Nonpharmacologic Therapies
Nonpharmacologic therapies include two well-studied modalities - aerobic exercise and cognitive behavioral therapy - as well as many others that have not. Improved outcomes have been shown in a number of studies of the effect of aerobic exercise in fibromyalgia patients (Minor, M. A., Hewett, J. E., Webel, R. R., Anderson, S. K., & Kay, D. R., 1989). Not only is pain reduced in many patients, but the general perception of overall symptoms seems to be improved as well (Janal, M. N., 1996).
An exercise program for fibromyalgia patients should be designed with the goals of physical tolerance and long-term compliance. High impact exercise frequently is poorly tolerated in these patients, so only low-impact aerobic activities ( walking, swimming, water aerobics, stationary cycling) should be considered. The chance of post-exertional worsening of symptoms is reduced by using low-impact conditioning programs initiated at a slow pace (sometimes beginning at only five minutes per day) that is gradually increased over time.
Cognitive behavioral therapy has been shown to be effective in a number of different chronic illnesses, including fibromyalgia. The three principles of this therapy outlined originally by Keefe (Keefe, F. J., Gil, K. M., & Ross, S. C., 1986) are:
- Provide a rationale for treatment to the patient
- Offer retraining of coping skills
- Teach the patient to apply these skills chronically.
A variety of techniques can be used to improve a patient's coping mechanisms, including relaxation training, activity pacing, advance scheduling, cognitive restructuring, problem solving, visual imagery, distraction strategies and goal setting. This type of therapy has proven efficacious in the management of chronic pain syndromes such as fibromyalgia, and the benefits are two-fold: sShort-term pain management is achieved; and, perhaps more importantly, long-term benefits include improved patient response to pain, reduced level of distress and a greater sense of control over their illness (N.I.H., 1996).
Reference list
Janal, M. N. (1996). Pain sensitivity, exercise and stoicism. J R.Soc.Med, 89, 376-381.
Keefe, F. J., Gil, K. M., & Ross, S. C. (1986). Behavioral approaches in the multidisciplinary management of chronic pain: Programs and issues. Clinical Psychology Review, 6, 87-113.
Minor, M. A., Hewett, J. E., Webel, R. R., Anderson, S. K., & Kay, D. R. (1989). Efficacy of physical conditioning exercise in patients with rheumatoid arthritis and osteoarthritis. Arthritis & Rheumatism, 32, 1396-1405.
N.I.H. (1996). Integration of behavioral and relaxation approaches into the treatment of chronic pain and insomnia. NIH Technology Assessment Panel on Integration of Behavioral and Relaxation Approaches into the Treatment of Chronic Pain and Insomnia. Journal of the American Medical Association, 276, 313-318.
