Fibromyalgia treatment

The mind-body approach to the treatment of fibromyalgia was pioneered by US rehabilitation physician Dr John Sarno.  If you are interested in reading more about the  scientific evidence which supports the effectiveness of this approach please take a look at the section on evidence based chronic pain treatment below.

It is my great pleasure to offer this service having learnt the nuances of the approach first hand whilst curing my own 4 year fibromyalgia / chronic fatigue syndrome. You can read some more below about how I recovered, the services I now offer to help other people recover or Sarno’s theory and associated resources.

 

How I recovered from 4 years of chronic pain / fatigue

In my own experience, I was on the diagnostic borderline between fibromyalgia syndrome (FMS), CFS and regional pain syndrome as I experienced multiple pain sites (e.g. starting in my wrists, then moving to my achilles tendons, feet, knees, thighs, lower back, shoulders and neck) as well as sleep disturbance and chronic fatigue.

If you have been suffering from fibromyalgia for some time you, like me, have probably consulted some or all of the following disciplines looking for an effective treatment:

  • doctors
  • medical specialists (e.g. rheumatologists)
  • acupuncturists
  • physiotherapists
  • massage therapists
  • osteopaths
  • myotherapists
  • alternative practitioners, e.g. kinesiologists, Alexander technique etc

In my experience, some helped a bit, some made it worse, and some didn’t help at all.  I found that rest was really the only thing that gave me significant relief… but when you want to get on with your life, needing to constantly rest to settle down the pain and inflammation is not a curative chronic pain treatment.

For those who are interested I have started writing a full account of my descent into and back out of chronic pain. (I’m also happy to talk to you about it in person).  If you have fibromyalgia you are probably most interested in how I recovered so the short version of my recovery follows:

After one particularly memorable consultation with a holistically oriented GP in Warranwood I walked out of the consulting room feeling that even though he hadn’t been able to offer me a definative treatment, I had been thoroughly heard.  I had really been listened to.

As I walked back into the waiting room to pay for the consult an intuition hit me like a veritable bolt of lightning.  I have no idea where it came from, but to this day I can remember the intensity and clarity of this sense of knowing.  It (i.e. my  intuition) said simply “understand your relationship to fear and anger”.

At that stage of my life my intuition didn’t speak to me very much, at least not in that “lightning-bolt out of the blue that you cant possibly ignore” kind of way.  So it was a very significant event and I felt a quiet sense of hope.  I now had a clear direction to pursue.

Understanding the mind-body approach

As soon as I could get in front of a computer I started searching for connections between emotions and pain syndromes.  I found the work of US rehabilitation specialist Dr John Sarno and ordered his book “The Mind-Body Prescription” from Amazon as it was impossible to get in Melbourne at that time.

As soon as it arrived I devoured the book.  His theory was that stress and unconscious emotions lie at the root of chronic pain and fatigue…this dovetailed remarkably with what my intuition told me.  His alternative diagnostic suggestion “Tension Myositis Syndrome” or TMS matched very well with my symptoms and with my tendency to be a perfectionist and a “goodist” – Sarno’s term for someone for whom doing good is  important. He observes that these traits are often present in people with chronic pain and working with them is an important part of making a full recovery.

I started to get better quickly at this point, after realising that the pain is not from physical damage from overuse as I had always believed.  Rather, Sarno suggests the pain is a response mediated by the Autonomic Nervous System as part of a whole-mind-body attempt to manage tension and the stuff that was below the surface of consciousness.

From here on, a virtuous cycle ensued in which less fear of the pain led to less pain, increasing my confidence in the mind-body approach, which in turn led to less fear of the pain that remained.  I had to work consistently at identifying and letting myself feel the emotions which were blocked but given the physical relief which ensued as a result (i.e. reduced pain) I experienced this as an exciting journey of discovery rather than a scary process.

Initially I tried Re-evaluation Counselling to help me understand my emotional self better, which was a great start.  But later on I found that somatic / body based approaches to psychotherapy (in particular Radix Body Centered Psychotherapy) helped me to access the unconscious stuff more deeply and safely.  As a major, major bonus I found that the more I did this style of work on myself my general level of wellbeing picked up immensely and other symptoms of depression / anxiety I had considered normal for years started to drop off also.

