Fibromyalgia – The Ache That Won’t Go Away


Fibromyalgia is a condition that many patients describe as a chronic, dull ache that is persistent all day long. People who have been diagnosed with it have associated fatigue, trouble with sleep patterns, numbness and tingling, and diffuse muscle pain. The theory is that people with fibromyalgia have heightened sensation of pain. Where a normal touch is perceived as mild to moderately painful. These tender areas are not just in one area such as the neck or back but diffuse throughout the body. People, at times, have categorized it like feeling like the flu. This widespread pain can range from mild to debilitating.

There are many treatment options for people with fibromyalgia. First, medications are beneficial and allow people to help manage their pain. These medications are varied and include muscle relaxers, neuromodulators, antidepressants, Low dose Naltrexone and NSAIDS. Opioid medications are not seen as a treatment choice.

Other treatment alternatives to help with this chronic pain include yoga, acupuncture, massage therapy, trigger point injections, and physical therapy. Many people try to avoid these therapies as these require them to use the muscles they perceive as painful. However, numerous studies show that exercise is the most important intervention to help with fibromyalgia.

Exercise helps patients gain strength, improve motion and foster better feeling of long-term health. People should start slow with stretching exercises and gradually increase to walking, water aerobics and even biking. Doing this a few minutes each day can turn into 30 minutes several times per week with the right plan. This will help with spasm, flexibility and endurance. Being active may initially increase the pain level these people experience but in the long term it will be beneficial and reduce pain levels.

The old saying of “no pain, no gain” is true for people with fibromyalgia but the rewards of putting in the work will lead to a better sense of well-being and improved pain scores. Making time for exercise throughout each week is essential for fibromyalgia treatment.

Depression and Pain

It is estimated that up to 85% of chronic pain patients suffer from severe depression.  Sometimes pain is a symptom of pre-existing depression, and sometimes the depression comes as a result of the effects of chronic pain.  With potentially one fifth of the US population suffering from chronic pain, understanding the association between depression and pain, and the subsequent treatment of the two, is becoming more and more important.  

The areas of the brain in charge of mood management include the prefrontal cortex, the amygdala, and the hippocampus.  Evaluation of the brain post-injury shows that body pain is controlled by most of the same regions of the brain. The chemicals in the brain associated with depression, such as serotonin and norepinephrine, play a major role in pain perception.  When the regulation of these chemicals fail, which can be the case with depression, pain perception is intensified. Additionally, autopsies performed on patients who had chronic depression showed a consistently smaller prefrontal cortex. This could potentially mean that depression can cause a physical change in the brain, therefore leading to a chronic, and possibly permanent change in the brain structure.  

Another correlation between chronic depression and pain is due to the similar impacts both can have on someone’s quality of life.  Depression can cause a lack of interest in hobbies, activities, socialization, and can therefore lead to isolation. Without the ability or desire to partake in everyday activities, more focus is paid to pain, which increases the perception of pain.  Pain can cause immobility, loss of ability to work or function, also leading to isolation, and therefore depression. Therefore, regardless of which came first, the onset of chronic pain or depression can either cause or increase the severity of the other.  

Being aware of the correlation between these two debilitating diagnoses can help lead to more effective treatment.  Physical therapy can help increase a patient’s strength and mobility, which is widely known to help with pain, however movement itself produces endorphins, the chemicals which help with happiness and reward, and therefore can decrease depression symptoms as well.  Psychotherapy is widely known to help with depression, however this can also help to alter a patient’s perception and focus on pain, and can either decrease the pain symptoms, or help a patient better cope with chronic pain symptoms. Many antidepressant medications are also used with chronic pain management, regardless of whether or not a patient has been diagnosed with depression as well.  

Overall, chronic pain can be extremely debilitating on its own, but unfortunately it commonly occurs with depression.  Treating one without acknowledging the other can lead to insufficient treatment of both, so understanding their correlation in onset, as well as treatment, can help patients improve their quality of life, both mentally and physically.  


