6 Things That Most Doctors Miss, Which Worsen Pain and Prevent Healing, Part 2

Posted on March 8, 2023March 3, 2024 by Andrew David Shiller, MD

This is Part 2 of a two-part video

Summary:

One of my readers wrote in: “Hey Doc, I’ve been doing all the things they taught me in rehab to recover after my accident and surgery. Pacing myself. Doing the exercises. I’ve progressed, but I’m stuck. I still have significant pain and my regular doctor has nothing to offer except drugs that mess up my head. And I haven’t been able to increase my exercise tolerance enough so I’m still limited in function. Why is that happening?” It’s a great question and I’ve heard variations of it over the years. Many people just get “stuck” with persistent pain or fatigue or weakness. And the conventional approaches often don’t have a solution. Based on a few decades of integrating natural healing methods into medical and rehabilitative care, I have often been able to help people who “tried everything”. Because they didn’t really try everything. They just did the conventional stuff. The key to success has been to look for and address the six things that I talk about in this video. So please check it out and let me know what you think. Thanks Andrew David Shiller, MD

Did You Know:

Movement Toward Health is a training program that teaches you skills for transforming your health, reducing pain, improving mood and energy. It opens periodically for new members. You can get more information and join the waitlist here: www.MTHTribe.com.
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/consult
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

Full Transcript:

Hey, it’s Dr. Shiller we’re talking today about the six things that can worsen pain and lead to disability and um, and slow the healing and recovery process. And it’s really important to check this out cuz this is not typical stuff you’re going to hear from conventional medicine. It’s not typically treatable with drugs and procedures, but it is treatable and fixable and healable through things that you can learn to do for yourself.

So these are game changing principles that have completely shifted things for so many of the people who have come to me with the, with that situation of I’m still suffering and I tried everything. Well, like, no, you didn’t try every, everything. These are things you didn’t try. Let’s do that. And in many, many, many cases, profound difference.

So let’s open this up. Let’s talk about it. . And so I first want to talk about, well, how does that process happen? What worsens it? Why is it that things tend to snowball after injury or illness and get worse and worse? And that leads to the clarity about like, okay, so what do we do about this to help you get better?

And so a little background of what I bring to this conversation. I trained in physical medicine, which is also called physiatry, pain management, internal medicine at some of the top places in the United States, and have worked in integrative rehabilitation medicine and pain management for over 20 years.

And so I’ve seen literally thousands, maybe tens of thousands of people who’ve had persistent challenging problems. alongside with my formal training, I did decades of training and clinical practice and teaching in what you might call complimentary or natural healing. So I developed this broader perspective than what they taught me at at Duke University in Harvard Medical School, and that’s, let me see, the things that conventional medicine over often overlooks.

which are really important to the recovery process and in my experience, that has been what has enabled me to frequently help people who are kind of stuck in that I’ve tried everything and I can’t get better place. And so my experience is mirrored in that of many of my colleagues who I’ve spoken with and who I’ve trained with, where when we bring these new perspectives, then there’s frequently dramatic results.

Frequently the patients who are stuck and not getting better are suddenly getting a whole lot better in feeling better. So it’s extraordinarily like a privilege and gratifying to be like, wow, this is actually. and helping means that person who was stuck in suffering with pain, inability to do stuff, brain fog, various kinds of symptoms, is now feeling better and able to function better.

And I want to be clear that this is not alternative, and this is not antagonistic to conventional medicine. It’s broadening the model. It’s understanding things more fundamentally, more systemically, more holistically, but not in the flaky. Like a grounded scientific way of understanding, well, what is your biology?

What is your mind body system? How does it function? How does it get out of function? So we’re gonna share six things that. Worsen pain and disability and prevent and block the healing process. We’re gonna share an overview of that and then in other videos I’m gonna drill down into those so you can get the detail and understand them more comprehensively.

But I really want you to have the big picture. This is probably gonna be two videos so that it’s more easily digestible. And so I really want you to plug into this whole learning series if this is a topic that seems important to you. So I want to tell you how to get access to it because I’ve set up a program that’s called Movement Towards Health, and it’s really about a training program.

It gives you skills for transforming the biology of pain and suffering and disability to the biology and the psychology of wellbeing and recovery. Um, and. , there’s a wait list for that program. It opens up periodically. My suggestion is get on that wait list because what will happen is you’ll get notifications about as these videos come out, so you can watch them.

