Fibromyalgia, More Than Physical Pain

Does she suffer from fibromyalgia? Antonia is a 52 year old woman. She has a life without too many limitations: she works in a lodge, cleans the building and takes care of her own house. She is a pleasant person, she talks with her friends and neighbors, and always with a smile. She hardly ever complains because she always has to move forward, at all costs, and no matter how she feels.

But only she knows the sacrifices she has to make on a daily basis to lead a seemingly normal life. She has pain in her body, in different places, in a diffuse way. She has a hard time activating in the morning because she does not rest well at night. Sometimes she is in so much pain that she cannot finish the dishes; she leaves the dishes full of washing-up liquid and washes them later. Other times, she feels like she has a wooden sword stuck in her back…  Does she have fibromyalgia?

People like Antonia, who constantly have pain sensations that appear for no apparent reason, can suffer from fibromyalgia. Normally, fibromyalgia syndrome is difficult to understand because the symptoms are not perceived externally. We can even believe that these people are inventing these pains or that they complain for no reason, looking for excuses not to do what they have to do. But this is not the case because their pain is real and they are suffering from it.

What is fibromyalgia?

On the one hand, fibromyalgia is generally described as  chronic pain in muscles and fibrous tissue  (ligaments and tendons), that is, in the muscular and skeletal system. On the other hand, it can also be defined as  hypersensitivity to pain. When faced with stimuli that produce pain, the brain’s response gives more information, as if there is more pain than there is in reality. When the stimulus that produces pain goes away, the pain may even continue to persist.

So, instead of leaning towards  a muscle alteration, research thinks it is an alteration in the central process, at the level of the spinal cord and the brain. This could be due to a lack of analgesic activity (less endogenous opiates) and changes in the main neurotransmitters associated with central sensitization (less serotonin, norepinephrine and dopamine).

Apart from pain, patients also present other symptoms such as fatigue, sleep disturbances, paresthesias in the extremities, lack of concentration and, sometimes, emotional symptoms such as depression or anxiety. .

Fibromyalgia is a very difficult symptom to describe. No specific cause, whether biological or psychological, has given a real explanation for these pains. Anyway, and fortunately, it was recognized by the World Health Organization (WHO) in 1992.

The criteria for diagnosing fibromyalgia are that the patient has generalized pain in 11 (out of 13) tender points of the body (especially in the neck, back and joints such as elbows and knees), lasting more than 3 consecutive months. And another pathology must not explain this pain.

This is how this ignored pain came to be recognized, thus gaining a little more voice. This assessment was a first step and it is very important so that these people feel more supported and can better cope with the disease.

Is Fibromyalgia Chronic Pain?

Antonia, like so many other people, faced with doubts about why she has been feeling these pains for a long time, consulted many doctors to find the cause and alleviate her suffering. For a long time, despair invaded her, until she was diagnosed with fibromyalgia. But that was not all: she had a hard time accepting that this pain would be chronic and that it would accompany it throughout her life.

Unfortunately, there is no specific treatment to relieve the pain of fibromyalgia. Anti-inflammatory drugs, which are usually used, are not effective because they do not eliminate the pain or only alleviate it. It always reappears. It is important to specify that  fibromyalgia is not a degenerative disease, it does not destroy the joints and does not cause irreversible damage or deformities. It is therefore necessary to demystify the false belief that suffering from this disease can cause serious mobility problems or involve having to resort to the assistance of a wheelchair.

Even if you can’t find a specific cause or medication for fibromyalgia syndrome, you can achieve a better quality of life. The person can learn to take care of themselves so that the pain does not increase; it can, at a minimum, reduce it, or even succeed in reducing it. Change is possible.

Is it safe to continue doing activities or is it better to rest?

Normally, people with fibromyalgia feel the need to do a lot of activity and don’t get much rest. So much so that they end up totally exhausting themselves. They then need to rest for hours and sometimes even days, because the pain they experience is so intense that it does not allow them to move.

Thus, it is not a question of linking activities or always resting. It is essential to find an intermediate point, which would change according to the person. It is very important that people with fibromyalgia learn to regulate their pace of activity and rest.

To regulate their rhythm of activity and rest, the first thing to do is to observe and listen to their body  to avoid reaching the maximum level of pain (the 10th, on a scale of 0 to 10). They must learn to be aware of when they are at level 5 and to allow themselves a moment of rest. In this way,  they will avoid the critical point of pain and fatigue, the  one that will make them feel that they can no longer take it and that they have to stop completely.

It should be emphasized that even if we devote more time to rest,  it is also advisable to carry out a minimum of daily physical activity, with a moderate intensity,  to prevent an alteration of the musculoskeletal system from not occurring. -use. Not doing any physical activity could worsen pain, fatigue, stiffness, and not only physically but also psychologically.

The importance of dedicating more time to rest so as not to achieve maximum pain sensation means  lowering expectations. This means not trying to do an excessive amount of work in the same day, setting more accessible goals or breaking up large tasks into smaller, more manageable tasks.

It is also beneficial that these people  learn to be more flexible and less demanding with themselves. For example, when one day they cannot do everything they planned because they are in more pain, they must avoid tormenting and punishing themselves because this will only increase their pain. to be.

Can psychological treatment relieve pain?

Better regulation of emotional and relationship levels has been shown to help relieve physical pain. Thus, psychotherapy allows these people to obtain a better quality of life and to improve on many points 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 more closely experience the suffering and pain effects of fibromyalgia syndrome)

People who suffer from fibromyalgia have, in general  (not all, because we have not defined a concrete personality), a  tendency to take more care and help others. They must learn to say “no”. Of course, helping others is good, but up to a point; it doesn’t have to mean neglecting yourself.

In this way, psychological treatment aims, among other things, for people to learn to take care of themselves and to respect themselves. This goal involves being able to say “no” under certain circumstances and relate to others in a more assertive way.

As is often the case, it’s always easier to say it than to do it. These people may know, for example, that rest would help them feel better. The problem is that, normally, people with fibromyalgia are not used to resting and, when they do, feel a great sense of guilt:  they feel the need to fulfill “their obligations”. They must therefore learn to spend time with themselves, without feeling bad.

Even though rest may seem like a simple goal, for many people it challenges their identity and somehow robs them of their value. From studies based on Kelly’s “personal construct theory”, we have found various “constructs” (adjectives) that relate to the “dilemmas” (obstacles) that these people face in achieving the changes they need, like, for example, the generous versus selfish “constructs”.

Normally, people with fibromyalgia  are seen as hardworking and generous people  and, subconsciously,  if they relegate their activities and “obligations”, feel that they are no longer like that  and turn into weak and selfish people. It is for this reason that one of the goals of psychotherapy is to make them realize that resting or asking for help from other people does not mean ceasing to be themselves.

What more can they do to take care of themselves?

It seems that the pain of fibromyalgia is out of control, that you cannot predict when it will get worse. Nothing can reduce it. However, according to “Gate Control Theory”, one can successfully  identify certain situations that “open” or “close” the pain barrier.

For example, it has been observed that many people with fibromyalgia agree that they experience  less pain sensations when they are more quiet and distracted,  in the presence of friends or relatives. In addition, the aspects that increase the pain are: feeling tense, stressed, anxious or preoccupied, for example after working out, after exercising too much or after having an argument. with somebody.

Once these people are aware that these situations affect the perception of pain,  it will be necessary to decrease those aspects that intensify the pain and increase those that reduce it, such as rewarding activities. It’s easy to say, of course, but hard to achieve for people who have spent their entire lives making a sacrifice that often tortures them more than their own illness.