In fibromyalgia, your pain is amplified. There are known biological changes that can contribute to the increased pain. Most of those changes can be helped if you know what to do. Suffering is a more complex thing. Suffering happens where pain meets your thoughts, beliefs, and emotions. There are simple tools that you can learn to shift your experience of pain and suffering. So you can be more comfortable, happier, and live better.Disability is an even more complex process. You have choices about how to mobilize your body-mind’s healing responses.
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Hey! It is Dr. Shiller, and I am going to speak with you today about fibromyalgia and disability. What I am going to say goes beyond just fibromyalgia. We are going to be talking about principles that are relevant to also chronic fatigue and chronic inflammatory illness to chronic pain problems in general, and this question that comes up over and over that eats at people is like what is this fibromyalgia thing? Is it a progressive disease that is going to eat up my body and destroy me like some kind of cancer or autoimmune thing? Like why does it have to be disabling? Am I going to get disabled? Am I going to lose all of my function and lose all of my self-respect and swirl down some sort of whirlpool into a black hole? Like what is going to happen to me? And the encouraging answer I want to give you is that it depends, that there are actually lots of places where you have an option and you have the potential power to shift the process, and what I am going to do in this talk is unpack, why does disability happen in fibromyalgia and what you can do about it? Because there is a lot of hope.So, check it out, listen, and hopefully this is useful for you. I am going to use some slides, because I am going to share a lot of information, and I want to give you visuals on it, okay? First thing we know is pain. Pain is the core thing that starts to bother so many people with fibromyalgia and one of the things that even the medical experts agree on is that there is central sensitization, and what does that mean? It means that the pain processing system is turned up, and this is a picture from Scientific America and basically you have a pain processing system that is the nerves from your say your hand, like if you have injured your hand, like in this diagram, and that signal goes up the nerves to the spinal cord and then through the brain to the parts of the brain, that says, “aah, my hand hurts.” and the part of your brain that gives you that like emotional angst a person often gets when they have pain, and the key thing that you need to know, listen up, is that your pain processing system is like an amplifier. There are several steps where the signal is transferred and processed by a lot of different factors, and that can turn things up like an amplifier, so that things that should not hurt, hurt, and if you have fibromyalgia, you probably recognize that experience where things hurt you that did not used to hurt you.Modern medicine does not really agree on a consensus about why central sensitization happens even though we know a lot of factors that cause it. We know a lot of different variables that can create hyper-extensive excitability and inflammation actually in the brain and activation of certain cellular and biological processes that turn up sensitivity of the brain, and these are some of them. We are not going to spend too much time on all of this and do not get hung up on it, but stuff that you may have already heard about it, you may have been looking into like inflammation and biochemical or oxidative stress, loss of cellular energy, hormonal changes, dysfunction in the biome or the gut motility or the gut lining, the leaky gut phenomenon in certain toxicity states, and then there is something called autonomic imbalance, and that is when that stress response is overactive compared to the relaxation response. Look into this if you have not heard of it before, but the key factor is that you have a system within your brain and spinal cord that touches every bit of your body, it is your autonomic nervous system, and it balances, it biases your energy allocation. Am I in get up and go fight flight freeze or am I in relax, rest, digest, assimilate nutrients, heal, sleep? They are two very different sets of processes and every part of you is involved in them, and one of the common things underlying a lot of pain, fatigue, and chronic illnesses is autonomic imbalance, and that is a whole other topic. Look for more information from me or other people about that. It is part of what drives the wheel of all these different changes that give rise to central sensitization and give rise to pain sensitization, and so autonomic balance is also an outcome of pain. When something hurts, like it creates that, that sense of it is not okay, that sense of loss of safety and that feeds into the process. So, just showing for the diagram, that it is a vicious cycle, where pain leads to autonomic imbalance, which leads to all of these processes moving forward and worsening of the process. Let us just think about pain for a second, because pain and suffering are profoundly interconnected, but they are not identical. Suffering and pain, the way a person experiences it are very subjective, they are very conditioned, they are very cultural. There are a lot of different things that affect how much a person suffers when they have pain, and that tends to be in the area of your beliefs and your emotional responses and your thoughts that you have about it, and so you know this is just the piece we already saw about all these sort of cellular and biochemical changes that affect pain sensitization, but then there is the interaction with the beliefs, the emotions, and thoughts, and what I am suggesting to you to start considering is that your suffering is an integration of all of these factors, it is the pain itself, and it is the way your body and mind and emotions respond