There’s also a place in there where you can binge watch them all at once, once they’re all in place. Um, and you’ll also get notification about the program and more information about it. You might find it interesting and you might want to join. If you don’t, it’s fine. Just enjoy and learn and be inspired.

to understand what it is that is perpetuating, creating the suffering that you’re having so that you can make conscious choices about what to do about it. Because most doctors are not gonna do that because they’re not aware about it. And of course, it doesn’t mean that they’re bad people or bad doctors.

It just means that the conventional medical model sees things a certain way and there’s a broader way of seeing things. and what I’m doing is sharing that broader way so that you can make conscious choices and do the stuff that you need to do so that you can feel better and live better. Okay, so we’re jumping in.

Problem one that worsens pain and illness and prevents healing is what we call autonomic imbalance. Okay? That’s a big scary word, but really what it means is like this, you probably know that you have a stressed. And a relaxation response. It’s built into your entire brain, spinal cord, and your whole nervous system.

It touches every cell in your body. One aspect of it is fight, flight, freeze. That’s your stress response, and the other is your. Rest, digest, and heal or relaxation response. And they’re meant to be in balance with each other. But what happens is that chronic pain, chronic illness shift the, the scale towards an overactivity of that stress fight, flight, freeze response, and a bunch of other things can shift the scale towards that, which feeds into chronic pain and chronic illness, and the underlying biology that drives chronic pain and chronic illness.

So it could be. The trauma, the injury, the illness. It could be earlier things that happened, your life that were traumatic. It could be stress, it could be lack of sleep. It could be chemical exposure or toxic exposure. It could be early life stress or adverse events, which are more and more proven to be associated with chronic pain and honest chronic illness.

And the issue is autonomic imbalance, where the system is shifted to an overactive fight flight, freeze. There are simple things that you can learn to do to bring balance to that fight, flight, freeze response. Some of them are things that you can learn on your own for free, and they are life changing for many people and they’re also life skills, and they empower you to deal with the difficulty in life no matter what it is.

So there are things you can learn on your own. There’s things you can learn together one-on-one with a therapist or in groups or various contexts that support you to retrain your system from being in this fight, flight, freeze response to being in a more relaxed, anti-inflammatory, healing oriented response.

And that’s also part of what we do in movement towards health. So moving on to number two is mood instability or mood imbalance. And the most common things you might think about are like depression and anxiety. There’s other things that go along with its symptoms of O C D. It’s a complex picture. The thing I want you to understand is that the biology of.

Depression and anxiety isn’t what we’ve always thought, which is, oh well, it’s about serotonin problems. Well, yeah, there can be issues with neurotransmitters and, and that’s how some of the pharmaceutical companies have made tons and tons of money, and they push that point of view because that’s how they make their money.

But there’s an aspect of it that has to do with inflammation. There’s an aspect of it has to do with. Your balance of your stress and react and, and relaxation response, that autonomic balance and it’s lifestyle. These are conditions that are affecting your thoughts, your emotions, and your core bodily functions.

Your brain, your brain chemistry, your immune system, your gastrointestinal system, your physical activity, your thoughts. All this stuff is deeply integrated and those things that you can do on those three levels of thought. Reframing and and mindset training of training your mind with various tools to shift your biology, of diet, of nutrients, of physical activity, lifestyle, stuff that can have a huge impact.

And the reason this is so important is because we know that depression and anxiety are part of what’s in that vicious cycle with chronic pain, with disability, with the disability cycle. And so we’ll talk more about that in a bit, but you really gotta get the mood stuff under. Number three is your overall biochemical, metabolic state of your body.

And so check out this slide, which shows some of these relationships, but like I mentioned, your. Brain and brain chemistry and your autonomic system function, your thoughts and your emotions, your gastrointestinal functions. So the biome, the barrier function of the gut, the immune system, the hormonal system of the body.

Um, these are profoundly integrated and they have a huge impact on how your body function. They have a huge impact on how you think, how you feel, how much energy you have, how much strength you have. They have an impact on sensitization of your pain pathways. So this is complex biochemistry and anatomy and metabolic stuff, and there’s things again that you can do.