Depression and pain. (2009, June). Retrieved January 14, 2020, from

Sansone, R. A., & Sansone, L. A. (2008, December). Pain, pain, go away: antidepressants and pain management. Retrieved January 14, 2020, from

Sheng, J., Liu, S., Wang, Y., Cui, R., & Zhang, X. (2017). The Link between Depression and Chronic Pain: Neural Mechanisms in the Brain. Retrieved January 14, 2020, from

MILD Procedure for Major Pain

It is estimated that around 80% of Americans will experience back pain in their lives.  There are many different causes of back pain, many different associated symptoms, and just as many treatments available.  One of the more feared treatments have been back surgery, since, until recently, it is most of the time severely invasive, and comes with an extended recovery time.  However, for certain types of back pain, a newer, less invasive procedure has been developed, aptly named Minimally Invasive Lumbar Decompression, or MILD. If lumbar spinal stenosis, or LSS, is the culprit, then MILD may be the treatment.

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In order to understand what the MILD procedure it, it is important to know what LSS is.  Lumbar spinal stenosis means a narrowing or pinching (stenosis) around the lower (lumbar) part of the spinal cord.  The spinal cord rests in the spinal canal, which is a tunnel in back part of the vertebrae. This tunnel is comprised of vertebral bones stacked on top of each other, with a disc in between them, and ligaments that run up and down keeping these bone/disc stacks both sturdy and mobile.  Years of wear and tear on the back can cause the discs to bulge, the bony joints to swell, or the ligaments to enlarge. Normally, the spinal cord has plenty of room in its spinal canal home, but if any of those wear and tear side effects occur, this can bulge, swell, or enlarge into the canal, and cause compression of the spinal cord.  This compression is responsible for back pain, and pain, numbness, tingling sensations that go down the legs. The pain is typically worsened with standing or walking, and relieved with leaning forward or sitting.

If the cause of the spinal stenosis and the pain symptoms is enlarged ligaments, that’s where the MILD procedure can help. This procedure involves a special, spoon-like tool that scrapes off the extra ligament that is pushing on to the spinal cord, and suctioning it out.  The incision is about 5mm long, about the width of a baby aspirin, so no stitches or staples are required. The procedure is done with local anesthesia and IV sedation, not full anesthesia, which makes recovery time quicker. After the procedure, patients are able to walk out of the hospital, no bed-bound recovery.  Risks of the procedure include infection and increased bleeding, but the complication rate is very rare, and the procedure has been demonstrated to be as safe as epidural steroid injections.

There are many therapies for back pain that help relieve the symptoms, and improve functionality, but are not correcting the problem itself.  There are many surgeries to correct the problem, but they can involve high risk, and lengthy recovery times. The MILD procedure is a way to correct the issue causing the pain, without the difficulties associated with an invasive spinal surgery.  


Deer TR, Mekahil N, Lopez G, Amirdelfan Kasra. (2010), Minimally Invasive Lumbar Decompression for Spinal Stenosis. The Evolving Treatment of Pain, 1(S1): 29-32

Mekhail, Nagy, et al. (2012), Functional and Patient-Reported Outcomes in Symptomatic Lumbar Spinal Stenosis Following Percutaneous Decompression. Pain Practice, 12(6): 417–425. doi: 10.1111/j.1533-2500.2012.00565.x

Staats PS, Chafin TB, Golovac S, Kim CK, Li S, Richardson WB, Vallejo R, Wahezi SE, Washabaugh EP, Benyamin RM, MiDAS ENCORE Investigators. Long-term safety and efficacy of minimally invasive lumbar decompression procedure for the treatment of lumbar spinal stenosis with neurogenic claudication: 2-year results of MiDAS ENCORE. Reg Anesth Pain Med. 2018;43:789-794.

