By Elisabeth Deffner (revised by Yennie Nguyen 01/2023)
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{The theory behind these treatments is the idea that a patient whose mind is connected to his body can use that connection to help decrease stress and manage pain and other symptoms of FM.}
Contents in this article:
- Acupuncture •Biofeedback •Breathing •Hypnotherapy
- Imagery •Massage Therapy •Meditation and Prayer •Music Therapy
The Mind Body Connection 
Myrna Scott was on antidepressants and muscle relaxers. She took pain and anti-anxiety medications. Nearly a dozen prescriptions were supposed to help her manage her fibromyalgia (FM) symptoms, but the Costa Mesa, Calif., resident found little relief. N fact, she felt increasingly worse because of devastating side effects like an intensely upset stomach and a generally “loopy” feeling.
Scott, 34, was diagnosed with FM in 2000. By August 2001, her marriage was failing, her health was steadily worsening, her stepchildren had gone back to live with their mother and Scott, severely agoraphobic, worried she might never leave the house again. She decided she had to force herself back into the world—so she signed up for a class in guided imagery at a nearby community college. “It really changed my life,” says Scott. “It’s given me some really good tools for pain management.”
The following year, Scott pursued certification as a guided imagery therapist and dramatically revised her medication regimen. From 10 different medications, she has dropped down to three.
“I just actually started a part-time job again—I haven’t been working for three years,” she adds with glee. “I still experience pain on a daily basis, but I am not completely incapacitated by it anymore.”
Scott, who plans to open a guided imagery practice, is just one of many who have found relief for their FM symptoms through one of several alternative treatments that use the patient’s mind as a tool for symptom management. The theory behind these treatments is the idea that a patient whose mind is connected to his body can use that connection to help decrease stress and manage pain and other symptoms of FM.
Though a number of recent studies have indicated that alternative modalities can prove beneficial for people with FM, no treatment is successful with every patient, and no treatment can guarantee total eradication of symptoms. Nevertheless, these approaches can provide many patients with tools to manage symptoms, decrease stress, improve sleep, and ease back into the lives they used to live. Keep in mind that with any treatment modality it is important to make sure the therapist is properly credentialed and to ask if they have experience working with FM patients.
[Acupuncture]
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8567806/
*What it is: A traditional Chinese method of healing in which the practitioner places needles at specific points along energy channels that run throughout the body. https://www.aetna.com/health-guide/questions-acupuncture-therapy.html
*What it costs: An initial visit can range from $100 – $300. Subsequent visits may range from $70 – $150
*How to find a practitioner near you: The American Society of Acupuncturists: https://www.asacu.org/find-a-practitioner/
Acupuncturists view fibromyalgia as more than the sum of its symptoms. It focuses attention on the circulatory function—not just of the blood, but also of the chi, or energy, of the body. “If chi and blood are both moving, local tissue function is improved,” explains acupuncturist William Morris, academic dean at Emperor’s College of Traditional Oriental Medicine in Santa Monica, Calif.
A number of recent studies have indicated that acupuncture can have beneficial effects on FM patients, easing pain and decreasing stress, as well as providing a sense of deep relaxation.
Morris usually asks his clients which aspects of their lives—stress at work or home, for instance—may be contributing to their FM symptoms. “We don’t necessarily consider a person’s life as separate from the problem,” he says—a stance typical of most practitioners of alternative modalities.
“Sometimes it’s easier to look at it as a wheelbarrow metaphor. Each of the contributing factors is like a brick in a wheelbarrow, until it comes to a point where there are so many bricks in the wheelbarrow the person can no longer pick it up,” he says. “[We’re looking at] solving each of those pieces one at a time, until the person has a high level of functionality.”
[Biofeedback]
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3776543/
https://pubmed.ncbi.nlm.nih.gov/17679735/
*What it is: Training subjects to control normally involuntary functions, like brain activity, blood pressure, muscle tension, and heart rate.
*What it costs: Biofeedback therapy may or may not be covered by insurance, and, when it is covered, the insurance plans widely vary. A series of treatments can cost about $3,500.
*How to find a practitioner near you: Applied Psychophysiology & Biofeedback: https://aapb.org/Find_a_Practitioner or Biofeedback Certification International Alliance: https://www.bcia.org/consumers-find-a-practitioner
“We believe that FM involves a hyperactivity of the central nervous system;
what you’re basically doing is working on calming that system down,” says Dr. Stuart Donaldson of Thought Technology, a Montreal-based manufacturer of biofeedback instruments. “You just can’t be as aggressive [in treatment].”
