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Tag: anxiety

How To Supercharge Your Healing From Fibromyalgia, Post-Covid, Depression, and Anxiety

Posted on by Andrew David Shiller, MD

                                                                                  For more videos subscribe to our YouTube channel.

Summary:

If you’ve got chronic pain, fibromyalgia, arthritis, difficulty walking, depression, anxiety, fatigue… Movement Toward Health might help you feel better and live better.

MTH was created by a Harvard Trained Medical Doctor with decades of experience in mind-body and body-mind healing. It fills the gap in the conventional medical/rehabilitation system.

You will be guided in several mind-body and body-mind practices that balance your nervous system, help you heal emotional trauma and pain, empower a healing mindset, and most importantly teach you to move again with fluidity, comfort, and joy. Even if previous PT or physical training was not successful.

Affortable, convenient, fun online training with an experienced expert. Put the joy back into movement.

*Get more information www.MTHtribe.com

Please share.

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 is available for telemedicine consultation worldwide regarding chronic pain, fibromyalgia, autoimmune disease, fatigue, and stress-related illness.  Contact the office or schedule a consultation at www.drshiller.com 
  • Dr Shiller gives regular free mind-body training sessions on zoom. Learn practical tools for transforming suffering, reducing stress and inflammation.  You can get the schedule and register at www.mindbodygroove.com
 
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What If You Can’t Meditate Because You Can’t Sit Still?

Posted on by Andrew David Shiller, MD

                                                                                  For more videos subscribe to our YouTube channel here

Summary:

Maybe you’re thinking that meditation can help you with fibromyalgia, chronic pain, autoimmune disease, depression, anxiety, or something else really hard. You’d probably be right. But it’s not always so easy to meditate or concentrate.

One of my students asked me just yesterday, “Hey my mind is so busy and I’m so distractible, I can’t settle down to do sitting meditation. But if I do Tai Chi first, it quiets me down, and then I can meditate. Is that OK?” 

Is that ok? Yes, it’s more than OK. It’s great. Tai Chi, Yoga, Chi Kung, and other forms of “Moving meditation” or “Mindful movement” can be great pathways. They are wonderful calming exercises that shift you from the inflammatory biology of an overactive stress response, to the anti-inflammatory biology of well-being. And they can be great ways to settle your mind down.

His question is astonishingly common. We live in a time where most of us are stressed out, distracted, with lots of difficulty concentrating.  So please check out the video, and let me know how you like it.

In my view, sitting meditation and moving meditation are like peanut butter and chocolate. Peas and carrots. Forrest and Jenny. That means they go great together.

That’s part of why Movement Toward Health emphasizes both modes of meditation practice.  

If you haven’t heard yet, Movement Toward Health is a systematic training that guides you through the Seven Steps of Inner Healing. It combines sitting meditation and moving meditation, mindset training, and visual imagery. It’s purpose is to build your knowledge and skills so you can reverse the vicious cycles that worsen your pain, immobility, fatigue, and other symptoms.So you can take your life back and live again.

You can get more info at www.MTHtribe.com

If you’re interested, I suggest checking it out right away. We will have a brief open enrollment  during the week of September 12th for this year’s cohort. Don’t miss out. (If you missed that, you can click that link and get on the waiting list to know when we will open again.

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 is available for telemedicine consultation worldwide regarding chronic pain, fibromyalgia, autoimmune disease, fatigue, and stress-related illness.  Contact the office or schedule a consultation at www.drshiller.com 
  • Dr Shiller gives regular free mind-body training sessions on zoom. Learn practical tools for transforming suffering, reducing stress and inflammation.  You can get the schedule and register at www.mindbodygroove.com
 
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Why Does Chronic Pain Happen? These Scientific Principles Can Empower Your Healing: Part 2

Posted on by Andrew David Shiller, MD
                                                                                                   Watch Part 1/2 HERE

                                                                         For more videos subscribe to our YouTube channel here

Summary:

Science is revealing why chronic pain and associated problems happen.  Understand this stuff and you’re on your way toward healing and feeling better. Chronic pain and illness don’t just happen.  They are processes that develop over time.  The body-mind learns chronic pain.  And it learns the things that go along with chronic pain, like anxiety, depression, insomnia, irritable howel, high blood pressure, and so on.   Just like your body-mind learns to be sick and suffering, you can unlearn sickness and suffering.  You can learn to heal.  If you want to feel better, then tune in to these videos and share them with others.

Did You Know:

  • Dr Shiller gives regular free mind-body training sessions on zoom. You can get the schedule and register at www.mindbodygroove.com
  • You can learn more about Dr Shiller’s practice and schedule a telemedicine or in-person consultation at www.drshiller.com
  • Movement Toward Health is an affordable and effective training program to teach you to heal and feel better and improve your functioning.  It will teach you to integrate breathing techniques, mindfulness, and mindful movement techniques that are drawn from Dr Shiller’s 30+ years learning, practicing, and teaching these approaches to people suffering chronic pain and chronic illness. To get more info and be notified of the next start date CLICK HERE .

Related Posts:

Full Transcript:

