Improve Sleep in Fibromyalgia Patients with Mindfulness

Improve Sleep in Fibromyalgia Patients with Mindfulness

 

By John M. de Castro, Ph.D.

 

“Now, I do live in the moment, and it is quite beautiful, I feel at peace, I feel much more confident and I am able to look to the future with confidence. I am much more compassionate with myself and everyone else. I now accept that this illness is not my fault and it is now 100 per cent easier to deal with the primary pain that comes with fibromyalgia by eliminating the secondary suffering of worry and anxiety.” – Lesa Vallentine

 

Fibromyalgia is a mysterious disorder whose causes are unknown. It is very common affecting over 5 million people in the U.S., about 2% of the population with about 7 times more women affected than men. It is characterized by widespread pain, abnormal pain processing, sleep disturbance, and fatigue that lead to psychological distress. Fibromyalgia may also have morning stiffness, tingling or numbness in hands and feet, headaches, including migraines, irritable bowel syndrome, sleep disturbances, thinking and memory problems, and painful menstrual periods. The symptoms are so severe and debilitating that about half the patients are unable to perform routine daily functions and about a third have to stop work. Although it is not itself fatal, suicide rates are higher in fibromyalgia sufferers.

 

There are no completely effective treatments for fibromyalgia. Symptoms are generally treated with pain relievers, antidepressant drugs and exercise. But, these only reduce the severity of the symptoms and do not treat the disease directly. Mindfulness practices have also been shown to be effective in reducing pain from fibromyalgia. But, it is unclear, however, if mindfulness training can reduce the sleep disturbances and insomnia that accompany fibromyalgia.

 

In today’s Research News article “Effects of Mindfulness Training on Sleep Problems in Patients With Fibromyalgia.” (See summary below or view the full text of the study at: https://www.frontiersin.org/articles/10.3389/fpsyg.2018.01365/full?utm_source=F-AAE&utm_medium=EMLF&utm_campaign=MRK_755938_69_Psycho_20180904_arts_A ), Amutio and colleagues recruited patients diagnosed with fibromyalgia and randomly assigned them to a no-treatment control condition or to receive 7 weeks of Flow Meditation practice. They met in groups once a week for 2 hours and practiced daily at home. Flow Meditation consisted of mindfulness exercises from Mindfulness-Based Stress Reduction (MBSR) training, mindfulness techniques used in acceptance and commitment therapy, and exposure to and debate on metaphors and exercises used in Zen and Vipassana meditation. The participants were measured before and after training and 3 months later for insomnia, sleep quality, daytime sleepiness, and sleep impairments.

 

They found that in comparison to baseline and the control group the mindfulness trained group had significant increases in sleep quality and significant decreases in insomnia, daytime sleepiness, and sleep impairments. These effects varied from moderate to large and did not diminish over the 3-month follow-up period. So, mindfulness training appears to be a safe, effective, and lasting treatment for the sleep problems occurring with fibromyalgia. These are very significant improvements as lack of sleep by fibromyalgia patients contributes mightily to the reduced quality of life and overall health of the sufferers. This combined with the previously observed reduction in perceived pain produced by mindfulness training suggests that this training is an excellent alternative or supplemental treatment for fibromyalgia.

 

Improve Sleep in Fibromyalgia Patients with Mindfulness.

 

“Mindfulness may be able to help patients learn to direct their attention away from pain, inhibit the central nervous system’s ability to perceive pain. reduce distressing thoughts and feelings that come with pain, which can keep them from making the pain worse, enhance body awareness, which may lead to improved self-care, promote deep muscle relaxation, lessening tension and irritability, and create a buffer against stress-related symptoms” – HealthLine

 

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Amutio A, Franco C, Sánchez-Sánchez LC, Pérez-Fuentes MdC, Gázquez-Linares JJ, Van Gordon W and Molero-Jurado MdM (2018) Effects of Mindfulness Training on Sleep Problems in Patients With Fibromyalgia. Front. Psychol. 9:1365. doi: 10.3389/fpsyg.2018.01365

