Fibromyalgia and Panic Attacks: Cognitive and Somatic Sensitization

“If you are experiencing strange symptoms that no one seems to be able to explain, they could be arising from a traumatic reaction to a past event that you may not even remember”, Peter A. Levine

Two words that are now often coined in conjunction with fibromyalgia are   cognitive sensitization and somatic sensitization. I have been exploring the research in this direction for the past couple of years and have recently had another ‘aha’ moment. I am not sure which comes first but with regard to ‘cognitive sensitization’,  because of the excessive degree of empathy for others and fear/anxiety for ourselves there is vivid brain activity in the amygdala.  People with fibromyalgia worry excessively  and our attention to health related information is extremely high.  The meaning that pain has for ourselves, the sufferer, or for others whom we perceive to suffer, poses increased threats which affects ‘somatic sensitization’, that is, increased reactivity of the nervous system. In turn this lowers the pain threshold and affects pain tolerance; the consequence is that  the fibromyalgia syndrome  develops.  The two are interrelated but what does that mean in simple language? One hears, in fact seeks out, health related information, subsequently anxiety and fear develop (the amygdala is over reacting to perceived threat) increasing the overstimulation. Then a low tolerance for pain develops. Accompanying this pain is a myriad of other symptoms. But is this too simply stated? What can this cognitive sensitization actually produce within ourselves? This is a process within the brain as it receives cues that bring about arousal from a past traumatic event, that becomes an actual sensitization of the neuro system.  In what ways then does this anxiety/fear invade our brains?

“The result, sadly, is that many of us become riddled with fear and anxiety and are never fully able to feel at home with ourselves or our world”, writes Peter A.Levine (p.21) Waking the Tiger. With the nervous system being in a state of hyper-arousal, we become overly sensitive to light, sound, weather conditions among other environmental factors that can cause pain, itching, tightening of the muscles, fatigue. We have difficulty with sleep, stressful situations, our startle reactions and we are hyper-vigilant. Often this dis-ease with our sensitive nervous systems results in heightened anxieties that become panic attacks.

Social neuroscience has explored the brain activity of many types of people and yet very little has been done with the over activation of those of us with fibromyalgia. Our tendency to interpret and be in tune with verbal and non verbal cues of others and be usually in a state of hyper-vigilance is worthy of intense research. it seems as though many of us with fibromyalgia are in caregiving roles such as nurses. We are addicted to giving care to others, too much empathy with the resultant over stimulation. Central sensitization seems to be the view of the researchers on fibromyalgia, that is the central nervous system is  usually on high alert and overly sensitive.  The sudden surge of extreme fearfulness, heart pounding, shortness of breath, tingling sensations, feeling of being in danger can develop anywhere and at any time. This is how a panic attack feels. We are chronic worriers for ourselves and for others leading to catastrophic thinking and being afraid of fear itself is what leads to panic attacks. When did these symptoms first begin to take shape in our psyche?

As Levine and Scaer have written (see other blogs on this topic) we have been subject to psychological trauma that produces bodily sensations that appear to be a bona fide disease, instead of the dis-ease of the scars from these traumas. Whether or not these lifelong traumas have developed even in utero or in childhood, it seems as though our hypersensitivity has lead us down this path.  We can change those brain pathways if only those who were quick to medicate us or find a cause that is not psycho-social in nature were supportive in our quest to find ways to heal ourselves. Both Levine and Scaer (among others) are pioneers in this respect and their work brings hope to those of us with this central sensitization.

9 comments

  1. Valda Garner says:

    Hi Barbara, I found your blog site while I was searching for more information about emotional sensitivity and fibromyalgia. I am delighted to find your blog site! I share your thoughts about sensitivity to others, being a care giver, and having an acute intuitiveness. I must tell you I was dismayed when I read that you have been ill with fibromyalgia for 40 years. I am an RN and have a masters degree in Organizational Management. I sustained a lifting injury while working in ICU 19 years ago. I had 2 surgeries 5 weeks apart and was in severe pain with no analgesic help. I never recovered from that injury. Instead I spiraled downward and developed CFS and then FMS. I recently started my blog, which has been focused so far on helping others cope with this illness and connecting with others that have fibromyalgia. This is a lonely journey without others that can relate to the daily struggles. Thank you for sharing your research and thoughts about this debilitating illness that has left so many people desperately searching for answers. Warmly, Valda

  2. Barbara Keddy
    Barbara Keddy says:

    Thanks Valda: While it can be a lonely journey it is far more optimistic now than it was even a decade ago. So much is now known about sensory and somatic sensitization that there is hope for us all! The brain research is nothing less than amazing and we must follow that research if we are to find answers to our chronic pain!
    Best wishes,
    Barbara

  3. Carolyn Thomas says:

    Hello again dear Barbara and Happy September to you (yes, it’s really here!)

    I just popped in today to see what you’ve been writing and – as usual! – found this intriguing gem. And once again – because I tend to interpret things through the lens of a heart attack survivor – there is much familiar wisdom here. For example,

    “…anxiety and fear develop (the amygdala is over reacting to perceived threat) increasing the overstimulation. Then a low tolerance for pain develops….”

    This precisely describes the nightmare of the heart attack survivor. Our cardiologists can patch us up, stent us, bypass us, zap our flawed electrical circuits and then pat us on the head and boot us out the doors of the Coronary Intensive Care units as if we are just another acute medicine case. But we’re not.