Okay, so we have been talking about some of the basics of about why chronic pain and chronic illness are learning experiences, the physiologic, biological changes that happen from the interconnection of all your body systems that bring about the suffering, that bring about the dysfunction, that bring about the disability, and these are things that when you understand them, you can start to choose to unlearn them and to reverse them and start to actually install patterns of responsiveness to life in your mind/body system, in your biochemical metabolic nutritional system, and your movement system. So, let us continue.  There are other aspects of neuroplasticity, right? So, like, you have protective responses in your body, you can actually say that the stress response is a protective response, because when that limbic system that says not safe to be, fires on, really what it is doing is making you vigilant so you can look out for further danger, and that is why so many people who have chronic stress, whether it is from some horrible trauma that develops PTSD or if it is just from living under chronic stress are a little bit hyped up, and they might be irritable emotionally, they might be just having a hard time sleeping, they might be developing digestive problems or cardiac problems, because their body is rehearsing a stress response, and that is a protective response.  The person so to speak is looking to protect from danger.  Meanwhile, the danger is over, but the system is stuck.  Hope that makes sense.  Similar things happen with your motor system, the nerves, muscles, joints, bones, the whole system that helps you move through space, move towards what you care about, and move away from what might be dangerous.  If you put your hand in a hot stove, immediately you have a reflex that causes you to withdraw your hand, that reflex is plastic.  If you have perpetual or persistent pain coming into a particular part of your body, those reflexes that create muscle contraction, tightening of connective tissue, shifting in joint position sense actually becomes set into the system. I told you about a woman who had some pain in her shoulder and after a while, two years, she was holding her arm like this, that is a protective withdrawal response.  Maybe, I need to sit back a little bit so you can see that, but basically, she was walking around like this all the time, it is a protective withdrawal response, okay.  Imagine you have got that in your hand and you are trying to reach out and type.  Every day, you try to type and you are working against contraction, you are working against yourself.  Same thing happens when someone is trying to walk.  That is part of what perpetuates the problem, protective responses in your mind/body system, protective responses in your neuromuscular system, and the other aspect of it is changes that happen in your hormones, your immune system, your gastrointestinal system, whether it is from chronic stress, chronic pain or whatever, that feeds into dysfunction in your gastrointestinal tract, and this is something that is showing up in all of the research of last 10 or 15 years or so, and that feeds into problems with the brain, because when the gastrointestinal tract gets dysfunctional, it creates a situation where there is biochemistry and immune changes that can feed into and worsen anxiety and depression, can feed into and worsen pain transmission.  There is this intimate connection that is in every part of your body, it is a learning process, it is the way your body presumably is trying to protect itself, but it gets a bit haywire and becomes chronic pain and chronic illness, and it is a learning process through neural networks that are all talking to each other, nerves, organs immune system functioning in a system that gradually learns to become dysfunctional, and so what I am suggesting is that there are ways to make it less dysfunctional, and that is what healing is about, but it takes time and practice. I want to take it to the next step, right. We talked about neuroplasticity as one mechanism of that, how the connection and communication among nerves of various regions of the brain or various parts of the body, the spinal cord, the immune system, the gastrointestinal system, it is all neuroplastic and it all responds to persistence of distress of pain of noxious painful stimulus.  There is another level of it, which is actually genetic, right? And we tend to think of, well, genes are just genes and what my genes say or what my body does, but what we know from the past few decades is that is not at all true, that we have genetic tendencies and that gene on your chromosome is surrounded by even greater amounts of material that is intelligent so to speak and it responds to your experience, it is called epigenetic material, and it determines whether your genes are turned on or turned off, and what we are knowing more and more and understanding with greater clarity is that if you are subject to persistent stress, persistent insomnia, persistent in pain, persistent emotional distress, it shifts gene expression, it is another aspect of the learning process, which can work against you or it can work for you. In summary, the processes by which chronic pain and chronic illness take place, they take place overtime, they are learning processes.  There are neural networks, there are circuits that work together through various organs, various areas of your brain, nerves that fire together wire together.  If you want to recover from chronic pain and chronic illness, what is really important is getting out of this mindset that someone else is going to come in and fix you, getting out of the mindset that someone has got some magic bullet that is going to change it all and realize that your habits, how you choose to think and work with your mind/body connection, what you choose to eat and how you nourish yourself biochemically, and what you do with your physical system can potentially retrain your brain, your body, your whole system to be more healthy, to recover a greater degree of function and health that gets taken away by that chronic process that generates chronic pain and chronic illness.  The mindset shift is one of being proactive of realizing that you know what, you need to be in charge.  You might have great healers that help you, you might have doctors that give you just the right medications or do just the right procedures, and I am not saying stop that stuff, but what I am saying that there is a piece about ownership and taking responsibility and learning, that is going to empower you, because you might go to a great therapeutic person, whatever they are, and you might see them once a week or once a month and they do something and something shifts.  Maybe, it is psychotherapy, maybe it is hands-on therapy, but what are you doing in between, and so what I am suggesting to you is to start to learn what you can do for yourself, what you can do to teach your body and direct the learning process, so that your system moves towards recovery and healing. Okay, so, this is the first video.  There is going to be another video that is going to get a bit more practical about it, and so stay tuned for that, and I hope you have enjoyed.  In the meantime, feel free to leave comments, leave questions, and hopefully I can respond.  Thanks so much.
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Why Does Chronic Pain Happen? These Scientific Principles Can Empower Your Healing: Part 1

Posted on by Andrew David Shiller, MD
                                                                                                  Watch Part 2/2 HERE

Summary:

Science is revealing why chronic pain and associated problems happen.  Understand this stuff and you’re on your way toward healing and feeling better. Chronic pain and illness don’t just happen.  They are processes that develop over time.  The body-mind learns chronic pain.  And it learns the things that go along with chronic pain, like anxiety, depression, insomnia, irritable howel, high blood pressure, and so on.   Just like your body-mind learns to be sick and suffering, you can unlearn sickness and suffering.  You can learn to heal.  If you want to feel better, then tune in to these videos and share them with others.

Did You Know:

  • Dr Shiller gives regular free mind-body training sessions on zoom. You can get the schedule and register at www.mindbodygroove.com
  • Movement Toward Health is an affordable and effective training program to teach you to heal and feel better and improve your functioning.  It will teach you to integrate breathing techniques, mindfulness, and mindful movement techniques that are drawn from Dr Shiller’s 30+ years learning, practicing, and teaching these approaches to people suffering chronic pain and chronic illness. To get more info and be notified of the next start date CLICK HERE.
  • You can learn more about Dr Shiller’s practice and schedule a telemedicine or in-person consultation at www.drshiller.com

Related Posts:

Full Transcript:

