I finally got my life back after years of chronic pain… but it wasn’t thanks to a miracle pill

Hazel Borland was a shadow of her former self after developing pain that plagued her for decades.

It started with back pain after the birth of her daughter Nikola, 30 years ago. After 12 years of persistent pain, Hazel was finally diagnosed with fibromyalgia – a chronic pain condition that affects 2.5 million people in Britain – at the age of 36.

Other symptoms include fatigue, sleep problems, brain fog (known as fibro fog), depression and anxiety. There is no cure and, as many of those affected find, painkillers make little difference.

“I have widespread, aching pain that is always in the background, but then I also get ‘nerves on fire,’ where my nerve endings – in one area or more widely spread – are ultra-sensitive,” says Hazel.

‘My worst areas of pain are my lower back and legs.’

Hazel previously had an active social life, but gave up sports and had to give up her job as an administrator. She rarely left her home in Elderslie, Scotland.

But her life has now been transformed – not by a new miracle pill, but, at least in part, by cognitive behavioral therapy (CBT), a form of talk therapy that coaches people to think differently about pain and how to deal with it.

“I’d tried everything – painkillers, physiotherapy, antidepressants – but nothing really made that much of a difference,” says Hazel, 54, who is married to Allan, 55.

Their daughter Nikola also has fibromyalgia (a genetic link is believed to exist).

‘I stopped going places, seeing friends and family and I gave up work because I was in pain, exhausted and completely preoccupied. I have also battled depression and anxiety for as long as I have had fibromyalgia.

‘But after CBT everything fell into place. Instead of being consumed by it, I became more accepting of my condition and understood that the way I thought affected my physical health; the fear of the pain kept me from moving on with my life. I still have pain, but it feels less intense.’

Her condition has improved so much that Hazel is now back to work as an office administrator three days a week and no longer turns down social invitations.

“We go to basketball games and concerts, which used to be unthinkable,” she says.

New research published in December in the journal Pain found that 60 percent of fibromyalgia patients who underwent CBT experienced an improvement in their symptoms.

And according to research from the Karolinska Institute in Sweden, it doesn’t seem to matter what type of cognitive behavioral therapy you have.

The researchers offered 274 people with fibromyalgia either traditional cognitive behavioral therapy (a combination of dealing with negative thoughts, relaxation, exercise and pacing – that is, not overdoing it); or exposure-based cognitive behavioral therapy (which encourages the patient to repeatedly face situations or activities that they previously avoided because of the pain).

After the ten-week online program, with eight written ‘modules’ and regular contact with a therapist, about six in ten patients in both groups reported improvements.

“CBT is based on the theory that if you change your behavior in relation to your pain, this can influence your perception of it,” Maria Hedman-Lagerlof, a psychologist who led the study, told Good Health.

‘The result may be that you care less about the pain and don’t let it affect how you spend your day to the same extent.

‘In this study, fibromyalgia patients who benefited experienced at least a 14 percent improvement in symptoms, and this improvement was maintained for up to twelve months after completing treatment.’

Previous research using MRI scans of the brain suggests that people with fibromyalgia may actually ‘feel’ less pain after cognitive behavioral therapy. In a study published in the Clinical Journal of Pain in 2017, 16 people with fibromyalgia who had a tendency to catastrophize (anticipating the worst event and feeling helpless about the pain) received four weeks of cognitive behavioral therapy or education about the condition.

Those who underwent CBT reported much less pain and catastrophizing at the six-month follow-up.

Dr. Patrick Hill, a clinical and health psychologist and council member of the British Pain Society, explains: ‘All pain is produced by the brain and central nervous system, depending on what the brain thinks is going on – it is not produced by the body produced and detected. in the brain.’

‘You can’t see pain on an MRI, but you can see brain activity associated with pain, and studies have suggested that this brain activity may be lower in people with fibromyalgia who have had CBT.’

