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

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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

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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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Pain and Suffering. How To Get Off The Mindbody Rollercoaster

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Summary:

Did you ever practice meditation that brought you to a really calm comfortable space, and then before you know it, you’re back in the distress and suffering? What is that about? This video unpacks the inner dynamics of the rollercoaster of mind-body practice. Why can it seem like all the. benefits just disappear like smoke. What is it a see-saw of feeling good then feeling crummy. We can understand it by looking at the inner mental/emotional/physical processes. We also get insight from the sages of Torah and Kabbala who talk about the very tangible existence of our “animal soul” and “divine soul” and how to get them to play nicely together. Please watch the video and share your comments or questions.

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

Related Posts:

Full Transcript:

Hi, it is Dr. Shiller here.  Today I want to speak in response to a comment that I recently got from one of the people in one of my classes, and I hear this comment quite a bit. It is very relevant for a lot of people, and this is someone who was doing some meditation training, some mind body skills development. Someone who is dealing with chronic pain and some other medical challenges and social challenges. Some really hard stuff going on for her, and her comment was like this: “Hey, Doc. During the meditation, I get to this really quiet sweet space, especially the things we do that are about opening up our hearts and like giving, and I really get to a great place and my pain is gone. And it can be gone for hours, it can be gone until the next day. It is amazing. I really appreciate this. But, and here is the kicker, right? But you know, I go back out into life, whether it is the same day or the next day, and something happens. And then suddenly, it is like, I never even did the meditation, I am in this place of distress in my mind and my emotions, my pain comes back. You know, I am starting to feel like I am just kind of a phony. Like, I am imagining it, like what is really going on here?  I can relate so much to the question, personally, when I was in medical school and in residency, and I was first starting to work with contemplative practice. I could very much relate to what this person is talking about, that the experience, the practice itself was deep and beautiful, and seems so transformative. Like, “Oh, my gosh, the world is going to be completely different now”. Then, you know, whatever amount of time later, it is like, boom! Getting sucked back in the same old stuff, the tension, the anxiety, I was having. Like neck pain and back pain and things like that. And so, it was really this sense of like, okay, was that real? Is this just a bunch of phoniness, like, what is really going on?  And what I want to say is that it is real.   The experience of dropping into quiet in your mind, your emotions, in your body, generates biology, that is healing. It generates mental emotional patterns that are healing, and very pleasant.  It is real, it is reality.  The issue is that you also have other aspects of your being, and your history, and your habits. There can very much be a dance between those two, I am going to call that dance and not tension, because to my eyes at this point, 20 years later, the dance is where the real artistry and the real healing and creativity of life comes in.  The first principle I want to share is that wherever your mind goes, there you are. And this is something that has been said by a lot of wise people over the years, including the Baal Shem Tov and Rabbi Nachman and in some of the sages of the Torah tradition. That wherever you put your consciousness, your conscious intention, or your unconscious intention, where your mind is, that is, what is generating your, a lot of your physiology. That is what is feeding into the thoughts, you are having, the emotions that are coming up. Yes, the bodily responses you are having, together with those thoughts and emotions. So, the art and the work is really a question of starting to become aware of that.  A lot of my students who are progressing further along, are starting to be aware of that, right? They start with the meditation that brings them the quiet to go, wow, this is amazing. Then they start to notice, oh, I keep thinking about that guy. Or I keep thinking about this experience or whenever I see this person, it brings on a sort of negative mind, emotion state. So, what do you do about that? Well, you start to work with it.  It is an aspect of self-learning, it is reflective learning, to start to see those patterns.  When you start to see those patterns, you start to become more mindful. You start to actually develop a kind of awareness that is not judgmental. You see that maybe, okay, I am self-judging, or self-doubting, or there is self-blame or even self-hatred.  Then you start to actually say, wait, no, I do not want to live from that place.  It is a little bit of an active will, just to decide that.   Then it is an act of awareness and something transformative that happens when you just start letting your heart receive it, and be aware of it.  If you were to see a little kid who is misbehaving, and they are a little kid, they are doing what little kids do. And if you are not too close to the issue, you kind of recognize and you are like, Yeah, and you can like, give that kid some support. Like, “Hey, come on over here. Listen, you know, I care about you. I love you. I see you doing that thing that is making a mess. You start to do that with yourself, and it can be transformative, because what happens is you develop the skill of dropping into a quiet place that just feels good and brings on the biochemistry and neurobiology of healing.  Then you also develop this presence of mind, this mindfulness, this compassionate, discerning awareness. That lets you see your habits of going to the negative places, and lets you start to make more conscious choices. Rather than just going with the habit. Because habits, most of them we developed from back then, when we were not so conscious. A lot of your worst habits, I can guarantee you came from a place of you actually taking care of yourself.  When you start to actually notice, wow, the reason I am reacting with anger is because back when this happened, I was scared, I was scared, I did not want it to happen again. So, I am angry, because I am trying to protect myself, and you start to see that kind of stuff.  And that is the process. That is the work of inner healing.  I want to bring another aspect to this from the Torah tradition.  And you know, the inner tradition of Torah brings this notion that every human being has got what we call an animal soul and a divine soul.  Your animal soul is really responsible for self-protection, self-preservation, reproduction, pleasure; it is your physical embodied self with all of the urges, and aversions that you have.  A lot of that is very conditioned, a lot of it is instinctual, a lot of it is cultural, it is stuff that we just are.  Then we have got this godly soul, it is a divine soul.  It is the part of us that as we grow and mature, we start to naturally have a sense of desire or urge, to be generous, to be giving, to include other people in our world, to care, to actually want to make a positive difference.  Those are aspects of our godly soul.  Those are aspects of your elevated divine soul.  In that tradition, the work of growth, the work of healing, the work of returning to our highest potential, is to come in contact with that elevated divine soul. To understand it, taste it, know it, become familiar with it, start to identify with it, and bring it with compassion, with intelligence to that animal soul.   The metaphor that often gets broad is like, if you are a person who rides horses, you know that the horse needs care, the horse needs to be brushed and cleaned, the feet need to be protected, the horse needs good food, shelter and protection from bad weather. If you want to be a good horse person, you need to take care of the horse. But you also need to ride the horse, and you need to direct the horse where you want to go. That is what horsemanship or horsewomanship is really about.  It is actually having the awareness and compassion for the animal, and actually having a clear connection to your own higher aspiration, your own higher purpose, your potential of who you are.  I invite you to really reflect on that metaphor, reflect on the different aspects of your own experience, that you might consider your animal bodily, embodied soul.  Rather than judging them as bad, just realizing that they are part of who you are, and part of what you can direct and learn to develop mastery over in your path of self-healing, of self-actualization, of being your most beautiful, powerful self in the world.  You are not a phony, you are someone who is learning to pay attention. You are someone who is learning that when you give your mind to matters of the divine soul, of purpose, of potential, of possibility of expansiveness, of connection, there is a certain physiology that is supported by that, and that comes out of that.  When you give your mind to the potentially more protective, negative, challenged aspects of the animal soul, you may experience negativity. But gradually over time, you learned to let your divine soul be the rider of the horse. In summary, what most people say who stick with the practice and stay true to it over time is that as you get familiar with it, as you develop a sense of greater self-acceptance, and you work through some of the challenges of relating to those more difficult parts of self, then the difference is less glaring, the extremes are less extreme and you develop a somewhat smoother pathway.  We all have times of elevation and times when we fall.  And what happens over time is the decline, the fall becomes for the sake of rising, and according to the Hasidic tradition, every time you have a fall, every time you slip into a negative pattern, every time you meet those difficult parts of self that are such troublemakers, it is really happening for the sake of them being elevated by your own divine soul and awareness.  There is really a path here of transformation that is available to you if you are sincere and dedicated and willing to develop awareness, develop the skill of self-regulation and quieting, develop mindfulness and compassion that the bumps are less strong, you spend more time in a place of relative, Hey, it is okay. I am with it, I have got this, things are going to be alright. And you spend less time cycling into the really heavy negative patterns. It takes time, it takes effort. This is real work, but it is also incredibly fruitful and valuable, because it not only influences the process of bodily healing, it leads you to excel, a sense of self and self-expression that is ever more beautiful and evermore connected to doing good things in the world and being the kind of person you want to be.   I hope this has been useful.  Feel free to leave any comments or send me comments or questions by email if you want.  And tune in again.  Look forward to being in touch.
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Fibromyalgia and Fatigue. Four Reasons Why You Flare Up and Can’t Make Progress

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Summary:

One of my readers writes:  

“Hey Doc, I’ve been doing all the right things to improve my fitness.  Pacing myself.  Accepting my low threshold and working within it with lighter weights and shorter workouts.  I’ve progressed, but I’m stuck and not able to increase my exercise tolerance enough.  Why is that happening?”

In the video, I dive into some of the reasons why fibromyalgia and chronic pain can be so limiting in terms of activity.  Sometimes there are things you can do to break through the barrier and build strength, endurance, and ability to function.

Check it out and let me know what you think.

