Table of contents:
- Fibromyalgia: psychological treatment
- Cognitive behavioral therapy
- Health education
- Fibromyalgia: drug treatment
- Fibromyalgia: physiotherapeutic treatment
- Fibromyalgia: natural treatment
By Nicolás Ruiz-Robledillo. January 16, 2018
Fibromyalgia is a chronic and complex disease, with nonspecific causes, that generates pain in the person who suffers it, which can become disabling and affect physically but also psychologically. No specific treatment is known to cure this disease, and today a series of pharmacological measures are combined with psychological intervention and some alternative therapies in order to improve the symptoms and quality of life of patients.
In this PsicologíaOnline article, we address the question of fibromyalgia treatment.
You may also be interested in: Fibromyalgia: what it is, causes and symptoms Index- Fibromyalgia: psychological treatment
- Cognitive behavioral therapy
- Health education
- Fibromyalgia: drug treatment
- Fibromyalgia: physiotherapeutic treatment
- Fibromyalgia: natural treatment
Fibromyalgia: psychological treatment
The main objective of psychological intervention in people with fibromyalgia is to control “the emotional aspects (mainly anxiety and depression), cognitive aspects (the perception of one's own efficacy, the belief about the personal capacity to overcome or manage the symptoms of fibromyalgia), behavioral (ordinary activities that are reduced or eliminated as a consequence of fibromyalgia) and social (impact of the disease on the patient's socio-family sphere) (García-Bardón, 2006).
As studies show, distorted thoughts and irrational beliefs about the perception of yourself and your current situation are directly related to pain and personal disability in the development of a chronic disease. In addition, the meaning that the individual brings to the situation, the way in which he constructs and attributes a meaning to it, determines the perception of pain and the way in which the symptoms appear. It is clear that cognitive patterns, as in other types of pathologies, play a crucial rolein the course of the pathology, assuming an important risk factor. It has been shown that the existence of negative cognitions about pain correlates with its perceived intensity, the patient's general emotional distress and the interference of pain in daily life. In addition, the coping styles that the subject sets in motion predict the chronic course of the disease, the catastrophic perceptions of it, or the fear of future problems or injuries. (Mingote et al. 2002).
In the study carried out by García-Bardón et al. (2006), 68.5% of the patients who underwent the intervention program developed by the authors had some type of psychological disorder before treatment . The pathologies that appeared most frequently were dysthymia (19.2%), major depressive disorder (17.8%), anxiety-depressive disorder secondary to an organic disease (12.3%), generalized anxiety disorder (2.7%) and adaptive (1.4%).
As can be seen, psychological intervention in this type of disorder is justified by the significant burden that these factors have both in the evolution and in the maintenance of symptoms. Despite the fact that the influence of these types of factors on the origin of fibromyalgia is not clear, as already mentioned, studies point to several hypotheses where factors such as stress or suffering from trauma may play an important role and, therefore,, psychological intervention at the primary prevention level would also play a relevant role.
Psychological intervention has often been divided in the studies carried out on fibromyalgia interventions into those that use cognitive behavioral therapy and those that use education / information as a therapeutic process.
Cognitive behavioral therapy
This type of intervention is based on the addition to the operant techniques of behavior modification, all those cognitive strategies based on distraction and the imaginative transformation of pain and context (Cruz et al. 2005).
The results obtained in this type of intervention are significant in most of the investigations carried out. In a study carried out by Moioli and Merayo (2005), after the intervention where relaxation techniques (progressive, passive and self-hypnosis), self-concept, emotional states, social skills were worked together with a physical training program, the patients notably improved in various components of the disease. After the end of the program, levels of anxiety, depression and pain decreased markedly.
These results are comparable to those obtained in another work, where a cognitive-behavioral intervention based on relaxation training, the development of coping strategies and information on pain was applied. In this study, carried out by Pérez et al (2010), the patients obtained a clinical improvement in their anxiety and depressive symptoms. According to the authors, the effectiveness of this type of approach in the treatment of fibromyalgia would lie mainly in teaching patients effective coping strategies to adequately cope with the demands of the disease, making a better adaptation possible of the individual to the suffering of this, thus leading to an improvement in their emotional state and in their quality of life.
