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Responding To Chronic Pain/Fibromyalgia
 
To read the other articles on responding to chronic pain/fibromyalgia click back to infomation.

What can you do about Fibromyalgia? Geoff Littlejohn

  • Understand the nature of fibromyalgia.
  • Realize that it is potentially reversible.
  • Seek assistance with stress management.
  • Get fit and strengthen weak muscles.
  • Improve your sleep with good habits and tri-cyclic anti-depressant medication.
  • Minimize your use of pain killers.
  • Engage in normal household, recreational and work activities.
  • Work in partnership with your therapist to become a good self-manager.


Victims and
Self-Managers

Victim
Self-Manager
  • Victims complain and blame.
  • Self-Managers act and change.
  • Victims expect others to fix it.
  • Self-Managers find their own solutions seeking assistance when appropriate.
  • Victims let problems be the excuses.
  • Self-Managers turn problems into opportunities.
  • Victims are powerless.
  • Self-Managers are powerful.
  • Victims avoid problems.
  • Self-Managers face problems.
  • Victims are overwhelmed by their feelings.
  • Self-Managers acknowledge, explore, experience and let go their feelings.
  • Victims can’t make decisions.
  • Self-Managers make decisions.
  • Victims act helpless.
  • Self-Managers seek information and resources.
  • Victims deny responsibility.
  • Self-Managers accept responsibility.
  • Victims are paralyzed by their circumstances.
  • Self-Managers are mobilized by their circumstances.

We are all victims sometimes! Top of Page



Using Treatment Wisely

There is no shortage of treatment options for chronic pain but the question, “which treatments are going to work?” needs answering. When self-management is the goal, treatment is viewed as something to complement what you are doing yourself, not as the solution. It is also advisable to select treatments which support self-management and teach you more about your body and pain. Before we look at the choices, it is important to recognize some of the treatment traps.

Treatment Traps

  1. Dependency
    There is a risk of becoming dependent on a treatment when you attend regularly for an extended period of time. Most people with pain start with physical treatments such as physiotherapy, chiropractic, and massage gaining short-term pain relief but sometimes experiencing an increase in their pain. It can be hard to understand why they continue the treatment for weeks, months, or years. One explanation is that they believe it is better to be doing something rather than nothing, and there is also the hope that it might cure them eventually. For those people receiving compensation for a workplace injury, some believe that stopping treatment may be viewed critically by the insurance company. Unfortunately, the dependency that develops can leave the person in pain feeling helpless and unable to manage without the treatment. If the insurance company decides to stop the treatment, they frequently experience a sharp increase in their pain both because of their disappointment and anger, and being left without any means of pain relief. The answer is to learn self-management skills which can provide pain relief, and then begin reducing the treatment slowly. It can be helpful to continue with massage or movement therapies such as the Feldenkrais Method, on a less frequent basis. A massage or Feldenkrais session each month can complement the program of self-management.


  2. The treatment “merry-go-round”
    It can be very tempting to keep trying new treatments when they are recommended by a doctor you have consulted, a therapist you respect and trust, or a friend who has had great success with her chiropractor or his physiotherapist. However, there are many dangers in getting caught on the treatment “merry-go-round” but the principal one is that you can’t get off. Sometimes you do need to follow a few leads but, if you notice that you are doing this compulsively, stop and reassess your situation. Read on to discover more of the potential dangers.

  3. The promise of a cure
    Unfortunately, some practitioners promise a cure and when the cure is not forthcoming, they encourage you to keep coming for longer. Sometimes practitioners say that you need to continue the treatment to maintain your level of functioning and avoid an increase in pain. Once you have learnt some self-management skills, it is best to avoid practitioners who make these promises or suggest that you need to keep coming regularly.

  4. Treatment which increases the pain
    Another unfortunate consequence of some treatment, is that it actually increases the pain. I have had clients tell me that their treatments were painful at the time or soon afterwards. It is probably better to avoid treatments which continue to cause you pain. However, some treatments may cause an initial increase in pain as muscles begin to relax and your range of movement increases. Learning to judge what is necessary pain, and what is unnecessary pain, is quite an art. Experienced practitioners can help you with this.