That’s the big part of the gift of the functional medicine model, is how to look at all that in a scientifically based way where we can think ration. about how to address these different aspects of dysfunction, like it shows in the slide and, and that involves, again, lifestyle stuff. It’s diet and it’s nutrients, it’s mind body therapies, it’s physical exercise, physical treatments.

And these things have made a profound impact for so many of my patients who are dealing with these difficult pain and related syndromes. So the point of all of this is to sensitize. that there are these dysfunctions that can be part of what’s perpetuating the challenges you’re having, and these are things that are within your control to work on.

They’re things that typically aren’t fixed by drugs, although sometimes medications can support the process. They’re things that are fixed and changed by the things you do for yourself sometimes in conjunction or in cooperation with appropriate care caregivers or therapists or practitioners. Okay, so that’s an overview of the first.

Of the six things that can worsen pain and disability and prevent recovery. And and that’s especially true if you’ve sort of done all the right conventional things and you’ve tried everything and you haven’t gotten better, you need to [00:11:00] think about these things. And so in summary, these are dysfunctions.

These are shifts in the functioning of your whole mind body unified system. And they’re not really taught in medical school, though they are supported by medical research. I suspect that in 20 or 30 years, they will be much more widely taught in medical school. Um, but there are, there is hope and there’s help.

There’s things you can learn to do. There’s practitioners who can help you, and the first step is understanding them so you can start to actually address. , in my experience and in the experience of many, many practitioners with whom I’ve worked or trained or, or, or taught, um, that the effects can be dramatic when you actually start to shift the underlying biology that makes these things worse.

We covered three of the six thing, these six things. Um, the second video will show you the rest of those. Look for the link below this video to get to that video, which is the se, the, the second set of three. Um, I want to share that [00:12:00] movement towards Health is a training program to give you skills to address these underlying issues.

And I encourage you to get on the waiting list. Movement towards Health opens periodically, and if you’re on the waiting list, you’ll hear about it, you’ll get an email and you won’t miss out. Um, and you’ll also get access to the additional training sessions that go into more depth into these aspects that go into more depth on the six things that can prevent the healing process from happening.

And I just wanna stress that. , this is about empowering you. You’ve got the capacity to learn things that shift your biology, and when you learn those, you actually are acquiring life skills. It’s about building your resilience, helping you have skills to live more effectively despite all the difficult things that are going on in life.

And we have a lot of different thing, difficult things going on in life in our generation. Okay, so obviously this is an overview video. I encourage you to go to mth tribe.com, get on that wailing list, dive deeper [00:13:00] into the materials, see how it impacts you, what you learn from it. So thanks for watching this.

Um, if you like this, I encourage you, first of all to leave a comment or shoot me an email. With one thing you learned about it, and also share the video wherever you’re finding it. Share it with people you care about, who you think might benefit from starting the OR, or deepening this learning process about this journey of self-healing.

So thanks again. Take care.

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Where Do You Start, If You Have Chronic Pain, Anxiety, and IBS?

Posted on January 13, 2021March 3, 2024 by Andrew David Shiller, MD

Summary:

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

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

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

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.

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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The Only Way To Heal From Fatigue, Pain, Fibromyalgia and Chronic Illness

Posted on October 21, 2020February 22, 2024 by Andrew David Shiller, MD

Heal the Roots of Unresolved Pain and Chronic Illness

Healing unresolved pain and chronic illness depends on an integrative, systems perspective. Your body-mind is smarter than your doctor, or any doctor. We need to look for the roots of the problem and enable the body-mind to heal itself.

The Thigh Bone’s Connected to the Hip Bone

If you pay attention to life in general, you have probably figured out that everything is connected to everything else.

For some reason, mainstream medical thinking doesn’t seem to “get it”. Maybe that’s part of why conventional treatment of fibromyalgia is so often ineffective or harmful.

If you have fibromyalgia, fatigue, chronic pain or chronic Illness, your understanding of connectivity can change your life for the better.

Here’s Why Your Doctor Can’t Help Your Fibromyalgia

Part of the reason why mainstream medicine doesn’t have your answer is that most conventional medical thinking is fragmented. I know, because I got my medical degree and specialty training in the best hospitals in America. We are trained to to look at medical problems in a fragmented way that disregards the natural healing intelligence that lives inside of you. And it doesn’t work for most chronic diseases, especially fibromyalgia, fatigue, and chronic pain.

