Coping with fibromyalgia – why does it hurt all over?

Latest studies suggest that it may affect about 2 percent of the US population.

Athlete with big muscles (illustrative) (photo credit: INGIMAGE)
Athlete with big muscles (illustrative)
(photo credit: INGIMAGE)
Fibromyalgia is a musculoskeletal disorder that includes terrible pain in the muscles and soft tissues throughout the body, unrelenting fatigue and sleep disturbances, anxiety, depression – and a lack of any obvious causes in physical examinations, blood tests and X rays.
And it’s not rare. The latest studies suggest that it may affect about 2 percent of the US population. Usually people suffering from this disorder get diagnosed after a family doctor and other medical specialists fail to find any medical cause for the wide array of persistent symptoms.
Current guidelines for making the diagnosis require that the symptoms be present for at least three months.
The problem for many family physicians and other healthcare professionals is that the boundary between medical and emotional illness is inherently difficult to draw, especially since many psychiatric disorders often present with prominent somatic symptoms that are often mistaken for medical illness. For example, people who suffer from panic attacks often get far too many medical tests for dizziness, shortness of breath, and palpitations, which are all symptoms of hyperventilation caused by the panic attack. In the case of undiagnosed fibromyalgia, when the physician tells the person that their symptoms are stress-related, many sufferers go through years of unrelenting distress, only to wonder if they are hypochondriacs, crazy, or imagining their condition. But make no mistake, the symptoms of fibromyalgia are very real.
Mark is a 53-year-old divorced man who came to psychotherapy for treatment of depression and help with his divorce after 25 years of marriage. His wife had always been critical of him, often denigrating him in front of their two children. Also, he had a lifelong history of difficulty holding down jobs and was barely supporting himself. Added financial pressure came from the alimony and child-support payments he had to make each month. He received little emotional support from his dysfunctional extended family, and with few friends to turn to, he felt alone.
For over two years, during the height of his marital tensions and subsequent divorce, he frequently visited his family physician, complaining about every conceivable medical symptom as well as widespread pain in his body. His symptoms included chronic headaches, extreme exhaustion and sleep difficulties.
He was referred to a psychiatrist, who prescribed medication to help him with his anxiety and depression. However, his symptoms of pain and difficulty sleeping continued to get worse.
One day, he came into therapy to tell me that his family doctor had diagnosed him with fibromyalgia. It was obvious that Mark felt a kind of relief at knowing he wasn’t making up his symptoms, but was still frustrated that no one could help him get rid of them.
So how can a psychotherapist help people like Mark? Most of the pain clinics in the US that treat fibromyalgia underscore the need to use an interdisciplinary team with both pharmacological and non-pharmacological treatment interventions.
Pain psychologists are a central part of the team. Medical interventions rely on antidepressants and analgesic as well as some anti-convulsant drugs. Mark, in fact, was given many of these medicines.
But medicine alone is not enough to rid someone of all the widespread pain.
Treatment also requires providing patient education about the disease in order to give the individual an understanding of what they can and cannot expect. Lifestyle changes, including mild aerobic exercise and gradual strength training, are prescribed as well. The focus on gradual physical training is important, since many people who suffer from fibromyalgia are sensitive to touch and bodily pressure. Therefore, the exercise needs to build up slowly. In fact, when done gradually, exercise training has been shown to reduce and limit fibromyalgia symptoms.
But at the core of treatment are psychological interventions, which include relaxation training, biofeedback and cognitive-behavioral therapy (CBT). In Mark’s case, a great deal of psychotherapy focused on motivating him to change his lifestyle, exercise, and see himself as more competent than he previously believed. He lacked self-confidence in all areas of his life, including as a worker and a parent.
It is important to note that there are some new pharmacological treatment breakthroughs on the horizon. However, in my experience, the psychological aspect is very powerful. People who suffer from fibromyalgia are often cut off from their emotions, overwhelmed by stress and coping poorly. The literature also notes that many of these people have undergone powerful emotional experiences, such as child neglect and/ or abuse, or some other trauma, such as assault, terrorism, or a natural disaster like a hurricane or earthquake. The latest views on fibromyalgia are that overwhelming emotional experience is just too much for the individual to handle, and this can create a sense of helplessness and dependency that translates into personal neglect (lack of exercise and poor dietary habits). Many experts believe that in the case of fibromyalgia there is a failure or a mishap in the central nervous system that affects its ability to modulate and attend to pain management in the body.
It is for these reasons that psychotherapy, usually CBT, and other lifestyle changes can make such a big difference in the lives of fibromyalgia patients.
The writer is a marital, child and adult psychotherapist, with offices in Jerusalem and Ra’anana. He also provides online videoconferencing psychotherapy.