If you prefer simple black-and-white answers, then getting your head around chronic pain syndromes such as fibromyalgia or myofascial pain syndrome will be frustrating. I came into the field of chronic pain management through the back door. From studying addictions I learned how some people lack adequate function in those parts of their brains required for pleasure, reward, or hedonic tone. People prone to develop addictions are unable to comfort themselves when in emotional pain or under sustained stress. So they use drugs or activities that stimulate the pleasure or reward center in their brains. A similar mechanism is thought to underlie chronic pain syndromes, but the pain sufferer does not have the fix that initially sustains and eventually destroys the addict.
Chronic pain syndrome is a cluster of signs and symptoms in which the pain and disability it creates cannot be explained by demonstrable tissue damage or pathology. It persists in time, at least 6 months. It is usually accompanied by chronic sleep deprivation. The sufferer becomes depressed, anxious, and often angry. Away from the structure and support of the workplace, the person becomes isolated as family and friends distance themselves. The family unit ceases to function well and the person loses interest in most activities including sex and romance. Since exercise causes pain, the sufferer becomes sedentary and muscles atrophy. Chronic pain patients are often given drugs such as sedatives, sleeping pills, and opioid analgesics (codeine, morphine) that work in the short term, but often perpetuate the syndrome.
So, who gets this horrible condition? Many clinical observers have remarked on the personality stereotypes of people who seem at increased risk: She's an overachieving, compulsive, responsible woman who spent the first 30 years of her life succeeding at everything she did. She was more attentive to others' needs than to her own. When asked to do extra work or take on more responsibility, she seldom refused. Childhood scars from living in a dysfunctional family or emotionally traumatizing events were never really resolved, or even acknowledged, she just shoved those hurts away, along with the many other losses and injuries she has suffered since. For as long as she can remember the voice in her head said something like, "In order to be safe and loved, you must please others and be perfect." She has trouble resolving conflict, and has real problems maintaining intimacy in relationships. She'd rather help others than let them close enough to help - or hurt - her. By the time I get involved in her care, her second marriage has failed, her teenage daughter is acting out, and she's been off work, this time for 4 months. But her painful condition was triggered by an apparently trivial event: a minor rear-end collision or a flu-like illness - the proverbial straw that brought down the camel.
Once established, chronic pain syndrome is truly biopsychosocial. There are changes in both the brain and spinal cord in the way pain signals are processed. The depletion of neurotransmitters, serotonin, dopamine, and endorphins results in worsening sleep disturbance, depression, and decreased tolerance for pain. Social isolation and inactivity exacerbate the problem. Feelings of despair, helplessness, and victimhood trap the sufferer in a nightmare cage. Certain drugs lock the door of the cage.
So, what works? The good news is, chronic pain syndrome need not cause worsening disability and suffering. The bad news is, even with a good program of recovery, the person will probably have some pain for a very long time. Research studies have shown that gradually increased levels of aerobic exercise, low-dose antidepressant medication, and cognitive-behavioral therapy are effective in treating fibromyalgia. The road to recovery begins with the step overcoming the feelings of helplessness and taking responsibility for recovery. The physician needs to give a clear message: "We know what you have, it's a chronic pain syndrome, investigations have ruled out life threatening or progressive conditions, if you do certain things you can improve your level of function and live a relatively normal life." It sometimes helps to get a thorough evaluation to find those areas where improved coping strategies are needed. Chronic pain sufferers are like jigsaw puzzles with several missing pieces, but they need help to identify which pieces are missing and then to find those pieces. Getting back to work, sometimes with modifications in duties and hours of work has been shown to speed recovery. As with other complex chronic illnesses, many find great help from spiritual sources.
Finally, chronic pain is chronic. Once chronic pain patients recover their function, emotional and social life, it is important to keep practicing those new attitudes and behaviors, sometimes with the help of a support group, as the original neurochemical defect persists. So without alternate ways of finding comfort, especially in times of emotional discomfort, relapse can be a real risk.