Did You Know:

  • You can learn to reduce pain, improve mobility, and increase energy. Movement Toward Health is an affordable online training program that helps you heal and grow in a warm and inviting community. It opens periodically for new members. You can get more information and join the waitlist here: www.MTHTribe.com 
  • Do you want experienced, compassionate guidance in overcoming chronic pain or illness? Dr Shiller is available for telemedicine consultation worldwide regarding chronic pain, fibromyalgia, autoimmune disease, fatigue, and stress-related illness.  Learn more here https://www.drshiller.com/stage-dr/consult
  • Have you learned to mobilize your most important self-healing superpower? If you balance your stress/relaxation response, it could change your life. Dr Shiller gives regular free mind-body training sessions on zoom. Even if you “can’t meditate”, he has a way of helping. Learn practical tools for transforming pain and suffering, reducing stress and inflammation.  Sessions are free. You can register atwww.mindbodygroove.com
 

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Full Transcript:

Hey, it is Dr. Shiller. Today, I want to talk in follow-up to a previous video in which I was discussing the suffering cycle and the disability cycle in chronic pain and chronic illness, especially fibromyalgia and related conditions, and how a person can understand that and start to break those cycles. And I got a very interesting response from one of my readers, one of the watchers, and I want to read you some of it, because you might have similar questions.  

She writes, “Doc, to be honest, I have made a lot of improvements, but I never got to a place of really big improvement.  I have tried gradually building my exercise.  I have done behavioral modifications to pace myself.  I have tried to stay within my exercise threshold.  I have done things to tweak a slightly low thyroid.  I do not have a positive ANA or a high inflammation marker, but I continued to get these really bad flare ups of fatigue and discomfort.  My pain is much better, but the fatigue and the post exercise, just malaise and feeling horrible keep catching up with me.  What do I do about that?

It is such a great question, because whether it is chronic pain, or fibromyalgia, or chronic fatigue syndrome, ME, as we call it, these are complex processes.  And there are a few different things that can be going on, and I would say there are really like, four or five reasons why it can be hard to break through and actually build that activity tolerance threshold, because that is really the issue here.  For someone who wants to either prevent getting more disability, disabled, or someone who wants to kind of climb out of that hole of disability and get more active, what stands in the way? 

The first thing we talked about in that first video is that the threshold gets lowered, right? Like everybody has a threshold, within which we can actually be active physically without damaging ourselves.  So, I can run two or three kilometers, a mile or two or three, and I can feel okay with that, but if I try to run a marathon, I would be wrecked for days, and maybe a week or longer, I might even get injured. 

Everyone’s body, you included, you have a certain threshold of how much energy your cells can put out, how much metabolism your muscles can do, and above that, what happens is it overloads the system and creates a kind of state of biochemical toxicity and inflammation and acidosis.  And if you are susceptible, because you have a low threshold, which is expressed in fibromyalgia, chronic fatigue, then that happens at much lower levels of exertion, and so you go over that threshold and suddenly this vicious cycle happens, which can increase inflammation, increase stress hormones, increase a whole bunch of different changes that create a flare, and so the question is, how do you work with that?  

This particular person talked about, is trying to stay within threshold and doing shorter workouts with less weight, and she made a certain amount of progress, but did not really elevate her threshold, like she really wanted to.  What else could be going on? One of the things is that we know that there are hormonal and immune dysregulation that happened.  

We know that sometimes there are aspects of biochemical toxicity. Sometimes there are aspects of dysfunction of the mitochondria, which are your cellular energy producing organs. And all of these things are very much integrated, your degree of inflammation, your mitochondrial function, your biochemical stress, or oxidative stress, are all intertwined with each other, and when you are in a susceptible place, any one of those going up too high, can she kind of create a little vicious cycle, stuff like low grade infection feeds into that, hormonal dysfunction, whether it is your thyroid hormone, your adrenal hormones, or your sex hormones can also make you susceptible. 

If you have ongoing toxicity to heavy metals or environmental pollutants, where you have got low-grade inflammation in your body from some kind of liver toxicity thing, that also makes your system more susceptible. So those things are incredibly important to address. That is a huge topic. I am trying to cover that right now. Although in future videos, I sure hope to God willing. 

The last aspect that I want to bring up is really the stress response of the body. Because as we know, we already talked about it, that the stress response, the fight-flight-freeze response, which is meant to be kind of modulated by a relaxation response is intimately connected with that mitochondrial function or hormonal immune axis. They are all intimately connected, because your stress response is how your body copes, and there has been all sorts of research showing that when a person has a prolonged overactive stress response, or an acute stress response, it shifts immune function, it can shift hormonal function, it can shift mitochondrial function. 

One of the ironic weird things about physical exercise is that it is a stressor, right? Like we know that to be true. You know, there is acute exercise, there is long-term exercise. But there has been tons of research that is showing that when you do exercise, your stress hormones go up, your autonomic system activates a stress response, because it is a get up and go.

The question is, when you are doing physical exercise, are you activating too much of a stress response? So, all those other biochemical things are really important. But what is going on in the stress relaxation response, is the autonomic nervous system. Which consists of that stress response and relaxation response. Is it kind of on the edge and so out of balance, that you do a little bit of exercise, and boom, you kick into a high stress state that flips off the mitochondrial function and your hormonal and so on and so on. 

It is possible, it is possible, and that is why personally, from my point of view, when people are dealing with low threshold states like fibro and chronic fatigue, it can be so useful to do what you could call mindful exercise.  

Mindful exercise means exercise with awareness, and it means exercise that is deeply relaxing. So, rather than going to the gym and pumping weights, even if they are small weights, we are getting on the treadmill, or doing the stair stepper, even if it is a low volume, low intensity, those can be stressors. And so, what you really might want to consider is doing exercise, whether it is a very gentle yoga, Feldenkrais awareness through motion, movement, Tai Chi, Chi Gong, things that are really meditative, with a lot of awareness, where the physical activity is not about exertion, the physical activity is about mobilization, it is about relaxation. It is about waking up your body’s natural ability to move, to breathe, to reduce co-contraction and resistance that you might have in your neuromuscular system, and so, it is a really good place to start if mainly what you have been doing has been typical gym exercise, without awareness, without relaxation, because gym exercise without awareness and relaxation can be a stressor, mindful exercise can be done in a relaxing way.  

Let us also get clear, right? A lot of people say, “Well, I tried to do yoga,” but then you find out what kind of yoga and it is more the aggressive kind. There are yoga practices that are really forceful, Ashtanga and Iyengar, you know, other things that, you know, I forgot, Vikram, that can be fairly aggressive. And that is not what I am talking about here. I am talking about gentle Hatha Yoga, where it is about awareness. It is about gradually coming into a soft pose, not pushing too hard. Lots of breath, lots of awareness, meeting the edge and just relaxing into it. So, it is a different way of moving.  And it could be what will help you get started and help you start to build your mobility, your flexibility, your strength, your body awareness, and what you need to progress to higher levels of physical activity. 

I hope that is interesting and helpful.  I am very grateful for your comments or questions.  Feel free to shoot those to me either where you are finding this video, or through an email.  

Thanks for watching, and looking forward to seeing you. 

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Fibromyalgia is Tough. Why is Disability Optional? Part B

This is part B of a two part video.  Please watch part A first. 

Click HERE to watch part A.

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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
You can learn more about Dr Shiller’s practice and schedule a telemedicine or in-person consultation at www.drshiller.com

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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.
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Fibromyalgia is Tough. Why is Disability Optional? Part A

This is part A of a two part video. 

Click HERE to watch part B.

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Summary:

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.

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
You can learn more about Dr Shiller’s practice and schedule a telemedicine or in-person consultation at www.drshiller.com

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Full Transcript:

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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Dr Shiller’s Integrative Approach to Fibromyalgia

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Summary:

Why is fibromyalgia so difficult to deal with?  What is the underlying biology of fibromyalgia?
This video discusses the following :
  • Pain processing is more sensitive  in the spinal cord and brain.  The amplifier is turned up. We know many of the things that can turn up pain processing.  And many of them are treatable!
  • A variety of triggers can bring on the changes of fibromyalgia
  • Triggers lead to biological imbalances that feed into the pain, fatigue, insomnia, brain fog, and other symptoms
  • Altered Gut-Brain-Immune function can worsen fibromyalgia, and many chronic illnesses.
  • Various lifestyle approaches can change the underlying biology of fibromyalgia and reduce symptoms.
  • It’s crucial to focus on healing, and not just the disease.
  • Aspects of healing include:
    • mindbody relationships
    • nutrition, diet, hormones, and gut health
    • the right kind of physical treatments and exercise
  • There are many tools that can help you heal.

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

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Dr Shiller’s Integrative Approach to Pain

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Video Overview:

Things you should understand about chronic pain.

  1. Your pain processing system can be turned up or turned down like an amplifier. Learn what factors make the system more sensitive, and ways to turn down the volume.
  2. Secondary sources of pain can worsen suffering and disability.  They are treatable, so understanding them is important.  Some secondary sources of pain include:
  • changes in neuromuscular function.
  • change in the fascia and connective tissues of the body
  • gut-brain-immune axis changes can increase pain, inflammation, anxiety/depression, and other chronic disease
  • hormonal changes
  • emotional distress worsens pain, which worsens emotional distress
Chronic pain is a process of change that are learned over time.  It can be unlearned. There are many natural approaches to helping the body and mind heal.   The video talks about these in more detail. Your healing path is unique to you. We can work together to find the healing resources that can help you feel better and live better.

