Download - Dealing with Chronic Pain in Fibromyalgia~ A holistic approach Dawn Johnson, MSN, BA, RN, CNHP
Dealing with Chronic Pain in Fibromyalgia~ A holistic approachDawn Johnson, MSN, BA, RN, CNHP
The Basics of FibromyalgiaAffects 6 million people in the
U.S.Widespread musculoskeletal pain
and stiffnessFatigue, sleep problems,
cognitive disturbances, depression often associated
Diagnosis: Hx of pain for at least 3 months and pain in at least 11 of 18 tender points
Diagnostic Tender Points
www.fibroandfatigue.com/images/tender-points.jpg
The Pain Cycle
SleepPain makes it hard
to sleep then lack of sleep makes
painworse
MoodLimits that it putson life can lead to
depression
ActivityPain and lack of
energy make it hard to be
active
EnergyCoping with pain
takes energy
DepressionAffects 20-70% of fibromyalgia
patientsSeen as a byproduct of the
disease, not depression causing fibromyalgia
Many report decreased quality of life
May lose hope related to chronic nature of the disease
The Woman’s ExperienceTransitions
◦Daily, family, social, working life◦Learning to live with changes◦“Experience of transitions is
apparently something that is invisible to almost everyone except the women themselves” (Soderburg, Lundman, 2001)
◦“FM is the choreographer of activity and relationships” (Soderburg, Lundman, 2001)
Family IssuesFrom the husband’s perspective:
◦Increased responsibility and workload
◦Learning to read woman’s needs◦Being supportive/understanding◦Lack of information on disease
(Soderberg, Strand, Haapala, & Lundman, 2003)
Family responseThe family will respond in one of
three ways◦FMS brings the family closer together◦The family experiences minimal
change in role responsibility◦There is a negative effect on family
members as a result of the illness
Affect on Family Family watch the pain and feel
helpless to make it go awayThey feel helpless in distracting
the FMS sufferer long enough to enjoy a bit of life
They hear differing stories from healthcare providers and read conflicting stories in media
Having a child with FMOften show fewer tender points,
have more stomachachesDifficulty including non-affected
children of the familyNeed for educating
teachers/friends/familyChild struggles with
relationships/fitting in
GenomicsYanus et al (1999)Studied genetics of 40
multicase FMS families
Confirmed the possible existence of a possible gene for FMS that is linked with the HLA region
Results are considered preliminary and more studies need to be carried out
Genomics
Stormorken and Brosstad, (1992)Noticed that family clustering and sensory
urgency indicate a genetic predisposition to FMS
AssessmentAssess what modalities have
been used by the client and what modalities they are willing to try
How does the illness affect the client’s work and social activities?
How is the client’s family affected?◦Instrumental activities◦Nurturing activities
How does it affect their sexuality?
AssessmentsAssess client assertivenessAssess any mood and concentration
problemsAssess family strengths and
weaknessesIdentify losses related to chronic
painDetermine how family and friends
contribute to the pain cycleDetermine QOL via questionnaires
Functions of the family unitSexual wellbeingEmotional supportPhysical assistance with
everyday tasksRecreational activity and social
commitments
Pain Logs
Encourage client to keep a diary to track pain, symptoms, modalities, and help identify pain triggers
InterventionsThe first goal for FMS help is to
help break the pain cycleInform the client that finding the
right treatments takes time and that plans may change as health and life situations change
Let family know how they are involved in the pain cycle without knowing it and let them know how to help break the pain cycle
InterventionsImportance of healthcare professional
believing patientIdentifying stressorsTeaching self-talk principles, decreasing
catastrophizingTeaching moderationPlanning: working towards realistic goalsHumorRelaxation
Usual Medical TreatmentsNSAIDS and aceaminophenTramadol (Ultram)Muscle relaxants (Flexeril, Soma,
Zanaflex)Tricyclic antidepressants (Elavil,
Emitrip)SSRIs (Zoloft), SSNRIs (Cymbalta)ExerciseRest, massage, acupuncture/pressureCognitive behavioral therapy
Role of Complementary Treatments in FMSMassageAcupunctureMeditationRelaxationBiofeedbackCounselingHerbs and Bach flower
therapyArt/ Music/ Pet therapyChiropractic/ OsteopathyAromatherapy
Lessening the fear of painFear of physical pain is a major cause of
painFour techniques to help manage fear of
pain:◦ Visualization◦ Breath awareness◦ Nonjudgmental appreciation of body
sensations, including sensations of pain◦ Mobilization of psychological strength
(Bacci, I, 2000)
Strategies to reduce stress
Plan your daySimplify your scheduleGet organizedTake occasional
breaksExercise regularlyGet enough sleepEat wellChange the paceBe positiveStay connectedBe patient
ModerationBreak apart lengthy taskMix activities, put those that take
a lot of effort with those that require minimal effort. Plan priority tasks at the time of day clients have the most energy
Rest periodically Work at a moderate pace
RelaxationDesignate a time for family
relaxationRelaxation helps the body
recuperateRefreshes one mentally,
physically, and emotionallyAllows the individual to focus
away from the painGives one a sense of control over
pain
Benefits of relaxation
Relieves the stress that aggravates pain
Prevent muscle spasms
Decreases muscle tension
Benefits correlate to effort and motivation one has in learning the skill
Physiological Changes
Relaxation helps to decrease:◦ Blood pressure◦ Respiratory rate◦ Heart workload◦ Muscle tension
Types of RelaxationRelaxed breathingProgressive muscle relaxationAutogenic relaxation Imagery
Assertive BehaviorOccurs when the client acts in the
one’s best interest and takes responsibility for expressing one’s needs, feelings, and ideas honestly and directly
Does no put down others in a direct, purposeful way
Uses “I statements” Role play often helps in implementing
assertiveness into one’s lifestyle
Exercise
Encourage family walks or activities
Swimming, aqua aerobics or yoga are good activities
