Welcome to part five! I hope you’re enjoying this series! Did you catch the last one Sleep? It was pretty meaty and I hope very helpful.
The fibromyalgia framework series is going to present my (evolving) view of managing fibromyalgia. In 2018 some of my strongly held theories were proven true by experience and research. I’ll share this with you.
We have discussed:
CENTRAL SENSITIVITY/OVERACTIVE NERVOUS SYSTEM IN FIBROMYALGIA
A lot of research suggests that Fibromyalgia is the result of central nervous system dysfunction – specifically an overactive nervous system, stressing and exhausting the brain (Dennis W. Dobritt, Fibromyalgia – A Brief Overview). Other literature suggests that the chronic pain causes the central nervous system to go into overdrive. However you look at it, the nervous system appears to be involved.
The theory of autonomic nervous system dysfunction resonates with me as a big part of the puzzle – not the entire answer.
A lot of programmes are popping up and claiming to “cure” chronic pain (Lightning Process, Curable app, the CFS Unraveled programme, various books with similar programmes) based upon the idea of retraining the brain. If these programmes are the entire answer for someone, I am happy for them. But mostly they are going to be one part of the puzzle.
Recently I read Dr David Hanscom’s book Back in Control which outlines his programme for recovery from chronic pain. It is heavily based upon rewiring the brain but he also includes several other key components – including sleep. He emphasizes how important sleep is and believes that before a person can be successful with treating chronic pain, they must be sleeping well. I don’t agree with all of his message, but I do like the fact that he recognizes the multiple components that are part of chronic pain-based illnesses. It is worth a read.
There are theories of anxiety and depression causing, or being the result of, fibromyalgia as well. As usual, nothing is universal. Throwing people with fibromyalgia on antidepressants (even without a diagnosis of depression) has long been the staple of some medical professionals, it certainly happens a lot here in New Zealand. But that really doesn’t improve their quality of life or their condition. Depression and anxiety are just other parts of the puzzle for a lot of us.
One of the key things I learnt from the first pain specialist I saw was about central sensitization. He helped me to see that by not treating my pain appropriately (I had a thing about avoiding medicines and try to take as little as possible) I was causing more pain – I was changing physiologically as a response to the ongoing pain and causing my nervous system to go into overdrive. So in addition to treating my pain, I needed to calm my nervous system down.
Luckily for me, prior to learning about this theory, I had already laid the ground work and made great progress with my overactive nervous system. Through meditation, which I have been practicing for a few years now, I no longer react as strongly to things that would have made my heart pound, breathing quicken and have me looking for the exit. Things that used to make me anxious no longer do. I also have the tools to calm myself down when my nervous system does go into overdrive. If I notice that I am getting wound up and my heartrate is climbing rapidly I will quietly take several deep, gentle breaths. Immediately calming my system. When I am feeling overwhelmed overall, I will sneak away to my room, and meditate.
Meditation and mindfulness are great ways to help train your brain to calm down. Dr Hanscom also recommends free writing once or twice a day for five or ten minutes and then ripping up the page as a way of creating separation from issues. Some might also benefit from counselling or specific work on trauma-induced anxiety. Below we will discuss meditation.
Meditation promotes a calming of the central nervous system, allowing the parasympathetic nervous system to activate. In the short-term that meant achieving deep rest during meditation, in the longer term it meant a dramatic reduction of the misfiring of my fight or flight response to minor stimuli.
- Complete rest
- Calming the central nervous system (Martinez-Martinez et al, 2014)
- A break from stimulus
- Focus on the body, accepting it as it is (mindfulness).
- Not trying to nap, which can be frustrating for those who can’t.
- For those who have trouble with orthostatic intolerance, just lying down can make you feel better.
- A boost in energy (however temporary).
- Improve the immune system (University Health News Daily, 2018)
- Treat depression
- Reduce pain
- Simply focus on your breath for a few moments. How you breathe in, how the breath feels a little warmer on the way out. How your body feels when you exhale. How your breaths get a little longer as you relax. Don’t push anything, just observe.
- Do your own body scan meditation – by quietly thinking of each part of your body in turn, noticing the feeling in each, accepting it, willing that part to relax and moving to the next.
- Do progressive relaxation – by tensing and releasing each part of your body in turn you can encourage it to relax deeply. As an example you could start with your feet, tense and release, your lower legs, upper legs, glutes, abdomen, arms, face.
- Guided meditations – YouTube has a heap available including Yoga Nidra, mindfulness meditations, meditation specific to pain or fatigue etc.
As an extra form of rest, you can lie down or recline in a chair with a heat pack.
MINDFULNESS FOR FIBROMYALGIA
A working definition for mindfulness is to be observant of thoughts and feelings without judging them. To allow our body to be as it and accept it as it is.
A research paper (Cash et al 2016) found that mindfulness meditation “ameliorated some of the major symptoms of fibromyalgia and reduced subjective illness burden.” Other studies have also shown the effects to be sustained at three year follow ups, with consistent practice.
There are plenty of courses and books around learning mindfulness. One such book is by Vidyamala Birch, founder of Breathworks (a UK based organization that teaches mindfulness) and chronic pain warrior, You Are Not Your Pain: Using Mindfulness to Relieve Pain, Reduce Stress and Restore Wellbeing – an Eight Week Program. I enjoyed this book immensely.
The concept of mindfulness can follow you out of the practice of mediation and into daily life.
- You Are Not Your Pain: Using Mindfulness to Relieve Pain, Reduce Stress and Restore Wellbeing – an Eight Week Program by Vidyamala Birch and Danny Penman (2013)
- Back in Control: A Surgeon’s Roadmap out of Chronic Pain by David Hanscom
- Cure: A Journey into the Science of Mind over Body by Jo Merchant (2016)
- Fight or Flight Response Overactive in Fibromyalgia
- What is Central Sensitization
- Central Sensitization Syndrome and Fibromyalgia
- Free writing for 5-15 minutes per day, then destroy the paper.
- Deep breathing (minimum of five quiet breaths when you feel the need, up to 10 minutes of specific mindful breathing a day) this is a nice 3 minute
- Write down your happiness level and social connection level each day, keep a gratitude list and remember your people.
- Do a loving-kindness meditation each day like this one
- Do a chronic pain relieving meditation like this one.
 Dennis W. Dobritt, DO, DABPM, FIPP. Fibromyalgia – A Brief Overview (a presentation). Retrieved from https://www.michigan.gov/documents/mdch/fibroacpsm_246421_7.pdf
 L.A. Martínez-Martínez, T. Mora, A. Vargas, M. Fuentes-Iniestra, & M. Martínez-Lavín. (2014). Sympathetic nervous system dysfunction in fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome, and interstitial cystitis: a review of case-control studies. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/24662556
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