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

Related Posts:

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Dr Shiller’s Clinical Services

Watch this video to get an overview of Dr Shiller’s integrative approach:

Scroll down past office logistics, for videos that talk about his approach to pain, fibromyalgia, osteoarthritis, depression/anxiety, and other difficult chronic conditions.

Office Logistics:

Dr Shiller meets with patients in Jerusalem, Beit Shemesh, Gush Etzion as well as by telemedicine. Telemedicine appointments are available for people in New York, New Jersey, Connecticut, Florida, Virginia, and Israel.  Other international clients can be seen on a case-by case basis.

He sees patients in the Leumit clinic in Beit Shemesh on Bar Ilan.  Contact the clinic directly if you are a Leumit patient. He does not work through the other Kupot or US insurance companies.  Patients with private insurance often get reimbursement.  Ask in advance for a visit summary.

Access the convenient online scheduler on the homepage here www.drshiller.com, and follow these instructions:

  • Click “schedule an appointment” in the upper right corner.
  • Follow instructions on the scheduling page.
  • If you need more help, contact the office directly.

Direct office contact:

  • 1-203-290-1368
  • 972-058-789-0369
  • office@drshiller.com

See more videos about Dr Shiller’s approach to difficult chronic problems.  Click on the relevant link below:

Healing Pain When Drugs and Procedures Don’t Help

Fibromyalgia: Feeling Better and Healing The Roots

Optimal Recovery After Injury, Surgery or Severe Illness

Topics Coming Soon:

  • Stress, Depression, and Anxiety
  • Osteoarthritis
  • Fatigue and Post-Covid Syndrome
  • Persistent Postoperative pain
  • Autoimmune Disease
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Unlearning Negative Mind Body Patterns That Create Pain and Illness: Part 2

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Summary:

In this video series we’ve been learning about how chronic pain and associated suffering develop.  The idea is to understand the chronic processes, so that you can make choices about how to reverse them and reclaim your sense of well-being and ability to function and live your life. The previous videos in this series shared how the body-mind “learns” chronic pain.  You can also “unlearn” chronic pain.  This video continues to explain how that process works. I spoke in previous videos about the biological processes that are involved in the development of chronic pain.  Have a look at those if you haven’t seen them yet.  You can see those posts HERE. We discussed how protective responses are built into the pain processing and movement control systems of your body-mind.  These processes get knocked “off the rails” by certain factors.  And persistent pain leads to gradual changes in those systems that can unfortunately make pain worse.  It’s like vicious cycles, where the pain system gets sensitized, and the movement control system stops working as well.  So movement hurts, and pain spreads. It’s richer than that, as persistent pain and the resulting stress-response lead to measurable changes in gene expression, hormonal regulation, cellular energy production, emotional regulation, immune balance, and gastrointestinal function.  And these all feed back into one another and can increase pain. So there is this snowball effect, where vicious cycles of biological relationships propagate forward and create the disease of chronic pain. The good news is that many of those changes can be reversed.  In my experience, your own mind/body connection is a crucial place to start the changes.  One great place to start is by developing the quality of ‘mindfulness”, which starts to shift the reactivity of the protective responses.  Just like your brain-body learns chronic pain, mindfulness can start the process of unlearning.

Did You Know:

  • Dr Shiller is available for telemedicine consultation in CT, NJ, and Florida, as well as worldwide regarding chronic pain, fibromyalgia, autoimmune disease, fatigue, and stress-related illness.  His US-based consultations are offered in conjunction with Rose Wellness to enhance the quality of care and ease of your experience as a patient.   Contact the office or schedule a consultation at Rose Wellness. For international consultations contact 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.
  • 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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Full Transcript:

As mindfulness develops, you start to notice stuff, you become more aware, because you start to develop your ability to pay attention and receive what is there.   You start to notice, “Gosh, I’m spending most of my life filtering through my thoughts and beliefs about what’s going to happen instead of actually seeing what’s going to happen” and almost everybody that goes down this path is like struck by that, “Oh my gosh, I was living in fantasy and I’m starting to touch living in reality” and part of that is you start to touch the sweetness and goodness of life, you start to smell and touch and taste things that are beautiful.  We will talk about that in the next part, because that is really important, but for now, we are talking about kind of inhibiting the negative patterns, because that is the other aspect of what we do, it is kind of like I said, stopping these unproductive reactive habits about your mind and your thinking, your nutritional habits, your posture, your bodily habits, what you do in the world, and it is not like you are being forced by some sort of blaming conscious and shitting yourself, like what is wrong with you, do not you know you should not do that, that is not the game, because what happens is you just start to pay attention and you just forgive everything and you just choose to be grateful and you let go and you practice letting go and being present, and what arises naturally is just a clear choice, like, “I don’t want to eat that stuff or gosh this person in my life is toxic.  I want to do something different because I’m, so much negativity there or gosh look at all my own toxic thoughts, how can I be with that and let go of them” S Mindfulness practice develops this observer, that starts to notice the negativity and you naturally start to just say, “No, thank you” and you naturally become more forgiving with yourself and forgiving with other people.  You naturally start to like accept your life as it is and that does not mean it is never going to change, but you are less reactive to the things that are difficult, that used to grab you and pull you into severe suffering, and it is remarkable the changes that just happen naturally that I have been privileged to witness with other people.  You know it is kind of like there is concrete and then suddenly the grass grows through the crack somehow, like there is life in there that wants to come out.  One example, there is a fellow that I worked with, his name is Bill, and he was a recovered alcoholic, but really struggling with cravings, a lot of difficult emotional stuff in his life, and every day was like a war to not drink, and you know we were practicing one day and Bill basically says, “I really have the urge to drink” and I said, well, okay, so what else are you experiencing?  He said, well, I feel tight in my chest and I feel irritable, my back hurts.  Okay, and what about the emotions?  I feel irritated, I feel angry with you for asking me all these stupid questions.  So, I said okay, so how about just sit with what you are experiencing, sit with the difficult emotions, just observe them and be with them, notice what they feel like, do not try to change them, just agree because that is what is happening.  He sits there for like a minute and a half and then like a smile comes on his face, like why are you smiling?  He’s like, well those emotions were really hard and then they just kind of went away, and I do not feel like I need to drink anymore.  That was a discovery, it was something that just came to him through observing his own life, and I could give you so many examples of things like that in my own life, in the life of so many patients, where it just comes from paying attention with compassion, dropping the judgment, forgiving, being present and cultivating this part of you that actually kind of hovers above your emotional self and your bodily self and is with you all the time, and it is an expression of a deep inner intelligence, and it is your healing intelligence and that is the power of doing that kind of training to unwind these pathways of mind, emotion, and physiologic reactivity that perpetuate and develop this process of chronic pain and chronic illness, and so, as you practice and train yourself to be aware with compassion and with discernment, things start to change spontaneously, you start to just, you know, you may have lived your whole life in patterns of reactivity that are mental, emotional, and physical, and you start to notice them and they start to kind of get lighter and get less heavy and you start to have more freedom of choice, and it is from practice, it is relearning, it is rewiring, nerves that fire together wire together.  When I have that experience of tasting the irritation that once created reactivity, and I choose to just be with it and let it be there and say yes, it is happening, I agree this is what is up, letting go the judgment, then I am turning off the reactivity, it is like, I am uncoupling it, you know, it is those two nerves, there is the irritated and then there is the reactive nerve, right?  I am irritated, so then I get emotional, and I am basically saying, “No, I’m not believing you anymore, you are just a habit.  I don’t need to get reactive when that happens” and then you start to actually uncouple your physical, emotional, mental experience from your ability to choose to have the kind of experience you want to have, and that changes your physiology, it changes your neural networks, it changes your gene expression, because you are living in a more calm, clear, connected state, where you are not as reactive.   We talked about how there can be setbacks and how a person can be learning to live in a calm or clear state of mind and body but then something happens that like knocks him on the ground, knocks him back into the hole or they fall in the water, so to speak metaphorically, so what is that about, how do you deal with that?  We talked a bit how just being mindful gradually that happens less and you develop the capacity to respond more effectively when it does happen, but the other thing is that there is deeper kinds of work than just sitting there and being mindful of what is going on.  There is deeper work that involves getting therapeutic support, whether it is with an individual or a group or in your own inner work and intentionally going in and meeting the dark places inside, because a lot of us, most human beings, we have had experiences of profound disappointment of hurt, of trauma, of fear, times when we felt like we were disconnected and it just was not okay and, you know, there is a language for this in various psychotherapeutic and spiritual traditions, but the point is meeting those places and evoking various tools for actually doing a deeper level of work, to reclaim that part of yourself and to free up the deeply held protective responses that you might have in your heart or your body, that is profound work as well.  It is a little bit beyond the context or it is a little bit beyond the scope of this video.  So, I am not going to go there now, but that is something else to think about and talk about, because a lot of people with chronic pain and illness have trauma.  We know that early life trauma is a huge part of what influences people to develop chronic pain and chronic illness and healing that trauma can be a profound influence on all of these physiologic processes, because what it does is sort of uncouples or discharges or disengages these deeply held patterns that said, “danger” and it is about healing those, so that your whole system can be more at ease in that rest, and there is techniques for learning that. Okay, so let us make a break now and we have talked really about the process of sort of saying no and uncoupling and unlearning negative protective responses, and we also want the process of installing and learning and actually awakening healing responses.  So, we will talk about that in the next vid, hope you tune in. 
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Unlearning Negative Mind Body Patterns That Create Pain and Illness: Part 1