Fortunately, even in mainstream science, the walls between disciplines and specializations are dissolving.

Major medical research institutions like Harvard Medical School and the National Institutes of Health now have programs in Systems Biology. Systems Biology is an approach to studying what most people know intuitively–that the whole is bigger than the sum of the parts. Systems Biology promises to solve some very difficult problems in the future.

It goes way beyond the notion that “the thigh bone’s connected to the hip bone.”

There is a stunning degree of integration among all the systems that were once considered separate. For instance, we know now that there is constant intimate communication among the immune system, the digestive system, the hormones, the mind, emotion, and brain activity, as well as everything else. According to medical research, changes in the function of the intestines can activate inflammation and change brain chemistry. Various environmental toxins can further stimulate immune reactions and drive further low grade inflammation. That inflammation and its associated oxidative stress can impair the function of mitochondria–those are the organs inside your your cells that produce energy. When you have chronic inflammation, toxicity, hormonal abnormalities, and your mitochondria are not working, you’re going to feel fatigue; your muscles are going to fail, and you’re going to have other debilitation symptoms. I imagine that sounds all too familiar.

These same complex system changes are important for the development of Fibromyalgia, as well as autoimmune diseases like lupus and rheumatoid arthritis, and neurodegenerative disease like Alzheimer’s, as well as cardiovascular disease.

This is a hugely important principle in understanding and healing from fibromyalgia, fatigue, and chronic illness. Research shows that people with Fibromyalgia have a variety of changes in their immune, digestive, hormonal, neurological, emotional and other systems. It seems that the relevant changes differ depending on the patient. That’s why some patients respond to some kinds of nutrition, medications, or lifestyle interventions, and others respond differently.

Unfortunately most medical scientists don’t look at the complex changes from a systems approach. And standard medical practice lags way behind the scientific research. So mainstream conventional medicine says that Fibromyalgia is because of changes in nerve sensitivity. But that’s not the cause. It’s a symptom! And one research group says the cause is changes in hormones. Another group blames inflammation. Another group says it’s due to impaired cellular energy production. And so on. Where’s the “I want to vomit” emoticon?

We all know the parable of the four blind men who bump into an elephant! Wake up, science!

Fibromyalgia is a complex systems problem with multiple contributory factors. Like most chronic illnesses. And it needs a multifactorial systems approach to heal.

All this theoretical stuff is very nice and interesting. I’m excited that, there is growth in our basic science understanding of complex problems like Fibromyalgia. But they will take time to percolate through to your primary care doctor’s office. And you’re suffering now.

What can we do now?

You Can Understand and Heal Fibromyalgia and Fatigue Through an Integrative Holistic Approach

As we discussed above, Fibromyalgia is best understood as a holistic problem. It arises from a set of vicious cycles of interaction among genetics, gut health, the microbiome, stress-hormone dysregulation, inflammation, cellular energy production, toxicity, etc. As a result, you have widespread pain, can’t sleep despite being exhausted, have digestive issues, have brain fog and get dizzy when you stand up, etc….

Think of it as a one of those big soap bubbles that wobbles through the air, or maybe a big snowball on a somewhat slushy warm day. Fibromyalgia develops over decades, as various vicious cycles of change percolate through the system. (For sure there are some people who have a sudden onset of symptoms after a trigger such as trauma, surgery, or illness. But their system typically has been moving toward the dysfunction for a long time before that) If you want to move the soap bubble, you need to work with its momentum, and contact it in several places at once. If you try to push on it with a stick, you’ll just pop it or break it. That’s why there isn’t “a pill” to fix fibromyalgia. And that’s why your healing will begin when you start to work on the whole system at once. It’s about helping your system heal, through lifestyle, metabolic healing, the right kind of exercise, and by activating the healing intelligence in your mind-body connection.

You can do this. Don’t despair.

Future posts are going to discuss more practical details. You can sign up for the newsletter and receive notification by clicking here.

Please forward this email to anyone you feel will benefit from it.

