Fibromyalgia syndrome (FMS) is the medical terminology used to represent a complex clinical disorder of symptoms characterized by soft tissue pain, stiffness, and altered deep pain threshold with psychological fallout. It can mimic or accompany symptoms of joint injury, but it is not an arthritic or neurological condition. The disorder affects between 3 to 6 million people – or as many as one in 50 Americans. About 80 and 90 percent of those diagnosed with fibromyalgia are women. I am one of the 10 percent of men afflicted with this disease.
There is usually an emotional overlay of depression and anxiety that affects the sufferer. There are numerous reasons why this is true. Many within the medical community have discounted fibromyalgia as a bona fide disease. Patients have been told that they are over-dramatizing their pain and that the stiffness or soreness has been psychologically induced. Others have been told that the condition was fabricated for attention or perceived by health providers as feigned helplessness. These assertions from medical experts make patients with FMS feel ignored, mistrusted, alone and without support. Patients often turn to self-blame, which fuels the pain cycle. A supposedly reputable physician once told me that “I just didn’t have a strong tolerance for pain.” I never saw him again.
The pain and symptoms of fibromyalgia are real and have a definite physical basis.
There is no known cause for fibromyalgia. Some researchers have speculated that physical trauma or viral influences have triggered FMS syndrome in many patients. There are no known abnormalities in the muscle tissue of fibromyalgia patients that would account for the disease.
Current research has focused on regions of the FMS patient’s brain and the susceptibility of certain brain locations to pain sensitivity. The brain receives a pain signal from the muscles and stays in a state of alert. For unknown reasons, the brain fails to let go of the pain signal and sets up a chronic pattern or pain syndrome. The brain stays in a constant feedback loop, consisting of a system of amplified pain signals.
Recent brain scan research studies have shed new light on this disorder. Results published in the May 2008 edition of the Journal of American College of Rheumatology shows that neuroscientists have been able to conduct scanning technology to areas of the brain affected by fibromyalgia. Mild pressure on trigger points of the patient has produced measurable brain response in processing the sensation of pain. The elevated response of pain in FMS patient’s brain scans was significantly different from those in the control group of the study. This is one of several studies that validate the reality of fibromyalgia as a disorder affecting the brain's response to muscular and neuropathic pain. Hopefully, future studies will lead to new treatment options.
Currently, treatment options consist of the use of a multidisciplinary approach. Medication management, physical therapy, meditation, exercise, alternative therapies, and cognitive-behavioral therapy are useful. CBT is a valuable therapeutic treatment option for those suffering from pain syndromes. One of the byproducts of pain can be the escalation of anxiety and depression. Likewise, anxiety and depression can intensify the impact of pain and make it more debilitating. Therapist must be familiar with the diagnosis of fibromyalgia and help patients accept the physical limitations that accompany a chronic pain disorder.
Cognitive-behavioral therapy’s goal is to teach the FMS patient to embrace pain rather than fight it. Cognitive distortions, such as magnification and “catastrophizing” need to be addressed so that patients learn to de-escalate fueling the pain process. How one thinks about his pain affects its impact. One can learn to rationally respond to pain by saying:
• "Although this problem is difficult, I can learn to manage it."
• "What's the use of getting all upset about my pain, it won't help anyway."
• "If I relax and walk into my pain, maybe all this will feel less troublesome."
• "I'm not alone in this. I have the support of my family and friends."
• "I'm not helpless, I have many strategies I can try to minimize the effect of my pain. Just keep moving!"
Therapy can assist the fibromyalgia patient to identify stressful triggers that exacerbate pain. This may involve examining family struggles, exploring inner-conflict, and working with core, self-defeating assumptions that affect thinking and behavior. Teaching the patient mindfulness meditation as a way of relaxing the sympathetic nervous system is beneficial. The goal is not to try to fix the unfixable, but to help patients manage their distress.
A therapist can provide the fibromyalgia patient with structured homework assignments that will help pain sufferers to experiment with new behaviors such as increased involvement and activities. Motivating the client to set realistic goals for everyday functioning can be helpful. Encouraging a multidisciplinary approach involving exercise, physical therapy, rehabilitation and medication management are essential.
Fibromyalgia patients fear that their disorder will cause them to lose the ability to function at work and at home. Teaching patients to focus on what they can do rather than their limitations is important. There is a tendency for fibromyalgia patients to distort reality by focusing on negative perceptions to the exclusion of the positive. Helping the patient and family to accept physical limitations is a necessary component to successful treatment.
Fibromyalgia patients can easily get enmeshed in a cycle of pain and associated emotional symptoms. It is the goal of any approach to assist the patient in coming to terms with his disorder and making plans to manage it. This is accomplished through acceptance and teaching the patient positive ways of thinking about his condition and multiple ways of treating it. As many in the medical community have insisted, fibromyalgia patients are not making it up. It’s a relief to know it’s in their head, but it’s not their fault!
James P. Krehbiel, Ed.S., LPC, CCBT is an educator, writer, licensed professional counselor and nationally certified cognitive-behavioral therapist practicing in Scottsdale, Arizona. He specializes in treating anxiety and depression for adults and children. He served as a teacher and guidance counselor for 30 years and has taught graduate-level counselor education courses for Chapman University. In 2005, he self-published Stepping Out of the Bubble: Reflections on the Pilgrimage of Counseling Therapy (Booklocker.com). His latest book, Troubled Childhood, Triumphant Life: Healing from the Battle Scars of Youth (New Horizon Press) is about the impact of adverse childhood experiences on adult functioning. He offers solution-focused strategies to assist adults in overcoming the perils of the past.
