Evidence-based practical approaches for managing fibromyalgia, for domestic abuse survivors.
In this final piece, in the FMS series, we will explore well-known and perhaps lesser discussed approaches to educating domestic abuse (DA) survivors to manage FMS in the context of domestic abuse recovery.
If you have arrived here without reading Parts I & II (links at the bottom), I strongly advise that you start at Part I, where we provide a helpful approach to understanding FMS... which helps to engage with the tools in this article.
The ideas in this article are considered a toolkit, rather than ordered as a list of priorities. It is the use of all of these, in combination and in support of each other — that creates impact.
Pacing / Energy Management
The basics of pacing are well established, here is a summary — hopefully, you have been shown these before:
Start slowly and gradually increase activity levels: Don’t overdo it initially. Begin with short, low-impact activities like walking or swimming and gradually increase the duration and intensity as tolerated.
Listen to your body: Pay attention to your body’s signals. Rest when you feel tired or experience pain. Pushing yourself too hard can lead to symptom flares and setbacks.
Break down tasks into smaller chunks: Large tasks can seem overwhelming. Instead, break them down into smaller, more manageable steps to avoid fatigue and frustration.
Schedule regular rest periods: Plan regular rest breaks throughout the day, even if you’re not feeling particularly tired. This can help prevent symptom buildup and maintain energy levels.
Prioritise activities: Identify the activities that are most important to you and focus on those. Don’t feel obligated to do everything you used to do before FMS.
Avoid overcommitting yourself: Don’t overload your schedule with too many activities or commitments. Leave some buffer time in your day to accommodate unexpected events or symptom flares.
Seek help when needed: Don’t hesitate to ask for help from family, friends, or professional caregivers when you need it. Delegating tasks can reduce your workload and allow you to rest.
Use assistive devices: If certain activities are difficult due to pain or fatigue, consider using assistive devices like grab bars, raised toilet seats, or shower chairs.
Find alternative ways to accomplish tasks: Think creatively about alternative ways to complete tasks that may be challenging due to FMS symptoms. For instance, use online grocery shopping instead of in-person shopping to save energy.
Having worked with many FMS patients, I have seen a problem with point 2:
“Listen to your body: Pay attention to your body’s signals. Rest when you feel tired or experience pain. Pushing yourself too hard can lead to symptom flares and setbacks.”.
Many FMS sufferers will say that they feel the pain later or the next day — their ability to monitor whether they have done too much is frustratingly imprecise and often only reveals itself with an FMS pain flare, later that day or the next day.
Here’s an approach to setting limits on exertion, that I learned through working with FMS teams:
Pick an activity that is known to risk flare-ups, e.g. vacuuming, walking, laundry.
Take a guess on what feels like a sensible limit — a specific guess (e.g. 15 minutes or 3x5 minutes with short breaks).
Complete the activity for 15 minutes and await the outcome, based on your usual flare-up pattern.
If there is no flare-up, increase the time by 20%. If there is a flare-up, reduce it by 20%, when your flare-up passes.
Repeat. Always log the time.
Once you have found the time period that does not cause a flare-up. Stick to it.
After 7–10 days, increase the duration by 10% and notice the outcome. If there is no flare-up, this is your new threshold. If there is a flare-up, reduce and repeat.
Repeat this for any activity that you are unsure of, in terms of your capability. Also for how long breaks need to be, to enable you to start again with a new task.
It takes time and it is tedious, but only needs to be for those biggies that make you sweat at the very idea. Log the times on your phone, treat this as your written in stone rules on how much of that thing you can do… ESPECIALLY for times when you feel great, as we will discuss next.
Boom and Bust
A very common pattern for people with FMS is what is called ‘Boom and Bust’. Periods of Boom are when you may feel better… less pain, more energy… a good day.
A good day! Yipee!
Time to get all of that work caught up on and those activities that were put off, done… do them while I can!
Boom, for people with FMS, is nearly always followed by Bust.
Pacing was ditched in the context of feeling great. All thresholds were ignored and a flare-up is triggered.
The goal of pacing is to create rules and approaches that mean we extend the length of good days, to good weeks. We therefore need to use the boom periods to give that extra energy you need to feel good, to think positively, to focus on the skills you need to feel self-worth… to support recovery.
When you bust, you will need to rest for longer. Every time you rest like this, you lose fitness. This means that boom periods become shorter and your pacing thresholds lower — you can do things for less time, every time you cycle through boom and bust.
