To read the other articles on responding to chronic
pain/fibromyalgia click back
- 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 complain
act and change.
- Victims expect others to fix it.
find their own solutions seeking assistance when appropriate.
- Victims let problems be the excuses.
turn problems into opportunities.
- Victims are powerless.
- Victims avoid problems.
- Victims are overwhelmed by their feelings.
acknowledge, explore, experience and let go their feelings.
- Victims cant make decisions.
- Victims act helpless.
seek information and resources.
- Victims deny responsibility.
- Victims are paralyzed by their circumstances.
are mobilized by their circumstances.
are all victims sometimes! Top of
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.
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.
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
The promise of a
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.
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.
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
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.
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.
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.
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.
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.
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.
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.
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.
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.
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
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.
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
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.
- Set realistic goals.
- Develop a routine.
- Keep records of your daily
- Review your progress.
- Reward your steps to recovery.
- Making a commitment,
- Writing a contract.
- Coach yourself.
- Be compassionate with
Seek appropriate support to design your program
and encouragement from family and friends to continue it. Remember
that you can heal yourself. Top
These tips were written for participants
of the “Path out
of Pain” course but could be modified to suit your particular
2. Take a moment to Calm
- Notice your physical
reactions such as tensing
up, holding your breath, moving constantly to avoid the
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
3. Turn your reactions
4. Repeat your coping
- 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
- Change your mental
reactions into responses by stopping the negative and panic
thoughts and replacing them with helpful thoughts. (see the
- 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
- Let the pain be and it will let you be
- “As I relax
the pain decreases”.
- “The pain
- “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)
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
- Withdrawing from everyone and isolating
- 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
- Is lying down going to solve the problem?
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
- Exploring comfort (with the tape to help
- Imagery that you create yourself or listen
to on a tape e.g healing light, peaceful place, white light,
cooling, numbing, loosening…
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
- Talk to a friend
8. Find activities to keep
your mind occupied so that
focus on the pain.
9. Modify Your Plans
rather than giving up everything.
10. Find Support and Encouragement
- a friend,
- a participant in you “Path out of
- a therapist,
- a member of the family, and
- the letter you wrote to yourself for flare-ups.