 

Fibromyalgia syndrome (FMS) is a complex psychosomatic pain condition. In addition to generalized pain and various cognitive difficulties, new FMS diagnostic criteria acknowledge fatigue and sleep problems as core aspects of this condition. Indeed, poor sleep quality has been found to be a significant predictor of pain, fatigue, and maladaptive social functioning in this patient group. While there is promising evidence supporting the role of mindfulness as a treatment for FMS, to date, mindfulness intervention studies have principally focused on dimensions of pain as the primary outcome with sleep problems either not being assessed or included as a secondary consideration. Given the role of sleep problems in the pathogenesis of FMS, and given that mindfulness has been shown to improve sleep problems in other clinical conditions, the present study explored the effects of a mindfulness-based intervention known as Flow Meditation (Meditación-Fluir) on a range of sleep-related outcomes (subjective insomnia, sleep quality, sleepiness, and sleep impairment) in individuals with FMS. Adult women with FMS (n = 39) were randomly assigned to the 7 weeks mindfulness treatment or a waiting list control group. Results showed that compared to the control group, individuals in the mindfulness group demonstrated significant improvements across all outcome measures and that the intervention effects were maintained at a 3 month follow-up assessment. The Meditación-Fluir program shows promise for alleviating sleep problems relating to FMS and may thus have a role in the treatment of FMS as well as other pain disorders in which sleep impairment is a central feature of the condition.

https://www.frontiersin.org/articles/10.3389/fpsyg.2018.01365/full?utm_source=F-AAE&utm_medium=EMLF&utm_campaign=MRK_755938_69_Psycho_20180904_arts_A

Reduce the Symptoms of Fibromyalgia with Tai Chi

Reduce the Symptoms of Fibromyalgia with Tai Chi

 

By John M. de Castro, Ph.D.

 

“Tai chi mind-body treatment results in similar or greater improvement in symptoms than aerobic exercise, the current most commonly prescribed non-drug treatment. This mind-body approach may be considered a therapeutic option in the multi-disciplinary management of fibromyalgia.” – Wang et al.

 

Fibromyalgia is a mysterious disorder whose causes are unknown. It is very common affecting over 5 million people in the U.S., about 2% of the population with about 7 times more women affected than men. It is characterized by widespread pain, abnormal pain processing, sleep disturbance, and fatigue that lead to psychological distress. Fibromyalgia may also have morning stiffness, tingling or numbness in hands and feet, headaches, including migraines, irritable bowel syndrome, sleep disturbances, thinking and memory problems, and painful menstrual periods. The symptoms are so severe and debilitating that about half the patients are unable to perform routine daily functions and about a third have to stop work. Although it is not itself fatal, suicide rates are higher in fibromyalgia sufferers.

 

There are no completely effective treatments for fibromyalgia. Symptoms are generally treated with pain relievers, antidepressant drugs and exercise. But, these only reduce the severity of the symptoms and do not treat the disease directly. Mindfulness practices have also been shown to be effective in reducing pain from fibromyalgia. Mindfulness practices that are also exercises may be particularly effective. Indeed, yoga practice has been shown to improve the symptoms of fibromyalgia. This suggests that Tai Chi, another mindful exercise might be similarly effective.

 

In today’s Research News article “Effect of tai chi versus aerobic exercise for fibromyalgia: comparative effectiveness randomized controlled trial.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5861462/ ), Wang and colleagues recruited patients with fibromyalgia and randomly assigned them to one of three groups; 60 minutes of Tai Chi once a week for 24 weeks, 60 minutes of Tai Chi twice a week for 12 weeks, or 60 minutes of light to moderate aerobic exercises twice a week for 24 weeks. Participants were encouraged to practice at home and continue the exercises after the end of formal sessions. Participants were measured before and at 12, 24, and 52 weeks into the intervention for overall severity of fibromyalgia, including intensity of pain, physical function, fatigue, morning tiredness, depression, anxiety, job difficulty, and overall wellbeing, anxiety, depression, self-efficacy, sleep quality, symptom severity, physical and mental health, coping strategies, social support, disability, and physical function, including muscle strength and power.