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Thanks

Dr Shiller

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

Posted on April 2, 2020March 3, 2024 by Andrew David Shiller, MD

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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4 Keys To A Mindset That Can Transform Your Fibromyalgia

Posted on February 6, 2020March 3, 2024 by Andrew David Shiller, MD

You don’t have to believe in ‘mind over matter’. But it’s probably obvious that your outlook and state of mind have a huge impact on so many levels of your functioning. Every person with chronic pain has the capacity to feel better and function on a higher level. Much of it depends on your willingness to choose and use what helps you.

The big question is whether your reality is going to be led by your body, or by your capacity to choose with your intellect? Are you going make choices that support your healing, or choices that feed into the problem? Are you going to be able to see the opportunities that are in front of you, or will you be stuck in unproductive thinking?

Key# 1. Forget About A Cure And Start Healing

Many people with fibro are caught between two false premises.

One false premise is that fibromyalgia is incurable.

The other false premise is that someone has a miracle cure.

Both premises are ridiculous. Let’s talk about why, and how you can start healing.

The Miracle Cure nonsense is easiest to explain. Many people think they’ve got the miracle cure. Maybe it’s because they found what worked for them. Maybe it’s because they’re selling something. But the facts point toward the reality that fibro is a complex syndrome with multiple related triggers and perpetuating factors. And that it is different in different people. No research has ever shown a treatment that helps everyone. And the accumulated clinical experience tells us that different folks respond to different treatments.

Why do people sometimes believe that fibro has no cure?

I see two reasons. One reason is that some people have struggled for years or decades and they’re still stuck. It’s unfortunate and I have compassion on that situation. But just because some people don’t find an answer, doesn’t mean that nobody can.

The second reason why people think there is no cure, is that mainstream medicine doesn’t understand fibromyalgia. The diagnostic criteria for fibro don’t take into account the underlying cause. So what are they trying to treat? The symptoms!

There is a middle ground. People with fibro who are successful in healing think out of the box and look for solutions. Typically the solution is multifactorial, and individualized. I’ll speak more about that in this and future documents.

So the first part of your mission is to find the middle ground. To find your individual path to healing fibro.

Key #2. Open Your Mind, But Don’t Let Your Brain Fall Out

The people who get better from a fibromyalgia diagnosis are people who go beyond what their doctors tell them. I’m not telling you to stop going to your doctor or stop thinking about medical research. Quite the opposite. I study all the research that comes out about fibro.

But you need to accept that current research methods aren’t adequate to study all the variables that appear to be involved in fibromyalgia. I’ll talk more about that in another email or piece of content. There IS a rational picture of how the different pieces fit together to cause your symptoms. And there are relatively safe ways to address those underlying causes. There are various lines of research that support the principles. But it is going to be decades before we have randomized controlled trials that sort out the different parts of the multi-disciplinary treatment that helps people with fibromyalgia. Until then, we have to rely on common sense, pre-clinical science, and careful trial and error.

Key #3. There’s No Failure, Just Success In Finding What Doesn’t Work.

There’s a famous quote heard by someone who was trying console Thomas Edison when he was struggling to invent a lightbulb. There are various versions, but Mr Edison reported replied with something like, “I have not failed 700 times. I have not failed once. I have succeeded in proving that those 700 ways will not work“

I doubt you’ll have to try 700 things to start seeing some improvement in your fibro symptoms. But you may go through some trial and error. That’s totally normal.

As you might have guessed it’s not an exact science.

But there are sensible choices about how to address the physiology that underlies fibromyalgia. So you need to be open to trying and learning what works and doesn’t work.

The most important thing is that you are finding your own individual path to healing.

Key# 4. Childlike wonder and Curiosity

I’ve been at this integrative healing thing for over 20 years. It has become clear that healing isn’t only about the technical things we do to ‘fix’ ourselves. Healing is a process that comes from within. Your bodymind is a highly organized and self-correcting system. And there is a currently unquantifiable transcendent quality of your being that has intelligence and wisdom.

You can insist that it’s generated by your brain. Or you can acknowledge that you have a higher soul.

Regardless of your worldview, your ability to access knowledge that is beyond you comes when you stop trying so hard. When you get curious. When you’re playful.

Curious playfulness unlocks creativity and joy. And those qualities are part of what opens us to healing.

Those are qualities that you can cultivate and develop. And they can help you.

Thanks for reading. Please comment below, and share this post with others.

