Like other chronic painful conditions, fibromyalgia may be associated with a significant amount of psychological distress. On average, people with fibromyalgia are not any more psychologically disturbed than those with other medical problems. However, a significant subset of people, perhaps those with more severe symptoms, do experience significant psychological difficulties. These problems include depression, anxiety, anger and interpersonal conflict.

But there is a big difference between saying that fibromyalgia is sometimes associated with psychological distress and the idea that it is "all in your head". Since the 1960s it has been recognized by researchers and clinicians who specialize in pain that it is inappropriate to view pain as something that is either all in the mind or all in the body. In reality, a person's experience of pain is determined by a range of factors including the amount of physical damage or dysfunction, their emotional state, their past experience, how well they can cope with it, etc. Thus pain, including fibromyalgia pain, is both in your body and in your mind.

It follows that if pain is both a physical and a psychological phenomenon, our efforts to manage it should include both physical and psychological techniques. The physical side of managing fibromyalgia should include a regular exercise program, adequate pacing of your daily activities and appropriate use of medications which may help (e.g., amitriptyline, cyclobenzaprine).

Psychological pain management techniques require that you take a close look at the way you are coping with your pain and how it has affected those around you. If you believe that your pain has resulted in levels of depression, anxiety or interpersonal problems that are quite severe and/or beyond your ability to manage, you may want to consider professional help. Consultation with a psychologist or psychiatrist who regularly works with people who have chronic pain may help you get your life back on track.

A variety of psychological pain management techniques are available. All of them require a considerable amount of effort and practice to be effective. Relaxation training techniques (including progressive muscle relaxation, imagery techniques, EMG biofeedback and meditation) can be helpful in keeping your muscles relaxed and your tension levels down. Different people prefer different techniques and you should select one that feels comfortable. You are not likely to practice a technique that doesn't "fit" for you.

Cognitive therapy techniques can also be helpful. Understandably, people with fibromyalgia can develop a hopeless, helpless attitude about managing their pain and about their lives in general. Seeing yourself, your situation and your future in this negative way simply adds to your suffering. You may also find yourself withdrawing from important and rewarding aspects of your life, becoming more irritable and unhappy. All of this will magnify your experience of pain and distress. Cognitive therapy techniques can help you to identify and change negative attitudes and beliefs and thereby prevent this kind of pain magnification.

It may also be important to look at the impact your pain has had on your family and friends. They may be as frustrated and unhappy as you are. They may have started to withdraw from you. Or they may be trying to help too much. In these situations, education about fibromyalgia and clear, direct interpersonal communications are essential. Chronic pain can be a fertile ground for misunderstandings and conflict. Again, unless these problems are dealt with, they can also increase your experience of pain and suffering.

These techniques, and others, can help you take control of your fibromyalgia. In the long run, how you cope with your pain will determine the quality of life you will have. You didn't choose to have fibromyalgia but you can choose to reduce its effect on your life.