Got Pain? Why You Should Try Acupuncture

  • Knee Pain

For many of us, who suffer from injuries or pain, we eventually seek medical help.  According to recent surveys, 80% of Americans will suffer from some pain at some point.  Many of these folks, suffer from chronic pain- defined as pain that has persisted for more than 3 months. Current options to manage pain include a myriad of options from physical therapy, dry needling, anti inflammatory medicines and as a last resort opioids. Given the recent opioid crisis, there has been a substantial push to reconsider options to manage pain.

Acupuncture has been around for thousands of years, some research even theorizing as early as 3300 BCE.  It began in China, using finely sharpened tools, and has since developed into a widely used medical practice.  It’s effectiveness has been appreciated for millenia, however, we have only recently began to understand how it actually works. It is estimated that about 2 billion people a year will get acupuncture treatments annually and it is used for a myriad of different conditions.  There have been multiple research studies, using MRIs, blood tests, and other methods, which have shown some of the amazing results acupuncture can have on a multitude of ailments.

A few studies have had patients receive acupuncture therapy, while a brain MRI was performed.  This testing showed consistent activation of different parts of the brain, which control different functions in the body, including pain perception, and mood.  For instance, studies comparing acupuncture and simple touching of the same areas (tactile stimulation), while an MRI was observing brain function, have shown that the amygdala and the hippocampus are deactivated during acupuncture, but not nearly as much during the tactile stimulation.  These two areas of the brain are activated during stress, hunger, pain, and other negative emotions. De-activating these areas will decrease the body’s perception of these negative emotions, therefore helping to manage depression, over-eating, and chronic pain.

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Acupuncture can have chemical impacts as well.  These impacts are due to the effects on neurotransmitters and endorphins, which help with mood and pain.  Acupuncture has been shown to increase the levels neurotransmitters, such as dopamine and seratonin, while decreasing noradrenaline.  Dopamine and seratonin play major roles in feelings of well-being and happiness. Noradrenaline is released during periods of stress, so decreasing the release of this neurotransmitter, can decrease the perception of stress.  Additionally, acupuncture has been shown to increase endogenous opioid peptides, or endorphins, which are the body’s natural pain relievers. These studies answer some of the questions as to how acupuncture can help with depression, anxiety, and pain.  

The Eastern medicine theory on the way acupuncture works, is due to qi (pronounced “chee”), or the body’s energy.  Qi flows through certain pathways, called meridians, and when these meridians are disrupted, the body reacts with pain.  There are twelve different meridians,
each corresponding to a different body system. The acupuncturist would follow the meridian map, according to the patient’s medical concern, and place needles in specific areas along the targeted pathway.  Doing so restores the body’s qi, and helps it flow smoothly through the meridians.

Joanna Wroblewska, MD has a quite unique perspective to this.  She is board certified in anesthesiology and pain management. On a typical day, she will treat patients with headaches, migraines, neck pain, back pain and even musculoskeletal pains such as joint pains.  With over a decade of experience, she has developed an exceptional perspective on how pain affects patients, not just physically, but emotionally, psychologically and socially.

Joanna has studied acupuncture and she integrates components of acupuncture into her daily medical practice. She acknowledges that acupuncture is not for everything or everyone, but it has a role.  When performed well, it has lasting results and can certainly supplement current
westernized approaches. She integrates acupuncture with current western treatments to treat various conditions and her patients are benefiting from this approach.

Acupuncture has various mechanisms of how it works.  The most postulated theory is that it helps stimulate your body’s own neural and hormonal systems to help create a balance within your body’s environment. Acupuncture is no longer an exotic treatment, but rather a very well accepted form of medical treatment.

Speak with our providers- Margaret Truesdell- PA-C and Joanna Wroblewska, MD to understand how acupuncture can have a lasting impression to benefit your health.  We welcome you to experience this unique combination of western medicine and acupuncture!