All right, greetings everybody, Dr. Shiller here.  So, there are some confusing beliefs in our culture that keep a lot of people sick and suffering and two of them are particularly difficult or toxic.  One of them is that you might think somebody else is going to fix you, and the second one is that there could be some sort of quick fix where your chronic pain or chronic illness is going to go away like right away when you start doing whatever it is that you might start doing to help it, and I just want to share with you why that is not a good way to think, why it is counterproductive, and how it is the opposite of how things really work, because what that does is potentially invites you to open your mindset to think about things in a way that is more productive that actually might bring you some real solutions that could help you.   The key thing is like this, chronic pain and chronic illness are learned, learned.  Okay that might sound kind of strange because when you think of learned, you might think like, “Oh, I sat down and read a book, and I wanted to learn French or how to cook or whatever it is you might want to learn.” It is not what we are talking about here, but we are talking about a process over time, where the physiology, the biology of your body actually practices and reinforces and develops certain patterns, and that is how chronic pain happens, that is how chronic illness happens, and the key thing is learning how that happens, so you can learn how to unlearn it, and you can re-learn how to live well and actually to help your body heal. Let us talk about that.  Let us talk about chronic pain for instance, like a lot of people who have chronic pain after some kind of trigger, there was an injury, maybe it was surgery, maybe it was an infection, maybe it was some kind of trauma or damage or a fall, and then what sometimes gradually happens is that the thing just gets worse over time, right? There can be worsening of pain in the actual region that got hurt and then there can be like a spreading of pain, so it might start in the person’s foot or hip and then it spreads to their back or whatever it is, goes to a different part of their body.  Sometimes, it can affect the whole body.   Sometimes, there can be issues with other organ systems that create secondary sources of pain, changes in the brain, the nerve, the muscle tissue. There can be things that drive chronic illness or even turn up pain sensitization, and that involves shifting in biochemistry of brain function, shifting in psychological function hormones, intestinal function, the balance of the immune system.  These are all things that can worsen chronic pain, that can create secondary sources of pain and that can generate chronic illness. Let us try to understand how that happens.  I just want to give an example of what I am talking about in case it is not clear yet.  A woman I will call Jane.  She was actually one of my first patients when I finished residency 20 years ago, and I learned so much from her and other people like her.  She basically had fallen down.  She was a teacher.  She got knocked over by some students.  She was trying to break up a fight, and she hit her head, she hit her shoulder, and she had what you described mild moderate injuries.  She was not really messed up from it.  She was not in the hospital, but gradually, she developed shoulder pain that spread all the way down her arm.  She started developing headaches.  She could not use her arm.  She held her arm like someone who had had a stroke.  She had headaches that were disabling.  She developed all sorts of psychological challenges.  She was in her mid-30s, and she was disabled.  She was not working, and she had gone to many doctors, and all of them tried what I was taught to do when I was in medical school in residency; let us try this thing, let us try that thing, let us try this medication. The thing is we were not really looking at what was going on with her physiology, and so let us talk about what that is, what happens physiologically, and what I am going to share with you is kind of a digest of what I have learned from reading medical research and basic science research.  A lot of this is stuff that is not in the clinic yet.  It is well known that a lot of basic science research does not make it to clinical practice for 10, 20, 30 years, because it is a whole other thing to like understand what is going on than it is to develop like randomized controlled trials with lots and lots of people that convince most doctors so that things get into practice. The challenge is when someone comes to you who has got this chronic problem, who has tried all the first-line things that the best neurosurgeons and neurologists and orthopedic surgeons try, and then they are still suffering, what do you do then? And so that is kind of how I have built my practice. So what do you do then? And that is the kind of patient I have been seeing for 20 years.  So, that is what I am speaking from, is that experience. Let us think about this underlying principle that we call neuroplasticity, and neuroplasticity means the brain, spinal cord, and nerves change over time.  In response to experience, they change their function, they change their connectivity.  Let us unpack that a little bit.  Let us talk first of all just about the sensitivity of nerves to pain.  So, you got a nerve in your finger and you get a bad injury on your finger and it burns or it hurts and that sends a signal up to your spinal cord, and from there, it goes up to your brain, and from the core of your brain where all the sensory and emotional and cognitive information is processed, it goes to the part of your brain that experiences pain.  The nerve itself when it is persistently stimulated reorganizes, it changes DNA synthesis, it changes synthesis of proteins and ion channels and various kinds of sort of physiologic biological properties that affect how that nerve responds to stimulation and how it functions, and so you can get spreading of pain around the area of injury and you can get a situation where that nerve sends out signals that are wrong.   That is the classic thing someone who has got nerve pain and you gently stroke the hand or something and it feels like fire and it burns or someone who has got neuropathy in their feet where they cannot stand the sheets, sitting on their toes at night.  So, they cannot sleep, that is sensitization of the nerves, and that is a physiologic change that happens over time in that nerve.  A similar thing happens in that whole tract going up to the part of your brain in the sensory cortex that says, how my hand hurts, because those interconnections, they are called synapses, right? So, one nerve talks to another nerve through a synapse.  So, the signal comes down the nerve and it gets to this junction that is called the synapse, it is between the two nerves, and what happens is the signal gets down, and if it is strong enough, it causes that nerve to release some juice into the space between the nerves, and that juice is chemicals.   It is neurotransmitter chemicals, and those contact that secondary nerve and stimulate the nerve to do various things.  If they stimulate it in a strong enough way that secondary nerve fires, and those two nerves are in relationship with each other, and the more that this one fires and makes this fire, the more they get used to firing, that is why they like to quote, “Nerves that fire together wire together.” What that means is that the synapse as it gets more frequently active, as it is stimulated with a strong stimulus, it gets more active.  So, they are kind of like good buddies talking to each other, they already know what the other guy is going to say, they are already in conversation, they remodel their connections.  So, it becomes more sensitive. Now, the function of your entire brain, spinal cord, and body is built on thousands of nerves talking to each other.  You have got regions of your brain that do certain properties, regions of your brain that do other functions, and the connectivity between all of those parts of your brain is what determines how well your brain or body works, and all of that is subject to this principle of neuroplasticity, where nerves that fire together wire together.  So, suppose that somebody has a horrible traumatic accident and part of that is that they develop a painful thing happening in their tissue or their body, it is an injury, a wound, a break, whatever it is, it is painful.  It is constantly sending a signal that is sensitizing.   Meanwhile, they also had a traumatic experience, and that traumatic car accident or bomb going off, whatever it was, God forbid, creates a situation where they are in a stress response, they are in a danger response.  Their system is stuck in that trauma, and that represents certain areas of the brain, often the limbic system, the frontal cortex that are interacting with each other and firing off this persistent pattern of “I am scared, it is not safe to be me.” All the information about your emotional reality is integrated with the information of your sensor reality, and so a traumatic experience that is practiced so to speak overtime, that becomes set into that person’s neurophysiology, habitually changes the pain transmission system, and that is probably, and it seems to be why we see it so often that people who have persistent or have had significant traumatic events often develop chronic pain, because the processing of pain and the processing of stress, a sense of danger, sense of lack of safety, grief, anger, frustration are intimately connected with each other.  So, that is just kind of one example of how habitual experience of trauma stimulates habitual experience of pain, and it is a vicious cycle, and that is a learning process that gets worse overtime in many cases, and the issue is how to unlearn that.  It gets richer and deeper though, okay. Okay, so we are going to take a break right now and cut this, and we will get to the continuation of this topic in the next video. Summing up, there is a foundation physiologically about why chronic pain and chronic illness are really learning processes and how you can, by understanding that, unlearn them, that is where we are going with this.  The whole idea is for you to understand how the learning process may have happened in you, so that you can make positive choices to unlearn the negative stuff and install learning for the positive stuff and actually bring yourself towards healing. So, please look out for the next part of the video of the same name, and we will continue with the topic.
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What Causes Chronic Pain What Can You Do About It? Part 3

