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.
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.
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,
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. Website
www.counseling.com/DrMcCoy/ or firstname.lastname@example.org