Counseling Fibromyalgia Patients with a Christian Touch

I. Description of the Problem - Fibromyalgia is a disease that is categorized as a musculoskeletal disease or neuropsychiatric condition that most old school physicians call a fake illness. There is no cure for FMS; although there are a few medications such as Lyrica that are being used to help treat the symptoms of this illness. This disease affects areas such as the muscles causing mild soreness to extreme debilitation. Depression is often associated with this disease due to the pain factors as well as the lack of support from family, friends, and even the medical community.

II. Statistical Data on the Topic- "Fibromyalgia is estimated to affect 2-4% of the population, with a female to male incidence ratio of approximately 9:1", this is a number that varies from website to website. However, no matter where you read your information; women are consistently always more affected than men are. (wikipedia, 2010) In one journal article the statistics are stated to be: "FM is believed to affect between 4 and 12 million people in the United States more than 75% of them are women, with the prevalence in midlife women. (Wilbur, Shaver, Kogan, Buntin, & Wang, 2006)"

III. Symptoms of the Problem- There are numerous symptoms to accompany the diagnoses of Fibromyalgia. Sadly, this is one of the reasons that some Doctors feel that this is a fake disease or a disease like Hypochondria. The symptoms are widespread and can change on a daily basis, making the patient at times looks as if they are seeking more than medical care and more like attention. According to Wikipedia.com the symptoms of Fibromyalgia are the following:

"The defining symptoms of fibromyalgia are chronic, widespread pain, fatigue, and heightened pain in response to tactile pressure (allodynia). Other symptoms may include tingling of the skin, prolonged muscle spasms, weakness in the limbs, nerve pain, muscle twitching, palpitations, functional bowel disturbances, and chronic sleep disturbances.

Many patients experience cognitive dysfunction (known as "brain fog" or "fibro fog"), which may be characterized by impaired concentration, problems with short and long-term memory, short-term memory consolidation, impaired speed of performance, inability to multi-task, cognitive overload, and diminished attention span. Fibromyalgia is often associated with anxiety, and depressive symptoms." (Wikipedia, 2010)

IV. Causes of the Problem- The causes for Fibromyalgia are yet to be determined scientifically. However, from a personal conversation with the head of Rheumatology at Johns Hopkins Bay View Medical Center several years ago; this counselor was told, "the bodies' pain thermostat is turned to super sensitive and receives pain signals differently than someone without Fibromyalgia". This seems to make sense as a simple fall can disable someone with fibromyalgia for a good amount of time, due to the lingering pain that is left behind long after the bruises are gone. After speaking with several people who have had a long diagnoses with Fibromyalgia, this counselor has found that one should never refer to FMS as a psychological disorder and one should also be very careful when talking about Depression and Anxiety, as they can get very emotional or even angry when leaning towards a mental illness and not acknowledging the physical aspect as the primary culprit as the problem. In addition, an article named "Physical Fitness in Postmenopausal Women with Fibromyalgia" states that "although the disease is the most common in postmenopausal women, research has been concentrated mainly on premenopausal women under the age of 50" (Valkenlnen, Hakkinen, Alen, Hannonen, Kukkonen-Harjula, & Hakkinen, 2008) In an article discussing Hysterectomies and Fibromyalgia patients they state that "because FM is mostly seen in females. This condition suggest that female sex hormones may play a role in the pathogenesis of FM." (Pamuk, Donmez, & Cakir, 2009) They also stated that "FM occurs or worsens markedly during the perimenopausal period. It was reported that musculoskelatal pain began or worsened after the discontinuation of hormeone replacement therapy" (Pamuk, Donmez, & Cakir, 2009).

V. Treatment of the Problem- According to one journal article stating "Most patients with chronic diseases are unable to solve their persisting pain conditions by themselves and to find distance to negative emotions associated with pain, they have to find strategies to adapt to a long-lasting course of disease. Patients have to find ways to maintain physical, emotional, and spiritual health despite of often long-lasting courses. Thus, patients' coping with chronic pain is an ongoing process which includes appraisals if stress, cognitive, behavioural, and emotional coping responses, and subsequent reappraisals of stress."(Bussing, Ostermann, Neugebauer, & Heusser, 2010)" The first item that must be addressed first off is what we counselors need to learn what not to do as these items are triggers for upsetting the client. After speaking again with several friends and finding out what has and has not worked for them; this counselor has found out that the first and foremost treatment that one should avoid is telling the client "that they look great, and therefore they could not be feeling that bad". This is not something someone would like to hear when their bodies are wrenching with extreme pain and fatigue. This counselor has found what is beneficial is education; the women that were interviewed found that they felt better and less stressed when they had a plan. The fact that they knew what was happening with their bodies was more so relieving than not know what tomorrow would bring. The second item that was talked about was group meetings for Fibromyalgia; and all the women agreed that they felt worse; physically, emotionally, and spiritually after their meetings. They did not feel better because the other women who were worse off than they were scared them and they felt hopeless and not hopeful. Next these women all felt that a doctor who listens and really spends their time talking with them is also a relieving factor; but more so a counselor who spends time with them talking about the hopefulness of the next day. They want to be lead into the light and not into darkness. These women all felt like they felt better just having someone believe them and stand by them (Sheedy, 2010) (Murray, 2010). As counselors, we need to make ourselves available to the women 24 hours a day and 7 days per week; as Fibromyalgia does not stop when the office hours close. There are times that these women encounter a day that is so horrifying from the pain that they feel as if they cannot go on. That is when we need to be there for them. Physical Therapy/ Exercise seem to be the item that is least liked, but after sometime, it can show some improvements. Overall, the medical community and Mental Health Community need to come together and work jointly for this population; because there are times when a client is suffering from Fibromyalgia flair and they need both medical and mental treatment. This is when we need to be able to have open communications with the treating doctors to develop a plan that works for the client spiritually, physically, and mentally. These patients need to be supported when they decide that they may need to investigate Disability benefits and take that time off to take care of them. Last, we must remember that the patient will be the best guide for determining a treatment plan that will work for them; as there are no two people who have the same symptoms of fibromyalgia. This is reinforced by this statement "Apart from effective pain management, a comprehensive approach is needed which enhances the psycho-spiritual well-being, i.e. self-awareness, coping and adjusting effectively with stress, relationships, sense of faith, sense of empowerment and confidence, and living with meaning and hope. (Bussing, Ostermann, Neugebauer, & Heusser, 2010)"