And join my email community to get notification about new blog posts, live events, and other quality information and inspiration. www.whathealsfibromyalgia.com.

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Can You Diagnose Fibromyalgia With a Poop Test?

Posted on January 14, 2020March 3, 2024 by Andrew David Shiller, MD

Can You Diagnose Fibromyalgia Through A Stool Test?

“Wow, I heard that now there is a test of the bacteria in your poop that can diagnose fibromyalgia!”

That was in a recent Facebook post from a person who has been suffering from fibromyalgia and got excited by a blog she had seen. It linked to a report about a report about some research, and said there was a new way to diagnose fibromyalgia. (The problem was, that yes, it was a report about a report).

Here’s Why It’s Dangerous To Read Headlines….

The truth that got distorted came from a research study published in 2019 showing distinct differences in intestinal bacterial composition and metabolism in women with fibromyalgia, compared to women without fibro.

But we have to think carefully to understand what that means for people with fibromyalgia. Unfortunately, we can’t diagnose fibromyalgia with a stool test.

Sometimes writers with good intention distort the meaning of research because they don’t understand how to interpret the data. Or perhaps they want to get attention and don’t care so much about the truth. So they write compelling but misleading headlines. So if you don’t have a science background, it can be really hard to know what’s real and what’s distorted info-mercial.

Perhaps I can give clarity to this article…

What Did The Research Really Prove?

The title of the article was “Altered microbiome composition in individuals with fibromyalgia”[1] in the journal Pain. June 2019. It’s a great study, and very important to the scientific understanding of fibromyalgia.

“Microbiome” is the name of the overall ecosystem of microbes (bacteria, yeast, and viruses) that live in your body. In the past 10-20 years there has been an explosion of research demonstrating how vast and important is the microbiome. The part of the microbiome that gets the most attention is the microbiome in the gut–the intestinal microbiome. That’s what this research studied.

It’s the first time that it has been proven that people with fibromyalgia have different bacteria in their poop. And these bacteria are associated with differences in metabolism and important immune-modulating compounds in the blood of the subjects. These metabolic changes could be related to the symptoms of fibromyalgia.

It also showed that those differences correlated with the severity of fibromyalgia symptoms. Important difficult things like pain intensity, fatigue, sleep disturbance, and cognitive impairment.

Those are the basic research findings. It’s really important and good news, as I will discuss later in this article. But it doesn’t add up to diagnosing fibro.

Does This Mean You Can Diagnose Fibromyalgia in My Poop?

Even the authors of this study say easy-to-misinterpret things like “furthermore, these results suggest that the composition of the microbiome could be indicative of the diagnosis of FM.” So to someone who really wants an objective test for fibro, they might think, “oh yeah, here it is, I’ve been walking around with an invisible illness and now we can get a definitive diagnosis!”.

Not so fast.

The authors said, “could be indicative”. That’s research-speak for “we have no firm conclusions, but I want to say something optimistic about the meaning of this research”.

The research compared people with fibromyalgia to healthy people. It tells us that something substantial and important is different about the biome of people with fibro compared to healthy people. And together with a ton more research, this kind of test may be used to diagnose fibromyalgia, and yield effective treatments for fibromyalgia that even conventional MD’s will be willing to discuss.

It also adds credence to the notion that there are actual physiological abnormalities in fibromyalgia, and its not “just all in your head”. We have plenty of evidence of real physiologic changes in fibromyalgia. But some boneheads are still stuck in the past and think it’s all psychological.

But the research didn’t distinguish fibromyalgia from other painful conditions that might have similar symptoms with fibromyalgia.

It’s kind of like showing that people with pneumonia have elevated white blood cell count. OK, so I know there is an infection. But an elevated white count doesn’t help distinguish pneumonia from other things with elevated white blood cell count, like soft tissue infection, or kidney infection.

In the same way, these research findings don’t distinguish fibromyalgia from neuropathy, arthritis, chronic myofascial pain, or other conditions that cause chronic pain and may well have changes in the biome.

What’s The Good News In This Study?

The good news is that the research lends support to our understanding of fibromyalgia, and the way that many pro-active doctors and patients already treat and heal from fibromyalgia.

