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Affecting an estimated 10 million Americans, fibromyalgia is increasingly being diagnosed in those with a chronic pain disorder. Although fibromyalgia is admittedly a complex, physiological syndrome, there may also be an emotional component that keeps victims locked in a cycle of pain. Massage therapists who recognize when fibromyalgia clients fall into a harmful ‘fear avoidance’ pattern can better assist affected individuals in breaking the never-ending cycle of pain perpetuating fear, and vice versa.
Also referred to as fibromyalgia syndrome, fibromyositis and fibrositis, fibromyalgia is a chronic arthritis-related syndrome primarily characterized by widespread muscle pain and tenderness. Technically, two criteria must be met to qualify for a diagnosis of fibromyalgia:
- Duration and all four quadrants – A history of widespread pain in all four quadrants of the body (above the waist on both sides and below the waist on both sides of the body) for three months or more.
- Positive tender points – Pain elicited with pressure at 11 of 18 tender point sites.
Although these criteria may appear to be straight forward, there are many complicating factors involved with fibromyalgia. A handful of those factors include:
- According to the National Fibromyalgia Association, it takes an average of five years to get an accurate diagnosis of fibromyalgia.
- Fibromyalgia can be a primary syndrome or it can be secondary to another autoimmune or rheumatic disease.
- Severe fatigue or a sleep disorder affects an estimated 90 percent of those with fibromyalgia.
- There is no blood test or X-ray that can detect fibromyalgia – and it manifests differently in each individual.
- Often times, a psychological component accompanies the physical aspect of pain in clients with fibromyalgia.
What Is Fear Avoidance?
As described by Nicole Nelson in the February 2013 issue of Massage Today, fear avoidance is a psychological model that accounts for why certain clients may make the leap from acute to chronic pain. Fear avoidance suggests that it is overly fearful individuals who wind up suffering with chronic pain, to the degree that they avoid seemingly benign movement patterns so as to protect themselves from further pain.
Developing fear avoidance after enduring significant physical pain is a logical emotional response. According to John Fry, PhD, a psychologist in Newport Beach, CA and board member of the National Fibromyalgia Association, “Nobody likes pain. You know how bad it’s been in the past, you know how it’s weighed you down, how you ended up in bed. You become fearful of moving around. You fear what it’s going to be like if it is an episode coming on.”
Study after study has repeatedly proven that exercise can relieve fibromyalgia symptoms. However, patients fearful of their pain are frequently reluctant to work out or even move around much at all, knowing that such activity could reignite their pain. The body then loses its conditioning, which results in greater pain. Thus, the patient gets stuck in a cycle of being afraid of aggravating his or her pain, which causes more pain due to inactivity – which just serves to justify the fear of pain.
Helping Affected Clients
First and foremost, compassion for those stuck in the fear-pain cycle is paramount. Because the path to fibromyalgia diagnosis often spans many years of suffering, those affected are likely to have been told their pain is all in their head. All too often, this patronizing cliché is spouted by practitioners who can’t explain the source of a patient’s pain.
Suffering from fear avoidance does not mean that a person’s pain is psychological. Instead, fear avoidance causes a de-conditioning of the body’s muscles, soft tissues and joints. The resultant inactivity is a physiological primer to musculoskeletal pain aggravation. Thankfully, helping ease clients’ fear of being active contributes to a reduction in their pain…as long as the therapist maintains respect and compassion for the client.
Here are some suggestions for helping fibromyalgia patients accept their pain (instead of fearing it):
- Explain that some treatments may cause some pain in the short-term, but will lead to long-term pain relief.
- Because there is no actual tissue damage with fibromyalgia, gentle, progressive exercise will not cause harm.
- Give your client access to studies showing that regular exercise/movement is the most effective means for relieving fibromyalgia-related pain.
- Work together on diaphragmatic breathing. Poor breathing practices can aggravate pain and contribute to fear.
- Acknowledge the fear that clients will feel discomfort when increasing their levels of activity, especially if they have been sedentary. However, insist on a graded, appropriate exercise plan for eventual pain relief.
- For those who remain stuck in fear avoidance, refer them to a cognitive behavioral therapist so that the client can confront their fears rather than be ruled by them.
Fibromyalgia is a complex, potentially agonizing pain syndrome. While the last thing someone with fibromyalgia needs is the additional musculoskeletal burden of being sedentary, the cycle initiated by fear avoidance can easily fuel a chronic pain cycle. Massage therapists with such clients can play an instrumental role in breaking this cycle – facilitating their freedom from fear and pain.
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