Pain Management of CFS, M.E. and Fibromyalgia
If you're reading this, chances are that your life, or the life of someone you know, is shaped to some extent by chronic pain — and by the physical and emotional suffering that usually accompany it.
Pain in CFS, ME or Fibromyalgia is an experience that can be reduced with certain learned techniques, because a major factor in determining how we experience pain is how we respond to it.
My training in this type of pain and stress management was at The British School of Osteopathy. It is termed ‘OsteoMAP’ which stands for Osteopathy with Mindfulness and Acceptance-Based Therapy. It was developed for people with long-term musculoskeletal pain, which may be alleviated but is unlikely to be completely resolved by manual therapy alone. However, I have found that it can help anyone in any kind of pain, even psychological.
OsteoMAP works best for people who are willing to make subtle changes to the way they view the pain they are in, and are ready to explore new possibilities for living a more fulfilling life, that is less limited by pain and enables them to do more of the things that really matter in their life.
How many sessions are needed? The course I offer is made up of four to six one-to-one, hour-long sessions which can be weekly or fortnightly, with flexibility around timing. Each session builds on learning from the previous session.
What can a newcomer typically expect from an initial session? People who are interested in joining are asked to come for a pre-course consultation, which takes an hour. The aim of this meeting is to explore what they are struggling with and what they would like to get out of the sessions. The first meeting is an important part of the process because the process itself may involve looking at how pain affects all areas of life, including day-to-day activities, emotions and mood, relationships with family and friends, and work, if relevant.
What sort of results can be expected from OsteoMAP? This is a difficult one to answer because everyone’s experience is different! The aim is to help people to develop mindfulness skills, and learn about their auto-pilot reactions to discomfort, so they have more opportunities to notice when there is a choice to respond differently.
In the most successful cases, pain vanishes very quickly. Other people take longer to feel better. We often find that letting go of futile struggles to eliminate pain leaves people with more energy to focus doing things that matter, which reduces the impact of pain. A few patients have said their pain levels didn't change but they ended the course feeling completely different about who they were.
What is Mindfulness? Mindfulness has become a fashionable term and is used within the NHS as well as in private practice to help with a wide range of conditions, including lasting pain, chronic fatigue, fibromyalgia, stress, sleep disorders, anxiety and depression. The Department of Health is funding osteopathic research in this area. There are many ways to describe mindfulness including:
"Mindfulness means deliberately attending to and becoming more aware of our experience: our thoughts, feelings and body sensations. This allows us to clearly perceive thoughts, physical sensations, emotions and events at the moment they occur without reacting in an automatic or habitual way. Experiences don’t overwhelm us and we become steady through life’s ups and downs."
Relaxation is very important for coping with pain because pain is not only stressful in itself, but stress exacerbates and maintains pain. Relaxation is very helpful in calming down your nervous system, which often becomes ‘over-excitable' when pain persists for a long time. Relaxation also boosts your body’s natural pain modifiers, such as endogenous endorphins, or "feel good" hormones.
Mental flexibility. Negative thoughts drive negative feelings, which can sensitise our nervous systems and increase our pain. Thinking very negatively about pain, or what we call 'pain catastrophising', is one of the strongest predictors that short-term acute pain will become longer-term persistent pain. OsteoMAP can reduce the burden of these negative thoughts because it changes your relationship to thinking itself. We start to see thoughts as just 'mental events' rather than facts, which lessens their impact. In other words, we don’t as easily buy into the negative story around our pain. This is especially important in overcoming upsetting emotional impacts of pain such as depression and anxiety.
Pain with less distress. Exciting research using brain scanning technology, like Functional Magnetic Resonance Imaging (fMRI), is beginning to shed light on patterns of activity in the brain when a person is in pain and when they are relaxed and using techniques, such as OsteoMAP. It looks like people are still aware of the sensory aspects of pain but they experience it as less unpleasant since it does not activate as many of the brain networks related to memory, emotion and self-referential thought. In more technical terms, this relates to a decoupling of sensory-discriminative and cognitive-evaluative brain networks. In other words, OsteoMAP-type techniques train your brain to experience pain with less distress.