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What Are Lifestyle and Therapeutic Methods for Treating and Managing

Fibromyalgia?

Experts recommend a multi-faceted approach for treating fibromyalgia that

involves exercise to reduce pain and strengthen muscles, regular sleep routines,

drug therapies to improve sleep and other symptoms, and psychological tools for

coping with the emotional disorders caused by the disease and for reducing

stress that can exacerbate pain. One study compared three treatment options

(biofeedback and relaxation techniques; exercise; and a combination of the other

two) with a passive educational approach used as a control. After two years, the

combination approach proved to be most beneficial and the passive control

approach was the least. Another study also found that interdisciplinary

treatment programs were effective in significantly improving pain in 42% of

patients. Improvements in pain and other symptoms, including depression and

sense of physical capability, persisted for at least six months, although

patients tended to become fatigued again. The effectiveness of the treatments

tended to depend on how depressed the patients were, the sense of their own

disability, personal support networks, and if the cause was unknown. The

severity of the pain at the start of treatment had little to do with outcome.

Patients must realize that such therapies are prolonged -- in some cases,

lifelong -- and they should not be discouraged by relapses. Enlisting family,

partners, and close friends, particularly with exercise and stretching programs,

and becoming involved with support groups of fellow patients are very helpful.

Patients must have realistic expectations about the long-term outlook and their

own individual capabilities. Improvement is subjective, and some patients are

pleased with only a 10% reduction in pain and other symptoms. It is important to

understand that the condition can be managed and patients can live a full life.

Exercise

Many studies have indicated that exercise is the most effective component in

managing fibromyalgia, and patients must expect to undergo a long-term exercise

program. Some patients of fibromyalgia avoid exercise for fear it will

exacerbate their pain. However, according to studies, any pain caused by

exercising subsides within 30 minutes. Physical activity prevents muscle

atrophy, increases a sense of well being, and, over time, reduces fatigue and

pain itself.

Aerobic Exercise. Regular low-impact aerobic exercises are the most helpful for

raising the pain threshold, although it may take months to perceive benefits. A

very gradual incremental program of activity, beginning with mild exercise and

building over time is important; patients who attempt strenuous exercise too

early actually experience an increase in pain and are likely to become

discouraged and quit. Every patient must be prepared for relapse and setbacks,

which are nearly universal, but this should not dissuade the patient from

exercising. Rather, they should experiment with various forms of physical

activity that can be tolerated using their available energy levels. Desirable

exercises are walking, swimming, and using of stationary bikes. Swimming and

water therapy, which eliminate weight-bearing, appear to be excellent choices

for getting started.

Some experts recommend the use of a training index for gauging progress and

establishing a goal. This index is the product of three calculations: the

duration of exercise in minutes, number of days per week that the patient

exercises, and the percentage of maximum heart rate. People just beginning an

exercise program should start with an index of 10 to 25 and aim over time for at

least 42. As examples for achieving these goals, an initial index of 15 may be

achieved with a maximum heart rate percentage of 60% during exercise performed

for 5 minutes 5 times a week (.60 x 5 x 5); the later goal of an index of 42

could be achieved with a maximum heart rate percentage of 70% that occurs with

20-minute exercises three days a week (.70 x 20 x 3 = 42). (Stretching exercises

should be performed for about 10 minutes before aerobic exercise, but they are

not considered part of the total exercise time that the patient uses in

calculating the index goal.)

Determining Percentage of Maximum Heart Rate

a.. Determine the maximum heart rate by subtracting one's age from 220.

b.. Determine the heart rate by measuring the pulse either at the carotid

artery on the neck or on the inside of the wrist during a workout. It's easiest

to count pulse beats for 10 seconds, then multiply by six for the per-minute

total.

c.. Calculate the percentage of maximum heart rate, by dividing the exercise

heart rate by the maximum heart rate and multiply by 100.

Stretching Techniques. Much of the pain experienced by patients occurs where

muscles join tendons or bones, particularly when the muscles are stretched.