Posted on by Andrew David Shiller, MD
This video is part three.  You can watch parts 1 and 2 here: PART 1: What Causes Chronic Pain & What Can You Do About It? PART 2: What Causes Chronic Pain & What Can You Do About It?

Summary:

Jim fell on the job and injured a nerve in his hand.  Despite expert treatment with various medications and physical therapy, his pain was getting worse.  It spread up his arm to his shoulder, neck, and back.  He developed headaches, digestive problems.  He couldn’t sleep, was anxious all the time, and it was hurting his family relationships Why Does Chronic Pain Develop and Spread? Chronic pain is a complex disease.   In many cases, the body-mind’s own protective responses become part of the problem.  That includes overactivity of the stress response, but also nerve-muscle guarding responses, and changes in the soft-tissue and fascia. Also, gut-brain-immune interactions can drive chronic pain, and are showing up in chronic illnesses including autoimmune disease, fibromyalgia, dementia, neuro-degeneration, arthritis, neuropathy, and more.  It might be decades before the research is organized into treatment that the average family doctor will offer.   In the meantime, many people benefit from safe lifestyle approaches that address the underlying causes of chronic pain and illness.  And that often helps people heal, feel better, and live better. The things that doctors and therapists do to you can be helpful.  But it’s even more important to empower yourself.  Your own inner intelligence is part of the healing process.  No matter how sick you are, there is health inside of you. Simple techniques of breathing, meditation, and movement can be transforming because they help turn off the protective responses that drive the disease of chronic pain.  And the right kind of movement can build your confidence, re-educate distorted movement patterns, and help you feel better and regain function. These are crucial parts of your healing program. This is part three of a three-part video series, you can see the first two parts at the links below.

Did You Know:

Dr Shiller gives regular free mind-body training sessions on zoom. You can get the schedule and register at www.mindbodygroove.com
You can learn more about Dr Shiller’s practice and schedule a telemedicine or in-person consultation at www.drshiller.com
Movement Toward Health is an affordable online program to help you develop skills in mindfulness, breathing techniques, and mindful movement.  Other participants have had significant improvements in pain, well-being, and sense of confidence to live life fully.  www.MTHtribe.com

Related Posts:

PART 1: What Causes Chronic Pain & What Can You Do About It? PART 2: What Causes Chronic Pain & What Can You Do About It?
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What Causes Chronic Pain & What Can You Do About It? Part 2

Posted on by Andrew David Shiller, MD
This is video two of a three-part series.  See the next video here: PART 3: What Causes Chronic Pain & What Can You Do About It? If you missed part one of this video series, watch it here: PART 1: What Causes Chronic Pain & What Can You Do About It?

Summary:

Jim fell on the job and injured a nerve in his hand.  Despite expert treatment with various medications and physical therapy, his pain was getting worse.  It spread up his arm to his shoulder, neck, and back.  He developed headaches, digestive problems.  He couldn’t sleep, was anxious all the time, and it was hurting his family relationships Why Does Chronic Pain Develop and Spread? Chronic pain is a complex disease.   In many cases, the body-mind’s own protective responses become part of the problem.  That includes overactivity of the stress response, but also nerve-muscle guarding responses, and changes in the soft-tissue and fascia. Also, gut-brain-immune interactions can drive chronic pain, and are showing up in chronic illnesses including autoimmune disease, fibromyalgia, dementia, neuro-degeneration, arthritis, neuropathy, and more.  It might be decades before the research is organized into treatment that the average family doctor will offer.   In the meantime, many people benefit from safe lifestyle approaches that address the underlying causes of chronic pain and illness.  And that often helps people heal, feel better, and live better. The things that doctors and therapists do to you can be helpful.  But it’s even more important to empower yourself.  Your own inner intelligence is part of the healing process.  No matter how sick you are, there is health inside of you. Simple techniques of breathing, meditation, and movement can be transforming because they help turn off the protective responses that drive the disease of chronic pain.  And the right kind of movement can build your confidence, re-educate distorted movement patterns, and help you feel better and regain function. These are a crucial part of your healing program. This is the second of a three-part video series.  You can access the other two parts at the links below.

Did You Know:

Movement Toward Health is an affordable online program to help you develop skills in mindfulness, breathing techniques, and mindful movement.  Other participants have had significant improvements in pain, well-being, and sense of confidence to live life fully.  www.MTHtribe.com Dr Shiller gives regular free mind-body training sessions on zoom. You can get the schedule and register at www.mindbodygroove.com
You can learn more about Dr Shiller’s practice and schedule a telemedicine or in-person consultation at www.drshiller.com

Related Posts:

PART 1: What Causes Chronic Pain & What Can You Do About It? PART 3: What Causes Chronic Pain & What Can You Do About It?
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Why Does Chronic Pain Happen & What Can You Do About It? Part 1

Posted on by Andrew David Shiller, MD
See the next video in this three part series here: PART 2: What Causes Chronic Pain & What Can You Do About It?

