• Brain White Matter Abnormalities in Women with IC/BPS

    woman in pain 267x400"Women with IC/BPS exhibited numerous white matter abnormalities that correlated with severity of pain, urinary symptoms, and impaired quality of life."1

    Particular brain anatomical and functional abnormalities could aid in identifying several chronic pain conditions in females.

    Using multi-center neuroimaging, researchers have associated interstitial cystitis (IC) and bladder pain syndrome (BPS)  in women with irregularities in brain white matter. The Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network neuroimaging study further showed these white matter abnormalities positively corresponded with increased pain, urinary symptoms and debilitated quality of life.

    Researchers studied 34 women with these conditions and 32 healthy women.  Each received questionnaires concerning daily function, mood and pain to evaluate these factors.  Diffusion tensor imaging (DTI) was used in assessing white matter microstructure in the brain, because it exemplified fractional anisotropy (FA), the directional water flow along axons. Areas of the brain that aligned with the parameters of the study were also studied for sex and syndrome dependence.

    Many white matter abnormalities were apparent in women suffering from IC/BPS, and these conditions were characterized by regional increases and decreases of directional water flow along axons. These increases and decreases in white matter integrity are correlated with the severity in IC/BPS symptoms, such as bladder pain, and suggest neuropathological contributions to chronic urological pelvic pain.


    1.  Farmer M, Huang L, Martucci K, Yang C, et al. Brain white matter abnormalities in female interstitial cystitis/bladder pain syndrome: a MAPP NEtwork neuroimaging study.  J Urol 2015; 194(1): 118-126.

  • FM Exercises

    Exercise and fibromyalgia – ugh!  For many people with fibromyalgia these are almost ‘fighting” words.  After all if, because of pain and fatigue, it is almost impossible to move from a chair or bed to get food or water, how in the world is a person supposed to exercise!  Such is the dilemma of people with fibromyalgia and other chronic pain conditions.  And yet, not moving ultimately causes more pain and fatigue and adds to a vicious cycle of deconditioning.  There is another word that is difficult to assimilate into a chronic pain patient’s vocabulary; especially if they were active all of their life before illness rendered them unmovable.
    Without moving a person’s muscles atrophy and then when they do try to walk to the mailbox, they hurt more the next day.  It is natural for a person to take warning signs being sent from their own body as clues to what they should or should not do.  For instance if they held their hand in an open flame, they would quickly remove it, because pain is the driving force of this protective response.  But in the case of fibromyalgia those warning signs are sometimes not the best choice of action.
    Closing down and not moving actually sets people up for a secondary pain problem: normal muscle atrophy that happens when a person is not active for as little as two weeks.  Those inactive muscles react the same as a healthy person’s who has not exercised for a period of time; when they finally do move they hurt from muscle micro-trauma caused from microscopic tears in the muscles.  The plus side for the healthy person is they will rebound quickly and after a few days of moving they will no longer hurt. 
    For people with fibromyalgia they get a double “whammy” when they don’t move; it is not all fibromyalgia pain, but a combination of normal exercise induced pain in conjunction with their fibromyalgia symptoms. But if the person with FM perseveres and continues to move, the muscles will become stronger and the normal exercise rebound pain will abate.  And as an added advantage they will become stronger and better able to support their bodies by conditioning their sick muscles, making them ultimately feel better with less overall pain.   
    The Oregon Health and Science University Fibromyalgia Research Center has worked for more than 25 years to develop better and more tolerable exercise programs for people with fibromyalgia. They are the forerunners of pushing for people with fibromyalgia to move. Through the years they have become the most successful research group in creating successful fibromyalgia exercise programs captured on DVDs.  The truly wonderful thing about their videos is that all of the people demonstrating the exercises are fibromyalgia patients. 
    Years ago when one of the exercise demonstrators first came to see Dr. Robert Bennett and his research group she was in a wheel chair; now she is part of the exercise video group.  The other wonderful thing about these videos is the professional fibromyalgia specific information shared by medical experts and researchers on each disk to help people live better with this illness. Through the years they have produced and updated four fibromyalgia exercise DVDs which educate fibromyalgia participants about how to correctly perform a variety of different movements including:
         •    Yoga and Pilates      •    Stretching and Relaxation      •    Strength and balance      •    Aerobic Exercise
    Find more information about each of these four DVD’s and incorporate them in to your fibromyalgia and chronic pain self-management strategies.  For more information about the Strength and Balance DVD offered on the Fibromyalgia Information Foundation web site, visit  http://www.myalgia.com/VIDEOS/Video_Introduction.htm 
    It is important to note that this DVD may be bought separately or as a package.

    Strength and Balance DVD

    1.   Test your balance and improving your posture.  Dr. Kim Jones instructs you in performing a series of balancing movements which test the major components of successful balancing (inner ear, eyes and muscles). She also demonstrates how to regain optimal postural alignment. Before beginning the exercises in this video, you'll want to be in good postural alignment, whether you are seated or standing. This will help prevent injury and unnecessary muscle fatigue.
    2.  Balance and Strength exercises.  Janice Hoffman, a certified clinical exercise specialist, takes 3 FM patients through a workout is divided into: 3 sections: (1) upper-body strength, (2) core (torso) strength and (3) lower-body strength and balance work. Gentle stretching for the specific muscles used during each workout section is included. Whether you are a beginner or are more advanced, this program will be useful for you. To progress, simply increase the amount of resistance, or decrease the firmness of your balance surface.
    3.   Balance strategies and adaptive aids.  Cinda Hugos, a physiotherapist, discusses various balance aids and the best footwear for good stability, along with strategies for navigating in crowded public locations.    
    4.  Education.  Dr. Robert Bennett presents a 20-minute session on the essential features of a comprehensive management program for FM patients, including the rationale for using various medications.