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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.

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.


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