“After a traumatic experience, the human system of self-preservation seems to go into permanent alert, as if the danger might return at anymoment” , Judith Lewis Herman
There has been a great deal of public awareness of late regarding the concept of Post Traumatic Stress Disorder. It seems as though the syndrome has become somewhat commonplace and many are quick to self diagnose. But, even more are recognizing that the condition is one caused by great stress and chronic anxiety and there are commonalities among us in our responses to traumatic experiences. What was once associated with abuse, now is believed to be the result of many occurrences that bring about dramatic memories, which in turn trigger danger to an overly stimulated nervous system. With the relatively recent wars in the Middle East whereby PTSD among veterans became all too common, public awareness has been heightened. In my book I discussed fibromyalgia in relation to what was then becoming known as Gulf War Syndrome, now it is more specifically known as PTSD that is capturing the attention of the experts. In the first world war it was known as shell shock. In the second world war it became known as battle fatigue, finally it is now more appropriately labelled as PTSD. Many of these veterans with PTSD have fibromyalgia, in fact I speculated then (and do so now) that they are one and the same thing. I will acknowledge there is the possibility that they are somewhat separate but akin to identical twins. The symptoms are identical.
“The welfare of each is bound up in the welfare of all”, Helen Keller
I have had two different experiences of being in a group of people where there has been a focus on chronic pain and in one session, outside of my home country, where the presentation was strictly about fibromyalgia. The interesting phenomenon I observed within myself was that the more that was spoken by either the group leaders or the people with the pain was that I personally began to feel more pain and that it was difficult to let go of it. I once again thought through what I had written on earlier blogs that the neural pathways that I have created in my own brain were easily reactivated when I thought of pain or other symptoms of FM. This is somewhat akin to PTSD, that is, the episodes are easily triggered by certain memories or events; the brain just can’t stop remembering.
But does that mean that support/ information groups are not effective? As far as information gatherings these groups can or cannot be helpful. If the information is accurate and does not precipitate bouts of pain (or other symptoms) then they are indeed worthwhile, especially if there are helpful suggestions about what can be done to self manage.
“People still insist on things like holistic healing and things that have no real basis in evidence because they want it to be true-it’s as simple as that”, Stephen Fry
If there is any alternate healing therapy that I have not tried over many years I don’t know what it can be. Chinese herbs, homeopathy, JinShin, acupuncture, Reiki, osteopathy, therapeutic touch, reflexology to name a few, most of them have not helped; they are not evidence based therapies. They cost me a great deal of money. They kept the practitioners in business. But, of them all osteopathy as a manual therapy was helpful as I thrive on the magic of touch, especially when the therapist is a skilled practitioner. I am also fond of gentle massage therapy, JinShin, chiropractic adjustments, and especially physiotherapy. Having a therapist who spends an hour with you, working on painful areas of your body can be extremely therapeutic. Of them all it is physiotherapy (physical therapy as it is called in the US) which has provided me with the most relief . I trust this practice the most as it is evidence based, a research profession situated in a university, sanctioned by grant giving foundations to further their research agenda. I have however heard from many who do not like to be touched and manual therapy is not for them. When I am touched by a therapist who has experienced hands it relaxes my nervous system. For those who do not like being touched by others, I recommend massaging yourself lightly as a soothing gesture. It does not cure but it provides relief and trains the brain to pause and work with paying attention to the moment rather than catastrophic-futuristic thinking which we are all prone to do.
“Women never have a half-hour in all their lives (excepting before or after anybody is up in the house) that they can call their own, without fear of offending or of hurting someone”, Florence Nightingale
Florence Nightingale is famous as the woman who developed modern nursing. From May 6-12th we celebrate ‘National Nurses Week’ in honour of her birthday which was on May 12th (1820). However, her birthday is now also celebrated as ‘International Chronic Fatigue Syndrome and Fibromyalgia Awareness Day’. It is thought by many to have been fibromyalgia that Ms.Nightingale suffered from most of her adult life.
“Your brain is the command center of your body”, Daniel G.Amen
There are about 100 billion neurons within the nervous system ; the neuron is the basic working unit of the human brain. Just imagine that! All these little neurons (cells within the nervous system) communicate with one another to transmit information through a complex web to other cells. The chronic pain that we fibromyalgia sufferers deal with on a daily basis is produced by our brain from these neurons. Ah, but we can control this pain, if we remember control rather than eliminate! So, what have researchers found about how this can be done? What can we do to take charge of these neurons that seem to be in a constant state of firing off messages of pain? There are, in fact, several strategies that seem promising, but only one will be discussed here, as its relationship to Mindfulness Meditation is another which I have discussed in depth over the years. In my view the two are closely related.
