Does Mindfulness Have a Role in the Treatment of Fibromyalgia Syndrome?
Fibromyalgia syndrome is a poorly understood chronic pain disorder. An estimated 3% of adults are reported to suffer from fibromyalgia, with higher levels of occurrence in females compared to males. The main symptoms of fibromyalgia syndrome are all-over body pain, tiredness, difficulty in sleeping, and cognitive dysfunction such as memory impairment. There is also a high level of association between fibromyalgia syndrome and poor quality of life, mental health issues such as depression and anxiety, irritable bowel syndrome, and unemployment.
Some of the reasons why fibromyalgia syndrome is believed to be a controversial illness are as follows:
- Individuals with fibromyalgia are reported to exert a higher burden upon healthcare resources when compared with individuals diagnosed with other chronic illnesses.
- Research has shown that individuals with fibromyalgia often experience difficulty in having their illness diagnosed, and often feel that their needs and symptoms are poorly understood by the medical profession.
- A diagnosis of fibromyalgia is primarily based upon the exclusion of other illnesses, the patient’s medical history, and their reaction to pressure being gently applied to ‘tender points’. In other words, there isn’t a reliable laboratory test for fibromyalgia syndrome (e.g., blood test, x-ray) and this means that it is difficult to be 100% certain that a given individual is genuinely suffering from the illness.
The current treatment-of-choice for fibromyalgia syndrome is the use of psychopharmacology (principally antidepressants) coupled with non-pharmacological approaches such as physical exercise, cognitive-behavioural therapy, self-help, and/or psycho-education. However, pharmacological treatments for fibromyalgia have shown only a limited degree of effectiveness, and many patients withdraw from treatment due to the side-effects of antidepressants as well as low levels of symptom reduction.
The lack of convincing treatment efficacy outcomes for existing pharmacological and non-pharmacological fibromyalgia interventions has led to the empirical evaluation of alternative treatment approaches. Since there exists evidence (which varies in quality and quantity) supporting the use of mindfulness in treating each of the individual symptoms of fibromyalgia syndrome (e.g., chronic pain, sleep disturbance, fatigue, depression, anxiety, and cognitive dysfunction), mindfulness-based interventions have been an obvious candidate in terms of investigating their effectiveness for treating the illness.
A systematic review and meta-analysis comprising six randomised and non-randomised controlled trials of mindfulness-based stress reduction (MBSR) for individuals with fibromyalgia (674 participants in total) found that individuals receiving MBSR experienced significant short-term improvements in quality of life and pain compared to individuals in the non-meditating control groups. A further systematic review (incorporating a range of intervention study designs) examined the findings from ten studies of mindfulness meditation (702 participants in total). The review concluded that mindfulness led to significant improvements in both physical symptoms (e.g., pain, sleep quality, functionality) and psychological symptoms (e.g. depression, anxiety, perceived helplessness).
In terms of the possible mechanisms by which mindfulness helps to alleviate the symptoms of fibromyalgia syndrome, the most widely proposed explanation is that mindfulness helps to increase perceptual distance from somatic pain and distressing psychological stimuli. By mindfully observing painful bodily sensations, it appears that individuals suffering from fibromyalgia (and other pain disorders) can begin to objectify and almost distance themselves from their pain. The same applies to feelings of psychological distress and fatigue that are often associated with musculoskeletal pain. Mindfully observing feelings of distress, frustration and low mood appears to weaken the intensity of such feelings, and to help create the ‘psychological space’ necessary for other – more psychologically adaptive – feelings and thought processes to arise.
Based on findings from a randomised controlled trial of an online mindfulness-based intervention, it has been suggested that stronger treatment outcomes can actually be achieved by using mindfulness not just as a means of improving patient’s ability to cope with pain and psychological distress, but as a means of helping improve patients’ ability to engage in effective social and interpersonal interactions. In other words, given the complexity of fibromyalgia syndrome, it appears that in order to maximise treatment effectiveness, mindfulness interventions targeting fibromyalgia should be purpose-designed and encourage participants to draw on both psychological and social resources.
In terms of other potential mechanisms of action, there is evidence to suggest that mindfulness leads to changes in neurological pain pathways, reduced levels of ruminative thinking and self-preoccupation, and improvements in spirituality. This latter potential mechanism is important because cross-sectional studies involving individuals with fibromyalgia have specifically identified a positive correlation between spirituality and positive affect (i.e., as levels of spirituality increase so do positive mood states), and a negative association between spirituality and symptoms of depression and anxiety (i.e., as levels of spirituality increase in individuals with fibromyalgia, their levels of depression and anxiety decrease).
Findings indicate that purpose-designed mindfulness-based interventions may have a role to play in the treatment of fibromyalgia syndrome. However, at present the overall quality of the evidence is weak and there is a need to replicate and consolidate findings using methodologically robust randomised controlled trials.
Ven Edo Shonin and Ven William Van Gordon
Branco, J. C., Bannwarth, B., Failde, I., Abello Carbonell, J., Blotman, F., Spaeth, M., … Matucci-Cerinic, M. (2010). Prevalence of fibromyalgia: a survey in five European countries. Seminars in Arthritis and Rheumatism, 39, 448-55.
Cramer, H., Haller, H., Lauche, R., & Dobos, G. (2012). Mindfulness-based stress reduction for low back pain. A systematic review. BMC Complementary and Alternative Medicine, 12, 162.
