Cognitive Therapy of Depression

A study regarding acupoints and magnetic wave therapy and Fibromyalgia was performed by the Mayo Clinic in the United States and presented at a pain conference held in Sydney, Australia. Great promise is shown when it comes to this non-invasive, ancient form of therapy. Anxiety, pain, and chronic fatigue are just some of the symptoms experienced by many fibromyalgia patients and shown to be effectively alleviated by stimulation of acupoints, or the points at which the body’s meridians contact the skin. While acupuncture is not seen as a cure for fibromyalgia, it can greatly enhance the patient’s quality of life over the long term, particularly with continued treatments.

This seems to be a viable alternative to the medications usually prescribed to counteract pain and depression.

About Fibromyalgia

Fibromyalgia is a syndrome rather than the definition of an ailment. It has no known cause but is characterised by a set of symptoms that are common and chronic. It may be related to arthritis but is not a true arthritic disease of the joints, which involves joint or tissue inflammation. Instead, fibromyalgia is considered a rheumatic condition which impairs the tissues and joints and causes pain. There are a variety of symptoms those diagnosed with fibromyalgia suffer from.

These include cognitive difficulties; disturbance of sleep; headaches; irritable bowel syndrome; stiffness, numbness, and tingling of the limbs; restless leg syndrome; and sensitivity to temperature and light. It is usually women who suffer from fibromyalgia, but this does not preclude it from affecting men and children; race or ethnic background is not an indicator of a person’s likelihood of contracting the syndrome.

How Magnetic Wave Acupuncture Helps with Pain

Acupuncture, which can be accomplished via magnetic waves, electrical impulse, massage, or other methods that do not utilise needles, can alleviate many of the symptoms of fibromyalgia without the side effects of prescription medications. The procedure is non-invasive and the positive effects are nearly immediate. Muscle manipulation is usually not tolerable by anyone suffering from fibromyalgia so acupuncture provides a way to treat the symptoms without causing further pain and discomfort.

Stimulation of acupoints has a positive effect on stress and anxiety because it can release melatonin, the body’s natural chemical for relaxation. This can help a patient sleep better. Because chronic fatigue often leads to depression, getting sufficient rest aids the patient’s mood tremendously. Magnetic acupressure also stimulates circulation, which can provide the sufferer with increased energy and vitality.

Yet another benefit of acupuncture is the release of endorphins, which block feelings of pain. All of these benefits were supported by the Mayo Clinic study. Many alternative therapists already knew how acupuncture could positively affect patients suffering from pain, anxiety, and sleeplessness but the fact that highly respected members of the medical community confirmed their beliefs has brought a new level of acknowledgement to the practice.

For anyone diagnosed with fibromyalgia, acupuncture can present a viable, complementary treatment to help them lead a more normal and functional life. With a magnetic wave device, the procedure can even be performed at home, making it both simple and cost-effective. Talk to your physician about adding acupoint therapy to your fibromyalgia therapy options. Ref: http://www.mayoclinic.org/news2006-rst/3495.html

Biofeedback studies have shown that Fibromyalgia patients who received treatments had fewer tender points, lower pain intensity and morning stiffness.  Biofeedback is a technique in which patients are trained to improve their health by learning to control certain internal bodily processes such as muscle tension causing pain, blood pressure, or anxiety.  It is a basic way of learning self-control tools that will be used throughout life. Recent biofeedback developments now provide a tool for improving functioning of the central nervous system.

Biofeedback is non-invasive and painless. It can expose the sources of physical pain, like headache or back pain, and gives us the information we need to reduce or eliminate the pain. It can help people with Fibromyalgia and Chronic Fatigue by eliminating pain and improving energy.

The most frequently used types of biofeedback therapy:  Electromyography (EMG) – measures muscle tension, Thermal biofeedback – measures skin temperature, and Neurofeedback or electroencephalography (EEG) – measures brain wave activity.

During a biofeedback session electrodes are attached to the skin. The electrodes feed information into devices that measure one’s internal involuntary responses.  The patient is then given mental exercises by the practitioner. This allows the mental activities that cause the physiologic responses to be identified, which make it possible to teach the patient how to gain control over them.  When a person has learned how to control his/her symptoms, the feedback displays the positive changes.

