Tag Archives: Fibromyalgia

31Aug/18

Fibromyalgia causes Kirsty Young to take a break

Kirsty Young on front page of The Guardian takes a break

Kirsty Young on the front page of The Guardian today

Fibromyalgia is a painful condition that may affect more people than is realised

It is unusual to see chronic pain hit the front pages, but today Kirsty Young announced that she is to take a break from Desert Island Discs because of fibromyalgia. The popular Radio 4 presenter says that she is likely to be away for a number of months.

Fibromyalgia is predominantly a painful condition, but accompanied by a range of other issues and characteristics. These can include headaches, migraines, irritable bowel syndrome (IBS), jaw dysfunction, pelvic pain, anxiety, fatigue, sleep disruption, the so-called brain fog (poor concentration, memory and ability to think clearly), depression and perfectionism to name but a few. The pain itself can often be widespread. Together this makes for a miserable time, frequently with great suffering due to the impact upon the person’s life.

Fibromyalgia and the neuroimmune system

The debate about fibromyalgia continues. Once ignored, there are still quarters who doubt and contest the existence due to a lack of biological markers. Slowly this has been changing and we know that there are likely to be neuroimmune changes that underpin the range of sensitivities.

With the neuroimmune system being very responsive to the way we live, think and act, this explains why many people who suffer fibromyalgia begin their story at, or soon after a period of emotional turmoil or stress. This need not be something huge in life, instead the drip, drip, drip of perceived pressure, the perfectionist need to reach unobtainable levels of performance, the self critic that triggers biological protect states and a lack of self-acceptance are easily enough to trigger such an episode. They are often slow-burners over time when you look back in the story. Each person has their own story that we must hear.

This is indeed why the figures of children and youngsters currently suffering is so alarming. When you listen to the narratives of people, often women, who suffer fibromyalgia, the patterns emerge. The same patterns that we are seeing in these kids who are being encouraged to be self-focused, to be competitive, to get top marks etc. And at a time when their biology is being sculpted and so vulnerable, this is a disaster on the way unless we wake up and changes the way society is going. I’m not even touching on the contribution of social media either!

Let’s be optimistic…because we can

As with other chronic pain problems, the mainstream thinking is out-dated and rather glum. Tacked onto the end of most articles are the same old ‘treatments’, wheeled out as an after thought, with a bit of a yawn. Exercise, talking therapies, medication (usually that’s first — as if dulling the symptoms will ever teach you anything about overcoming the problem!), relaxation and mindfulness are the common ones. Yes, they can be helpful, but there is so much more to it!

The first step is to understand fibromyalgia and the pain and the other symptoms. There is an over-arching biology at play, a level of sensitivity that is manifesting as the lived experience of the person. With understanding we shed fears and limiting beliefs, and put energies into focusing on the steps to overcoming the challenges. We need a direction: what is your picture of success? What do you want, I ask people who come to see me, asking them to frame it in terms of what they want, not what they don’t want (I don’t want this pain is a common start point that soon becomes, I want to go to work, I want to play with the kids, I want to sleep etc etc.).

The clear picture of success is a daily reference point as you create new habits to change state. We seek to generate the best states as often as we can: pleasure, joy, resourceful, excitement, love, compassion, gratitude and many more. We can do this in a number of ways including focus, movement, breathing, a shift in approach and visualisation. These states are accessible to all because they exist in us and are the way we build wellness; and there’s one thing we need to build when we suffer chronic pain, and that’s wellness.

What is pain?

This is a huge question so I shall be to the point here. Pain is all about protection, and forms part of the way we survive. The brain is only interested in survival, so if there is an actual or possible threat, we will respond just in case. Of course we are more than a brain and this amazing organ needs a body to act upon the world. Hence we must always think about the whole person, which is the purpose of the biopsychosocial model. It is the person who suffers, not the body part or system.

Pain is well related to the perception of threat, but is poorly related to tissue damage or state. We have known this for many years, yet much of society still acts according to outdated thinking. Many people and much of healthcare continues to try to explain pain by pictures on a scan. This is not the way it works.

Pain is very much tied into how the person is in their life and their style of life. How do you do life’s challenges is usually reflected in how you do pain and the choices you make. They may not be the best choices and could well need a new approach based on truly understanding pain.

Survive mode ~ constant protection

One of the features of fibromyalgia is the constant state of protect. The systems that look out for us maintain a level of alert and increasingly the world looks more and more dangerous. Remember that we work on a just in case basis. 9 times out of 10 there is no lion behind the bush, but there may be, and that’s all we need to trigger another defensive reaction. This is done automatically in the main, orchestrated by the sympathetic nervous system (fright or flight).