Davis, M. C., & Zautra, A. J. (2013). An online mindfulness intervention targeting socioemotional regulation in fibromyalgia: results of a randomized controlled trial. Annals of Behavioural Medicine, 46, 273-284.
Dennis, N. L., Larkin, M., & Derbyshire, S. W. G. (2013). ‘A giant mess’ – making sense of complexity in the accounts of people with fibromyalgia. British Journal of Health Psychology, 18, 763-781.
Häuser, W., Wolfe, F., Tölle, T., Üçeyler, N., & Sommer, C. (2012). The role of antidepressants in the management of fibromyalgia syndrome: a systematic review and meta-analysis. CNS Drugs, 26, 297-307.
Henke, M., & Chur-Hansen, A. (2014). The effectiveness of mindfulness-based programs on physical symptoms and psychological distress in patients with fibromyalgia: a systematic review. International Journal of Wellbeing, 4, 28-45.
Hickie, I., Pols, R. G., Koschera, A., & Davenport, T. (2004). Why are Somatoform Disorders so Poorly Recognized and Treated? In: G. Andrews & Henderson S. (Eds). Unmet Need in Psychiatry: Problems, Resources, Responses (pp. 309-323). Cambridge: Cambridge University Press.
Hughes, G., Martinez, C., Myon, E., Taïeb, C., & Wessely, S. (2005). The impact of a diagnosis of fibromyalgia on health care resource use by primary care patients in the UK: an observational study based on clinical practice. Arthritis and Rheumatism, 54, 177-183.
Jones, K. D., Sherman, C. A., Mist, S. D., Carson, J. W., Bennett, R. M., & Li, F. (2012). A randomized controlled trial of 8-form Tai chi improves symptoms and functional mobility in fibromyalgia patients. Clinical Rheumatology, 31, 1205-1214.
Langhorst, J., Klose, P., Dobos, G. J., Bernardy, K, & Häuser, W. (2013). Efficacy and safety of meditative movement therapies in fibromyalgia syndrome: a systematic review and meta-analysis of randomized controlled trials. Rheumatology International, 33, 193-207.
Lauche, R., Cramer, H., Dobos, G., Langhorst, J., & Schmidt, S. (2013). A systematic review and meta-analysis of mindfulness-based stress reduction for the fibromyalgia syndrome. Journal of Psychosomatic Research, 75, 500-510.
Moreira-Almeida, A., & Koenig, H. G. (2008). Religiousness and spirituality in fibromyalgia and chronic pain patients. Current Pain and Headache Reports, 12, 327-332.
Nüesch, E., Häuser, W., Bernardy, K., Barth, J., & Jüni, P. (2013). Comparative efficacy of pharmacological and non-pharmacological interventions in fibromyalgia syndrome: network meta-analysis. Annals of the Rheumatic Diseases, 72, 955-962.
Peterson, E. L. (2007). Fibromyalgia – Management of a misunderstood disorder. Journal of the American Academy of Nurse Practitioners. 19, 341-348.
Rimes, K. A., & Wingrove, J. (2013). Mindfulness-based cognitive therapy for people with chronic fatigue syndrome still experiencing excessive fatigue after cognitive behaviour therapy: a pilot randomized study. Clinical Psychology and Psychotherapy, 20, 107-117.
Scott, M., & Jones, K. (2014). Mindfulness in a fibromyalgia population. The Journal of Alternative and Complementary Medicine, 20, A94-A95.
Sicras-Mainar, A., Rejas, J., Navarro, R., Blanca, M., Morcillo, A., Larios, R., … Villarroya, C. (2009). Treating patients with fibromyalgia in primary care settings under routine medical practice: a claim database cost and burden of illness study. Arthritis Research & Therapy, 11, R54. DOI:10.1186/ar2673.
Wolfe, F., Brähler, E., Hinz, A., & Häuser, W. (2013). Fibromyalgia prevalence, somatic symptom reporting, and the dimensionality of polysymptomatic distress: results from a survey of the general population. Arthritis Care and Research, 65, 777-785.
Wolfe, F. (2009). Fibromyalgia wars. Journal of Rheumatology, 36, 671-678.
Wolfe, F., Anderson, J., Harkness, D., Bennett, R. M., Caro, X. J., Goldenberg, D. L., … Yunus, M. B. (1997a). A prospective, longitudinal, multicenter study of service utilization and costs in fibromyalgia. Arthritis and Rheumatology, 40, 1560-1570.
Wolfe, F., Anderson, J., Harkness, D., Bennett, R. M., Caro, X. J., Goldenberg, D. L., … Yunus, M. B. (1997b). Work and disability status of persons with fibromyalgia. The Journal of Rheumatology, 24, 1171-1178.
Shonin, E., & Van Gordon, W. (2013). Searching for the present moment, Mindfulness, 5, 105-107.
Shonin, E., Van Gordon, W., Compare, A., Zangeneh, M., & Griffiths, M. D. (2015). Buddhist-derived loving-kindness and compassion meditation for the treatment of psychopathology: A systematic review. Mindfulness, 6, 1161-1180.
Van Gordon, W., Shonin, E., & Griffiths, M. (2015). Towards a second-generation of mindfulness-based interventions. Australia and New Zealand Journal of Psychiatry, 49, 591-591.
Shonin, E., Van Gordon, W., & Griffiths, M. D. (2013). Meditation as medication: Are attitudes changing? British Journal of General Practice, 63, 654.
Shonin, E., & Van Gordon, W. (2015). The lineage of mindfulness. Mindfulness, 6, 141-145.