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Pain is usually the central symptom in fibromyalgia and is often a problem for CFS patients as well. For people with FM, pain is generally felt all over the body, though it can start in one region and spread or move from one area to another.

It may be accompanied by neurological problems such as tingling and burning or numbness in the hands, arms, feet, legs or face. For people with CFS, pain may be experienced in the joints or, more commonly, as an overall body pain ("I feel like I've been run over by a truck.")

Because pain in CFS and FM can have a variety of causes, it is usually managed with a variety of strategies. If pain is a problem for you, you can create a pain management plan from the following options.

Medications

People with FM and CFS often treat pain with medications. Because no medication is consistently helpful and because sometimes pain relievers lose effectiveness as the body becomes accustomed to them, experimentation is usually required. Usually, patients are started on dosages that are a small fraction of normal dosage levels.

FM and CFS patients who seek pain relief through medications usually begin with non-prescription products, such as aspirin and other over-the-counter pain relievers. Others find help through prescription medications such as Ultram (Tramadol) and, in some cases, narcotics. Prescription drugs that improve sleep can have a beneficial effect on pain as well.

Anti-depressants, such as Elavil (Amitriptyline), Prozac and Paxil are often tried. The FDA (US government body regulating food and drugs) has approved three drugs for the treatment of fibromyalgia: Lyrica (pregabalin), Cymbalta (duloxetine hydrochloride) and Savella (milnacipran HCl).

Many fibromyalgia patients also experience Myofascial Pain Syndrome (MPS), a pain condition localized in trigger points (specific locations in muscles or fascia), often in the neck or shoulders. MPS may be treated with medication and the injection of local anesthetics into the trigger points.

Some patients experience neuropathic or nerve pain, burning or electric shock sensations, felt most commonly in the hands and feet. This type of pain is often treated with anti-seizure medications, such as Neurontin.

Exercise, Posture & Movement

Exercise is one of the most-commonly prescribed treatments for FM and can be helpful for CFS as well. An exercise program done regularly can help reduce stiffness, counteract deconditioning and improve outlook. A program of gentle stretching can be helpful for both FM and CFS. In addition, people with FM are usually helped by frequent breaks for stretching, to reduce stiffness.

FM patients especially can help reduce their pain by experimenting with how they hold their body and how they move. Many patients find that staying in one position for an extended period of time increases stiffness and intensifies pain, so moving periodically can help you avoid pain. Limiting the length of time spent doing repetitive motions like chopping can help, too. For more on exercise and movement, see Chapter 16.

Pacing

A frequent cause of pain is overdoing or having an activity level that is beyond a person's limits. Pacing offers a way to bring stability and control by keeping activity level within the limits imposed by illness. Pacing can involve a variety of strategies, including:

• Reducing overall activity level
• Setting priorities and delegating
• Taking scheduled rests
• Having short activity periods
• Switching between high and low intensity tasks
• Using the best hours of day for the most demanding activities
• Knowing mental and social limits
• Keeping records to see links between activity and symptoms

For a discussion of pacing strategies, see Chapter 9.
 

Relaxation

Being in pain can create muscle tension and anxiety, both of which can intensify the experience of pain. Muscle tension is directly painful, while anxiety contributes to the experience of pain indirectly by increasing stress and a sense of helplessness. Relaxation is an antidote to both tension and stress. Also, it offers a distraction from pain.

For some people, relaxation involves the regular use of a formal relaxation or meditation procedure, such as those described in Chapter 13 of The Patients Guide to CFS and FM . Other relaxing activities include exercise, mindful breathing, baths and hot tubs, massage, rest breaks and listening to tapes.

Addressing Worry, Frustration & Depression

The experience of pain is intensified by emotions like worry, frustration and depression. Worry and frustration create muscle tension, which makes pain more intense. Relaxation procedures can reduce pain both directly by easing muscle tension and indirectly through reducing stress. People who are depressed have a lower threshold for pain. Self-help strategies, sometimes in combination with medications, can help manage it. For more on feelings, see Chapter 19.

Treating Fatigue & Poor Sleep

Pain, fatigue and poor sleep are tightly connected. Fatigue deepens the experience of pain. When we feel tired, we experience pain more intensely, thus reducing fatigue lessens pain. Similarly, poor sleep intensifies pain, so improving sleep can help control pain. Of the three symptoms, poor sleep is often addressed first.

Heat, Cold & Massage

Heat, cold and massage can be used for temporary relief of pain. Heat is best utilized for reducing the pain that results from muscle tension and inactivity. The warmth increases blood flow and thereby produces some relaxation, reducing pain and stiffness. For localized pain, heating pads or hot packs are used frequently. For overall relief, people often use warm baths, soaks in a hot tub or lying on an electric mattress pad.

Cold treatments decrease inflammation by reducing blood flow to an area. They also may numb the areas that are sending pain signals. You might use gel packs, ice packs or bags of frozen vegetables. With both heat and cold, you should not use the treatment for more than 15 or 20 minutes at a time.

Massage of painful areas can also provide temporary relief from pain. Like heat, massage increases blood flow and can also relieve spasms. You can consider three different forms of massage: self-massage using your hands, massage using a handheld device, and professional massage. If you use a massage therapist, ask her to be cautious and to check frequently on your pain sensitivity.

Problem Solving

You can gain some control over pain by identifying the situations that trigger or intensify pain and then taking steps to change them. For example, you might find that you are not able to keep up with household chores as you used to.

Using problem solving, you brainstorm a variety of solutions, such as spreading the chores out over several days, doing them on one day but taking rest breaks, and getting help from others, either family members or hired help. You then try a solution to see whether it works, evaluate and try again.

If you have a job and find that your pain increases when you work under deadlines, problem solving could take several forms. You may train yourself to take time to relax your muscles. Looking at your situation more broadly, you may identify work overload as a recurring problem and consider reducing your hours, changing your responsibilities or taking time off from work. For more on job options, see Chapter 15.

Pleasurable Thoughts and Activities (Distraction)

Immersing yourself in pleasant thoughts and activities can lessen pain by providing distraction. Imagery can be especially helpful, as you visualize a pleasant scene, involving as many senses as possible. If you want to transport yourself to the beach, see the light shimmering on the water, feel the warmth of the sun on your skin, hear the waves crashing and smell the mustard from the hotdogs.

Engaging in activities that bring pleasure can also provide distraction from pain. Examples include reading a book, watching a movie, taking a bath, listening to or playing music and spending time in nature.

Healthy Self-Talk

Thoughts can have a dramatic effect on our moods and, in turn, on our perceptions of pain. This can be a vicious cycle. An increase in symptoms may trigger negative thoughts like "I'll never get better" or "It's hopeless." Such thoughts can then make us feel anxious, sad, angry and helpless, intensifying pain and triggering another round of negative thoughts and more muscle tension.

It's possible, however, to learn to recognize and to change your habitually negative thoughts using a three-step process described in Chapter 31. Similar treatments can be found in books like Feeling Good by David Burns and Learned Optimism by Martin Seligman, or you can get help from counselors trained in Cognitive Therapy.