Han, J S. “Acupuncture and Endorphins.” Current Neurology and Neuroscience Reports., U.S. National Library of Medicine, 6 May 2004,

Huang, Wenjin, et al. “Characterizing Acupuncture Stimuli Using Brain Imaging …” National Institute of Health, National Center for Biotechnology Information, 9 Apr. 2012,

Hui, Kathleen, et al. “Acupuncture, the Limbic System, and the Anticorrelated …” National Institute of Health, National Center for Biotechnology Information, 27 Aug. 2013,

Wen, Guoqiang, et al. “Effect of Acupuncture on Neurotransmitters/Modulators.” Journal of Trauma and Acute Care Surgery, Lippincott Williams and Wilkins, 5 Apr. 2016,

Wen, Guoqiang, et al. “Effect of Acupuncture on Neurotransmitters/Modulators.” Journal of Trauma and Acute Care Surgery, Lippincott Williams and Wilkins, 5 Apr. 2016,

Wen, Guoqiang, et al. “Effect of Acupuncture on Neurotransmitters/Modulators.” Journal of Trauma and Acute Care Surgery, Lippincott Williams and Wilkins, 5 Apr. 2016,

White, A. “A Brief History of Acupuncture.” Rheumatology, vol. 43, no. 5, 2004, pp. 662–663.,

Thoracic Pain

While chest pain should always be evaluated to eliminate issues involving the heart, many patients exhibiting chest pain find that their pain is due to muscles and nerves in the upper and middle back. The thoracic vertebrae are the narrowest part of the spinal canal, making them the most susceptible to issues of injury. Carolinas Pain Center can evaluate your thoracic pain and begin a course of treatment to help you manage this difficult condition.

Shoulder, Arm, and Hand Pain

Pain in the shoulders and arms can be exhausting in addition to being painful. The act of reaching, typing, or carrying even the smallest object can be excruciating. Pain in the hands is just as debilitating and can affect even the most menial of tasks, like holding a glass, picking up a pen, or manipulating your computer’s mouse. The causes of these types of pain are varied and may include rotator cuff or inflammatory conditions, muscle spasms, or arthritis. Carolinas Pain Center can evaluate your shoulder, arm, or hand pain and get you started on a course of treatment to eliminate this pain from your life.

Pelvic Pain

Pain in the lower abdomen and groin areas can be incapacitating. While this pain can often have a surgical solution, it is not uncommon for the pain to persist even after surgery. It can affect such simple tasks as walking or sitting, making exercise or recreation almost impossible. In some cases, even sexual activity may become affected. The goal of treatment for this kind of pain at Carolinas Pain Center is to determine the cause, whether due to injury, infection, inflammation or nerve trauma, and then to apply a specialized, multidisciplinary approach to pain management that will have you leading a normal life as quickly as possible.

Pain in Children and Adolescents

Pediatric pain management must involve highly specialized and sensitive care for these unique patients. Pain in children is often difficult to assess due to the limited ability of the patient to verbally communicate what he or she is feeling. While an adult may ask for pain relief medication or therapy, a child often does not understand this option and does not ask for help. While an adult may tolerate an aggressive treatment plan, children often do not respond well to this. Adults are often able to continue to function in their daily routines of work and household management, even in social settings, but children are not able to function at this level. Missing school, and not feeling well enough to be with friends can often result in an unhealthy detachment. Their physical pain can lead to anxiety, depression, and even a withdrawal from the family members seeking their well-being. This makes treating pediatric pain even more challenging.

Neck Pain

Neck pain is a difficult condition to bear, both physically and mentally. Carolinas Pain Center understands the devastating impact it has on patients. Our state-of-the-art treatments and multidisciplinary approaches to each individual case will help you manage your neck pain and return you to a normal life as quickly as possible.

Lower Extremity Pain

Pain in legs, hips, knees, ankles, and feet can be life-disrupting. Simple daily tasks become excruciating, and exercise or recreation must take a seat for awhile. Pain in the lower extremities can have causes ranging from wear-and-tear due to normal motion and function, to trauma or infection. This pain is manageable, and the Carolinas Pain Center can help you get it under control.