VI. Biblical Perspectives on the Problem-

"Is anyone among you sick? Let him call for the elders of the Church, and let them pray over him, anointing him with oil in the name of the Lord. In addition, the prayer of faith will save the sick, and the Lord will raise him up. And if he has committed sins, he will be forgiven." (James 5:14)

This is what we need to be forwarding on to our broken clients, this mean broken in body, mind, or spirit. We need to let out clients know that they are not being punished by God, and that they can overcome this even if this means that they can overcome in their mind and spirit. Paul had an affliction that he begged God thrice and was denied. This counselor assumes that God uses illnesses for the benefit of our future ministries or just to build us up into stronger Christians.

"To keep me from becoming conceited because of these surpassingly great revelations, there was given me a thorn in my flesh, a messenger of Satan, to torment me. Three times, I pleaded with the Lord to take it away from me. However, he said to me, "My grace is sufficient for you, for my power is made perfect in weakness." Therefore I will boast all the more gladly about my weaknesses, so that Christ's power may rest on me. (NIV)"

Again, we must be restoring God's love and his strength into these clients to reassure them that God is not hurting them, but using them for something great!

VII. Suggested Homework Assignments- During the course of this research finding a homework assignment to share with the Fibromyalgia client was a bit challenging. The first homework assignment is for the client to work on getting a good night sleep, even if this means getting a prescription for a mild sedative to help them sleep. Sleep is essential for the FMS client to feel good both physically and mentally. Second, for the patient to make time for himself or herself, meaning take a small amount of time during the morning, afternoon, and evening to just pray, rest, relax, read their Bible or favorite book. Third, this will be to make a list of things in their life that are negative and that are bringing them to trigger points with feeling bad or worse when encountering these items or persons; from their we will begin to devise a plan to help the client find better ways of handling the situations or persons so they can get as much stress out of their lives as possible. (As stress is another aggravating factor to a FMS patient) Last, will be find as much educational information on this disease and devise a life strategy, meaning to help the patient see that tomorrow will be okay and even if it is not okay, there will be ways to handle it in addition allow the client to feel as if they have a friend and a support that listens and believes in them. Lastly, to let the patient know that God loves them unconditionally and they are loved no matter what they are, or their diagnoses, or have done in their past.

VII. Additional Information to Share- This counselor suffers from Chronic Pain from Systemic Lupus in addition to Fibromyalgia; so when writing this paper this counselor finding herself wanting to share so many personal experiences. However, when counseling someone with this illness; please always keep in mind that even Cancer is not visible to the exterior and that just because you cannot see it does not mean that it is not real. Remember that just because they look beautiful, it does not discount their illness. God Bless and Good Luck on your counseling journey.

Reference

wikipedia. (2010, March 22). Retrieved July 2010, 10, from wikipedia : http://en.wikipedia.org/wiki/Larry_Crabb

Bussing, A., Ostermann, T., Neugebauer, E., & Heusser, P. (2010). Adaptive coping strategies in patients with chronic pain and their interpretation of disease. BMC Public Health, 507.

Lange, K. (2010, August). Fibromyalgia often disregarded, ignored. The Nations Health. La Crosse , WI: Gale Learning.

Lee, Y.-R. (2010). Fibromyalgia and Childhood abuse: Exploration of stress reactivity as a developmetal mediator. Developmental Review, 294-307.

Murray, J. (2010, September 18). Retired Housewife. (K. S. Kelly, Interviewer)

Pamuk, O., Donmez, S., & Cakir, N. (2009). Increased frequencies of hysterectomy and early menopause in fibromyalgia patients: a comparitive study. Clinical Rheumatology, 561- 564.

Reilly, P. (1999). How should we manage Fibromyalgia? Annuals of the Rhuematic Diseases, 325.

Sheedy, K. (2010, September 18). Disabled/ Retired Masters Level Nurse. (K. S. Kelly, Interviewer)

Valkenlnen, H., Hakkinen, A., Alen, M., Hannonen, P., Kukkonen-Harjula, K., & Hakkinen, K. (2008). Physical Fitness in Postmenopausal Women with Fibromyalgia. Sport Medicine, 408-413.

Wilbur, J., Shaver, J., Kogan, J., Buntin, M., & Wang, E. (2006). Menopausal Transition Symptoms in Midlife Women Living with Fibromyalgia and Chronic Fatigue. Health Care for Women International, 27:600-614.