  5. Treatment which increases pain sensitisation
    Over the years I have noticed that clients who have received a lot of manipulative therapy seem to be very sensitive to touch, and report very high levels of pain. I do question the value of treatment that involves strong pressure on the same area for weeks or months. It could contribute to the pain sensitisation state.

  6. Conflicting advice
    If you get on the treatment “merry-go-round” you are likely to get conflicting advice from different practitioners. Try to find a group of like-minded practitioners who support each others work. Part of becoming a good self-manager is learning to critically evaluate the advice you are given. Blindly following one set of advice after another, is bound to lead to confusion and stress for you.

  7. Conflicting approaches
    It is also possible to find that one treatment conflicts with another particularly with regard to different approaches to movement and exercise. Again, if you can find a group of like-minded practitioners, you are likely to get better results.

  8. False hope
    When your pain has become chronic, be wary of any practitioner who is promising you a cure with their treatment. I have yet to discover the ‘magic bullet’ for chronic pain. The “Path out of Pain” program is about moving towards a pain free state but how much pain relief you get will depend on many factors. It requires a lot of skill and motivation to find a path out of pain and the course is only the beginning. Some people face very difficult circumstances, or have had their pain for a long time, and their potential for recovery is reduced. People who have developed a high level of pain sensitisation need a lot of courage, and belief in this approach, to learn how to reduce their pain sensitisation. I can’t make definite predictions about the amount of recovery each client I see will achieve, but I can discuss the factors which will enhance the process and those that will hinder it.

Personal recommendations
When you read my story in “about” you will see that I explored a number of different approaches to managing my pain. I did have a sense that I was on a journey and that it wasn’t just a treatment merry-go-round. Most things I tried provided some help but the most helpful ones involved active participation by me. The therapies I continue to use are the ones that I found most helpful in my recovery.

  • The Feldenkrais Method is one of my favourites and my own movement routine is strongly influenced by this method. I enjoy the “Awareness through Movement” classes and tapes, as well as “Functional Integration” sessions with a Feldenkrais practitioner.
  • Meditation has become an integral part of my life since my chronic pain experience. Although the regularity of my daily practice has varied over the years, I have learnt to bring more and more mindfulness to my daily living. Hakomi, the psychotherapy I use in my practice, has a base in mindfulness. Using mindfulness, clients can access material not available in normal consciousness.
  • Massage and other bodywork is very relaxing and nourishing, particularly when you lead a busy life. Even though I have had fibromyalgia, I find deep tissue massage most beneficial. A lot depends on the practitioner you see and I have my favourites. Bodywork such as Hellerwork, Rolfing, and Structural Integration can improve posture and movement as well as releasing tension. If you have fibromyalgia, you will need to find a masseur/bodyworker who understands this condition and can work with you to find the appropriate amount of pressure to use.
  • Hakomi, a body-centred psychotherapy, is the therapy I chose to study. It is a depth psychotherapy which can be used to address limiting beliefs and habits as well as resolving trauma. Working through the body is most helpful when the main symptom, pain, is in the body. In addition, there is often a link between chronic pain and trauma, whether the trauma occurred in childhood or more recently. You can read more about Hakomi on this website and you can follow the links to other Hakomi sites.
  • Hypnosis can be used to reinforce any of the changes you are trying to make, and it can be helpful in reducing the pain and improving sleep. I continue to use hypnosis in my work and find it powerful when I am working on my own issues.
  • Cognitive-Behaviour Therapy (CBT) is widely used in pain management programs throughout the world. Changing what you think can change how you feel. Just being aware of what you are thinking can even make a difference. The “Path out of Pain” course addresses self-defeating beliefs about pain, the self, and the circumstances arising from living with chronic pain.

