One of the things any ethical therapist needs to consider carefully is the amount of hope one gives to clients. Some conditions can be completely cured, some can be helped and with some there isn’t much that can be done. Not giving people enough hope, where hope is justified, is in my view not providing proper service. And at the other end of the spectrum, providing false hope is unethical as it can add to the suffering of an already vulnerable person.

In chronic pain conditions where a known organic (i.e. physical) cause is absent, many in mainstream medicine and allied health are happy to accept an important role for psychosocial factors.  Few believe however that debilitating chronic pain conditions such as fibromyalgia can be cured completely by a mindbody approach.  So as ethical practitioners, doctors making this diagnosis will tend to tell clients that there isn’t a known cure, so as to not provide false hope. Clients are referred to various forms of pain management strategies which may involve drugs or cognitive therapeutic interventions, with the worthy goals of maximising the persons ability to function with pain and reduction of the associated distress and dysfunction.  What often tends to happen however is that pain sufferers fall into a downward spiral (or at least a holding pattern) of disability and feelings of hopelessness about their situation.

After reading Sarno and curing my own fibromyalgia / CFS I realised that there is in fact both a cause and a cure for many forms of chronic pain and fatigue. After training in psychology and somatic psychotherapy and reading the published research I came to see a growing evidence base for the mind-body cure.  So I have come to view the conventional medical practice of referring clients to pain management as unnecessarily prolonging the suffering of many pain sufferers.

It must be acknowledged that the mind-body approach doesn’t work for everyone. After known medical causes have been excluded, the client needs to able to accept the mind-body diagnosis.  Not everyone is happy to accept that pain could be caused by psychological or emotional factors, and some even feel demeaned by such a diagnosis (despite this never being the intention of mindbody approaches).  But then again, few medical or psychotherapeutic treatments can claim a 100% success rate.

But getting back to the question of healing versus pain management, is it ethical to not refer clients to a completely natural treatment that has demonstrated benefit and the power to cure or substantially alleviate suffering?  In my view it is not.

So why is it that Sarno as a professor of medicine for many years has been unable to achieve broader acceptance of the mind-body cure for pain? The answer probably lies in his personal preference towards being a clinician rather than a researcher.  He has helped thousands of clients in his decades in medicine, some of whom have been completely cured of pain that other doctors had recommended surgery for.  But in the scientific method “case studies” are considered the poor cousin of randomised controlled trials, and skeptics will discount such evidence as inadequate.

In evidence based practice the weight of published data in controlled experiments allows the scientist-practitioner to make inferences about how the world is, and which treatments work.  Hsu and Schubiner’s recent randomised controlled trial of a mindbody approach to fibromyalgia treatment is an exciting step in the direction of broader  understanding of the healing power of accepting the deeper aspects of our self.

It is frustrating though that still, in 2011, large numbers of pain sufferers are being directed towards pain management approaches which are expensive to the public purse and won’t assist people in making a full recovery.  In pain conditions where a cure is possible, and fibromyalgia is only one of those, healing should be the goal.

 

Other pages which may be of interest

Fibromyalgia treatment
Evidence based chronic pain treatment


Important:
always work with your doctor to exclude other serious illnesses before concluding that your illness is the result of a mindbody process.


 

 

4 Responses to Fibromyalgia treatment: should pain management or healing be the goal?

  1. Katie says:

    great news letter Hal! you seem to take a diplomatic stance about the issue…I feel there is a danger in being too anti symptom management.. personally I feel symptom management has an important part to play, as many people may not be ready to experience the underlying emotions. Saying that I’m all for informing the more conventional powers to make the options available to all… keep up the great work!!! I’m sure you’ll gain support

  2. hal says:

    Hey Katie thanks for your comment. I’m certainly not against symptom management, it is a vital part of an effective treatment. The point I was trying to make is that only providing symptom management leaves out the possibility of fully healing, or significantly reducing the pain of fibromyalgia through mind-body healing. It therefore contributes to the spiral of hopelessness, stress, pain and disability which characterises fibro and related pain syndromes.

    You also make a great point about getting the pace of treatment right, because in my experience, the pain is always there for a reason. Helping people to accept and heal the underlying emotions, trauma and stress which create fibro needs to be done sensitively and carefully at a pace which can be organically integrated.

    And thanks for the encouragement! It is a very slow process turning the ship around but we’re getting there!

  3. Linda says:

    Dear Hal
    I have had fibro for fifteen years. I have done and tried everything. I am now very overweight and take a lot of codeine. I am now in a place of mental defeat and manage my condition by pacing myself and pain meds, which unfortunately means more weight gain. Did you really heal yourself? I have had ten years of psychotherapy btw.
    Linda

    • hal says:

      Hi Linda,

      Sorry to hear you are still suffering with fibro and also after doing so much therapy.

      Yes I did heal myself, I only have very occasional and minor twinges of pain and fatigue which I think are best considered (as Dr Sarno suggests) an ordinary part of being human. Nothing like the chronic pain and fatigue and other symptoms I used to get.

      I think it was you who called me on the phone recently and we had a discussion about therapy but in case I am mistaking you for someone else, I think there are some important differences in styles of psychotherapy which can make a big difference in ones speed of recovery from TMS. This is why I have trained as a somatic psychotherapist and not as a more talk-style therapist. To respect your privacy I wont go into it further online so please contact me if you would like to talk more.

      All the best,

      Hal

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