Fibromyalgia and Exercise

Exercise can help treat fibromyalgia

Adapted from:  William R. Yates, MD September 20, 2011

http://www.kevinmd.com/blog/2011/09/exercise-treat-fibromyalgia.html

 

What is fibromyalgia and what exactly what does exercise have to do with the treatment and long-term outcome of the condition?  A recent study published in Medicine & Science in Sports & Exercise is helpful in understanding the relationship between fibromyalgia and exercise and how clinicians (and patients) might find better strategies for treatment.


Fibromyalgia is a clinically defined pain syndrome estimated to affect about 5 per cent of the general population with criteria for diagnosisdefined by the American College of Rheumatology to include:

• Pain in all four quadrants of the body
• Pain along the spine
• Presence of 11 of 18 specific tender points

The 18 specific tender points (or trigger points) are outlined in the accompanying public domain figure from the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) and Wikipedia.

Women have higher prevalence rates for fibromyalgia.  The reason for this gender discrepancy in unknown as is the cause of the disorder.   Patients meeting criteria for this medical pain disorder commonly have significant cognitive and emotional symptoms as well.   Endorsement rates for problems with cognitive impairment (poor concentration, memory problems, psychomotor speed problems and diminished attention span) are common in fibromyalgia.  Additionally, rates of anxiety and mood symptoms and disorders appear high.  The cause for this association is also unknown.

Like many pain syndromes, exercise seems to be helpful in the long-term management of fibromyalgia.  Although a natural response to pain is to reduce activity, this physical withdrawal can be counterproductive to a good long-term outcome.  It is important for people with fibromyalgia and their health professionals to assess and monitor response to exercise as a key component to treatment.

McLoughlin and a research team from the University of Iowa and the University of Wisconsin studied the relationship between self-reported exercise and actual exercisein a group of women with fibromyalgia and a group of women without fibromyalgia.  They utilized an accelerometerthat was worn on the hip for 7 days to compare actual activity levels to what the women were reporting.   The key findings from the study were:

• Fibromyalgia subjects reported less physical activity (confirmed by accelerometer data) than controls
• Both those with fibromyalgia and controls reported higher levels of activity than could be validated by accelerometer data
• Self-report activity levels were poorly correlated with accelerometer activity in fibromyalgia but not controls
• High depression scores in fibromyalgia correlated with lower physical activity

For clinicians, the take home message here is you can’t rely only on your fibromyalgia patient’s self-report of exercise.  I think we will be seeing more use of devices such as accelerometers in clinical practice to get a more objective measure of physical activity.  Similar movement measurement capabilities (like those found in accelerometers) are available in the iPhone and iPod Touch.  Such tools may also be used to monitor change in activity with a new intervention, i.e. attending Jazzercise on a regular basis.  Targeting depression treatment in women with fibromyalgia may be one method to improve the chances of getting activity levels up.

The need for implementing activity programs is not limited to the medical illness of fibromyalgia.  Similar programs in obesity, heart disease, diabetes and lung disease are needed.  Collecting activity levels in these and other medical conditions may give clinicians additional insight into the effects of inactivity on disease progression.

Getting activity levels up in fibromyalgia can lead to significant improvement.  A recent trial of exercise in fibromyalgia by Fontaine and colleagues found regular activity reduced pain and reduced functional impairment.  This intervention paired education with a pedometer data that would be monitored by the research team.  When accountability is incorporated in exercise trials, compliance and benefits go up.


Wayne Coghlan, B.Sc., M.A., D.C. M.A. in Counselling Psychology. Anger Management Collingwood. Anger management; Men's issues; Family and Marital Counselling; Stress Management; Personal psychology and counselling. As also a Doctor of Chiropractic I have a special appreciation of the mind-body connection.

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Fibromyalgia, chiropractor, collingwood, fibromyalgia, counsellor, counselor, psychologist, psychology, psychotherapy, anger, repressed anger, mind body, Coghlan, pain, aching, Anger management,

Fibromyalgia, Repressed Anger, Chiropractic Therapy  


 Please note that I wear two professional hats... counselling and chiropractor. To access the chiropractor side of things please visit http://drwaynecoghlan.blogspot.ca/

It has been my experience that the majority of patients I encounter with a diagnosis of fibromyalgia have chronic unresolved emotional issues. Usually, it is some form of unresolved anger or grief, and usually some form of persistent anxiety or apprehension. 

Now that is a bold and sweeping statement, and I appreciate that a disease as complex as fibromyalgia will have many different components to it. This is definitely not a one-size-fits-all statement. Yet the pattern persists.

And I’ve had some people become quite annoyed because I asked if they considered if unresolved issues were somehow a factor in their illness.  I expect their unwillingness to explore the question was defensive of the implication that their fibromyalgia was somehow “in their heads.” To which I sympathize. People with fibromyalgia yearn for legitimization that they do indeed have a “real” disease.  Yet an inability to even explore the question may keep people locked in their pattern of mind-body dissonance.  

It is not such a radical idea that the mind and body are intricately interlinked and that what is unresolved in one part, may negatively affect the other. There is credible research that supports, that for many people diagnosed with fibromylagia, personality types, emotional intelligence, and life circumstances play a huge role in the complex web of factors that foments this debilitating condition. A few examples are listed below.

