By Karen Lee Richards*
Other treatment options physicians may recommend for fibromyalgia include:
- Cognitive Behavioral Therapy
- Physical Therapy
- Transcutaneous electrical nerve stimulation
Cognitive Behavioral Therapy (CBT)
Cognitive behavioral therapy is a form of talk therapy. Its use with fibromyalgia is aimed at helping people identify the negative thoughts and emotions related to their pain and develop positive coping strategies to help reduce their pain levels and enable them to function better.
Proponents of CBT say that it helps patients feel more in control and less a victim of their pain. They say it can also be effective in improving sleep and reducing depression and anxiety.
CBT generally consists of 10 – 20 sessions with a certified cognitive behavioral therapist. It may be done one-on-one or in a group.
In a 2006 review of 13 programs using CBT, Drs. Robert Bennett and David Nelson noted that the key elements of cognitive behavioral therapy for fibromyalgia include:
- Education about the nature of fibromyalgia (e.g. central sensitization and other central pain processes, interaction between emotions, behavior and cognition in coping and functioning).
- Realistic goal setting for work or work-like activities, social activities, and involvement with family and friends.
- Relaxation training (e.g. progressive muscle relaxation training, controlled diaphragmatic breathing).
- Appropriate behavioral pacing of activities to not overdo or underdo activity levels.
- Identification of dysfunctional thought patterns and techniques to counter negative automatic thoughts, and the underlying maladaptive attitudes or beliefs fueling these thoughts.
- Communication skills training, to enhance appropriate assertiveness and allow a corresponding release of tension from controlling and bottling up negative thoughts and feelings, and enhance interactions with health-care providers and others.
- Strategies for acquisition, maintenance, and generalization of skills.
- Strategies for relapse prevention and for managing painful flare-ups.
The review concluded, “the current evidence provides modest support for the use of CBT in the management of fibromyalgia, especially when it is part of a more comprehensive program utilizing medications and exercise.”
Physical Therapy (PT)
It is important to find a physical therapist who has a good understanding of fibromyalgia and has experience treating people with FM. The right therapist can help you design a treatment program tailored to your specific needs.
Some of the methods physical therapists may use include:
- Helping you improve your posture to relieve stress on certain muscles.
- Teaching you how to move in ways that can help reduce muscle fatigue and pain.
- Stretching exercises to improve muscle flexibility.
- Relaxation exercises to reduce muscle tension.
- Exercises specifically designed to build strength and increase range of motion.
- Moist heat and/or cold packs to ease pain and stimulate your body’s own healing processes.
- Manual therapy techniques that can help relieve pain in muscles and connective tissues.
When looking for a physical therapist, the American Physical Therapy Association suggests these tips:
- Get recommendations from family and friends or from other health care providers.
- When you contact a physical therapy clinic for an appointment, ask about the physical therapist’s experience in helping people with fibromyalgia.
- During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible, and say what makes your symptoms worse.
A good place to start your search for a physical therapist is by using the American Physical Therapy Association’s Find a PT tool.
Biofeedback is a technique that measures bodily functions – such as heart rate, breathing and muscle tension – and gives you information about them in order to help train you to control them.
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Electrodes are placed on various parts of your body to measure various bodily functions, which are relayed to you through a monitor that displays a series of beeps or flashing lights. A therapist will then teach you how to control these functions using relaxation exercises and breathing techniques. The idea is to help you see how relaxing your muscles or slowing your breathing can affect the way your body functions. The ultimate goal is to help you learn techniques that will reduce your pain.
There is little high-quality research on biofeedback for fibromyalgia and what there is has mixed results. A systematic review of studies using biofeedback for FM found only seven worth including and none reported long-term effects. Those studies found that biofeedback did reduce pain in FM but did not reduce other symptoms like fatigue, sleep problems and depression, nor did it improve quality of life.
Transcutaneous Electrical Nerve Stimulation (TENS)
Transcutaneous electrical nerve stimulation is a type of therapy that uses low-voltage electrical current to relieve pain. Since it is most effective in treating localized or regional pain, it’s not generally used for the overall pain of fibromyalgia. It may, however, be helpful for specific areas of the body where the pain may be more concentrated.
A TENS unit is a small, portable, battery-operated machine that has leads connected to electrodes, which are attached to your skin using self-adhesive pads. The TENS unit then delivers small electrical impulses that produce a tingling sensation.
The electrical impulses work by blocking or reducing the pain signals going to the spinal cord and brain, which can help reduce or relieve pain or muscle spasms. They also stimulate the production of endorphins, the body’s natural painkillers.
There hasn’t been a great deal of research into the use of TENS for fibromyalgia, but the studies that have been done have generally found that it can provide some short-term pain relief. There was one interesting 2013 study that investigated the use of two TENS units simultaneously for FM. The researchers concluded, “While the application of a single active TENS improved pain relief in fibromyalgia pain, pain and fatigue were further improved when two active devices were simultaneously applied at the low back and cervical area, with no side effects.”
TENS units can be rented or purchased from medical supply companies. They are medical devices and should only be used under the direction of a qualified health care practitioner.
* Karen Lee Richards is ProHealth’s Editor-in-Chief. A fibromyalgia patient herself, she co-founded the nonprofit organization now known as the National Fibromyalgia Association (NFA) and served as its vice-president for eight years. She was also the executive editor of Fibromyalgia AWARE, the very first full-color, glossy magazine devoted to FM and other invisible illnesses. After leaving the NFA, Karen served as the Guide to Fibromyalgia and Chronic Fatigue Syndrome for the New York Times website About.com, and then for eight years as the Chronic Pain Health Guide for The HealthCentral Network.
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