Living with fibromyalgia is difficult, and its effects go beyond chronic pain. It is a taxing condition that can affect mood, sleep, and even memory and cognition. With 2-4% of the population being affected by it [2], the need to find ways for management is at the top of many people’s minds in order to make life easier for those that suffer.
Chronic pain as a study is still riddled with mysteries, and techniques for management are being pioneered every day. The difficulty in management and finding techniques that provide relief is a large difficulty of chronic pain and can affect all of one’s life as it can be pervasive in everything a person tries to do. Yet, managing pain in order to live a fulfilling life is a human right [3], and deserves recognition and treatment as much as any disease.
Fibromyalgia: What Is It and Where Does It Come From?
Fibromyalgia is a complex disorder mostly defined by tender points across the body, as well as general musculoskeletal pain. [4] Generally, this pain comes along with other features such as headaches, fatigue, and mood issues. It is diverse and difficult to pin down as there are many symptoms that happen concurrently, that researchers are still trying to figure out exactly what fibromyalgia ‘is’ and the best ways to understand where it is coming from [5]. Luckily, as we progress more into understanding pain and the barriers it places upon our lives, the more we learn and develop ways to understand and treat chronic pain better.
There are many factors that contribute to someone having fibromyalgia, and it is diverse in how it affects people. Women are more affected by it and it is a condition that increases in prevalence with age. [6]
It is a common myth that fibromyalgia is a diagnosis for middle-aged women. Indeed, previous research showed that more than 90% of fibromyalgia patients were women, the majority between the ages of 40 and 60. However, more recent research suggested that these estimations have been based on the selection bias. When an unbiased sample was analyzed, the prevalence of fibromyalgia in women was around 60%. [7]
To first diagnose fibromyalgia, chronic pain both widespread on the body as well as in specific tender points must be felt for at least 3 months. As well, the often associated features that contribute to the condition as well as being unfortunate side effects are often issues of mood, headaches, sleep disturbance or ‘restless’ sleep.
Psychological Impact of Fibromyalgia
Additionally, psychological symptoms such as anxiety or a personal/family history of depression seem to contribute towards a higher prevalence of fibromyalgia [3,8]. Stressors in life such as low-income or divorce have been found to contribute as well [9]. There is evidence of a high prevalence of depression, anxiety, borderline personality, obsessive-compulsive personality, and post-traumatic stress disorder in fibromyalgia patients., which are associated with a worse clinical profile.
There is also evidence of high levels of negative affect, neuroticism, perfectionism, stress, anger, and alexithymia in fibromyalgia patients [10]. Additionally, fibromyalgia patients tend to have a negative self-image and body image perception, as well as low self-esteem and perceived self-efficacy [11].
The Treatments and Best Practices for Fibromyalgia
Managing fibromyalgia is varied, with many different methods both with medication and therapeutic strategies helping minimize symptoms and alleviate one’s health. Over-the-counter pain relievers might help some with the body pains, and prescribed antidepressants have been shown to help with the pain and mental symptoms (ex. fatigue and mood) of fibromyalgia [12]. However, only a minority of patients experience substantial symptom relief with medications.
Since fibromyalgia is a condition that requires constant work and integrating management into one’s life, some of the best courses of action are therapy in order to get the best handle on managing the symptoms and living with the chronic pain of the condition. Different methods of psychological therapies have been found to help quite a lot with the management and as research grows, this avenue of strategies seems to be more and more promising in offering the best long term relief.
Evidence-based interdisciplinary guidelines give a strong recommendation for aerobic exercise and cognitive behavioral therapies.
The therapeutic abilities of Cognitive-Behavioral Therapy (CBT) have been found to be quite effective in managing many aspects of Fibromyalgia. A 4-week (with 6 month follow-up) study of Fibromyalgia patients with a high level of catastrophizing was found that CBT showed reductions in both pain and catastrophizing of symptoms and suggests that CBT can help management for the long term “pain-related brain responses” [13].
Another study using CBT on adolescents with juvenile fibromyalgia also found the psychological method to be effective, stating that there was a significant reduction in depression symptoms and the functional disability that fibromyalgia inflicts [14]. Seemingly, professional therapy through psychological treatment is very effective at managing the multitude of life difficulties that fibromyalgia presents.
Methods such as Intensive Short-Term Psychodynamic Psychotherapy (ISTDP) have been found to be helpful in treating conditions like fibromyalgia as they help clients manage emotions and improve the symptoms of both chronic pain and mood [15].
