Fibromyalgia: high pain, coping and mental illness

I want to mention this study because it makes a very good point about the need for acceptance and resiliency that comes from acceptance in coping with fibromyalgia. And also the complications mental illness puts on acceptance.

Fibromyalgia coping and high pain

The study: Patients With Fibromyalgia Reporting Severe Pain but Low Impact of the Syndrome: Clinical and Pain-Related Cognitive Features

283 people with high pain levels of fibromyalgia were included in this study and separated into 2 groups:

  • Those with low impact
  • those with moderate to high impact

Things that were looked at:

  1. Perceived stress,
  2. anxiety,
  3. depressive symptoms
  4. pain catastrophizing,
  5. psychological inflexibility, and
  6. perceived control over pain

Results

Lower stress, anxiety, and depressive symptoms, along with reduced pain catastrophism, psychological inflexibility, and perceived control over pain, were found in the low-impact group. Significant predictors of group membership (low-impact vs. moderate-to-high impact) in regression analyses were “cognitive fusion” (psychological inflexibility), “helplessness” (pain catastrophizing), and depressive symptomatology, together with pain intensity and other FM symptoms.

Conclusions

The present study provides further evidence on resilience resources in chronic pain by identifying some variables (ie, reduced depressive symptomatology, pain catastrophizing, and psychological inflexibility) differentially characterizing a profile of patients with FM who are especially able to adapt to high levels of pain.

My thoughts

It doesn’t surprise me this is the case. We all know depression does not actually help with thinking about pain and coping. And it, in itself, causes body aches and pains without any other pain condition. It Complicates pain conditions like fibromyalgia and it compromises coping.

When my depression was full-blown I definitely was in the moderate to high impact and I definitely had significant issues with catastrophizing. And fixating on the worse and believing nothing would ever improve so why bother approach that doesn’t get one anywhere. And the impact on my life was High and yeah the pain was High. And that was a very long suckfest.

And when my depression was effectively managed through therapy and medication you do have more perceived control over your pain. You do stop catastrophizing. Certainly, you have control over the depressive symptoms and thoughts. And, lo’ and behold, you can manage the pain better. You can cope better. High pain doesn’t change but Coping does.

So I do not disagree with this study in its entirety. Not in coping or perceived pain or in our perceived control over pain or in our coping with pain.

And the study is on high pain. The Impact of high pain in fibromyalgia. So how do we cope with high pain… high impact or low impact with high pain. Well, I had high impact for some time. So while I am not depressed and yes I have dealt with all the issues stated, my pain level for fibromyalgia is the same moderate to high impact. And it has never changed. Only my capacity to cope and my capacity to find acceptance and resiliency. Not catastrophize. Not fixating on the worst and not trying anything. I do believe certain things help and I am always willing to try new things to help with my capacity to cope with the pain. I believe if I cannot reduce the physical pain then maybe I can help my capacity to cope with the mental and emotional suffering due to pain. And then yes, the impact was reduced, maybe to moderate… (you have to consider the fact I also have high impact from chronic migraines in my case)

So psychologically, yes, we handle pain a lot better when our comorbid mental illness or anxiety and depressive symptoms are managed properly. Because we manage it better emotionally and mentally better. We perceive it differently. Even though Physically it is the same, at least in my experience, physically it never changed. But coping it does change if we manage the mental and emotional response to pain. It helps. Does it go down to low impact as a result of treating anxiety and depression? I do not know. Maybe if one didn’t have comorbid pain.

However, we can agree mental illness really affects our coping. And we really need to treat it with our fibromyalgia to have effective pain management. Only then do we have acceptance and develop resiliency (depression and anxiety inhibit acceptance). I have great acceptance and resiliency now. But my biggest roadblock to acceptance and having any resiliency has always been the untreated Major Depressive Disorder which refused to let me accept any damn part of chronic pain and illness Or functionally deal with it in my life.