Biofeedback has been proven to be an effective therapy for many conditions.  It is primarily used to treat high blood pressure, chronic pain, tension headache, migraine headache, and urinary incontinence.  Studies have shown that most patients who respond best from biofeedback have conditions that are brought on by or made worse by stress.  This would imply that relaxation is the most important factor for success.

The FM treatment using electro-encephalogram (EEG) is based on the research of Mary Lee Esty, Ph.D.; Stuart Donaldson, Ph.D.; and Len Ochs, Ph.D. Technology is used to detect and treat brain dysfunction that has been caused by a mild traumatic brain injury such as in an automobile accident. Patients first have a brain mapping performed to identify areas of the brain which have been injured and are functioning abnormally in terms of brain-wave activity. Electrical activity produced by the brain reflects a person’s level of functioning and can be monitored by EEG. A condition known as “EEG slowing” is present in people who have suffered damage to the brain and nervous system as a result of trauma and go on to develop Fibromyalgia or other chronic conditions.

The Flexyx Neurotherapy System (FNS) is both a brainwave biofeedback and treatment system, as well as an evaluation system. It is for patients with central nervous system dysfunctions, cognitive dysfunction (memory, etc.), mood disorders, low energy, movement difficulties, trouble with balance, and pain problems.  FNS is an advanced form of biofeedback which, returns a feedback signal to the patient connected to the EEG. This form of EEG uses electrodes connected to the skin.  Researchers have found that FM patients concentrate better when they close their eyes, which lessens sensory stimulation.

Flexyx Neurofeedback System is also non-invasive and painless.  The patient sits in a comfortable chair and wears dark glasses that generate feedback. The patient need only relax.  The treatment measures brain waves, and directs the brain waves back to the person as a reflection (mirrored).  FNS resets the natural, self-regulation skills we are unaware of in our brain and nervous system so they can function normally.  This makes it possible to implement the best treatment plan.

After the treatments are completed, surface Electromyography (sEMG) therapy is usually conducted to help retrain muscles, and Myofascial Release Therapy is used to restore proper muscle balance, obtain optimum posture, and address other neuromuscular problems.  There may be other treatment options discussed and utilized depending on the findings and your therapist.

The hope is to help chronic pain sufferers develop greater awareness and deliberate control over the physiological processes that are outside conscious awareness.

As Fibromyalgia (FM) sufferers we are often made to feel like our pain is “all in your head”, but research has consistently proven that Fibromyalgia is not a form of depression or hypochondria. IT IS REAL!  However, there is a connection between FM and other chronic pain conditions to depression and anxiety.  Treatment is important because both can make FM worse and interfere with symptom management.

There is some debate by medical and mental professionals about what causes what.  The “What came first?  The chicken or the egg” debate translates into “What came first?  The chronic pain or the depression?”  TRUE Fibromyalgia experts, researchers and others know that the chronic pain of FM & overlapping conditions leads to depression and anxiety. 

Fibromyalgia is a common condition in which a person suffers from chronic musculoskeletal pain. There are points called tender points, sometimes all over the body, and these tender and painful points are used as part of the diagnosis of FM. Individuals with FM may also be more susceptible to pain in general. Whenever the tender points are simply touched, they can send sharp pain impulses. Many Fibromyalgia sufferers experience pain all over and some experience pain only in specific regions. It can involve the muscles and the joints. Sometimes, there is so much pain that it is hard to pinpoint exactly where the pain originates.  Fibromyalgia is often accompanied by other overlapping conditions such as chronic myofascial pain (CMP), chronic fatigue syndrome (CFS), irritable bowel syndrome (IBS), restless legs syndrome (RLS), migraine & tension headaches, interstitial cystitis (IC), mitral valve prolapse (MVP), cognitive dysfunction, depression, anxiety and more.  The symptoms of Fibromyalgia, alone, are wide-ranging and debilitating.  Do they really think that depression and anxiety is the CAUSE for ALL of the above?

Depression is a mental illness characterized by feelings of profound sadness and lack of interest in enjoyable activities. It is a constant low mood that interferes with the ability to function and appreciate things in life. It may cause a wide range of symptoms, both physical and emotional. It can last for weeks, months, or years. People with depression rarely recover without treatment and if you have Fibromyalgia, you may have to fight it for the rest of your life.