Summary:

Jim fell on the job and injured a nerve in his hand.  Despite expert treatment with various medications and physical therapy, his pain was getting worse.  It spread up his arm to his shoulder, neck, and back.  He developed headaches, digestive problems.  He couldn’t sleep, was anxious all the time, and it was hurting his family relationships

Why Does Chronic Pain Develop and Spread?

Chronic pain is a complex disease.   In many cases, the body-mind’s own protective responses become part of the problem.  That includes overactivity of the stress response, but also nerve-muscle guarding responses, and changes in the soft-tissue and fascia. Also, gut-brain-immune interactions can drive chronic pain, and are showing up in chronic illnesses including autoimmune disease, fibromyalgia, dementia, neuro-degeneration, arthritis, neuropathy, and more.  It might be decades before the research is organized into treatment that the average family doctor will offer.   In the meantime, many people benefit from safe lifestyle approaches that address the underlying causes of chronic pain and illness.  And that often helps people heal, feel better, and live better. The things that doctors and therapists do to you can be helpful.  But it’s even more important to empower yourself.  Your own inner intelligence is part of the healing process.  No matter how sick you are, there is health inside of you. Simple techniques of breathing, meditation, and movement can be transforming because they help turn off the protective responses that drive the disease of chronic pain.  And the right kind of movement can build your confidence, re-educate distorted movement patterns, and help you feel better and regain function. This is the first in a three part video series.  The other videos can be accessed at the links below.

Did You Know:

Movement Toward Health is an affordable online program to help you develop skills in mindfulness, breathing techniques, and mindful movement.  Other participants have had significant improvements in pain, well-being, and sense of confidence to live life fully.  www.MTHtribe.com Dr Shiller gives regular free mind-body training sessions on zoom. You can get the schedule and register at www.mindbodygroove.com
You can learn more about Dr Shiller’s practice and schedule a telemedicine or in-person consultation at www.drshiller.com

Related Posts:

PART 2: What Causes Chronic Pain & What Can You Do About It? PART 3: What Causes Chronic Pain & What Can You Do About It?
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Where Do You Start, If You Have Chronic Pain, Anxiety, and IBS?

Posted on by Andrew David Shiller, MD

Summary:

One of my readers asked a great question: “Doc, what are your thoughts about EBV and Herpes as causes of fibromyalgia?  And what about bio-film and leaky gut?  I have bad IBS, and always feel so tired.  Oh, and I also have bipolar, PTSD, and panic attacks due to trauma and abuse”.

How does someone start to heal if there is so much going on?

It’s important to remember that many chronic pain and illness syndromes share underlying biological imbalances.  If you can start to identify those issues, you can understand what is driving your symptoms.  And that can help clarify your path to healing. At the core of almost every chronic pain and illness syndrome is the intimate relationship among the gut, the immune system, and the brain.   Gut-brain-immune interactions are showing up in chronic illnesses including autoimmune disease, fibromyalgia, dementia, neuro-degeneration, arthritis, neuropathy, and more.  It might be decades before the research is organized into treatment that the average family doctor will offer.  In the meantime, many people benefit from safe lifestyle approaches that address the underlying causes of chronic pain and illness.  And that often helps people heal, feel better, and live better. It’s helpful to think through the history of early life experiences, illness, triggers, and what issues are most prominent in life now.  And to start to understand how these things interact. The reader who shared this question was asking about everything BUT her ongoing anxiety and panic, related to her history of emotional and physical abuse.  It’s a shame, because those issues can heal.  And then the person can heal.  And the person usually doesn’t heal the physical illness if they don’t heal the toxic shame, self-blame, anxiety, and hypervigilance that often develops after such tragic events. So many folks with anxiety and chronic illness have been stigmatized with ‘it’s all in your head”, when really they have significant biological issues.  The sad thing is many docs don’t seem to “get it”, even though the research shows the issues quite clearly.  And unfortunately, that’s triple-bad for patients.  They don’t get their needs met.  They get blamed and shamed for their illness, which often makes them worse.  And the stigma often creates an obstacle to recognizing the mind-body relationships that are driving the physical illness.  The patients continue to suffer because they are unwilling to do the crucial mind-body healing work, which is a foundation of healing and recovery. Chronic pain and illness mean that your actual physiology is in “protective mode”.  If you have anxiety, panic, depression, history of trauma, then that protective mode is amplified intensely.  It’s incredibly important to develop the power of your mind and heart to shift the patterns that create disease.  And to create a sense of safety, acceptance and compassion, and to get it “into your bones”. Once you learn these tools and make them real in your life, amazing things can happen. Scroll down for full transcript

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Full Transcript:

Presentation Slides Hey everybody, Dr. Shiller here, and I want to talk today in response to a question that a reader sent in, because it is so relevant to many people when it comes to the whole idea of healing chronic pain and chronic illness.  I want to talk a bit about some of the chronic syndrome that have common underlying issues, why we look at them slightly differently in the functional approach compared to the way a lot of us learned in medical school, and in particular to talk about really the relationship of some of the core physiological imbalances, some of the biology underlying chronic pain and chronic illness, no matter what the issue is, there is this underlying biology, and how does someone like me think about it.  So, you can kind of look at your situation and try to get some insight, and so it is a great question she sent in, because it evokes a piece of confusion a lot of people share, and so I want you to hear this and take it in so that you do not get confused by it.   So, here is her question.  Doc, what are your thoughts about the article that I have read that said that mononucleosis which is Epstein-Barr virus and herpes virus can be the cause of fibromyalgia.   Look, she has fibromyalgia and chronic pain.  What is going on here is very generalizable though.  I am going to tell you why.  So, what do you think about these viruses that can cause viral, and what about the effect of the hysterectomy I had due to bad endometriosis?  So, if this is an individualized thing, how do I narrow down my own personal cause?   And she goes on to say, “Oh, by the way, I have bipolar disease and PTSD and panic attacks due to physical and emotional abuse,” like wow, wow, like a heart- breaking complex situation, that is not this person’s fault, she has a real physiologic illness, and she has a lot of like social and emotional trauma going on.   She goes on to ask more questions; doc, what are your thoughts about leaky gut and biofilms?  Do I need to diagnose that and treat that?  I have irritable bowel syndrome pretty badly, I am always feeling so drained and lethargic and exhausted, and you know it has been really hard, because I do not really trust my doctors anymore.  A lot of them have treated me like I am a drug seeker, and you know not only do I have fibromyalgia, but I got really bad osteoarthritis.  I am only 45.  I have already had a hip replacement.  I am going to have another joint surgery coming up.   I hurt so bad every day that I feel like living like this is just not like living life. And so the reason this is relevant to a lot of people, not just with her sort of diagnoses is because it is a complex picture and her head is spinning around with all the different possibilities of, like what do I do next?  And I hear that all the time, it is so confusing.  You read all the stuff on the internet, and she is talking about biofilms and leaky gut and like what comes first?  What should a person start doing?   What I want to say is that the thing screaming at me from her case is the PTSD and the panic attacks, and the fact that she has got like an ongoing, really intense kind of psychiatric illness, and the issues with that are not just relevant to people with psychiatric illness.  If you are someone who has had early life trauma or you have had traumatic experiences or if it is less severe than that.  Suppose you are just like a normal person who does not consider yourself mentally ill, but you actually like noted, yeah, like I had that really tough experience when I was in high school or college when there was that breakup of that really close relationship where I lost the person I loved and cared about or I was in college and I was abused by my professor or whatever it was and right around then my symptoms started happening, or maybe it was that car accident that did not seem so bad or I had that surgery and then suddenly things started unwinding.  Well, this is for you too, okay, because the thing that is so important is that people frequently overlook the incredible power of the mind-body connection, and I want to flesh this out for you a little bit, okay.   –Next Slide– So, let us start off by looking at some of these slides just to understand, like how do these syndromes develop?  And you will notice what I have written here, that many chronic debilitating problems share biological imbalances, whether it is chronic pain, fibromyalgia, abdominal pain, and leaky or irritable bowel like she had, fatigue, depression, anxiety, but also things like migraine, dementia, neurodegenerative disorders, neuropathy, autoimmune disease, chronic fatigue.  There are underlying imbalances that drive these diseases and they show up differently in different people, and part of the problem and challenge of conventional medicine is that they are looking at the disease as the sort of here, the disease will tell us what the problem is.  If they are not looking at the kind of person who has a disease and how this disease probably developed based on the more detailed history, and that is what we do in functional medicine.  So, let us keep going on this here.   –Next Slide– So, we try to identify and treat the underlying biological imbalances that give rise to all these different diseases as opposed to saying, hey for this disease, we use this drug, because that is the approach that often does not work for people, and if you have a chronic illness, you may have experienced that yourself. –Next Slide– So, identifying the underlying biological imbalance, how do we do that?  We think about three things.  We think about antecedents, the foundational issues in the person’s life or history that set the stage.  We think about triggers, transient events that shift the system and create like a different reality, and then mediators, things that keep you sick, persistent underlying physiological imbalances, and so the antecedents and the triggers give us an idea of what the mediators that might be most important are in a given patient, and that is when we start thinking about treatment.   –Next Slide– So, let us keep going and unpack this some more.  So, antecedents are things like genetics, adverse childhood events or early life trauma, which can actually turn on the genes of stress in an overactive hypervigilant, mental/emotional system that is intimately connected with your immune system, your gut, and everything in your body.  Illnesses or exposure, lifestyle, these are early life of things that set the stage of who you are biologically, so that when the trigger comes along and it could be a stressor, an infection, a trauma or a toxic exposure or a drug exposure, it could be a serious illness, and that creates a shift, and that shift sets up some kind of mediator.  It could be a change in the immune system and a kind of onset all the time.   Sensitization of the nerves or the brain, what we call central sensitization or peripheral sensitization, dysfunction in the mitochondria that produce biochemical energy, imbalance in the autonomic nervous system which is that stress relaxation balance that you are meant to have, but sometimes because of various antecedents and triggers, it gets locked into a locked-on position.  Issues with the gastrointestinal tract and dysbiosis, hyperpermeability, malabsorption, classic things that go on with irritable bowel syndrome, and as you can imagine, all of these mediators can feed into each other, and so it is kind of like a snowball that is going down the hill or a river that is flowing downstream.  It kind of gathers energy overtime, and that is why you may have had the experience of like, “Oh, yeah, that thing happened.  I was not feeling too well, it did not really get better, or I got something that got better, but then something else happened, and then like it has just gotten worse and worse over years,” and I hear that everyday over and over from almost everybody who shows up with chronic illness and chronic pain.  There was some antecedent, there was a trigger, then there are these mediators that perpetuate and roll downhill like a snowball or flow downstream like a river. –Next Slide– Regardless what your diagnosis is, whether it is any of these things.  Frequently, there are antecedents, triggers, and mediators, and these diagnoses are like the outcome, they are like what happens when the actual end organ gets sick and that is when people tend to have symptoms and go to the doctor, but we know that when a person has a chronic syndrome, it frequently starts a long time before that.  