So, one primary job is to restore some balance and the ability to discriminate between real and possible and no danger. As a clinician I share the knowledge, we practice certain skills together and then the person takes them into their own world to use independently. This creates new experiences and reference points for moving on. At all times we are keeping our picture of success in mind — am I thinking and acting in line with my picture or am I being distracted?

Moving forward

The firm grounding of understanding forms a foundation to create a daily practice of rituals and new habits to build wellness. Shifting out of protect to other states is like changing gears in a car. We have to coach ourselves in each moment, nurturing the positive states that biologically are congruent with survival, and change state when we are suffering. Of course there will be a reason why we are in a suffering state and this is not to be ignored. There is a need to be met, which could be reassurance to self, or a need to address a difficult emotion, a need to nourish the body with movement, or more often a range of needs. With understanding and practical tools we can begin to consistently meet our needs and forge a way forward, transforming our suffering moment by moment, day by day.

We are a whole. Each moment is made of thoughts, feelings, perceptions and actions unified as our conscious experience. That is all we have as our biology is in the dark and there are many hidden states that we do not have access to. Same with the brain that has to guess what the signals flowing in may mean. The mind is best thought of as embodied, which has several important implications.

Firstly, the way our body is experienced impacts on our ability to think, decide, and remember. All are grounded in our physical presence., which we must care for and nourish in a compassionate way. Secondly, our body is how we enact our thoughts, feelings and decisions, so it must work for us. Movement is key for survival and hence anything that could affect our ability to act in the world is deeply threatening. And thirdly, for these to happen we must be connected with our bodies. Many people appear to be disconnected or ‘avoid’ their bodies because they don’t like how they look or feel. Simply, you cannot address this unless you are engaged with your body.

Understand pain (and your condition) to understand your potential

I wish Kirsty Young well. It can appear to be a tough road, especially when many of the messages are doom and gloom. However, I would say that we are now in a time of disruption; disrupting this kind of dated thinking. Disrupting is what I am doing (Understand Pain social enterprise), because we do not need to suffer the way in which we are. We have many ways to reduce and transform suffering.

There are numerous practices and tools that can support and encourage a way forward for each person, but they need the know-how. That’s the key bit. The practices must address all the dimensions of a pain experience. And this is why I brought strengths-based coaching together with pain science using the true biopsychosocial model. To use what we know about pain with an approach that gets the best of people so that they can achieve their picture of success. Tools are just tools, but with know-how we add wisdom to their use to get results.

On we go!

For more on The Pain Coach Programme to manage and overcome pain, see here 

Understand Pain Social Enterprise 

18Jun/16

Biology of pelvic pain

Pain nowMost of the biology of pelvic pain does not exist in the pelvis. The same is true for any pain — back pain, knee pain, neck pain etc. Much like the screen turning blank in the cinema, the problem itself is not the screen but instead the projector or the power source. In other words, to think about pain requires us to go well beyond the place where it is experienced.

Pain is of course lived and whilst it must have a location, the relationship between pain and injury is unreliable. With a huge number of factors influencing the chances of feeling pain in any given circumstance, there is a requirement for a perception of threat that is salient and exceeds other predictions in terms of a hierarchy. Once felt, pain compels action much like thirst and hunger. Again, like thirst and hunger, context and meaning we give to the sensations influence that very experience, which clarifies to a greater extent the difference between on-going (chronic) pain and that of labour.

To feel pain we need a concept of the body, which itself is constructed elsewhere as the sensory information flowing from the body systems is predicted to mean something based upon what is already known and has been experienced, we need a nervous system, an immune system, a sensorimotor system, a sense of self and consciousness to name but a few. Where in the pelvis do these reside?

This is not to ignore where we may feel pain as this is an ‘access’ to the pain experience that should be used in terms of movement and touch. However, it is the person who is in pain and not the body part. My pelvis is not in pain, I am. My pelvis does not go and seek help, I do. My pelvis does not ease its pain, I do. So when ‘treating’ a person, we must go beyond the place where the pain is felt to be successful. And it is vital that the person is considered a whole; there is no separation of mind-body. The notion of physiological, body, psychological division etc. etc., just does not fit with the lived experience; I think, and I do so with my whole person — embodied cognition.

Locally one will usually find evidence of protection and guarding, which themselves manifest as the tightness, spasm, painful responses to touch and movement. This is all manifest of an overall state of protection, co-ordinated largely unconsciously accompanied by a range of behaviours and thinking that quickly become habitual — they are certainly learned from priors, our reference point. This is simply why delving gently into the story is important, as we can identify vulnerabilities to persisting pain such as previous experiences of pain, functional pain syndromes, stressful episodes in life; all those things that put us on alert when the range of cues and triggers gradually expand so now I am vigilant and responding to all sorts of normal situations with fear.