to that pain, and of course as I am sure you have experienced autonomic imbalance is part of that too, because when you are suffering, when you are suffering, what you are doing, what happens is your being feels distress, it feels danger, and your stress response tends to be activated, and that feeds into all the physiologic changes like we talked about, it feeds into central sensitization, and it feeds into your beliefs and emotions and thoughts, because when we are stressed out, it changes the way we receive the world. If you are living in a reality where you are stressed out a lot of the time, that us feeding the disease process. We are going to talk more about this, but that is one of the places where you potentially have leverage. Okay, let is keep moving. I just want to point out that you could kind of separate and say, look, there is kind of metabolic process, it is just a label we are giving it for ease of understanding, that all these biological processes that we talked about that give rise to central sensitization, they are kind of on the level of metabolism and biochemistry, they are in your cells, they are in your organs, your endocrine system, and then there is your mind-body system, your beliefs, your thoughts, your emotions, right? And your autonomic balance and your central sensitization is kind of in between those two, because both of them influence it quite a bit, your metabolic biochemical state, nutrition, a lot of things like that, and your mind-body state.Let us take this to the next step, right, because there is this principle, there is a principle called fear avoidance that every good pain practitioner understands, because basically when a person is afraid of their pain, they do not want to move, and it hurts when you move. So, you do not want to move, and it is the most natural normal thing in the world, and there is no shame, and there is no blame, it is just the reality that when things hurt, you naturally do not want to move, and your reflexes know that. If I put my hand on a hot fire, I guard it, I pull it back, it is a protective reflex, and your whole system is organized around protective reflexes, and so if your autonomic system is on fire and you have autonomic imbalance, your protective avoidant reflexes are going to be even more active, but the problem is when that becomes systemic and when it hurts so you do not move, and you get, I am sorry, I am just pointing out here, sorry that autonomic imbalance thing is integrated with everything, but the main thing here to think about is that when all this stuff is happening and you respond to that natural tendency of fear avoidance by not being active, by not moving, you get inactive, your muscles and your tissues get weaker, you become stiff, and that is when disability happens. Disability is a process that happens in response to the way your body and mind are reacting and responding to pain, and it is not your fault, right? A lot of this is things that just creep up on you, and before you know it, you cannot do stuff you used to do, and the horrible thing that I have heard from so many people as they get less and less active and more and more disabled is like, well, I cannot take care of my kids, I cannot do my job, what happened to me? Who am I? This is not me, and your sense of self, your beliefs, your emotional state becomes even more out of balance, and it fits into the vicious cycles, and so it is disability cycle, and every good pain clinic knows this, which is part of why they have behavioral medicine people working together with the pain doctors, working together with the physical therapists and other therapists, because this is a holistic whole person process, and the better you understand this, the better off you will be. Let us just kind of follow this through because your movement system of your body, your muscles, your nerves. When you are physically active, you change your physiology for the better. Physical activity is one of the most helpful things you can do, it changes a lot of these metabolic processes, and so when you are inactive and becoming disabled, you are feeding into the underlying physiology that gives rise to pain sensitization. By being inactive, you are generating more inflammation and oxidative stress, potential toxic metabolites, hormonal changes, gut dysfunction, it feeds into the whole process. This is not about blame and shame, this is about opportunity, this is about understanding all these different factors and unpacking them. So, you can start to see what is relevant for you, so that you can start to make conscious choices to help yourself heal, to help unwind all of this. Every one of the changes that I put on this slide; all of these different things are biological, mental emotional, physiological processes that you have potential choice over. They all can be slowed, stopped, or even reversed depending on various lifestyle or other choices that you make, and so I am sharing all this so you can start to make those choices.The next part of this talk is really to talk about what we can do about it. I am going to pause and stop here, because we have already been at this for about 10 minutes. I am going to split this into part A and B. So, we just did as part A. Part B will be coming, look for that, and we will talk in part B about what do you really do about it. You know there is a healing process, and that healing process is addressing the metabolic, the mind-body, and the motor or mechanical parts of this. so, that is what we will do in part B. I hope you will tune in for that. I hope this has been interesting to you.My work is dedicated to helping you learn and grow in that way. I want to hear about how you like this video. If it is good for you, let me know, leave feedback in the comments or send me an email, sign up for my email community, so you can get updates about when I produce more content, and I am here and at at your service. Thanks for watching.
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