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FIBROMYALGIA
Fibromyalgia Syndrome (FMS) is a condition involving pain occurring
in muscles, joints and associated tissues. Almost everyone has experienced
this type of pain for short periods, for instance after exercising,
when under stress, or when sleep-deprived. For the FMS sufferer, this
pain never fully goes away. It is present in all areas of the body and
follows a recognizable pattern of tender or trigger points. Pressure
applied to these points produces severe pain, which may radiate to surrounding
or unrelated areas. FMS sufferers experience moderate to extreme muscle
fatigue that may be intermittent or continuous. FMS is usually associated
with sleep deprivation-muscle pain makes sleep difficult, and decreased
sleep leads to increased muscle pain. The pain of FMS is not readily
"seen" by others so its severity is not always apparent. As
a result, many patients feel that their pain is not taken seriously.
This can lead to feelings of isolation and depression, which often brings
greater stress and greater pain.
FMS can develop after a physical injury, or it may arise for no apparent
reason. When it follows an injury, the original muscle pain becomes
generalized and spreads to the surrounding areas, and throughout the
body. The onset of FMS is frequently associated with a recent severe
emotional stress such as the loss of a loved one. Although not itself
the cause of FMS, stress does seem to put certain people at greater
risk for developing the disorder.
Physically, tender points are almost always a part of FMS although the
degree of tenderness, location and number of these points may vary from
day to day. This often makes FMS difficult to diagnose.
Since several other diseases have symptoms similar to FMS, it is important
that a complete medical evaluation be performed by a physician who is
knowledgeable and understands the unique problems surrounding this disease.
** The Mind-Body Connection **
Health care professionals are learning that the physical aspects of
chronic pain conditions such as FMS cannot be effectively understood
without consideration of the associated emotional and environmental
factors. The part of the nervous system that automatically regulates
such things as heartbeat, breathing, digestion, blood flow and muscle
tone is involved in FMS. These nerves also regulate the feeling and
expression of emotions and the response to danger or stress. In fact,
these are the nerves that become activated when the person is stressed.
Overactivity of these nerves can lead to a number of different stress
related illnesses such as irritable bowel syndrome, ulcer, painful menstrual
periods, weak immune responses, rheumatoid arthritis, loss of hair and
others. When these nerves are overactivated, it also can result in the
generalized muscle pain of FMS. Many times FMS starts when a physical
injury occurs during a time of increased stress, such as job or marital
changes or loss of a loved one. Understanding the connection between
stress, emotion, and health is central to a complete understanding and
effective treatment of FMS. Without this understanding, remission is
unlikely to occur.
WHAT CAN BE DONE?
The Pain Institute in Chicago was formed with the mission of providing
a seamlessly integrated treatment program for chronic pain conditions.
The Pain Institute's programs combine standard medical procedures with
specialized psychological, guided imagery, and massage therapy and other
physical therapy treatments. We have found that by using this comprehensive,
integrated approach, the nerves and the body's muscle spasm and pain
responses can be "retrained". This approach has provided complete
remission of the disease in the majority of FMS sufferers treated at
The Pain Institute. The treatment program consists of a thorough medical
evaluation and an assessment of the individual's specific needs and
abilities. An individualized treatment program is developed that meets
the persons particular needs and treatment goals. Physical, medical
and psychological techniques all are employed.
Fibromyalgia affects not only muscles, joints, fascia and nerves, but
the sufferer's entire life. At The Pain Institute, we believe that the
only way to treat such an all-encompassing disease is to treat the individual
in their totality-as a whole person. In this way, the majority of Fibromyalgia
sufferers treated at The Pain Institute have found freedom from this
disease.
CASE REPORT - RECOVERING FROM FIBROMYALGIA
Mrs. B. was a 52-year-old woman with a five year history of pain in
her hips, legs, lower back, and chest. Fibromyalgia Syndrome was diagnosed
after a cardiologist ruled out heart-related or other organic cause
for the pain in her chest and arms. Her symptoms first appeared as pain
and stiffness in her hips when she was working as a computer operator.
She initially attributed this to being unaccustomed to sedentary work.
She also thought that several falls during vigorous exercise over the
years had finally begun to take their toll on her body and assumed that
she had developed some form of arthritis. As her condition progressed,
the stiffness and pain spread to her legs, lower back, and tail bone.
As her condition worsened she sought various forms of therapy, including
myofascial therapy, which gave her only temporary relief.
She also noticed that her pain tended to become worse when she was under
stress. Mrs. B. often would become anxious in the presence of a co-worker
at her data entry job. She described this person as cold, uncooperative,
unpleasant and unapproachable. She developed an allergy to the perfume
that the co-worker wore. She stated that she felt attacked by this co-worker
and often felt sick when around her. She stated that she usually wanted
to remove herself from these situations but was unable to because of
the pressures of work. She became increasingly uncomfortable with the
conflict and this seemed to worsen her pain and stiffness.
At the same time, Mrs. B and her husband moved into a new house. She
quit her job to relieve her stress and began working part-time at an
arts and crafts store, believing this would be a relaxing occupation.
However, she soon found herself working fourteen-hour days doing tasks
that were more difficult than she had anticipated. This work was physically
demanding, requiring her to unload truckloads of crafts supplies in
heavy boxes. She began to feel aches and pains in her chest and arms
and finally woke from sleep one night with chest pain radiating down
her arms. Fearing a heart attack, she went to the hospital but the cardiologist
found her heart to be normal and suggested that she might have FMS.
Once again, she found that increasing emotional stresses at her job
made the pain worse. The owner of the shop became seriously ill, and
his wife took over operation of the business. Due to her own obviously
high stress level, the owners wife had a tendency to be short of patience,
abrasive, and less than empathic to Mrs. B's concerns. An uncomfortable
interpersonal situation had once again developed. Mrs. B. felt that
her physical concerns were being ignored, and this exacerbated her pain.
Evaluation at The Pain Institute revealed that Mrs. B. had tender points
in most areas of her body. The extent and distribution of these points
were consistent with the diagnosis of fibromyalgia. Additional medical
testing confirmed this diagnosis.
Mrs. B. was able to use visualization exercises very effectively from
the start of her treatment at The Pain Institute. During the first session
she was able to decrease her pain from a level of seven to a level of
two on a self-rated ten point scale. The use of visualization was so
effective that she did not require medications. In addition, the use
of massage therapy and neuromuscular retraining enhanced and prolonged
the relief she achieved with visualization.
She began practicing this visualization exercise several times a day
and came to the clinic weekly for eight weeks. Her visualization training
exercises were integrated with the massage and physical therapy sessions
for maximum effectiveness. After eight weeks her symptoms were in remission
except for an occasional pain in one ankle. This pain eventually subsided
as well.
Since completing treatment at The Pain Institute, she has experienced
infrequent recurrences of mild pain which she has been able to relieve
using visualization exercises and self massage at home. She considers
her illness to be effectively over.
It should be added that part of her "cure" has included changing
her occupation. After her recovery she returned to school and is taking
courses in counseling. She stated that this allows her to feel more
in control of her life and work situation. Reducing stress from her
life has helped her to manage her pain condition. Learning to control
her situation to reduce this stress, along with learning to control
her body's reactions to stressful situations, resulted in long term
recovery from FMS.
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