Meaning making in Fibromyalgia

Fibromyalgia Syndrome (FMS) is defined as a condition characterized by a combination of chronic and diffuse musculoskeletal pain, stiffness, and tenderness, usually accompanied by sleep difficulties and fatigue. It is a chronic pain syndrome with a complex, multifactorial and partially known etiopathogenesis that affects women mostly. It is characterized by generalized musculoskeletal pain and palpation-specific tender points, also often associated with sleep disorders, fatigue, somatic and cognitive symptoms, as well as psychic disorders.

An increase in the prevalence of fibromyalgia in general population from 0.2 to 6.6% as per a bibliographical survey conducted between 2005 to 2014. Further, in a study, the relationship between psychological distress and fibromyalgia has been established in terms of high prevalence of current or lifetime depression, anxiety, and somatization disorder among clinical patients.  

An article  described fibromyalgia as one of  the top offenders among others such as arthritis and low back or muscle pain, causing emotional distress and  dysfunctionality. Since, the exact causes of fibromyalgia remains unknown, it is thought to be related to some abnormalities.  In some cases, the level of chemicals in the brain and changes in the CNS (central nervous system) such as- brain, spinal cord and nerves. In other cases it could have been triggered due to genetic, emotional or physical stressful events, such as injury, giving birth or other environmental related factors.

Usually for a diagnosis of FMS the following criteria is taken into consideration - (1) pain and symptoms over the past week, based on the total of number of painful areas out of 18 parts of the body such as base of the skull, lower neck in front, neck and shoulder, edge of upper breast, upper inner shoulder, below side bone at elbow, upper outer buttock, hip bone and just above knee on inside. As well as level of severity of symptoms like fatigue, waking unrefreshed,  cognitive (memory or thought) problems, and a number of other general physical symptoms; (2) symptoms lasting at least three months at a similar level; (3) no other health problem that will explain the pain and other symptoms. FIQR is one way that has been often used as an index of disease activity, symptom identification to provide a diagnosis and therapeutic efficacy.

An individual undergoing symptoms of any kind are likely to make meanings of, it  may be an illness, an incident or just a conversation that he/she would have indulged at some point of their lives. Meaning making in psychology refers to a process of how an individual construes, understands or makes sense of life events, relationships and the self. It helps individuals to retain, revise or replace the elements of the existing system to develop a more nuanced understanding. The ability to find meaning has shown to collate with psychological well being of an individual.

The question which may usually arise is that why meaning making in psychological factors in health- the obvious answers could be the better recognition of distress, provide a framework to the distress through meaning making and reflect upon personal meaning which could serve psychological well-being and better adjustment of an individual.

A myriad of meanings serves in adaptation and coping in cases of chronic illnesses such as fibromyalgia. During the course of illness meaning affects self efficacy. Self-efficacy can be defined as “judgments about one’s capability of organizing different skills in order to execute appropriate courses of actions to deal effectively with the environment”.  It operates as an important factor, which is expressed in four categories - cognitive, motivational, emotional, and decisional in the control of systems pertaining to pain. It operates as an essential cognitive factor in controlling of symptoms such as pain by helping to explain many of the behaviors and disabilities pertaining to FMS. Additionally, the manner in which the diagnosis is made somewhat makes it a predictable disease trajectory and  might also influence how diagnosis is integrated into identities.  This predictability of disease trajectory influences self efficacy, progression of symptoms, perceived severity of symptoms and treatment choices/mediums. The diagnosis of  FMS in itself inflicts a great deal of distress in the lives of patients, as shown in a study, wherein participants expressed their feelings of worry pertaining to daily living and their future related goals. Emotion-focused coping was one of the effective strategy to work around the overwhelming emotions of the patients undergoing FMS. It was helpful for them deal with negative emotional responses as a result of FMS, such as stress due to factors such as uncontrontrolability, lack of resources and uncertainty to work around it. Assessing these factors, and management of negative emotion to foster coping are some of the ways to help the patients in efficient symptom management.  Another method that could be used is Dialectical Behavior Therapy (DBT). DBT has four components - mindfulness, distress tolerance, emotion regulation and assertiveness. It serves as bringing acceptance and coping.

For any illness, coping remains an integral part to help/relief to the patient, in recent studies a drug named Pregabalin also known as Lyrica tends to have a positive impact on patients with FM in relieving pain intensity ranging from moderate or severe pain.  Another important point is to foster better stability, and their physiological and psychological wellbeing by validating of individuals undergoing FMS, especially as it is  marked by distress which resides at the intersection of neurology, internal medicine, and psychiatry.

Furthermore the growth in FM literature will not only help in early diagnosis and intervention for the patients undergoing FM but also help in understanding other related factors such as socioeconomic status, impact of poverty on the illness in the context of FM.

Anjali Kanojia