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Summary:

In this video series we’ve been learning about how chronic pain and associated suffering develop.  The idea is to understand the chronic processes, so that you can make choices about how to reverse them and reclaim your sense of well-being and ability to function and live your life. The previous videos in this series shared how the body-mind “learns” chronic pain.  You can also “unlearn” chronic pain.  This video begins to explain how. I spoke in previous videos about the biological processes that are involved in the development of chronic pain.  Have a look at those if you haven’t seen them yet.  You can see those posts HERE. We discussed how protective responses are built into the pain processing and movement control systems of your body-mind.  These processes get knocked “off the rails” by certain factors.  And persistent pain leads to gradual changes in those systems that can unfortunately make pain worse.  It’s like vicious cycles, where the pain system gets sensitized, and the movement control system stops working as well.  So movement hurts, and pain spreads. It’s richer than that, as persistent pain and the resulting stress-response lead to measurable changes in gene expression, hormonal regulation, cellular energy production, emotional regulation, immune balance, and gastrointestinal function.  And these all feed back into one another and can increase pain. So there is this snowball effect, where vicious cycles of biological relationships propagate forward and create the disease of chronic pain. The good news is that many of those changes can be reversed.  In my experience, your own mind/body connection is a crucial place to start the changes.  One great place to start is by developing the quality of ‘mindfulness”, which starts to shift the reactivity of the protective responses.  Just like your brain-body learns chronic pain, mindfulness can start the process of unlearning.

Did You Know:

  • Dr Shiller is available for telemedicine consultation in CT, NJ, and Florida.  worldwide regarding chronic pain, fibromyalgia, autoimmune disease, fatigue, and stress-related illness.  His US-based consultations are offered in conjunction with Rose Wellness to enhance the quality of care and ease of your experience as a patient.   Contact the office or schedule a consultation at Rose Wellness.
  • 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.
  • Dr Shiller gives regular free mind-body training sessions on zoom. You can get the schedule and register at www.mindbodygroove.com

Related Posts:

Full Transcript:

All right, so in the last video, we talked about how chronic pain and illness are processes that gradually develop over time, that genetics and life experiences and various triggers can start this process, and that your biology shifts, your system, your mind body system so to speak practices various protective and maladaptive responses and that is built into your neural networks, so practicing it over time, your system learns it and it becomes kind of set, and that is affecting your neurologic activities and emotional and mental responses, your neuromuscular functioning of your motor system, your gastrointestinal system, your hormones, your immune system.  To varying degrees, those are all influenced, because it is all one system, and it is all working together, presumably to protect you from danger but effectively to generate these secondary problems of chronic pain and chronic illness.  The system gets unbalanced, the neural networks change, gene expression can change, and the outcome is chronic pain and chronic illness, and just like it can be learned, it can be unlearned, and so this video is going to start talking about how do you help the healing process, how do you unlearn chronic pain, how do you relearn health? Healing is a learning process, it is about the conscious choices that you make on a daily basis, lifestyle, behavior, habits, thought patterns, mindset.  You could break it into three parts, because I like to do that to make it easier and they are called three M’s, there is your mind body system, your metabolic or biochemical system, and your motor or your movement system, and all of those are ways that you can kind of grab hold of your physiology and on a regular consistent basis start to shift your physiology towards health.   Obviously there is a lot to unpack there, but the point is that you really need to think about it as I am taking charge of my health.  I am not expecting someone to fix me.  I am not looking for an overnight miracle that suddenly I am going to be better.   What I am looking for is gradual change over time that happens, because I have made conscious choices, and I have been doing stuff to help my mind body system to optimize my metabolic system, nutrition, inflammation, all of that, and to actually use the power of my movement system to help my body heal. This whole aspect of retraining and unlearning pain and illness and relearning health.  There are these two parts of aspects of unlearning the bad stuff and learning the good stuff, pretty simple, right? Let us start by talking about unlearning the bad stuff and you got to start that conversation by talking about stress and almost everybody now knows that you have a stress response and you have a relaxation response, this is physiology that has been demonstrated for 50 years and interventions to evoke the relaxation response have been tested over and over and over again in so many different realms of health and showing their benefit, because they balance that system out.   You are meant to go through stress in life, life is not meant to be stress-free despite what the magazines tell you, but the point is, you have stress and then you have relaxation, and the system is in balance. Most of us in our current time are stressed, there is a lot of difficult things going on in the world, and if you have got chronic pain, chronic illness, there is a protective stress response going on and you probably like overdoing it on the stress response and under-doing the relaxation response. Simple techniques, there is a bunch of different ones, can actually evoke the relaxation response, and lots of research showing us that those are beneficial in a variety of different kinds of conditions and situations, to enhance well-being, to help people cope with pain, to reduce the effects of chronic illness in various ways on various organ systems.   The key is consistency. We are talking about a learning model.  We are talking about the body has practiced for months or years, an unbalanced stress response and all of that influences in the whole body-wide system, and so what you are looking at doing is shifting that, and that means consistency, nerves that fire together wire together, you want to shift your neural networks, you want to bathe your whole body and mind in biochemistry that starts to shift gene expression overtime.  You want to try to do it on a regular basis.   Hopefully that all makes sense, but there are a couple of problems with relaxation training.   I have been teaching meditation for a lot of years, and what I hear over and over again from a lot of people is, “doc, I try to relax and I get more tense.”  It is  a really common thing, because you know what, if I am trying to do something, I am not relaxing, effort is the opposite of relaxing, and what you could say is stress is when we are trying to put an unbalanced force on something, an absence of stress is just stopping, it is effortless, there is no effort, there is no trying to get anywhere, and so a lot of the relaxation response methods that are sort of like active, “Hey, you are going to relax,” they can trip a person up that way.  If it works for you, great, do it.   In my own experience, just simply bringing the awareness to the present moment, bringing awareness to the sensual experience of life, bodily sensations, breathing, sounds, textures, even the taste of food, that is all about bringing your awareness and your consciousness into the here and now, and there is not stress here and now.  Mental emotional stress comes from future and past; it comes from comparing and thinking and striving and yearning and trying, and when you just bring your awareness into the here and now, the whole system starts to calm down and relax.   In my experience, that is often a big change for people who are sort of stuck in the “I can’t meditate, I can’t relax.” Okay, so do not meditate, do not relax, just pay attention in a structured way, just notice what you are experiencing, notice your breathing, let your breathing be like waves coming in from the sea and rolling up on the shore and rolling out to the sea. It is an experiential process.   The second big challenge with relaxation and stress management in general is what I have heard from so many people, which is, “I feel great when I am  doing it, but then as soon as I get back to life, wow, everything hits me and suddenly like I am  back into the vortex, and I am into the reactivity” and you know whatever it is, like the wife or the husband or the co-worker who does something unkind or the pain flare or the financial issues that trigger something, and before you know it, you have fallen back in the hole.   So, what do you do about that?   One of the first things you do about that is realize that it is totally normal, if you have been practicing being in a reactive stress state for months or years, then your body is used to it, that is what we are talking about here, we are trying to change physiologic habits, and it can take time, and it is totally normal that you get pulled back into the challenging stuff.   There is a deeper level to this if you start really thinking about the structure of a human being and a human soul, which is that we often have areas in our deeply held experience in our heart, even in our bodily memory that are associated with painful traumatic experiences, and until we start to actually unravel that and unwind that, they are going to still pull, they are going to pull our attention, they are going to pull our physiology, they are going to have a pull on your emotional experiences.   That is where it gets a bit deeper, because the idea of bringing your attention and your awareness to the present moment experience, yes, it can be very relaxing, but there is a deeper process. What happens is you develop this quality of your own mind that is able to be present, and you actually gradually condition your mind and your emotions to observe what is going on without getting sucked into the drama, without getting sucked into the judgments and the habits of self-blame, self-judgment, criticism of self or others and the emotional reactivity that they create.   In my own experience and what I have witnessed with so many people, there is this process by which the awareness develops overtime, there is a part of your mind and soul that is elevated above your emotional reactivity, and you develop it, you build it, you condition it, you teach it, you learn it by practicing it, and that is why the real benefits from meditation happen from practice. By doing it on a consistent basis, by observing, by being present, by letting go of the reactivity, by falling off and getting sucked into it and then letting go again.   It is a training process whereby you are essentially saying to your whole being, I am paying attention, and I am here, and I am not going to go down those pathways, I am saying no essentially to the normal reactivity, like I am sitting there and breathing, and I am paying attention, and I notice the thought that comes up that often triggers me, and I choose to just let it go.  I notice an emotion that might come up, that might trigger me, maybe it is sadness or fear, and I just choose to hold it; I decide to compassionately relate to it.   Okay, there is a difficult emotion, I am feeling fear, I am experiencing pain, let me just be present to that as if it was a little child who needed my loving care and attention and hold it in my heart without getting into the whole reactive, oh my gosh, how’s it going to change, I can’t live like this.  The things, the habits of reactivity that naturally become part of our being when we are dealing with chronic pain and illness can be unlearned and that is really what mindfulness training is about, there is a lot of different layers to it, but the basic idea is developing awareness and consciousness that are present, discerning, and compassionate. Which means I understand why this could happen, with all the different things that have gone on in life that have happened to me, that have happened to the world, of course, this is what is happening right now.  I am falling back into fear and irritation and anger.  I am slipping into chronic pain.  I have been rehearsing it for 10 years.   Okay, I am noticing it, I am letting go, I am not getting caught in the spiral, and what happens is that there is this part of your mind or your brain or your being depending on who you want to think about it, that you develop, and it gets called mindfulness in some circles, in the teachings of Torah and Kabbalah, it is the higher soul, it is the Neshama, the part of us that is just present to our life experience and can connect our sort of lower needs and drives with our higher aspirations, and it is your biggest ally in healing. Many of the people who I serve appreciate shorter videos, because it is easy to absorb that way, and we are going to continue to learn about unlearning pain, but I am we will just to take a break here and continue in the next video, you can find that whether on the blog or on the YouTube page or elsewhere, just look for the next number in the sequence and please join me there, please share if you find this interesting, and talk to you soon.
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Why Does Chronic Pain Happen? These Scientific Principles Can Empower Your Healing: Part 2

