Stress and pain are irreversibly linked in fibromyalgia. For many people, some kind of stressful event is what initially triggers fibromyalgia. It often shows up after a serious illness, some kind of emotional or mental shock or with PTSD (Post Traumatic Stress Disorder). There is probably a genetic tendency toward fibromyalgia, and many people believe that stress unmasks the disorder.

Fibromyalgia is thought to be a central nervous system disorder in which either pain-sensing nerves are excessively sensitive, or the brain is extremely sensitive to pain impulses. People with fibromyalgia have poor functioning of the HPA axis—hpyophysis-pituitary-adrenal axis—which is our body's system for responding to stress with neurochemicals like adrenalin and serotonin. We don't know how pain sensation and an abnormal stress response are related, but we do know that people with fibromyalgia experience more pain when they are stressed.

Just having fibromyalgia is stressful. Dealing with constant pain, fatigue and mental cloudiness is stressful. Not being able to accomplish things is stressful, especially if it affects your employment situation. That can lead to financial stress. The fact that few people understand what you are going through and expect you to behave “normally” is stressful. Dealing with a chronic illness and lifestyle changes is stressful. That's the everyday stress load; adding anything to it tends to tip the scale and cause the fibromyalgia symptoms to be worse.

Stress reduction is an important part of managing your fibromyalgia. Here are a few ways that may help alleviate some of your stress.

1. Good self care. Eating a nutritious diet, getting the right amount of the right kind of exercise, establishing regular sleep habits and giving yourself grace are all part of taking good care of yourself. They are important. You will feel worse, and be able to do less if you do not take care of yourself.

2. Practice body awareness. People who deal with chronic pain, as in fibromyalgia, become accustomed to ignoring their bodies; it's one way they cope with the pain. If you learn to recognize your body's cues that you are becoming tense, you can use a relaxation technique or exercise early on, before stress becomes unmanageable. At the same time, you don't want to lose that protective lack of awareness about pain. Take breaks every so often and just sit quietly and pay attention to how you feel. Learn where you feel stress first. Do you get heartburn? Do your shoulders get tight? Once you learn that, you can periodically scan to see if your body is showing tension.

3. Change the way you think. This takes practice, but it gives you a chance to respond to situations instead of reacting.

4. Keep a stress journal. This has two purposes. You can journal about stressful incidents and use the journal as a tool to help you identify situations that are stressful to you. This can help you either avoid repeating these situations or be better prepared should they be unavoidable. Journaling about a stressful event also helps you debrief and de-stress after the event.

5. Learn stress management techniques, such as visualization, meditation and breathing. These techniques decrease the level of neurochemicals circulating in your body, and help decrease both stress and pain.

6. Physical therapy, stretching and massage can help decrease muscle tension and stress, and help minimize pain.

7. Talk to a counselor who specializes in stress management and pain treatment. He or she can help you learn new ways to manage stressful events.

If you decrease your stress, you will probably experience less pain and fatigue from your fibromyalgia. Changing your lifestyle so that you are taking care of yourself can help prevent flare-ups and give you a better quality of life.