Understanding
Fibromyalgia
Fibromyalgia is a pain sensitization
syndrome. This means that pain is registered at a lower threshold
than previously. Consequently,
even light touch causes pain, and movement, previously not painful,
becomes painful. Most importantly, this pain is not caused
by
damage or pathology in the tissues being touched or moved. It
is caused by the lowered pain threshold.
The pain is not due to tissue damage
or pathology.
Stress/Injury/Virus/Trauma |
Fibromyalgia can develop after
an injury, trauma, a virus, and sometimes a combination of
these.
Reversal of the fibromyalgia syndrome involves restoring the
normal pain threshold. Every aspect of the self-management
program
can assist with restoration of the normal pain threshold. |
It is important to realize that pain
threshold
and pain tolerance are different.
You aren’t a wimp when your pain threshold is lowered. Your
pain is real and you aren’t making a fuss about nothing.
The
pain is not imaginary: it is due to pain sensitization.
A participant
in one group described it as the pain nerves “lying”.
Indeed the pain nerves are giving an abnormal message to the brain
and we, therefore, say that it is a disorder of the pain system.
This causes a lot of concern for people in pain and they may go
to many doctors trying to find out what is wrong with their neck,
back, wrist or elbow, and sometimes go to different doctors for
different parts of their body. They end up confused and frustrated
because no one seems to be able to give them a diagnosis. Sometimes
doctors suggest that it is all in the person’s mind because
they can find nothing wrong on the X-rays, CT scans and other tests.
They find no evidence of a structural problem or a disease such
as rheumatoid arthritis. This is good news because it means that
the problem is potentially reversible.
However, there are no operations or treatments which can reverse
the pain sensitization/amplification state.
Fibromyalgia is potentially reversible: it
can be reversed by you.
You may have some doubts about this,
hoping that there is someone who can fix it and feeling some reluctance
about being
actively
involved in your recovery. On the other hand, it enables you
to
take charge of your life again. You can bring about your own
recovery; you don’t have to wait for someone to do it
for you. Even time will not solve the problem unless you start
to change the things that have turned on the pain amplifier.
You can turn down the pain amplifier.
Disease Or Dis-Ease?
There is no evidence for a disease causing the pain sensitization:
it is more appropriate to think of it as dis-ease. In other
words,
your body is expressing a lack of ease. Pain itself causes muscles
in the body to become tense. This can be felt as a chronic,
high
level of tension in different muscle groups, and sometimes, as
a muscle spasm occurring after a particular movement or after
sleeping
in a different position. All of this can be frightening for the
person in pain and send them off seeking another doctor or therapist.
 |
A cycle of chronic tension develops where pain
causes tension and tension causes pain. The tension is both
physical and psychological. Our worries, fears, conflicts, expectations
and losses all create tension (or dis-ease) in our mind and
this activates part of our nervous system called the sympathetic
nervous system (SNS) which prepares us for action. Our muscles
become tense ready for action and the cycle of tension and pain
is perpetuated. Often there is no action to release the energy
and it gets stored as muscle tension. Exercise can help release
the stored energy. |
Muscle tension and spasm in muscles of the spine cause changes in
the dynamics of the spine. There can be postural changes and restrictions
of movement. Muscle imbalances can strain joints and ligaments, possibly
causing local inflammation at times, and this generates more pain
and tenderness.
It is also common for changes to occur in the dynamics of the shoulder
girdle and pelvic girdle. When the muscles become unbalanced, they
can no longer work in a coordinated way, and, instead of movements
being smooth and painless, they become jerky and painful. Strengthening,
stretching, and re-education, may all be necessary to restore normal
function and pain-free movement.
Sometimes manual therapy can assist with releasing the spasm and mobilizing
stiff joints in the spine however this will never provide a full solution
to the pain of fibromyalgia. It is even possible that manual therapy
could aggravate the problem if the treatment becomes too frequent,
or if it continues for too long. Therapy which helps re-educate the
muscles provides a longer term solution. The Feldenkrais Method, the
Alexander Technique and yoga can all be beneficial in releasing the
muscle tension and teaching the muscles to work more easily and effortlessly.
Even this may not be enough if there is inner dis-ease. People in
pain experience a lot of stress from the pain itself and the changes
in their lives brought about by the pain. Sometimes they tended to
be worriers, perfectionists, nervy, or just very busy people before
the onset of the pain, and hence, were already experiencing a high
level of stress in their lives. Stress from our own expectations is
usually as great or greater than that from other people and the circumstances
of our lives.
Developing Awareness
The first step in recovery is developing an awareness of your habitual
ways of moving, standing, sitting, relating to people, reacting
to
situations, and generally creating dis-ease in your body and life.
With this awareness you are in a position to make choices and to
change
your habits. Bringing awareness to everything you think and do is
a skill which can be learnt, but, it takes time and patience to
master.
If you are prepared to do this work you might be surprised and delighted
at the consequences. You can liberate yourself from pain and stress
by developing awareness and responding with change.
You can liberate yourself from
pain and stress.
Origins Of Fibromyalgia
The cause of fibromyalgia is not known but it seems to develop
after injuries, viral infections, a traumatic event, and sometimes
just
out of the blue. A common factor seems to be stress and it is therefore
called a stress-related condition. Stress can be insidious and
many
people don’t even realize that they are stressed. They may
be chronically stressed, or the stressors in their life may have
slowly mounted over time without them realizing the toll it was
taking. It is unfortunate that many people are reluctant to accept
the diagnosis of a stress-related condition because it seems less
valid than one which is purely physical. However, an increasing
number of illnesses are being recognized as stress-related, meaning
that stress plays a part in the illness developing, persisting,
or getting worse.
If you can accept that your chronic pain is related to stress then
you can set about identifying your stressors, and find ways to relieve,
or reduce, the stress in your life. If you find it difficult to
accept the role of stress, then you might like to look at why this
is so. In no way does it make your problem imaginary, neurotic,
or less valid. It simply means that a physical solution is probably
not available. Physical therapy will be part of the solution but
it is not enough on its own.
Physical therapy is not enough
on its own.
Fibromyalgia and Other Conditions
Fibromyalgia can be present along with other conditions such as
rheumatoid arthritis, osteoarthritis, lupus, disc disease and
so
on. What this means is that the pain experienced by people with
these conditions will be greater than expected for the current
state
of their disease. For example, someone with rheumatoid arthritis
may go to the doctor because their pain has increased but the
doctor
finds no evidence of the disease being active. Long standing pain,
the stress of living with the illness, and other personal and
life
stressors can contribute to a pain sensitization state which is
generating the pain. The pain will only diminish when these factors
are addressed, because the normal medication for the disease will
not reduce the pain.
Fibromyalgia can be present with
other conditions.
|
