Summary:

You learned in part A of this series why the pain system gets sensitized in fibromyalgia and chronic pain, and what creates suffering, and why it can be so disabling.  Click here to see part A if you missed it or want to review.. In this video (part B), you’ll learn some of the main things that you can do to reduce suffering, and break the “fear-avoidance-disability cycle” that otherwise can suck your life down the drain. This isn’t easy work.  But have hope.  There are things you can do to help yourself.  Please let me know what you think by sending an email or commenting on this post.

Did You Know:

You can receive updates about new content and learning opportunities for transforming pain and suffering, by joining Dr Shiller’s email community here: drshillerupdates.com Dr Shiller gives regular free mind-body training sessions on zoom. You can get the schedule and register at www.mindbodygroove.com

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• How to unlearn the mind-body patterns that create chronic pain and illness.
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• Life-changing stuff most doctors don’t tell you about fibromyalgia, chronic pain, and chronic illness.
• LDN can be great.  But here’s why it is not a miracle cure for pain, fatigue, and fibromyalgia.

Full Transcript:

Hi, Dr. Shiller here.  We are continuing with part II of fibromyalgia and chronic pain.  Why are they so disabling and what can you do about it?  In part I, we looked at the whole variety of different metabolic and mind-body and sort of mechanical structural factors that can give rise to the disability and really loss of life and function that happens when people have chronic pain, especially fibromyalgia. In this part, we are going to talk about what you can do about it.  I encourage you to watch part I if you have not seen it yet.  So, look for that link connected to this video.  I am going to bring back up the slide we ended with, let us look at that.  So, just summing up, like you know that talk in 30 seconds that there are metabolic mind-body and sort of movement or motor mechanical system aspects to this whole process that the biology that gives rise to central sensitization is influenced by the mind-body variables, like your beliefs, emotions, and thoughts, and especially autonomic imbalance.    Autonomic imbalance is that over-activity of the stress response that can happen with chronic pain and chronic illness.  Fear avoidance is that, I do not want to do stuff because it hurts, because you are not active, and you get inactive, then your body gets weak and stiff, and you get disabled, and because you are not moving, that feeds into all of the physiologic and mind-body variables, and the place where you actually have therapeutic leverage is to actually work on these things, right?  I am not going to talk about the metabolic part, those are incredibly important.  I talk about those in other talks.  So, have a look for that stuff.   I am going to focus today on the mind-body stuff and the motor mechanical stuff, and summing up all of this, the things that we really can address with the right kind of mind-body and movement system care are really the autonomic imbalance, fear avoidance, and inactivity, and the rest that flows out of addressing those things.  So, let us just talk about a few principles or interventions, and I am going to share the big picture, the top-level stuff.  Every one of these big picture top-level things are things you can drill down to and learn more, and I will do that in other talks.  I am really interested in your feedback, what you want to hear more about.  So, feel free to respond in the comments as I am going through about what you need to hear more about or send an email or whatever it is, reach out to my office and let me know.  The whole point of this content is for you, to help you, to empower you.  So, let us go forward with this, okay.  Other videos about metabolic and the mind-body stuff.  There is a number of different steps to mind-body healing, and there is mind-body tools that you can learn to shift your physiology and especially your autonomic imbalance as well as the kind of fear avoidance thing and to heal your beliefs, emotions, and thoughts, and it is incredibly transformative because you stop and unwind these cycles that give rise to the suffering and the disability of fibromyalgia and chronic pain.   Self-regulation is the foundation. Self-regulation means tools, like simple breathing and focusing techniques that actually shift your neurobiology and your biochemistry, stimulate the vagus nerve, the vagus nerve is this big nerve that comes out of your brain stem, serves your entire intestinal tract, and it is anti-inflammatory when you stimulate your vagus by going into a deep relaxation, it slows down inflammation.  When you are stressed out, aggravated, when you have autonomic imbalance towards sympathetic, your vagal nerve is shut down, and it is a pro-inflammatory state, and that is why we got so much research showing that an overactive stress response is pro-inflammatory and that various mind-body techniques modulate the immune system in a positive way and help it function more effectively.   There are various techniques of self-regulation, mindset and beliefs, where you put your mind is where you are going to go.  It is like a person driving one of those race cars in the Monaco grand prix or wherever, where if they look at the guardrail or the tree, you are going run into the tree, and if you look for the open space, you are going to drive into the open space.  Another way to think about it is that if you are focusing on negative stuff in your life, the pain, the suffering, the lack, the loss, the person who hurt you, the blame, the guilt, all of that kind of stuff, you are going to generate negativity, and it is going to cause more suffering for you, for you.  You are going to suffer more because of what you think about, and again this is not blame and shame.  This is just inviting you to start seeing that if you focus on the positive stuff and you start to give your mind over to the good things that you can do to help yourself, then you are going to move in that direction.   It is much harder to do than it is to talk about it.  So, there is a lot more to learn about this, but it is a huge piece, and I encourage you to start thinking about it.  Mindfulness could also be described as compassionate present moment awareness.  Most of us are used to thinking in an analytical judgmental, how can I fix this or change it mode, we are doing?  How can I do it better? And we are all conditioned for that.  We get especially conditioned for that when we are under stress and we are suffering, because we want a solution, we want to fix it.   Mindfulness is turning that upside down, it is shifting into a place of being present and compassionate, and when you talk about it, when you read about it might make sense or not make sense, but either way, you are not doing it.   Doing it is an experience, you need to practice it, you need to learn it, and what I suggest is you find a guide, whether it is, you know, on the internet with or mind space or headspace or apps, okay that is a good start, but find a teacher, find someone who can help you learn it, because it is transformative, and I can tell you from my own experience and seeing so many people who like thought about it, they read all the books.   I know mindfulness, no.  