Health education
Interventions that are based on providing the patient with information about the disease, its course and its treatment have also been found to have positive effects (García-Campayo et al. 2005; García-Bardón et al. 2007).
In a study carried out by Mayorga-Buiza et al. (2010), where an intervention program in health education was applied, positive effects are shown in various variables of the disease. The program that was applied was based on the development of four education sessions, in an interval of two months, whose content of the sessions consisted of general information about the disease, an explanation of its benign nature, guidance on possible causes, influence of the state of mind and the coping mechanisms on its course, information about physical / rehabilitative measures and postural hygiene and relaxation techniques. After applying the program, the patients improved the perception of their quality of life, anxiety-depressive symptoms were reduced, and as the main result,patients reduced their visits to primary care by 60%.
In another study carried out by García-Campayo et al. (2005), where an intervention based on the presentation of information about the disease was implemented (what is fibromyalgia, why does it occur, what are its symptoms, how is it diagnosed and what means exist to treat it), the results were shown, again, significant.
Fibromyalgia: drug treatment
Based on the review of pharmacological interventions carried out by Alegre et al. (2005), it is observed that the drugs that have acquired the greatest relevance in the treatment of patients with fibromyalgia are antidepressants, mainly those that correspond to the type of tricyclics and selective serotonin reuptake inhibitors (SSRIs). Low doses of amitriptyline and cyclobenzaprine have been shown to moderately improve pain, despite the frequency of occurrence of adverse effects in patients receiving these drugs.
Studies conducted with other antidepressant drugs, such as SSRIs (Selective Serotonin Reuptake Inhibitors), have focused mainly on fluoxetine, although in general it is not clear in the different studies carried out according to the review carried out by the authors, the efficacy of the administration of this type of antidepressant drug in patients. In this sense, according to the review carried out by Sarzi-Puttini et al. (2008), the differences in the response to the different treatments could be determined by genetic differentiation. According to the author, recent studies on genetic polymorphism have shown that based on where it is found, that is, in the serotonergic or dopaminergic systems, an antidepressant or dopaminergic treatment, respectively, would be the most appropriate to prescribe.
In relation to other types of treatments, which include analgesics, muscle relaxants, antiepileptics or anticonvulsants, the results have also been mixed (Alegre et al. 2005, Sarzi-Puttini et al. 2008). According to the reviews carried out, the results have not been satisfactory largely due to the limitations of the studies carried out, mainly due to the small number of participating patients and the concomitance of pharmacological treatments. In general, some efficacy has been found in the joint administration of analgesics and non-steroidal anti-inflammatory drugs, mainly in spontaneous pain, but not in the "trigger points" discussed above. Regarding muscle relaxants, only pain and sleep improved in the short term, but the effect was not maintained in the long term, perhaps due to the habituation effects of this type of substances. Drugs with antiepileptic and / or anticonvulsant properties have also shown inconclusive results, although they have been shown to be effective in some studies in reducing levels of pain, sleep and fatigue.
In general, it seems that the most effective pharmacological treatment resides in the implementation of interventions where antidepressants form the cornerstone of therapy, although the studies are not conclusive due to various limitations. Further research is needed in this regard, trying to reduce the limitations presented by the study of a pathology whose etiology is still unknown and whose treatment, therefore, also becomes uncertain.
Fibromyalgia: physiotherapeutic treatment
The general poor physical condition of patients suffering from fibromyalgia can contribute to the perpetuation of pain, so one of the most recommended treatments in the disease consists of low intensity aerobic exercise (walking, cycling or swimming in pools with hot water) (Cruz et al. 2005).
According to the review by Fernández et al. (2008), the prescription of physical exercise has shown significant results in the symptoms developed by patients suffering from this disease. According to the author, the criteria provided by the "American College of Sport Medicine" (ACSM) are the following:
- The frequency of physical exercise should be at least 2 days per week, with an exercise intensity between 40% and 85% of the reserve heart rate, or between 55% and 90% of the maximum heart rate.
- In addition, the duration of the exercise should be at least 20 min. (between 20 and 60 min), either through continuous exercises or intermittent exercises distributed throughout the day.
