What can be done about fibromyalgia pain?
Hello my friend!
In the first two blogs, I talked about what is fibromyalgia pain – that it is a neuroplastic type of pain which comes from misfiring neurons of the brain pain centers and pain pathways.
In the second blog How does fibromyalgia pain come to be?, I explained that it is believed that certain emotions, including past traumatic events, current or past stress all increase “agitation” levels of our central nervous system which in turn sends danger signals in the brain and that CAN PRODUCE PAIN in the body!
I also stressed several times that the PAIN of FIBROMYALGIA IS REAL. You feel it is real. The reason it has gotten a lot of negative “press” in the past is that women were felt to be making the pain up or that the pain was “in their heads”.
The pain is REAL and it is caused by the brain. It is NOT a product of their imagination!
Today, I will summarize my framework for approaching this problem.
So, in summary, there are THREE BASIC steps that one has to follow in order to get started on the journey of improvement from fibromyalgia pain. They are:
1. Confirm the diagnosis of Fibromyalgia.
2. Embrace the mind-body connection and the notion that the brain can cause pain.
3. Reframe the meaning of pain and create the sensation of SAFETY for your nervous system. Steps that have high chance of getting you there include:
a. Practice of self-compassion and mindfulness.
b. Somatic tracking.
c. Believe in (yourself and) your brain’s capacity to rewire the pain pathways.
Let me elaborate.
1. Confirm the diagnosis of Fibromyalgia.
It is of crucial importance to have the diagnosis confirmed by a Rheumatologist. This is not just to plug for myself or my practice. I truly believe, and there is data to support this, that Rheumatologists are uniquely trained and positioned to diagnose the condition. Why you ask?
We are trained to look for clues on your history (meaning what you tell us, what your symptoms are) and your exam, that may point to the diagnosis of an inflammatory or autoimmune process. Fibromyalgia symptoms MAY LOOK LIKE inflammatory symptoms of someone with RA or other inflammatory conditions. We, the rheumatologists, are the ones who help you distinguish that.
The reason it is important is that RA, Lupus and other inflammatory conditions get treated with medications that suppress the immune system and decrease inflammation. Fibromyalgia does not get treated with these meds. So it is of crucial importance to distinguish.
For the first visit, we generally want to see, or check ourselves, several labs including blood counts, liver, kidney, inflammation, muscle test and thyroid. Sometimes we check vitamin D level. If these are all normal and exams are normal, we don’t usually look further. In some instances, if the labs are normal but the exam is not completely normal we look further. That is why you want to see us first.
So I hope I helped explain this topic.
2. The second point was to start embracing the concept of neuroplastic pain. This is so crucially important. We as physicians are still learning how to explain this to our patients so that they have a good understanding of the scope. I still see quite a few patients whose first reaction to my explanation about neuroplastic pain is: “oh are you saying my pain is not real?”. That means that despite my best efforts to reassure the person that the pain is real, there is no damage to the tissues, the message still gets lost. It IS A LOT to take in. If you have lived with pain for years or even a decade, and you believe that there is something wrong with your body, you can feel naturally dis-inclined to believe that the body is ok and that the pain is all produced by your brain. You could ask “why would my brain do that”? So yes, I get it, it is hard to accept at first.
I usually just start by asking my patients to be OPEN to the idea of neuroplastic pain. They don’t have to believe it or accept it right away. Because you can start taking steps to feeling better even without believing it fully.
But it IS important to start being OPEN to the idea of neuroplastic pain. Acceptance changes something in our brain that allows learning and new information to settle in.
3. The last step is to be willing to do things you never tried before.
I would like to touch upon the practice of Self compassion and mindfulness daily today.
And as serendipity would have it, I had the privilege of listening to Dr. Kristin Neff speak late in 2021. Dr. Neff is the leading researcher on compassion, self-compassion and its effects on mental health. It was truly transformational for me to hear her confirm what I have suspected for so long. Mindfulness and self-compassion are crucial in healing our nervous system (and thus improving the pain).
So what does it mean, you might ask, to practice self compassion? It means CARING about the pain and suffering of others and YOUR OWN.
I mentioned in the earlier blog that stress activates our “flight or fight” response. That sends danger signals to our primitive brain and increases cortisol levels in our body. Increased cortisol levels can directly lead to pain through increasing tension in the back muscles (and other muscles in the body) or just increasing sensitivity of the neurons to pain signals.
Practicing self compassion lowers blood pressure, heart rate and INCREASES levels of oxytocin in our body. Oxytocin is the “feel good” hormone that is released when the mothers first bond with their newborns, or anytime we have somebody touch us with care and kindness.
A practice of self compassion does not have to be complicated. It has three main components (kindness, awareness and the sense of common humanity) and literally means the following steps:
- Find a comfortable position, close your eyes.
- Slow down your breathing.
- Bring your attention to something stressful happening in your life.
- ACKNOWLEDGE the pain or suffering you are feeling. Name it – it could be anxiety, sadness, frustration. FEEL THE EMOTION.
- Now imagine what you would say to a good friend if they were in this situation – it could be something like: of course you are sad or frustrated. Or angry. This is the human experience. It happens. Life is not perfect. Mistakes happen. Life happens. This is the human experience. You did or are doing the best you can. This is all you can do.
- And NOW SAY IT TO YOURSELF.
- Feel the emotion, allow yourself to feel it.
- Put a hand over your chest as if putting it over the heart to protect it, and feel kindness to yourself as if it was your friend or someone you love, because - it is. You are your best friend.
- Believe this friend that this is part of human experience, other people suffer too. You are not alone.
- You don’t have to fix it, you don’t have to do anything else, you are just bringing awareness to the emotions you are feeling, and you say kind things to yourself, because you care.
- That’s it, you can open your eyes.
Self compassion is not sugar coating things. It is also NOT letting yourself off the hook. It is OPENING YOURSELF TO PAIN WITH KINDNESS. If you made a mistake, and you feel guilty, with kindness you can commit to doing your best not making the same mistake again. Rather than feeling shame you feel resolved not to make the mistake again.
When your brain gets kindness in response to frustration, anger, anxiety, something changes in the way you are able to deal with stress and pain. Your chemistry changes.
Everyone has THEIR OWN flavor of suffering. I have rheumatoid arthritis and some chronic aching in my back, another person has back pain, and yet another person has a history of significant trauma. Everyone has some flavor of pain and the amount is different and the way it manifests is different. THE HUMAN EXPERIENCE is about CHALLENGES. That’s what it means to be HUMAN. There is not a single person alive who does not have some pain or difficulty.
When we remember that truth, what happens is that instead of feeling all alone in our suffering and isolated in our struggles, we feel more connected to other people. The sense of CONNECTEDNESS gives us a sense of strength and coping and feeling we can handle this because this is a human condition.
So the main three components of self compassion are mindfulness/awareness of our pain, kind warm response to the pain and remembering that everyone has struggles. I am going to leave you with that thought.