Fibromyalgia syndrome (FMS) is a disorder characterized by severe musculoskeletal and nerve pain. Extreme pain in muscles and soft tissues can be very debilitating. Psychological symptoms, such as depression and anxiety are frequently experienced by patients with fibromyalgia because it negatively impacts their quality of life and their ability to function. With the proper combination of medical and mental healthcare, patients reduce or alleviate their physical and psychological symptoms.
What Is Fibromyalgia?
Fibromyalgia is a disorder that causes severe, debilitating nerve pain throughout the body. The pain can be described as achy, burning and pins and needles. People of all ages can experience fibromyalgia. The duration of the symptoms must last for three months or more. To confirm a diagnosis of fibromyalgia, pain must occur at 11 or more of 18 specific points of the body, and is characterized as widespread, occurring on both sides of the body.1
There are theories about the cause of fibromyalgia. It is thought that fibromyalgia increases painful sensations by changing the way the brain and spinal cord process painful and non painful signals.2 Medical experts hypothesize it may have a genetic component. It may also be triggered by a serious physical trauma or emotional trauma like post traumatic stress disorder (PTSD). Other possible causes are infections and severe stress.
Fibromyalgia & Mental Health
Fibromyalgia is deeply connected to mental health. Experts have found that mental health disorders such as depression, anxiety, and sleep disorders are often precursors to the disease.3 Some studies suggest that pathways in the brain related to depression and anxiety also lead to the pain receptors that trigger fibromyalgia.4
Additionally, fibromyalgia is an “invisible” illness, in that those suffering from it may not be taken seriously by others who may minimize or dismiss the intensity and frequency of symptoms. Patients may feel they have to validate or explain their symptoms to justify themselves. This can add to feelings of isolation, depression, and anxiety experienced by fibromyalgia patients.
Research has found high levels of depression and anxiety in patients with fibromyalgia because of its physical symptoms. Furthermore, the number of reported medical symptoms in patients with fibromyalgia has been positively associated with current and past depressive and anxiety disorders.”5
The Connection Between Fibromyalgia & Depression
Researchers have found that patients diagnosed with fibromyalgia may be up to three times more likely to report depression than those not diagnosed. There is a connection between physical fibromyalgia symptoms and the feelings of depression associated with fibromyalgia pain. Fear of movement causing increased pain can exacerbate these psychological symptoms.
Experts still disagree about whether fibromyalgia triggers depression or if depression occurs after a fibromyalgia diagnosis. They do concur the incidence of depression escalates in conjunction with fibromyalgia.
The physical discomfort, lack of sleep, and the diminished ability to concentrate due to the physical symptoms can result in more isolation and a reduction in the ability to function at work or school. Ongoing pain frequently results in reduced exercise and physical activities. All of these can be contributing factors in ongoing depression.
Examples of the psychological symptoms of depression that may occur in individuals with fibromyalgia include:
- Inability to participate in or enjoy activities that gave pleasure in the past
- A sense of helplessness and hopelessness
- Loss of energy, lethargy
- Increased isolation
- Feelings of self harm or thoughts about death.
- Reduced concentration
- Increased irritability
- Loss of self esteem
Fibromyalgia & Anxiety
Dealing with chronic pain creates stress and increased anxiety. There is ongoing uncertainty about future health, body image, and whether treatments will be successful in alleviating pain. There is also anxiety in relation to how fibromyalgia is negatively impacting relationships.
Concerns about loss of independence and lack of control over your body can emerge. Patients can tend to increasingly focus on, and even obsess over their pain when lack of control prevails. Lack of treatment or initial treatment failures can worsen the present anxiety.
The Emotional Strains of Fibromyalgia
Fibromyalgia is a difficult disorder to diagnose and treat. This creates additional emotional stress for fibromyalgia patients. Researchers found that fibromyalgia patients feel a “double burden”—their life is full of physical and emotional pain that goes unacknowledged.6
A clinical study of FMS patients revealed that fibromyalgia seems to undermine a person’s self-confidence and sense of self. FMS patients experience a transition or change in identity due to the illness, which is invisible to the people who saw them as healthy based on their external or physical appearance. Clearly, FMS patients can be perceived negatively, which worsens their symptoms and functioning.7
Relational Strains of Fibromyalgia
When a loved one is in emotional and physical pain, family members are impacted in many ways. These dynamics create feelings of helplessness, sadness, anxiety, and fear about the future health and well being of their loved one. It also alters the dynamics of marital and partner relationships by adding a caregiving component. The stress taken on by the partner of a fibromyalgia patient is often overlooked and should be addressed.
