HOW TO COPE IN A PAIN
CRISIS - FIBROMYALGIA
by Kathryn Karr, RN, leader of a fibromyalgia support group in Niagara
Falls, Ontario.
In this article, I hope to help you think about your pain and about some
alternatives you may have for coping and managing your fibromyalgia other than
just being in the vicious circle of pain, anxiety, and worse pain. The steps
below are based on problem-solving that has been proved to work, as well as on
my own experience with fibromyalgia.
Coming to terms with fibromyalgia
1. Recognise that the pain is starting
to increase. Do not deny it until it becomes a crisis that you cannot handle.
It may not be true that if you ignore it, it will go away. You may need to take
action.
2. Analyse the possible reasons for the
increase in pain, for instance, over activity, emotional stress, physical
stress (lifting).
3. Generate possible solutions that may
assist in bringing it under control (e.g. more rest, heat, massage, alternating
activities, sit-ups or other exercises, speaking with your doctor about
restarting medications (if discontinued), re-examining your personal
expectations of yourself such as your ability to say "no" when you
need to, methods to resolve interpersonal stress, or just deciding what is
stressful to you). Maintain your daily routine as much as possible.
4. Encourage yourself with such thoughts
as: "I'll get through this just like I have the other episodes"
"I will not let this episode get me as depressed as I have other times,
because it is time-limited and I will feel better after I do the right things
for myself".
5. Devise a plan. Decide what
alternatives you are going to try. Communicate with family members, your
co-workers, or whoever is also affected by this episode, what you intend to do
and what changes will need to be accommodated in your normal routine. Also ask
family members, or others, what they have observed lately so that they may help
you to determine what has led up to this episode. It is also important to
enlist the help of others for housework, shopping, etc. Be clear on what you
can and cannot do, so that others can work with you in the recovery process.
Lower your expectations of yourself and others.
6. Evaluate the effectiveness of what
you are doing. Are you improving? (If not, why not?) Is it time to consult your
doctor? Are you doing anything that impedes your progress? Ask your family;
they often see things that you are unaware you are doing.
Resume your normal exercise routine as soon as you can. However, after an
episode of worse pain, you will have lost some ground and must begin slowly
again, making gradual increases. Remember that very small increases are better
than none, or large ones that cause setbacks. Do not let pain crises build on
each other so that you become more disabled. Keep working on improving your
well being.
Anti-depressants
Sufferers of fibromyalgia often make such comments as: "Why has my
specialist/doctor prescribed anti-depressants? I'm so angry - I may be
depressed, but it's dealing with all this constant pain, and not having the
energy to do the things I like doing that is the real problem."
Unfortunately specialists and doctors sometimes do not have time to explain
the reasons why medication is prescribed. Anti-depressants are prescribed for
many reasons, not only for depression.
Research has borne out that many fibromyalgia sufferers miss out on the
stage of sleep that restores both body and mind so that you wake up feeling
refreshed. If our bodies can be encouraged into just a small amount of this
sleep, this in turn can help ease the pain and thus help alleviate depression.
If a car engine is not serviced, and is not supplied with oil and water, the
engine eventually breaks down. The same problem happens to our bodies if we do
not get the restorative sleep we need. We then do not get the service our
muscles and other tissues require, and thus we get more pain and tiredness, and
then comes the depression.
When first taking any type of anti-depressant you may feel washed out,
drowsy throughout the day, and feel worse than you normally do. For the first
time your body is being allowed to relax, it is breathing a sigh of relief, it
needs a chance to have a total rest.
If the drowsiness does not wear off after a week or two, try taking your
tablet earlier in the evening, since it takes time for the medication to take
effect. Perhaps the dosage prescribed for you is too high. Discuss your worries
with your doctor.
Maybe the type of anti-depressant prescribed for you causes a reaction that
may not suit you. The most commonly prescribed is Amitryptiline, but there are
other types. It may be worth you and your doctor persevering to try and find
one that is effective. One thing to remember about this type of tablet is that
they may take up to three weeks to start having a beneficial effect. So do not
lose heart and stop them if they seem to be making no difference. Give them a
fair trial of four to six weeks at least, unless they are causing any
unpleasant side-effects.
Once you get your body into a regular sleeping pattern, you may find that
you do not need the medication for a while, but always discuss coming off
medication with your doctor first; you could make matters worse by stopping it
suddenly or too early. If you are worried about side-effects, your doctor will
be happy to discuss this with you. A frequently reported side-effect is a dry
mouth. But as a dry mouth is one of the symptoms of Fibromyalgia, it may not be
the anti-depressants causing this. Try sucking on an ice cube - this refreshes
your mouth. It is better than constantly drinking, which in turn can set off
the symptoms of irritable bladder.
Unless you give the anti-depressants a try, how do you know they will not
alleviate some of the problems you are experiencing? Do not leave those tablets
sitting on the shelf.
Many sufferers have reported that anti-depressants work for them. It does
not cure your fibromyalgia, but it can make life a little more tolerable and
give your body the rest it needs. Remember, do not stop any kind of medication
without first consulting your doctor.
Help and advice
For help or advice on the disability living allowance, contact:
Mrs Janet Horton
Fibromyalgia Helpline
1 Fellstone Vale
Withnell
Chorley
Lancs
PR6 8UE
(Please enclose an SAE)
 01254 831518 (Monday/Wednesday/Friday, 9.30 a.m.-1.00 p.m.)
Other very helpful organisations that can help with questions relating to
benefits are Welfare Rights and DIAL. For details see your local telephone
directory. The main body for fibromyalgia sufferers is:
Fibromyalgia Association UK
8 Rochester Grove
Hazel Grove
Stockport
Cheshire
SK7 4JD
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