practices like yoga, acupuncture, and physical therapy can also help relieve fibromyalgia pain.
Fibromyalgia fatigue can be just as challenging to manage as pain. Learn strategies to help you sleep better.
Living with fibromyalgia
Your quality of life can be affected when you live with pain, fatigue, and other symptoms on a daily basis. Complicating things are the misunderstandings many people have about fibromyalgia. Because your symptoms are hard to see, it’s easy for those around you to dismiss your pain as imaginary.
Know that your condition is real. Be persistent in your pursuit of a treatment that works for you. You may need to try more than one therapy, or use a few techniques in combination, before you start to feel better.
Lean on people who understand what you’re going through, like:
your healthcare professional
Be gentle on yourself. Try not to overdo it. Most importantly, have faith that you can learn to cope with and manage your condition.
Fibromyalgia facts and statistics
Fibromyalgia is a chronic condition that causes:
Currently, there’s no cure, and researchers don’t fully understand what causes it. Treatment focuses on medications and lifestyle changes to help ease the symptoms.
About 4 million AmericansTrusted Source ages 18 and over, or about 2 percent of the population, have been diagnosed with fibromyalgia. Most fibromyalgia cases are diagnosed in female people, but males and children can also be affected. Most people get diagnosed in middle age.
Fibromyalgia is a chronic (long-term) condition. But some people may experience remission-type periods in which their pain and fatigue improve.