                                                                                                   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

                                                                                                  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

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

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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

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

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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

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

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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?

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

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
Join the email-community to receive reliable, MD-reviewed information, inspiration, and guidance to help you Reclaim Your Life From Unresolved Pain and Chronic Illness http://bit.ly/3aOrrsQ
Inner Healing Essentials is an intensive six-week course taught by Dr Shiller, which teaches you the Six Steps To Inner Healing.  It empowers you to transform stress into vitality, and begin to take back your life from chronic pain and illness.  A new class begins quarterly.  To get more info and be notified of the next start date: https://andrew-david-shiller.mykajabi.com/inner-healing-essentials-waitlist.

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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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6 Letters You Should Know if You Have Fibromyalgia: Part 1

Fibromyalgia pain and fatigue are very difficult and disabling symptoms.  Many people are told by their doctors that the only option for pain reduction is medications like Lyrica, Cymbalta, and others, or psychotherapy and exercise. My experience, and the science of fibromyalgia, say differently. Fibromyalgia isn’t hopeless.  But for most people, there is no miracle cure. On the other hand, if you are open-minded and willing to try some rational things, you can likely address the biological imbalances that underlie the pain, fatigue and other symptoms of fibromyalgia. Then you’re on the road to feeling better.

Two Molecules You Should Know

This post talks about two different molecules that help many people with fibromyalgia and other kinds of chronic pain. The six letters you should know are: LDN and PEA These two will be discussed in two different posts, so you can focus on one at a time. As a medical doctor who has treated thousands of people with fibromyalgia and chronic pain, I find LDN and PEA very interesting. The first reason is that there are some research studies showing plausible mechanisms and also clinical effects on pain and other symptoms. The second reason is that they both go “upstream” from the pain symptom and get closer to the root cause of your pain, compared to pain medications.

Getting Closer to the Source of Pain

When speaking about “upstream” we mean that they work on one or more of the mechanisms of what causes the pain, rather than just blocking the pain. Let’s try to understand that. The conventional view of fibromyalgia is that the pain processing system is sensitized. This means that things which wouldn’t normally hurt a healthy person, can result in pain in someone with fibromyalgia. But conventional medicine is unable to say why it is sensitized. Despite that, we do have growing research looking at a number of pathways by which the pain processing amplifiers in the brain and spinal cord can be “turned up”. There are potential roles for stress hormones, sleep disturbance, and perhaps most importantly, inflammation. The last twenty or so years have shown an explosion of research showing that “sterile inflammation” or immune imbalance are drivers of most chronic illness. Fibromyalgia included. In the case of fibromyalgia, we know that there are changes in immune chemicals called cytokines.  These cytokines are present not only in the peripheral blood but also in the brain and spinal cord. We also have evidence that there is an activation of brain-based immune cells called microglia. Microglial activation causes an increase in a brain-stimulating chemical called glutamate. Too much glutamate creates “excitability” of the brain, and that can explain increased pain, mood changes, and even psychiatric illness, sleep disturbance, irritable bowel syndrome, hormonal abnormalities, and small fiber neuropathy. LDN and PEA both seem to reduce microglial activation and inflammatory cytokines. Both have been shown to reduce pain and help with other symptoms like irritable bowel, mood disturbances, and so on.

The First Three Letters You Need to Know: LDN

LDN is “Low Dose Naltrexone.” LDN stimulates your body to produce more of its own natural pain-blocking chemicals called endorphins or enkephalins. These are compounds that are present in your body already. Every organ in your body has receptors for these compounds. There is evidence that many people with fibromyalgia have reduced the activity of endorphins and enkephalins. Besides blocking pain, enkephalins reduce the activity of immune cells that produce inflammatory chemicals. These inflammatory chemicals, called cytokines, have been implicated in many symptoms that are experienced by people with fibromyalgia, including increased pain sensitivity, brain fog, and fatigue. LDN is a totally different thing than the usual use of Naltrexone. In higher doses, naltrexone blocks the body’s opioid system. This is why it is often prescribed by people with substance abuse to help them avoid using alcohol or narcotic drugs. A few decades ago, it was discovered that the same medication could have a profound effect on chronic pain and inflammation when used a much lower dose. That’s how LDN came into use for pain and inflammation.

The Non-Drug, Drug

LDN works in a way that is quite unusual for medications. Most medications have some kind of direct action on the body, and this creates their therapeutic effect. For instance, opioid medicines like Tramadol or Oxycodone directly bind opioid receptors, and that leads to blocking pain signals. Or if you take thyroid replacement, it is processed by your body, and then it binds to thyroid hormone receptors and stimulates cellular activity. In contrast, LDN itself doesn’t block pain or inflammation. It temporarily blocks your opioid receptors for several hours. This triggers your body to produce more of its own naturally occurring opioids. So your body’s own natural opioids block pain and exert the immune-modulating effects of LDN.

Does LDN Really Work?

While there is nothing that is 100% effective, LDN works in many cases. The existing clinical trials have shown promising results. LDN appears to reduce pain in people with fibromyalgia, and also reduce inflammatory cytokines in the body. It appears to reduce the activation of glial cells. These are the brain cells that are often overactive in fibromyalgia, and they can contribute to a variety of symptoms, including increased pain and brain fog. Because of its subtle anti-inflammatory effects, LDN is used in a variety of pain and inflammatory syndromes. Small studies have shown benefit in fibromyalgia, chronic fatigue syndrome, depression, chronic regional pain syndrome (CRPS), Crohn’s disease, ulcerative colitis, irritable bowel syndrome, Multiple Sclerosis (improved symptoms), and some skin conditions. In my clinical experience, LDN works very well for many people. In some cases,  there are people for whom it has literally made their fibromyalgia “go away”. More commonly, it results in a significant improvement in pain, energy, and often mood. Other diagnoses in which I’ve seen notable improvement include Hashimotos thyroid disease, ulcerative colitis, Crohn’s disease, psoriatic arthritis, osteoarthritis. For people who are interested in a pharmacologic treatment for fibromyalgia, especially patients who are pursuing lifestyle measures in their healing, LDN is my first-line recommendation at this point.

Is LDN Safe?

There are well-designed small trials demonstrating clinical effect and mechanism of action. Available evidence suggests that LDN is a safe medication, and naltrexone itself has a long safety record. While there are no large long-term randomized controlled trials of LDN, I suspect that won’t change because it’s a generic drug and there is no profit incentive to pursue large clinical trials.

Are There Common Side Effects?

The most common side effects of LDN appear to get better when you stop the medication. Issues that I’ve seen in my practice are similar to what is shown in the available research. That includes vivid dreams, insomnia, increased pain, sleepiness, headache, abdominal discomfort, and nausea. Some people decide not to continue it because of side effects.