The start point is always developing the person’s working knowledge of their pain, which also validates their story. So many people still report that they feel that they have not been believed, which I find incredible. How can someone work in healthCARE and not believe what a person says? Baffling. Once the working knowledge is being utilised and is generating a new backstory, new reference points emerge. We create opportunities for good experiences over and over, moment to moment, day after day, in line with their desired outcome, the healthy ‘me’ that is envisioned from word go. This strong foundation that opens choices once more then permits exploration of normal and desired activities supported by sensorimotor training and other nourishing movements, alongside techniques in focus, relisience and motivation. Realising and actualising change in a desired direction must be acknowledged as the person lives this change knowing that they can.

Pain can and does change when you understand it, know where you want to go and how to get there, quickly getting back to wise, healthy action when distracted (i.e./ flare ups, mood variance, loss of focus etc). The biology of the pain is one aspect, hidden in the dark within us, and the lived experience is another. The two are drawn together to give meaning and to develop an understanding of the thinking and action that sculpt a new perception of self and pain, resuming the sense of who I am, as only known and lived by that person.

23Mar/16

Women in pain

Women in painI see more women in pain than men in pain. Naturally, it depends upon the individual as to whether they seek help or not, yet as a general observation it appears that women in pain are more likely to take some action.

The most common presentation is a female aged between 30 and 55 years, who has suffered pain for some time, months or even years, which is now impacting upon her life in a number of ways. Typically the pain is affecting homelife, particulalrly looking after young children,  and worklife, or both in some cases as the pain pervades out into every nook and cranny. Sometimes this happens over a few months but often it is a slow-burner that is suddenly realised. When we have a conversation about the pain, cafe style*, it becomes apparent that there have been painful incidents punctuating a consistent level of sensitivity, building or kindling. The pains emerging in the person include back pain, neck pain, wrist pain, knee pain, foot pain — any joint pain — muscular pain; and can be accompanied by a range of pains known as functional pain syndromes: pelvic pain (dysmennorhoea, period pain, endometriosis, vulvodynia), irritable bowel syndrome, migraine, headache, fibromyalgia, jaw pain. The person, whilst unique and has a unique story to tell, is often hard on themselves by nature, a perfectionist, anxious and a worrier.

There are many, many women suffering a number of these problems that appear to be unrelated, but this is not usually the case. Upstream changes, or biological adaptations, play a role in the symptoms emerging, yet of course the way a condition manifests is dependent upon the individual themselves, with the uniqueness of each person, their tale, beliefs and life experiences.

Nothing happens in isolation. In other words, there is a point in time when we experience a sensation that we label and communicate, but this is not in isolation to what has been before. The story that the person tells me is vital because it reveals both the unfolding of how the individual comes to be sat in the room and allows me to begin giving some meaning to the experience; i.e. helping the person understand their pain and how it sits within their lifestyle and their reality. I say within because pain should not define who we are, yet it often appears to and hence needs to be put into perspective; the first step to overcoming the problem.

So, there are priming events that often begin much earlier in life than the pain that eventually brings the person along to the clinic. These priming events are biological responses to injuries, infections and other situations that are also learning situations. Learning how to respond at time point A then ‘primes’ for time point B as a response kicks in based on how our brains predict the best hypothesis for what ‘this all means’–what we are experiencing now is the brain’s best guess about what all the sensory information means based upon what has happened before, probability playing a role. One of the reasons for a good conversation is to identify the pattern of pain over the years, how it has gradually become more intrusive as the episodes intensify and become more frequent. The pattern can then be explained, given meaning and then provide a platform to create a way forward.

We are designed to change and each moment is unique. This gives us unending opportunities to steer ourselves towards a healthier existence and leading a meaningful life. To get there though, we must have a belief that we ‘can’ and be able to hold that vision. This vision of the healthy me is one that allows us to ask ourselves the question ‘am I heading towards the healthy me with these thoughts and actions, or not?’. If we are not heading in that direction, then we are being distracted and need to resume the healthy course, actively choosing to do so. How are you choosing to feel today? This is an interesting question to ask oneself.

We still have a certain amount of energy each day and a need for sleep and recuperation. Exceeding our capacity means that we are not meeting our basic needs — security, nutrition, hydration, rest. There is only a certain amount of time that we can keep drawing on our energy before we must refresh. Failing to attend to the basic needs leeds to on-going stress responses that are meant only for short bursts. Prolonged activation begins to play havoc in our body systems as we are in survive mode, not thrive mode. In particular, systems that slow down include the digestive system and the reproductive system. Many, many of the women I see have issues with both — e.g./ poor digestion, bloating, sensitivity, intolerances, fertility problems. The biology that underpins behaviours of protection (fright or flight) are preparing you to fight or run away. Having a meal or trying to conceive are low on the biological agenda when you are surviving.

