Letters to the Editor
Use of Mindfulness Meditation for Fibromyalgia
TO THE EDITOR: I congratulate Drs. Millea and Holloway1 on an excellent review of treatment options for fibromyalgia. However, the article overlooked mention of the use of mindfulness meditation for treatment in fibromyalgia. Mindfulness meditation is the intentional effort to pay nonjudgmental attention to present-moment experiences and sustain this attention over time. The aim is to cultivate a stable and nonreactive present-moment awareness. Kaplan and colleagues2 demonstrated a significant improvement (40 to 50 percent) among patients with fibromyalgia utilizing mindfulness meditation. In this study, fibromyalgia was defined as a "chronic illness characterized by widespread pain, fatigue, sleep disturbance, and resistance to treatment."2
As a family physician who receives fibromyalgia referrals and teaches mindfulness meditation, I have found that patients are grateful for the improvement after learning this mind/body process. Usually, 25 percent of our mindfulness classes consist of patients with fibromyalgia. Often, the gentle stretching of mindful yoga is particularly beneficial; undoubtedly, some of its benefit comes from the active participation by the patient in a supportive group environment, as mentioned in the editorial that accompanied Millea and Holloway's review of fibromyalgia.3
Mindfulness meditation is taught at over 250 sites around the country. A list of local teachers is available from the Center for Mindfulness in Medicine.4 The excellent accompanying editorial3 mentioned the complex of symptom-based diagnoses that are part of a sensory amplification syndrome. It is this group of patients who can benefit the most from mindfulness meditation.
REFERENCES
- Millea PJ, Holloway RL. Treating fibromyalgia. Am Fam Physician 2000;62:1575-82.
- Kaplan KH, Goldenberg DL, Galvin-Nadeau M. The impact of a meditation-based stress reduction program on fibromyalgia. Gen Hosp Psychiatry 1993;15:284-9.
- Clauw DJ. Treating fibromyalgia: science vs. art. Am Fam Physician 2000;62:1492, 1494.
- Center for Mindfulness. University of Massachusetts Medical School. 55 Lake Avenue North. Worcester, MA 01655.
IN REPLY: We appreciate Dr. von Weiss's pointing out our oversight regarding mindfulness meditation in fibromyalgia. Practicing mindfulness meditation or one of the other trance-inducing techniques on a regular basis can produce remarkable benefits, including reduction in the morbidity associated with pain.1 Kabat-Zinn and colleagues2 define mindfulness meditation as "moment to moment, nonjudgmental awareness," and demonstrate how easily patients can be introduced through audio tapes to techniques used to enhance the treatment of chronic conditions.
Research is beginning to uncover the mechanism of action of these techniques. Tooley and associates3 determined that melatonin levels increased significantly on the night following a period of meditation by experienced meditators. Lazar and colleagues4 used functional magnetic resonance to study brain activity during meditation by experienced meditators and found significant increases in the regions of the brain associated with attention, modulation of pain perception and control of the autonomic nervous system. The use of Transcendental meditation has also been associated with improved cardiovascular functioning.5 Our article6 noted that some of these same neuroendocrine systems are directly implicated in the pathophysiology of fibromyalgia.
During meditation, a person focuses attention on sensations, including breathing, thoughts, or particular objects. Ideally, what is perceived is unimpeded by evaluative notions or current concerns for previous knowledge. Inhibiting these processes creates a space for awareness within which the perceived often reveals itself in a startling new and rich fashion. Mindfulness and related techniques are potential options when constructing a treatment plan for patients with fibromyalgia.
REFERENCES
- Astin JA. Stress reduction through mindfulness meditation. Effects on psychological symptomatology, sense of control, and spiritual experiences. Psychother Psychosom 1997;66:97-106.
- Kabat-Zinn J, Wheeler E, Light T, Skillings A, Scharf MJ, Cropley TG, et al. Influence of a mindfulness meditation-based stress reduction intervention on rates of skin clearing in patients with moderate to severe psoriasis undergoing phototherapy (UVB) and photochemotherapy (PUVA). Psychosom Med 1998;60:625-32.
- Tooley GA, Armstrong SM, Norman TR, Sali A. Acute increases in night-time plasma melatonin levels following a period of meditation. Biol Psychol 2000;53:69-78.
- Lazar SW, Bush G, Gollub RL, Fricchione GL, Khalsa G, Benson H. Functional brain mapping of the relaxation response and meditation. Neuroreport 2000;11:1581-5.
- Castillo-Richmond A, Schneider RH, Alexander CN, Cook R, Myers H, Nidich S, et al. Effects of stress reduction on carotid atherosclerosis in hypertensive African Americans. Stroke 2000;31:568-73.
- Millea PJ, Holloway RL. Treating Fibromyalgia. Am Fam Physician 2000;62:1575-82.
Removal of Treble Fishhooks
TO THE EDITOR: I would like to commend the authors of "Fishhook Removal."1 I have attempted all of the methods described in the article at one time or another, based on the presentation of the anatomic location involved. However, one situation needs additional clarification: the presentation of a treble hook when two or three of the barbs are imbedded simultaneously. The mechanical structure of a treble hook does not allow simultaneous advancement of the hook with this type of presentation.
In this case, I have used a technique of cutting through the base of the treble with orthopedic pin cutters that separate the remaining hooks of the treble into single hooks. At this point, any of the mentioned methods can be employed.
The key to success is to use orthopedic pin cutters. No other instrument, including ring cutters, pliers, or trauma scissors, are heavy enough to cut through the nickel-plated base that are found on various treble hooks. We have successfully removed treble hooks on numerous occasions with this method when the "Big Catch of the Day" was a human here in Guantanamo Bay, Cuba.
REFERENCE
- Gammons M, Jackson E. Fishhook Removal. Am Fam Physician 2001;63:2231-6.
A patient information handout on Cushing's syndrome and Cushing's disease (September 1, 2000, page 1135) contained an inaccuracy in the discussion of the causes of Cushing's syndrome, in the first column of the first page. Both inhaled steroid medicines for asthma and steroid skin creams for eczema and other skin conditions can cause Cushing's syndrome, although this is rare. A corrected version of the patient information handout is available at www.aafp.org/afp/20000901/1133ph.html.
The article "Management of Asthma in Children" (April 1, 2001, page 1341) contained an error in the patient information handout, on page 1354. Prednisone should be listed as a controller medicine, not a quick-relief medicine. The corrected version of the patient information handout is available at www.aafp.org/afp/20010401/1353ph.html.
Send letters to Jay Siwek, M.D., Editor, American Family Physician, 11400 Tomahawk Creek Pkwy., Leawood, KS 66211-2672; fax: 913-906-6080; e-mail: afplet@aafp.org. Please include your complete address, telephone number, and fax number. Letters should be submitted on disk, double-spaced, fewer than 500 words, and limited to one table or figure and six references. Please submit a word count. Letters submitted for publication in AFP must not be submitted to any other publication. Possible conflicts of interest must be disclosed at time of submission. Submission of a letter will be construed as granting the AAFP permission to publish the letter in any of its publications in any form. The editors may edit letters to meet style and space requirements.
Copyright © 2002 by the American Academy of Family Physicians.
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