What are the benefits of psychotherapy in the treatment of fibromyalgia?

What is fibromyalgia? 

Fibromyalgia affects about 2% of the US population. In 1992 it was recognized as a chronic condition by the WHO and classified as chronic widespread pain in the latest International Classification of Diseases (ICD).

Fibromyalgia is a pain syndrome which causes a number of chronic symptoms of moderate to severe intensity, including chronic diffuse pain with no apparent cause, sensitivity to pressure, fatigue, cognitive problems and sleep disorders.

However, the fact that the pain is not localized and is highly dependent on the person affected, and that biological markers for this conditions do not exist, makes fibromyalgia difficult to diagnose. Patients often face a long period of waiting to get the correct diagnosis.

The latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) classifies fibromyalgia as a "somatoform disorder" (a mental disorder characterized by intense focus on physical (somatic) symptoms, resulting in significant suffering and/or disruption of daily functioning). According to the DSM-5, this diagnosis is considered when no medical condition is identified but certain symptoms, suggestive of illness or injury, have been present for at least 6 months on a permanent basis.

It is therefore possible to think that non-drug treatments could help fibromyalgia patients improve their quality of life.

What are the limitations of drug treatments for fibromyalgia? 

Drug treatments, such as analgesics, anti-epileptics or antidepressants, may be prescribed as a second-line treatment.

Around 91% of patients suffering from fibromyalgia are prescribed various medications which are supposed to relieve their pain. However, the majority of these patients show a certain degree of drug resistance. One study highlighted that only 0-12% of patients were satisfied with their treatments.

Medications usually prescribed to fibromyalgia patients tend to help only in the short term. In contrast, psychotherapy could have long-term positive effects on fibromyalgia.

How can psychotherapy help patients affected with fibromyalgia? 

There are three subjective components of chronic pain:

• The affective component, which represents emotions, in this case linked to pain.
  
• The cognitive component, which refers to all mental processes likely to influence our perception of pain. For example: anxious anticipation, ruminations, etc.
  
• The behavioral component (avoidance, isolation, etc.).
  

Psychotherapy can help patients manage the last two components.

Numerous interventional studies have been carried out, demonstrating the effectiveness of non-medicinal therapies for fibromyalgia. Here are some examples of psychological treatments that are generally used in the management of fibromyalgia:

• Cognitive behavioral therapy (CBT) has shown encouraging results in reducing pain symptoms.
  
• ACT (Acceptance and Commitment Therapy) is also widely used. It is one of a number of recent so-called "contextual" therapies, also known as "third wave" therapies. ACT aims to improve psychological flexibility, by making the patient work on their acceptance of pain, which results in a lower impact of the disease on the patient's life.
  
• EMDR (Eye Movement Desensitization and Reprocessing) can reduce stress, pain and fatigue, according to several studies.
  
• Hypnosis can modify the patient's perception of pain and reduce its intensity, creating an analgesic effect. According to some studies, patients also claim to have more control over their pain.
  
• Mindfulness and meditation may also have an effect on pain, improving patients' quality of life, although their effects are not long-lasting.

Conclusion 

Fibromyalgia is a chronic condition that is still poorly diagnosed, often plunging patients into a long and difficult journey towards the correct diagnosis.

The first-line treatment is based on a non-medicinal approach, which essentially consists of moderate physical exercise, adjusted to the needs and abilities of each patient. Yoga, qi gong and tai chi can be considered for this purpose.

A psychological approach is another option: it aims at improving pain modulation, which impaired in fibromyalgia. Some therapies are recommended more than others because of their proven results on fibromyalgia patients: ACT, CBT, EMDR, hypnosis, mindfulness, etc.

Patients may also be prescribed medication, but it is often less effective in the long term.