Too much to do, too little time. Modern day living urges us to be busy being busy. Demands flying in from all quarters, yet it is the way we perceive a situation, the way we think about it that triggers the way we respond, not the situation itself. This gives us a very handy buffer. By gaining insight into the way we automatically think and perceive, this being learned over years (i.e. habits), we can become increasingly skilled at choosing different ways of thinking, letting thoughts go, and focusing on what enables us to grow. This very quickly changes our reality, our body, our environment and the sum of all, which is the lived experience.

With on-going pain we develop habits of thought and action, including the way we move that is integral to the way we sense our bodies. Our body sense and sense of self changes in pain, as does our perception of the environment (things can look further away when we have chronic pain or steeper when we are tired), all of which add up to provide evidence that we are under threat. More threat = more pain because the amount of pain we suffer is down to the level of perception of threat and not the amount of tissue damage. We have known this for years, yet mainstream healthcare and thinking remains steadfastly into structures and pathology. It is no mystery then, as to why chronic pain is one of the main global health burdens when the thinking is wrong! So what can we do?

If you are a woman suffering widespread aches and pains, tiredness and frequent bouts of anxiety, there is good news! As I said earlier, we are designed to change, and change is happening all the time. We need to decide which way we wish to change and then follow a plan, or programme, that takes you towards your vision of the healthy you. Pain is a lived experience and hence the programme must fit your life and unique needs as the techniques, strategies of thought and action interweave your life, moment to moment, taking every opportunity to create the right conditions. The blend of movements, gradually building exercises, mindful practice, sensorimotor training, recuperation, resilience, focus, motivation and more, together form a healthy bunch of habits that are all about you getting healthy again, which is the best way to get rid of this pain. No threat, no pain.

* the cafe style conversation is my chosen way of unfolding the person’s story. How do we chat in a cafe? It is relaxed and open, allowing for the full flow of conversation.

  • Pain Coach Programme t. 07518 445493
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21Sep/15

Vulvodynia

VulvodyniaVulvodynia is a painful condition, often exquisitely so, located in the vulva, which is the skin surrounding the vagina. Usually unexplained, this troubling condition can arise seemingly from nowhere, interfere with intimate relations and hence attempts to conceive. Vulvodynia is also known as a functional pain syndrome–these are painful problems that lack a pathology of note that explains the extent of the pain and include irritable bowel syndrome, fibromyalgia, TMJ dysfunction, migraine and pelvic pain. Functional pain syndromes are often concurrent with hypermobility, anxiety and depression, a further common character trait being perfectionism and a tendency for the person to be hard on themselves thereby creating a cycle of chronic stress.

The pain of vulvodynia is often very localised and triggered by direct contact. Naturally this occurs during sex and touch, but sometimes sitting position can bring on the pain. As with any sensitisation, there is a primary location of pain but there can also be a secondary area surrounding that is due to central nervous system (and other systems) involvement. Suspected vulvodynia or other pains in the pelvis should be assessed and examined by a gynaecologist as a first step before beginning treatment, and by a consultant who knows and understands both the condition and the impact — Miss Deborah Boyle at 132 Harley Street.

With vulvodynia often being part of an overall picture of sensitivity, it means that there is a common biological adaptation that is upstream of the range of seemingly different conditions (the functional pain syndromes). As soon as the individual understands that pain is not an accurate indicator if tissue damage, but rather a reflection of the perceived threat and prioritisation by the body-person, there is a realisation that the pain can change. Pain can change because perceptions can change as we take on board new information and consequently think and act differently, creating new habits. The new habits set the conditions for on-going and sustained change that includes overcoming pain.

We have limited attention and hence can only be aware of certain amount of stimuli in any given moment. If pain is consuming much or all of your attention and consciousness, then this is all that is happening in that moment, with all other possible experiences being disregarded–it is a matter of prioritisation. When the perception of threat is reduced by a constructive thought or action, the pain moves out of our attention span and we become aware of other thoughts, feelings and experiences. How we respond to pain is unique and learned through our lifetime right up until that point; all those bumps and bruises as a child, how our parents reacted, more serious injuries or illnesses and the messages we received from doctors, teachers and other ‘big people’, then through adult life, moulding our beliefs about ourselves, the world, health and pain each time we feel it. The sum of all this activity, most of which we are unaware of, sets up how you respond to the next ache, pain or injury, blended of course with genetics. It seems that some people are genetically set up to be more inflammatory, meaning that responses to injury are potentially more vigorous and go on for longer. Understanding this means that the right messages and treatment can be given, thereby appropriately addressing the injury or pain. One of the big problems is that this does not happen, and the explanations are structural and based upon the body tissues. This ignores the fact that we have body systems that protect and these systems have sampling mechanisms in the tissues and organs but largely exist elsewhere–e.g./ nervous system, autonomic nervous system, endocrine system, sensorimotor system, immune system. We have to go upstream as well as improve the health and mobility of the local tissues.