 

They found that at 24 and again at 52 weeks all groups showed significant improvement but the Tai Chi groups had significantly greater improvement than the aerobic exercise group in overall fibromyalgia severity, self-efficacy, anxiety, and coping strategies. Hence, participation in Tai Chi exercise produce significant improvement in the symptoms of fibromyalgia that were better than those produced by aerobic exercise.

 

These are remarkable findings that Tai Chi practice is better than aerobic exercise in treating the symptoms of fibromyalgia. Both helped, but Tai Chi helped more. Fibromyalgia patients suffer greatly and to bring relief with a simple, gentle, safe exercise is very important. Tai Chi is inexpensive to administer, can be performed in groups or alone, at home or in a facility or even public park, and can be quickly learned. In addition, it can be practiced in social groups without professional supervision. This can make it fun, improving the likelihood of long-term engagement in the practice. Hence, Tai Chi practice would appear to be a wonderful effective treatment for the relief of the suffering of fibromyalgia patients.

 

So, reduce the symptoms of fibromyalgia with Tai Chi.

 

“The authors attributed the success of the program to the postures and low impact movements of Tai Chi, and to the “controlled breathing and movements leading to restful state and mental tranquility.” Pain thresholds were likely raised in the process, which helped break the cycle of movement pain.“ – Joanna Fernandes

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Wang, C., Schmid, C. H., Fielding, R. A., Harvey, W. F., Reid, K. F., Price, L. L., … McAlindon, T. (2018). Effect of tai chi versus aerobic exercise for fibromyalgia: comparative effectiveness randomized controlled trial. The BMJ, 360, k851. http://doi.org/10.1136/bmj.k851

 

Abstract

Objectives

To determine the effectiveness of tai chi interventions compared with aerobic exercise, a current core standard treatment in patients with fibromyalgia, and to test whether the effectiveness of tai chi depends on its dosage or duration.

Design

Prospective, randomized, 52 week, single blind comparative effectiveness trial.

Setting

Urban tertiary care academic hospital in the United States between March 2012 and September 2016.

Participants

226 adults with fibromyalgia (as defined by the American College of Rheumatology 1990 and 2010 criteria) were included in the intention to treat analyses: 151 were assigned to one of four tai chi groups and 75 to an aerobic exercise group.

Interventions

Participants were randomly assigned to either supervised aerobic exercise (24 weeks, twice weekly) or one of four classic Yang style supervised tai chi interventions (12 or 24 weeks, once or twice weekly). Participants were followed for 52 weeks. Adherence was rigorously encouraged in person and by telephone.

Main outcome measures

The primary outcome was change in the revised fibromyalgia impact questionnaire (FIQR) scores at 24 weeks compared with baseline. Secondary outcomes included changes of scores in patient’s global assessment, anxiety, depression, self efficacy, coping strategies, physical functional performance, functional limitation, sleep, and health related quality of life.

Results

FIQR scores improved in all five treatment groups, but the combined tai chi groups improved statistically significantly more than the aerobic exercise group in FIQR scores at 24 weeks (difference between groups=5.5 points, 95% confidence interval 0.6 to 10.4, P=0.03) and several secondary outcomes (patient’s global assessment=0.9 points, 0.3 to 1.4, P=0.005; anxiety=1.2 points, 0.3 to 2.1, P=0.006; self efficacy=1.0 points, 0.5 to 1.6, P=0.0004; and coping strategies, 2.6 points, 0.8 to 4.3, P=0.005). Tai chi treatment compared with aerobic exercise administered with the same intensity and duration (24 weeks, twice weekly) had greater benefit (between group difference in FIQR scores=16.2 points, 8.7 to 23.6, P<0.001). The groups who received tai chi for 24 weeks showed greater improvements than those who received it for 12 weeks (difference in FIQR scores=9.6 points, 2.6 to 16.6, P=0.007). There was no significant increase in benefit for groups who received tai chi twice weekly compared with once weekly. Participants attended the tai chi training sessions more often than participants attended aerobic exercise. The effects of tai chi were consistent across all instructors. No serious adverse events related to the interventions were reported.