Anxiety is a normal state of apprehension, tension, and uneasiness in response to a real or perceived threat.  Although anxiety is considered a normal response to temporary periods of stress or uncertain situations, prolonged, intense, periods of anxiety may indicate an anxiety disorder. Other indicators of an anxiety disorder are anxiety that occurs without an external threat and anxiety that impairs daily functioning.

What can cause depression & anxiety?  Stressful life events, chronic stress, low self-esteem, imbalances in brain chemicals and hormones, lack of control over circumstances (helplessness and hopelessness), negative thought patterns and beliefs, chronic pain, chronic physical or mental illness, including thyroid disease & headaches can ALL cause both.  Little or no social  and familial support can be a main factor in depression for FM patients. Family history of depression & anxiety can also be a factor.

Lack of quality sleep is also believed to have an influence on depression.  Since FM & Chronic Fatigue Syndrome patients tend to have insomnia and/or other sleep disorders, it stands to reason that poor sleep can lead to depression.

There is a wide variety of medications, vitamins, minerals, herbs and therapies that can help ease the impact of pain, anxiety and depression.  With so many out there, you and your doctor may have to go through the process of trial and error to find what works best for you!

Exercise is not only good for FM, it is also highly beneficial for depression and anxiety.  Recent studies suggest exercise can change your brain chemistry. Exercising can boost your level of serotonin, a brain chemical that is effects mood and pain perception. It can also stimulate the production of endorphins, natural painkillers that can give you an overall feeling of well-being.

Exercise is a great for stress, too. It relieves muscle tension and it gets the heart rate up. The combination makes us more relaxed and alert, which helps us deal with our problems in a calmer and more controlled way.

There are several other methods you can use to combat stress, including: meditation, deep breathing exercises, progressive muscle relaxation, mental imagery relaxation, relaxation to music, biofeedback, counseling – to help you recognize and release stress. 

You can learn more about this topic, medications, supplements, alternative therapies and more at my website AND I will be writing more articles – so check back here!

Occupational Therapy (OT), helps people regain, develop and build skills that are important for independent living, health and happiness.  Fibromyalgia sufferers can experience physical, emotional, or other challenges that prevent them from living the life they once led.  Chronic pain and depression can make it difficult for FM patients to do everyday tasks or be as active and as independent as they’d like.  If you have trouble performing daily activities because of these limitations OT may be able to help you.

Most FM patients find there are certain things they do on a daily basis that seem to make their pain worse. These activities frequently involve the repetitive use of muscles or continued tensing of a muscle, such as the muscles of the upper back while looking at a computer screen. You need to note these associations and determine how you can modify or eliminate them. That’s where occupational therapy can help. OT is designed to help Fibromyalgia Syndrome and other chronic pain patients regain the independent lifestyle they once knew before the onset of their illness.  Occupational therapists are trained in both physical and psychiatric rehabilitation.

An occupational therapy program is customized for the patient by combining an evaluation of medical history, environmental issues and personal goals.  Therapy includes solutions for pain due to repetitive movements in the work place or elsewhere.  Job modifications, changes in ergonomics, and a reduction in work hours may be necessary.  Sometimes an occupational therapist can work with the patient’s employer or supervisors, educating them about FM and discussing contributing factors in the workplace.  You might be taught to conserve your energy, use appropriate splints if needed, and minimize tissue trauma.

Occupational therapy should help you maximize function through strengthening activities, retraining cognitive and visual-perceptual skills and helping prevent misalignment of the vertebrae.  If you have had a back injury, ergonomics encourages the use of proper equipment and lifting techniques.  For muscle pain, the proper positioning of body and equipment can help prevent everything from mild soreness to serious tears and strains.  For eyestrain, headache and fatigue, you might need adjustments in lighting, noise levels, posture and work positions can help relieve physical and mental stress.

An occupational therapist can help you identify what aspects of the way you carry out your daily routine is helping or hindering your healing.  Patients are also taught stress management, how to assert themselves, time management, and planning/pacing skills, in order to help to reduce stress, anxiety, and fatigue.  Occupational therapy can help you discover what job or home activities could be increasing your neck, back, or arm pain.  Your therapist can watch you at work and make specific recommendations for reducing the strain on your body and provide specific therapy and exercises to help improve range of motion and reduce pain.