Going upstream is vital in overcoming vulvodynia, and this is where the Pain Coach Programme works–this is my part of the treatment programme. You may also choose to work with a women’s health physiotherapist who will work more locally. So what is the Pain Coach Programme?

The Pain Coach Programme is a a blend of the latest neuroscience of pain with a strengths based coaching approach to success. Understanding your pain and that you have the biology and strengths to overcome your pain is a vital start point. You have been successful in the past using these strengths, and you can do so again by drawing on these characteristics and using them to develop your health in terms of how you think and act. Overcoming pain is all about resuming a meaningful life, engaging with activities and people as you want to, in a way that allows you to flourish. The Pain Coach Programme provides you with the knowledge and skills that you need to in effect become your own coach, moment to moment making clear decisions that take you towards your vision of how you want to live. This alongside treatment and specific training to develop normal movement and a healthy body-mind. The skills you learn also help you to fully engage in life, whether this be at home, at work or at play.

If you suffer vulvodynia or other painful problems, call us now to start your programme: 07518 445493

28Sep/14

Fibromyalgia in women | #fibromyalgia

I see many women suffering with fibromyalgia. I also see many women who have widespread aches and pains, frequently without an injury, but rather a gradual increase in pain across the body. This maybe fibromyalgia, but in essence we are talking about sensitisation that evolves if no action is taken.

The commonest profile is this: a woman with young children (may have had some problems conceiving), aches and pains across the body, disturbed sleep or too little sleep, always tired, emotions and mood vary, concentration and focus can wax and wane, irritable bowel syndrome (IBS — bloating, pain), migraines, headaches, jaw pain (perhaps grinding in her sleep), anxious, ‘stressy’, very little time to rest and recuperate, repeated bladder infections (often there is no actual infection, but the symptoms are the same) and poor recovery from illnesses. 

There is a common biological thread with these problems. On appearance it would be logical to assume that they are unrelated — many healthcare professionals also take this view. BUT, this is not the case. These functional pain syndromes are all manifest of adaptations in the nervous system, immune system, autonomic nervous system and endocrine system. The good news is that the changes are not set in stone because we are mouldable, or plastic. We learn and adapt according to our thinking, beliefs and actions.

Understanding your pain changes your thinking so this is the initial step. Thoughts are based on beliefs and evolve to ‘I can change my pain’ when you know the facts. First setting up your thinking, then creating a vision to aim for and finally making a definite plan to follow allows you to head towards sustainable change with healthy habits. It is a challenge, but one that is wholly worthwhile.

Women in Pain Clinic is based at 132 Harley Street in London — call now to start your programme and move forward 07932 689081

 

 

25Jun/14

Where have ‘I’ gone?

Neuroscience focuses upon the brain. Neuroscience has shown us that the brain is involved with pain. Consequently the brain has been blamed for pain, the unpleasant motivator that is designed to grab our attention and enforce action that protects us from a threat, actual or potential.

Recent thinking that sensibly gathers paradigms from both neuroscience and philosophy challenges us to re-consider the brain-based explanation for pain, even if we are bringing other body systems into the frame. Mick Thacker argues that pain must come from the whole person, not a part of that person. Whilst I have always subscribed to a holistic view, considering all the dimensions of a pain experience (physical, cognitive, emotional), I have been guilty of the journeying on the brain train. As ever though, our knowledge and ways of thinking and using the knowledge evolve and now pain must be thought of as a holistic expression of the whole person.

My left buttock has been hurting for the last three days, so this has provided me with an opportunity to explore this pain and what it means for my ‘self’. It is of course me that is in pain, a localised feeling in the buttock, but nonetheless it is me, myself and I. The pain invades my attention, thoughts, decisions and plans that all involve me and my interaction with the immediate environment in this particular context. Yes this involves my brain, but my brain is me. One organ or one thought does not define me, yet I need both to sense myself.

Listening to a patient describe their pain is to listen to them describing themselves. What I hear and observe in people with persisting pain such as fibromyalgia, is a story of suffering. Suffering is a loss of the sense of self, and that is a whole, not a part. Pain is a feature but so is loneliness, avoidance, fear, anxiety and isolation. So are we just trying to change pain as this is the most frequent request made by patients? In my view, we are seeking to create the conditions for change in a direction that reduces suffering, this of course including the easing of symptoms. We can only achieve this by working with the whole person and not a part.

