Getting out of the Fibromyalgia Pain Cycle
Fibromyalgia is a painful, often debilitating condition with many symptoms. The causes can seem mysterious, so determining a successful treatment approach can be daunting.
In this post I’ll discuss how fibromyalgia can be the result of an ongoing, self-perpetuating cycle of chronic pain, psychological stress, overactive immune system response, lack of sleep, and sensitization of the nervous system. I will also discuss the best course of action toward recovery from this type of fibromyalgia.
There are a number of medical conditions that mimic fibromyalgia, and when pursuing a diagnosis it is essential to rule them out.
Autoimmune connective tissue disorders
Blood sugar abnormalities
Chemical and food sensitivities
Chronic fatigue syndrome
Disc and joint degeneration
Reactions to medications
Rheumatic auto-immune disorders such as rheumatoid arthritis or lupus
Small fiber polyneuropathy
What is fibromyalgia?
Muscle pain and fatigue are the two most common symptoms of fibromyalgia. Traditionally, fibromyalgia has been diagnosed based on sensitivity to touch at 11 or more out of 18 specific tender points on the body. However, in 2010 a new diagnostic approach was adopted that will likely lead to an increase in the number of people diagnosed with the condition. The new criteria are based on how widespread the pain is combined with the severity and duration of the symptoms.
Common symptoms of fibromyalgia include:
- Widespread muscle tightness and joint pain
- Muscle tenderness, soreness, twitching, or spasms
- Burning or pins and needles sensations
- Tender points in specific areas of the body
- Hypersensitivity to cold or pain
- Difficulty with memory and concentration
- Feeling nervous, worried, or having mood swings
- Disorders including anxiety, depression, and post-traumatic stress disorder
- Digestive symptoms including constipation, nausea, or passing excessive amounts of gas
Who gets fibromyalgia?
Fibromyalgia affects about 10 million Americans, and between 75% and 90% of fibromyalgia patients are women.
Women likely suffer from fibromyalgia more than men at least in part due to hormones. Estrogen, the female sex hormone, is protective against pain. But women’s estrogen levels fluctuate throughout the month, and fibromyalgia sufferers report more pain during times of the month when their estrogen levels are low.
Testosterone, the male sex hormone, also protects against pain. But women have a small amount of testosterone compared to men, and men’s testosterone levels don’t fluctuate the way women’s estrogen levels do.
Social stigmas may also contribute to the higher rates of reported cases of fibromyalgia in women than in men. Men are less likely to go to the doctor when they experience pain because they don’t want to appear weak. Also, doctors often overlook fibromyalgia as a possible diagnosis in men because it’s thought of as a female problem.
Why does fibromyalgia begin?
While many factors are likely involved in developing fibromyalgia, one of the most commonly agreed upon causes is stress.
The onset of fibromyalgia can sometimes be attributed to a specific stressful incident, such as an injury, surgery, car accident, or physical attack. In these cases, the combination of physical pain and emotional stress surrounding the incident triggers the cycle of pain and stress that leads to fibromyalgia.
Fibromyalgia can also develop gradually. Ongoing emotional or physical trauma may cause injuries or chronic muscular tension and anxiety that over time leads to chronic pain.
Chronic functional pain resulting from a recurring injury or poor posture and movement can also be very stressful and prevent you from getting restful sleep. So, fibromyalgia can actually begin with run-of-the-mill back pain or joint pain.
Fibromyalgia can even begin with an illness. When our natural immune system response becomes overactive or prolonged due to stress, a host of issues arise such as fatigue, chronic inflammation, and autoimmune conditions that can cause pain as well as structural damage to joints, connective tissues, and organs.
Fibromyalgia sufferers have been shown to be more vulnerable to the negative effects of stress, have impaired and maladaptive coping mechanisms, be more likely to catastrophize, have higher levels of neuroticism, and have higher rates of anxiety, depression, and PTSD.
