FMS is real. Most individuals do not understand what they cannot see. Pain is invisible. The pain of fibromyalgia is real even though unseen. There is no bleeding, swelling, discoloration, or other visible abnormalities. Families and the public may have difficulty accepting the biophysical aspects of the disease. The FMS patient is encouraged to avoid withdrawal from favorite activities when possible. These activities provide pleasure and help the FMS patient avoid depression (Robertson 1999) (Schultz, 2004).
Exercises recommended for FMS should be gentle to prevent muscle damage. They should include stretching, and should be conducted on the floor or in a stable position because patients with FMs are prone to dizziness and falls should be avoided. The types of exercise should focus on aerobics, strength training and flexibility exercises. Recommended exercises are Tai Chi, pilates, yoga, or exercises in a warm pool (Robertson 1999) (Schultz 2004).
Bicycling and walking are other exercises that are beneficial. When riding a bike or if walking near the street, remember safety precautions. Monitor symptoms during and after exercising. Increased pain should be avoided. Take breaks and do not exercise on days when activity is high such as running errands, house work, etc. Start slowly and increase exercise times or levels as tolerated (Robertson 1999) (Schultz 2004).
Avoid “triggers” (activities or situations that cause increases in symptoms) as much as possible. Triggers may be different for different individuals. Common triggers are fatigue, lack of sleep, damp or cold weather, stress and overexertion.
Sleeping problems may cause changes in the immune system that cause pain, inflammation, fatigue, and decreased pain tolerance. Sleeplessness can be avoided by listening to soft music, consuming a warm non-alcoholic beverage, and relaxation techniques practiced before bed time. Avoid caffeine, exercise, and large meals 4-6 hours before bed time. Develop a routine for sleep and awakening and maintain the routine. If unable to fall asleep in 15-20 minutes, go to another room and perform a relaxing activity such as reading. When sleepy, return to bed. The bed should be used for sleep and sexual activity only.
Dressing appropriately for weather extremes and learning to deal with stress (biofeedback, hypnosis guided imagery, meditation) can also reduce triggers. Many sources question the helpfulness of bio feedback in FMS. The patient should select whatever therapy works.
Cognitive behavioral therapy (CBT) is an important part of the treatment component. It involves changes in attitude and response to negative situations. Participants attend sessions and learn how to view stressors differently. They may be asked to keep a diary of stressors and record any symptom changes during times of stress. They are expected to confront negative thoughts and behaviors, set limits, and prioritize activities. Many FMS patients have personalities that demand perfection and once they fall short of perfection, they believe they are failures. CBT can improve these attitudes and beliefs and help the patient overlook their lack of perfection.
Again, therapy should be selected, in conjunction with the physician, on an individual basis. Not all treatments work equally for all patients. Trial and error should be anticipated.
The nurse can be a patient advocate by acknowledgement of the reality and severity of the patient’s symptoms, encouraging active patient involvement in treatment and care decisions, remind the patient that there are no “instant cures”. The goal of treatment is to alleviate symptoms as much as possible and improve the quality of life. Remind the patient to identify and accept limitations on activity and assist them in making the most of their strengths while minimizing tasks that cannot be accomplished successfully (Robertson, 2006).
