Fibromyalgia and the Fear of Activity
Fibromyalgia and the Fear of Chronic Pain
For some with fibromyalgia, it's all too easy to get caught in a relentless cycle of fear and pain. Here's how to break it.
By Dennis Thompson Jr.
Medically Reviewed by Lindsey Marcellin, MD, MPH
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Living with fibromyalgia often means coping with daily, intense pain that not only makes movement difficult, but can have a dramatic impact on family, work, and social life. In one study, women with fibromyalgia described their pain as unbearable and overwhelming. It's only natural to fear this sensation, but in a chain reaction of sorts, that fear can intensify pain and make it even worse.
"Nobody likes pain," says John Fry, PhD, a psychologist in Newport Beach, Calif., and board member of the National Fibromyalgia Association. "You know how bad it's been in the past. You know how it's weighed you down, how you ended up in bed. You become fearful of moving around. You fear what it's going to be like if it is an episode coming on."
Understandably, fibromyalgia patients who are fearful of pain tend to be worse off than those patients who cope better with their pain. Studies have found that fibromyalgia patients fearful of pain report greater disability. They also are more depressed and anxious and feel more helpless and powerless regarding their condition.
Why Do We Fear Pain?
There are several theories regarding the effect of the fear of pain on fibromyalgia patients:
- Hypersensitivity.Fibromyalgia patients who have developed a fear of pain become more aware of any pain they are feeling. "If you're always anxiously checking your body out to see if you have any pain, you're focusing on whatever pain you do have," Fry says. "It's not just a psychological phenomenon, there's a real physiological marker for that principle."
- Avoidance.It’s been shown that exercise can relieve fibromyalgia symptoms. However, patients fearful of pain can be reluctant to work out or even move around much at all. The body then loses its conditioning, which results in greater pain.
- Catastrophization.The fear of pain can convince fibromyalgia patients that things are worse than they really are, a process known as catastrophization. These patients feel helpless regarding their pain, magnify the intensity of their pain, and become less able to pursue coping strategies that could otherwise lessen their pain.
Breaking the Fear-of-Pain Cycle
The outlook is not hopeless for fibromyalgia patients who have become afraid of their pain. In fact, researchers believe that relieving fear can go a long way toward relieving the pain. Why? Patients who accept that their condition inevitably involves a moderate amount of pain are better able to:
- Focus on the more enjoyable and pleasurable aspects of life.
- Understand that the pain is not their fault, and they have not personally failed because they feel pain.
- Pursue lifestyle changes that could help limit their pain, such as exercise or physical therapy.
Fry recommends that people who fear pain "fight the battle of the mind" using cognitive behavioral therapy to confront their fears rather than being ruled by them. In cognitive behavioral therapy, patients evaluate their beliefs and try to better understand how those beliefs affect their emotional and physical health.
"You ask questions of yourself to see what positives there are so you don’t neglect them because you're so focused on the negatives," Fry says.
Patients can also help themselves by changing the subject — focusing on something else when they can feel the fear of pain welling up inside them, Fry adds.
Video: Depression and Chronic Pain
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