The rest, as they say, is history.  These days I consider myself thoroughly cured of fibromyalgia pain.  I still get the occasional twinge of pain which goes away rapidly when I apply my now well practiced mind-body approach to eliminating any symptoms.  And when I am typing frantically to get something finished, or playing the drums loudly, or digging in the garden without pain, I often experience a sense of amazement and disbelief at how much my life has changed.

After spending periods of months in despair that I would be in pain for the rest of my life I feel extremely grateful to have my health back. I also have a much deeper understanding of myself and the reality of the mind-body connection.

How can I help

Having a chronic pain syndrome was a major life change for me.  Since then I have completed a psychology degree studied a range of mind-body psychotherapy approaches in order to pursue my passion for helping other people who are suffering with chronic illness or lack of wellbeing.

I am now practicing in Melbourne, Australia (but phone/skype sessions are also doable by arrangement) and offer the following services in the realm of mind-body healing / wellness:

  • assistance with understanding your pain syndrome and working with your doctor (you should always rule out other serious illnesses with a good doctor before treating your pain as solely a mind-body process)
  • assistance applying the mind-body approach to your unique life circumstances
  • somatic / body oriented psychotherapy to help you get to the root of what is creating the pain syndrome

If you would like my current fee schedule or to speak to me about any of the above, please contact me here. You may also be interested in the following short video I made explaining a bit more about how body psychotherapy can create lasting change.

VIDEO: How does somatic (body-oriented) psychotherapy create lasting change? (5:10)

The theory in a nutshell

As you may have gleaned from reading my website so far I suspect that fibromyalgia syndrome is a severe form of Tension Myositis Syndrome, the diagnostic and accompanying mind-body treatment approach developed by Dr John Sarno throughout his career in rehabilitation medicine.

I myself was on the diagnostic borderline between fibromyalgia syndrome (FMS), CFS and regional pain syndrome as I experienced multiple pain sites (e.g. starting in my wrists, then moving to my achilles tendons, feet, knees, thighs, lower back, shoulders and neck) as well as sleep disturbance and chronic fatigue.

Whilst I am also open to the idea that fibromyalgia has a complex aetiology, my hunch garnered from personal experience is that the body has a way of holding stress, trauma and emotion in such a way that blocks emotional experience and replaces it with pain and fatigue. This may sound crazy to you, and if it does I urge you to consider it only as a hypothesis, and to do some reading and research on the subject. A number of excellent resources have now been produced (see below) demonstrating how the mind-body connection can be used to recover from what many western doctors consider untreatable syndromes such as fibromyalgia, CFS, CRPS and RSI.

The essence of this approach is that if contact can be restored (safely of course) with whatever is in the unconscious realm which is causing the problem, the syndrome can be reversed. Over a period of months of concerted personal work, this was my experience and as I moved through the layers of emotion and stuck energy which showed up as I did somatic style psychotherapy, my fatigue and pain levels dropped away until the point where I no longer had a chronic pain or fatigue problem. It wasn’t always easy but the feeling of getting progressively better each week was incredibly uplifting compared to the cycle of pain and disability I had been in for so many years.

Whilst western medicine on the whole has been slow to embrace the mindbody approach, research is progressing and I encourage you to read more on this (see links below and my roundup of relevant research papers on the science page). If you would like to discuss this treatment approach with me (obligation free) please contact me.

Recommended resources for the lay reader:

“‘Mind-body’ therapy shows promise for fibromyalgia” – report on a study published in the Journal of General Internal Medicine 2010 http://www.reuters.com/article/2010/07/02/us-therapy-fibromyalgia-idUSTRE6614LQ20100702

“The Divided Mind (1-5) Fibromyalgia Pain Treatment – The Epidemic of Mindbody Disorders”- Audio Interview with Dr John Sarno http://www.youtube.com/watch?v=N5rg39kz8bM

Sarno, John. “The Mind-Body Prescription” Warner Books 1999.