Conclusion

LDN is a relatively safe, non-typical medication that helps many people with fibromyalgia. The risk/benefit is pretty good compared to the other medications that get used for fibromyalgia. In contrast to typical pain meds, it has minimal likelihood of side-effects like sleepy, groggy, zombie feeling that often happens with Lyrica or Gabapentin. LDN has the advantage of often addressing multiple fibromyalgia symptoms, including pain, irritable bowel, and fatigue. However, because it is ‘off label’, many doctors don’t know about it. So you might have to do some effort to find someone to prescribe it locally. There are some doctors who are willing to prescribe by virtual visit. To find a local doctor who provides it, you may check out the provider directory at the LDN Research Trust website, or  feel free to contact my office. Stay tuned for Part 2 where we discuss PEA.  You can get notified of when it’s posted, and join the email community at this link: www.whathealsfibromyalgia.com Please feel free to share this article with anyone who you know is suffering from pain or fibromyalgia and could benefit from the information given. You can see a short video that speaks about LDN and Fibromyalgia on my Youtube channel: https://www.youtube.com/watch?v=m_uUkInZ1OQ Note: This article is for informational purposes only. There is no doctor-patient relationship here, and this article is not medical advice. Please consult your doctor about any therapeutic choices you might make. ******

REFERENCES

1 Desmeules, Jules, Jocelyne Chabert, Michela Rebsamen, Elisabetta Rapiti, Valerie Piguet, Marie Besson, Pierre Dayer, and Christine Cedraschi. “Central Pain Sensitization, COMT Val158Met Polymorphism, and Emotional Factors in Fibromyalgia.” The Journal of Pain 15, no. 2 (February 2014): 129–35. https://doi.org/10.1016/j.jpain.2013.10.004. 2 Ramanathan, Seethalakshmi, Jaak Panksepp, and Brian Johnson. “Is Fibromyalgia An Endocrine/Endorphin Deficit Disorder? Is Low Dose Naltrexone a New Treatment Option?” Psychosomatics 53, no. 6 (November 2012): 591–94. https://doi.org/10.1016/j.psym.2011.11.006. 3 Üçeyler, Nurcan, Winfried Häuser, and Claudia Sommer. “Systematic Review with Meta-Analysis: Cytokines in Fibromyalgia Syndrome.” BMC Musculoskeletal Disorders 12, no. 1 (December 2011): 245. https://doi.org/10.1186/1471-2474-12-245. 4 Rodriguez-Pintó, Ignasi, Nancy Agmon-Levin, Amital Howard, and Yehuda Shoenfeld. “Fibromyalgia and Cytokines.” Immunology Letters 161, no. 2 (October 2014): 200–203. https://doi.org/10.1016/j.imlet.2014.01.009. 5 Behm, Frederick G, Igor M Gavin, Oleksiy Karpenko, Valerie Lindgren, Sujata Gaitonde, Peter A Gashkoff, and Bruce S Gillis. “Unique Immunologic Patterns in Fibromyalgia.” BMC Clinical Pathology 12, no. 1 (December 2012): 25. https://doi.org/10.1186/1472-6890-12-25. 6 Parkitny, Luke, and Jarred Younger. “Reduced Pro-Inflammatory Cytokines after Eight Weeks of Low-Dose Naltrexone for Fibromyalgia.” Biomedicines 5, no. 4 (April 18, 2017): 16. https://doi.org/10.3390/biomedicines5020016. 7 Younger, Jarred, Luke Parkitny, and David McLain. “The Use of Low-Dose Naltrexone (LDN) as a Novel Anti-Inflammatory Treatment for Chronic Pain.” Clinical Rheumatology 33, no. 4 (April 2014): 451–59. https://doi.org/10.1007/s10067-014-2517-2. 8 Kadetoff, Diana, Jon Lampa, Marie Westman, Magnus Andersson, and Eva Kosek. “Evidence of Central Inflammation in Fibromyalgia — Increased Cerebrospinal Fluid Interleukin-8 Levels.” Journal of Neuroimmunology 242, no. 1–2 (January 2012): 33–38. https://doi.org/10.1016/j.jneuroim.2011.10.013. 9 Albrecht, Daniel S., Anton Forsberg, Angelica Sandström, Courtney Bergan, Diana Kadetoff, Ekaterina Protsenko, Jon Lampa, et al. “Brain Glial Activation in Fibromyalgia – A Multi-Site Positron Emission Tomography Investigation.” Brain, Behavior, and Immunity 75 (January 2019): 72–83. https://doi.org/10.1016/j.bbi.2018.09.018. 10 Patten, D.K., Schultz, B.G., Berlau, D.J., 2018. The Safety and Efficacy of Low-Dose Naltrexone in the Management of Chronic Pain and Inflammation in Multiple Sclerosis, Fibromyalgia, Crohn’s Disease, and Other Chronic Pain Disorders. Pharmacotherapy 38, 382–389. https://doi.org/10.1002/phar.2086 11 Low Dose Naltrexone: Side Effects and Efficacy in Gastrointestinal Disorders [WWW Document], n.d. . IJPC. URL https://ijpc.com/Abstracts/Abstract.cfm?ABS=3116 (accessed 3.1.20).
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Chronic Pain and Illness? Find The Flowers Among The Thorns, and Choose Health.

Here is a thought about how you can live better, despite chronic illness or pain.   It starts with the well-known fact that your inner reality has a huge impact on your outer reality.  The question is, “how do you see yourself in relation to your illness?”   Your self-image falls on a spectrum between sick and well, between broken and whole.   Your self-image is part of what determines your success in coping, living, healing despite your diagnosis.
 
Do you you see yourself as sick and broken?  Or do you see yourself as someone who is well (despite the disease), as someone who is whole?
Do you identify with your illness?  Or are you a well person who has a diagnosis?

Lets unpack this because its really important.

Living in The World of Brokenness

For many people, the experience of illness is an experience of brokenness.  It can triggered by the pain, the fearful diagnosis, difficulty functioning, or uncertainty about the future.  The constant feeling of “there’s something wrong with me” can create a tremendous sense of distress.  And if you are unable to function as you used to, then there’s another source of distress and suffering.  It’s not a good feeling.  It can automatically create a sense of vulnerability.  A sense of  “I need someone to fix me”.

A sense of vulnerability and need could be realistic and a good thing.   So if you have a fever and are coughing up green junk and feel exhausted, you get evaluated and a diagnosis of pneumonia and an antibiotic and hopefully you’ll be feeling better soon.   And it would be unwise and perhaps dangerous to tell yourself you’re not sick, that you should tough it out and not get professional help.

But there’s a way that “the diagnosis” or  focus on the symptom can be a problem.  Because sometimes the search for the diagnosis, or the diagnosis itself, takes away your power, and you don’t get anything in return.

Yeah, sometimes the diagnosis hurts you more than it helps you.

Some diagnoses or symptoms cannot be fixed medically.

Chronic widespread pain (like fibromyalgia) is often an example of that.  The problem is a hypersensitivity of the pain pathways.  And if you keep trying to find “the diagnosis” or go to another doctor for every symptom of pain,  it doesn’t necessarily bring you healing or a cure.  Sometimes it is very disempowering.  You’re looking for someone to fix you, rather than learning if there is something you can do to help yourself.  I can’t count the number of patients who have unsuccessfully gone to specialist after specialist looking to be cured.  Each time they get their hopes up, and then they are disappointed.

It can stimulate a spiral of negative thinking.

One big problem with “negative thinking” is that your thoughts can make you sick.  Research is now showing your state of mind can have a huge impact on the outcome of chronic illness. Research supports the common sense that there are often better outcomes when the patient is able to connect with their purpose, goals, relationships, and inner resources for healing.

I always share this caveat when I share that idea:   If this article is triggering a sense of blaming yourself because you’re stuck in the “sickness cycle”, please stop right now.  Beating yourself up about it feeds the problem.  It’s not your fault.   Most people don’t learn about this until their backs are to the wall.  So start to learn.  You can do it.

Here’s why its not your fault.

Our medical system is focussed on sickness and finding the expert to fix the sickness.

In medical school we learned to identify people by their problems.  We worked hard to efficiently deliver the “problem list” in the context of a case presentation.  We’ve got dozens and dozens of 3-4 letter abbreviations for diseases.  Sometimes we identify a person by many of them at once.  “This is a 63 year old man with COPD, CAD s/p MI, DMII, DVT, Afib with complaints of fatigue.”.  When I was in training they didn’t encourage us to refer to people as their illness.  We weren’t rewarded for saying things like, “the leukemia in room 214 is complaining of chest pain”, but sadly it was known to happen anyhow.

Maybe you’ve seen more than one medical provider who mainly focussed on your illness.  Maybe you got a diagnosis and now you ‘have a herniated disc’ or ‘have fibromyalgia’ or ‘have psoriatic arthritis’.  The medical provider probably did very little to connect you with your own resources for healing.  It doesn’t surprise me how many of my patients think of themselves as sick.  It’s not your fault.  You trusted the expert.

They may have done the best that modern medicine has to offer, but they didn’t have the whole picture.

Mainstream media and society often support the same unproductive mindset.

The power and miracles of modern medicine have led us to believe that technology will cure everything.  And the media love to make us worry, so we tune in and spend money.

Without great wisdom and support, it’s very easy to stay stuck in a sense frustration and grief about what has been lost.  And to live in fear about the uncertain future.  Life can feel very broken.  And that’s a toxic way to live that often feeds into processes that brought us to the illness and pain.  And so the cycle continues.

Despite all this, there is another way.   We can cultivate and learn to find wholeness despite pain, illness, and suffering.  And then we shift the process from a vicious cycle of suffering and sickness, to a process of transformation and healing.

