From FMS Self-Help Course: Managing Emotions

Feelings such as worry, frustration, sadness and loss are common and understandable responses to long-term illnesses such as Fibromyalgia and CFS. They are a result of the changes, limitations and uncertainty brought by illness. Managing feelings deserves a place in your self-management plan, just because they are so common.

There are two additional reasons as well. First, CFS and Fibromyalgia often make emotional reactions stronger than they were before and harder to control. People often say they cry more frequently, get upset more easily or have more angry outbursts than before they were ill. The intensification of feelings applies to positive emotions as well as negative, experiences like seeing a sunset or enjoying a family gathering. Any experience that triggers the production of adrenaline intensifies emotions and, often, makes symptoms worse as well.

Second, emotions can interact with symptoms in a vicious cycle. For example, being in constant pain can trigger worries about the future. Worry leads to muscle tension, which, in turn, increases pain. You can interrupt this cycle in several ways, for example by learning relaxation to reduce muscle tension or by changing your “self-talk” to reduce worry.

Depression

Depression is common in people with CFS and fibromyalgia. Some of the depression is situational, a reaction to the limits, disruption, losses and uncertainty brought by long-term illness. This type of depression is captured in the remark, “Who could have these conditions and not be depressed?” Self-management strategies are often helpful in response to this type of depression.

Depression may be biochemical, as well, created by changes in the chemistry of the brain. Self-management strategies may also be useful for this type of depression, but treatment normally includes medication, too.

Depression may be triggered by a sense of helplessness, by fear, frustration and anxiety, by loss, or by uncertainty about the future. Signs of depression include feelings of unhappiness or sadness, lack of interest in friends or activities, isolation, suicidal thoughts, and loss of self-esteem. Serious or long-term depression or thoughts of suicide call for immediate help from a doctor, therapist or suicide-prevention service.

Loss

CFS and fibromyalgia usually bring many serious losses. We often experience loss of control over our bodies, loss of friends and loss of valued activities. We may be forced to give up our job and thereby lose income, companionship and challenge. And often we have to abandon dreams, thus losing the future we had envisioned for ourselves. In sum, we experience the loss of the person we used to be and the person we hoped to become.

Loss can trigger a variety of reactions, including denial, worry, anger, guilt, and sadness. An individual may experience some, but not necessarily all, of these reactions, may experience some more than once or may feel more than one at the same time. Working through loss is often a several year process, normally ending in acceptance. Acceptance combines recognition that life has changed with a realization of the need to lead a different kind of life than before.

The assignment for this week is to answer and discuss the following questions:

• What do you do to help yourself feel better when you’re feeling blue?
  
  
• What strategies help you work through the losses brought by your illness?

I will be posting my answers soon. How would you answer these questions?

Love and hugs,

Jessica

Self-Help: Managing Stress

I have never been one to manage stress effectively. If anything, I would try to compartmentalize everything so I wouldn't have to deal with anything as it happens. It seemed so much easier at the time.

Week 4 of the online Fibromyalgia Self-Help course focuses on managing stress. "Stress is a double challenge to people with Chronic Fatigue Syndrome and Fibromyalgia. First, illness adds new sources of stress to those common in everyday life. Second, CFS and FM are very stress-sensitive illnesses. A given level of stress takes a greater toll than on healthy people. Thus, the double challenge: your stresses are multiplied at a time when you are more vulnerable to the effects of stress."

Stress can come from many different sources, including:

• Symptoms: Ongoing discomfort is tiring and worrisome
  
  
• Limits: Frustration from living within strict limits
  
  
• Loss: Loss of control, of income, of friends and of dreams for future
  
  
• Isolation: Stress from spending time alone or feeling different or alienated
  
  
• Money: Financial pressure
  
  
• Relationships: Often strained; may lose some relationships
  
  
• Thoughts: Unrealistic expectations or overly-pessimistic thoughts
  
  
• Uncertainty: Worry about the future
  
  
• Sound/Light: Sensitivity to sensory overload
  
  
• Allergies: Sensitivities to foods and other substances
  
  
• Fatigue: Sleep deprivation
  
  

My post for week 4 follows:

Overwhelming stress is one of the main reasons I had to leave my job and drop out of graduate school. The stress got so bad there wasn't a day that I didn't break down into an uncontrollable and hysterical fit of crying. I don't even have to explain how that affected my pain level.

Things I currently do to relieve stress:

1. Audiobooks. I download audiobooks onto my iPod, lay down with an eye mask to block the light, and be read to. Sometimes I'll do this for an hour or so, but on particularly bad days I've been known to do this the entire day. It keeps my mind focused on the story being told and off of other things.

2. Laughing. Whether it's something something funny I find on the Internet or having a funny conversation with a friend or family. Laughing always eases the stress.

3. Acceptance. This is the hardest part and something I am still working on. Accepting that this is my life right now and I have to learn to understand and cope with this new me. I grieve for my former life and cycle through the stages of grief. When I reach acceptance, I feel at peace. Of course, I still cycle through the other stages at times - just waiting to get back to acceptance.