There is also very promising new work being done in the therapeutic method of Emotional Awareness and Expression Therapy (EAET), which is a modification of the ISTDP therapy, where patients focus on the brain’s relationship to the body and how emotions interact with their conditions. Trials run over a few years showed that EAET was promisingly effective in the field of chronic pain and functional somatic syndromes (such as fibromyalgia).
Specifically, EAET consistently reduced interference from pain as well as pain itself, and found improvements in anxiety and depression[16]. There is still research to be done to find the long term effects, especially for moods and anxiety, as often results in those take time to show in a person, but there is much promise for EAET to become an important pain management and emotional processing therapy for those with conditions such as fibromyalgia.
References
[1] Wolfe, F. (2009). Fibromyalgia wars. The Journal of Rheumatology, 36(4), 671-678.
[2] Lumley, M. A., Schubiner, H., Lockhart, N. A., Kidwell, K. M., Harte, S. E., Clauw, D. J., & Williams, D. A. (2017). Emotional awareness and expression therapy, cognitive behavioral therapy, and education for fibromyalgia: a cluster-randomized controlled trial. PAIN, 158(12), 2354-2363.
[3] Brennan, F., Carr, D. B., & Cousins, M. (2007). Pain Management: A Fundamental Human Right. Anasthesia & Analgesia, 105(1), 205-221.
[4] Chakrabarty, S., & Zoorob, R. (2007). Fibromyalgia. American Family Physician, 76(2), 247-254.
[5] Häuser, W., Ablin, J., Fitzcharles, M., Littlejohn, G., Luciano, J. V., Usui, C., & Walitt, B. (2015). Fibromyalgia. Nature Reviews | Disease Primers, 1, 1-16.
[6] Neumann, L., & Buskila, D. (2003). Epidemiology of Fibromyalgia. Current Pain and Headache Reports, 7, 362-368.
[7] Wolfe, F., Walitt, B., Perrot, S., Rasker, J. J., & Häuser, W. (2018). Fibromyalgia diagnosis and biased assessment: Sex, prevalence and bias. PloS one, 13(9), e0203755.
[8] Mountz, J. M., Bradley, L. A., Modell, J. G., Alexander, R. W., Triana-Alexander, M., Aaron, L. A., Stewart, K. E., Alarcón, G. S., & Mountz, J. D. (1995). FIBROMYALGIA IN WOMEN. Arthritis and Rheumatism, 38(7), 926-938.
[9] White, K. P., & Harth, M. (2001). Classification, Epidemiology, and Natural History of Fibromyalgia. Current Pain and headache Reports, 5, 320-329.
[10] Galvez-Sánchez, C. M., Duschek, S., & Del Paso, G. A. R. (2019). Psychological impact of fibromyalgia: current perspectives. Psychology research and behavior management, 12, 117.
[11] Boyington, J. E., Schoster, B., & Callahan, L. F. (2015) Comparisons of body image perceptions of a sample of black and white women with rheumatoid arthritis and fibromyalgia in the US. Open Rheumatol Journal, 9(1), 1–7.
[12] Moret, C., Briley, M. (2006). Antidepressants in the treatment of fibromyalgia. Neuropsychiatric Disease and Treatment, 2(4), 537-548.
[13] Lazaridou, A., Kim, J., Cahalan, C. M., Loggia, M. L., Franceschelli, O., Berna, C., Schur, P., Napadow, V., & Edwards, R. R. (2017). Effects of Cognitive-Behavioral Therapy (CBT) on brain connectivity supporting catastrophizing in fibromyalgia. The Clinical Journal of Pain, 33(3), 215-221.
[14] Kashikar-Zuck. S., Ting, T. V., Arnold. L. M., Bean, J., Powers, S. W., Graham. T. B., Passo, M, H., Schikler, K. N., Hashkes, P. J., Spalding, S., Lynch-Jordan, A. M., Banez, G., Richards, M. M., & Lovell, D. J. (2012). Cognitive Behavioral Therapy for the Treatment of Juvenile Fibromyalgia. Arthritis and Rheumantism, 64(1), 297-305.
[15] Abbass, A., Lumley, M. A., Town, J., Holmes, H., Luyten, P., Cooper, A., Russell, L., Schubiner, H., Meulemeester, C., D., & Kisely, S. (2021). Short-term psychodynamic psychotherapy for functional somatic disorders: A systematic review and meta-analysis of within-treatment effects. Journal of Psychosomatic Research, 145.
[16] Lumley, M. A., & Schubiner, H. (2019). Emotional Awareness and Expression Therapy for Chronic Pain: Rationale, Principles, and Techniques, Evidence, and Critical Review. Current Rheumatology Reports, 21, 30.