Conclusion

Tai chi mind-body treatment results in similar or greater improvement in symptoms than aerobic exercise, the current most commonly prescribed non-drug treatment, for a variety of outcomes for patients with fibromyalgia. Longer duration of tai chi showed greater improvement. This mind-body approach may be considered a therapeutic option in the multidisciplinary management of fibromyalgia.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5861462/

 

Lessen Fibromyalgia Pain with Mindfulness

Lessen Fibromyalgia Pain with Mindfulness

 

By John M. de Castro, Ph.D.

 

“You’ve heard the expression “mind over matter,” but did you know that it’s a tried-and-true approach to easing many conditions, including fibromyalgia?” – Madeline Vann

 

Fibromyalgia is a mysterious disorder whose causes are unknown. It is very common affecting over 5 million people in the U.S., about 2% of the population with about 7 times more women affected than men. It is characterized by widespread pain, abnormal pain processing, sleep disturbance, and fatigue that lead to psychological distress. Fibromyalgia may also have morning stiffness, tingling or numbness in hands and feet, headaches, including migraines, irritable bowel syndrome, sleep disturbances, thinking and memory problems, and painful menstrual periods. The symptoms are so severe and debilitating that about half the patients are unable to perform routine daily functions and about a third have to stop work. Although it is not itself fatal, suicide rates are higher in fibromyalgia sufferers.

 

There are no completely effective treatments for fibromyalgia. Symptoms are generally treated with pain relievers, antidepressant drugs and exercise. But, these only reduce the severity of the symptoms and do not treat the disease directly. Mindfulness practices have also been shown to be effective in reducing pain from fibromyalgia. In today’s Research News article “Mindfulness Meditation for Fibromyalgia: Mechanistic and Clinical Considerations.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5693231/ ), Adler-Neal and Zeidan review and summarize the published research literature on the employment of mindfulness training for the relief of fibromyalgia symptoms.

 

They report that “mindfulness interventions . . . are generally premised on (a) developing sustained attention to arising sensory, affective, and cognitive events, (b) recognizing such experiences as momentary and fleeting, and (c) attenuating reactions/judgments to said experiences. Mindfulness training reliably improves catastrophizing, anxiety, depression, mood, and stress. Thus, improvements in mood and cognitive flexibility could lead to greater pain relief by altering the way patients interpret/contextualize pain-related ruminations.”

 

They report that the research finds that mindfulness training, especially if tailored for fibromyalgia, significantly improves fatigue, stress, sleep, pain, pain coping, positive emotions, family stress, loneliness and global well-being in fibromyalgia patients. In addition, these benefits appear to be sustained for at least 2 months after the completion of training. Hence, mindfulness training would appear to be a safe and effective treatment for fibromyalgia.

 

The improvements produced by mindfulness training appear to be mediated by changes in the nervous system. It heightens activity in the brain cortical areas that underlie the cognitional and emotional evaluation of pain and decreased activation of brain thalamic areas that process sensory information. Hence, mindfulness training appears to alter the brain to improve mechanisms underlying attention and emotions and decrease sensory sensitivity to pain. This can deaden pain itself plus improve the non-judgmental and non-reactive awareness of the pain, reducing the suffering of fibromyalgia pain.

 

People with fibromyalgia suffer to an extent where some contemplate suicide. It is wonderful to see that relatively simple and safe mindfulness training can effectively reduce the suffering.

 

So, lessen fibromyalgia pain with mindfulness.