Only by resisting the urge to do too much when you feel better, do you gain fitness — by avoiding extensive rest. This is a self-loving cycle, where you are creating the best opportunity to heal — not looking for the best opportunity to get tasks done!
It’s hard, but in the long-term, it rewards you with more fitness and more stamina.
Re-educate your brain to listen
FMS is characterised by the brain listening to the pain sensitivity system at maximum volume. It can be all-consuming for the mind.
You need to educate the brain that there are other things to pay attention to…
fun.
pleasant tastes, smells, sensations.
great memories.
loved ones.
music
…. so, so much to think about in the world.
When you have that extra energy on a boom day, this is where you will need to plan to spend some of it.
Take the opportunity to exaggerate the good day — notice a warm bath, drop a bath bomb and embrace the smell — notice how your body has the capacity to smell and feel amazing things… not just feel pain constantly!
Eat well. Play hard. Love harder.
You are leveraging the fact that today feels better to embrace life, rather than spend it all away on tasks that sabotage recovery.
By doing this, you re-educate the brain to appreciate the other information that is coming in and so dialing up the volume on other information, reducing the volume of the pain sensations.
Get Support
Both DA experience and FMS can make it challenging to connect to others — fear, shame, and the realities of pain, fatigue, and limited ability to do things. With this said, the value of socialising with supportive friends and/or family is key in recovery from both.
We need close people when we escape DA relationships, to help us to go back — and to help us to stay away from them in the future. Trusted people can be great anchors into a new and good life. We also need people to help us to re-realise that we have needs and that these needs should be met.
Whilst building this network, FMS survivors need to understand pain communication concepts:
There is risk with FMS, I’ve witnessed, in that people who suffer from it can find themselves talking about their symptoms a LOT. It stems from the confusion and irregular pattern of the symptoms alongside how invisible the condition is to others. But I’ve also heard from many loved ones that they eventually experience compassion fatigue. The constant complaints wear down the intent to support, as no matter how much help is offered the complaints don’t reduce.
A better approach is to spend a moment, when struggling, to identify one small way a friend could help. Simply say,
“It would really help me if you could XXXX”
Provide your close supporter with a way to be useful and a way to have impact.
For example, if a plan to go to coffee is hampered by a flare-up you could say,
“I need us to reschedule this for Saturday, as I’m struggling, if that’s ok?”
or
“It would really help if you came over to my house and, if you don’t mind, serve the coffee… as I’m very tired today”.
It may seem demanding or pushy, but from all of the work I’ve done with couples and families — people just want to be told how they can help!
Of course, don’t overdo it and don’t feel afraid to tell people that they can say no, if your demand is too much… and that you really won’t be offended.
The goal here is to socialise without FMS being the focus of the conversation. When FMS interferes, ask for help — so that socialising can get back on track.
Some supporters will want to do more — help in more ways — which is fine… but again, spend time on what you need and communicate it well. It burns people out when they spend a lot of energy helping and it seems to be the wrong help, as no benefit is witnessed.
Reacting with compassion
I’ve created an entire 6-week self-compassion course for you that’s here, and it’s free! Digital learning, meditations and self-compassion practices.
I won’t say more here other than self-compassion in place of disappointment, shame and anger at yourself is the goal and I’ve mapped out a way to practice it.
Exercise
People with FMS often become fearful of exercise, as it so often triggers a flare-up.
This fear is understandable but will lead to further loss of fitness and an increase in pain over time. Here is an evidence-based summary of exercises that seem to work, showing that there are a lot of options for you. It really isn’t what you do that matters — as long as you do something often and you both pace and avoid boom and bust experiences (as described above).
Pacing is a lifestyle, when it comes to FMS — a lifestyle choice that broadens the activities you can succeed with, over time. The aim is to learn to trust your body again and to get the confidence and skills to add in whatever you'd like to do - at the pace that fits!
Sleep
Sleep is a nightmare when it comes to FMS!
FMS (pain flare-ups, stress, shame etc) reduce sleep and reduced sleep worsens FMS symptoms.
I’ve been asked many times how to fix sleep with FMS and, with the right work, I’ve seen many people with FMS improve their sleep drastically.
