Rethink the Way You View Pain: Fibromyalgia Edition

Hello everyone! I am in my seventh term out of twelfth term in physical therapy school, so I have been concentrating all of my efforts into this program. One of those efforts was a research project comparing a few treatments for fibromyalgia, and I ultimately decided to narrow it down to two: pain neuroscience education and exercise.

The topic of fibromyalgia is personal to me because it is a condition I have. It’s relatively mild compared to what others have, but I have always found that exercise has helped to manage the bulk of my symptoms. However, I understand exercise can be painful for some with this condition, which is why I wanted to explore other treatments beyond exercise–hence, pain neuroscience education.

Before I talk about these treatments that could effectively help fibromyalgia sufferers, let me talk first about what fibromyalgia is:

Fibromyalgia syndrome, as it’s known as, consists of “chronic, widespread pain, unrefreshing sleep, physical exhaustion, and cognitive difficulties.”1

And here are some stats:

1. 2-4% of the world’s population lives with this condition
2. The United States contains the highest population of those diagnosed with fibromyalgia
3. Various things can cause fibromyalgia to develop: emotional or physical trauma, other underlying conditions, neurobiologic abnormalities, environmental reasons, etc.
4. More women than men have been diagnosed with this condition
5. Fibromyalgia is a syndrome, meaning it is defined by multiple symptoms and not just one symptom alone
6. There is no gold standard for diagnosis and the usage of tender points to diagnose this condition is outdated1

Now let’s discuss exactly what pain neuroscience education is. Pain neuroscience education essentially retrains your brain to think differently about your pain; thus, you move from not understanding the cause of your pain to understanding the cause of your pain and the science behind it, which makes it easier to both understand your pain and reduce it.2 People with fibromyalgia have this misconception that fibromyalgia pain has no underlying cause and occurs for no reason, when that is not the case at all. It was also once thought that this was not an inflammatory condition, but it in fact is, because there are low levels of inflammation in the tissue. This is where physical therapists can come in: they can provide that pain neuroscience education to help you re-frame your pain. Pain neuroscience education can improve your activities of daily living, reduce muscle tissue sensitivity, and reduce your fear of moving, as fibromyalgia pain, even with low levels of inflammation in muscle tissue, is not harmful pain.3

I myself have always been fascinated by pain science, and even when I was diagnosed with this condition, I took right away to trying to understand it. I believe doing so has led to a better quality of life for me.

Up next is exercise, which I believe a lot of fibromyalgia sufferers are very familiar with. I do not believe exercise should be used as a solo treatment but in conjunction with pain neuroscience education. If used as a solo intervention, a lot of sufferers with moderate to severe pain may not do it because of that fear of movement, which pain neuroscience education alleviates. That fear of movement generally stems from the knowledge that exercise can come with some soreness the next day, which can be tenfold in those with a chronic pain condition. I think pain neuroscience education will help to reduce this fear of pain, providing the necessary education to help patients understand the long-term outcomes of exercise.

One study by Arakaki et al4 actually looked into the use of a Swiss ball with weights and found that this particular combination reduced pain, improved activities of daily living, and actually resulted in reduced medication to manage fibromyalgia. They used a Swiss ball because it helps with both proprioception (knowing the positioning of your joints) and balance, which weights alone aren’t as effective with. In order to reduce the likelihood of a flare, you do want to start out with low intensity, low load strength training, meaning you want to do more repetitions with less weight (you could arguably start out with bands). Physical therapy is also useful for this, as physical therapists can monitor what you are doing, ensure correct form, and scale the exercises appropriately.4

If you want to learn more about these two forms of treatment for fibromyalgia, please e-mail me at a.forbes@usa.edu!

References

1. Häuser W, Fitzcharles MA. “Facts and myths pertaining to fibromyalgia.” Dialogues Clin Neurosci. 2018;20(1):53-62. doi:10.31887/DCNS.2018.20.1/whauser
2. Pain Neuroscience Education. physio-pedia.com. https://www.physio-pedia.com/Pain_Neuroscience_Education_(PNE)
3. Saracoglu I, Leblebicier MA, Yaman F, Kavuncu V. Pain neuroscience education combined with usual treatment for fibromyalgia syndrome: A randomized controlled trial. Int J Rheum Dis. 2021;24(11):1409-1418. doi:10.1111/1756-185X.14223
4. Arakaki JS, Jennings F, Estrela GQ, Cruz Martinelli VDG, Natour J. “Strengthening exercises using swiss ball improve pain, health status, quality of life and muscle strength in patients with fibromyalgia: a randomized controlled trial.” Reumatismo. 2021;73(1):15-23. Published 2021 Apr 19. doi:10.4081/reumatismo.2021.1357