Fibromyalgia – Not Just Physical Pain

Antonia is a 52 year old woman. She seems to live her life without reaching her limits: she works in an inn where she tends the garden and takes care of her own home. She is a nice person, she speaks regularly to her friends and neighbors, always has a smile on her face. She almost never complains because she has to keep going no matter how she feels. But only she knows about the sacrifice she has to make every day in order to maintain this impression. She feels pain in her body, sometimes in certain places and sometimes everywhere. She has a hard time getting up in the morning because she doesn’t sleep well at night. Sometimes she is in such enormous pain that she cannot finish washing the dishes. She then soaks it up and continues later. At other times she feels like someone is ramming a knife in her back …

People like Antonia who experience persistent pain for no apparent reason may have fibromyalgia. It is very difficult to recognize fibromyalgia because the symptoms are ambiguous and, above all, cannot be measured. It may seem like people are making up their pain or complaining for no reason – making excuses not to do the things they have to do. But that is not true. Their pain is real and they suffer.

What is fibromyalgia?

It is really difficult to describe fibromyalgia as a disease. In fact, no specific biological or psychological cause has yet been found that could explain the pain. This is why experts sometimes do not speak of a disease, but of a syndrome. Above all, fibromyalgia means:

• Chronic pain in muscles and connective tissue, especially ligaments and tendons

• Hypersensitivity to pain, meaning that the brain reacts to pain stimuli as if they were much larger than they actually are. Even when the stimulus that caused the pain no longer exists, the pain remains.
  

In addition to pain, there are usually other symptoms, namely sleep disorders and tiredness, lack of concentration, psychological symptoms such as depression or anxiety disorders, tingling in the limbs.

Fibromyalgia is more than a muscle disease. Studies show that those affected have a disorder in the central nervous system, in the brain. The symptoms could also be caused by a lack of analgesic substances in the blood, ie by a lack of endogenous opiods, and by imbalances in the neurotransmitters that are linked to the perception of pain , i.e. above all serotonin, noradrenaline and dopamine.

It is important to emphasize that fibromyalgia is not a degenerative disease. It does not destroy muscles, joints and bones and does not cause irreversible lesions or deformations. This is why we can dispel the myth that the disease can lead to serious mobility problems that require a wheelchair.

Antonia, like so many other people, did not know what was causing her long-lasting pain. So she turned to many doctors for causes and relief. She felt hopeless until she was diagnosed with fibromyalgia. D was amit their history of suffering from over, but she got a name. It was very difficult for her to accept that her pain is chronic and would stay with her throughout her life.

This is how an ignored pain was named and given a voice. Recognizing fibromyalgia as a real ailment is an important step for all fibromyalgia patients to feel less alone and to cope better with the disease.

The following criteria must be met to diagnose fibromyalgia :

• The pain occurs for more than three consecutive months in at least 11/13 sensitive points, especially in the neck and back, in joints such as elbows and knees).
• In addition, there is no other clinical explanation for the symptoms.

Unfortunately, there is no drug treatment that can relieve the pain caused by fibromyalgia. Anti-inflammatory drugs are short-term pain relief, but can have serious side effects when taken regularly over long periods of time.

Although the cause of fibromyalgia is unknown and causal therapy is not available, there are ways to improve quality of life. The person can learn from taking care of themselves so that the pain does not worsen. The idea is to keep it on the same level or reduce it. Change is possible.

Is it okay to stay active or is it better to rest?

Most people with fibromyalgia feel the need to stay active and take few breaks. So much so that there are times when they can become extremely exhausted and then have to rest for hours or even days as their pain is so severe that they can no longer move. It is therefore better not to move all the time – but also not to rest all the time.

It is essential to find a balance that differs from person to person. People with fibromyalgia need to learn to find their rhythm between activity and rest. To do this, we recommend first observing and listening to your body. The pain shouldn’t get extreme: patients need to learn to recognize that their pain has reached a certain level and then allow themselves to pause. This will keep the pain and exhaustion from reaching critical levels  – otherwise they will feel like there is nothing they can do and will be forced to pause.

Although more time should be devoted to relaxation, it is recommended that moderate physical activity be performed at least once a day.

Breaks plus activity

We want to prevent problems that come with inactivity. No physical exercise could aggravate the pain, fatigue and stiffness – not only physically but also mentally.

“The way to relax is the art of working.”

John Steinbeck

Taking more breaks to keep the pain from reaching extreme levels means lowering your expectations. It means not trying to do an excessive amount of work in a single day. The prerequisite for this is to set achievable goals and break down large tasks into smaller portions.

It is also good to learn to be more flexible and less demanding towards yourself: For example, if there is a day on which you cannot do everything that you have set out to do because you are in too much pain, then do not torment or punish yourself even for it. It will only make you feel worse.

Relieving pain in fibromyalgia: can psychological treatment help?

It was found that better handling of one’s own emotions and acceptance in the social environment help to alleviate physical pain. Psychotherapy allows people with fibromyalgia to lead better lives and see improvements in areas such as:

• Accept pain and live with it
• Express emotions
• Improve sleep quality
• Improve relationships with others

People with fibromyalgia generally tend to help others more than themselves. You then have to learn to say no. Of course it is good to help others, but there must be limits so that those affected do not start to neglect themselves. Psychological treatment in such cases can be designed to teach how to take care of and respect oneself.

But, as is so often the case, this is easier said than done. Sometimes those affected know that a break would do them good. The problem is, people with fibromyalgia are mostly not used to resting, and when they do, they feel guilty. They feel the need to honor their obligations. That’s why they need to learn to spend time with themselves without feeling bad about it.

Fibromyalgia and Identity

Even if breaks have a clear purpose, for people with fibromyalgia they challenge their identities. They reduce their self-esteem. Typically, people with fibromyalgia see themselves as hardworking and generous people and are more likely to perceive themselves as lazy and selfish for ignoring their commitments.

According to George A. Kelly’s Psychology of Personal Constructs  , some “constructs” (descriptions) are related to “dilemmas” (obstacles) that become obstacles to instilling change. For example the generous versus the selfish construct.

Therefore, one goal of psychotherapy can be to help them realize that resting or asking for help doesn’t mean they are worth less.

It is important that the changes are consistent with their identity so that they can work.

How can those affected still take care of themselves?

Apparently, the pain of fibromyalgia is uncontrollable and unpredictable. As if nothing could help. However, according to the control barrier theory, certain situations can open and close the locks.

• For example, it has been found that many people with fibromyalgia feel less pain when they are more relaxed and distracted in the presence of friends and family.
• On the other hand, there are situations that aggravate the pain: tension, stress, worry. After work, for example, or after excessive sporting activity or during an argument.

Sufferers are not always aware that these situations have an impact on the perception of pain. With such awareness, the next step would be to reduce those factors that increase pain and encourage those that decrease it. This is easy to say, but difficult for people who have sacrificed themselves a lifetime, which often tormented them more than the disease itself.

“If the pain is excessive and you face it alone, it is destructive. If the person connects with others and expresses the pain in words, it becomes an experience of growth. Sharing and accepting pain is a way to grow. “

Luigi Cancrini