Although there is much talk about the pain during a session, what is often verbalised and demonstrated is a change in sense of self. We do not feel the same as before, and certainly as pain persists, this sense alters further. Yes we can identify mechanisms that underpin such change such as adaptations in the brain maps, however it is still the entire person who has the experience. Only by keeping this in mind will we be in the right track with treatment, training and mentoring patients to guide them forward. It must be their whole person that is proactively involved in this journey, cultivating a sense of self that fits with expectation and the vision of how things should be.

RS
Specialist Pain Physio Clinics, London — empathetic treatment, training & mentoring for chronic pain

08May/14

Fibromyalgia — creating conditions for change

Pain and symptoms can and do change. They can change moment to moment and day to day, but if you suffer persisting symptoms, all of the variations can blend into a long physical and mental struggle. Striving for change needs understanding, motivation, resilience and a plan of how to reach your goals.

Fibromyalgia is biology in action. An integrated response of the nervous system, immune system, autonomic system and endocrine system, all of the manifestations of fibromyalgia are the outputs, the end result of how those systems operate together. Unpleasant and troubling as the pain and symptoms are, this is the body trying to recover and making the individual aware. Most of the processes happen beneath our conscious level, but those that don’t cause suffering, whereby suffering is a loss of a sense of self.

Together the sensations that we feel, the thoughts that we have and the environment around us are the experience. Edelman calls this the econiche, the interaction and end result of this interaction being the individual’s reality. The reality has to be unique: what I see and what you see in the same scene can be different based upon what we know, what we expect, current mood and attention to name a few variables. The same could be said for pain that will be influenced by similar variables. There is a biology of pain and the biology of the influences upon the pain.

My farming analogy that is based upon my belief that pain can change (neuroplasticity — the ability of the nervous system to adapt and learn; it is always changing….there it goes again, it’s just changed. And again), is a useful way of explaining to patients how we think about these systems and interactions, how we have to create the right conditions for change. Much as a farmer will prepare his field and cultivate the best soil for his crops to grow, the individual must take conscious action for the body systems to work towards wellbeing. This is the ‘why?’, with the ‘how?’ being a comprehensive approach that targets the physical, cognitive and emotional dimensions of pain.

Come and see us to find out how you can create the right conditions for changing your pain and symptoms: call 07932 689081

06May/14

London Fibromyalgia Clinics | London FMS Clinics

London Fibromyalgia Clinics — I think differently about fibromyalgia, functional pain syndromes and chronic pain. Believing that there is a need to challenge the way these problems are addressed, I created a specialist clinic that draws upon neuroscience, philosophy and other disciplines to create innovative and effective ways for individuals to move forward in their lives.

Fibromyalgia is known as a functional pain syndrome, sharing a common biology with other problems such as migraine, irritable bowel syndrome (IBS), pelvic pain, musculoskeletal pain and painful bladder syndrome. This common biology is an adaptation in the central nervous system called central sensitisation with changes in the excitability of the nervous system alongside on-going responses of the immune system. The way that the body systems and the brain adapt and learn means that it has become persistently protective, igniting painful and other responses to a range of normal cues and situations. The sensitivity results in on-going pain and general sickness responses (e.g./ aches and pains, tiredness, fatigue, appetite changes, mood changes, anxiety, loss of concentration, brain fog, altered body sense); the latter just like a feeling of the flu.

Stress often plays a role. Stress is a response to a perceived threat, the meaning of which we give to the situation as an individual. The physiology that follows is designed to protect us from wild animals — either to run away or fight. Whilst this is useful when danger presents itself and in the short-term, if these responses continue, they impact upon the immune system, switch off the digestive system and reproductive system (neither eating or digesting a meal are useful in the face of danger; reproduction is not useful in the face of danger — resulting in a sensitive and/or sluggish gut, and fertility problems), prepare the motor system and mobilise energy in preparation for flight or fight.

It is a combination of genetics and experience that results in the condition. Our genes are moulded by these experiences and to what we are exposed: stress, injury, pathology. Protection is triggered but not turned off, the responses continuing as if there is a problem, even when it is resolved. These on-going responses then create further changes, for example chronic inflammation, and a continued loop that maintains the condition. That is until the circumstances are changed and the conditions created to move out of the loop and onto a route of wellbeing.

Believing that pain can and does change via neuroplasticity, I create bespoke treatment and training programmes for individuals who visit the clinic from all over the UK. The programmes ensure that you fully understand the problems and comprehensively target the biological mechanisms addressing the physical, cognitive and emotional dimensions. I help you to develop the knowledge and skills that you need to move forward in your life with a range of proactive strategies, techniques and treatments grounded in neuroscience.