 

“While being mindful did make them more aware of pain or a symptom of their condition, it also helped them be open to something good happening and they had the choice to focus on the good. Many people spoke of trying to negotiate a balance in their feelings,” – Jaqui Long

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Adler-Neal, A. L., & Zeidan, F. (2017). Mindfulness Meditation for Fibromyalgia: Mechanistic and Clinical Considerations. Current Rheumatology Reports, 19(9), 59. http://doi.org/10.1007/s11926-017-0686-0

 

Abstract

Purpose of Review

Fibromyalgia is a disorder characterized by widespread pain and a spectrum of psychological comorbidities, rendering treatment difficult and often a financial burden. Fibromyalgia is a complicated chronic pain condition that requires a multimodal therapeutic approach to optimize treatment efficacy. Thus, it has been postulated that mind-body techniques may prove fruitful in treating fibromyalgia. Mindfulness meditation, a behavioral technique premised on non-reactive sensory awareness, attenuates pain and improves mental health outcomes. However, the impact of mindfulness meditation on fibromyalgia-related outcomes has not been comprehensively characterized. The present review delineates the existing evidence supporting the effectiveness and hypothesized mechanisms of mindfulness meditation in treating fibromyalgia-related outcomes.

Recent Findings

Mindfulness-based interventions premised on cultivating acceptance, non-attachment, and social engagement may be most effective in decreasing fibromyalgia-related pain and psychological symptoms. Mindfulness-based therapies may alleviate fibromyalgia-related outcomes through multiple neural, psychological, and physiological processes.

Summary

Mindfulness meditation may provide an effective complementary treatment approach for fibromyalgia patients, especially when combined with other reliable techniques (exercise; cognitive behavioral therapy). However, characterizing the specific analgesic mechanisms supporting mindfulness meditation is a critical step to fostering the clinical validity of this technique. Identification of the specific analgesic mechanisms supporting mindfulness-based pain relief could be utilized to better design behavioral interventions to specifically target fibromyalgia-related outcomes.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5693231/

Produce Lasting Improvement in Fibromyalgia with Yoga

Produce Lasting Improvement in Fibromyalgia with Yoga

 

By John M. de Castro, Ph.D.

 

“For the nearly 10 million people who suffer from this condition, the thought of any movement can be overwhelming. What makes yoga perfect though is that it can be adapted for each person’s individual needs. Additionally, yoga’s ability to calm the mind and reduce stress may also serve to reduce the main trigger of fibromyalgia attacks, as well as slowly loosen cramped muscles.” – Liz Rosenblum

 

Fibromyalgia is a mysterious disorder whose causes are unknown. It is very common affecting over 5 million people in the U.S., about 2% of the population with about 7 times more women affected than men. It is characterized by widespread pain, abnormal pain processing, sleep disturbance, and fatigue that lead to psychological distress. There are no completely effective treatments for fibromyalgia. Symptoms are generally treated with pain relievers, antidepressant drugs and exercise. But, these only reduce the severity of the symptoms and do not treat the disease directly. Mindfulness practices have also been shown to be effective in reducing pain from fibromyalgia.

 

Yoga is both an exercise and a mindfulness practice. So, it would make sense to investigate the effectiveness of yoga practice in treating fibromyalgia. Indeed, in a previous study, Carson and colleagues (Insert Link to Prior study) found that, yoga practice produced significant improvements in overall fibromyalgia symptoms. These findings need to be replicated and follow-up needs to be performed to establish the duration of the benefits. In today’s Research News article “Follow-up of Yoga of Awareness for Fibromyalgia: Results at 3 Months and Replication in the Wait-list Group.” See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5568073/, Carson and colleagues follow up their previous study (Insert Link to Prior study) to replicate their findings and investigate whether the benefits last.

