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Strategies for Pain

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By Bruce Campbell


(Note: From the series Treating CFS and Fibromylgia.)

Pain is usually the central symptom in fibromyalgia and is often a problem for CFS patients as well.


For people with FM, pain is generally felt all over the body, though it can start in one region and spread or move from one area to another. It may be accompanied by neurological problems such as tingling and burning or numbness in the hands, arms, feet, legs or face. For people with CFS, pain may be experienced in the joints or, more commonly, as an overall body pain ("I feel like I've been run over by a truck.")


Treatments for Pain

Because pain can have a variety of causes, including overactivity, deconditioning, non-restorative sleep, anxiety and stress, it is best managed with a variety of strategies, involving both medications and self-management techniques.


Medications
People with FM and CFS who seek pain relief through medications usually begin with non-prescription products, such as aspirin and other over-the-counter pain relievers. Others find help through prescription medications such as Ultram (Tramadol) and, in some cases, narcotics. Prescription drugs that improve sleep can have a beneficial effect on pain as well. Anti-depressants, such as Elavil (Amitriptyline), Prozac and Paxil are often tried.


In 2007, the FDA approved Lyrica (pregabalin) as the first drug tested and proved helpful for the treatment of fibromyalgia. Since then, two other drugs have been approved: Cymbalta (duloxetine hydrochloride) and Savella (milnacipran HCl).


It is impossible to predict which treatment will be successful, so experimentation is usually required to find medications that are helpful. Usually, patients are started on dosages that are a small fraction of normal dosage levels.


Some patients experience neuropathic or nerve pain, burning or electric shock sensations, felt most commonly in the hands and feet. This type of pain is often treated with anti-seizure medications, such as Neurontin.


Many fibromyalgia patients also experience Myofascial Pain Syndrome (MPS), a pain condition localized in trigger points (specific locations in muscles or fascia), often in the neck or shoulders. MPS may be treated with medication and the injection of local anesthetics into the trigger points.


Exercise, Posture & Movement
Exercise is one of the most-commonly prescribed treatments for FM and can be helpful for CFS as well. An exercise program done regularly can help reduce stiffness, counteract deconditioning and improve one's outlook. A program of gentle stretching can be helpful for both FM and CFS. In addition, people with FM are usually helped by frequent breaks for stretching, to reduce stiffness.


FM patients especially can help reduce their pain by experimenting with how they hold their body and how they move. Try different postures to find which ones minimize 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 increases stiffness and intensifies pain, so moving periodically can help you avoid pain.


Pacing
A frequent cause of pain is overdoing or having an activity level that is beyond a person's limits. Pacing, which can include some or all of the following strategies, is an effective antidote.

  • Reducing overall activity level
  • Setting priorities
  • Taking scheduled rests
  • Having short activity periods
  • Switching between high and low intensity tasks
  • Using best hours of day for most demanding activities
  • Delegating
  • Knowing mental and social limits
  • Keeping records to see links between activity and symptoms


Relaxation
Being in pain often triggers muscle tension and anxiety, both of which can intensify the experience of pain. Muscle tension is directly painful, while anxiety contributes to the experience of pain indirectly by increasing stress and a sense of helplessness. Relaxation is an antidote to both tension and stress. Also, it offers a distraction from pain.


Relaxing activities may include exercise, mindful breathing, baths and hot tubs, massage, rest and listening to tapes. You might also consider practicing a formal relaxation or meditation procedure on a regular basis. (For more on relaxation, including step-by-step instructions on several relaxation procedures, see articles in the Stress Management archive.)


Heat, Cold & Massage
Heat, cold and massage 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 decrease 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 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.


Treating Depression
Depression, which is common in FM and CFS, intensifies pain. People who are depressed have a lower threshold for pain. To the extent that we feel helpless, our experience of pain is likely to be worse. Self-help strategies, sometimes in combination with medications and counseling, can help manage the emotional aspects of chronic disease. See the Emotions archive for ideas on treating depression.


Pleasurable Thoughts and Activities (Distraction)
Experiencing ongoing pain can lead to becoming preoccupied with pain. Immersing yourself in pleasant thoughts and activities can lessen pain symptoms by providing distraction. Imagery can be especially helpful, as you visualize a pleasant scene. The imagery will be more effective if you can involve as many senses as possible. If you want to transport yourself to the beach, see the light shimmering on the water, feel the warmth of the sun on your skin, hear the waves crashing and smell the mustard from the hotdogs.


Engaging in activities that bring pleasure can also provide distraction from pain. Examples include reading a book, watching a movie, listening to or playing music and spending time in nature.


Healthy Self-Talk
Thoughts can have a dramatic effect on our moods and then in turn on our perceptions of pain. This can be a vicious cycle. 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 us feel anxious, sad, angry and helpless, intensifying pain and triggering another round of negative thoughts and more muscle tension. Learn to recognize and to change your habitually negative thoughts using a three-step process described in the article Taming Stressful Thoughts.


Improving Sleep
Lack of good sleep increases fatigue, which in turn intensifies the experience of pain. Taking steps to improve sleep will also reduce pain. Treating sleep problems often involves medications. Self-management strategies for improving sleep include limiting the use of daytime naps, having a comfortable and quiet sleep environment, going to bed and getting up at consistent times, and avoiding stimulants like coffee, chocolate and smoking. (For a discussion of medications for sleep, as well as self-help strategies, see the article Solutions for Sleep.)


Note on Coping Bonus: Because the four symptoms discussed in this series share common causes (overactivity, stress and emotions), treating these causes with strategies such as pacing, stress management and managing emotions has a multiplied effect, since the strategies address multiple symptoms.