Call now for more information or to book an appointment: 07518 445493

28Feb/13

Fibromyalgia and the autonomic nervous system

Several recent papers have looked at the autonomic nervous system in fibromyalgia – see below

Clin Physiol Funct Imaging. 2013 Mar;33(2):83-91. doi: 10.1111/cpf.12000. Epub 2012 Nov 4.

Autonomic nervous system profile in fibromyalgia patients and its modulation by exercise: a mini review.

Kulshreshtha P, Deepak KK.

This review imparts an impressionistic tone to our current understanding of autonomic nervous system abnormalities in fibromyalgia. In the wake of symptoms present in patients with fibromyalgia (FM), autonomic dysfunction seems plausible in fibromyalgia. A popular notion is that of a relentless sympathetic hyperactivity and hyporeactivity based on heart rate variability (HRV) analyses and responses to various physiological stimuli. However, some exactly opposite findings suggesting normal/hypersympathetic reactivity in patients with fibromyalgia do exist. This heterogeneous picture along with multiple comorbidities accounts for the quantitative and qualitative differences in the degree of dysautonomia present in patients with FM. We contend that HRV changes in fibromyalgia may not actually represent increased cardiac sympathetic tone. Normal muscle sympathetic nerve activity (MSNA) and normal autonomic reactivity tests in patients with fibromyalgia suggest defective vascular end organ in fibromyalgia. Previously, we proposed a model linking deconditioning with physical inactivity resulting from widespread pain in patients with fibromyalgia. Deconditioning also modulates the autonomic nervous system (high sympathetic tone and a low parasympathetic tone). A high peripheral sympathetic tone causes regional ischaemia, which in turn results in widespread pain. Thus, vascular dysregulation and hypoperfusion in patients with FM give rise to ischaemic pain leading to physical inactivity. Microvascular abnormalities are also found in patients with FM. Therapeutic interventions (e.g. exercise) that result in vasodilatation and favourable autonomic alterations have proven to be effective. In this review, we focus on the vascular end organ in patients with fibromyalgia in particular and its modulation by exercise in general.

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Clin Auton Res. 2012 Jun;22(3):117-22. doi: 10.1007/s10286-011-0150-6. Epub 2011 Oct 25.

A comprehensive study of autonomic dysfunction in the fibromyalgia patients.

Kulshreshtha P, Gupta R, Yadav RK, Bijlani RL, Deepak KK.

Abstract

OBJECTIVES:

The hypothesis of autonomic nervous system involvement in pathophysiology in the patients with fibromyalgia has been addressed and tested time and again but the existing reports are both contradictory and inconclusive. A complete knowledge of the degree of autonomic dysfunction in fibromyalgia patients would be more substantial. We conducted a comprehensive non-invasive study to investigate the complete autonomic profile of female patients with fibromyalgia.

METHOD:

An autonomic function test using a standard battery and heart rate variability analysis in the 42 fibromyalgia patients as well as 42 age matched healthy controls was performed. Both autonomic activity (tone) and reactivity were measured. Autonomic tone (both time and frequency domain parameters) was measured using heart rate variability (HRV) analysis. Autonomic reactivity was measured using a standard battery of autonomic function tests.

RESULTS:

Resting blood pressure (both systolic and diastolic) was significantly higher in the fibromyalgia patients than controls. The time domain variables and HF% as recorded by HRV were significantly lower in the patients than the controls. The autonomic reactivity for sympathetic and parasympathetic nervous system was found to be within normal limits.

INTERPRETATION:

The cardiac autonomic function is normal and the autonomic reflex arc seems to be intact in the patients with fibromyalgia.

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It seems that ANS function may be normal in fibromyalgia. Of course there are many other factors to consider including the role of the immune system, central sensitisation, the endocrine system and the effects of stress.

In common with other persisting pain problems, fibromyalgia is a multidimensional and multisystem condition and must be addressed as such. Exercise has a role in that we need movement and exertion at an appropriate level for normal health. Of course any physical activity must be organised, planned and be titrated to the individual, similar to a drug. There must also be confidence in the activity and coping skills for the effects of exercise to deal with hypervigilance and catastrophising that often feature.

Fibromyalgia is a functional pain syndrome. Often in the clinic we see individual’s with more that one functional pain, for example pelvic pain, dysmennorhoea, IBS, migraine, bladder dysfunction and TMJ pain. We address these problems at source by using strategies that target the pain mechanisms and address the physical-cognitive-emotional factors that are integral to fibromyalgia and other enduring pain states.

