Episode 3: What can be done about fibromyalgia pain Part 1

In this episode I give a summary of my approach to fibromyalgia pain. It has 3 main steps and we talk about the first two and one substep of the 3rd step :-)

Hello there!

Welcome to Winning at Fibromyalgia Podcast

Episode #3: What can be done about fibromyalgia pain?

I am Dr. Martina Ziegenbein, the executive producer of the podcast. I am so excited to be here today.

In the first two episodes, I talked about what is fibromyalgia pain – that it is neuroplastic type of pain which comes from misfiring neurons of the brain pain centers and pain pathways.

IN the second podcast How does the fibro pain come to be, I explained that it is believed that certain emotions, including past traumatic events, current or past stress all increase cortisol levels in our system which 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 but it is caused by the brain. It is NOT a product of their imagination!

Today, I will summarize my framework of approaching this problem.

As a way of disclaimer and disclosure, I would like to mention my resources and where I go for information. I am a board certified Rheumatologist and my basic and first understanding of fibromyalgia was from reading all kinds of articles, resources and attending numerous lectures on fibromyalgia organized by ACR (American college of rheumatology).

In that regard, I follow work and available resources from the team of Dr. Daniel Clauw at University of Michigan who has been leading Fibromyalgia research for decades. His is the group that was among first to CONFIRM with fMRIs that the pain was real.

I also recently became acquainted with work of Dr. Alan Gordon whose book Way out talks about all kinds of research related to brain pain/neuroplastic pain and what to do about it. I will talk about his PAIN REPROCESSING SYSTEM In the coming episodes.

I integrate ALL of this information when I work with patients and am currently putting a course together for women in an online format.

So, in summary, there are only 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.  START accepting the notion and concept of neuroplastic pain.

3.  Be willing to do things you have never done before, in order to get results you have never gotten before.

1. Practice of self-compassion and mindfulness DAILY.
2. Pain reprocessing therapy.
3. Evaluate your life for all stressors and where you might live out of integrity with your true self.

Let me elaborate on the first two.

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 profession. 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 condition. 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 immune system and decrease inflammation. Fibromyalgia does not get treated with these meds. So it is of crucial importance to distinguish.

Generally speaking, once we are confident in our diagnosis, we don’t usually follow fibromyalgia patients longitudinally in our practice. I do so because I specialize in helping women with fibromyalgia. General rheumatologists specialize in seeing patients with inflammatory conditions. There is no harm, in my opinion, to check in with rheumatologists every 3-5 years, or if there are any new symptoms that worry you or your primary care physician.

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 exam is 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 accepting 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 being 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. 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.

I have to dislose something here. Up until today, this item only included practicing mindfulness. And as serendipity would have it, I had the privilege of listening to Dr. Kristin Neff speak earlier today. Dr. Neff is the leading researcher on compassion, self-compassion and its effects on mental health. I am part of the Empowering Women Physician coaching program and she was a guest speaker today. It was truly transformational for me to hear her confirm what I have suspected for so long. Mindfulness is important and is actually part of having and practicing self-compassion for ourselves.

So what does it mean, you might ask, to practice selfcompassion? It means CARING about the pain and suffering of others and YOUR OWN.

I mentioned in the earlier episode 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 selfcompassion 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 it if 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.

Selfcompassion is not sugarcoating 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 guilt, 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, other person has back pain, and yet another person has 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.

If you like this or found it helpful, please leave a comment or review. You can find me at Fb as Martina lenartova. Or on my website at: https://www.winningatfibromyalgia.com.

I look forward to chatting with you in the next session.