Evidence based chronic pain treatment

Dr John Sarno’s Tension Myositis Syndrome (TMS)  / PsychoPhysical Disorder (PPD) approach to the diagnosis and treatment of a range of mindbody conditions  has been the subject of a number of peer reviewed studies.  Whilst undertaking my psychology degree at ANU I had the opportunity to read many of Sarno’s original research studies as well as his books (the latter being generally oriented more towards the sufferer who is trying to get well rather than the academic reader).

In recent years Sarno’s approach has been adopted by a new generation of mind-body oriented physicians and therapists. Encouragingly other authors have also published peer reviewed journal articles on his approach. Whilst there are still relatively few articles written specifically about TMS / PPD theory, there is a substantial mainstream literature exploring the connection between pain presentation and psychosocial factors.  Unfortunately many of these articles only explore cognitive based approaches to pain management. These can be very useful in managing pain levels in many circumstances.  However, the emerging mindbody literature is increasingly demonstrating that a significant subset of pain sufferers will be able to make a complete recovery if they are prepared to work with the unconscious aspects of emotion, which are not the subject of cognitive treatments.

Of the TMS / PPD studies I have reviewed personally all have indicated significant effect sizes for given treatment groups.  This, in combination together with my own clinical experience leads me to conclude that Sarno’s approach is highly effective for the subgroup of patients who can accept the mind-body aspects of their condition.  Studies have been conducted on back pain, fibromyalgia, irritable bowel syndrome and other common pain conditions.

The scholarly reader, practitioner or interested layperson is referred to the following recent articles as a starting point:

 

Michael C. Hsu, Howard Schubiner, Mark A. Lumley, John S. Stracks, Daniel J. Clauw and David A. Williams. 2010. “Sustained Pain Reduction Through Affective Self-awareness in Fibromyalgia: A Randomized Controlled Trial”. Journal of General Internal Medicine; Oct 2010, Vol. 25 Issue 10, p1064-1070.

Hsu, Michael C., Schubiner, Howard. 2010. “Recovery from Chronic Musculoskeletal Pain with Psychodynamic Consultation and Brief Intervention: A Report of Three Illustrative Cases”. Pain Medicine; Jun 2010, Vol. 11 Issue 6, p977-980.

Gordon, Alan. 2010. “Miracles of mindbody medicine”. Healthcare Counselling & Psychotherapy Journal; Jan2010, Vol. 10 Issue 1, p13-18.

 

Alan Gordon in the article listed above comments on a retrospective analysis of treatment success using the TMS / PPD  framework:

“Sarno conducted three formal retrospective studies at the Rusk Institute in 1982, 1987, and 1999 to assess the effectiveness of TMS treatment. In all, 371 randomly selected chronic pain clients were interviewed six months to three years after treatment to determine their level of pain and functional ability. A total of 72 per cent reported being free or nearly free of pain with unrestricted activity, while 16 per cent reported some improvement, and 12 per cent little to no improvement.  One of these three studies was unique in that it included only clients with documented herniated discs. Over a third had been previously advised by physicians to undergo surgery. However, when interviewed between one and three years after TMS treatment, a remarkable 88 per cent of these clients reported being free or nearly free of pain.” (Gordon 2010: p17)

 

The following is an illustrative case study reported by Hsu and Schubiner:

” ‘Nancy’ is a 52-year-old woman who sought treatment for fibromyalgia diagnosed 14 years earlier. Her past medical history was noted for eczema as a child, and irritable bowel syndrome as a young adult while working at a stressful job. In 1980, she had a motor vehicle accident and developed neck and back pain, which had persisted to the time of her presentation. In 1993, she was diagnosed with fibromyalgia, having developed gradual onset of muscle tenderness,fatigue, temporomandibular joint disorder, insomnia, and widespread pain. She was initially treated with medications,physical therapy, and massage therapy. Consultations included two rheumatologists and a pain management clinic, without lasting benefit. Three years prior to presentation,she was diagnosed with a cerebral hemangioblastoma that required surgery. Her pain persisted following the surgery, and she was prescribed Paxil (GlaxoSmithKline, London, England, UK) for persistent anxiety.