Here are a few tips to optimize your workspace for comfort:  Allow enough leg room under your workstation and use a document holder so that your documents are at the same height and distance as your computer screen.  Your feet should be flat on the floor, your knees should be level with your hips, and good lower back support is a must. Avoid positions in which your body is twisted.  Sit about an arm’s length away from your screen and tilt the screen back a little.  Your arms should rest at your sides with your elbows at a right angle and your wrists need to be straight.  Cushioned grips and ergonomically-designed tools to reduce vibration, pressure and relieve stress are beneficial and something as simple as a pillow behind your lower back or a stool to raise your feet can provide relief.

Posture or movement training is often required for FM sufferers to undo lifelong bad habits which can cause or increase pain and to re-educate muscles and joints that have become misaligned.  The muscles in the back of your neck, between your shoulder blades and your upper and mid back experience chronic tension. Stretches and strengthening are crucial.  Lumbar (lower & mid back) support is even more so.  Fibromyalgia patients who have significant problems with foot pain resulting from poor posture or body mechanics may also benefit from special shoe inserts (orthotics) prescribed by a podiatrist.

If there are techniques we can use to better our quality of life by lessening our pain, why not do it?  We need to take advantage of every opportunity to make our lives better!  If we don’t, who will?

Fibromyalgia syndrome (FMS) is the medical terminology used to represent a complex clinical disorder of symptoms characterized by soft tissue pain, stiffness, and altered deep pain threshold with psychological fallout.  It can mimic or accompany symptoms of joint injury, but it is not an arthritic or neurological condition.  The disorder affects between 3 to 6 million people – or as many as one in 50 Americans.  About 80 and 90 percent of those diagnosed with fibromyalgia are women. 

There is usually an emotional overlay of depression and anxiety that affects the sufferer.  There are numerous reasons why this is true.  Many within the medical community have discounted fibromyalgia as a bona fide disease.  Patients have been told that they are over-dramatizing their pain and that the stiffness or soreness has been psychologically induced.  Others have been told that the condition was fabricated for attention or perceived by health providers as feigned helplessness.  These assertions from medical experts make patients with FMS feel ignored, mistrusted, alone and without support.  Patients often turn to self-blame, which fuels the pain cycle.The pain and symptoms of fibromyalgia are real and have a definite physical basis. There is no known cause for fibromyalgia.  Some researchers have speculated that physical trauma or viral influences have triggered FMS syndrome in many patients.  There are no known abnormalities in the muscle tissue of fibromyalgia patients that would account for the disease.

Current research has focused on regions of the FMS patient’s brain and the susceptibility of certain brain locations to pain sensitivity.  The brain receives a pain signal from the muscles and stays in a state of alert.  For unknown reasons, the brain fails to let go of the pain signal and sets up a chronic pattern or pain syndrome.  The brain stays in a constant feedback loop, consisting of a system of amplified pain signals.

Recent brain scan research studies have shed new light on this disorder.  Results published in the May 2008 edition of the Journal of American College of Rheumatology shows that neuroscientists have been able to conduct scanning technology to areas of the brain affected by fibromyalgia.  Mild pressure on trigger points of the patient has produced measurable brain response in processing the sensation of pain.  The elevated response of pain in FMS patient’s brain scans was significantly different from those in the control group of the study.  This is one of several studies that validate the reality of fibromyalgia as a disorder affecting the brain’s response to muscular and neuropathic pain.  Hopefully, future studies will lead to new treatment options.

Currently, treatment options consist of the use of a multidisciplinary approach.  Medication management, physical therapy, meditation, exercise, alternative therapies, and cognitive-behavioral therapy are useful.  CBT is a valuable therapeutic treatment option for those suffering from pain syndromes.  One of the byproducts of pain can be the escalation of anxiety and depression.  Likewise, anxiety and depression can intensify the impact of pain and make it more debilitating.

Cognitive-behavioral therapy’s goal is to teach the FMS patient to embrace pain rather than fight it.  Cognitive distortions, such as magnification and “catastrophizing” need to be addressed so that patients learn to de-escalate fueling the pain process.  How one thinks about his pain affects its impact.  One can learn to rationally respond to pain by sayin

Cognitive-behavioral therapy can assist the fibromyalgia patient to identify stressful triggers that exacerbate pain.  This may involve examining family struggles, exploring inner-conflict, and working with core, self-defeating assumptions that affect thinking and behavior.  Teaching the patient mindfulness meditation as a way of relaxing the sympathetic nervous system is beneficial.

