Does Mindfulness Have a Role in the Treatment of Fibromyalgia Syndrome?

Fibromyalgia syndrome is a poorly-understood chronic pain disorder. An estimated 3% of

adults are reported to suffer from fibromyalgia, with higher levels of occurrence in females
compared to males. The main symptoms of fibromyalgia syndrome are all-over body pain,
tiredness, difficulty in sleeping, and cognitive dysfunction such as memory impairment.
There is also a high level of association between fibromyalgia syndrome and poor quality
of life, mental health issues such as depression and anxiety, irritable bowel syndrome, and
unemployment.
Some of the reasons why fibromyalgia syndrome is believed to be a controversial illness are
as follows:
1. Individuals with fibromyalgia are reported to exert a higher burden upon healthcare
resources when compared with individuals diagnosed with other chronic illnesses.
2. Research has shown that individuals with fibromyalgia often experience difficulty in
having their illness diagnosed, and often feel that their needs and symptoms are
poorly understood by the medical profession.
3. A diagnosis of fibromyalgia is primarily based upon the exclusion of other illnesses,
the patients medical history, and their reaction to pressure being gently applied to
tender points. In other words, there isnt a reliable laboratory test for fibromyalgia
syndrome (e.g., blood test, x-ray) and this means that it is difficult to be 100% certain
that a given individual is genuinely suffering from the illness.
The current treatment-of-choice for fibromyalgia syndrome is the use of
psychopharmacology (principally antidepressants) coupled with non-pharmacological
approaches such as physical exercise, cognitive-behavioural therapy, self-help, and/or
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psycho-education. However, pharmacological treatments for fibromyalgia have shown only

a limited degree of effectiveness, and many patients withdraw from treatment due to the
side-effects of antidepressants as well as low levels of symptom reduction.
The lack of convincing treatment efficacy outcomes for existing pharmacological and nonpharmacological fibromyalgia interventions has led to the empirical evaluation of
alternative treatment approaches. Since there exists evidence (which varies in quality and
quantity) supporting the use of mindfulness in treating each of the individual symptoms of
fibromyalgia syndrome (e.g., chronic pain, sleep disturbance, fatigue, depression, anxiety,
and cognitive dysfunction), mindfulness-based interventions have been an obvious
candidate in terms of investigating their effectiveness for treating the illness.
A systematic review and meta-analysis comprising six randomised and non-randomised
controlled trials of mindfulness-based stress reduction (MBSR) for individuals with
fibromyalgia (674 participants in total) found that individuals receiving MBSR experienced
significant short-term improvements in quality of life and pain compared to individuals in
the non-meditating control groups. A further systematic review (incorporating a range of
intervention study designs) examined the findings from ten studies of mindfulness
meditation (702 participants in total). The review concluded that mindfulness led to
significant improvements in both physical symptoms (e.g., pain, sleep quality, functionality)
and psychological symptoms (e.g. depression, anxiety, perceived helplessness).
In terms of the possible mechanisms by which mindfulness helps to alleviate the symptoms
of fibromyalgia syndrome, the most widely proposed explanation is that mindfulness helps
to increase perceptual distance from somatic pain and distressing psychological stimuli. By
mindfully observing painful bodily sensations, it appears that individuals suffering from
fibromyalgia (and other pain disorders) can begin to objectify and almost distance
themselves from their pain. The same applies to feelings of psychological distress and
fatigue that are often associated with musculoskeletal pain. Mindfully observing feelings of
distress, frustration and low mood appears to weaken the intensity of such feelings, and to
help create the psychological space necessary for other more psychologically adaptive
feelings and thought processes to arise.
Based on findings from a randomised controlled trial of an online mindfulness-based
intervention, it has been suggested that stronger treatment outcomes can actually be
achieved by using mindfulness not just as a means of improving patients ability to cope
with pain and psychological distress, but as a means of helping improve patients ability to
engage in effective social and interpersonal interactions. In other words, given the
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complexity of fibromyalgia syndrome, it appears that in order to maximise treatment

effectiveness, mindfulness interventions targeting fibromyalgia should be purposedesigned and encourage participants to draw on both psychological and social resources.
In terms of other potential mechanisms of action, there is evidence to suggest that
mindfulness leads to changes in neurological pain pathways, reduced levels of ruminative
thinking and self-preoccupation, and improvements in spirituality. This latter potential
mechanism is important because cross-sectional studies involving individuals with
fibromyalgia have specifically identified a positive correlation between spirituality and
positive affect (i.e., as levels of spirituality increase so do positive mood states), and a
negative association between spirituality and symptoms of depression and anxiety (i.e., as
levels of spirituality increase in individuals with fibromyalgia, their levels of depression and
anxiety decrease).
Findings indicate that purpose-designed mindfulness-based interventions may have a role
to play in the treatment of fibromyalgia syndrome. However, at present the overall quality
of the evidence is weak and there is a need to replicate and consolidate findings using
methodologically robust randomised controlled trials.
Ven Edo Shonin and Ven William Van Gordon

Further Reading
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Davis, M. C., & Zautra, A. J. (2013). An online mindfulness intervention targeting
socioemotional regulation in fibromyalgia: results of a randomized controlled trial.
Annals of Behavioural Medicine, 46, 273-284.
Dennis, N. L., Larkin, M., & Derbyshire, S. W. G. (2013). 'A giant mess' - making sense of
complexity in the accounts of people with fibromyalgia. British Journal of Health
Psychology, 18, 763-781.

Huser, W., Wolfe, F., Tlle, T., eyler, N., & Sommer, C. (2012). The role of
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