A popular approach to pain management is a form of therapy called ‘Acceptance and Commitment’. Primarily this means an acceptance that one does have pain, it is chronic, and yet to go on to engage in those things in life that gives one pleasure. In short, it is a commitment to pleasurable activities by not engaging in negative thoughts about the pain, what caused it, and all memories of the past experiences of this pain. This kind of therapy, in my view, can be as effective through Mindful Meditation. It is possible to change the brain through discipline and consistent letting go of the thoughts that reinforce the feelings associated with the pain. The brain, after all, is plastic (“neuroplasticity”, which I have discussed so often in other blogs) and can change. That doesn’t mean the pain will go away, but rather it is an acceptance of it and a commitment to live life to the fullest by exploring the thoughts that arise in relation to the feelings and a willingness to accept what it is (again my favourite quote : “it is what it is”). An example that I use while meditating is this- I tell it I haven’t the time to think about it right now. I say ” I will make an appointment with you (the pain) later on, but for now I am letting you go from my thoughts”. It may sound hokey but it does work. I wish I could say that I am always successful with this strategy, but of course it doesn’t mean the pain has disappeared. Rather, it helps me to live life as fully as I can accepting my dis-abilities, rather than giving in to hopelessness. It is giving those little neurons a message to take to the brain that is less anxiety provoking.
“To truly laugh, you must be able to take yourpain, and play with it”, Charlie Chaplin
This is a review of the many blogs where I have discussed the pain discourse, keeping it simple and giving us room to breathe through the suffering we experience on a day-to-day basis. It is important to understand some of the basic language and physiology of pain as we become the conquerors of these brain pathways that often lead to despair. Instead we must take a more lighthearted approach and do as Chaplin suggests: play with it.
“Everything that is done in the world is done by hope”, Dr. Martin Luther King Jr.
Happy International Women’s Day!
It is almost Easter and after the horrendous winter weather I (and thousands of others) have experienced I am anxious for the ice and snow to leave so that I can become more mobile. I don’t know if that will happen. My fibromyalgia legs and hips have become a challenge that have plagued me for the past year. Sleepless nights, pain upon stair climbing, medications that I fear are not good for me have all resulted in increased anxiety. But without hope what is there? I am working on optimism as my mantra rather than the usual gloom and doom I am noted for. Who can look at flowers and not believe in hope for a better day?
“Everybody gets so much information all day long that they lose their common sense”, Gertrude Stein
To write that I am frustrated, angry, and discouraged over the recent hoopla this week in the news from the U.S. Institute of Medicine (IOM) report on Chronic Fatigue Syndrome is to be putting it mildly. As is usual with someone who has CFS and fibromyalgia (FMS) I awoke several times last night. During these wakeful periods I wanted to write this blog with great haste in protest for whomever would read this rant from me. I have to admonish my readers that this report is not to be viewed with great enthusiasm. The IOM state that CFS should now to be regarded as a disease. I write this knowing that the majority of my readers want these conditions to be regarded as such for which a medication can be taken and our conditions would be cured. But as I have repeatedly written over many years, this cluster of symptoms which make up a syndrome cannot be ‘cured’ with the usual allopathic or alternative medicines. It is far more complex than that. Hunts for viral, bacterial and hormonal causes have been on-going for many decades. I had hoped that this was all behind us. Is this trend going to be re-invented?
“If there is nostruggle, there is no progress” , Frederick Douglass
There is a tendency among those of us with chronic pain to be ever so watchful on days we are in pain or extremely fatigued. We take it easy on those days and begin to wonder if we will ever be feeling well again. But, oh! On those days when we are feeling well our tendency is to be optimistic, think we are cured and immediately do more than we should. We then pay for it with a big flare-up. It is usually one step forward, one step backward. The struggle continues. Sound familiar?
