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Recent findings have dispelled the belief that fibromyalgia is a
psychosomatic disorder. It has a rather short history as a physical
disorder, only achieving that status a mere 15 years ago.
Fibromyalgia is often foreshadowed by a physical and/or a psychologic
trauma. For many years, much to the distress of its sufferers, fibromyalgia's
etiology lay hidden in a mire of unanswered questions. Some researchers
believe that disturbances in the "autonomic and endocrine stress
response systems may underlie the etiology" of this agonizing
condition (Millea, et al, 2001).
According to Millea and colleagues (2001), "fibromyalgia is
a rheumatologic condition characterized by spontaneous, wide spread
soft tissue pain, sleep disturbance, fatigue and extensively distributed
areas of tenderness." Researchers are beginning to appreciate
and analyze the complex relationship between the biochemical, physiological
and psychological components of the disorder (Flemming, et al, 1997).
Flemming and colleagues suggest that fibromyalgia is sympathetically
maintained pain, which develops from an injury or illness. The illness
or injury becomes "linked with the fight or flight mechanism,
which is known as the sympathetic nervous system." It is not
known how this relationship is established, however, once established
the pain may become chronic. Normally, when an injury heals-- pain,
our biological alarm system, no longer serves a beneficial purpose.
Consequently, the resultant pain subsides. This normal progression
to wellness does not happen in fibromyalgia. It is possible that
chronic pain also has a benevolent objective. However, since we
are currently ill equipped to decipher its message, chronic pain
is considered a medical pain in the neck by physicians and suffers
alike.
Co-morbid conditions
Fibromyalgia
is often accompanied by "fatigue, headaches, irritable bowel
syndrome, and insomnia" (Worrel, 2001). In addition, the more
debilitating examples of fibromyalgia are frequently found in individuals
with a history of depression.
According to Worrel, "Elevation of cerebrospinal fluid substance
P levels (a neurotransmitter associated with enhanced pain perception)
is found in a significant number of fibromyalgia cases." Other
disorders, such as hypothyroidism and myofascial pain syndrome,
can mimic fibromyalgia. Fortunately, hypothyroidism can be ruled
out by a simple test.
Chronic Pain
Management
Many management
techniques are used to treat fibromyalgia. Treatments are often
combined in a comprehensive treatment package to obtain the most
relief for an individual patient. Some types of pain can be treated
by "purely psychological means such as relaxation training
or imagery exercise" (Fleming, et al, 1997). Guided imagery
is used to help the patient relax, which facilitates healing. This
technique is used in hundreds of hospitals around the country to
treat various medical conditions. It is also commonly employed in
psychotherapy settings, pain clinics and it is available on self-help
tapes and CDs.
Anxiety and stress have a negative impact on fibromyalgia patients.
Millea (2001) suggests that pain flare-ups can increase the patient's
stress load; conversely, environmental stress can initiate a pain
flare-up. Relaxation guided imagery is a powerful tool when employed
to soothe patients and minimize their response to stress.
Health care providers need to hear their patients' stories about
the challenges of living each day with a chronic pain disorder.
Feeling heard and understood by their physician or therapist is
an essential condition of an effective treatment. A chronic disorder
necessitates a partnership in which the medical professional works
with the patient to choose the most beneficial treatments. According
to research this may include some non-pharmacological treatments
such as Cognitive-Behavioral Therapy (CBT), relaxation techniques
and massage. A recent study published in the Journal of the American
Medical Association suggests that the treatments demonstrating the
most promise for "patients with chronic fatigue were graded
exercise and cognitive therapy" (Whiting 2001). Chronic fatigue
is frequently a comorbid condition with fibromyalgia.
The Mayo Clinic uses a multidisciplinary treatment program, which
includes psychotherapy to treat fibromyalgia. They employ a l½
day intensive schedule. It appears that even this very brief program
improves symptoms in 70 percent of their patients (Worrel, BA et
al, 2001).
In a recent study, CBT offered an alternative approach that demonstrated
clinically significant improvement within six weeks (Edlinger, 2001).
In another study, on chronic fatigue syndrome, the researchers compared
standard treatment with cognitive therapy and standard treatment
without cognitive therapy. "Seventy-three percent of the cognitive
group were spending less time in bed and functioning normally after
a year" (WebMD Health). Only 27% of the other group experienced
the same gains. Flemming (1997) suggests amplifying standard treatments'
efficacy by including bodywork and relaxation. According to the
eminent wellness physician, Dr. Andrew Weil, guided imagery tapes
are useful in reducing pain and speeding the healing process. In
addition, something as simple and straightforward as an accurate
diagnosis can legitimize the patient's experience. Patients are
relieved to discover they have a legitimate medical disorder and
the pain is not imaginary.
In a study on low back pain, researchers found that relaxation response
training was effective in reducing pain severity. Twenty-eight of
the patients also had fibromyalgia. Many of the study subjects reported
reduced pain and a reduction in other symptoms, as well as "improved
function and general health" (Millea, 2001). One panel of experts
concluded that relaxation techniques were helpful in managing chronic
pain. Furthermore, the techniques were valuable in managing the
stress inherent in living with a chronic pain disorder. Yet anther
study suggests that patients who believe they have little control
over their symptoms report more severe and chronic fatigue. CBT
is helping patients to change their inaccurate, self-defeating beliefs
and regain a sense of control over their lives. A belief in one's
ability to manage one's disorder frequently becomes a self-fulfilling
prophecy.
CBT and relaxation therapy (a part of CBT) offer a non-pharmacological
treatment option for treating chronic pain. In summary, according
to the research studies, CBT and relaxation can be used to enhance
one's coping ability, relieve pain, encourage restful sleep patterns,
increase one's sense of control and well-being, reduce fatigue and
improve general health. Cognitive-behavioral therapists can be found
through CBT organizations such as the Association of Cognitive Behavioral
Therapists at http://www.nacbt.org/ online.
Dr. Dorothy McCoy (2002)
Psychotherapist and author of self-help books, workbooks, CDs and
e-courses on anxiety and other health issues.dlamp@lowcountry.com |