    It’s pervasive among heart circles to heart patients report that every subsequent chest twinge or bubble produces extreme anxiety and fear responses. “Is this something? Is it nothing? Should I call 911?” Absolutely exhausting and overwhelming and terrifying. No wonder we’re anxious and fearful! Unlike other forms of pain, chest pain to a heart patient means only one thing: death. It’s like walking around with a ticking time bomb. In fact, I’ve heard many survivors observe that having a heart condition feels like your body has “betrayed” you, that what you’ve taken for granted your whole life (your heart beating) may at any moment be taken away in a spectacularly traumatic fashion.

    That’s why folks like Dr. Stephen Parker (a cardiac psychologist in Alaska, but more importantly, a heart attack survivor himself) says NO WONDER up to 65% of heart attack survivors experience depression. “A heart attack is a deeply wounding event”, as he likes to say. “The meaning that pain has for ourselves” is tremendously powerful – for all patients suffering pain. Our meaning, as I said, is interpreted a fatal warning.

    I’m very interested in your brain observations on sensory and somatic sensitization – isn’t that what’s at work for all of us who interpret every pain signal as intensely meaningful?

  4. Barbara Keddy
    Barbara Keddy says:

    This ‘stuff’ on the brain is so complex eeeiouuu!Trying to get a fuller grasp on it, but it becomes more and more involved! Know though that pain and the brain cannot be separated.
    As usual wonderful to hear from you…Best, Barbara

  5. Lachelle Mckeague says:

    Learning how to deal with stress is important. If you have gotten to the point you dread certain situations because you had an attack during those circumstances, you should start looking at those times differently and for what they are. Many people get troubles built up in their minds and those though5ts take over when those people least expect it. These are the thoughts that pave the way for serious attacks. When you know the source of your pressure, dealing with it head on is necessary sometimes to take it away. If you are having issues at your job, talk to your boss or other co-workers about it. Talking and counseling are great ways to relieve the pressure that may be causing you to suffer severe anxiety. The same is also true about family problems. Making sure you take the time to talk to your family about what is bothering is of the utmost importance.-

  6. kate says:

    I’m a 76 year old woman who was diagnosed 22 years ago with fibromyalgia. I’ve done a lot of reading (obsessive? yes)about fibromyalgia and have learned a lot that has led me to take care of myself in ways that have ended the pain of fibro. I am now entirely free of pain, though I recognize that my brain still acts in ways typical of fibro sufferers. And I’ve recently developed the continuous itching that affects some fibro sufferers, which I am now in the process of learning how to deal with.

    In my research on fibro I’ve found references to abnormalities in the way the brain receives or uses oxytocin, the hormone that is most closely related to child birth and bonding, particularly with babies and children. Men (Dr. Oz, for example) tend to interpret oxytocin relative to increasing the pleasures of sex, which is certainly one of the benefits of healthy levels of oxytocin. But it seems to me to be most relevant to women as the childbearing, baby bonding hormone.

    This, it came to me in an “aha’ moment of my own, could very well explain why fibro mainly affects women, many of whom are in care giving professions or roles. My most recent bout of pain came over me four years ago when I became the sole care giver for my older sister who is wheelchair bound, suffering from severe arthritis and dementia. (She is now in a nursing home.) When I learned about the role of oxytocin in fibro I decided to change my care-giver thoughts from stressful worries about being responsible for keeping her healthy and well cared for, to thoughts about how fortunate I was to have someone who needed my care, who gave me the opportunity to experience and express love – to bond with her instead of seeing her as just a responsibility.

    That, along with other changes, helped me overcome that bout of fibro pain too. I adopted a rescue kitten who needed lots of care. She had been left on the doorstep of the Humane Society in a cardboard box with 18 other cats, and had some difficult health problems. I nursed her back to health, and she rewards me by cuddling close to my chest and purring. When she does that, I gratefully concentrate on the warm love and bonding feelings, and can just feel the oxytocins take over my brain, giving me calm thoughts and a relaxed body. She “rescued” me.

    Another cognitive behavioral therapy I gave myself when the pain was bad, was to curl up in the fetal position and just relax, body and mind. This really helped.

    Anyway, I am so glad to have found you and your blogs. I am reading as much as I can, though trying not to be too obsessive about it. :>)

  7. Barbara Keddy
    Barbara Keddy says:

    Kate, yours is an inspiring story. Thank you for your in-sights. It isn’t often I hear from older women who have had fibro for so many years. It is true that women tend to be in the caregiving role more so than men and it is a point I have figured prominently in my book.
    Please keep in touch,
    Regards,
    Barbara

  8. kate says:

    Thank you Barbara for your positive comments! Makes me feel good.

    I just re-read my post and wanted to make one thing more clear. Though oxycontin is sometimes prescribed for fibro, I’ve also read that prescriptions aren’t very effective, and I would never take it. I do believe that a person can include actions, thoughts and situations in one’s life that will help the body produce and use this hormone naturally to help you feel better, feel good. Change the care giving role from a stressful burden to a joyful loving warm relationship with another, whether the other is a person, a group, a pet, a political cause, a nation, or the planet.

    Hope that makes sense. And I’ll stop now before I get carried away.

    Kate

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