” People with chronic pain inevitably develop an intimate relationship with their pain”, Deborah Barrett
The myriad of symptoms associated with fibromyalgia is vast, but chronic pain is among the most debilitating. Chronic pain results in a circular configuration of interrelated other symptoms, such as sleeplessness and fatigue not to mention the hopelessness and depression associated with them that are first cousins to the others. I have lived with them all since I was very young and now am facing the added burden of aging which can itself present many other challenges. Many days I ask myself :”what is to be done?” Then I fall into a state of despair. Other days I try to pull myself up by the bootstraps and realize that the only answer to my chronic pain must come from within me.Today, by chance I glanced at my bookshelf and found Pain Tracking staring at me asking me to re-read it and I felt the faint hope of some relief. I developed my own tracking system and this will be what guides me this new year.
I have brought on another pain attack- again! I have overdone it with social situations that have caused anxiety and resulted in overstimulation! This time the pain in my left foot is excruciating. The reason? I wore something other than the sneakers that are my daily companions. No, I did not wear high heels, but nonetheless they were not my regular footwear. There are many times I think I have to wear something on my feet that are a bit more dressy. Yet, I am now known to wear funky sneakers to most places, so why do I conform and wear ‘regular’ shoes when I know my body will rebel? Given that my muscles (like all of us with fibromyalgia) have become weakened over the years because of my inability to sustain regular exercise, I have found that supportive shoes are the best answer to stability. For that reason I have recently chosen to brighten my days with coloured sneakers that bring a smile to most people. But, without them my legs and feet are painful.
“America is one of the few advanced nations that allow direct advertising of prescription drugs, Robert Reich
BigPharma makes huge profits from those of us suffering from chronic pain, fatigue, depression, anxiety, itching, digestive issues- to name a few of the common symptoms of fibromyalgia. Every day we are inundated with advertisements about prescription drugs that would alleviate these symptoms. Equally as rich is the vitamin industry which advocates specific supplements for the treatment of fibromyalgia, few of which are science based. Generally we take them willy nilly without any idea if they are helpful or not.
Just as I thought I had experienced everything unusual with regard to this annoying, frustrating, challenging dis-ease, fibromyalgia, I developed another aggravating symptom- VERTIGO! It all began one month ago, at night, turning over in bed, the room began spinning. It was very frightening. It lasted about 30 seconds followed by nausea. I had another episode the next night as well. The morning after the second episode, leaning forward I had a very violent attack which prompted me to go to the doctor.
This vertigo is not to be confused with dizziness that is brief and passes quickly. Rather, vertigo is experienced as spinning. It was described to me as small calcium crystals lodged in the inner ear and could be encouraged to move through by a positional manoeuvre. The doctor asked me if I was game to try this technique and I agreed. Lying on the table my head was hanging somewhat over the end while he held my head and rotated it for 30 seconds. This manoeuvre is described on the Mayo Clinic site and it is suggested that the person can actually try this at home.
“We can only become what we are by the radical and deep-seated refusal of that which others have made of us”, Jean-Paul Sartre
It isn’t often that I have the opportunity of sitting down for five hours with someone who is, like myself, an older woman, living with fibromyalgia. I had this pleasure recently of meeting Dr. Kaye Brand from Perth, Australia who was visiting Halifax, Nova Scotia. She is a physiotherapist and President of the Fibromyalgia Support Network Inc. in Western Australia (http://FibroNetwork.org.au) . We had a great exchange of ideas and she graciously consented to be interviewed by me. What follows is her story interspersed at times with my own.
” Most of us have unhealthy thoughts and emotions that have either developed as a result of trauma or hardships in their childhood, or the way they were raised”, Steven Seagal
It would seem that those of us with fibromyalgia have developed the condition at an early age which may have taken a tremendous shock, accident, or crisis to bring about a full blown fibromyalgia. Some of us have had repeated crises in our sensitive lives and did not even experience a single unusual occurrence for the syndrome to develop. Nonetheless, we are a group of people with specific personality traits that allow us to dwell on trauma that seems to be stuck in our minds/brains reactivating the experience more frequently than is healthy. So, how in fact can we find ways to train the brain to refocus away from past trauma? The work of Dr. Richie Davidson, neuroscientist, has presented us with the interesting option of “spending as little as 30 minutes per day training our minds to do something different” (p.52 Mindful August 214) which can result in changing the brain. To that end I had decided that quilting was not the answer as I had previously tried that and not had much success (see blog Fibromyalgia and Multitasking, May 17, 2009). Instead I would try my hand at writing about personal issues.
