Fibromyalgia treatment

Fibromyalgia is a chronic and complex disease with nonspecific causes, which causes pain in the the person who suffers from it, which can become disabling and affect physically but also psychological. 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 patients.

In this PsychologyOnline article, we address the question of fibromyalgia treatment.

Index

1. Fibromyalgia: psychological treatment
2. Cognitive behavioral therapy
3. Health education
4. Fibromyalgia: drug treatment
5. Fibromyalgia: physiotherapeutic treatment
6. Fibromyalgia: natural treatment

The psychological intervention in people with fibromyalgia Its main objective is to control “the emotional aspects (anxiety and depression, mainly), cognitive (the perception of one's own efficacy, belief in one's ability to overcome or manage fibromyalgia symptoms), behavioral (ordinary activities that are carried out 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 self-perception and self-awareness Your current situation is directly related to pain and personal disability in the development of a chronic illness. 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 symptom. It is clear that cognitive schemas, as it happens in other types of pathologies, play a crucial role in the course of the pathology, assuming an important risk factor. Negative cognitions about pain have been shown to correlate with intensity perceived from this, the general emotional discomfort of the patient 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 about 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 trastorn. The pathologies that appeared more frequently were dysthymia (19.2%), major depressive disorder (17.8%), anxious-depressive secondary to organic disease (12.3%), generalized anxiety disorder (2.7%) and adjustment disorder (1.4%).

As can be seen, psychological intervention in this type of disorder is justified by the important burden that these factors have both in the evolution and in the maintenance of the symptom. Despite the fact that the influence of this type 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 they can play an important role and, therefore, psychological intervention at the primary prevention level would also play a relevant role.

Psychological intervention has been frequently divided in the studies carried out on interventions in fibromyalgia in those that employ cognitive behavioral therapy and those who use the education / information as a therapeutic process.

This type of intervention is based on the addition to the operant techniques of the 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 were worked (progressive, passive and self-hypnosis), self-concept, emotional states, social skills coupled with a physical training program, patients improved markedly in various components of disease. Upon completion of the program, anxiety, depression and pain levels decreased notably.

These results are comparable to those obtained in another work, where a cognitive-behavioral intervention was applied based on relaxation training, development of coping strategies and information about pain. In this study, carried out by Pérez et al (2010), the patients obtained a clinical improvement in anxiety and depressive symptoms. According to the authors, the efficacy of this type of approach in the treatment of fibromyalgia would mainly reside in the teaching effective coping strategies to patients to adequately cope with the demands presented by the disease, making possible a better adaptation of the individual to the suffering of this, thus leading to an improvement in their emotional state and in their quality of life.

Interventions that are based on providing the patient information about the disease, the course of this 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, explanation of its benign nature, guidance on possible causes, influence of state of mind and coping mechanisms about its course, information about physical / rehabilitative measures and postural hygiene and techniques of relaxation. After the application of 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 was implemented based on the presentation of information about the disease (what is fibromyalgia, why is it produces, what are its symptoms, how is it diagnosed and what means exist to treat it), the results were shown, again, significant.

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 the antidepressants, mainly, those that correspond to the type of tricyclics and selective serotonin reuptake inhibitors (SSRIs). Low doses of amitriptyline Y cyclobenzaprine they moderately improve pain, despite the frequency of appearance of adverse effects in patients who are administered these drugs.

Studies with other antidepressant drugs, such as SSRIs (Selective Serotonin Reuptake Inhibitors), have focused mainly on the fluoxetine, although in general it is not clear in the different studies carried out according to the review carried out 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, that is, in the serotonergic system or in the dopaminergic system, 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 due in large part to the limitations of the studies carried out, mainly, due to the small number of participating patients and the concomitance of treatments pharmacological. In general, some efficacy has been found in the joint administration of painkillers and non-steroidal anti-inflammatory drugsmainly in the spontaneous pain, but not in the "trigger points" discussed above. Regarding muscle relaxants, only short-term pain and sleep improved, but the The effect was not maintained in the long term, perhaps due to habituation effects typical of this type of substances. Drugs with antiepileptic and / or anticonvulsant properties have also shown results inconclusive, 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 lies in the implementation of interventions where the Antidepressants form the cornerstone of therapy, although studies are inconclusive due to various limitations. More research is needed in this regard, trying to reduce the limitations of the study of a pathology whose etiology is still unknown and whose treatment, therefore, also becomes uncertain.

The general poor physical condition of fibromyalgia patients may contribute to the perpetuation of pain, so one of the most recommended treatments in the disease consists of on the performing 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 intensity of exercise between 40% and 85% of heart rate reserve, or between 55% and 90% of heart rate maximum.
• 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 a treatment based on aerobic exercise were studied. The conclusions reached by the researchers after analyzing these studies were as follows: the most significant improvements are found in the personal wellness factor, although 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 several exercise modalities did not produce better results either.

Currently, studies have continued to be carried out, where the 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 of 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 constant involvement in the initiation and development of the Program. In addition, consistent with the results obtained in the previous review, it is clear that the exercise continues without improving in a significant and stable way 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, results were obtained similar in relation to the size of the moderate effect of aerobic exercise on physical and general function, but also They found positive effects on pain. Despite the numerous limitations presented in the studies, as described above, this new review shows that the Aerobic exercise has significant effects on depression, tender points, general well-being, physical function, self-efficacy, and symptom.

In general, it is necessary to more in-depth research in this area, trying to apply measures and psychosocial intervention techniques that initially promote adherence to treatment on the part of the patients, so that the researchers are certain that they have carried out the training program in a adequate. For this, it is essential to improve aspects such as the pain or 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 above, in improving the general function of the individual that allows him to carry out the exercises prescribed.

The absence of effective treatments leads patients to seek alternative interventions that can alleviate the symptoms they suffer. In this sense, alternative therapies They 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 sufficient research to obtain reliable conclusions about the effectiveness of the application of this type of methods in reducing symptoms and improving the quality of life of patients, although some studies are 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, the Thalassotherapy, together with physical exercise and health education, it contributes to an improvement in symptoms and quality of life in patients. According to the Thermotherapy, This notably improves the symptoms by establishing hot water baths (38 ºC) for fifteen minutes together with the rehabilitation treatment of the pathology. Exercise in an 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, and ability to physical and quality of life in the short term, maintaining the improvement in pain and symptoms in the medium term psychological.

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 more intensity of pain, greater emotional distress and increased interference produced by the disorder in the development of the activities of the daily life.

Generally, 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, with the aim of including them or not, in standardized therapeutic plans where different techniques are integrated whose results have been tested.

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 Fibromyalgia treatment, we recommend that you enter our category of Clinical psychology.