Coping With the Mental Health Effects of Fibromyalgia

What Is Fibromyalgia?

Fibromyalgia is a disorder that causes severe, debilitating nerve pain throughout the body, described as achy, burning, and pins and needles. 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

What Are the Risk Factors for Fibromyalgia?

Medical experts have not identified a single cause of fibromyalgia. Both genetics and environment likely play a role, and people of all ages and demographics can have this condition.² With that, it’s important to consider the potential risk factors that may increase one’s susceptibility to developing it.

The risk factors for fibromyalgia include:²

• Being a woman: Women are more likely to be diagnosed with fibromyalgia than men.
• Having a family history: People with fibromyalgia often have a parent or sibling with the condition.
• Other conditions: There appears to be some relationship with having fibromyalgia and also having other conditions, such as rheumatoid arthritis, lupus, and osteoarthritis.
• Illness: Having viral infections may increase one’s vulnerability to fibromyalgia.
• Age: People are more likely to be diagnosed with fibromyalgia during middle age, and the risk increases throughout old age.

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.³ Furthermore, the number of reported medical symptoms in patients with fibromyalgia has been positively associated with current and past depressive and anxiety disorders.¹

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. People 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.

Fibromyalgia and Depression

Researchers have found that people 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 that 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 and lethargy
• Increased isolation
• Feelings of self harm or thoughts about death.
• Reduced concentration
• Increased irritability
• Loss of self esteem

Anxiety and Fibromyalgia

Dealing with chronic pain creates increased stress and 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.

Fibromyalgia and PTSD

It has been suggested by trauma specialists that trauma is stored in the body and that it leaves a lasting imprint on one’s behavior and temperament. The automatic response to protect oneself is coded within the memory and driven by the amygdala and hippocampus. Such brain activity is closely connected to hyperarousal and pain response, which coincide with fibromyalgia symptoms.

Research shows that there is a relationship between fibromyalgia and PTSD.⁴ People with both conditions indicate higher levels of pain, more functional impairment, increased psychological distress, and a lower quality of life compared to individuals with PTSD who don’t have fibromyalgia. Additionally, people with fibromyalgia had poorer mental health outcomes than control groups.

Emotional Stress and 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, leading to toxic stress.⁵

A clinical study of fibromyalgia patients revealed that it seems to undermine a person’s self-confidence and sense of self. People with fibromyalgia 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, patients can be perceived negatively, which worsens their symptoms and functioning.⁵

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.

Family members of fibromyalgia patients have a greater prevalence of mood disorders.⁶ Family members may need support in addition to the FMS patient. Researchers have found 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.⁷

Is Depression Common With Chronic Pain Conditions?

Many people with chronic pain conditions also experience depression. Both conditions can aggravate the other. Someone with pre-existing depression may already experience unexplained body tension, sleep problems, and fatigue, all of which can exacerbate chronic pain. Subsequently, living with chronic pain can adversely affect someone’s quality of life, which can perpetuate more depression.

Does Stress Increase Fibromyalgia-Related Depression?

Stress affects both physical and mental health, and it can worsen fibromyalgia symptoms. Furthermore, stress is associated with increased pain and emotional exhaustion. Many people also find that it’s challenging to practice self-care like eating a healthy diet, exercising regularly, or connecting with a positive support system when they feel stressed. These compounding effects may exacerbate depression.

What May Worsen Mental Health in Those With Fibromyalgia?

Some of the symptoms associated with fibromyalgia can create more mental health challenges for those with the condition, including sleep disturbances, thinking difficulties, and fatigue. These symptoms make recovering from anxiety and depression more challenging for patients, and can also complicate the treatment process.

Data looking at how fibromyalgia impacts the psychological makeup 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.⁶

What Happens When Fibromyalgia Is Left Untreated?

Fibromyalgia is a chronic condition, and symptoms may fluctuate. If left untreated, pain and fatigue could worsen over time. If someone has a mood or anxiety disorder, they may notice that their mental health decreases when their fibromyalgia flares. In some cases, untreated fibromyalgia leads people to limit their activities, which can reduce their overall physical functioning.

Treatments for Fibromyalgia and Depression

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 people with fibromyalgia.

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 for treating pain. 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.

How to Find a Therapist

Online therapist directories are a good starting point when finding a counselor. You can also 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?

Medication

Medication can help reduce and alleviate some of the distressing symptoms associated with fibromyalgia. A doctor may prescribe one or more medications to manage the pain. With that said, it’s important to remember that fibromyalgia looks different for everyone, and it’s important to assess the risk and benefits of each medication.

Antidepressants may be prescribed to reduce pain and fatigue. For example, SNRIs work by increasing serotonin and norepinephrine levels in the brain. This effect may improve one’s sensitivity to pain. Tricyclic antidepressants have sedative effects that may help people struggling with sleep issues. Anticonvulsants, muscle relaxants, and NSAIDs are also used for pain reduction and anti-inflammatory benefits.⁸

Alternative Therapies

Many people pursue alternative therapies to complement their fibromyalgia treatment. Strengthening the mind-body connection may have a positive effect on reducing pain, so it can be beneficial to incorporate holistic practices in daily life. While these treatments are often combined with other approaches, they can be tried as an initial starting point.

Potential alternative therapies that can help with fibromyalgia pain include:

• Meditation & mindfulness practices: Meditation and mindfulness help people learn to live in the present moment. This work can cultivate more gratitude and build a greater sense of resilience.
• Acupuncture: Acupuncture is an ancient Chinese medicine that can be used to relieve chronic pain.
• Yoga: Yoga is a mindful exercise that may also yield positive benefits for sleep, self-esteem, and overall improved mental health.
• Tai chi: Tai chi may help people manage chronic pain conditions and build a healthier relationship with their body.

5 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 five suggested interventions that can offer symptom relief for people with fibromyalgia:

1. 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.
2. Manage medication: Antidepressant medications may help with mood stabilization. Consult your doctor about medication recommendations if anxiety and depression persist or get worse.
3. 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.
4. 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 might be more comfortable finding an online support group, since it won’t require leaving the house.
5. 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.