“Besidesfocused attention, other factors that enhance neuroplasticity include aerobic exercise, novelty and emotionalarousal”, Daniel J. Siegal
I have been absent from writing on his site for over two months because I did not practice what I preach. While I have been an advocate of neuroplasticity, that is, the power to change our brains, I have not heeded that which I know to be an approach that is safe for those of us with fibromyalgia. In fact, aerobic exercise, novelty and emotional arousal are the three key ingredients of a health lifestyle for those of us with chronic pain. Focused attention is therefore paramount for us; we need to be constantly in touch with the changing circuits of the mind. Mindfulness meditation is one of the key links to focussed attention, to living in the moment. But, it is the combination of the four elements cited above that present a balance for those of us with the overstimulated nervous system that challenges us daily.
” Our memory is in large part the starting point for how we think, how our preferences form, and how we make decisions”, Maria Konnikova
Several weeks ago on CBC radio when I heard an interview with Dr. Konnikova regarding the science of memory , I became intrigued with the ways in which she has based an understanding of neuroscience upon the brains and memories of two fictional characters- Sherlock Holmes and Dr. Watson. Being a Holmes lover and extremely interested in how the brain works- as my readers will well know from my many blogs, I hastened to read this amazing book regarding these two distinct minds which she dubs the brain attics. This term she pilfers from Holmes who said: “I consider a man’s [sic] brain originally is like a little empty attic, and you have to stock it with such furniture as you choose” (cited in Konnikova, p. 26).
“The happiest women, like the happiest nations, have no history”, George Eliot
I have based my unproven theory about why more women than men are diagnosed with fibromyalgia upon a feminist analysis of the political and cultural roles of women in societies in general- both historically and at present, and how gender is socially constructed. I have not changed my mind on this issue, but it is indeed more complex than that. However, I have begun to look less at statistics in regard to the ratio of women to men because I believe that fibromyalgia is a catch-all term that includes both genders who suffer from chronic pain and that it is under-reported by men. In my view the concept of fibromyalgia developed as more and more women began to speak out about similar characteristics and symptoms which encouraged physicians to deem that it was primarily a condition that afflicted more women than men. There isn’t any way to be accurate about how much of the population of any country has fibromyalgia. In many places there isn’t even a term for the condition; more to the point many men are hesitant to report the symptoms to a health care professional for fear of being seen as less masculine. There is little doubt that for bi-sexual and transgendered people the issues are even more complex.
It is widely known that women, more so than men, are more prone to seek medical attention for both their families and themselves. Furthermore, women are generally more sensitive to bodily changes and other nuances that are often difficult to describe. An example of this is the reported “sense of impending doom” that women often experience weeks or days before a heart attack (I can attest to that!). Yet, when women mention to their health care providers symptoms that should be suspiciously attributed to heart disease, there is still a general misconception that heart disease is primarily a man’s condition. Conversely, when a woman discusses her chronic pain, fatigue and other symptoms, the label of fibromyalgia is more readily applied. If a man admits to having chronic pain the affected areas are more likely to be vigorously examined and attributed to, for example- a disk, muscular strain and so on. It is my view that emotions, in particular, anxiety, is responsible for fibromyalgia. Since emotions are culturally and socially defined girls are perceived to be sensitive and emotional whereas boys are rewarded for being dominant. However, the differences are in how emotions are expressed rather than experienced.
“My anxiety remains an unhealed wound that, at times, holds me back and fills me with shame-but it may also be, at the same time, a source of strength and a bestower of certain blessings”, Scott Stossel
I have begun to think of fibromyalgia as an extreme case of prolonged anxiety that began in early life, perhaps in utero, or even as an inherited gene. In addition to this epiphany of mine, the concept of a ‘highly sensitive person’ (HSP) has changed for me to mean the ‘highly anxious person’. Having just read both Smith’s (Monkey Mind)and Stossel’s (My Age of Anxiety) memoirs (and Stossels’ science and historical account of anxiety) I have become convinced that fibromyalgia is another word for heightened anxiety. Since I am not a therapist, I can only speculate about the definition/cause of fibromyalgia, but to this date my proposed theory is that anxiety, hypersensitivity and fibromyalgia are identical triplets. I have just within the past year ‘come out’ (as Stossel has) as a highly anxious person, rather than one who has the fuzzy label of fibromyalgia.