The chronic pain syndrome of fibromyalgia afflicts nearly 2% of women and a smaller proportion of men, and is both enigmatic and controversial. Many patients with fibromyalgia are misinformed and told that they are imagining or exaggerating their pain. Others with fibromyalgia learn that they have a medical disease that is chronic and unremitting—in other words, that they’re doomed to suffer from this pain syndrome for the rest of their lives. The unfortunate part of these messages is that they aren’t completely true.

Emotions and fibromyalgiaResearch indicates that the pain and suffering associated with fibromyalgia are real, as illustrated by functional MRI studies and the fact that there are no significant pathological processes occurring at the peripheral sites of pain. Rather, there are overly sensitized central nervous system pathways that initiate and maintain pain, and most patients with fibromyalgia have associated syndromes such as headaches, fatigue, IBS, pelvic pain, interstitial cystitis, and/or temporomandibular joint syndrome, suggesting the presence of an overarching central sensitization dysfunction.

Linking Stress to Fibromyalgia

There is substantial literature documenting the links between
stressful life events, how patients manage strong negative emotions,
and fibromyalgia. Patients with fibromyalgia are much more likely than
controls to have had significant adverse events in childhood and
adulthood. More than half of patients with fibromyalgia have PTSD or
substantial PTSD symptoms. People with fibromyalgia are also more
likely to suppress emotions and report an “inability to express”
themselves.

My colleagues and I published a small randomized, controlled trial of
a mind-body approach to fibromyalgia in the June 2010 Journal of
General Internal Medicine. This mind-body approach—which was termed
“affective self-awareness”—utilized a model that explains fibromyalgia
and the associated syndromes as being initiated and maintained by
learned nerve pathways which were triggered by reactions to suppressed
or unconscious emotions. A detailed interview was developed which
elucidated the direct links between childhood and adult stressors and
the onset of each of the fibromyalgia spectrum symptoms. The patients’
suffering was validated as real, yet explained as a mind-body
syndrome, a physiological reaction in the body that has been learned
and can be reversed.

Promising New Findings

In our investigation, an intervention was implemented in which a
3-week class was taught in a small group setting. It included
therapeutic writing exercises, mindfulness meditation, affirmations,
and confronting emotions and situations that had been avoided. We
found that 45% of patients in the intervention group had at least a
30% reduction in pain when reassessed at 6 months. In addition, 20%
had at least a 50% drop in pain, and 25% obtained pain scores of less
than 3 on a 0–10 pain scale. In comparison, none of the patients in
the wait-list control group had any of these outcomes.

Given that fibromyalgia is considered chronic and remissions are rare,
the results from this relatively brief, psychological intervention
without pharmaceutical treatment are striking.

Dr. Schubiner’s group is currently preparing a larger study to test
this model. The hope is that this approach will serve to bridge the chasm
and offer significant reductions in pain and associated symptoms. Many
patients can accept the fact that the pain of fibromyalgia is real and
symptoms are caused by sensitized nerve pathways which are primarily triggered
by emotional reactions to stressful life events. Taking the mind and body
approach may be effective to reduce fibromyalgia pain.
This article was donated by

Howard Schubiner, MD
Director, Mind Body Medicine Center
Department of Internal Medicine
Providence Hospital
Clinical Professor, Department of Internal Medicine
Wayne State University School of Medicine