Fibromyalgia isn’t an easy condition to grasp, but fortunately it has become better understood over time. Gone are the days when people with this condition were put in the too-hard-basket. But this is not to say that Fibromyalgia is simple. Instead of discovering a single cause of Fibromyalgia, we now know it to be a result of a range of factors that work together to put your body’s pain system in an overactive state, causing widespread pain and other symptoms.
Today, evidence suggests that the best approach to Fibromyalgia is a whole person approach that includes psychological therapies and physical conditioning. To understand why this is, let’s discuss a few things about pain and then I’ll summarise current scientific evidence for managing Fibromyalgia that underpins the moregooddays approach.
What is the pain system?
There is no one part of the body or brain that is responsible for pain. It’s a whole system. The immune system regulates the sensitivity of nerves by producing inflammation, nerves transmit information from the body, spinal cord can amplify or dampen this inflammation, and the brain processes this information and has the final say in what we experience1. All these components (and more) work together to make up the Pain System and determine how physically sensitive we are, whether we will have pain, and how much.
What contributes to Pain System Hypersensitivity?
Many factors can influence the sensitivity of our pain systems. For example, stress hormones such as cortisol can trigger the immune system to release more inflammation, and our psychology can change the way our nervous systems process information from the body also increasing pain system sensitivity2,3,4,5. Sleep, diet, past trauma and many other factors can also influence pain system hypersensitivity6,7,8.
Current scientific evidence for Fibromyalgia treatment
The difficult to explain, ongoing and fluctuating nature of fibromyalgia can cause added stress and needs careful explaining. Understanding Fibromyalgia better results in less worry, helps you know how best to approach it, gives you confidence and tools to take control, and ultimately leads to better recovery9. Therefore Education is an important science-backed component of Fibromyalgia treatment and a core component of the moregooddays program.
Psychology isn’t just about psychology. As we’ve noted, our psychology effects things like stress hormones levels, inflammation, and nervous system sensitivity thus having very real physical effects on our bodies that result in real symptoms. There are many different psychological techniques, and we have carefully selected those that are known to help people with Fibromyalgia and chronic pain, many of which are summarised below and included in the moregooddays program.
Cognitive Behavioural Therapy (CBT)
CBT sounds swanky, but it just means attending to our own thoughts and actions. The things we think and the things we do shape our bodies and our minds overtime. In a way, we become what we do and think because (just like learning a new skill) we get better at what we practice. A simple example would be if we spend a lot of time worrying about what other people think and avoiding interacting with others, then we only become more worrying about what other people think and become more and more reclusive. The antidote is to think and act towards what you want to be. Another way to say this is “fake it, until you make it” and it’s one of the oldest principles in psychology. Easier said than done, but we’re here to help, and research supports the helpfulness of this approach15.
Acceptance Commitment Therapy (ACT)
ACT is about mentally hitting the reset button. It recognises that some of the suffering caused by pain stems from the stress that comes from fighting it and struggling to escape it. It might sound strange, but accepting things as they are can be incredibly helpful towards recovery. ACT aims not only to help you reach this place, but also help you rethink what is important to you and get back to living your values. ACT has been shown to be helpful in improving pain, depression, anxiety, sleep quality and quality of life in people with Fibromyalgia14.
Pain Reprocessing Therapy (PRT)
PRT aims to transform the way the brain processes information from the body, by changing its meaning to the person experiencing pain. This helps, because our beliefs and understanding are part of the framework for our brains subconscious processing. In one study, 33 out of 50 people with chronic pain became pain free after they learned a new understanding of pain that was both less worrying and science-backed16. In the control group who did not get pain reprocessing therapy, only 5 out of 50 participants became pain free.
Stress Management & Mindfulness
Stress management techniques are an essential part of treatment, and when combined as part of a treatment plan have demonstrated improvement in self-confidence and real physical function.10,11Mindfulness is more than just an escape from stress in the moment. It is a technique to practice being in the here and now, not worrying about what might or might not happen in the future, and what did or did not happen in the past. In this way, mindfulness is a way of being, not just a meditation. This approach has shown to help alleviate symptoms such as pain and depression12,13. Moreover, these have been shown to be helpful even when delivered in online platforms13.
Sleep therapy is a critical part of Fibromyalgia treatment, because poor sleep is linked to pain and other symptoms like fatigue17. It is said that the body operates in two modes: Fight or Flight or Rest and Repair. Since sleep is therefore critical to facilitating the rest and repair state, improving sleep can be an important step. The good news is that there are proven approaches to improving sleep in people with Fibromyalgia, such as sticking to an optimal sleep schedule and keeping a sleep diary, which is covered in the moregooddays program. Unsurprisingly, better sleep doesn’t only help improve pain and fatigue, but also other problems such as anxiety and depression18.
Conditioning the body
Moving and exercise is not always easy when you are in pain. However, when done at the right dose using pacing and graded activity movement-based approaches, exercise has been shown to improve pain, fatigue and sleep disturbance in patients with fibromyalgia19. As such, the moregooddays program will walk you through understanding how to get the right dose of movement to help condition your body and reduce pain.
The right medications when used correctly can be helpful in the recovery process. These are best discussed with your trusted doctor and pharmacist and not covered by the moregooddays program. However, we think they are best used as ‘therapy-enablers’ rather than ‘pain-killers’. This is because they are unlikely to help in the long-term but may help you in the short-term in a way that allows you to better engage in psychological and movement-based approaches that will reshape your body and pain system overtime. What we mean is that pain can drain you of energy, motivation, and physical comfort needed to fully engage in your recovery plan. So, if careful medication use can help you gain greater capacity to engage in therapy, we are all for it.