Over my many years in chiropractic practice, I have come to appreciate that easily 2/3 of conditions I treat originate, or are strongly influenced by emotional factors. And 2/3 of the conditions I treat are more mechanical in nature. That extra 1/3 would be the overlap between the two.

I have also come to appreciate that, often, when I put my hands on a patient’s upper back, there is a different feel to the muscles when the person is dealing more with an emotional injury, than physical. More so, the degree and generality of tension throughout the upper back, neck, and shoulders.

It is not so much that anger gets locked into the body, more so that emotional and physical patterns become interlinked and chronic. When the physical pattern is relieved, often the emotional pattern is free to be expressed. I have had patients break into tears when they are finally able to relieve their angst.

Along with my Doctor of Chiropractic qualifications, I also hold a Master’s degree in Counselling Psychology. When appropriate, some empathetic questioning can help a patient understand where deeper issues are operative.

Fibromyalgia is a complex disorder where one factor triggers the next in a cyclic web pattern. We can argue if anger is the start or the result of fibromyalgia, yet it is part of the cycle. If we can intervene at any point of the cycle, we can reduce the impact.

Along with physical healing – massage and adjustment where appropriate, eating healthy, quality and quantity of rest, invigorating exercise, nurturing the spiritual self….  emotional healing can also play a significant role.

If you, or someone you care about is afflicted with fibromyalgia… please arrange a no obligation consultation and perhaps allow me to work with you.

Best regards, Dr. Wayne Coghlan

There is much information on fibromyalgia on the internet, some of it good. One has to be careful, however, to discern the useful information from what is, at best entertaining, and some that may be harmful. I usually look at the source of the information and if it is research based rather than someone’s opinion or anecdotal information. A stronger source of credible information is Google Scholar – which allows access to academic research.

Rather than restate the background information on the disease, I will refer the reader to the following sites for reference. What I do wish to address is the connection between fibromyalgia and repressed anger. Please read on…..

http://www.mayoclinic.com/health/fibromyalgia/DS00079/METHOD=print&DSECTION=all  

http://www.mayoclinic.com/health/fibromyalgia/DS00079

http://en.wikipedia.org/wiki/Fibromyalgia

There is a good body of knowledge that personality and emotions can play a significant role in the onset and aggravation of fibromyalgia. In particular unresolved anger can manifest in an emotional – psychological – neurochemical - physical cycle that, if it does not precipitate, can aggravate the ongoing condition.

A few examples:

“Anger towards oneself, which is anger-in, was higher in patients with fibromyalgia patients than in the rheumatoid arthritis sample. A stepwise regression model showed that the anger-out scores and the anxiety scores predicted the level of pain severity, and this explained 32% of the variance in the fibromyalgia syndrome group. Although anger-in is consistently higher in fibromyalgia patients, it is the behavioral expression of anger, together with anxiety, that predicts the severity of the pain.” Kemal Sayar, Huseyin Gulec, Murat Topbas. Alexithymia and anger in patients with fibromyalgia. Clinical Rheumatology. October 2004, Volume 23, Issue 5, pp 441-448. http://link.springer.com/article/10.1007/s10067-004-0918-3

“Through biological and behavioural mechanisms, patients with fibromyalgia may also show an increase of pain in response to emotions. Anger, and how it is regulated, may be particularly important in chronic pain.”…”Our study suggests that anger and a general tendency to inhibit anger predicts heightened pain in the everyday life of female patients with fibromyalgia. Psychological intervention could focus on healthy anger expression to try to mitigate the symptoms of fibromyalgia.” Henriët Van Middendorp, Mark A. Lumley, Mirjam Moerbeek, Johannes W.G. Jacobs, Johannes W.J. Bijlsma, Rinie Geenen., Effects of anger and anger regulation styles on pain in daily life of women with fibromyalgia: A diary study. European Journal of Pain Volume 14, Issue 2, pages 176–182, February 2010.  DOI: 10.1016/j.ejpain.2009.03.007

This study demonstrates increased negative emotions and decreased positive emotions, as well as increased emotional-avoidance strategies, in women with fibromyalgia. Henriët van Middendorp, Mark A. LumleyJohannes,  W.G. Jacobs, Lorenz J.P. van DoornenJohannes,  W.J. Bijlsma, Rinie Geenen., Emotions and emotional approach and avoidance strategies in fibromyalgia.,  Journal of Psychosomatic Research, Volume 64, Issue 2 , Pages 159-167, February 2008

http://www.jpsychores.com/article/S0022-3999%2807%2900328

Repeated traumatic experiences during childhood and as adults can be discovered in many cases, which helps to understand some of the difficulties met in psychotherapy with FMS patients. Modified psychotherapy techniques are recommended using pain-centered behavioral methods initially, and progressing only later to an insight orientated approach. P. Keel, Psychological and psychiatric aspects of fibromyalgia syndrome (FMS)., Zeitschrift für Rheumatologie, December 1998, Volume 57, Issue 2 Supplement, pp S97-S100

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Wayne Coghlan, B.Sc., M.A., D.C. M.A. in Counselling Psychology. Anger Management Collingwood. Anger management; Men's issues; Family and Marital Counselling; Stress Management; Personal psychology and counselling. As also a Doctor of Chiropractic I have a special appreciation of the mind-body connection.