- The use of this aerobic-type exercise should last for at least 6 weeks.
In a review cited by the authors (Busch et al. 2002, cited by Fernández et al. 2008), the conclusions of different studies carried out with patients suffering from fibromyalgia who had received an exercise-based treatment were studied aerobic. The conclusions reached by the researchers after analyzing these studies were as follows: the most significant improvements are found in the personal well-being factorAlthough moderate level effects have also been found in the physical fitness of patients undergoing this treatment. However, the effects of the intervention on fatigue, pain or sleep are generally weak and inconsistent. Furthermore, there is also no solid evidence that exercise significantly improves the psychological state of patients. The combination of various exercise modes did not produce better results either.
Currently, studies have continued to be carried out, where interventions have been based on the application of training programs based on physical exercise. In a more current review of these studies (Fernández et al., 2008), it is revealed that one of the main problems with this type of intervention is the lack of adherence to treatment.In most cases, severe pain, stress, disability, depressed mood or social support are factors that prevent the individual from constantly being involved in the start and development of the program. Furthermore, in congruence with the results obtained in the previous review, it is revealed that exercise continues to not significantly and stable improve those central symptoms of the clinical picture, such as fatigue, pain or psychological state.
The data obtained in other reviews are similar, although they differ in certain aspects (Busch et al., 2008). In this new review carried out as an update by the same authors who carried it out in 2002, similar results were obtained in relation to the size of the moderate effect of aerobic exercise on physical and general function, but positive effects on pain were also found . Despite the numerous limitations presented in the studies, as described above, this new review shows that aerobic exercise produces significant effects on depression, tender points, general well-being, physical function, self-efficacy and symptoms.
In general, more in-depth research in this area is necessary, trying to apply measures and psychosocial intervention techniques that, at first, promote adherence to treatment by patients, so that researchers are certain that it you have carried out the training program properly. For this, it is essential to improve aspects such as pain or the psychological state of the subject, in order to establish a basic functional capacity from which the patient can begin the exercises. Psychological intervention at this point can help the patient in promoting adherence to treatment and previously, in improving the general function of the individual that allows him to carry out the prescribed exercises.
Fibromyalgia: natural treatment
The absence of effective treatments leads patients to seek alternative interventions that can alleviate the symptoms they suffer. In this sense, alternative therapies are a forgotten field of study in the development of fibromyalgia research, despite the fact that patients make use of them to a greater or lesser extent. The current literature does not offer enough research to obtain reliable conclusions about the effectiveness of the application of this type of method in reducing symptoms and improving the quality of life of patients, although some studies are already beginning to offer some results.
In a review by Llor (2008), the ability of alternative therapies to improve the symptoms of various rheumatological pathologies is evidenced. In relation to fibromyalgia, balneotherapy reduces pain in a similar way to physical exercise, in addition to improving clinical symptoms, mainly sleep. On the other hand, Thalassotherapy, together with physical exercise and health education contributes to an improvement of symptoms and quality of life in patients. Regarding Thermotherapy,This notably improves symptoms by establishing hot water baths (38 ºC) for fifteen minutes together with the rehabilitative treatment of the pathology. Exercise in the aquatic environment is one of the therapies that has the most evidence in relation to its effects on symptoms. Exercises in hot pools notably improve pain, psychological symptoms, physical capacity and quality of life in the short term, maintaining the improvement in pain and psychological symptoms in the medium term.
However, Thieme et al. (2003) found evidence against the application of thermotherapy programs in combination with relaxation techniques. After the application of this type of intervention, the individuals showed greater intensity of pain, greater emotional distress and greater interference produced by the disorder in the development of activities of daily living.
In general, there is no reliable empirical evidence about the benefits of this type of therapy in the pathology under study. A more exhaustive study of the possibilities of applying this type of intervention in patients suffering from fibromyalgia is necessary, with the aim of including them or not, in standardized therapeutic plans where different techniques whose results have been proven are integrated.
This article is merely informative, in Psychology-Online we do not have the power to make a diagnosis or recommend a treatment. We invite you to go to a psychologist to treat your particular case.
If you want to read more articles similar to Treatment for fibromyalgia, we recommend that you enter our category of Clinical Psychology.