RS – Specialist Pain Physio Clinics, London

05Nov/12

Women and pain | Part 1

 

‘As many as 50 million American women live with one or more neglected and poorly understood chronic pain conditions’ 

Generally I see more female patients than male. This observation supports the view that chronic pain is more prevalent in women than in men for some conditions – see the International Association for the Study of Pain fact sheet here. There are some ideas as to why this may be, including the role of the sex hormones and psychosocial factors such as emotion, coping strategies and roles in life. Additionally, experimental studies have shown that women have lower pain thresholds (this is a physiological reading) and tolerance to a range of pain stimuli when compared to men although this does not clarify that women actually feel more pain – see here. Pain is a subjective experience of course, and modulated by many factors.

A campaign for women’s pain | Chronic pain in women (2010) report

It is not uncommon for a female patient to tell me about her back pain and continue the narrative towards other body areas that hurt and cause problems. This may include pelvic pain, migraine, headache, irritable bowel syndrome, chronic knee pain, widespread sensitivity and gynaecological problems (including dysmenorrhoea, endometriosis and difficulty conceiving). These seemingly varied conditions are typically looked after by a range of medical and surgical disciplines: gynaecology, neurology, rheumatology, gastroenterology and orthopaedics. More recent science and thinking has started to join the dots on these problems, offering new insight into the underpinning mechanisms and more importantly approaches that can affect all the conditions in a positive way. This is certainly my thinking on this hugely significant matter.

Reconceptualising pain

Undoubtedly pain is complex. This is particularly the case when pain persists, disrupting and impacting upon life. Reconceptualising pain according to modern neuroscience is making a real difference to how we think and treat pain – see this video. Briefly, thinking of pain as an output from the brain as a result of a complex interaction of circumstance, biology, thought, emotion and memory begins to give an insight into the workings of the brain and body. Pain is individual, it is in the ‘now’ but so coloured by the past and what it may mean to the individual. The context or situation in which the pain arises is so very important. We talk about pain from the brain but of course we really feel it in our physical bodies, but the location is where the brain is projecting the sensation – see this video.

Neuroscience has shown us that the danger signals from the body tissues are significantly modulated by the brain before the end output is experienced. Factors that influence the messages include attention, expectation and the circustance in which the individual finds herself. We have powerful mechanisms that can both facilitate and inhibit the flow of these signals and these reside within the brain and brain stem. For this reason we must consider the person’s situation, their expectations, hopes, goals, past experiences and current difficulties, and how these can affect their current pain.

Stress & emotion

Any hugely emotive issue within someone’s life can impact enormously upon pain and sensitivity. This can be the stress of a situation including caring for a relative, losing someone close, work related issues and divorce. The problem of conception certainly features in a number of cases that I see, causing stress and turmoil for both partners but clearly in different ways. Fertility receives a great deal of attention in the media and there are a many clinics offering treatment and therapies, in effect raising awareness and attention levels towards the problem. The pain caused by difficulties having children can manifest physically through the stress that is created by the situation. Thoughts, feeling and emotions are nerve impulses in the brain like any other and will trigger physical responses including tension. Stress physiology affects all body systems, for example the gastrointestinal system (e.g./ irritable bowel), nervous system (e.g. headaches, back pain) and the immune system (e.g. repeated infections).

Lifestyle

Lifestyle factors play a significant role in persisting pain. Modern technology and habits that we form easily may not be helpful when we have a sensitive nervous system. For example, sedentary work, the light from computer screens, pressures at work, limited exercise, poor diet, binge drinking and smoking to name but a few. All are toxic in some way as can be our own thinking about ourselves. When we have a thought, and we have thousands each day, and we pay attention, becoming absorbed in the process, the brain reacts as if we are actually in that situation. Consequently we have physical and emotional responses that can be repeated over and over when we dwell on the same thinking. This is rumination and is likely due to ‘hyper-connectivity’ between certain brain areas – see here. We can challenge this in several ways including by changing our thinking and using mindfulness, both of which will alter brain activity and dampen these responses. It does take practice but the benefits are attainable for everyone.

In summary, the underlying factors that must be addressed are individual and both physical and psychological. Pain is complex and personal, potentially affecting many different areas of life. How we live our lives, what we think and how we feel are all highly relevant in the problem of pain as borne out of sensible thinking and the neuroscience of pain. Understanding the pain, learning strategies to reduce the impact, receiving treatment that targets the underlying mechanisms, making healthy changes to lifestyle and developing good habits alongside the contemporary brain based therapies can make a huge difference and provide a route forwards.

For information on our ‘join the dots’ treatment programmes for chronic pain, contact us here or call 07932 689081