RESEARCH FINDINGS USING GUIDED
IMAGERY FOR
FIBROMYALGIA
August, 2006
Prevalence
and Costs
Fibromyalgia syndrome (FMS)
affects between 2%-6% of the population, with 80%-90% of
those affected being women (“Fibromyalgia,” 2005.
Estimates of direct
and indirect healthcare and economic costs range up to 20
billion dollars annually (Wolfe, Anderson et al, 1997b).
Many FMS patients are unable to work or to carry out the
activities of daily living, and suffer depression and other
related conditions. Fibromyalgia, along with back pain and
arthritis, have been identified as the chronic pain
syndromes that contribute the greatest clinical and
economic burden to society (“Fibroymyalgia;” Wolfe,
Anderson et al, 1997a.)
What
is Fibromyalgia?
The
American College of Rheumatology (ACR) criteria for a
diagnosis of fibromyalgia includes having pain in more than
three locations in the body for more than three months,
accompanied by specific anatomical tender points. There are
18 of these points, 9 on each side of the body. For an
adult to be diagnosed with fibromyalgia, he or she must
have severe discomfort when pressure is applied to 11 out
of 18 of these tender points (Romano, 2000; Smith, 2001;
Wolfe, 1990), although there these guidelines are not
universally accepted (“Fibromyalgia,”
2005).
In addition to fibromyalgia’s characteristic muscle pain
and fatigue, symptoms can include sleep difficulties,
depression, inability to concentrate (so-called
“fibro-fog”), headaches, morning stiffness, abdominal pain,
bloating, alternating constipation and diarrhea,
infertility, and parasthesias (Fibromyalgia, 2005).
The causes of fibromyalgia remain unclear, but some of the
suspected factors include physical trauma, chronic pain,
muscle abnormalities, viral or bacterial infection, immune
system dysfunction, emotional trauma, and hormonal changes
(“Fibromyalgia,” 2005). Some experts believe that cases of
fibromyalgia caused by trauma or serious infectious illness
tend to be more severe and have a worse prognosis (Romano,
2000).
Medical
Treatment
Since
the cause is unknown, medical treatment of fibromyalgia is
largely symptomatic. Medications for pain management
including anti-inflammatories, narcotics, and
acetaminophen. Other medications include antidepressants,
cyclobenzaprine for muscle spasm, anti-anxiety drugs,
antispasmodics for bowel symptoms, and sleep medications.
Because each patient presents with different
symptomatology, treatment, including complementary and
alternative approaches, must be individualized (Goldenberg,
Burckhardt, et al, 2005; Morris, Bowen, et al, 2005).
Mind/Body
Treatments Often More Effective
FMS
patients with chronic pain symptoms can clearly benefit
from relaxation techniques, biofeedback, hypnosis,
cognitive-behavioral therapy and meditation skills (Berman
& Swyers, 1997; Berman & Swyers, 1999; Beckelew,
Conway, et al, 1998; Edinger, Wohlgemuth, et al, 2005;
“Fibromyalgia,” 2005; Haanen, Hoenderdos, et al, 1991;
Hadhazy, Ezzo, et al, 2000; Jackson, O’Malley &
Kroenke, 2006; Kaplan, Goldenberg, et al, 1993; Leao &
da Silva, 2004; Singh, Berman et al, 1998).
Interestingly,
patients fared better when hypnosis was combined with
analgesic suggestions than when hypnosis was combined with
relaxation suggestions (Castel, Perez, et al, 2006).
Results in juvenile
fibromyalgia patients using CBT have also been impressive,
with one study’s authors’ reporting significant reductions
(p=.006) in patient pain, anxiety, fatigue, somatic
symptoms and quality of sleep (Degotardi, Klass, et al,
2005; Kashikar-Zuck, Swain, et al, 2005).
A recent review
concluded that CBT was effective, especially when used as
part of a comprehensive program; it was particularly
effective with juvenile fibromyalgia (Bennett & Nelson,
2006).
In one 2006 study, subjects who
received cognitive-behavioral treatment for FMS reported
significant reductions in pain, and improvements in
cognitive and affective variables; the operant-behavior
treatment group had significant improvements in physical
functioning and behavioral variables; both groups
maintained their improvements at 6- and 12-month follow up;
subjects in the attention-placebo group actually
deteriorated (Thieme, Herta & Dennis, 2006). Authors of
a 2006 review concluded that for the 11 painful syndromes
reviewed (including FMS), CBT was “the most consistently
demonstrated to be effective” (Jackson, O’Malley &
Kroenke, 2006).
Patients self-using audiotaped guided imagery reported
improved self-efficacy and improvement in non-pain FM
symptoms (Menzies, Taylor, et al, 2006).
There is strong evidence that these mind-body therapies
plus exercise are more effective than standard medical
treatment and can lead to patients needing fewer office
visits and less medication (Bernard, Prince, et al, 2000;
Buckelew, Conway, et al, 1998; Hadhazy, Ezzo, et al, 2000;
Rossy, Buckelew, et al, 1999; Wolfe, Anderson, et al,
1997b).
Research suggests that mind-body therapies are particularly
effective when used as part of a multidisciplinary approach
to treatment (Berman & Swyers, 1999; Bernhard, Price
& Edsall, 2000; Romano, 2000) Patients taking an active role
in their treatment can be a vital factor in coping
successfully with FMS (Buckelew, Huyser, et al, 1996; Drum,
1999); patients with high positive
expectancy also have improved outcomes (Goossens, Vlaeyen
et al, 2005)—mind body approaches such as guided imagery
and hypnosis can help build positive expectancy.
Conclusion
Used as a complementary
treatment, guided imagery can help patients cope with
fibromyalgia syndrome, save medical care resources, and
reduce patient economic burdens and
suffering.
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