Clarifying the Role of Psychological Factors in Fibromyalgia

Fibromyalgia is a chronic medical condition that largely affects women of child-bearing age. Individuals with fibromyalgia experience widespread musculoskeletal pain of unknown cause, and many also commonly have fatigue and stiffness. While research is attempting to uncover the cause of fibromyalgia, healthcare practitioners are struggling to provide effective treatment options to people with fibromyalgia.

A growing body of evidence suggests that the symptoms of fibromyalgia may be improved by therapies that focus on the psychological aspects of this painful condition. In addition to the common fibromyalgia symptoms of stiffness, fatigue and diffuse chronic pain, research shows that many fibromyalgia sufferers also experience depression and/or anxiety. The potential changes in pain perception and central nervous system hyperexcitability associated with depression and anxiety may play an important role in fibromyalgia.

Studies investigating the factors that exacerbate fibromyalgia have also identified a key role for psychological issues. Emotional distress or emotional trauma was identified as one of the most frequently cited exacerbating factors in fibromyalgia patients. Additional commonly identified psychological triggers in people with fibromyalgia included short term mental stress, chronic stress, and worrying.

Many individuals with fibromyalgia are placed on medications. Amitryptiline is a common prescription medication used in fibromyalgia. Amitryptiline is intended to provide relief from both depressive symptoms and fibromyalgia pain. Several studies have been conducted on this tricyclic antidepressant also known by the brand name Elavil.

A meta-analysis was conducted on nine studies evaluating the efficacy of this popular antidepressant medication in fibromyalgia patients. The meta-analysis surprisingly showed the most significant effect on quality of sleep. Unfortunately, there was little beneficial effect on stiffness and a minimal effect was seen for sensitivity to pressure in these fibromyalgia patients.

There is growing evidence that fibromyalgia patients may have altered or abnormal pain processing. In order to effectively treat the symptoms of fibromyalgia, it is important to determine the initiating events as well as those factors that perpetuate the augmented pain processing. These factors likely involve physical sensation as well as emotion, cognition, and behavioral factors. The high likelihood that psychological processes play a role in fibromyalgia has prompted a search for effective pharmacologic and nonpharmacologic therapies to address the psychologic realm of fibromyalgia.

A review of psychotherapeutic approaches to pain relief in fibromyalgia suggests that cognitive behavioral therapy (CBT) and operant behavioral therapy (OBT) may be effective. Surprisingly, biofeedback therapy did not appear to be a significantly effective treatment option for fibromyalgia pain. Relaxation achieved via autogenic training or Jacobson relaxation training also did not offer significant improvement in fibromyalgia pain.

Two additional psychotherapeutic approaches to fibromyalgia did appear to be at least moderately effective. These were hypnosis (including guided imagery) and therapeutic writing. In light of the mounting research on the role of psychological health in fibromyalgia, further research is needed on the application of psychological therapies to fibromyalgia patients.

Source:

Thieme K, Gracely RH. Are psychological treatments effective for fibromyalgia pain? Curr Rheumatol Rep. 2009 Dec;11(6):443-50.