Wednesday, November 3, 2010

Fibromyalgia: Multimodal Therapy

Fibromyalgia: Multimodal Therapy at the Rheinische Rheuma Zentrum

Multimodal doesn't simply mean to add different therapies. Our team has worked a long time together and regularly meets to discuss the needs of the patients. The team consists of a nurse, physical therapist / physical education teacher, at times an occupational therapist, a psychologist (behavioural therapist, pain specialist), and a rheumatologist. The success of the therapy depends on the cooperation of the Department of Psychology and the Department of Rheumatology, and in the orientation at behavioural therapeutic principles of the team.
The therapy is change oriented; patients should be enabled to increase their self-help capacity.

Patients must fulfil certain requirements as no pending social welfare lawsuit, command of the German language, motivation to change, no medication that affects the central nervous system (like benzodiazepines, tilidin, and others), and no other disease needing special attention at the same time, able to take part in a group therapy.
We had patients with migratory background (Turkey, Poland, Italy, Russia, Kazakhstan, Croatia ...), but were fluent in German. We had patients with concomitant inflammatory rheumatic diseases, but these were in remission at the time of the therapy. We also had one patient with both hips replaced within a year, but half a year after the last operation she was able to take part in the therapy.

Patients are in the day clinic, meaning weekends and evenings they're out of the hospital. ..., but they get homework. They apply, what they learn, in real life. They agree to stop talking about pain.

Day starts with rounds: group with rheumatologist and nurse, sometimes the psychologist joins. The nurse records non-verbal pain behaviour. Then the patients do aquatic training or aqua jogging, training therapy, gymnastics, walking (activities change). The pivotal point is: not every patient is alike, some are depressive avoiders, who need to be activated, and some are merry sustainers, who need to restrained, sometimes like in ice hockey 2 minutes on the penalty bench.

Later in the day they train progressive muscle relaxation (Jacobson). But the two sessions with the psychologist per day are the core of the therapy. They use stress coping and problem solving techniques.

We started with this therapy about 12 years ago. It isn't something mystical; you could find the ingredients elsewhere as well. Save, you must be very consequent, fill in loop holes, and look also that no other disease will get too much attention (e.g. a common cold).

Instant pain relief isn’t our goal; we look for less pain constantly in and over longer periods of time. We monitor with a battery of psychological tests and the FIQ.

We had a long waiting list, so that we had to close it. We'll be through with our list be next year and await the patients. We expect too many patients for our capacity, but there won't be a lottery like for green cards.

Written 03.11.2010, revised 19.11.2010 2.0

1 comment:

  1. In fact I put together two forms of therapy. The first ono's goal is educating and giving the opportunity to know what CBT is about (10 days)and the second's goal is to change coping strategies. The second has been named by our psychologist: Fibromyalgia Intensive Training.