Stretching, or flexibility exercises, are part of the warm-up and cool-down

routines of any regular program, but the stretching technique used for muscle

relaxation and pain reduction must be performed by a person other than the

patient, usually a family member or close friend. One such technique is known as

" spray and stretch " . Using this method, the tender points are located by

pressing on the suspected areas, which are then targeted and sprayed with either

ethyl chloride (Chloroethane) or Fluori-Methane, which are chemicals that cool

the blood vessels in the skin. The patient must be in a comfortable position and

the face covered if the spray is being used near the head. The spray bottle is

held upside-down about 12 to 18 inches from the targeted area. The spray is not

used as an anesthetic but to inactivate the tender points so that the patient's

partner can slowly stretch the affected muscle. (Anesthetic skin creams do not

appear to be effective for this treatment.) After the procedure, the muscle

should feel looser, and the patient should have a greater range of motion with

that muscle.

In some cases, injections of lidocaine, called " trigger-point injections " , may

be used for particularly painful tender points as an aid to stretching. The

injection causes intense, transient pain in the trigger point, but after the

medication has taken effect, the ability to stretch the muscle is greatly

enhanced. After an injection, the spray may be used on the whole muscle to

inactivate less severe tender points. In some cases, injections may be needed

two or three times over six to eight weeks. There is some soreness afterward,

which can be severe, and the benefits of the treatment may not be apparent

immediately.

With use of either injections or the spray, the benefits may last from a few

days to weeks. Neither the spray nor the injection is useful without muscle

stretching.

Cognitive Therapy

Studies continue to show that when fibromyalgia patients increase their

psychological capacity to deal with the specific conditions of their disorder

and their lives, they are more apt to experience physical improvement.

Behavioral cognitive therapy is an effective method for enhancing patients'

belief in their own abilities and to develop methods for dealing with stressful

situations. A specific goal of cognitive therapy is to change the distorted

perceptions that patients have of the world and of themselves; for fibromyalgia

patients, this means that they learn to think differently about their pain. Many

fibromyalgia patients live their lives in extremes. They first become heroes or

martyrs, doggedly pushing themselves past the point of endurance until they

collapse and withdraw. This inevitable backlash reverses their self-perception,

and they then view themselves as complete failures, unable to cope with the

simplest task. One important aim of cognitive therapy is to help such patients

discover a middle route, whereby they can prioritize their responsibilities and

drop some of the less important tasks or delegate them to others. Such behavior

will eventually lead to a more manageable life and to less of an absolutist

perspective on themselves and others. Using specific tasks and self-observation,

patients gradually shift their fixed ideas that they are helpless against the

pain that dominates their lives to the perception that pain is only one negative

and, to a degree, a manageable experience among many positive ones. Fulfilling

experiences and many areas of control are still available. Cognitive therapy may

be expensive and not covered by insurance. It should be noted that, in one

center, educational discussion groups were as effective, or even more so, than a

cognitive therapy program. Such results cannot necessarily be applied to all

centers; therapeutic success varies widely depending on the skill of the

therapist. The studies do indicate, however, that patients who cannot afford

cognitive therapy may do as well with strong, intelligently managed support

groups.

Maintaining a Healthy Lifestyle

Establishing Regular Sleep Routines. Sleep is essential, particularly since pain

is aggravated by disturbed sleep. Improvement is low in those who are unable to

sleep consistently and at night. Swing shift work, for example, is extremely

hard on fibromyalgia patients.

Diet. Fibromyalgia patients should maintain a healthy diet low in animal fat and

high in fiber, with plenty of fresh fruits and vegetables. There is no evidence

that any specific dietary factor is effective in managing fibromyalgia; taken in

moderation, vitamins and most nutritional supplements are probably not harmful,

but megadoses of vitamins and even certain supplements may be toxic.

Stress Reduction Techniques

There is some evidence that people with fibromyalgia have a more stressful

response to daily conflicts and encounters than those without the disorder. A

number of relaxation and stress-reduction techniques have proven to be helpful

in managing chronic pain.

Deep Breathing. Inhale slowly and deeply to the count of ten, making sure that

the stomach and abdomen expand. Inhale through the nose and exhale slowly and

completely, also to the count of ten. To help quiet the mind, concentrate fully

on breathing and counting through each cycle. Repeat five to ten times and make

a habit of doing the exercise several times each day, even when not feeling

stressed.

