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.

Morning Stiffness in Fibromyalgia

Re-blogged from Kristin Thorson, Editor, Fibromyalgia Network  (Posted: March 27, 2012)

 

 

“When clinicians are asked which symptoms are the most debilitating in patients with fibromyalgia, the most common responses include pain, fatigue, and sleep disturbances,” states lead author of a recent study by Robert Bennett, M.D., of Oregon Health and Science University in Portland.[1] He also adds patients report stiffness as an important symptom. And who wouldn’t complain about waking up each morning to a body that feels in the final stages of rigor mortis?

Indeed, 90 percent of the fibromyalgia patients in the Fibromyalgia Network’s recent survey of Fibro Over Time endorsed significant problems with morning stiffness (see our Winter 2012 Journal). But what do most doctors think of your stiffness? Bennett says they “generally regard it as a minor symptom” or a sign of inflammation unrelated to the fibromyalgia.

When doctors think of stiffness, they conjure up rheumatoid arthritis and other inflammation-related joint diseases that make it harder for these patients to get going in the morning. Yet studies in fibromyalgia patients show stiffness is usually worse in the morning and Bennett points out, “morning stiffness has been rated as more severe in fibromyalgia than rheumatoid arthritis.” He says people with both conditions have worse stiffness than those with fibro alone. But why would fibromyalgia patients be troubled by stiffness?

As people age, they get arthritis, become less active, and expect a little morning stiffness. However, this does not explain why 25- or 45-year old fibromyalgia patients showed signs of joint stiffness on a test involving the ankle.[2] A detailed report was provided in our February 2011 eNews Alert, but suffice it to say, fibro patients showed twice as much stiffness as age-matched healthy controls.

Stiffness sometimes correlates with pain, and since Cymbalta is FDA-approved to treat the pain of fibromyalgia, Bennett and colleagues thought it might relieve the symptom of stiffness. The study was supported by Eli Lilly, the maker of Cymbalta, to see if the drug could help with this symptom. Stiffness did improve, but only by a tiny amount of 10 percent. This compares closely to the 13 percent benefit found in the trials of Lyrica.

If the pain of fibro was solely related to the stiffness, the FDA-approved drugs should be able to produce significant improvement in this symptom. Yet they don’t.

Fibromyalgia is a rather “messy” multi-system condition. There is the central nervous system component involved in processing pain, an area all three FDA-approved drugs work on (Cymbalta, Lyrica and Savella). People with fibro also have trigger points or knots in their muscles, which cause serious pain and restrictive movement.[3] In addition, one has to remember the circulatory system, and fibromyalgia patients have increased arterial stiffness (see Winter 2012 Journal).[4]

Your arteries should be flexible, but studies show a reduction of the elastic-like qualities in fibro patients compared to age-matched controls. An overly active sympathetic nervous system is thought to be partly to blame.

Therapies to relax your sympathetic nerves, such as a hot shower and many other approaches, often ease morning stiffness. Even one of the three FDA-approved drugs may help, but just don’t expect too much from them.

 


[1] Bennett R, et al. Clin Ther [epub ahead of print] Mar 13, 2012

[2] Dierick F, et al. Eur J Appl Physiol 111:2163-71, 2011

[3] Ge HY, et al. Arthritis Res Ther 13(2):R48, Mar 22, 2011

[4] Cho KI, et al. Clin Rheumatol 30:647-54, 2011