Treating CFIDS & Fibromyalgia

Strategies for Pain

www.cfidsselfhelp.org

(Second in a series on treatment options for major symptoms of CFS and fibromyalgia. Other articles discuss fatigue, poor sleep and cognitive problems.)

By Bruce Campbell 

Having CFIDS or fibromyalgia means living with symptoms that persist. The absence of a cure does not mean that there are no treatments. On the contrary, there are many ways to alleviate the symptoms of the two illnesses. This series discusses the major treatment options for four of the most common symptoms of CFS and fibromyalgia: fatigue, pain, poor sleep and cognitive problems. This article focuses on treatments for pain.

As mentioned in the first article, the approach taken in this series is based on three principles:

1. Feeling better: The focus of treatment is not on curing but rather on reducing the effects of symptoms, bringing greater stability and lessening psychological suffering.
   
    

2. Multiple strategies: Because most patients have more than one symptom and most symptoms have more than one cause, it is helpful to use multiple coping strategies.
   
    

3. Experimentation: Because patients are different and because there is no standard treatment for either illness, symptom control is usually achieved through trial and error.

Treating Pain

Pain is usually the central symptom in fibromyalgia and often is a problem for CFS patients as well. Like fatigue, pain can have a variety of causes and is best managed with a variety of strategies, often involving both medications and self-management techniques.

For many CFS and fibromyalgia patients, pain relief through medications may be modest, achieved through the use of non-prescription products such as aspirin and other over-the-counter pain relievers. Others find help through prescription pain relievers such as Ultram (Tramadol) and in some cases narcotics. Prescription medications that improve sleep can have a beneficial effect on pain as well. Anti-depressants such as Elavil (Amitriptyline), Prozac and Paxil are often tried. 

Successful treatment of CFS and fibromyalgia is usually very individualized, depending on factors such as a person's symptom pattern and her response to different medications. Experimentation is usually required to find medications that are helpful. It is difficult to predict which treatment may be successful. Sometimes a medication will be effective for a time, then lose effectiveness. Usually, patients are started on dosages that are a small fraction of normal dosage levels.

As with fatigue, pain is a reflection of the limits imposed by illness, so pacing is helpful. The key is to know your activity limits and to stay within them using techniques like short activity periods, task switching and rest breaks. Taking regular, scheduled rests can be particularly helpful. Such rest is one of the most popular strategies used by people in our program. People who use planned rest often take one or two rests a day, ranging in length from 10 minutes to half an hour. Whatever the length, the secret is to rest on a schedule, regardless of how you feel, rather than waiting for symptoms to intensify. For more on pacing, see Pace Yourself.

With pain, just as with fatigue, it is usually helpful to explore interactions among the three major symptoms, in this case by exploring how fatigue and poor sleep affect pain. For most people, fatigue deepens the perception of pain. When we feel tired, we experience pain more intensely, thus reducing fatigue lessens pain. Similarly, poor sleep intensifies pain so improving sleep can help control pain.

Pain can have other causes as well, including the following:

• Too Much Activity: Ignoring the body’s signals to stop, we often push beyond our limits. Being too active or not balancing activity with rest both worsen pain.
  
   

• Stress and Emotions: Stress deepens our perception of pain and also often leads to muscle tension, which causes pain. Muscle tension is also caused by emotions like worry, frustration and depression. Also, negative emotions often lead to preoccupation with symptoms, which increases the experience of pain
  
   

• Inactivity: Muscles deteriorate through inactivity. Weak muscles contribute to pain. Exercise can help.
  
   

• Body Mechanics: Poor posture or staying too long in one position can make pain more intense.
  
   

• Environmental Factors: Feeling hot or cold, or changes in barometric pressure can deepen pain.

Strategies Effective for Multiple Symptoms

Several causes of pain also appeared on the list of causes of fatigue: overactivity, stress, emotions and inactivity. Using the strategies recommended for combating fatigue also helps with pain. For overactivity, the response is pacing. For stress, stress management techniques. Relaxation procedures and meditation have a double benefit. Because stress deepens the perception of pain, calming through relaxation reduces stress. Because a common response to stress is muscle tension, which creates pain, relaxation also reduces pain by lessening muscle tension. Stress reduction strategies such as those outlined in "Stress Reduction: Five Practical Techniques" have been shown to reduce pain as much as medications, without the side effects or cost.

Since worry, frustration and other emotions create muscle tension, relaxation procedures that reduce pain through reducing stress can also help reduce the effects of negative emotions. Also, our subjective experience of pain is increased by emotions. Fear intensifies pain, so managing anxiety can help control pain. For more, see "Honor Your Emotions." 

Another set of strategies for controlling pain through managing emotions has to do with changes in your thinking. An increase in symptoms may trigger negative thoughts like "I'm not getting anywhere," "I'll never get better," or "It's hopeless." Such thoughts can then make you feel anxious, sad, angry and helpless, intensifying pain and triggering another round of negative thoughts. The article "Taming Stressful Thoughts" describes a system for recognizing and gradually changing habitual negative thoughts.

Because the causes of all four symptoms discussed in this series include overactivity, stress and emotions, using strategies such as pacing, stress management and managing emotions can have a multiplied effect, since they address multiple symptoms.

Pain-Specific Remedies

In addition to using medications and self-management strategies that reduce several symptoms at the same time, there are other non-medical measures you can take specifically in response to pain. We’ll look at three: body mechanics, physical treatments like heat, cold and massage, and guaifenesin.

Being attentive to body mechanics can help you limit your pain. Experiment with how you hold your body and how you move it. Try different postures, both standing and sitting, to find which ones minimize your pain. Also, note how long you can maintain a posture without creating problems. Many patients find that staying in one position for an extended period of time creates stiffness and intensifies pain. The solution is to move periodically. Check your body frequently for muscle tension. Areas that are often tensed up include the jaw, neck and shoulders. Movement, massage or telling yourself to relax can help.

When working in the kitchen, consider placing one foot on a footstool to reduce the strain on your back. If chopping or other tasks that involve repetitive motion cause pain, experiment to find how long you can work without creating pain and how long you have to pause before returning to work. If you have problems standing, consider sitting on a stool.

Physical treatments can help, too. Heat and cold can be used for temporary relief of pain. Heat is best utilized for reducing the pain that results from muscle tension and inactivity. The warmth increases blood flow and thereby produces some relaxation, reducing pain and stiffness. For localized pain, you might use a heating pad or hot packs. For overall relief, people often use warm baths, soaks in a hot tub or lying on an electric mattress pad.

Cold treatments are helpful in decreasing inflammation by reducing blood flow to an area. They also may numb the areas that are sending pain signals. You might use gel packs, ice packs or even bags of frozen vegetables. With both heat and cold, you should not use the treatment for more than 15 or 20 minutes at a time.

Massage of painful areas can also provide temporary relief from pain. Like heat, massage increases blood flow and can also relieve spasms. You can consider three different forms of massage: self-massage using your hands, massage using a handheld device, and professional massage. If you use a massage therapist, ask her to be cautious and to check frequently on your pain sensitivity.

Another popular alternative treatment for pain is guaifenesin, an expectorant and the main ingredient in many cough syrups. The idea of using it as a treatment for fibromyalgia was developed by Dr. Paul St. Armand of UCLA, who believes that use of the product helps correct a metabolic defect in the excretion of phosphates. Although taking guaifenesin has few side effects, many users report that their symptoms increase initially and that improvement doesn’t occur for several months. Like most treatments for CFS and fibromyalgia, guaifenesin is not a cure-all, but it appears to help some patients who use it.