Click here to read more about treatment in the practitioners’ section. There are 2 articles you may like to read: “Moving out of Pain; Hands-On or Hands-Off” and “Attitudes to Pain; Non-intervention as a strategy. Top of Page



Self-Care

Balancing work, rest and play leads to good self-care but many people with chronic pain have made self-care a low priority in life. Understanding the reasons for this, can be an important part of finding your path out of pain. You may need some assistance from a counsellor or psychologist to discover the beliefs which have made it difficult for you to take good care of yourself. Sometimes people have not been taught how to create a healthy lifestyle and the “Path out of Pain” course teaches many of the necessary skills. A good diet, exercise, relaxation, rest, recreation, time alone and time with family and friends, are all part of good self-care. Becoming a self-manager involves learning and changing.
Remember to:
  • Set realistic goals.
  • Develop a routine.
  • Keep records of your daily program.
  • Review your progress.
  • Reward your steps to recovery.
Start by:
  • Making a commitment,
  • Writing a contract.
Then:
  • Coach yourself.
  • Be compassionate with yourself.

Seek appropriate support to design your program and encouragement from family and friends to continue it. Remember that you can heal yourself. Top of Page



10 Tips for Flare-ups

These tips were written for participants of the “Path out of Pain” course but could be modified to suit your particular situation.

1. Catch Yourself Reacting.
  • Notice your physical reactions such as tensing up, holding your breath, moving constantly to avoid the pain, making faces, stopping movement to avoid the pain.
  • Notice your mental reactions, such as panic thoughts, catastrophising, and other negative thoughts .
  • Notice your emotional reactions, such as worry, frustration, helplessness, hopelessness, resentfulness, anger, depression and anxiety.
2. Take a moment to Calm yourself.

3. Turn your
reactions into responses
  • Change your physical reactions into responses e.g. relax your muscles, breath gently, allow yourself to be still, let the experience in, and let the pain be.
  • Change your mental reactions into responses by stopping the negative and panic thoughts and replacing them with helpful thoughts. (see the coping statements)
  • Change your emotional reactions into responses e.g. focus on the present, face your fear, accept how it is now, remember what you can do to help yourself.
  • Let the pain be and it will let you be
4. Repeat your coping statements to yourself.
  • “As I relax the pain decreases”.
  • “The pain will pass”.
  • “I can handle the pain right now”.
  • “I've been through this before”.
  • “I have lots of skills to help me through this”.
  • “It is only a sensation”. (from the “Opening to Pain” tape)

5. Avoid these automatic ways of trying to get rid of the pain:

  • Rushing to the doctor to find out what is causing the pain;
  • Rushing to your physiotherapist or chiropractor to get a quick fix;
  • Carrying on with your activities and ignoring the pain;
  • Withdrawing from everyone and isolating yourself;
  • Lying down for long periods.

Then, confront Your Fear and Doubt

  • Do I really need to see a doctor?
  • Is this pain really a warning signal?
  • Do I have to have treatment to handle the pain?
  • Is lying down going to solve the problem?

6. Use your self-management skills

  • Muscle relaxation with or without a tape;
  • Opening to pain (with the tape to help you);
  • Gentle movement e.g neck and shoulder or low back release and relief;
  • Activate your stabilizers e.g emergency pain relief, pull backs;
  • Abdominal breathing in one of your relief positions;
  • Exploring comfort (with the tape to help you);
  • Imagery that you create yourself or listen to on a tape e.g healing light, peaceful place, white light, cooling, numbing, loosening…

7. Find pleasurable things to do, for example:

  • Have a bath or shower or apply hot packs to the painful areas.
  • Listen to some music.
  • Listen to a relaxation tape.
  • Remember the good times and the progress you have made.
  • Watch a movie or entertaining program on TV.
  • Talk to a friend

8. Find activities to keep your mind occupied so that you don’t focus on the pain.

9.
Modify Your Plans rather than giving up everything.

10. Find
Support and Encouragement from

  • a friend,
  • a participant in you “Path out of Pain” course,
  • a therapist,
  • a member of the family, and
  • the letter you wrote to yourself for flare-ups.
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