Target:

1. Rest for at least an hour a day, 7 days a week. Confidence: 10

2. Return to pool exercises, at least 3 times a week. Confidence: 8

3. Hire somebody to do housework. Confidence: 8

Note: As I said before, I always had a hard time managing stress and there are too many times that I don't know what to do. What do YOU do?

Gentle hugs and wishes for a stress-free day,

Jessica

Self-Help: Pacing

Week 3 of the online Fibromyalgia self-help course was all about PACING. Again, the course is based on Dr. Bruce Campbell's book, "The Patient's Guide to Chronic Fatigue Syndrome and Fibromyalgia." The premise of the book and course is to develop personal strategies for managing fatigue and pain, pacing ourselves, managing stress, etc. Each week we are given an assignment and have to post our management techniques to the group. . This is my post on Pacing for week 3:

I've been going through a really tough time lately, which I'm sure all of you understand. I seem to be in a flare that is going into its 7th month and am struggling to find some relief. Despite the fact that I have suffered from chronic pain for 16 years, up until two years ago I was able to finish my Bachelor's degree, start my Master's degree, work full time, and have an active social life. Now I have trouble just getting up and walking to the kitchen. I had to drop out of school, three courses away from a Master of Arts in Education. I had to give up my job. And I've lost my social life, as well.

Pacing has always been an issue for me. I hate when things are undone or not completed, so I tend to get started on something and not stop until it's done - despite the pain it causes. My son constantly reminds me to pace myself, rest more, or simply let him do it. It's hard to give up that control. In my former life, I always had to be in control.

What makes symptoms worse?

• Lack of sleep
  
  
• Emotions
  
  
• Physical exertion
  
  
• Not enough movement/too much movement (trying to find that fine line, the happy medium)
  
  
• Stress

What gives me a sense of control?

• Being able to complete something I started
  
  
• Getting things done
  
  
• Being able to successfully reclaim some area of my former life

Target:
Last week my target was to clean my room, bathroom, and put away laundry. I was only able to put away the laundry. I learned that I should set small, attainable goals and targets each day. Some days my target may be to just wash my hair, others to just rest, and some days I may be able to clean half my room. Small and attainable goals are the key to pacing.

Note: This was a huge breakthrough for me, though it seems so simple. I used to be the person always doing something, despite my pain (up until 2-1/2 years ago). I worked all the time, went to school full time, kept my house clean, raised my son alone. It was exhausting, but I managed. Now I can no longer manage and that was the hardest part. I would try to do the things I used to be able to do and the result was being confined to bed, writhing in pain for days, sometimes weeks. I'm learning to accept my limitations and pace myself.

As I share my postings for this self-help group, I would love to read your responses to the questions I have had to answer in my assignments. What makes your symptoms worse? What are you doing to manage fatigue and pain? Etc, etc. I believe we can learn from each other's responses.

Gentle hugs and pace yourself,

Jessica

Managing Fatigue and Pain

If you've read my recent posts, you know that I'm enrolled in an online Fibromyalgia self-help course. The course is based on Dr. Bruce Campbell's book, "The Patient's Guide to Chronic Fatigue Syndrome and Fibromyalgia." The premise of the book and course is to develop personal strategies for managing fatigue and pain, pacing ourselves, managing stress, etc. Each week we are given an assignment and have to post our management techniques to the group. Week 2 was Managing Fatigue and Pain. This is my post for that week:

I’m still developing strategies to better my sleep and fight fatigue, despite the fact that I’ve suffered from insomnia and fatigue since I was 16. It seems that something will work one week and not work the next. But this is what I’m working on now:

• Putting myself on a sleep schedule. I try to go sleep at the same time each night and let my body decide when it’s time to get up. It’s when that schedule is interrupted that I feel the most fatigued.
  
  
• B-complex sublingual liquid, B12 methylcobalomin sublingual tablets, and D-Ribose for energy.
  
  
• Keeping my mind active, even if I can’t keep my body active. I blog and I play sodoku, Scrabble, and mahjongg on a hand-held game system. I also read a lot of books! Anything to keep my mind going.
  
  
• Laughing. I have animated discussion with my online support group, my son, my mom, my best friend. Laughing can release endorphins that relieve pain (so I won’t add it to the next section), and leaves you feeling good, strong, and awake!
  
  
• Limit any shopping to quick trips. I let my son do the major grocery shopping. When I have to do the shopping, I suffer the consequences in terms of pain and fatigue for days.

I am also still developing strategies to manage the pain of Fibromyalgia and my spinal conditions. My current pain management strategies are:

• Using a TENS unit for back, hip, and leg pain.
  
  
• Water aerobics at the YMCA at least 3 times a week, as well as sitting in their hot tub before and after exercises, to keep my muscles moving.
  
  
• Weekly massage therapy with a licensed Physical/Massage Therapist.
  
  
• Taking medication on a regular schedule and not waiting until I hurt to do so.
  