Moderate do not do too much on good days and nothing on bad days
ExerciseStart session with warm-upStretch before and after exercise
gently and do not bounceInform clients that they may have
some soreness at firstWear appropriate shoes that fit and
supportUse heat and ice as directedMake sure it is OK with provider to
start and exercise program
Nutrition
Encourage a healthy diet low in animal fat and high in fiber
Include a variety of fruits and vegetables
Weight loss can help decrease pain
Sleep Hygiene
Avoid caffeinated beverages or stimulants prior to bedtime
Wake up and go to sleep at similar times each day
May use essential oils or herbs to promote sleep and relaxation
Family involvement
People with a solid support system have advantages to those without solid support
Family supportThose with family support:
◦Cope better with chronic pain◦Are less likely to experience
depression◦Are more independent◦Recover faster from illness◦Have a stronger immune system◦Have lower blood pressure◦Have lower cholesterol◦Live longer
Family Needs
Caregivers have four needs◦ Physical◦ Emotional◦ Spiritual◦ Financial
Family involvement
Encourage loved one to make an effort to control pain and be active
Help distract loved one from pain
Help create safe, comfortable surroundings. Reduce noise and glare
Family and Friend involvement
Family cooks a healthy meal togetherGo for a walk togetherEncourage family member ask
questions and to listen to the clients answers
Take time; be patientEncourage client to describe to
family how they can helpEncourage family to educate
themselves about the symptoms that may signal a flare
Family involvementSuggestions for the family:
◦ Encourage the family to learn about chronic pain◦ Do not let conversations lead to talking about
pain◦ Encourage family not to hover over client◦ Join in activities◦ Encourage family not to give up activities “for
the client’s sake”◦ Encourage family to be available to listen to the
client◦ Encourage family to take care of themselves◦ Encourage family to work as a unit to SOLVE
problems
SOLVE problems
State the problemOutline the
problemList possible
solutionsView
consequencesExecute the
solution
Dealing with Pain BehaviorsPain behaviors are things people
say or do that signal they are in pain
These include◦Wincing◦Groaning◦Frequently talking about pain◦Avoiding others◦Being irritable with family, friends,
coworkers
Dealing with pain behaviorsFamily response may fall into two
categories:◦Punishing◦Caretaking
Best response for family is to be neutral and not respond to the behavior
Developing a support systemAnswer phone callsAccept invitations to events, even if it is
difficult at first Do not wait to be invited somewhere, take
initiative and call someoneSet aside past differences and approach your
relationships with a clean slateTake part in community events or family get-
togethersStart a conversation with a person next to
you at a local gatheringTalk about things people are interested in
and be an active listenerDo not give up on existing
Finding supportTake part in community events or
family get-togethersStart a conversation with a
person next to you at a local gathering
Talk about things people are interested in and be an active listener
Do not give up on existing relationships
Goal Setting
SMART GoalsSpecific- what is you wantMeasurable - How much do you wantAchievable- Something you can
achieveRealistic- The goal is realistic for youTime- The goal will be accomplished in
a time periodExample: I will incorporate 30 minutes
of stationary biking into my schedule 3 days a week for 2 months.
Family Contracts
Have client sign a contract with their support system that they will exercise, stay involved in enjoyable activities, refrain from pain talk, etc..
Make sure to include rewards and consequences.
Difficult Day PlanningStart planning for a difficult day
on a good dayDifferentiate between an acute
emergency and a difficult dayIdentify signs of a flare What behaviors would lead to a
difficult day?
Difficult Day PlanningReview what has worked in the pastIdentify support people and resources
and what they might do to help get one through a difficult day
What should one avoid on a difficult day?
Picture oneself getting through a difficult day
Reward oneself for making it through a difficult day
ConclusionFMS is a treatable syndromeGood family and support system
relationships are linked to better control of FMS symptoms
FMS is treated with a combination of medication, complementary therapies, and lifestyle changes
ReferencesBacci, I. (2005). Effortless pain relief: a guide to self-healing from chronic pain. Free Press;
USA.Paulson, M., Norberg, A., & Soderberg, S. (2003). Living in the shadow of fibromyalgic pain:
the meaning of female partner’s experiences. Journal of Clinical Nursing, 12, 235-243. Reich, J., Olmsted, M., & Van Puymbroeck, C. (2006). Illness uncertainty, partner caregiver
burden and support, and relationship satisfaction in fibromyalgia and osteoarthritis patients. Arthritis & Rheumatism, 55, 86-93. Soderberg, S., Strand, M., Haapala, M., & Lundman, B. (2003). Living with a woman with
fibromyalgia from the perspective of the husband. Journal of Advanced Nursing, 42, 143-50.
Soderberg, S., & Lundman, B. (2001). Transitions experienced by women with fibromyalgia. Health Care for Women International, 22, 617-631. .
Stormorken, H., & Brosstad, F. (1992). Fibormyalgia: family clustering and sensory urgency with early onset indicate genetic disposition and thus a “true” disease.
Scandinavian Journal of Rheumatology, 21, 207. Swanson, D. (1999). Mayo Clinic on chronic pain: lead a more active and productive life with
answers from the world-renowned mayo clinic. Kensington Publishing Corporation, USA.Sylvain, H., & Talbot, L. (2002). Synergy towards health: a nursing intervention model for
women living with fibromyalgia, and their spouses. Journal of Advanced Nursing, 38 (3), 264-273. Yunus, M., Khan, M., Rawlings, K., Green, J., Olson, J., & Shah, S. (1999). Genetic linkage
analysis of multicase families with fibromyalgia syndrome. Journal of Rheumatology, 26, 408-12.