Fibromyalgia is a long term condition in which pain and fatigue are often felt in the body. Whilst there isn’t a ‘cure’ for it, there is strong research showing that psychotherapy for fibromyalgia can be a useful way of coping and improving quality of life.
Find out more about how Cognitive Behavioural Therapy can work as a Fibromyalgia treatment.
What Is Fibromyalgia?
Fibromyalgia is a condition that is thought to affect the nervous system in the body, which results in people experiencing unpleasant physical sensations – particularly pain, aches, weariness and tiredness. Some people describe sensation of a Fibromyalgia flare-up as being similar to having ‘flu’ or a bad cold in which tenderness develops around the body. Generally pain and tenderness is most common around the neck, upper and lower back and the waist area. Doctors often refer to it as a medically unexplained condition or a long term condition as symptoms are consistent for many people, although there is no specific test that can be carried out to identify it.
Women are roughly 7 times more likely to experience symptoms of fibromyalgia than men, and typically it occurs in mid-adulthood between the ages of 30-50. Like many problems it can fluctuate from day to day and during the day depending a range of factor including lifestyle. Sometimes Fibromyalgia can last for several months, but more often it can be experienced as a chronic condition that lasts for longer.
Are There Medical Treatments For Fibromyalgia?
There has been a growing interest in the causes of Fibromyalgia and this has led to advances in ideas of treatments that can be helpful.
For main management, some people find the use of ‘over the counter’ pain medications such as paracetamol can be helpful – however generally these are reported to be less helpful. Depending upon the levels of pain and distress being experienced stronger painkillers such as tramadol are also sometimes prescribed.
Along with pain medications some types of antidepressant medications have been used with positive results. For example older types of antidepressants such as tricyclics (for example amitriptyline) can be be useful as these also help muscle relaxation.
How Psychotherapy For Fibromyalgia Can Help:
Psychotherapies such as Cognitive Behavioural Therapy work by helping people with fibromyalgia increase their understandings of their condition by exploring the role that thinking and coping styles play in interacting with physical sensations.
Often experiences of chronic pain can change the way people think about their bodies – and these changes in thinking can lead them to reacting differently in how they cope.
Fibromyalgia treatment using CBT will usually start by recording how Fibromyalgia affects you from day to day using a special diary that records the activities you do, the amount of rest time you have and the levels of pain you experience. Simple changes can often be made in a relatively small number of sessions that will help you to gain helpful balances between rest and activity periods. For example, many people find that in the absence of physical pain they push themselves to achieve as much as possible before the pain sensations start again. This often ends up becoming a self-fulfilling prophesy in which the extra exertion increases pain sensations which leads people to withdraw and rest. This in turn can lead them to stopping all activities until overwhelming levels of sensations decrease.
Over the longer term this pattern can reduce people’s tolerance to experiencing fibromyalgia-generated pain sensations. In our clinic we have frequently found that it is not uncommon for people with fibromyalgia to describe having average to high tolerance thresholds for other types of physical pain (for example an accidental cut or burn) but to be much more sensitised to tenderness and chronic pain from fibromyalgia, with lower tolerance levels for experiencing these sensations without a much more notable effect on their lives.
What Can You Do next?
There are some immediate lifestyle changes that can be helpful for many people with Fibromyalgia that centre around gaining pain information and experimenting with the effects of pacing. As you read the ideas below it is important to keep in mind that we are talking about ‘averages’, and so we have chosen to record numbers across a week as these tend to be more accurate than looking at individual days or parts of days in their own.
1) Separate in your mind the difference between ‘stopping’ and ‘slowing’. Many people find themselves falling into the ‘boom and bust’ pattern described above. One way of starting to change this cycle is by considering pace. Rather than reacting to physical sensations of fibromyalgia pain by stopping (for example laying down or going to bed), try instead to slow down the pace of activities without actually stopping (for example taking some time to sit and read, or taking a brief slow paced walk.) When we talk about rest or ‘slow’ periods below, this is what we mean.
2) Keep an ‘activity and pain diary.’ For one week divide a sheet of paper into seven columns – one for each day. Add rows for each day that break the day into one or two hour blocks. Over the course of an average week try to record what activities you are doing in each block (including resting periods) together with a score out of ten for the levels of physical pain and a score for how strenuous each block of activity was.
3) At the end of the week take a look at your diary to get an idea of the average number of hours of activity you do each day. One immediate change is to plan the next week ahead in order to add ‘slow’ times into your schedule. For example if you have found that an average day consists of 7 hours activity try to break this into 4 activity blocks that are separated by ‘slow’ times. That way you will achieve the same amount of activities, but in a way that is more balanced across the day. This can be an easier way to start making some lifestyle changes for many people as it doesn’t necessarily involve actually stopping or curling back on the amount you do in life, which can sometimes be a difficult idea for people at first.
4) Follow your new plan above and record average levels of pain sensations through the next week. Are there any changes? Many people will notice that their average level of physical pain from fibromyalgia symptoms decreases slightly. If this doesn’t happen for you then it might be worth exploring whether you are gauging the amount of activity helpfully – for example, it may be that you need to allow for extra ‘slow periods’ or that the amount you are trying to achieve overall is unrealistic.
5) If you notice that your levels of sensation have reduced somewhat then it might be a helpful idea to explore if there is a current gap between your current average weekly activity levels, and the longer term level of activity that you would like to be doing in your life. For example, if you find that you can manage 5 hours activity with relatively low symptoms but eventually need to be doing 8 hours in order to manage returning to work then there is a difference that you can work on gradually closing up.
If this is the case then it can be useful experimenting with a gradual increase in the average amount of daily activity time you have, or an increase in the average levels of intensity across the day. For the example above, you might experiment with having 2 weeks of similar intensity activities, but with an average of 5.5 hours of daily activity in order to compare average pain level changes across the two weeks. Alternatively you might decide to keep to 5 hours of average daily activity, but to increase slightly the intensity levels of things you are doing. The key here is to make a small change and to assess it over a reasonable period of time.
Where Can I get More Ideas Or Help?
The ideas above are only a very brief snapshot of a pacing program that you might find helpful. There are plenty of additional psychological and physical changes that are showing promising results in helping people manage fibromyalgia symptoms.
It is important to remember that the goal of psychotherapy for fibromyalgia is usually towards managing symptoms in a different way that has a lower impact on your life – it isn’t to try and eradicate sensations from your body. If a psychotherapy approach is useful to you then it is likely that your tolerance to sensations will increase over the long term such that general day to day awareness of them decreases somewhat.
There are several options averrable for exploring this in more detail:
1) Your GP – Is a good place to start in exploring which local NHS services may be able to help you. These services usually fall under the umbrella of ‘Health Psychology’ teams, and vary on accessibility depending upon where you live. You may find that due to pressures on the NHS there can sometimes be longer waiting times if there is a service in your area.
2) Private Psychotherapy Clinics – Are a good alternative that can often mean that you access psychotherapies such as Cognitive Behavioural Therapy much more quickly. As CBT has the strongest growing evidence-base of research in working psychologically with long term conditions such as fibromyalgia it is important to ensure that the Therapist you choose holds accreditation with the British Association of Behavioural & Cognitive Psychotherapies (BABCP).
3) Support Groups & Forums – Such as UK Fibromyalgia’s online forums can also be good places to exchange ideas and information with other people who experience the same problems or who have tried certain treatments. It is important to remember that everybody is different, but usually information will help give you ideas that you can experiment with yourself.
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