There is actually data showing with rheumatologic disease, like osteo or like rheumatoid arthritis or lupus that there is symptom onset, then there is positive lab tests and then there is when you get a diagnosis and that can be months or years before you get a diagnosis, and that process is typically going on for a while before the person even has symptoms.  So, these are processes.  They are not discrete events in time.  A discrete event in time can trigger the process.  That is part of what is important about understanding it and part of thinking through in your life, okay, like, what was I like as a kid?  Do I have a family history of illnesses or diseases like this? Like what are my antecedents? What are the triggering events that seem to bring things on and make them worse? and start trying to understand, well what might the key thing be?   –Next Slide– Okay, let us keep going.  All right, the gut-brain immune axis.  This is just key.  You could broaden this, you can add the endocrine system, you can add other aspects of your systems, because all of the systems in your body are one system, but this is a place where the money is frequently.  This is the place where the money is in terms of you understanding what the issues are for you and why you stay sick?  So, we had had a growing development of lots and lots of data over the years showing us these incredible connections between your brain, your gastrointestinal system, and your immune system, and at this point, like every specialty has journal articles and research findings coming out all the time, talking about these relationships, whether it is psychiatry journals, rheumatology journals, cardiology journals, and general internal medicine.  It is all about this.   These are the underlying physiologic things going on, and conventional medicine has not had enough time to do enough research, to really put all of this stuff together in a way that satisfies, you know, sort of the mainstream advisory boards and collectives that get together and make clinical guidelines, because it is still fuzzy, but there is a lot of underlying science that gives us directions about what to do, and those of us who practice functional medicine are early adopters.  We are looking at patients who are otherwise getting sicker and sicker, because conventional medicine is not helping them, and we are saying, okay, we do not have complete data yet, we never will.   Not everything that counts can be counted.  We do have pictures and patterns that are showing up, and when we do relatively safe lifestyle interventions, the risk-benefit ratio of treatment is pretty good.  So, let us keep moving through, and let us think a bit more about this issue that people get mixed up on, right, because this patient in particular was asking me, well, what about what is going on in my gut or did I have a viral infection that stimulated my immune system? And the answer is, yeah, those things might be really important, but you have got PTSD, you have got chronic anxiety, you have got panic attacks, that means your stress response is on all the time, saying danger, danger, danger, and that is going to re-stimulate your gut, and it is going to re-stimulate your immune system.   –Next Slide– Let us unpack this a bit.  This is just a progress in neuro-pharmacology and biological psychiatry, right?  This is a graphic of your brain and here is your gut and here is a blow-up of your intestinal tract, showing like the inside. We call this the lumen, and in the lumen here, all the bacteria that make up your biome, you got trillions of bacteria in your gut, and they are not just hanging out there living the life. They are helping you metabolize food. They are producing metabolic products that are circulated into your system and affect all of the tissues, especially your brain.  They are modulating and moderating the immune system that is living in the walls of your gut and that is in turn affecting your entire system.  Chronic stress has all these neurologic pathways, by which it affects the gut, and it affects the biome and changes the biome. It is when the biome changes, for instance, certain shifts in the biome can create toxic metabolites that go to your brain and create anxiety, bipolar disease, panic, depression, and perpetuate that.   There are also biochemical pathways, like the hypothalamic-pituitary-adrenal axis.  Cortisol also influencing the thyroid axis that feeds into the gut biome situation, and from there, what is going on in the gut biome and what is going on with the integrity of the wall of your gut feeds into the overactivity of the immune cells that are living around there, and that gets systemic, and they produce pro-inflammatory cytokines, inflammatory chemicals that go to your brain and feed the issues.   So, this is a loop of interaction between your brain, your gastrointestinal function, your biome, your gut barrier, and the immune function of your entire body.  So, that is why people are thinking about dysbiosis and leaky gut and biofilms, that is why people are thinking about viral infections as issues or triggers that cause these chronic disease processes, because they set off this system, but that is why you also need to be thinking about your mind-body connection and the balance of your autonomic nervous system.   –Next Slide– Here is a cartoon that just looks at this, like barrier dysfunction, leaky gut, intestinal permeability thing.  These are all kind of different words for the same phenomenon depending on who you are talking to, but here is your normal gut.  You got these junctions between the cells of your gut that keep the bad stuff inside and absorb the good stuff, so that you absorb nutrients, but you keep the bacteria in your gut, and you remove the waste products.   So, along comes stressors, toxic exposures, infections, various kinds of things and create change in that biome and create leaky gut or intestinal permeability, and you have got stuff leaking through, and your immune system that surrounds the gut and your vasculature, your blood vessels that surround the gut, are exposed to all sorts of stuff, that can be incompletely digested food, that can be bacterial components that generate a big immune response systemically, and that is part of what drives the chronic inflammation that drives chronic illness and chronic pain.  I hope you are starting to see the picture. –Next Slide– So, let us keep going here.  The last element of these changes that happens is so relevant to this particular person who had irritable bowel and fibromyalgia, which often go together and there is a reason why, and this is it, right?  Because that cycle of overactive stress response that affects gut function and dysbiosis and leaky gut and overactivity of the immune response creates peripheral and central sensitization, that means the nerves are overactive, that means everything hurts in your brain.  It can also mean brain fog, it can mean more anxiety.  It is a neurological overactivity, because the brain has too many excitatory chemicals.  In the gut what happens is the actual nerve endings get sensitive and the actual function of the motor system that makes your gut very carefully move the food along gets either overactive or underactive. You get constipation/diarrhea or diarrhea/constipation, depending on the kind of irritable bowel that you have got going on, but that is part of the problem, stuff is moving through too fast, you are not absorbing nutrients.   –Next Slide– So, what do we do about all this?  Well, I have talked about this before, and this is the way I think.  I think about these three domains.  I call them the three Ms; mind, movement, metabolism.   Mind is your mind-body relationship.  It is the fact that between your ears, you have a capacity for free choice, you have a capacity for mobilizing your mindset, your thoughts, for transforming emotions, for actually shifting your physiology, and this is real science, it is not kumbaya, goofy, goofy, floofy, floofy.   It is real physiology of how mind-body training and how mind-body techniques and the right kind of therapeutic tools shift your physiology. Your movement system is your musculoskeletal, neuromuscular nerves, the way that you move in space, your body was made for movement, and that shifts everything too.  Exercise is the best medicine going.  