Through the use of CBT, a therapist can provide the fibromyalgia patient with structured homework assignments that will help pain sufferers to experiment with new behaviors such as increased involvement and activities.  Motivating the client to set realistic goals for everyday functioning can be helpful.  Encouraging a multidisciplinary approach involving exercise, physical therapy, rehabilitation and pain management are essential.

Fibromyalgia patients fear that their disorder will cause them to lose the ability to function at work and at home.  Teaching patients to focus on what they can do rather than their limitations is important.  There is a tendency for fibromyalgia patients to distort reality by focusing on negative perceptions to the exclusion of the positive.  Helping the patient and family to accept physical limitations is a necessary component to successful treatment.

Fibromyalgia patients can easily get enmeshed in a cycle of pain and associated emotional symptoms.  It is the goal of cognitive-behavioral therapy to assist the patient in coming to terms with his disorder and making plans to manage it.  This is accomplished through acceptance and teaching the patient positive ways of thinking about his condition and multiple ways of treating it.

As Fibromyalgia (FM) sufferers we are often made to feel like our pain is “all in your head”, but research has consistently proven that Fibromyalgia is not a form of depression or hypochondria. IT IS REAL!  However, there is a connection between FM and other chronic pain conditions to depression and anxiety.  Treatment is important because both can make FM worse and interfere with symptom management.

There is some debate by medical and mental professionals about what causes what.  The “What came first?  The chicken or the egg” debate translates into “What came first?  The chronic pain or the depression?”  TRUE Fibromyalgia experts, researchers and others know that the chronic pain of FM & overlapping conditions leads to depression and anxiety. 

Fibromyalgia is a common condition in which a person suffers from chronic musculoskeletal pain. There are points called tender points, sometimes all over the body, and these tender and painful points are used as part of the diagnosis of FM. Individuals with FM may also be more susceptible to pain in general. Whenever the tender points are simply touched, they can send sharp pain impulses. Many Fibromyalgia sufferers experience pain all over and some experience pain only in specific regions. It can involve the muscles and the joints. Sometimes, there is so much pain that it is hard to pinpoint exactly where the pain originates.  Fibromyalgia is often accompanied by other overlapping conditions such as chronic myofascial pain (CMP), chronic fatigue syndrome (CFS), irritable bowel syndrome (IBS), restless legs syndrome (RLS), migraine & tension headaches, interstitial cystitis (IC), mitral valve prolapse (MVP), cognitive dysfunction, depression, anxiety and more.  The symptoms of Fibromyalgia, alone, are wide-ranging and debilitating.  Do they really think that depression and anxiety is the CAUSE for ALL of the above?

Depression is a mental illness characterized by feelings of profound sadness and lack of interest in enjoyable activities. It is a constant low mood that interferes with the ability to function and appreciate things in life. It may cause a wide range of symptoms, both physical and emotional. It can last for weeks, months, or years. People with depression rarely recover without treatment and if you have Fibromyalgia, you may have to fight it for the rest of your life.

Anxiety is a normal state of apprehension, tension, and uneasiness in response to a real or perceived threat.  Although anxiety is considered a normal response to temporary periods of stress or uncertain situations, prolonged, intense, periods of anxiety may indicate an anxiety disorder. Other indicators of an anxiety disorder are anxiety that occurs without an external threat and anxiety that impairs daily functioning.

What can cause depression & anxiety?  Stressful life events, chronic stress, low self-esteem, imbalances in brain chemicals and hormones, lack of control over circumstances (helplessness and hopelessness), negative thought patterns and beliefs, chronic pain, chronic physical or mental illness, including thyroid disease & headaches can ALL cause both.  Little or no social  and familial support can be a main factor in depression for FM patients. Family history of depression & anxiety can also be a factor.

Lack of quality sleep is also believed to have an influence on depression.  Since FM & Chronic Fatigue Syndrome patients tend to have insomnia and/or other sleep disorders, it stands to reason that poor sleep can lead to depression.

There is a wide variety of medications, vitamins, minerals, herbs and therapies that can help ease the impact of pain, anxiety and depression.  With so many out there, you and your doctor may have to go through the process of trial and error to find what works best for you!

Exercise is not only good for FM, it is also highly beneficial for depression and anxiety.  Recent studies suggest exercise can change your brain chemistry. Exercising can boost your level of serotonin, a brain chemical that is effects mood and pain perception. It can also stimulate the production of endorphins, natural painkillers that can give you an overall feeling of well-being.