So it seems that for some people, a stressful incident, pattern of events, a chronic pain or illness will trigger an ongoing, downward cycle of psychological stress, physical pain, and sleeplessness. Since all the functions of our body are connected, getting stuck in this cycle can lead to dysregulation of other systems of the body, causing symptoms like nerve sensation, headaches, and cognitive and digestive issues.
The cycle of stress, suffering, sleeplessness, and sadness
When people talk about chronic pain, they often refer to the “terrible triad” of suffering, sleeplessness, and sadness. I would add stress to this list of symptoms; chronic pain is typically very stressful, and stress worsens our experience of pain, our ability to sleep, and our mood, keeping us stuck in a vicious cycle.
This self-perpetuating cycle is extremely difficult for fibromyalgia patients to get out of because the condition involves all aspects of their health, and each function of their body and mind affects the others.
We automatically hold psychological stress in our body; this is part of our natural physiological response to stress. Our muscles instinctively tighten up to protect our body when we feel that we’re being attacked in any way. (Read The Life-Changing Link Between Anxiety and Muscle Tension to learn more.) When our muscles are chronically tight, they become sore and painful, put pressure on our joints and nerves, and lead to painful musculoskeletal conditions.
When we’re in pain for long periods of time, our nervous system adapts by making us more sensitive to pain; this is called sensitization of the nervous system. It can occur in both the central and peripheral nervous system, so our brain, spinal cord, and peripheral nerves are all involved in making us feel more pain than we should. This sensitization makes it all the more difficult for fibromyalgia sufferers to get out of pain.
Both stress and pain prevent us from getting a full, restful night of sleep. Even the most cheerful person will become grumpy and tense after a few nights of inadequate sleep, so imagine the effects of months or years of sleeplessness. Extended periods of poor sleep can lead to mood disorders, a weakened immune system, and an impaired ability to recover from physical pain and injuries.
As you might expect, depression is common among fibromyalgia sufferers. People with fibromyalgia have decreased activity in opioid receptors in parts of the brain that affect mood and the emotional processing of pain. Researchers say that this reduced response might explain why fibromyalgia patients are likely to have depression and are less responsive to opioid painkillers. Abnormal levels of neurotransmitters like serotonin and norepinephrine, which often occur in depression, can also make us more sensitive to pain.
How to get out of the fibromyalgia pain cycle
Researchers at the University of Oslo in Norway interviewed patients who had recovered completely from fibromyalgia, and found that they had not recovered as a result of a specific treatment, but rather by making changes to their lifestyle and reducing their stress level.
As everyone’s experience of fibromyalgia is different, you’ll have to experiment to figure out what helps you. Remember, all areas of your health are connected. My personal belief is that all six aspects of your health that I describe below must be addressed. If you leave one out, you may be missing a critical piece of your puzzle.
Be comfortable with making baby steps and letting your recovery be a gradual process. Celebrate every little step toward recovery that you take. It may help you to keep a log or journal to track how you feel day to day, things that trigger or worsen your symptoms, and anything that helps to relieve your symptoms.
Here are the lifestyle changes that I recommend to recover from fibromyalgia:
1. Use talk therapy to address sources of psychological stress such abuse, accidents, or loss of a loved one.
There’s no substitute for talking out loud about what’s bothering you. Fear often keeps people with depression, anxiety, and other stress-related conditions from seeking help from others. If you’re scared to talk to someone, know that literally hundreds of millions of people out there are suffering just like you are, and they’re all scared too. Conquering the fear will help you get past your condition and move forward. It’s much easier to solve your problems when you’re able to talk about them with an expert. If you’re not comfortable talking to someone in person or going to a support group, there are other options like text, phone, and video chat therapy services.
2. Take control of lifestyle-related stress.
You must remove sources of stress, and you must make time in your daily life to just relax. This may mean making changes in your job, schedule, daily habits, and relationships. A critical part of your recovery is to let your nervous system calm down and get out of the constant stress-response mode that it’s in. So, make time every day to do things that truly calm you down, like reading, watching TV, spending time outside, or meditating.