You got to just know how to do the right stuff for you, and then your metabolism like we are talking about, what is going on with the gut, the immune system, the hormone system, the neurotransmitters, all that biochemistry, and there is ways to think about all of these things and treat them with lifestyle.   –Next Slide– So, like, all right, these are important things, right?  Metabolic/biochemical, that is this part, metabolism, right?  These are some of the things we work with, your diet, you know working with food sensitivities, the right nutrients, low antigen, high polyphenol diet.   This is a whole lecture obviously just to talk about this, supporting the adrenal system.  There is an off-label medication that I use a lot called low-dose naltrexone, because it gently shifts the immune system and enhances certain biochemicals that enhance well-being and block pain and then there is healing the gut.  There is ways to treat dysbiosis and leaky gut.  There is ways to treat biofilms, which can perpetuate dysbiosis. –Next Slide– And then the movement or mechanical system.  Movement is medicine, it can be healing.  If you are sedentary because of pain, because of joint injury, because of obesity, because every time you do exercise, you get wiped out because you have got chronic fatigue or fibromyalgia, you need to find a way to exercise that works for you, and I guarantee there is a way.  I have worked with so many people who have felt like, I cannot move, I cannot do anything, but then you teach them in the right way, how they can learn to move, start where they are.  Accept the current limitations and build and build and open your envelopes that you get stronger, more flexible. Build your endurance while you are doing these other aspects of healing, and obviously, there is aerobic exercise, stretching, strengthening. But most importantly potentially, especially if you are chronically ill, is mindful movement arts, whether it is yoga or tai chi or chi-gung or Feldenkrais. These are approaches that are really about helping you bring your awareness into your body.  So, you are actually directly aware, you can bring compassion to yourself, you can learn to move from the inside out, as opposed to some kind of no pain, no gain thing, which just flares you up and makes you worse.   –Next Slide– Okay, but here is the whole point of this talk.  The real thing I want you to take home that is so important is, yeah, we have got all these different issues that give rise to these illnesses, but autonomic imbalance is huge and people do not like to recognize it.  We do not want to think there is something wrong, right?  And part of it I think is because so many people have been stigmatized, accused, humiliated, and otherwise dismissed; oh, you are just anxious, blah, blah, blah.  I am not talking about that.  I am talking about the fact that your state of calm versus anxiety.  Your state of autonomic balance or imbalance is fully integrated with the underlying biological processes that give rise and perpetuate your chronic illness and your chronic pain, and if you do not address that, it is just like you are not addressing your gut imbalances or your hormonal imbalances. The fact that you are sedentary or the fact that whatever it is, it is one complete system and you really need to address the autonomic imbalance.The good thing is, there are ways to do that, there are so many techniques and tools and technologies. –Next Slide– Let us talk more about that, and I just want to like another little diagram here, right?  You have a state of mind and consciousness, it is your mind-body state, and it is the way you are in relation to yourself, and that influences everything.  It influences your pain pathways, it influences your brain function, your immune function, your cellular energy production, your relationships and roles with people around you, which influences your happiness, which feeds into the whole system.   Your motivation and self-care, like are you doing things that nourish you and heal you or you are doing things that feel good in the moment but actually make you sicker, like eating the wrong food or using substances that create transient feeling good, but in the long run, feed into your illness process, and then of course like your whole gut barrier biome motility.  Your gut-brain axis is so powerful, and if you are not doing this, you are missing the boat, but on the other hand, when you start to open your mind and start to learn tools, then you are pulling all this stuff together and you can start creating a more healing state.   –Next Slide– I just want to emphasize this a bit more than chronic illness and chronic pain, your body believes you are in danger.  There are biochemical, physiologic, biological, mental emotional signals that perpetuate that message.  Whether it is life stress pain, trauma, immune dysfunction, toxin, drugs, acute illness, surgery, or the pandemic crisis that is going on, and all of the social difficult stuff going on, it all creates a sense of, you know, and it creates a vigilance, right?   And that vigilance that you might experience mentally and emotionally is so to speak being experienced by yourselves, and that is part of what recent science is showing us, that our biology has a danger detector, our immune system has danger detectors, our mitochondria are danger detectors, and there is a cellular protective response, that is kind of like circling the wagons.  The cells stop producing so much energy, they stop producing as much DNA and protein synthesis which they need to survive and thrive.  There is activation of the immune system, hypervigilance, and decreased cellular communication, and that feeds into the danger response, and it gets stuck there, and the question is, how did you shift that?  We treat all the physiology, we get you moving, sleeping, doing all those healthy behaviors that are so important, but there is activating the biochemistry and neurology of safety, and that is your mind-body connection. –Next Slide– And one little other thing just to keep in the back of your mind is that your brain has got three sort of functional aspects.  These are not anatomically separate, but they are kind of anatomically different, right?  There is your neocortex which is like your thinking psychological brain, and then there is your limbic system which is your emotional brain, and then there is your brain stem which is like your physiologic cellular influencing brain, and they are so integrated, but there are distinct things that you do to address those different aspects, and so, talk therapy like CBT is great, it helps you think better, but it does not necessarily get at your limbic system unless your therapist happens to be super talented and also work in things to connect with you on that level, and that does not necessarily get into your body unless someone is teaching you some kind of body awareness, body calming, mindfulness, somatic experiencing, EMDR.  There are various techniques.  Internal family system.    There are different tools that you can learn, that you can do by yourself, or if you need the help, you get help from someone who helps you work through it and learn how to do it and learn how to hold you in that space, so that you can hold your own being in that space of safety, and that sends that cellular signal, and bit by bit, that is how you heal.   –Next Slide– In my eyes, there are six steps to mind-body healing:  relaxation, mindfulness, body awareness, insight, like developing your inner maps, you understand what is going on in your inner and outer world.  There is activating the power of your heart and soul to heal you, but to generate positivity and love and compassion and caring and to actually connect to the higher aspects of your own being, which are there to heal you and that is part of what transforms you.   So, this is a huge topic.  I will be talking more about it.   If you have not subscribed to the YouTube channel, do it, and you can also sign up to get on the email list, so that you are part of my email community.  Get notified when new posts come out, and you know, I am constantly putting stuff out there in terms of mind-body healing as well as these other aspects of healing.  Some of it is free, in terms of free sessions we do online.  Some of it is more in-depth and more developed and really helps you build skills overtime, and so you are invited to keep tuning in.  Send your feedback, I would love to hear it, and I am wishing you all the best for speedy healing.  Take care.
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