Don’t Give Fibromyalgia the Upper Hand!

Upping Your Exercise Routine

As we know, previous studies have found short-term benefits of exercise for FM. But many of us fail to keep up with exercise programs out of fear that it will worsen pain.

According to a new study, for those who are able, exercising once or twice more weekly (that is: more than you are already doing) may alleviate some of the symptoms.

hydrobicsPatients received individualized exercise prescriptions and completed baseline and follow-up physical activity assessments, to evaluate the relationship between long-term maintenance of moderate-vigorous physical activity (MVPA) and clinical outcomes in FM. MVPA (in this study) was considered to be an increase 10 or more metabolic equivalent hours per week above usual activities  Outcomes included improvements in overall well-being, pain severity ratings, and depression.

“This study shows that if they’re able to stay with the exercise program in the long term it actually is helpful to them,” said Matteson, chair of the department of rheumatology at the Mayo Clinic in Rochester, Minnesota.

Although sustained physical activity was not associated with greater clinical benefit compared to unsustained physical activity, these findings also suggest that performing greater volumes of physical activity is not associated with worsening pain in FM. Future research is needed to determine the relationship between sustained MVPA participation and subsequent improvement in patient outcomes.

“One of the best known therapeutic activities for fibromyalgia patients is exercise,” said Anthony Kaleth, who specializes in exercise testing at Indiana University – Purdue University Indianapolis. “Our study confirmed that result.”

physical-activity_240Any increase in activity, whether or not it was maintained, resulted in positive changes in symptoms and no increased pain, according to the findings in Arthritis Care and Research.

If they had followed the participants for a longer period of time, they might have seen more benefits for people who maintained the program, Kaleth said.

Most people use a combination of medications, including pain relievers, antidepressants and anti-seizure drugs to alleviate fibromyalgia symptoms. Doctors also recommend keeping active with walking, swimming or water aerobics, but many patients are reluctant to start exercising.

“They’re more worried that it’s going to be painful, but that’s more of a psychological effect,” Kaleth said.

physical_activity_web(1)Starting off too vigorously before building up endurance can be painful for anyone, with or without fibromyalgia, Dr. Eric Matteson, chair of the department of rheumatology at the Mayo Clinic in Rochester, Minnesota, said.

“This is a stepping stone I think in terms of the actual result that we found,” Kaleth said.

When Does it Stop Being Hocus Pocus?

The prevalence of co-morbid psychological symptoms in individuals with FM has led many health practitioners to look for guidance on the use of psycho-therapeutic treatment options.  Cognitive behavioural therapy (CBT) has been known to have benefit but it can be time intensive and costly, prohibiting its use in many individuals.

In addition to this more traditional therapy (remember when this was considered hocus-pocus!), current research suggests that hypnosis and guided imagery may have a role in treating FM.  This interesting treatment option was discussed in a recent review of the literature investigating the effectiveness of psychotherapeutic treatments in FM.

The review focused on two randomized controlled trials evaluating the use of hypnotherapy and three studies evaluating the use of guided imagery.  These five randomized controlled trials, the gold standard experimental design in clinical research, found consistent positive results in the treated patients as compared to the control patients.

Hypnotherapy

In one study, 40 patients were treated with eight hypnotherapy sessions over the course of 3 months.  These hypnosis sessions focused on sensory and affective (emotion-based) approaches to FM pain control.  The results show that pain intensity was reduced, there was less fatigue on awakening, and the participants sleep patterns were improved.

A second study evaluated the effect of up to five hypnosis sessions on 53 patients.  This study also found that hypnotherapy improved sleep quality and resulted in less morning stiffness.

For many, hypnosis brings to mind a parlour game or nightclub act, where a man with a swinging watch gets volunteers to walk like a chicken or bark like a dog. But clinical or medical hypnosis is more than fun and games. It is an altered state of awareness used by licensed therapists to treat psychological or physical problems.

During hypnosis, the conscious part of the brain is temporarily tuned out as the person focuses on relaxation and lets go of distracting thoughts. The American Society of Clinical Hypnotists likens hypnosis to using a magnifying glass to focus the rays of the sun and make them more powerful. When our minds are concentrated and focused, we are able to use them more powerfully. When hypnotized, a person may experience physiologic changes, such as a slowing of the pulse and respiration, and an increase in alpha brain waves. The person may also become more open to specific suggestions and goals (such as reducing pain!) In the post-suggestion phase, the therapist reinforces continued use of the new behaviour.

Benefits of Hypnosis

Research has shown medical hypnosis to be helpful for acute and chronic pain. In 1996, a panel of the National Institutes of Health found hypnosis to be effective in easing cancer pain. More recent studies have demonstrated its effectiveness for pain related to other conditions. An analysis of 18 studies by researchers at Mount Sinai School of Medicine in New York revealed moderate to large pain-relieving effects from hypnosis, supporting the effectiveness of hypnotic techniques for pain management.

If you want to try hypnosis, you can expect to see a practitioner by yourself for a course of 1-hour or half-hour treatments, although some practitioners may start with a longer initial consultation and follow-up with 10- to 15-minute appointments. Your therapist can give you a post-hypnotic suggestion that will enable you to induce self-hypnosis after the treatment course is completed.

To find a hypnotherapist, speak to your doctor.

More reading on Hypnosis:

Find a licensed Hypnotherapist:

Guided Imagery

The three studies which evaluated the effectiveness of guided imagery found that pain was reduced in intensity and anxiety was lessened.  In particular, one study compared guided imagery that used pleasant imagery with guided imagery focused upon the “active workings of the internal pain control systems”.  The pleasant guided imagery was significantly more effective in reducing FM pain.

This technique uses visual imagery and body awareness to achieve relaxation. The person imagines being in a peaceful place and then focuses on different physical sensations, such as heaviness of the limbs or a calm heartbeat. People may practice on their own, creating their own images, or be guided by a therapist. Patients may also be encouraged to see themselves coping more effectively with stressors in their lives.

We have very few effective treatment options.  Fortunately, research is beginning to discover the effectiveness of certain psychotherapeutic treatment options.  Hypnosis and guided imagery may be one effective option to improve the mental, emotional, and physical symptoms of FM.