Nancy stated that she was in pain most of her adult life. As a homemaker, she had great difficulty doing housework or gardening and would have to lie down and rest in the afternoon. She could not participate in recreational activities with her family, including sitting at the movies.

Her social history was pertinent for being raised by a kind, loving father, and an uninvolved, nonsupportive mother. She became a legal assistant, married, then had two children. At the time of the development of her fibromyalgia and other symptoms, she was raising her children while building a new home. She was determined to be a“perfect” mother and wife, and endorsed being very stressed during this time. When asked what her mother was doing at the time, she started to cry, explaining that her mother was doing what she always did, i.e., taking care of herself and not meeting the needs of her daughter and now also her grandchildren. Nancy endorsed having very high expectations for herself and feeling overly responsible for things not in her control.

On examination, she met the criteria for fibromyalgia with many tender points. The rest of the exam was normal. Her average pain was a “6” out of 10 at the beginning of the MBM program; afterwards, it had decreased to a “1” and remained at that level by her 6-month follow-up appointment.She had no further interventions and was able to discontinue her Paxil. Nancy now reports that she is able to enjoy aquatic exercise and Hatha Yoga workouts, gardening, keeping up with her children and attending events with her family. She currently considers herself to be“cured”, with only an occasional stiff neck that she can easily dismiss. ” (Hsu and Schubiner, 2010: p978-9)

Nancy’s (not her real name) case is illustrative because it indicates the power of the mindbody connection to cause and cure severe pain (and anxiety) in certain people.

 

Sarno’s primary research was published in a number of papers including:

Sarno, John. 1981. “Etiology of Neck and Back Pain: An Autonomic Myoneuralgia?”.  Journal of Nervous and Mental Disease Vol 169 No 1  p55-59.

Sarno, John. 1977. “Psychosomatic back ache”. Journal of Family Practice Vol 5: p353-357.

Sarno, John. 1976. “Chronic back pain and psychic conflict”. Scandinavian Journal of Rehabilitation Medicine Vol 8: p143-153.

 

Sarnos monographs are also recommended, particularly his later works “The MindBody Prescription” and “The Divided Mind”:

Sarno J. The mindbody prescription: Healing the body, healing the pain. New York: Warner Books; 1998.

Sarno J. The divided mind: The epidemic of mindbody disorders. New York: Harper Collins Publishers Inc; 2006.

“The MindBody Prescription” also contains a section for the academic reader with further explication of Sarno’s position on the psychodynamics of pain syndromes.

 

Some other peer reviewed journal articles which lend support to the notion that mindbody factors are important in pain treatment:

 

David Schechter, AP Smith, J Beck, J Roach, R Karim, S Azen. 2007. “Outcomes of a Mind-Body Treatment Program for Chronic Back Pain with No Distinct Structural Pathology-A Case Series of Patients Diagnosed and Treated as Tension Myositis Syndrome “. Alternative Therapies in Health and Medicine. 2007. Vol. 13 (5): 26–35

Burns JW, Quartana PJ, Bruehl S. 2008. “Anger inhibition and pain: conceptualizations, evidence and new directions.” J Behav Med. 2008 Jun;31(3):259-79

Burns JW, Quartana P, Gilliam W, Gray E, Matsuura J, Nappi C, Wolfe B, Lofland K. 2008. “Effects of anger suppression on pain severity and pain behaviors among chronic pain patients: evaluation of an ironic process model.” Health Psychol. 2008 Sep;27(5):645-52.

Berry DS, Pennebaker JW. 1993. “Nonverbal and verbal emotional expression and health.”. Psychother Psychosom. 1993;59(1):11-9.

EA Walker, D Keegan, G Gardner, M Sullivan, WJ Katon, and D Bernstein. 1997. “Psychosocial factors in fibromyalgia compared with rheumatoid arthritis: I. Psychiatric diagnoses and functional disability” Psychosom Med November 1, 1997 59:565-571

 

The reader is also referred to the evidence summary and substantial bibliographies contained in the “Medical evidence” section of the TMS Wiki website.

 

 

 

 

One Response to Fibromyalgia treatment

  1. […] 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 […]

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