Unlike other chronic pain conditions such as osteoporosis and endometriosis, which have a direct ‘visible’ cause, fibromyalgia is thought to be related to an oversensitive and overreactive nervous system.

Those affected experience pain and fatigue in response to harmless triggers, such as doing more activity than normal. “Over time, biological, social and psychological factors interact to create vicious cycles,” says Dr. Hill.

‘If you have persistent pain, you will naturally do less; This leads to muscle wasting, after which you gain weight, lose your self-confidence and your mood starts to drop.

“You may not be able to work, you lose money, you feel depressed and you stop going out, which makes the pain more dominant.”

Initially, Hazel’s back pain was attributed to her daughter’s difficult delivery.

“But it became more and more widespread, and I then started having constant fatigue and brain fog,” she recalls.

‘I felt very sad. I went to the doctor and was prescribed painkillers, antidepressants and physiotherapy, but none of it really helped.’ (Antidepressants are thought to help by increasing the chemical messengers in the spinal cord that reduce pain signals.)

CBT is a relatively new approach to pain, included in the 2021 National Institute for Health and Care Excellence (NICE) guidelines, which states that people with ‘chronic primary pain’ – with no apparent underlying cause and lasting more than three months – no longer allowed to suffer from pain. Regular painkillers such as paracetamol, non-steroidal anti-inflammatory drugs (such as ibuprofen), benzodiazepines or opioids should be started. Instead, they should try other approaches such as exercise programs, psychological therapies (for example, cognitive behavioral therapy), acupuncture, and antidepressants.

The NICE guidelines reflect a lack of evidence that common painkillers make any difference to the quality of life for people with chronic pain, as they build up tolerance to the medication. In addition, they can cause side effects.

‘The general rule is that these drug therapies are about 30 per cent effective for 30 per cent of patients,’ says Dr Kim Lawson, a pharmacologist at Sheffield Hallam University and chair of the medical advisory board of the charity Fibromyalgia Action UK.

The new study suggests that cognitive behavioral therapy may be twice as effective as medication. But it doesn’t work for everyone; it is also not clear how long the effects may last; and many patients are skeptical about even trying it.

“We know that on average it takes between two and three years, but often up to ten years, before a diagnosis of fibromyalgia is made, often after the GP has switched from one specialist to another,” says Des Quinn, chairman of Fibromyalgia Action UK.

‘To be told that psychological therapy could help, some patients feel as if they are being told that it is all in their heads and that they are being fobbed off. That is not the case, but many patients experience it that way.’

Cognitive behavioral therapy isn’t about saying the pain is ‘in your head’, but about recognizing that managing it requires changing your attitude towards it, says Kim Lawson.

‘We need to do much more work to educate patients and doctors about the complexities of fibromyalgia and that a multifaceted approach, addressing physical, social and psychological factors, is likely to yield the best results, so combining medication with psychological support ‘, he says. say.

Since Hazel first developed pain 30 years ago, she has undergone several courses of CBT.

“The first was shortly after I was diagnosed in 2005 and I didn’t find it all that helpful,” she says.

‘Mentally I wasn’t in the right place. I was looking for a pill that would help. It was the last course, which I took about two years ago, that really helped me understand that the way I think affects my physical health.

‘I still take painkillers and antidepressants – albeit at a lower dose – but CBT is helping me live a more normal life.’

The NHS is now taking a cognitive behavioral therapy-based approach to chronic conditions such as diabetes, atrial fibrillation (an irregular heartbeat) and irritable bowel syndrome.

‘If you have a condition that causes painful symptoms, it is normal to feel anger, resentment and worry and this can turn into a negative spiral in which the symptoms – and the thoughts and feelings around them – take up more and more space in your life ”, explains Maria Hedman-Lagerlof.

‘Ultimately your whole life can be about your medical condition and we know that the more you think about pain, for example, can cause the mind to become more reactive to it – it becomes a highway in the brain. CBT is about changing that focus.”