Biofeedback is a noninvasive treatment that can be remarkably effective for FM patients, dramatically reducing pain, improving sleep, and eradicating fibro fog. Subjects are connected to computerized sensors that show them when their muscles are tense, for instance, by flashing a light or beeping. The goal is to show the flashing or beeping by relaxing the muscles and the subjects learn what different levels of tension feel like as they do so. Eventually, they can use their newfound skills without being hooked up to the machines.
“It can be compared to learning how to bicycle,” says Dr. Gabriel Sella, also of Thought Technology. “Originally, one does not want to believe that one can learn how to sit on a saddle on two wheels hardly touching the ground and pedal to produce movement against gravity. Then this skill is hardly ever forgotten. “Once the patient learns the skill of controlling the brain waves with EEG [brain wave] biofeedback and muscular contraction and relaxation with sEMG [muscle activity] biofeedback, the process—and the results—seem to be flowing effortlessly and are hardly ever forgotten.”
[Breathing]
*What it is: Exercises that encourage good breathing habits, which reduce stress and effect relaxation.
“The process of breathing lies at the center of every action and reaction we make or have and so, by returning to it we go to the core of our stress response,” writes Donna Farhi in The Breathing Book. “By refining and improving the quality of our breathing we can feel its positive impact on all aspects of our being.”
One of the exercises Farhi advocates for pain relief is focusing—with as much detachment as you can manage—on a painful area. “Imagine that your breath is originating from the very center of where you feel the pain,” she writes. “Touch yourself with your breath with the utmost tenderness and compassion.”
She also recommends exhaling (rather than holding your breath) when you anticipate a painful stimulus; stroking a painful area lightly to re-establish a connection with it; and breathing deeply, slowly, and consciously.
In his presentation at NFA’s 2001 FAME Conference, Dr. Dennis Turk, principal investigator for the Fibromyalgia Research Center at the University of Washington Medical Center, suggested this breathing exercise to induce relaxation: Lie on your back comfortably, and place your hands below your belly button. Closing your eyes, imagine a balloon inside your abdomen. When you inhale, imagine the balloon filling with air, and when you exhale, imagine the balloon collapsing.
[Hypnotherapy]
https://my.clevelandclinic.org/health/treatments/22676-hypnosis
*What it is: A treatment in which the practitioner includes hypnosis and then provides suggestions to ease pain and other symptoms.
*What it costs: A mid-range price for a session is $96.
*How to find a practitioner near you: Locate a pain center at a large hospital associated with a medical school, or visit American Society of Clinical Hypnosis: https://www.asch.net/aws/ASCH/pt/sp/find-member .
“Between 20-25% of the patients who come to the NYU Pain Management Center have FM,” estimates Allen Lebovits, Ph.D., NYU Medical Center. He uses a variety of treatments to help those patients, including guided imagery, biofeedback, cognitive behavioral therapy, and hypnosis (sometimes in combination). “Our goal is not necessarily to cure pain—though if that happens, that’s good. Our goal is to return patients to a more optimal level of functioning,” says Lebovits. “We get them as quickly as possible back to work, back to relationships, back to life.”
They do that by teaching the patients how to get their bodies into a state of deep relaxation—which, Lebovits explains, is basically the definition of the state of hypnosis. While patients are under hypnosis, they receive post-hypnotic suggestions like, “You will feel very comfortable and pleasant for the rest of the day.” Patients may also get a posthypnotic signal—raising the right index finger, perhaps—by which they can produce that feeling of relaxation themselves. “We don’t take away the pain of FM,” says Lebovits, “[but] we can make patients more comfortable, and we get them more functional.”
[Imagery]
https://pubmed.ncbi.nlm.nih.gov/25470476/
*What it is: Imagining specific positive images to effect physiological change.
*What it costs: An average hourly rate for a guided imagery session is about $60.
*How to find a practitioner near you: The Association for Music & Imagery:
https://ami-bonnymethod.org/find-a-practitioner
“If you believe in the efficiency of any given modality or treatment, your body believes that and will allow it to be more effective for you,” says Laurie Hassold-Gillette. A guided imagery therapist based in Southern California, Hassold-Gillette believes that giving the right tools, a person’s mind can help the body heal itself. “You have to learn how to get out of your own way,” she says with a laugh. “That’s what imagery is really helpful at doing.”
A recent study in Norway showed that “pleasant imagery” was effective in reducing fibromyalgia pain. According to Hassold-Gillette, several imageries can be particularly helpful to people with FM. (Though she recommends visiting a guided imagery therapist at least once to get some basic instruction, imagery is a process one can perform individually.)
