The Psychological Aspects of Fibromyalgia

Fibromyalgia is a condition that is characterized by a generalized achiness throughout the entire body along with anxiety, depression and lethargy. Other symptoms include heightened sensitivity to pressure, irregular bowel movements, numbness and headaches.

One of the biggest challenges faced by those suffering with fibromyalgia is gaining the sympathy of their friends and loved ones. Fibromyalgia is an ‘invisible’ disease meaning that the symptoms are not readily apparent and diagnosis is difficult and this can lead to the accusation that the problem is ‘all in their head’.

Of course this is not an accurate description at all of fibromyalgia but that’s not to say that the cause isn’t somewhat psychological or ‘psychogenic’ to use the correct terminology. This is a subtle difference but an important one: the pain is by no means ‘imagined’ but it may be at least partially created by the patient’s psychology.

The Link Between Depression and Fibromyalgia

There appears to be a close connection between depression and fibromyalgia and those suffering with one will also often suffer with the other.

The most common explanation for this is that fibromyalgia is caused by irregularities in brain chemistry that lead to generally heightened sensitivity alongside low mood and it seems likely that this is the result of a genetic tendency followed by environmental factors that ultimately result in heightened sensitivity and low mood. This might be caused by low serotonin (1) which is a neurotransmitter that normally improves mood and provides natural pain relief, and/or by an increase in pro-inflammatory cytokines (2). Excitatory glutamate pathways have also been examined.

Ultimately, this then results in not only an increase in negative emotion but also a heightened sensitivity to pain which is usually associated more with the ‘fight or flight’ response. This may then be at least partly what’s responsible for fibromyalgia. The lack of serotonin means you lose your usual natural analgesic, while increases in excitatory neurotransmitters like glutamate and norepinephrine make you more highly sensitive to all stimuli, including pain.

Brain Inflammation and Fibromyalgia

The link between pro-inflammatory cytokines and fibromyalgia is an interesting one seeing as it has also been connected with depression. When you are ill, your brain produces these cytokines which triggers inflammation. This is particularly pronounced when you have the flu and is thus responsible for feelings of lethargy (via the breakdown of mitochondria (3)) and depression and quite possibly the achiness. This is what we know as ‘sickness behavior’.

Interestingly, this inflammation can also cause sensitivity to pain by increasing excitatory neurotransmitters – upregulating glutamine and down-regulating GABA for instance (4). It could in fact then be that inflammation is what causes the other chemical imbalances associated with the condition and the symptoms of pain. Using anti-inflammatories has been shown in several studies to be an effective way to treat depression (5, 6) and thus may also help with fibromyalgia. Some foods can also help to combat brain inflammation, such as vanilla.

Other Psychological Treatments for Fibromyalgia

Other treatments that address the psychological aspects of fibromyalgia include cognitive behavioral therapy to try and reduce stress and the use of antidepressants such as SSRIs (serotonin reuptake inhibitors) and even anti-seizure medications like benzodiazepines/barbiturates. While antidepressants can be an effective treatment for fibromyalgia, it’s important to weigh up their benefits against the potential drawbacks, including the possibility of addiction and severe side effects. If you are in excruciating pain then antidepressants may be a necessity but otherwise it is better to try and use therapy and other methods instead.

One of the big questions in psychology is whether neurotransmitters cause us to feel certain ways and think certain things, or whether thinking certain things causes changes in our neurotransmitters. Cognitive behavioral therapy takes the stance that altering your thought patterns is an effective way to control your neurotransmitters and thus to change your mood and potentially treat conditions like fibromyalgia by combating stress. Studies suggest that CBT can be effective in the long term treatment and lessening symptoms (7).

Lifestyle Changes for Fibromyalgia

Finally, lifestyle changes can also have a very positive effect on treating fibromyalgia. Most important is to get regular exercise which increases the release of serotonin and neurotransmitters while encouraging general health. This is one of the very best treatments for depression and fibromyalgia but the problem is that it can be very difficult if you are experiencing chronic pain. For these reasons, it’s important to use analgesics and to choose forms of exercise that are low impact – maybe even to avoid weight bearing exercise. Cycling on a recumbent bike or going swimming are two good options, as is going for gentle but regular walks.

Sleep is also very important for reducing symptoms but again there is something of a vicious circle at play here as sleep is also more difficult when fibromyalgia is present. Make sure to place great importance on doing the best you can to at least be restful for long periods in the evenings, to make your room dark and quiet and to relax your thoughts by reading a book or just taking a break from the computer immediately prior to sleeping.

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Keith Hillman

Keith Hillman is a full time writer specializing in psychology as well as the broader health niche. He has a BSc degree in psychology from Surrey University, where he particularly focused on neuroscience and biological psychology. Since then, he has written countless articles on a range of topics within psychology for numerous of magazines and websites. He continues to be an avid reader of the latest studies and books on the subject, as well as self-development literature.

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