August, 2006

Prevalence and Costs
Fibromyalgia syndrome (FMS) affects between 2%-6% of the population, with 80%-90% of those affected being women (“Fibromyalgia,” 2005. Estimates of direct and indirect healthcare and economic costs range up to 20 billion dollars annually (Wolfe, Anderson et al, 1997b). Many FMS patients are unable to work or to carry out the activities of daily living, and suffer depression and other related conditions. Fibromyalgia, along with back pain and arthritis, have been identified as the chronic pain syndromes that contribute the greatest clinical and economic burden to society (“Fibroymyalgia;” Wolfe, Anderson et al, 1997a.)

What is Fibromyalgia?
The American College of Rheumatology (ACR) criteria for a diagnosis of fibromyalgia includes having pain in more than three locations in the body for more than three months, accompanied by specific anatomical tender points. There are 18 of these points, 9 on each side of the body. For an adult to be diagnosed with fibromyalgia, he or she must have severe discomfort when pressure is applied to 11 out of 18 of these tender points (Romano, 2000; Smith, 2001; Wolfe, 1990), although there these guidelines are not universally accepted (“Fibromyalgia,” 2005).

In addition to fibromyalgia’s characteristic muscle pain and fatigue, symptoms can include sleep difficulties, depression, inability to concentrate (so-called “fibro-fog”), headaches, morning stiffness, abdominal pain, bloating, alternating constipation and diarrhea, infertility, and parasthesias (Fibromyalgia, 2005).

The causes of fibromyalgia remain unclear, but some of the suspected factors include physical trauma, chronic pain, muscle abnormalities, viral or bacterial infection, immune system dysfunction, emotional trauma, and hormonal changes (“Fibromyalgia,” 2005). Some experts believe that cases of fibromyalgia caused by trauma or serious infectious illness tend to be more severe and have a worse prognosis (Romano, 2000).

Medical Treatment
Since the cause is unknown, medical treatment of fibromyalgia is largely symptomatic. Medications for pain management including anti-inflammatories, narcotics, and acetaminophen. Other medications include antidepressants, cyclobenzaprine for muscle spasm, anti-anxiety drugs, antispasmodics for bowel symptoms, and sleep medications. Because each patient presents with different symptomatology, treatment, including complementary and alternative approaches, must be individualized (Goldenberg, Burckhardt, et al, 2005; Morris, Bowen, et al, 2005).

Mind/Body Treatments Often More Effective
FMS patients with chronic pain symptoms can clearly benefit from relaxation techniques, biofeedback, hypnosis, cognitive-behavioral therapy and meditation skills (Berman & Swyers, 1997; Berman & Swyers, 1999; Beckelew, Conway, et al, 1998; Edinger, Wohlgemuth, et al, 2005; “Fibromyalgia,” 2005; Haanen, Hoenderdos, et al, 1991; Hadhazy, Ezzo, et al, 2000; Jackson, O’Malley & Kroenke, 2006; Kaplan, Goldenberg, et al, 1993; Leao & da Silva, 2004; Singh, Berman et al, 1998). Interestingly, patients fared better when hypnosis was combined with analgesic suggestions than when hypnosis was combined with relaxation suggestions (Castel, Perez, et al, 2006).

Results in juvenile fibromyalgia patients using CBT have also been impressive, with one study’s authors’ reporting significant reductions (p=.006) in patient pain, anxiety, fatigue, somatic symptoms and quality of sleep (Degotardi, Klass, et al, 2005; Kashikar-Zuck, Swain, et al, 2005). A recent review concluded that CBT was effective, especially when used as part of a comprehensive program; it was particularly effective with juvenile fibromyalgia (Bennett & Nelson, 2006).

In one 2006 study, subjects who received cognitive-behavioral treatment for FMS reported significant reductions in pain, and improvements in cognitive and affective variables; the operant-behavior treatment group had significant improvements in physical functioning and behavioral variables; both groups maintained their improvements at 6- and 12-month follow up; subjects in the attention-placebo group actually deteriorated (Thieme, Herta & Dennis, 2006). Authors of a 2006 review concluded that for the 11 painful syndromes reviewed (including FMS), CBT was “the most consistently demonstrated to be effective” (Jackson, O’Malley & Kroenke, 2006).

Patients self-using audiotaped guided imagery reported improved self-efficacy and improvement in non-pain FM symptoms (Menzies, Taylor, et al, 2006).

There is strong evidence that these mind-body therapies plus exercise are more effective than standard medical treatment and can lead to patients needing fewer office visits and less medication (Bernard, Prince, et al, 2000; Buckelew, Conway, et al, 1998; Hadhazy, Ezzo, et al, 2000; Rossy, Buckelew, et al, 1999; Wolfe, Anderson, et al, 1997b).

Research suggests that mind-body therapies are particularly effective when used as part of a multidisciplinary approach to treatment (Berman & Swyers, 1999; Bernhard, Price & Edsall, 2000; Romano, 2000) Patients taking an active role in their treatment can be a vital factor in coping successfully with FMS (Buckelew, Huyser, et al, 1996; Drum, 1999); patients with high positive expectancy also have improved outcomes (Goossens, Vlaeyen et al, 2005)—mind body approaches such as guided imagery and hypnosis can help build positive expectancy.

Used as a complementary treatment, guided imagery can help patients cope with fibromyalgia syndrome, save medical care resources, and reduce patient economic burdens and suffering.

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