Heat has the immediate effect of calming the nervous system (unless it’s too hot!). So if you enjoy sitting in a hot tub, sauna, or steam room, I recommend doing it on a regular basis. If you don’t, I suggest simply making sure you’re not cold; wear layers of clothing and keep your home at a comfortable temperature.
You’ll also need to think about and modify your habitual reactions to stress. It can be very helpful to address this in talk therapy. And please read the last section, “5. Start noticing your habitual thought patterns and reactions to stress,” in The Life-Changing Link Between Anxiety and Muscle Tension.
3. Release chronic muscle tension with gentle pandiculation exercises.
As I discussed earlier, we hold our psychological stress in our body in the form of muscular tension, and this tightness can cause pain and other physical problems. Clinical Somatics pandiculation exercises are extremely effective in releasing the stress-related tension that we hold in our body. To learn more, read The Pain Relief Secret, or start learning the exercises at home in the Level One Course. You can also read a case of how Clinical Somatics cured fibromyalgia here.
4. Get regular moderate exercise.
Exercise balances our hormones and neurotransmitters, reducing pain and stress and regulating our mood. Exercise, especially aerobic exercise, is now recognized as a necessary part of recovery from both depression and anxiety. The book Spark by John Ratey is an excellent book on this topic.
If you can’t exercise because it makes your pain worse, try other ways to get moving and get your heart rate up. Clinical Somatics exercises are extremely gentle, and give you a way to release muscle tension and improve flexibility and muscular control without doing any big, strenuous movements. Sitting in a hot tub, sauna, or steam room will get your heart rate up without you having to move a muscle. And you may find that gentle activities like Tai Chi, swimming, or walking slowly are an approachable way to start moving.
5. Eat a healthy, balanced diet.
The definition of a “healthy, balanced diet” is constantly evolving. There is a great deal of research being done on our gut microbiome, the collection of over 100 trillion microorganisms that live inside our gastrointestinal tract. These microorganisms communicate with our brain and help to regulate functions of our entire body.
When our microbiome is out of balance, we can develop digestive problems, depression, anxiety, obesity, allergies, and fatigue. Research also shows the connection between our gut microbiome and neurological diseases such as Alzheimer’s and Parkinson’s. Given the far-reaching effects of our diet, and how far the standard American diet is from being ideal, I believe The Mind-Gut Connection by Emeran Mayer should be a mandatory read for all of us.
6. Take steps toward getting a restful night of sleep.
Sleep may feel like the most elusive piece of the puzzle, because it often feels like we can’t control it—we simply have to lie down and hope we fall asleep. So control what you can:
- Commit to a regular sleep schedule.
- Start winding down before bed by doing relaxing activities and turning off lights.
- Limit your caffeine intake to one serving a day (in the first half of the day), or eliminate it completely.
- Limit alcohol to one serving a day, or ideally, eliminate it completely.
- Take steps to reduce your stress and get regular exercise, as both of these will improve your ability to sleep.
- Consider using a safe, natural sleep aide like melatonin to help you get into a healthy sleep cycle, and be sure to discuss it with your doctor.
- Create a restful sleep environment: a quiet space, limited electronic devices, and a comfortable mattress and pillow. Consider using a weighted blanket, which many people find helps them feel relaxed and safe (I love mine!). If you share a bed with someone and feel that it might be affecting your ability to sleep, try sleeping alone.
- Don’t worry if you wake up in the night. Our natural sleep cycle is about four hours long, so it’s perfectly natural to wake up periodically. I found this article on sleep cycles to be enlightening.
*Numbers 2, 4, 5, and 6 will strengthen your immune system and reduce any immune response that may be contributing to your symptoms.
Perhaps the most important part of your recovery is believing that you can and will get better. Read stories of others who have recovered, talk to people about the process you’re going through, celebrate the baby steps, and don’t give up—you can get better.