Multimodal pain management and cognitive behavioral therapy
If fibromyalgia really affects your quality of life and daily routine, and if other treatments aren’t effective enough, multimodal pain management is an option. Cognitive behavioral therapy helps you to recognize thoughts and behaviors that make the pain worse, and then try to change them.
Chronic (long-term) pain can cause various problems, such as sleep problems and exhaustion. It can also greatly affect your physical fitness and affect all areas of your life, including your relationships, family life, work, household chores, hobbies and recreational activities.
The pain often has an impact on your mood, too. Chronic pain can make people feel scared – for instance, scared of moving too much or worried that the symptoms will keep on getting worse and increasingly dominate their life. Some people then become withdrawn and lose hope that things will improve. If the anxiety becomes overwhelming, it’s easy to fall into a vicious cycle of fears, feeling down, pain, sleep problems, exhaustion and worsening symptoms.
Because chronic pain can be caused by various things and affect many areas of life, it is often a good idea to use a combination of different treatments. This is where multimodal pain management comes in.
What is multimodal pain management?
In multimodal pain management approaches, doctors from different areas of specialization – including pain medicine, physiotherapy, occupational therapy and psychotherapy – work closely together. The treatment involves a combination of exercise, patient education, relaxation techniques and medication. Psychotherapists show patients psychological strategies that help them cope with chronic pain and stress at work or home. This is either done in groups or one-on-one sessions.
Multimodal pain management programs are mainly offered by pain centers, psychosomatic medicine departments in hospitals, and rehabilitation centers with a focus on rheumatology, orthopedics and psychosomatic medicine. In some programs you may stay at the hospital or center the whole time, and in others you may have some treatments as an outpatient. They last at least seven days, but usually last two to four weeks.
The aim of the treatment is to “help people to help themselves” – in other words, learn strategies, exercises and techniques that they can use on their own once they go home.
Multimodal pain management is particularly suitable if other treatments haven’t helped enough or the fibromyalgia symptoms are having a great impact on the person’s quality of life or ability to function in everyday life. The treatment can be prescribed by a practice-based doctor, for instance a family doctor, orthopedist or pain specialist. People generally have to wait about three months before they get a place in a multimodal pain management program.
What is cognitive behavioral therapy and when is it considered?
A lot of people who have fibromyalgia don’t understand how psychotherapy can help them because they think that it’s only used for the treatment of psychological problems. This isn’t true, though. Psychological treatment – cognitive behavioral therapy (CBT) in particular – can also help in people who have tinnitus, sleep problems and various chronic pain disorders.
This is because your own thoughts, feelings and behavior greatly influence how you experience chronic pain or other symptoms. For instance, some people find the pain to be far worse on a stressful day at work than they do at the weekend when they’re out and about with good friends.
The aim of cognitive behavioral therapy is to recognize negative thought patterns and behaviors which make the pain worse. You then try to change those thought patterns and behaviors, for instance by questioning the assumptions that the (often automatic) thoughts are based on. Multimodal pain management programs also include various techniques that can help people cope with pain, such as relaxation and stress management techniques, mindfulness training and visualization (guided imagery).
CBT can be particularly helpful in people who live in constant fear of pain, which actually makes the pain worse. It is also especially suitable for people with fibromyalgia who also have an anxiety disorder or depression.
Bernardy K, Klose P, Busch AJ, Choy EH, Häuser W. Cognitive behavioural therapies for fibromyalgia. Cochrane Database Syst Rev 2013; (9): CD009796.
Deutsche Schmerzgesellschaft. Definition, Pathophysiologie, Diagnostik und Therapie des Fibromyalgiesyndroms. AWMF-Registernr.: 145-004. March 17, 2017.
Papadopoulou D, Fassoulaki A, Tsoulas C, Siafaka I, Vadalouca A. A meta-analysis to determine the effect of pharmacological and non-pharmacological treatments on fibromyalgia symptoms comprising OMERACT-10 response criteria. Clin Rheumatol 2016; 35(3): 573-586.
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