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Am Fam Physician. 2002;65(3):380-384

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.

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, non-judgmental 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.

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This series is coordinated by Kenny Lin, MD, MPH, deputy editor.

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