Living in the World of Wholeness.

Even if you have significant illness, you also have abundant health.

You might not be paying attention to it.  But it’s there.

Your ability to read and understand this means that you have significant health.  Do you have any idea how much neurological complexity and health goes into reading this article?

Its awe-inspiring if you think about the three trillion cells that make up your body, and the innumerable chemical reactions and physiologic processes that are constantly working so you can think, speak, move, eat, digest, breathe, etc.  The very fact that you’re alive means that you have abundant health moving through you.  And every bit of the health is worth paying attention to.

Because your attention is a key to connecting to your health.

If you take it a step further, and find ways to reconnect to  purpose, goals, meaningful relationships, and inner sources of strength, then you’re doing something quite heroic.

You’re beginning to live in wholeness despite your illness or pain.

When you are connected to your health, your sense of wellbeing, you have a sense of wholeness, even if you have an illness or pain. You know there is a part of your being that is unaffected by the illness.   Maybe you can even tap into a state of mind where you feel good, confident, clear.    You are bigger than the illness.  You have purpose and meaning in  life.  you have tools and inner resources for dealing with the pain, the disability, the infirmity.  You have a sense of power, a sense of coherence.  You’re resilient.  You are whole, despite the parts that are not yet back to 100% function.

It’s a process.  And no matter where you are right now, you can start moving toward healing and wholeness.

When you contact your inner resources for healing, the pain and illness becomes a catalyst for growth.  Loss, grief, and fear become focal points for transformation.  When we crack the shell of darkness, then we find the light that hides inside of it.

And living with a sense of wholeness is not a contradiction to having a diagnosis and getting medical care.  This isn’t “either/or”.   You can keep going to your doctor and doing the sensible effective biomedical things that support you.  This is about addressing the whole picture.

 A sense of wholeness can be cultivated.
 
How can we be whole while we are sick and sometimes feel broken?

It starts with awareness.  You can choose to give your attention to your vitality, to your connection with life.

You can intentionally reconnect with purposeful activities, even if they aren’t the same as the things that used to be meaningful to you.

You can learn to let go of the past.  To forgive the people who hurt you.  To forgive yourself.  To forgive the Source of your life.

You can find opportunities to be in meaningful relationships.  Sometimes that means letting go of toxic relationships, and finding healthy ones.

You can learn to bring your awareness to your sensory experience in each moment.  To see the flow of thoughts, emotions, and bodily sensation. You can activate your sense of  wonder, creativity, and spirituality.  Your own inner sense will begin to unravel the knots of suffering and reveal your new connection to life.

You’re developing the power of your mind to access a healing state of mind and body. The research is beginning to show that has a positive impact on the illness itself.

The Timeless Need for Wholeness

There’s a remarkable illustrative episode in the Torah portion of Va’era.  (You don’t need to be Jewish, Religious, Spiritual, or anything else in order to appreciate the power of this metaphor).

The Patriarch Abraham is sitting at the opening of his tent.  G-d appears to him.  The oral tradition tells us that it is the third day after Abraham circumcised himself in his old age.  He is suffering very much.  And G-d comes to visit him.  We learn about visiting the sick from this episode.  But it’s a different kind of visiting the sick that many of us are used to.  Usually when we go to the hospital to visit someone who is sick, we ask about their pain, about their diagnosis, about when they can go home.  But there is something striking here. The commentator Rashi notes that when G-d went to visit Abraham, he went to “inquire about Avraham’s Shalom”.

Shalom is an interesting word.

Most people know it means “peace” and “hello”.  But at its root, it means “wholeness”.

Shalom is a coherent state of being where everything makes sense.

Shalom is the kind of peace that can contain conflict.   It’s the wholeness that can contain brokenness.  It’s the comfort that can contain the pain of a 80 year old man who just gave himself a painful operation without anesthesia.  Shalom comes from being connected to truth, to purpose, to love.  It is a sense of coherence.

The Torah is giving us a hint.  When we are visiting the sick it’s vitally important to bring their attention to their wholeness.  If you are sick yourself, it’s vitally important to pay attention to your wholeness.  To find a place of ease and stillness in your spirit, mind, heart, body.  To connect to your inner sense of what matters.  To remember that you are more than just your illness.

How do You Cultivate Wholeness?

There are many ways to cultivate a sense of wholeness.  Perhaps you are already familiar with one or more.

Are you practicing it?

Life is so complex and distracting.  Living without a chronic illness or pain is challenging enough in these days.  If you have chronic illness or pain, even more-so.

I invite you to recommit to your practice.  It could be meditation, time in nature, playing music, prayer, song, journaling, or a combination of these.

Do it regularly.  Consistency in key.

If you don’t have a practice, I encourage you to find one.

Even 5 minutes a day is a good start.

A growing body of research shows extraordinary benefits to regular meditation and other mindbody practices.  When you regularly access a state of calm, peaceful clarity, it has beneficial effects on inflammation, pain, emotional distress, and even expression of genes that help you cope with and heal from stress, pain, and illness.

An even deeper process happens that may be beyond measurement.  When we gently and lovingly turn our own consciousness back in on itself, we naturally heal the roots of our unproductive habits of thinking, feeling, and acting.  We gain energy and access to our deeper capacity for beauty, order, generosity, forgiveness, calm, love.

Life becomes a process of living and our external circumstances become less hard and difficult.   It can take work, especially if you are suffering.  But the rewards are invaluable.

Believe in yourself.  Believe in your life.  The possibilities are always greater than we imagine.

You might find beautiful red flowers blooming where you once only saw thorns.

And please leave feedback to this article and share it if you see fit.

Wishing you Shalom

Here are some interesting references:
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Healing Neuropathy with LDN and Functional Medicine

                                                                                                           For more videos subscribe to our YouTube channel here

Summary:

Did You Know:

Dr Shiller is responding to the chaos and overwhelm of the corona pandemic by offering regular free stress-busting 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:

Full Transcript:

Barbara was 57 and had severe burning pain in her legs and feet.
Her pain began after chemotherapy treatment for ovarian cancer which took place 4 years ago.
Thank God the cancer was caught early, and since treatment she has no evidence of cancer. But she does have burning in her feet.   Her joints hurt.  She also has fatigue and aching in her muscles that was diagnosed as fibromyalgia.  She is not able to sleep.   She feels exhausted all the time.  Getting less and less functional as the months go by.  She’s scared and anxious about what’s going to happen.
She saw a doctor who did an EMG, which is a nerve test, and he told her she had neuropathy.  They tried various medications like Lyrica and amitryptilline.  But they gave her side effects like dizziness and fuzzy-headedness and inability to think and remember.
She continues to take the Lyrica because nothing else helps the severe pain.  But she’s fuzzy all day, even when she only takes it at night.  And she can’t take it during the day so there is more pain by day.

What Should We Learn From This?

We’re going to jump off from here and learn a few main points:
  1. What is neuropathy and how is it related to chemotherapy?
  2. Why does conventional medicine have such a hard time helping it?
  3. What did we do with Barbara that helped her?
  4. What is the role of functional medicine in helping neuropathy?

What is neuropathy?

Neuropathy is when the nerves get sick.  Nerves are not like electrical wires.  They are living cells that have a cell body that is usually in or near the spinal cord.   Nerve cells have projections called axons that are living dynamic tubes that nerves use to communicate with other nerves.  For instance, the nerves that provide sensation and activate muscles in our lower legs and feet have their cell bodies in or near the spine  So they are quite long.  Other nerves are shorter, like the ones that provide sensation to the skin near the spine.
In order to function, nerves are constantly building and repairing themselves.  They cell body has these awesome manufacturing plants that make proteins, enzymes, ion channels, and produce energy.  All of these things are necessary for nerve function. In neuropathy, the nerve gets sick, so it doesn’t do all the things it needs to and the nerve stops functioning.  That’s why a person with neuropathy can have numbness, pain, loss of coordination, muscle weakness, muscle spasms, and so on.

What Causes Neuropathy?

Many things can cause neuropathy.  Diabetes may be the most common cause. There are the toxic effects of chemotherapy, like in this case of Barbara.    Neuropathy can be caused by metabolic diseases like thyroid abnormalities, and autoimmune disorders.  Other causes include nutritional deficiencies like B12 or folate, heavy metal toxicity, and other environmental toxicities.
Studies have shown that something like 65% of people getting chemotherapy get peripheral neuropathy.  For some of them, it  resolves over time after chemo ends.  But something like 30% of people still have neuropathy 6 months later.  It’s a severe problem that causes much suffering and disability.

What Can We Do About Neuropathy?

Conventional medicine—doesn’t do much.
A good neurologist will look for underlying diseases or nutritional deficiencies.  But still, many people never have an identified cause.
Drugs can sometimes control the pain.  But they’re like a band-aid.  they don’t address the underlying cause, so the neuropathy can get worse.  And the medications often cause side effects.

What About Supplements and Nutrients For Neuropathy?