Because they get into the training and they start to do it, and okay if things are challenging and hard and then suddenly, “oh my gosh,” like they have a realization, they have an experience that shifts everything. I did not know that could happen.  I did not know I could feel that way.  I did not know I could have that much free choice about my life.  You got to practice it, to get there.  Everyone can do it to a certain extent, go for it, okay. Next thing, body awareness.  I work with a lot of people who think good thoughts, they are prayerful, they are spiritual, they are religious, they are doing good things, thinking good thoughts, but meanwhile their body is in alarm reaction because of their trauma, because of their pain, because of their disease.  It is completely different when you take the good thoughts, the positive, calm, happy mindful mind and you bring it to your bodily experience, and you start to send up a message of safety to your body, you start to bathe your cells in the biology and neurobiology and neurochemistry of safety and positivity, transformative. Cultivating positive emotion, healing emotion, healing trauma. We know that people who have had adverse childhood experiences get more illness, they get more chronic disease, it is a complex phenomenon, it does not mean it is all in your head, but what it does mean is that emotional trauma, physical trauma shift your physiology, and there are tools that you can learn to shift it back into a healthy state.  These are a collection of mind-body tools that can be transformative, and all of these are things to drill down to.  Every one of these mind-body tools that I have listed here are things that you can learn to actually develop skill and cultivate, and once you do that, once you start to build that skill, it is yours.  It is not something you have to go back to every week to your therapist or your treatment person.  You have got tools, you have got transformative tools, that can help you break a fibromyalgia flare, that can help you find your way out when something triggers you, that can help you change your physiology and reverse those vicious cycles that give rise to the suffering and the fear avoidance, inactivity, and the disability. Okay, let us get into the motor mechanical, the movement piece of this.  One aspect of this is bodywork, and there is two main kinds of bodywork.  There is the hands-on direct stuff, where a person is pushing and prodding and doing stuff to move, to crack and crunch and move you, that can be great for some people.  In my experience, it is not so great with people with fibromyalgia, because it tends to flare you up.  There is another kind of manual bodywork techniques that you could describe as indirect, they are very gentle, they are more about consciousness and finding the freedom in the tissue and your body, your fascia, your tissue unwinds and moves in response to that, and that can be profoundly transformative.  You can find that from a good osteopath, from a good manually trained physical/occupational therapist, some very good massage therapists, and some chiropractors, but you want to ask if they have worked a lot with people who have chronic pain and fibromyalgia, if they know indirect gentle techniques to release tissue, to release neuromuscular imbalances and reflexes that are counterproductive. Okay, and then there is stuff you can do for yourself.  There is movement arts, and my emphasis, my bias is towards what you might call meditative or mindful movement arts, because exercise can hurt.   If you just go out there and treat your body like it is a peanut piece of meat and you get on the treadmill and just go, go, go for 20 minutes, you are  going to go above your threshold, and you are going to make yourself worse, and you probably have had that experience with some well-intentioned physical therapist, exercise therapist, or family member who said just get up and go, go do it.  But what happens when you get up and go is you activate your stress response, you activate counterproductive reflexes, you go over your threshold, and you create a crisis in your cellular physiology, and you actually feed into this cycle, and you get a fibromyalgia flare, and that is not good for anybody, and maybe you have been there, done that, and maybe you never want to move again and maybe you are  thinking who is this guy telling me I should move, forget about that. I get that, I have heard that from a lot of people, but when they started to learn to do a meditative quiet kind of motion and movement that respects the limitations of your body, that respects the low threshold, that actually lets you drop your calm, happy awareness into the body, and you know where you can move.  You develop your intuition of your own body’s capability, and you start to move with that intuition and you build, you open up your envelope, you gradually learn to develop more flexibility, more strength, more endurance, and over time, you are climbing out of that hole of disability, and that happens through meditative movement, and so whether it is Feldenkrais or yoga or Tai Chi Qigong, Pilates, or other things that somebody may have invented.  Find someone who is really good at it, find someone who has got a lot of experience and a lot of compassion and a lot of humility, who is willing to meet you where you are at and be your guide.   Let them teach you and let yourself learn, let your inner wisdom grow, so that you know how to work with your own body, and over time, you are going to heal, you are going to feel better.  You may need to work on this for the rest of your life to stay healthy, but you are going to be able to start doing only stuff that is meaningful for you.  You are going to be able to get back to stuff that matters.  It might not be like you were when you were 24 or 36, it might be like you are now, and then you build from there.  So, you restart and you restart and you grow and you heal. Okay, so summing up.  Fibromyalgia, chronic pain, there is a spiral of lots of different factors that lead to disability and disuse, and there is a process for preventing and reversing that, it has to do with addressing your metabolic biochemical system, to get the underlying cause of the symptoms.  It has to get to do with your mind-body system, addressing your thoughts, your beliefs, your emotions, and addressing most importantly that autonomic imbalance, it is about learning how to move again.  This is a healing path, nobody can do it for you, it is your healing path and it is unique to you.   I really encourage you to find your guides, find the people who can help you address those three aspects of this situation or maybe some people can address more than one for you, but you need to start walking down that road, that healing path, which is yours, you find your guides, you let them teach you, you become an expert in yourself, and with time, what is going to happen is you are  going to become the hero of your own story, because no one else is your hero.   They are your guides, you are the hero, you are the one who is making the journey, you are in a place where you are stuck, where you are feeling horrible or you are terrified that you are going to get worse, and what is on the other end of your journey is, I feel empowered, I feel capable, I feel stronger, I know what I need to do.  I might not be perfect, I might have setbacks, but I know how to deal with the setbacks and what you are going to do is learn to be a fuller self.  You are going to learn to reconnect to purpose, to do stuff that you care about, to start feeling better about life again. So, 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 your service.  Thanks for watching.