Soft Tissue Rheumatism and Mind
by Dr. Anupama Sonees
Soft tissue rheumatism (STR) primarily of two types of which fibromyalgia syndrome (FMS) or generalised STR is one of the most common cause of chronic widespread pain. It is accompanied frequently with sleep disturbances and variety of non-specific complaints. Patient typically exhibit tenderness to palpation of specific points on the body. There are no significant laboratory or pathologic findings that aid in the diagnosis.
The term fibromyalgia was introduced in 1976 by Hench F M is characterized by reduced pain threshold pain with normally innocuous stimuli. STR pain is often accompanied by wide range of symptoms including fatigue, sleep depression, stiffness and more.
Fibromyalgia is known to be associated with triggers also considered as stresses.
1. Physical trauma
4. Autoimmune disorders like RA, SLE.
Most of the triggers above cannot be predicted but can be prevented by ensuring healthy lifestyle. Some like Psychiatric illnesses and autoimmune disorders need specific Treatment. Timely detection of these conditions and counseling about occurrence of STR goes a long way in patients capacity to handle this painful condition.
STR as discussed is as much a disease of mind as of body. This domain is many times unattended during discussions on this topic or treatment. This article plans to give a basic understanding on this subject.
Management of symptoms -
Sleep :- There is a disregulation of sleep and of the rhythms of the body. Management requires regularizing both the patients behavioral and psychological functions the two most common faulty habits are variable bedtime, inadequate nocturnal sleep time that results in disorganization of circadian rhythms and sleep deprivation with sleepiness and fatigue. Efforts should be directed to stabilize the regulatory functions of sleep by going to bed and awakening at suitable specific time to assure adequate duration of sleep. While sleep needs vary from person to person. The average adult requires approximately 7 to 8.5 hrs of sleep. Effort should be directed for sleep hygiene to reducing psychological distress where anxiety / depression interferes sleep. This might require special counseling as physiotherapy.
Sleep problems are of varied types and hence need specific treatment. Apart from life style modification discussed above, doctors can prescribe number of medications like -tricyclic antidepressant agents. Sleep problems associated with FM can be effectively tackled when the cause is ascertained and redressal treatment is ensured.
Fatigue :- Fatigue is a very common accompaniment of FM. Patients describe persistent low energies and early tiring. Many medical problems like low hemoglobin need to be ruled out by the doctor before confirming this to be a specific symptom. The management of fatigue in fibromyalgia involves a combination of both non pharmacologic and pharmacologic approaches for maximum benefit.
Aerobic exercise may be useful in managing fatigue. Some patients find exercise difficult until they have been placed on an effective analgesic regimen in management of fatigue cognitive – behavioral therapy is beneficial in management of fatigue. Cognitive therapy is based on the premise that the modifying maladaptive thoughts result in changes in affect and behavior. Therefore, errors in thinking, such as overgeneralizing, magnifying negatives, are challenged and replaced with more realistic and effective thoughts. Thus, decreasing emotional distress and self defeating behavior. In cognitive therapy catastrophic thought such as, “My pain is awful and there is nothing I can do about it” are reframed to “As bad as my pain might get, there are things I can do to make it atleast a little better.”
Psychiatric illness :- Most of the Psychiatric illness are neglected and that is the reason illness worsen. It not only affects the person but the entire family. Family member support is important in controlling psychiatric `illness. Firstly, it is to be understood that like physical illness, most of the psychiatric conditions are transient and complete recovery with treatment is possible.
One should not hesitate to consult psychiatrist. Mood disorder and pain often addressed together. Common examples of Mood disorder are depression, anxiety and simple phobia. Depression may need to be managed aggressively because of suicidal potential.
Psychiatrist help patient to develop pain coping skill through biofeedback, visualization technique and counseling.
Meditation – means putting all your attention on a specific object / area. At least 15-20- min do meditation. Here are some simple tips you can follow.
- Sit with your back straight and in an area where you won't be disturbed.
- Choose time there are no distraction.
- Never meditate after having a heavy meal.
If you can't meditate then you can enchant any name of god, or any song you like loudly and try to hear it. It will also help to refresh your mind.
Meditation you can learn from yoga teacher.
Benefits of meditation will lower stress level, feel more energetic, uninterrupted deep sleep leading to overcome symptoms of STR.
In summary the article highlights the impact of FM on mind. These associations are very common and needs attention. The treatment starts with first understanding this phenomenon. With goal directed easy efforts and medications under doctor's guidance a happy and fulfilling life can be ensured.