Well, it’s a no-brainer that if someone is deficient in B12 or folate, then supplementing those can be very helpful.  Remember that when we talk about lab values, ‘normal’ doesn’t always mean normal.  Many people have a B12 in the low normal range, but they still have neuropathy or other neurological dysfunction.  That’s because different people have different needs for nutrients.  If I have a patient with a neurological disorder or neuropathy, I like their B12 to be in the middle range.  There’s also a special test called a methyl-malonic acid that looks at how the B12 functions.  Its often helpful to see if a low normal B12 is actually normal for a given person.
Nutraceutical research in general has a problem, and that problem is true for neuropathy as well.  The problem is that most research is done on single nutrients.    Kind of like the nutrient is a medication.   It’s a “Take this pill for this problem approach”.   But that’s often not so realistic.  In your body, there are multiple interacting biochemical pathways, and nutrients dance together as a group.  In the world of functional medicine, we tend to supplement things together in the way they normally function in the body.  So when we study a single nutrient, we are often missing the potential mechanisms, in which several nutrients are interacting with one another.
So, for instance, someone who has an MTHFR gene mutation that impairs their metabolism of folate, may have significant reduction in their body’s ability to eliminate toxic compounds, and they may also have impairments in their functioning of vitamin B12, B6, and other nutrients.  That can lead to oxidative stress and inflammation, which can cause all kinds of problems, including neuropathy.  So, someone with that mutation and neuropathy would get a number of nutrients that are aimed at a. enhancing the overall cycle of folate metabolism, and b. reducing oxidative stress, and c. stimulating the detoxification processes in the liver.
That’s a complex multifactorial process.   It’s really hard to do good research on a complex multi-factorial process.  It takes large groups of patients and costs a ton of money.  And no-one stands to gain approval for a new blockbuster patented drug.  So no-one wants to invest 50-100 million dollars in that research.
But that doesn’t mean research is bad.
For sure, if there is a randomized controlled trial that shows that a given nutrient is helpful, then of course, lets try it.  But if there are not randomized controlled trials that give evidence of efficacy, don’t take that as evidence of inefficacy.  That’s just dumb, but it’s the way many doctors seem to think.  If we know the physiology of nerve dysfunction and know that certain biochemical processes are impaired in nerve dysfunction, then I’m very willing to give nutrients that support that biological function.  Because we are not talking about doing surgery or something destructive.  The risk-benefit analysis is still often in favor of supplementing, even when there is no evidence from trials.  OK, so that’s a sensitive topic and we will talk about it more another time.
Regarding neuropathy though, we do have studies showing that alpha-lipoic acid, which is a nutrient and antioxidant that helps cellular energy production, helps with diabetic neuropathy.  It may be useful in other kinds of neuropathy.  So a reasonable number of mainstream docs will recommend it for neuropathy, especially in diabetes.
But overall, the therapeutic options offered by mainstream medicine are not so effective for many many people with neuropathy.  So they continue to suffer, like the patient I discussed in the beginning.
But,
If we are willing to think out of the box, then there are things to do that can be helpful.  Let’s talk about that.  Let’s start by talking about the cutting edge understanding of neuropathy.   This is what is in the primary scientific literature, and it can take decades to get into mainstream medical practice.

What Are Some of The Root Causes of Neuropathy?

Inflammation

Modern science is showing us that many cases of neuropathy have their root in a vicious cycle of Inflammation, Oxidative Stress, and Mitochondrial dysfunction.  What does that mean?
Inflammation means the immune system is over-active.  We’re not talking about red hot warm tender knee joint, or the inflammation of sinusitis.  we’re talking about low-grade activation of the immune system which is being shown to be the root of most chronic illnesses.  Modern medical science is showing this, but mainstream medicine doesn’t yet know what to do with it.

Oxidative Stress

One of the results and causes of inflammation is oxidative stress.  Oxidative stress is kind of like the biochemical stress of living.  And it gets higher when there is toxicity or inflammation.  Oxidative stress is the biochemical metabolic load on the body’s ability to regulate itself.
And those two issues—inflammation and oxidative stress—are intimately connected with dysfunction of mitochondria.

Mitochondrial Dysfunction

Mitochondria are organs inside our cells that produce energy.  When the mitochondria don’t function, the cells have an energy crisis. In the nerves, that means the nerves start to break down.  And then the symptoms of neuropathy often happen.
This dance of vicious cycles of inflammation, oxidative stress, and mitochondrial dysfunction is implicated in many of our most difficult chronic illnesses.  Fibromyalgia is a great example.  You may remember that this patient also had a diagnosis of fibromyalgia.
Two ‘diseases’ one set of physiologic imbalances.

 Please Understand This Crucial Point About Chronic Illness

This is a really important point.  It’s relevant for most people with any chronic illness.  Two diseases, and one set of physiologic imbalances.  That’s not the way that doctors get trained to think.  We get trained to think about one cause, one disease, and one treatment.  That was the gift of the antibiotic era.  Before penicillin was invented, a person would come to the doctor with pneumonia, and most likely they would die.  After we isolated streptococcus and found that penicillin kills it, most people with pneumonia would be better in a few days.  It was miraculous and changed the way doctors think about medicine.  And the idea of one cause, one disease, and one treatment became a dominant way of thinking about illness.   That helps in some situations.  But not in chronic illness.

Common Underlying Causes with Variable Expression

Like I said, The physiologic imbalances that give rise to neuropathy, often also give rise to fibromyalgia.  And they can give rise to autoimmunity or arthritis, or irritable bowel, or chronic tendinitis or bursitis and so on.
So often, people come to me with ‘everything is falling apart syndrome’.  And that’s what it feels like because they have all these problems.  And conventional medicine, which sees each disease as an isolated entity with one cause and one treatment, usually doesn’t look for root cause of everything.  It gives each problem a name, and gives each problem a medication or two, and then the person has a long problem list with 8-10 medications, but nobody is addressing the underlying physiologic imbalances.  So the person is getting sicker, and collecting more diagnoses and medications and more medication side effects.

Functional Medicine–Find The Root Cause of Illness

Functional medicine is different.  We look for root cause.  I looked at Barbara and saw neuropathy, fibromyalgia, sleep disturbance, and anxiety, and they’re all connected in a vicious cycle.  And low grade sterile inflammation with oxidative stress and mitochondrial dysfunction are part of the cycle.

How Did We Help This Patient?

There is a powerful lifestyle approach to these kinds of problems that comes out of functional medicine.  But she was getting ready to go on a long trip, and there wasn’t time or space to do all that.
So, we started with LDN (low dose naltrexone).

What’s is LDN, and why did I prescribe it for her?

LDN is a medication that is very unusual.  It doesn’t work the way most drugs work.
It evokes the natural intelligence in the body.
Naltrexone blocks the opioid system of the body.  In high dose, it can help a heroin addict stay clean, because they can’t get high.
In very low doses, (hence the name low dose naltrexone, or LDN), it tricks the body to produce
more of its own natural pain blocking chemicals called endorphins and enkephalins.
Some of these natural  molecules modulate the immune system.  LDN has been shown to reduce the level of inflammatory signaling molecules called cytokines.
That’s why research suggests that LDN  is  helpful in many chronic pain states, fibromyalgia, chronic fatigue, and other chronic illnesses.
So she started LDN. We do it at low low dose initially.  She called me when she had been on the therapeutic dose for about 2 weeks.  The burning pain was gone.  She still had aching in her joints but it was tolerable.
So what does that mean?  Did LDN work only partially?
This is very important
So pay close attention.
She hadn’t been on it long enough to know.
LDN, as I said, stimulates the body’s own pain blocking chemicals, and it reduces low grade inflammation that can cause oxidative stress and mitochondrial dysfunction.
This is not comparable to a drug that so to speak ‘takes time to build up in the blood’.  LDN does not “build up” in the body.  It does its job for a few hours and is inactivated.  But THE BODY ITSELF does the work.  LDN stimulates a healing process by which the body works on itself to block pain and reduce inflammation.  So it takes time.
In other words, just like the disease process that causes fatigue, fibromyalgia, and neuropathy takes place gradually, so does the healing process with LDN or other means that help the body heal.
She she’s going to continue to take the LDN and lets see how it impacts her other symptoms and overall health.

Healing Chronic Illness Is a Complex Process

And just a note about the bigger picture.
To my eyes, LDN is part of  a broader set of tools to heal chronic illness and chronic pain.  As we discussed above there is a vicious cycle of  of inflammation, oxidative stress, and impaired cellular energy production that drives problems like neuropathy, fibromyalgia, and chronic fatigue.  That same process drives other chronic illnesses like Alzheimers, Parkinsons, diabetes, heart disease, and autoimmune diseases like arthritis, colitis, lupus, multiple sclerosis, and so on.
We have proven ways to address the underlying imbalances in physiology through diet, specific nutrients, enhancing digestion and detoxification, mindbody therapies, and so-on.  The first step is to identify what issues are most relevant for a given patient.  then we try to make the lifestyle changes that gradually bring the system back to health.  That process is called functional medicine.  It takes work and a willingness to make lifestyle changes, but the potential benefits are tremendous.
that’s it for today.  Thanks for watching.
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Thanks again
I’m Andrew David Shiller
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