Harvard Health research confirms family members of fibromyalgia patients have a greater prevalence of mood disorders.8 Family members may need support in addition to the FMS patient.
Researchers at the University of Missouri looked at how the diagnosis of fibromyalgia affected the mental health of marital partners. They concluded that fibromyalgia is hard on both spouses due to its life changing nature. They also found a strong link between fibromyalgia and feelings of depression and fatigue. These feelings can lead to marital struggles.9
What May Worsen Mental Health in Those With Fibromyalgia?
Some of the additional symptoms associated with fibromyalgia can create more mental health challenges for those that receive a fibromyalgia diagnosis like sleep disturbances, thinking difficulties, and fatigue. These symptoms make recovering from anxiety and depression more challenging for patients. It can also complicate the treatment process.
Data looking at how FMS impacts the psychological make up of patients concluded that fibromyalgia patients may have a reduced capacity to face and cope successfully with environmental and daily life demands due to pain.10
Treating Anxiety & Depression Along With Fibromyalgia
It is very important to find a mental health practitioner who has experience working with patients who have fibromyalgia or other chronic pain disorders. Patients need affirmation that what they are experiencing physically, mentally, and emotionally is not unique to them and is not uncommon among FMS patients.
Counseling is a great way to begin to learn how to manage mental health challenges associated with fibromyalgia. Cognitive behavioral therapy (CBT) is a short term type of therapy that is very effective. It teaches techniques to help patients alter negative thinking regarding uncomfortable situations and relationships. CBT helps patients to feel more control over their body and mind which is a powerful tool for fibromyalgia patients. It is solution oriented and helps formulate positive thinking and behavioral changes.
Online directories are a good starting point to look for a therapist. Ask the doctor treating your fibromyalgia if they can recommend a therapist specializing in working with fibromyalgia patients.
Here are some questions to ask your therapist when treating mental health issues associated with fibromyalgia:
- Have you worked with fibromyalgia patients before?
- What kind of therapy will I be doing with you?
- How long will my therapy take?
- How long have you been practicing?
- How do you think your therapy will help me cope with my fibromyalgia?
- How do my fibromyalgia symptoms affect my mental health?
6 Ways to Maintain Mental Health While Living With Fibromyalgia
There are a lot of actions fibromyalgia patients can take that will help them to begin to manage and gain control over the complexity of symptoms that present with their diagnosis. The level of pain and the way it manifests closely influences the emotional state of each patient. There are techniques that can be used that will offer physical and consequently emotional relief as well.
Here are six suggested interventions that can offer symptom relief for FMS patients:
- Mindfulness techniques: Mindfulness exercises like deep breathing and meditation are great stress relievers. These exercises also help slow down your mind and your body and can offer pain relief.
- Consult your physician about safe exercise options: Activities like water activities or bicycling create less stress on joints. It can simultaneously reduce pain and help alleviate depression and anxiety.
- Manage medication: Antidepressant medications may help with mood stabilization. Consult your doctor about medication recommendations if anxiety and depression persist or get worse.
- Reduce isolation and maintain socialization: Pain may limit mobility. Isolation fosters depression. If you cannot go out, spend time with trusted friends and family that can come to visit you.
- Find support groups: Conferring with other people who have a similar diagnosis and understanding of your situation can be therapeutic. They can be a source of comfort and invaluable support. You can find fibromyalgia support groups in your state by going to the National Fibromyalgia and Chronic Pain Association’s website.
- Reach out to others: Identify a trusted person you can talk with to share your feelings, concerns, fears, and achievements regarding your medical and mental health conditions
Final Thoughts on Fibromyalgia & Mental Health
Fibromyalgia is a chronic medical condition. Living with ongoing daily pain creates both physical and psychological challenges. Fibromyalgia needs to be addressed with a two-pronged approach–medical treatment for pain management and psychological treatment to help stabilize mood and learn techniques to cope with your condition. This is a recipe for the most successful treatment plan to help you adapt your lifestyle in meaningful ways and maximize your ability to function.