Maintaining Compassion for Fibromyalgia Clients

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Having compassion for clients in pain seems like a no-brainer. However, compassion fatigue is a very real dilemma affecting professionals in the healthcare industry. Some therapists cope with the challenges of providing healthcare by being less attuned to complaining. Unfortunately, compassion fatigue alienates clients most in need – especially those with fibromyalgia.

About Fibromyalgia

An increasingly common syndrome that cannot be proven by any medical imaging test, fibromyalgia is a chronic condition characterized by widespread pain, fatigue, depression and sleep problems. Currently estimated to affect around four million Americans, descriptions akin to fibromyalgia have existed for centuries. Interestingly, as portrayed in the New Living Translation of the Bible, Job described fibromyalgia-like suffering;

“I, too, have been assigned months of futility, long and weary nights of misery. When I go to bed, I think, `When will it be morning?’ But the night drags on, and I toss till dawn…And now my heart is broken. Depression haunts my days. My weary nights are filled with pain as though something were relentlessly gnawing at my bones.” (Job 7:3-4; 30:16-17 – NLT).

While the cause of fibromyalgia syndrome (FMS) is still unknown, researchers in the field have singled out its most likely origins:

1. Autonomic Nervous System Dysfunction – FMS may be caused by a problem with the brain’s autonomic nervous system. Problems with the hormones and neurotransmitters the autonomic nervous system uses can interrupt certain bodily processes, causing many fibromyalgia symptoms.
2. Sleep Disorders – A large percentage of FMS sufferers have difficulty sleeping. Though once seen as a fibromyalgia symptom, some clinicians believe that sleep disorders may be at the root of FMS. Affected people seem unable to reach the deepest stage of sleep, a problem that prevents injured muscles and nerves from being repaired.
3. Trauma – Many fibromyalgia patients have suffered from serious injury or muscle trauma (like a car accident), prior to the onset of FMS. Trauma can injure the central nervous system, which may increase sensitivity to pain, interfere with sleep patterns and disturb cognitive thought processes.
4. Infection – Infectious illnesses, including certain viruses, may be at the root of FMS. Certain infections attack the central nervous system, inhibiting the production of neurotransmitters that could cause fibromyalgia pain.

The Toll FMS Takes

Despite their recurring presentation of suffering, practitioners who acknowledge the immense pain of their clients with FMS can be a welcome source of comfort. These individuals are not just complainers looking for sympathy. They live a life drastically impeded by ongoing pain. An online survey conducted by Synovate Healthcare and developed by the National Fibromyalgia Association, the American Pain Foundation, and Pfizer Inc. demonstrated the far reaches of FMS.

Completed by over 2,500 people with diagnosed FMS, this survey brought the reality of living with this disorder to the public’s attention. The survey’s key findings included:

• 92 percent of respondents reported that their condition has had a major effect on life decisions, including whether to remain in a relationship, start a new one, or change jobs.
• 68 percent of respondents say their pain limits their ability to care for their family.
• 95 percent of the 650 respondents with children under 18 say their pain affects parenting duties, making it difficult to manage their kids’ schedules, enjoy their kids’ milestones and manage their household.
• 98 percent of respondents indicated they have compensated for or attempted to compensate for their pain by changing their daily routine to make life easier or more bearable.

There is little doubt that the pain of FMS affects relationships, parenting duties, and major life decisions. Acknowledging the depth of a client’s struggle with FMS can be extremely affirming – something they are not likely to receive elsewhere.

Compassion Fatigue

As a consequence of the work they perform, massage therapists can be particularly vulnerable to compassion fatigue. Day in and day out, massage therapists are likely listening to the misery and complaints of every person they interact with. Being the recipient of this seemingly endless supply of negativity can take its toll on practitioners.

In particular, practitioners who work closely with fibromyalgia patients may be exposed to their chronic suffering and complaints regularly. Over time, constantly dealing with the pain and challenges faced by these clients can lead to compassion fatigue, a state of emotional and physical exhaustion that can diminish a practitioner’s ability to empathize and provide adequate care.

In an Acupuncture Today interview with the medical director of Moonview Sanctuary in Los Angeles, Terry V. Eagan, MD, gives us this understanding of compassion fatigue:

“Many caregivers have been providing care since childhood. They may have had special attributes to which others were drawn regarding problem-solving or advice-giving, or knew how to ‘lessen the load’ of others. Many of these individuals then find themselves in the helping professions. If they do not take special care of their own emotional/psychological/physical/spiritual needs, they may then be at risk for developing compassion fatigue, a syndrome where caregivers begin to experience some of the very symptoms of the clients they serve (for example, dealing with patients who have suffered extreme trauma may take an emotional toll on the caregiver). Caregivers are often self-sacrificing, overly identify with the suffering of others, and do not practice good self-care.”

Based on Eagan’s description of compassion fatigue, it is easy to see how previously caring therapists could evolve to apathy.  Fibromyalgia patients often require long-term support and understanding due to the nature of their condition, and practitioners need to maintain compassion and empathy to offer effective care. However, the continuous exposure to their struggles can overwhelm practitioners emotionally, leading to compassion fatigue. Practitioners experiencing compassion fatigue might find it difficult to connect with their patients, potentially hindering the therapeutic relationship and the healing process.

Some symptoms of compassion fatigue may include:

• Feeling physical, psychological, and emotional exhaustion
• Feeling helpless, hopeless, or powerless
• A sense of being detached, numb or having decreased interest in activities you used to enjoy
• Physical symptoms, including appetite and sleep disturbances, nausea, and dizziness
• Reduced feelings of empathy and sensitivity
• Feeling overwhelmed, increased anxiety, sadness, anger, and irritability
• Difficulty concentrating and making decisions
• Increased conflict in personal relationships
• Neglect of your own self-care
• Withdrawal and self-isolation

To mitigate compassion fatigue, practitioners need to balance empathy and self-care, ensuring they maintain their emotional well-being while providing necessary support to fibromyalgia patients.

Practicing good self-care is where the hard work of maintaining compassion lies. In addition to being in a healthy physical condition, tending to emotional blockages, and having a spiritual and creative outlet, the Four Steps of Energetic Separation for Bodyworkers can be extremely helpful for being able to remain present and compassionate with clients. These four steps to maintain energetic boundaries are described as:

1. Self-awareness – The initial step in establishing energetic boundaries for therapists involves self-care and self-awareness, emphasizing the importance of addressing personal physical and emotional issues to differentiate from clients’ concerns and prevent practitioner burnout.
2. Grounding – The second step involves grounding techniques such as meditation or qi gong exercises, enabling practitioners to connect with universal energy, ensuring they act as facilitators channeling energy from heaven and earth to clients rather than depleting their own personal energy.
3. Protection – The third step involves protection techniques, such as visualizing a protective force field during massage sessions, ensuring that practitioners can channel energy to clients while preventing negative energy transfer.
4. Cleansing – The fourth step involves cleansing rituals after massage sessions, such as meridian brushing or other practices, to rid therapists of any unintentionally absorbed negative energy and prevent its lingering effects.

It is extremely frustrating to have a chronic pain condition that impedes nearly every part of your life, has no definitive cause or cure, can’t be seen by others, and is not detected by traditional medical diagnostic techniques. Massage therapists who may have fallen victim to compassion fatigue are urged to notice this. To return to the compassionate caregiver that once defined them, prioritizing self-care is necessary. Without compassion, a massage therapist will likely have difficulty connecting with fibromyalgia clients and cannot provide the acknowledgment, understanding, and support that are so desperately needed. When compassion is expressed, clients are more likely to feel seen, heard, and recognized – essential ingredients for the healing process.

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