Progressive Muscle Relaxation. After lying down in a comfortable position

without crossing the limbs, concentrate on each part of the body, beginning with

the top of the head and progressing downward to focus on all the muscles in the

body. Be sure to include the forehead, ears, eyes, mouth, neck, shoulders, arms

and hands, fingers, chest, belly, thighs, calves and feet. (Some individuals

even imagine tensing and releasing internal muscles once the external review is

complete.) A slow, deep breathing pattern should be maintained throughout this

exercise. Tense each muscle as tightly as possible for a count of five to ten

and then release it completely; experience the muscle as totally relaxed and

lead-heavy. Continue until the feet are reached. In the beginning it is useful

to have a friend or partner check for tension by lifting an arm dropping it; the

arm should fall freely. Practice makes the exercise much more effective and

produces relaxation much more rapidly.

Meditation. Meditation, used for many years in eastern cultures, is now widely

accepted in this country as an effective relaxation technique. For example, one

recent study reported that patients who performed qigong, an Oriental technique,

reported reduced pain, fatigue, and sleeplessness and improved function, mood,

and general health after eight weeks. The practiced meditater can achieve a

reduction in heart rate, blood pressure, adrenaline levels, and skin temperature

while meditating. A number of organizations, both religious and nonreligious,

teach meditation; the names of these organization along with instructional books

can be found at public libraries. The goal of all meditative procedures, both

religious and therapeutic, is to quiet the mind, essentially to relax thought.

The first step is to be as physically comfortable as possible in a quiet place,

preferably in a semi-dark room isolated from noise or distraction. One should be

sitting up with the eyes closed and concentrating on a simple image or sound.

Some methods suggest imagining a point of light behind the forehead and between

the eyes. Other techniques, such as transcendental mediation, assign " mantras " ,

words that have particular chanting sounds, which are repeated silently. (Anyone

can make up a word or a sound; the only condition is that the word or sound not

be associated with a real thing, which can distract the meditater from the

internal process.) When the mind begins to wander, the meditater gently brings

concentration back to the central image or sound. Some recommend meditating for

no longer than 20 minutes in the morning after awakening and then again in early

evening before dinner. Even once a day is helpful. When successful, the

meditater experiences deep relaxation and renewed energy. (One should probably

not meditate before going to bed; some people who meditate before sleep wake up

in the middle of the night, alert and unable to return to sleep.)

One technique requiring little adaptation of the daily schedule has been termed

mini-meditation. The method involves heightening awareness of the immediate

surrounding environment. One should first choose a routine activity when alone.

For example, while washing dishes concentrate on the feel of the water and

dishes; allow the mind to wander to any immediate sensory experience, such as

sounds outside the window, smells from the stove, or colors in the room. If the

mind begins to think about the past or future, abstractions or worries, redirect

it gently back. This redirection of brain activity from thoughts and worries to

the senses disrupts the stress response and prompts relaxation. It also helps

promote an emotional and sensual appreciation of simple pleasures already

present in a person's life.

Biofeedback. During biofeedback, electric leads are taped to a subject's head.

The person is encouraged to relax using methods such as those described above.

Brains waves are measured and an auditory signal is emitted when alpha waves are

detected, a frequency that coincides with a state of deep relaxation. By

repeating the process, subjects associate the sound with the relaxed state and

learn to achieve relaxation by themselves.

Massage Therapy. Massage therapy is thought to stimulate the parasympathetic

nervous system, which slows down the heart and relaxes the body. Rather than

causing drowsiness, massage actually increases alertness; the reduction of

stress and anxiety levels and the resulting relaxation, however, do contribute

to better sleep. A number of massage therapies are available for relaxing

muscles, including the following: (1) shiatsu, which applies intense pressure to

parts of the body, can be painful but people report deep relaxation at the end;

(2) reflexology manipulates hands and feet using Eastern techniques; (3) Swedish

massage has been available for years and some experts believe is still the best

method for relaxation.

Other Procedures

Because of the difficulties in treating fibromyalgia, many patients seek

alternative treatments. Everyone should be wary of those who promise a cure or

urge the purchase of expensive but useless and potentially dangerous treatments.

Acupuncture. Acupuncture may be effective for some patients. One study measured

blood levels of the chemicals serotonin and substance P, which change in

response to pain or its cessation. After acupuncture, the blood levels of these

chemicals increased, which paralleled the reduction in fibromyalgia pain.

Magnet Therapy. Magnet therapy has received some attention and one study using

magnets that were only slightly more powerful than refrigerator magnets showed

some benefits.

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