 

They recruited adult women who were diagnosed with fibromyalgia for at least a year. They were randomly assigned to receive either yoga practice or be on a wait-list control condition. The Yoga for Awareness training occurred in a group setting for 2 hours, once a week for 8 weeks. Participants were also encouraged to practice at home for 20-40 minutes, 5 to 7 days per week. Yoga for Awareness sessions consisted of yoga stretching poses, mindfulness meditation, breathing exercises, presentations on the application of yogic principles to optimal coping, and group discussions. Participants were measured before and after training for fibromyalgia symptoms and disability, including myalgic tender points, strength deficits, and balance deficits, and pain coping including acceptance, catastrophizing, and adaptive and maladaptive strategies. In addition, daily diaries were maintained of “pain, fatigue, emotional distress, and vigor, along with success at coping via acceptance and relaxation strategies.” In this follow-up study, the wait-list control was provided the yoga training for 8 weeks and the previous yoga group was followed for durability of the symptom relief.

 

They found that after treating the previous control group, like with the previous study, there were significant improvements in overall fibromyalgia symptoms and its impact, including pain, fatigue, stiffness, sleep problems, depression, anxiety, memory problems, tenderness, balance, environmental sensitivity, and strength. There were even improvements in the strategies that the patients used to cope with the pain, including increased engagement with the pain, pain problem solving, reappraisal and decreased pain catastrophizing, self-isolation, and disengagement. The daily diaries also revealed significant improvements as a result of yoga practice including reduced pain, fatigue, emotional distress and increased vigor, relaxation, and success with acceptance. The improvements were significantly related to the amount of home practice with the greater the number of days per week that yoga was practiced at home the greater the improvements in overall fibromyalgia symptoms. They also found that the group treated in the previous study maintained their improvements in fibromyalgia symptoms, functional deficits, and coping abilities with no benefit showing a significantly lessened benefit.

 

Hence, they were able to replicate their prior findings, demonstrating that they were not a one-time event, and they were able to demonstrate that the benefits last at least for 3 months after the end of formal treatment. This is important as fibromyalgia lasts a lifetime. So, having lasting benefit is a prerequisite for a treatment. Yoga practice appears to fulfill these prerequisites and is a safe and effective treatment for fibromyalgia.

 

So, produce lasting improvement in fibromyalgia with yoga.

 

“Yoga’s ability to shift the nervous system out of the stress response and into the relaxation response is vital to people whose central nervous systems are sensitive and naturally hyped way up. It also acts directly on the very muscles where fibromyalgia pain occurs.” – Catherine Guthrie

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Carson, J. W., Carson, K. M., Jones, K. D., Mist, S. D., & Bennett, R. M. (2012). Follow-up of Yoga of Awareness for Fibromyalgia: Results at 3 Months and Replication in the Wait-list Group. The Clinical Journal of Pain, 28(9), 804–813. http://doi.org/10.1097/AJP.0b013e31824549b5

 

Abstract

Objectives

Published preliminary findings from a randomized-controlled trial suggest that an 8-week Yoga of Awareness intervention may be effective for improving symptoms, functional deficits, and coping abilities in fibromyalgia. The primary aims of this study were to evaluate the same intervention’s posttreatment effects in a wait-list group and to test the intervention’s effects at 3-month follow-up in the immediate treatment group.

Methods

Unpaired t tests were used to compare data from a per protocol sample of 21 women in the immediate treatment group who had completed treatment and 18 women in the wait-list group who had completed treatment. Within-group paired t tests were performed to compare posttreatment data with 3-month follow-up data in the immediate treatment group. The primary outcome measure was the Fibromyalgia Impact Questionnaire Revised (FIQR). Multilevel random-effects models were also used to examine associations between yoga practice rates and outcomes.

Results

Posttreatment results in the wait-list group largely mirrored results seen at posttreatment in the immediate treatment group, with the FIQR Total Score improving by 31.9% across the 2 groups. Follow-up results showed that patients sustained most of their posttreatment gains, with the FIQR Total Score remaining 21.9% improved at 3 months. Yoga practice rates were good, and more practice was associated with more benefit for a variety of outcomes.

Discussion

These findings indicate that the benefits of Yoga of Awareness in fibromyalgia are replicable and can be maintained.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5568073/