Obesity: A briefing for Complementary Therapists
How Hypnotherapy can help the symptoms of Fibromyalgia as an effective treatment
By Julie Page – Cambridgeshire
This dissertation is about the very complex diagnosis of Fibromyalgia, and how hypnotherapy could play a part in the relieving of some of the symptoms associated with it. In order to do this we must firstly look at how it is diagnosed.
What is Fibromyalgia?
Fibromyalgia is a collection of symptoms otherwise known as FMS, Fibromyalgia Syndrome. It is a condition of widespread pain with tender points, chronic fatigue and poor sleep patterns. Sufferers report feeling as if they have the flu like symptoms. It is a very common illness, affecting more women than men. The pain that is felt in the muscles can be like a burning sensation and the severity of the symptoms can vary widely and the illness waxes and wanes. Other symptoms include:
- Non refreshing sleep
- Waking up stiff and tired
- Headaches and Migraines
- I.B.S
- Cognitive disturbances known as ‘fibro fog’
- Sensitivities to light, smoke, noise and other environmental factors
- Allergies
- Tenderness upon palpation at 11 of the 18 tender points
- Widespread pain reported for more than 3 months
Causes of Fibromyalgia
It is not fully understood what actually causes Fibromyalgia. There are no standard laboratory tests or x-rays to identify it. Indeed, it is very difficult to get a Doctor that has had any training or knowledge of this illness. Sufferers report triggers such as trauma, viral infection, accident or a traumatic life event may contribute to the symptoms. It is also reported that stress, anxiety and depression can contribute to the intensity of the symptoms.
Diagnosis
Diagnosis is made by taking a detailed patient history and that the sufferer has had the widespread pain for more than 3 months, and has 11 positive reactions out of the 18 tender points upon palpation. Upon examination it will become clear where the main source of the pain is located. It should be noted that the primary pain site can move around the body. As with the change of site the number of tender points may change. It is very difficult at times even when the diagnosis seems quite clear, that care should be taken as other illnesses can mimic the signs and symptoms of Fibromyalgia. Illnesses like Hypothyroidism, Statin treatments, Polymyalgia Rheumatica and other Rheumatological conditions have similar presenting symptoms. It is very unlikely that a patient will just present with Fibromyalgia, indeed a co morbid condition will also be associated with it. The symptoms of Fibromyalgia wax and wane and can be mild or very debilitating in severity. Finding a supportive GP can be very difficult. There are medical professionals who do not believe in the diagnosis of Fibromyalgia. It has been noted by some as an hysterical illness and linked to depression, anxiety and stress . There are now some new studies which show that Fibromyalgia is a breakdown in the way the brain processes pain. French researchers have found abnormalities in the brains of sufferers on scans. The sample study was small, however, the scans showed blood flow abnormalities in those with Fibromyalgia and was not present in those who were healthy volunteers. This area of the brain is key in the distinguishing of pain severity and it’s perception. One thing that is clear, is sufferers become withdrawn by the impact that a diagnosis of Fibromyalgia has upon their lives. In some instances a normal working life is impossible as is the inclusion in socializing with family and friends. This is why it is vital that anybody diagnosed with Fibromyalgia must have a multidisciplinary approach to treatment. Not just pharmacological but psychotherapeutic.
Treatments
In treating Fibromyalgia a multi disciplinary approach is required. A combination of pharmacology and complementary therapies appears to work best. Some sufferers report little value in analgesia or anti inflammatory tablets as an effective treatment. However there are some who require opioid therapy in the most severe cases. Anti depressants give good value for helping to induce sleep and can be given in a low dose as not to become addictive. Referral to a pain management programme can be helpful in some cases. Physiotherapy and hydrotherapy can also be effective however, sufferers can become very tired when they exercise. Heat treatments, rest and reducing stressful situations also aid to a more inclusive lifestyle. Massage therapy and trigger point applications have proved valuable in the inclusive treatments. Management of the condition is important along with support from family and friends. A healthy nutritious diet is helpful, along with the avoidance of caffeine drinks and alcohol. C.B.T (Cognitive Behavior Therapy) and Hypnotherapy as well as other complimentary therapies should be prescribed in treatment of Fibromyalgia.
How can Hypnotherapy help?
As already detailed, the main symptoms of Fibromyalgia is pain and fatigue. Gaining control of pain perception and fatigue upon awakening and changing sleep patterns helps in the reduction of analgesics required as triggered by hypnosis. Hypnosis encourages self control, motivation and expectation of treatment success. In addition to hypnosis I would apply instruction of C.B.T to enhance the therapy. Therapeutic homework, developing coping skills in decreasing symptoms. Self hypnosis in reflection and visualization techniques to gain problem solving social skills. Ensuring daily exercise and leisure activities are entered into. Consolidating skills maintaining achievements through positive feedback. Avoiding a relapse into stressful situations as well as suggestions focused on the pain, the sufferer should also be taught to control their breathing whilst in the therapeutic state. Deep breathing is an excellent way to clear the lungs and the exhaled air should be visualized as the pain, muscle spasms and sensitivities being expelled from the body. The rapport with the therapist can vastly improve the outcome of the therapy. The treatment sessions should last for around 6 – 8 weeks with follow-ups to enhance the progression of the therapy. It is encouraging to see that hypno-suggestion can enhance self-esteem which is vital in the overall management of the sufferer to promote positivity towards the treatment process.
Case study
Petra a 40 year old female
Married with no children
Medical history : Disc herniation L5 S1 15 years
Fibromyalgia diagnosed 9 years but has had symptoms for around 14 years.