Exercise is a great for stress, too. It relieves muscle tension and it gets the heart rate up. The combination makes us more relaxed and alert, which helps us deal with our problems in a calmer and more controlled way.

There are several other methods you can use to combat stress, including: meditation, deep breathing exercises, progressive muscle relaxation, mental imagery relaxation, relaxation to music, biofeedback, counseling – to help you recognize and release stress. 

You can learn more about this topic, medications, supplements, alternative therapies and more at my website AND I will be writing more articles – so check back here!

Cognitive-Behavioral Therapy (CBT) is often used to teach Fibromyalgia and other chronic pain sufferers how to cope with their illnesses.  It is said to help treat many conditions and diseases like FM, back pain, rheumatoid arthritis and cancer.  It helps determine how well a patient manages their pain and teaches them how to take control of it.  Depression plays a key role in the inability to be proactive in our treatment.  So, our state of mind is very important when it comes to getting better.

Studies show that when FM patients effectively deal with the particular symptoms and over-lapping conditions of their illness and of their lives, they feel better. Cognitive-behavioral therapy (CBT) increases a patients’ belief in their own power to cope with the things they face and helps them develop ways for dealing with depression and stressful situations.

The goal of CBT is to make patients aware of self-defeating behaviors and emotions so that they can be changed consciously. Healthy, positive thoughts and emotions supersede the negative, resulting in a powerful influence on your life and lessening your pain.  Over time, the idea that you are helpless against the pain goes away and, instead, you learn that you can manage the pain.  Many studies show an improved quality of life and overall reduction in average pain scores.

Cognitive behavioral therapy has shown to be as beneficial as anti-depressant medications for patients with depression.  In one large study there were considerably higher results of reaction and remission from depression when cognitive behavior therapy was used in addition to anti-depressant medications than when either method was used alone.  CBT is used to change the patients negative feelings and social withdrawal.

Cognitive therapy is very helpful in defining and setting limits (something I know I have a problem with) and is vitally important for FM patients. Many “Fibromytes” live their lives in extremes. We push ourselves too far and suddenly we break-down. This reverses the way we view ourselves, we become demoralized, feel worthless, and give up our power to cope with the simplest tasks. One important goal of cognitive therapy is to help us find a middle ground. Patients learn to prioritize their responsibilities, and drop some of the less important tasks or delegate them to others. My biggest problem is just saying “NO”.  I want to please everyone and prove to them and myself that I can do whatever is asked of me.  When I reach my limits and cannot complete a task, I tend to go through a period of self-loathing.  Learning to say “NO” and other coping skills can ultimately lead to a more manageable life. We can learn to view ourselves and others in a better light.

CBT is also a useful treatment for anxiety disorders, including phobias, panic attacks, and obsessive-compulsive disorders. In CBT, patients learn to be aware of and change negative thinking patterns. It is a way to gain conscious control over unwanted thoughts or feelings which are, as a rule, connected to anxiety.  Those of us who suffer from panic attacks learn our bodies’ negative responses and actions during an attack and CBT helps us find ways to counteract the reason for the attacks.  CBT can also help improve quality of sleep so we can hopefully reduce some of our medications.

Cognitive therapy requires approximately six to twenty sessions that last one hour.  The cognitive therapy program may involve keeping a diary to look at all aspects of your daily activities, coping skills and mind-set.  This helps you learn what changes need to be made, limits that need to be set and a way to organize and prioritize activities.  Many of these things contribute to stress and can make your pain better or worse.  Setting limits keeps us from getting discouraged and helps us learn to take each task one step at a time.  CBT also helps us confront negative thoughts and emotions and we are taught how to reverse them.  It all boils down to self-perception:  self-loathing, worthlessness, helplessness, hopelessness, negative self-talk, believing that other people view us the same way.  CBT helps us reverse those thought processes so we can pick ourselves up and keep going.  Patients will learn to find things we once enjoyed doing and make the time to do them with the help of learning how to schedule activities without being overwhelmed.

As we know accomplishing too much too soon can often cause a relapse of symptoms. We should respect these relapses and slow down. We should not consider them a sign of failure.  That’s just how Fibromyalgia works. Don’t be so hard on yourself!