The Fibromyalgia Dialectic: Finding the Balance Between Rest and Move

One of the most confusing aspects of Fibro is that often the person suffering does not know whether to rest more or to move more. These two ideas seem to be diametrically opposed. The truth is, they are both right. And that’s the confusing part.

There is a new and growing trend in treatment called DBT — Dialectical Behavior Therapy. The dialectic addresses two states of mind that seem to be opposites, but actually coexist: the need to accept wherever we are in the moment and the need to change. For the ideal therapeutic result, both the therapist and the patient must understand that they are both true, and operative in the moment. For Fibro patients, they are often caught between the body’s desire to stay still — as interpreted through the amount of pain being perceived, and the knowledge that motion may relieve pain.

It is no secret that exercise helps Fibro, and in fact helps all kinds of chronic pain and illness. The problem with the Fibro sufferer is that they are thinking two things at once:

Mind says, “Go to the pool! Take a walk! You’ll feel so much better!”

Body says, “Accept me where I am! Listen, I’m telling you to rest!”

This is often followed by, “If you go for that walk/swim/yoga class you’ll pay a price. You’ll feel worse later. You’ll over do it. And the pain will be worse tomorrow.”

Pain is then multiplied by the added layer of fear, and motion no longer seems possible.

The therapeutic goal is to recognize that these ideas can and do exist together in the mind, and that does not mean you stay stuck. The secret to successful treatment is to find the balance, and not allow fear to dominate the internal conversation.

Acknowledge pain. Move gently. Allow for healing as a possibility. Be a warrior.

A Better Model for Treatment of Fibromyalgia

It is estimated that over 5 million Americans suffer from Fibromyalgia, most of them women, the vast majority of those over 40. Fibro is clinically defined as pain in a number of points throughout the body, and symptoms can also include fatigue, sleep disorder, nausea, headaches, memory loss and depression. Pain and other symptoms can range from mild to severe, and from acute to chronic. While a number of medical treatments have emerged in the last few years, no one treatment helps everyone, and in some cases, treatments that work for a while stop being helpful.

Many doctors feel defeated by Fibro. It’s complicated to treat and Fibro patients are frequently ill. Many physicians are now referring Fibro cases for CBT. This is a great step and can be the key to successful management, even cure. So, how does it work? Let’s take a look:

Now, all of these treatments can be helpful. A combination of these treatments may be the ideal cocktail for lifelong management of Fibro symptoms. However, if the patient is like most of mine, they are not in either a mental or physical state to pursue any treatment that involves getting up out of bed. As it is presented, this treatment model overwhelms the Fibro sufferer with guilt, as they now know how many things they are not doing to help themselves, in addition to being in constant pain. This compounds depression and keeps people in bed.

So, practitioners would be more effective if they learned to think about the treatment model differently. The central goal is to improve the person’s quality of life, which begins with increasing basic level of functioning. When a person is in extreme pain, can’t sleep, and is also depressed, it is not likely that person will be able to get to the gym. So, here is my alternative treatment model:

In this model, the therapist focuses on helping the patient recognize destructive patterns of thought and behavior that keep them stuck.

People often ask me if I believe Fibromyalgia is “all in your head.” I don’t. I think pain and suffering in the body are real. I do believe that there is an emotional/psychological component though, and often the gateway to successful treatment is through the thoughts and feelings. This is also why traditional western medicine is not very successful as a treatment model.

Fibromyalgia is a complex condition, but it can be treated and managed well. A word of caution, though: If someone tells you they have the one cure that works for everyone, try someone else. It’s just not true. But we’ll keep at it until we find one that works for you.

(this post first appeared on Get Help Israel)