Treatment and diagnosis:
Petra presented initially to her GP with low back pain with referred right leg pain. After investigation a disc herniation at L5 S1 was diagnosed. Petra was initially told to rest for 2 weeks. No improvement was noticed, so she was referred to hospital for physiotherapy and manipulation. Still no improvement so Petra was sent to see a rheumatologist who admitted her to his back pain programme. Petra was treated again with physiotherapy and hydrotherapy. Petra was seen by other related professionals. Still no improvement so Petra was offered a treatment called discolysis, where enzymes of paw paw fruit are injected into the intraverble disc space. Sadly Petra suffered a reaction to an anti sickness drug after the treatment which affected her very badly. She describes being in a lot of pain with pins and needles in her arms and legs. Burning in her muscles and felt incredibly tired even just doing small amounts of movement or just daily functioning. She reported these new symptoms to her doctors only to be dismissed. Her condition became worse, she began to lose muscle form and lost weight. Her mental state at this time was in question as she was constantly berated and she continued to have many symptoms that were unexplained in the normal sets of blood tests. After leaving hospital feeling demoralized and in a wheelchair she began into a spiral of depression and not making any progress. She was unsupported in the community and was left to get on with it with only pain killers as treatment. After 7 years she sought a second opinion as she could no longer bear the pain and disability.
After being seen by a new doctor she was successfully diagnosed with Fibromyalgia. Again there was no definitive treatment but was relieved to know what was causing her symptoms.
Hypnotherapy treatment:
I have seen Petra now for the last 10 months. Based upon a medical history and treatments and by agreement from her GP, it was decided that Petra was a good candidate for hypnotherapy and CBT treatment. I started by finding out where Petra was at the present time in her illness. She was of good spirits but wanted to take charge of her treatment and to lower her medication needs. At the time of meeting her she was prescribed morphine sulphate, dihydorcodine and amitryptiline. In order to reduce Petra’s opioid’s it was decided to go down the route of visualization and suggestion therapy with CBT, reorganizing her life and leisure experiences. I found that this approach works the best rather than a single option. The opioid’s were seen as a chemical crutch that she could reduce over time. Each time she thought she needed more medication she visualized herself in a beautiful garden surrounded by lavender flowering pants. The sent of the lavender put her in a state of inner peace and happiness and that her pain was under control so long as she inhaled the scent of the lavender. Slowly breathing in and out as she enjoyed the scent in the peaceful garden.
Her pain is controlled with a suggestion that each time she felt discomfort she would remember what her life was like before her diagnosis, and when she hurt her back and was subjected to all the negativity associated with it. This was achieved by Petra doing hypnoanalysis, focusing on a time when she was a squash player. In doing so her taking her frustrations of mobility and pain out on the ball in a squash game, she visualizesed hitting the squash ball hard against the wall. The harder the better, releasing all the tension but regaining control over the pain and able to move around more freely. Petra reported excellent results with both of these treatments, in therapy and at home doing hypnoanalysis. Several sessions on a one to one basis targeting the visualization and suggestion therapy greatly improved Petra’s pain levels and medication use. Also her mobility and dealing with the pain was also improved. Relaxation, coping strategies to aid mobility and stamina were noticeable. Over the sessions improvements were made to Petra’s personal life with CBT. Petra lacked confidence and by means of CBT we worked on making her life more worthwhile and for her to share a hobby with her husband. Petra was most receptive to CBT and in the end was able to even arrange a treatment pattern that suited her lifestyle herself. At our last session Petra said that she felt much better and was able to control the pain with the relaxation therapy. Although she still has quite a bad case of Fibromyalgia she firmly believed that the treatment was working and is making her life more purposeful. Petra now has more control over her Fibromyalgia and is positive in attitude and her approach to coping with this complex illness. She now has a full life and is aware of how to manage things better and live more independently.
Conclusion
Dose hypnotherapy and CBT have a place in the treatment of Fibromyalgia? Most emphatically yes! We have established that Fibromyalgia is a very complex illness, but hypnotherapy can play an important role in it’s treatment and support. Pain management is vital and teaching a sufferer to control their own pain with hypnoanalysis can lead to the release of naturally occurring endorphin’s , which can be more effective than morphine. Patients report a reduction in pharmacological requirements when taking part in hypnotherapy as well as an exercise programme and massage therapy.
Focusing in therapy away from the pain by olfactory senses taking in scents to over power the sensation of pain in the body is a very powerful tool. Several hours of relief at a time have been reported to me using this method. I can not stress enough that building on the skills that are constructed in therapy with the client are essential. Putting the person back and centered in mind, body and soul will allow control and to move away from the perception of disability, pain and other symptoms.
Bibliography
American Family Physician, Practical Therapeutic October 1 2000
Paul J. Millea MD MS
Richard L. Holloway P.H.D
Medical College of Wisconsin, Milwaukee
Hypnotic Treatment Synergies the Psychological Treatment of Fibromyalgia, A pilot study.
American Journal of Clinical Hypnosis, April 2008 by Martinez – Valero Consuelo, Castel, Antonio, Capafons, Antonio, Sala, Jose, Espejo Begona, Cardena Etzel.
Article : Fibromyalgia No Longer an ‘Invisible’ Disease by Drucilla Dyess
Family Magazine incorporating FMAUK Association Year 9 issue 5 – www.FMAUK.org
Hypnotherapy in Medicine
The Subconscious Approach to Healing
John Krukowski CH
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