Firstly, all of the lessons and exercises provided need to be thought about and installed into your life:
understand what FMS is (part 1)
understand why you might have it (part 1)
understand the role of emotions in FMS… and how domestic abuse experience impacts on this (part 2)
learn pacing and reduce flare-ups
get a support network and socialise
learn to focus on positive body experiences often.
Understand the role of exercise and implement a plan.. carefully!
This brings us to sleep hygeine, which is admittedly an odd phrase. It refers to the fact that many sleep issues are due to messy sleep habit which break our ability to sleep in a cycle.
Sleep is such a strange human behaviour, as we know little about it really. What we do know is that we can reduce our ability to sleep and that trying to sleep is the worst approach, as any effort (we call this sleep effort) is actually going to cause us to wake up. Sleep, when it happens, is effortless… and anyone who’s had children will know, we can train a sleep pattern.
I’ll provide a link to a sleep hygiene plan below, here I want to motivate you to do the work. The number one reason these approaches fail is that people give up on them, they can be very difficult to commit to and stick to.
FMS and DA disrupt sleep, in that both of them can cause us to feel pain and or emotional distress when we want to fall asleep. There is no quick fix to some of this, but with the right work, we can create the best opportunity to fall asleep.
This is the key phrase here… the best opportunity. Sleep has to be invited through strict sleep routine rules that help us to feel the urge to fall asleep (sleep drive) at bedtime when it has become dark. Our rhythm can become out of sync over time due to disrupted sleep and methods we use in an attempt to fall asleep (staying in bed for hours awake, looking at our phones, eating, etc). Getting informed and sticking to a plan creates the best opportunity — and sticking to this no matter the outcome is our best approach for long-term gains.
This can be very frustrating, I know! But accepting that the body will sleep when it needs to and that you will provide the best opportunity is something we just have to trust. When sleep has been poor, lower activity goals for that day — but not to zero. We always want to keep active, as being active helps us to grow a sleep drive through the day.
I won’t say any more on the details, as it’s well laid out in the link below:
Address the scars of abuse
As I said at the start, all of the steps in this article are central to FMS and DA recovery. Here I will discuss the need to resolve the emotional scars of domestic abuse, which can both fuel and block FMS recovery for all of the reasons stated in this 3 part series.
The outcome of domestic abuse for many people includes fear/anxiety, confusion, guilt, shame, and sometimes physical injury. For many, whilst in the relationship, sleep was regularly disturbed by attack and/or the stress of the living situation. The outcome of this, for all, is a long-term habit of high emotional living and psychological hypervigilance — we are scanning the world for any sign of threats. This is a habit learned from monitoring an abuser’s previous mood, behaviours… and signs that their mood might signal the arrival of abuse.
This hypervigilance is another type of volume dial — we are watching the world like hawks, sensitive to things others wouldn’t even notice. It can bleed out, it can push the dial up on the body's sensory system — experienced as FMS, for some. For these people, both dials have to be lowered as each over-active sensory system feeds the other. Abuse from a partner/ex or the trauma-based emotions triggered after escape can push both dials up. Pain flare-ups can also push both dials up.
This three-part series has focused on how to reduce the pain perception dial. The other dial, requires significant trauma recovery work, with similar needs as we see in FMS. To recover from the trauma aspects of DA, we need to understand and process:
the past abuse (how it happened, why you tolerated it).
the effect on you (how it shaped us)
the emotions and trauma responses we leave with
how to soothe these emotions
how to get closer, to meet your needs and to feel self-worth
understand how to response compassionately to yourself
understand how to maintain these changes, going into new relationships
This work is critical, alongside FMS self-care approaches. It helps to know that when we work on both, they also feed each other in a nurturing fashion — pacing, self-care, self-compassion and more understanding is generally soothing and supports empowerment.
A digital option for you & your clients
How to address these specific abuse related needs? This is extensive work, which I wrote into a book ‘Get Out Get Love’ and has since been developed into a digital programme for you to self-deliver (self-paced, private, very affordable). Take a look and consider starting the journey to recovery - it is self-paced and you get access for a year, at a very low price (free trial available).
Summary
The goal of this 3 part series was to demythologise FMS and to create a sense of empowerment through education and by giving you ideas and tools that are evidenced to work.
FMS recovery is a slow process and so patience is required, learning to use self-compassion alongside this journey is one way to learn a calm and self-forgiving mindset alongside the challenges of FMS.
I hope this helps. Feel free to post us any comments / questions via our contact page.