One imagery calls for you to imagine your body in a state of perfect health. Recall how it felt to be without pain and stress. Studies have demonstrated that the body can replicate that state of health that the mind recalls. “Your body doesn’t know the difference between remembering the state of health and being in the state of health,” explains Hassold-Gillette.
[Massage Therapy]
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3930706/
*What it is: The rubbing or kneading of parts of the body to relax the muscles and stimulate circulation.
*What it costs: An hour session can range from $50 to over $100.
*How to find a practitioner near you: American Massage Therapy Association: https://www.amtamassage.org/find-massage-therapist/
At Heart and Hands Therapeutic Massage in Kenosha, Wisconsin, registered nurse Meryl Fury has treated people from their 20s to their 80s who have FM. She began studying massage techniques 24 years ago.
When massaging a person with FM, it is more important than usual for the therapist to stay in communication with the client, ensuring that the massage is not too firm. “FM clients in general—this is a big generalization—tend to like a little less pressure,” says Fury. “And most of the time they do not respond well to ice.” Yet recently she massaged a 20-something client with FM who told Fury the harder the massage, the better she liked it. Each individual’s needs are unique.
Massage certainly can ease muscular aches and pains, but it works on a deeper level, too, Fury says. It can loosen toxins—lactic acid, for instance—that have built up in the muscles (drinking plenty of water after a massage session flushes those toxins out of the body); it can also provide an emotional release for the client. Sometimes people pour their hearts out to the massage therapist as they lie on the table. “It can be a very profound experience,” Fury says. “It’s a tool people can use to maintain control over FM.”
[Meditation and Prayer]
* What it is: A process in which a person quiets his mind, allows his thoughts to transcend mental activity, and possibly communicates with a higher power.
Studies at Harvard have shown mindfulness meditation, which teaches people to concentrate on the here and now, can significantly reduce pain in FM patients. That is not news to Dr. Nancy Selfridge, author of Freedom from Fibromyalgia: The 5-Week Program Proven to Conquer Pain. “You cannot separate the mind and body in any process,” she says.
“Most [people with FM] need to learn a meditative practice. They need to carve out downtime, quiet time, in order to start to feel better,” adds Selfridge, who has FM. “I really incorporate people’s spirituality as much as I can in their treatment.”
Registered nurse Peggy Muench also has discovered that prayer and a spiritual life can help FM patients. She is completing her doctoral dissertation on the interconnection of psychological well-being, spirituality, and hopefulness among people with FM. “I absolutely, positively, undeniably believe that the thoughts we think and the beliefs that we hold impact the neurochemistry of our brain; it makes sense,” says Muench. “That’s why so many of these psychological therapies—therapies that focus on challenging thought patterns—these things work. I think it’s a little too simplistic to say that’s all we need to do but including spirituality in that process is so important. Outlook does make a big difference.”
[Music Therapy]
https://pubmed.ncbi.nlm.nih.gov/32505520/
*What it is: Structured use of musical experiences to restore, maintain, and improve emotional, psychological, and physical well-being.
*What it costs: An approximate average rate for an individual music therapy session is $100. ( Free Versions Available on line)
*How to find a practitioner near you: Certification Board for Music Therapists: https://my.cbmt.org/cbmtssa/f?p=CRTSSA:17800:3697031038465:::17800::
Music therapy can take many different forms; patients may prefer to listen to music or to perform it. Either way, it can be helpful in pain reduction. A German study showed a significant decrease in pain intensity and pain-related disability among the FM patients who participated in music therapy in this study.
“It does seem with chronic pain in an acute state like FM, people either want to release pain, and want something active—they want to pound a drum and scream—or they want to be soothed, played for, and put to sleep,” says Joanne Loewy, Director of Music Therapy at Beth Israel Medical Center in New York. “In between [these ends of the spectrum] there would be the use of imagery and music.”
It may seem intuitively logical that music can make people feel better, but music therapy involves a lot more than just listening to an upbeat song. “Pain and music travel along the same neural pathways,” explains Loewy. “In music therapy, we take their mind to the pain and show them ways to work with it musically. [They may] breathe with meter and harmonic framing, or they might sing.”
Music therapists often incorporate other alternative modalities into their treatment; they may create a guided imagery tape tailored to the patient’s favorite sounds, or encourage breathing exercises facilitated by a wind instrument.
“To reduce someone’s stress, you really have to understand the roots of it,” says Loewy. “Through a good music therapy assessment and ongoing treatment, you can get to that which is affecting the mind, and that which is affecting the body, and distinguish between the two—not necessarily through words.”
Prices given in this article reflect an approximate average and will vary by region and therapist.
