Key 2: Use Multiple Coping Strategies

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By Bruce Campbell

(Note: From the series Ten Keys to Successful Coping: 2005.)

Some illnesses can be treated successfully with a single medication. Unfortunately, that is not the case for CFS or fibromyalgia. For the three reasons discussed in this article, you will probably be more successful addressing your illness if you use a variety of coping strategies.
 

Multiple Symptoms

One reason for using multiple coping strategies is to address multiple symptoms. People with CFS struggle with fatigue, but often also experience poor sleep, body pain, mental confusion (brain fog) and orthostatic intolerance.

For fibromyalgia patients, pain is normally the major symptom, but poor sleep and fatigue are also very common, as well as other symptoms like headaches and cognitive problems ("fibro fog"). Most patients adopt a variety of treatment strategies to address their different symptoms.

Multiple Causes

A second reason for using multiple coping strategies is because symptoms often have more than one cause. Take fatigue. All the following factors may cause or intensify fatigue.

Because fatigue can have many causes, you may benefit from adopting several strategies in response. You can think of strategies for symptom management in three groups.

First, there are ways to counteract the interactions among the main symptoms of fatigue, pain and sleep. Fatigue, for example, affects both pain and sleep. Being tired makes the experience of pain more intense and may lead to excessive daytime rest, which can make sleep problems worse. Pain is tiring and also produces muscle tension, which is fatiguing.

Pain can also make it difficult to get sleep or to sleep comfortably. Poor sleep, in turn, increases both fatigue and pain. You may be able to break the vicious cycle in which these three symptoms reinforce one another and create an upward spiral. An improvement in one symptom can have a positive effect on the other two. Probably the commonest symptom to attack first is poor sleep.

The second set of strategies is to take measures that combat factors that worsen all three major symptoms. These factors include overactivity, stress and inactivity. The major strategy for combating overactivity is pacing. Pacing, which means finding the right balance of activity and rest, involves understanding your limits and then honoring them.

Key 4 will show you how to determine your limits or "energy envelope." Key 5 discusses how to honor stay within your envelope using techniques like short activity periods, task switching and rest breaks.
 

You can combat stress through stress reduction and by avoiding stressful situations, as explained in Key 7. Because worry can lead to muscle tension, which increases both fatigue and pain, relaxation procedures can help combat both symptoms. Relaxation can make it easier to fall asleep.

Lack of activity can intensify both fatigue and pain. If you are less active than before, you become less fit and tire more easily. Lower activity is likely to increase stiffness and pain. Exercise counteracts both de-conditioning and stiffness, and also helps reduce worry and depression.

The third group of symptom-management strategies are ones tailored to specific symptoms. You may elect to take medications to control pain, for example, or combat pain using heat, cold or massage. Medications and good sleeping habits may help improve sleep.
 

Comprehensive Effects

There is a third reason for adopting multiple coping strategies. Living with CFS and fibromyalgia involves much more than managing symptoms. Both illnesses have comprehensive effects, touching many parts of your life: your ability to work, your moods, your finances, your relationships, your hopes and dreams for the future, even your sense of who you are as a person. Complicating your challenge, there are complex interactions between your illness and other parts of your life. (See diagram.)
 

Interactions of illness and other factors

Consider the interaction between illness and activity. Illness imposes limits, forcing a person to live a different and more restricted life than before (arrow pointing out). But the relationship also works in the other direction as well.

If you feel frustrated at the restrictions imposed by your illness, you may respond by doing more than your body can tolerate, which results in higher symptoms (arrow pointing in). Doing too much repeatedly can resulted in even greater limits.

The same pattern of reciprocal effects applies to illness and stress. Illness is a tremendous source of stress. Living with symptoms on a daily basis is inherently stressful. Further, CFS and fibromyalgia can make you more vulnerable to stress than before, because they seem to reset the body's "stress thermostat."

But the relationship runs the other direction as well. The way you respond to stress can make symptoms worse or help reduce them. For example, if you respond to stress with worry, you can intensify symptoms. If, however, you learn to relax in response to stress, you can ease your symptoms.

The relationships between illness and other aspects of our lives are probably even more intricate than the diagram suggests. Sometimes one factor from the rim of the illness wheel can affect another factor on the rim, which in turn affects symptoms. For example, illness makes relationships more difficult, which creates stress, which in turn can exacerbate symptoms.

In summary, CFS and fibromyalgia have comprehensive effects, touching many parts of your life. They are much more than simple medical problems.
 

Your Individualized Self-Management Plan

Because each person's symptoms are different and each person has unique life circumstances, every patient will have an individualized plan for managing their illness. This plan will involve a set of strategies for managing symptoms and will also address the other issues I just described. Although the specifics will vary from person to person, I suggest you include responses in each of five categories.

Symptom Management: The first challenge is to control your symptoms. Your approach may include drugs, which can help relieve pain, improve sleep or treat other symptoms. But your plan will also probably involve adapting to the limitation imposed by illness, using such strategies as pacing.

In the words of Dr. Charles Lapp: "There is no drug, no potion, no supplement, herb or diet that even competes with lifestyle change for the treatment of CFS or FM."

Controlling Stress: Being ill is inherently stressful and, unfortunately, both CFS and fibromyalgia are very stress-sensitive illnesses that intensify the effects of a given level of stress. Stress and symptoms can reinforce one another.

If you feel under stress, your body will tense up, increasing pain. The pain can in turn make you feel more stressed. Learning ways to control stress have big effects on both symptoms and quality of life. (See Key 7.)

Getting Support: Serious illnesses like CFS and fibromyalgia create great strains in families and test other relationships as well. You may feel isolated both physically and psychologically. Life with long-term illness is much easier if you can develop good family relationships and have support from outside the family as well. (See Key 8.)

Managing Emotions: Strong emotions like fear, anger, grief and depression are common reactions to having chronic illness. Such emotions are a normal and understandable response to being in a situation in which life is disrupted and routine is replaced with uncertainty.

Unfortunately, CFS and fibromyalgia seem to make emotional reactions even stronger than before and harder to control. Self-help can play a role in managing the emotional aspects of chronic disease. (See Key 9.)

Creating a New Life: Chronic illness brings with it many serious losses, so much so that it can be called the loss of the person you used to be. The pervasiveness of loss presents you with a double challenge: to grieve the loss of the person you used to be and to create a new life. (See Key 10.)
 

In Summary

Because CFS and fibromyalgia have multiple symptoms, because the symptoms have multiple causes, and because the illnesses have comprehensive effects, it makes sense to use many coping strategies.