And, oh, I can say we need to treat the mental illness with our chronic pain condition.., easy peasy but it isn’t easy. It is arduous and work and takes time. And it is damn hard. And no one gets out of it the same way. And depression can re-occur. So there is that tidbit. And medication for depression is sometimes hard to find. Sometimes just therapy works and certainly, it helped me a great deal but not enough. My brain needed medication as well. Give or take four years of therapy and then medication and slowly but surely I have managed the depression. And by doing so it has helped with pain management, acceptance, and resiliency.

Then winter comes along with its winter blues and that hit me. And a new med was added. Because this is something I will deal with all the time. My point is, when we have depression and anxiety layered on top of fibromyalgia it’s Complicated. Not impossible to cope with but complications. Because we have to treat both at the same time all the time to have any effective coping. Which is exactly what the study is saying anyway, we do have to treat the depressive symptoms, and we will be able to deal with high pain better. But maybe the impact fluctuates just as our mental health does. And that is what makes it so unpredictable. When it is a moderate impact we think we are capable of more than we actually are. And then high impact happens and we lose all we gained, again, because we failed to realize we have to pace All the time and we have limits All the time. And the mental and emotional impact fluctuates with time and life and pain.

But, yes, when it comes to managing high pain, treating my depression certainly has helped me survive. And that is a good reminder for us to focus as much on our mental health as we do our physical health. Both matter and the impact on how we cope can be quite significant. The study just backs up what we already know we do when we are depressed and in high pain. It is not a fun place to be in, obviously. But it is a damn hard battle to get out of. And getting effective treatment isn’t as easy as one would think. And even when we do… we have to remember we still have that mental illness and it will be a factor in our treatment for a long time. And can cause problems coping at any time.

See more on fibromyalgia research

Fibromyalgia small fiber neuropathy

Fibromyalgia: inflammation in the brain

Fibromyalgia flare research
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14 comments

  1. This word… catastrophize… is a great word. I’m member of several fibro groups on FB and I’ve had to only glance. I’ve always said I have mild fibro compared to others, but I think I’ve mostly learned to cope better.

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    1. I’ve always said I had moderate FM but really I had severe chronic daily migraines that compromised my coping more so that I felt I the FM was better managed. So… hasn’t been a great process for some time. Although I figured it out. Took some time. High pain and depression do actually make for difficult coping as this study suggests. And it nailed that right. So you have a lot to work through on that path.

      Liked by 1 person

  2. I couldn’t agree more, Nikki! This is so consistent with my own experience. I have C-PTSD and struggle with anxiety and depression as part of my dysautonomia. When I first became ill I couldn’t make sense of why my mental health just fell apart, but it was like I’d been stripped of every skill I’d learned in over a decade of therapy. It took me years to do anything about it and I suffered terribly the whole time thinking it was somehow out of my control. Addressing my mental health issues certainly didn’t cure me, but it definitely helps me live a much more satisfying life, cope much better with my symptoms and helps keep me motivated to do everything necessary to keep myself from crumbling into a bedridden mess again. One can make the other more complex in either direction and working to heal those issues is so essential to achieving some semblance of happiness and normalcy in the chronic illness life. Thanks for sharing this great study and your own experience. Xx

    Liked by 1 person

    1. Thank you for sharing your experience as well! ❤ It is such a battle when they mix together. It just complicates everything and we really have a difficult time for a while trying to just get through

      Liked by 1 person

  3. Hi Nikki,
    Firstly, thanks for the info, really appreciate it.
    Hope you don’t mind me asking you something? in your opinion, this is a bit of a chicken or the egg question i guess, with ME/CFS or Fibromyalgia, what are your thoughts on what the first symptoms would more than likely be? Anxiety, Stress, Pain, Fatigue, Depression, Self talk or a Significant emotional event? or any others you can think of?

    Would love your feedback?

    Best regards,
    Dave

    Liked by 1 person

    1. I think that depends on the individual. I believe the first symptoms would be the primary symptoms of the syndrom to some degree in the individual. So pain, fatigue, cognitive issues, sleep issues and that sort of thing. Certainly when I developed FM young I had sleep dysfunction and pain first.
      When it comes to FM there has been research to suggest there can be a triggering event in some people… so accident, trauma of any sort, illness… and a lot of people fall into one of those categories but not All people.

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