The chronic pain syndrome of fibromyalgia afflicts nearly 2% of women and a smaller proportion of men, and is both enigmatic and controversial. Many patients with fibromyalgia are misinformed and told that they are imagining or exaggerating their pain. Others with fibromyalgia learn that they have a medical disease that is chronic and unremitting—in other words, that they’re doomed to suffer from this pain syndrome for the rest of their lives. The unfortunate part of these messages is that they aren’t completely true.
Research indicates that the pain and suffering associated with fibromyalgia are real, as illustrated by functional MRI studies and the fact that there are no significant pathological processes occurring at the peripheral sites of pain. Rather, there are overly sensitized central nervous system pathways that initiate and maintain pain, and most patients with fibromyalgia have associated syndromes such as headaches, fatigue, IBS, pelvic pain, interstitial cystitis, and/or temporomandibular joint syndrome, suggesting the presence of an overarching central sensitization dysfunction.
Linking Stress to Fibromyalgia
There is substantial literature documenting the links between stressful life events, how patients manage strong negative emotions, and fibromyalgia. Patients with fibromyalgia are much more likely than controls to have had significant adverse events in childhood and adulthood. More than half of patients with fibromyalgia have PTSD or substantial PTSD symptoms. People with fibromyalgia are also more likely to suppress emotions and report an “inability to express” themselves.
“There is substantial literature documenting the links between stressful life events, how patients manage strong negative emotions, and fibromyalgia.”
My colleagues and I published a small randomized, controlled trial of a mind-body approach to fibromyalgia in the June 2010 Journal of General Internal Medicine. This mind-body approach—which was termed “affective self-awareness”—utilized a model that explains fibromyalgia and the associated syndromes as being initiated and maintained by learned nerve pathways which were triggered by reactions to suppressed or unconscious emotions. A detailed interview was developed that elucidated the direct links between childhood and adult stressors and the onset of each of the fibromyalgia spectrum symptoms. The patients’ suffering was validated as real, yet explained as a mind-body syndrome, a physiological reaction in the body that has been learned and can be reversed.
Promising New Findings
In our investigation, an intervention was implemented in which a 3-week class was taught in a small group setting. It included therapeutic writing exercises, mindfulness meditation, affirmations, and confronting emotions and situations that had been avoided. We found that 45% of patients in the intervention group had at least a 30% reduction in pain when reassessed at 6 months. In addition, 20% had at least a 50% drop in pain, and 25% obtained pain scores of less than 3 on a 0-10 pain scale. In comparison, none of the patients in the wait-list control group had any of these outcomes.
Given that fibromyalgia is considered chronic and remissions are rare, the results from this relatively brief, psychological intervention without pharmaceutical treatment are striking. Our group is currently preparing a larger study to test the model. The hope is that this approach will serve to bridge the chasm and offer significant reductions in pain and associated symptoms. Many patients can accept the premises that the pain of fibromyalgia is real and that symptoms are caused by sensitized nerve pathways, which are primarily triggered by emotional reactions to stressful life events. Taking a mind-body approach may be effective to reduce fibromyalgia pain and achieve greater quality of life.
Readings & Resources (click to view)
Aaron LA, Buchwald D. Chronic diffuse musculoskeletal pain, fibromyalgia and co-morbid unexplained clinical conditions. Best Pract Res Clin Rheumatol. 2003;17:563-574.
Brosschot JF, Aarsse HR. Restricted emotional processing and somatic attribution in fibromyalgia. Int J Psych Med. 2001;31:127-146.
Cohen H, Neumann L, Haiman Y, Matar MA, Press J, Buskila D. Prevalence of posttraumatic stress disorder in fibromyalgia patients: overlapping syndromes or post-traumatic fibromyalgia syndrome? Sem Arthritis & Rheumatism. 2002;32:38-50.
Dailey PA, Bishop GD, Russell IJ, Fletcher EM. Psychological stress and the fibrositis/fibromyalgia syndrome. J Rheumatol. 1990;17:1380-1385.
Geisser ME, Glass JM, Rajcevska LD, et al. A psychophysical study of auditory and pressure sensitivity in patients with fibromyalgia and healthy controls. J Pain. 2008;9:417-422.