  
• Pacing myself and being mindful of my limits when it comes to doing any manual tasks.

Target:

I have a ton of things around the house that need to get done. I am trying not to focus too much on the little things, though. :)

What: Clean bedroom, bathroom, and do laundry

How much: at least 20-30 minutes a day with resting periods

When: Evenings

How often: 3 days a week

Confidence: 6

Note: That week I did not meet my target because even that was too much. Thus, the low confidence level. The key is pacing and not overdoing it. I'll go into pacing more in my next blog post.

Love and hugs,

Jessica

Fibromyalgia Wellness Project

The Fibromyalgia Wellness Project, a research study sponsored by the National Institute of Arthritis, Musculoskeletal and Skin Diseases (NIAMS), National Institutes of Health. This project is  conducted by Collinge and Associates, an independent research organization directed by William Collinge, PhD. The project is now inviting participation by people living with fibromyalgia.

What are the benefits?

• You may discover new ways to reduce your symptoms and improve the quality of your life.

• You will be contributing to knowledge that may help others living with fibromyalgia.

Who is eligible?

• Adults (over 18) with fibromyalgia.

• You must be able to read English and complete the assessment forms on this website.

• You must have daily access to the internet at home to use SMARTLog.

What is involved?

• Read the Consent Form and attest to your understanding and agreement.

• Complete the Application Form on this site.

• Fill out monthly surveys (10-20 minutes) on your well-being and quality of life, at the beginning of each month of use of the website, and at the end of the study period.

• Complete the SMARTLog several times each week (about 5-10 minutes each time). You can do this in the evening before bed, or in several visits through the day.

• Ask for and receive SMART Profiles telling you what inputs lead to reduced symptoms for you.

• Try out new strategies on your own or treatments to see if they help you to reduce your  symptoms.

How long is the study?

This study is being conducted in two stages:

-- The first stage (“Alpha”) is three months.

-- The second stage (“Beta”) will be nine months.

-- You can participate in either or both stages.

The longer you participate, the more likely you are to learn strategies that reduce your symptoms. We recommend at least three months.

Sign up here: http://www.fmwellness.org

Hospital Anxiety and Depression (HAD) Score

Results: Hospital Anxiety and Depression (HAD) Scores

You scored, out of a possible 21 for both Anxiety and Depression:

Between 16 and 21 for Anxiety: a rather high level

Between 11 and 15 for Depression: a moderate level

Note: This test is not a substitute for an assessment by a qualified professional. Symptoms can vary with time.

Check your score here!

Global Year Against Musculoskeletal Pain

New Global Year Campaign Launches October 19

Each year, IASP chooses a different aspect of pain that has global implications and sponsors a 12-month campaign to raise awareness of that area of pain. For our 2009–2010 Global Year Against Pain, we selected musculoskeletal pain as our focus.

Why Musculoskeletal Pain?

More people around the world experience musculoskeletal pain than any other type of pain. And the problem is complex and far-reaching, with many different types of pain falling into this category, including neck pain, limb pain, low back pain, joint pain, bone pain, and chronic widespread pain—just to name a few. Yet, despite the wide-ranging conditions and symptoms, all types of musculoskeletal pain share similar underlying mechanisms, manifestations, and potential treatments. The Global Year initiative provides an ideal forum for us to explore, and raise the profile of, these important issues.

Global Year Preparations

The new campaign, which is scheduled for an official launch on Monday, October 19, 2009, will draw much-needed attention to a host of issues faced by those with musculoskeletal pain. The 2009–2010 Global Year Team, led by co-chairs Dr. Lars Arendt-Nielsen (Denmark) and Dr. Kathleen A. Sluka (USA), has been busy preparing a variety of materials, resources, and communications to ensure a successful campaign. Team members have also been finalizing more than two dozen Global Year fact sheets on a number of specifics topics related to musculoskeletal pain, including:

• Evidence-Based Treatment of Acute Musculoskeletal Pain
• Acute/Chronic Musculoskeletal Pain (including Sensitization)
• Rheumatoid Arthritis
• Basic Aspects of Joint Pain
• Repetitive Strain Injuries/Overuse
• Exercise in Management of Musculoskeletal Pain

More Details Coming Soon

Watch for more information in upcoming issues of the IASP Newsletter, as well as special email announcements later this year, with more details about the new Global Year campaign. Several issues of Pain: Clinical Updates in the coming year will focus on topics related to musculoskeletal pain. In addition, the Global Year pages on the IASP website (www.iasp-pain.org/GlobalYear/MSP) will provide further details and resources, including an overview presentation for speakers and chapters to use at their Global Year events. Members will also be invited to sign up to receive periodic email updates on Global Year news.

Ready to Get Involved?

While the Global Year Team will provide the objectives and framework for the Global Year Against Musculoskeletal Pain, the real success of the campaign will come through the efforts of our members and chapters around the world. The team encourages all our members and chapters to make plans now for meetings, symposia, media events, and other local activities in support of this vital initiative.

From International Association for the Study of Pain