Mind Emotion and Pain
Emotion can be defined as a relatively permanent state of anxiety occurring in a variety of mental disorders. Anxiety and depression can enhance the perception of the severity and unpleasantness of pain in part because the same neurotransmitters that influence mood also influence pain.
Emotions may even help influence the function of the immune system. For example, negative emotional states and exposure to stressors can increase the release of proteins produced by the immune system called “cytokines” that help promote inflammatory responses. Many of the brain regions involved in processing the intensity and unpleasantness of pain are also involved processing emotional states as well as cognitive activity such as learning, memory, choosing coping strategies, and other functions involved in managing chronic pain and illness. Fatigue, sleep disturbance, and difficulty in concentrating often accompany chronic pain. These problems may interfere with one's ability to plan ahead to cope with increases in pain or the worsening of symptoms as well as to take pain medications correctly.
Hypnotic suggestions have been studied primarily in laboratory settings using healthy persons but they do temporarily change individual’s ratings of pain intensity and unpleasantness, and actually produce changes in the activity of brain structures involved in processing these aspects of pain. In contrast, acupuncture, acupressure and massage have been studied using patients and they often are effective in reducing pain, although the relief is generally short-lived.
Relaxation training, biofeedback and cognitive-behavioral therapy (CBT) have been associated with longer-lasting improvements. CBT refers to a package of interventions, usually involving 10-12 treatment sessions, that provide education, training and practice in effectively using pain coping strategies (e.g., relaxation skills), and skills for maintaining one's improvements. This treatment, in particular, has been shown effective in reducing pain and negative emotional states (e.g., depressive symptoms) among patients with rheumatoid arthritis and knee osteoarthritis. It also has been shown to improve ability to perform activities of daily living among patients with fibromyalgia.
Placebo effects generally produce improvements in pain or emotional states that range from 20 percent to 40 percent of those produced by active treatments. Placebo effects on pain are associated with increases in endogenous opioids or dopamine, the body's natural chemicals that normally inhibit pain in the brain. However, placebo effects usually last for shorter periods of time than those produced by active treatments such as medication.
The best way to do so would be to provide evidence for complementary treatments such as newspaper reports of studies that have been published in scientific journals. Information from the Internet should be supported by findings that have appeared in mainstream scientific publications.
Most mind-body interventions are best learned from a professional such as a licensed psychologist or nurse practitioner. Several ongoing studies are now looking at whether the 10 to 12 face-to-face training sessions in standard programs can be reduced with materials such as DVDs and workbooks for patients to use and practice at home. Over the next two or three years, many of these self-management training programs may become available to patients.
If you're living with fibromyalgia, you might think that relief only comes from the bottle. That is, the medicine is only the remedy for your problem. But studies have found that a combination of medical and non-medical therapies work best to quiet fibromyalgia pain.
Non-medical therapy includes how much or how little you exercise, how much you sleep, nutrition, even your attitude toward pain. Perhaps a better term might be "lifestyle therapy."
Studies also have found that "complementary" medicine may help. Also known as complementary and alternative medicine, or CAM, these take a more holistic approach to managing fibromyalgia pain. CAM's overall effectiveness varies, and people who use CAM should do so only in consultation with their physician.
And remember, it's a good idea to talk with your doctor before beginning or changing an exercise routine, your diet or other lifestyle habits. Together, you and your doctor can work on a whole body approach to minimize fibromyalgia pain.
Lifestyle Therapy
To help regain some control over your fibromyalgia, you may want to work on the following:
1. Better sleep. If you are like many people with fibromyalgia, you may have difficulty sleeping. This can leave you fatigued and without the energy needed to fight your condition. Fortunately, you can take steps to improve the quality of your sleep, including going to bed and getting up at the same time every day and maintaining a comfortable sleep environment.
2. Dietary changes. Can you reduce symptoms by shaking up your diet? Medical studies are inconclusive, but there is little doubt that a well-balanced diet can improve your overall health. Avoiding spicy foods and late-night beverages also may help curtail insomnia, a common symptom of fibromyalgia.
3. Exercise. The mere thought of a workout may seem overwhelming when struggling with the pain and fatigue of fibromyalgia. However, staying fit is one of the best ways to keep symptoms at bay. Start slowly and gradually increase your level of effort. Aerobic, strength-training and flexibility exercises all may offer benefits.
4. Occupational changes. Your job may be a prime source of symptom flare-ups. In many cases, mild adjustments to your work routines (such as switching to a more comfortable desk) can help. However, people with physically demanding occupations sometimes need to find a new field of work.
Complementary or Alternative Therapies
Some people use non-medical therapies to treat their fibromyalgia. Science has not yet confirmed the effectiveness of many such approaches, but some appear to offer benefits. Again, talk with your doctor before starting these therapies.
These therapies include:
1. Acupuncture. In this treatment, needles are inserted into target points of the body to provide pain relief and improve sleep patterns. The word acupuncture comes from the Latin acus, "needle", and pungere, "to prick". Modern acupuncture texts present them as ideas that are useful in clinical practice and continue to inform the practice of acupuncture. Although controversial, some studies show significant benefits to using acupuncture to treat fibromyalgia.
2. Chiropractic or osteopathic treatments. Chiropractic is a primary health care profession that diagnosis, treats and prevents neuromuscular disorders. Chiropractic is a neurological science that suggests that the nervous system controls all physiological processes of the human body, and therefor many abnormalities can be traced to a neurological source. A chiropractor may manipulate the spine to reduce pain and motion restrictions associated with fibromyalgia. Osteopathic doctors are who study and train in a method similar to medical doctors. These doctors also may use manipulation of joints and the spine to treat fibromyalgia. However, experts warn that manipulation treatments carry risks unless performed by well-trained practitioners.
3. Hypnotherapy. Hypnosis may be used to induce a trance-like state of altered awareness and perception during which there may be heightened responsiveness to suggestions to manage stress. People are brought to a state of deep relaxation and reduced muscle pain. Hypnotherapy is therapy that is undertaken with a subject in hypnosis. The word "hypnosis" (from the Greek hypnos, "sleep") is an abbreviation of James Braid's (1841) term "neuro-hypnotism", meaning "sleep of the nervous system". A person who is hypnotized displays certain unusual characteristics and propensities, compared with a non-hypnotized subject, most notably hyper-suggestibility, which some authorities have considered a sine qua non of hypnosis.
4. Massage therapy. Massage therapy involves manipulating the body's muscles and soft tissues to improve blood circulation. he word comes from the French massage "friction of kneading", or from Arabic massa meaning "to touch, feel or handle" or from Latin massa meaning "mass, dough". In distinction the ancient Greek word for massage was anatripsis, and the Latin was frictio. This helps increase the flow of nutrients into the tissues while also getting rid of waste products. Massage that progresses slowly during deep muscle work produces sometimes produces lasting results for people with fibromyalgia.
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