Fibromyalgia: More Than Physical Pain

Will you suffer from fibromyalgia? Antonella is 52 years old. He leads a life without too many limitations: he works in a concierge, cleans the building, and takes care of his house. He is a good person, he talks to his friends and neighbors, he is always smiling. He hardly ever complains, because he always has to go on, no matter how he is.

But only she knows how much it costs her every day to lead a seemingly normal life. It is afflicted with pains throughout the body, in different parts and in a widespread way. In the morning it is very difficult to get active because at night it does not rest well. Sometimes the pain he feels is so bad that he can’t finish washing the dishes, leaves them soapy and then comes back to rinse them. Other times he has the sensation of having a wooden sword stuck in his back … Will he suffer from fibromyalgia? “

People like Antonella, who continually experience pain for no apparent reason, can suffer from fibromyalgia. Fibromyalgia is usually difficult to recognize because the symptoms are not visible. It may seem that these people are making up their pain or complaining for no reason, that they are making excuses for not doing what they have to do. Yet, this is not the case, because their pain is real and they really suffer.

What is Fibromyalgia?

On the one hand, fibromyalgia is described as a chronic pain in the muscles and fibrous tissues (tendons and ligaments), that is, in the muscular and skeletal system. On the other hand, it can also be defined as hypersensitivity to pain. In the presence of the pain-producing stimuli, the brain’s response is greater, more pain than you should feel. Even when there is no stimulus that causes pain, the pain can persist.

For this reason, rather than a muscle disorder, the research focuses on an alteration of central processing, at the level of the spinal cord and brain. This could be due to a lack of analgesic activity (fewer endogenous opioids) and an alteration of the main neurotransmitters associated with central sensitization (less serotonin, norepinephrine and dopamine).

In addition to pain, other symptoms usually occur, such as weakness, sleep disturbances, numbness in the limbs, lack of concentration, and sometimes affective symptoms such as depression or anxiety.

Fibromyalgia turns out to be a very difficult syndrome to describe. In fact,  no specific cause has been determined, neither biological nor psychological, capable of explaining these pains. Fortunately, however, it was recognized by the World Health Organization (WHO) in 1992.

The criteria for the diagnosis of fibromyalgia are related to the presence of pain in 11 (out of 13) sensitive points of the body (particularly in the cervical, back and joints such as elbows and knees), for more than 3 consecutive months. Unless there are other pathologies that the pain can be traced back to.

This is how this unknown pain got some recognition. This recognition represents an important first step so that these people can feel more cared for and can better cope with the disease.

Is fibromyalgia a chronic pain?

“Antonella, like many others in her same situation, doubtful about the cause of these pains she has been suffering from for some time, decides to be seen by many doctors to alleviate her suffering. During this time she is overwhelmed by a feeling of hopelessness, until she is diagnosed with fibromyalgia. But it is very difficult for her to accept that this pain is chronic and that it will accompany her throughout her life. “

Unfortunately, there is no specific drug to relieve pain caused by fibromyalgia. Commonly used anti-inflammatories are ineffective, because they do not eliminate the pain, at best they relieve it, but then it reappears. It is important to note that fibromyalgia is not a degenerative disease, it does not destroy the joints, and it does not cause irreversible injury or deformity. Therefore, it is necessary to demystify the false belief that this disease can cause serious mobility problems, even requiring the use of a wheelchair.

Even if there is no specific cause or medication for fibromyalgia syndrome, it is possible to have a better quality of life. The person can learn to take care of himself so that the pain does not increase, at least it remains constant or even decreases. Change is possible.

Should you continue doing activities or is it better to rest?

People with fibromyalgia usually feel the need to perform a lot of activities and don’t spend much time on rest. So much so that they get so tired that they have to rest for hours and sometimes even days, because the pain they feel is so intense that it doesn’t even allow them to move.

We can therefore say that it is not good to move constantly or to rest all the time. It is imperative to find the right fit, which clearly changes from person to person. It is very important that people with fibromyalgia learn to regulate their rhythm of alternating between activity and rest.

For this purpose, it is advisable to observe and listen to your body, to avoid reaching the maximum level of pain (i.e. 10 on a scale of 0 to 10). You have to learn to recognize level 5 and allow yourself the opportunity to rest. In this way,  you will avoid the peak of pain and fatigue, in which you would feel you can not make it anymore, being therefore forced to stop completely.

It is interesting to note that even if you dedicate more time to rest, it is still advisable to do a minimum of physical activity of moderate intensity every day, to avoid producing alterations in the musculoskeletal system due to disuse. Not doing any physical activity could aggravate pain, fatigue, stiffness. Not only on a physical level, but also on a psychological level.

Dedicating more time to rest in order not to reach the maximum sensation of pain implies the reduction of expectations. This means, therefore, not doing too much work in a single day, setting more achievable goals or dividing the most demanding tasks into smaller and more manageable activities.

It is also useful to  learn to be more flexible and less demanding with yourself. For example, if one day we fail to do everything we had planned because we feel greater pain, we must avoid tormenting and punishing ourselves, as this attitude will increase the discomfort.

Can psychological treatment relieve pain?

Better regulation of emotional and relationship levels has been shown to help relieve physical pain. For this reason psychotherapy allows to obtain a better quality of life and to improve in many aspects such as:

• Accept the pain and live with it.
• Restore emotional balance.
• Increase the quality of sleep.
• Improve relationships with others, especially with family (who experience the suffering and pain effects of fibromyalgia more closely).

People with fibromyalgia in general (not all, since no particular personality has been defined) tend to be more dedicated to others than to themselves. They must learn to say “no”. Obviously helping others is positive, but without ever overstepping the limit that leads to neglecting oneself.

Psychological treatment, therefore, must also be focused on learning to have greater care and respect for oneself. This goal involves being able to say “no” in certain circumstances and to relate more assertively.

As always, this is easier said than done. Fibromyalgia sufferers know full well that resting will help them feel better. The problem is that he is usually not used to doing this and otherwise feels a great sense of guilt. He feels the need to respect “his obligations”. These people, therefore, must learn to dedicate time to themselves without feeling guilty. While rest may seem like a simple purpose, for many of them this rest questions their identity and somehow takes away their value.

Following some studies based on the “theory of personal constructs” by G. Kelly, several “constructs” (adjectives) related to the “dilemmas” (obstacles) that these people face to make the changes they need have been identified, such as for example the selfish versus generous “constructs”.

People with fibromyalgia see themselves as active and generous people and, unconsciously, if they do not carry out their activities and “obligations” they feel that they are no longer so, that they have become weak and selfish. For this reason, one of the goals of psychotherapy is to help them understand that resting or asking for help from others does not mean giving up being themselves.

What else can you do to take care of yourself?

It seems that the pain of fibromyalgia is uncontrollable, it is not possible to predict when it will intensify and there is nothing that can reduce it. However, according to the “gate theory”, it is possible to  identify some situations that “open” the gate of pain or “close it”.

For example, it has been observed that many people with fibromyalgia report feeling  less pain when they are more relaxed and distracted, in the company of family and friends. On the other hand, the aspects that increase the pain are: feeling tense, stressed, overwhelmed or worried, for example after work, excessive exercise or arguments.

Once we become aware of the fact that these situations affect the perception of pain, we should decrease the aspects that intensify the pain and increase those that reduce it, such as rewarding activities. Easy to say, but difficult to accomplish for people who spend their entire lives making a sacrifice that tortures them much more than the disease itself.