Alterations in the biome can be associated with a number of other physiologic changes, leading to inflammation, oxidative stress, mitochondrial dysfunction, and the symptoms of fibromyalgia. Many people with fibromyalgia will get significantly better when they do functional and lifestyle steps to correct dysbiosis and the intestinal permeability[2] that often accompanies it[3]. That kind of treatment rests on the assumption that dysbiosis is part of the problem in fibromyalgia. Now we have evidence to support that assumption. That’s good news!

How Does This Study Help Us Understand and Treat Fibromyalgia?

This study provides evidence for one piece of the complex puzzle that is fibromyalgia.

Lets unpack the assumptions and principles that underlie this ‘functional and lifestyle’ approach to treating fibromyalgia. The past few decades have seen development of a few lines of research that support the approach, even if it’s not yet accepted by mainstream doctors. Research has shown that:

Many chronic illnesses are associated with characteristic changes in the intestinal biome.
Changes in the biome are often associated with increased intestinal permeability. Also known as “leaky gut syndrome”, intestinal permeability was a joke to conventional docs when I was in training. Recent years have shown that it is a real phenomena[4][5] and is associated with chronic illnesses affecting many bodily systems.
Intestinal permeability is associated with various compounds that inappropriately leak out of the intestine and into the blood circulation. That includes bacterial cell wall components like lipopolysaccharide (LPS), Hydrogen sulfide, undigested food particles, and bacteria themselves. These can all cause activation of the immune system and ‘sterile inflammation’[6].
Sterile inflammation is increasingly being understood to underlie many of our chronic illnesses including chronic pain[7] and fibromyalgia[8].
Sterile inflammation can lead to activation of brain immune cells called “glial cells”. Glial activation has been shown in people with fibromyalgia. They are likely part of what drives central sensitization (so that everything hurts), brain fog and other neurological symptoms[9].
Changes in intestinal barrier function and consequent systemic inflammation can have synergy with chronic stress and autonomic dysfunction, environmental toxins, and other variables. The resulting vicious cycles shift the physiology over the course of months or years, and then the symptoms show up.

As you can see, it’s a pretty complex picture. This research demonstrates that people with fibro have dysbiosis. And that fits with these other abnormalities that can cause the characteristic symptoms. Hopefully further research will complete the picture so that more doctors see the multifactorial nature of fibromyalgia and other chronic diseases.

My Life Is a Wreck from Fibro. What Can I Do Now?

We can see how fibromyalgia is a multisystem dysfunction. How does it get started? Various genetic and early-life experiences can set the stage. Later in life, various events can ‘pull the trigger’ and start or accelerate one or more of these vicious cycles. And certain physiologic changes and lifestyle habits can perpetuate the process.

Based on those principles, there is an often-effective path of fibromyalgia treatment. It’s for people who are suffering and don’t want to wait 20-40 years until we have a rock solid mechanistic picture and therapies that are proven in randomized controlled trials. They want to take reasonable, safe, and rational action based on the best currently available evidence. Does that sound like you?

Many of my colleagues and I accommodate that desire. Rather than just treating the symptoms with sleep medications or nerve-pain medications like Lyrica or Cymbalta, we take a multifactorial approach to address the dysfunctions described above. (Of course, sometimes symptomatic treatment with medications is appropriate. Each case is different.)

We evaluate various antecedents, triggers, and perpetuating factors that can contribute to the physiologic changes and symptoms of fibromyalgia. We look at fibromyalgia as a complex systems process that develops over time, like water flowing downstream. Treatment involves addressing those physiologic changes directly, going ‘upstream’ as far as possible toward the actual roots of the physiologic dysfunction.

For instance, recommendations commonly include:

Eliminating foods that can stimulate the intestinal immune system and contribute to intestinal permeability.
Consuming foods and supplements that support healthy biome and intestinal barrier, and reduce oxidative stress and inflammation.
Taking nutrients that support mitochondrial function and neuromuscular function.
The use LDN (low dose naltrexone). It is a prescription medication which reduces inflammatory chemicals and causes the body to strengthen its own pain blocking endorphins and enkephalins[10].
I also use PEA, which is a natural product that works through cannabinoid receptors and other mechanisms to reduce activation of inflammatory cells that contribute to pain[11].
Nutritional or pharmacologic treatment to treat subclinical thyroid or adrenal dysfunction.
Mind-Body training, which can normalize the stress system, reduce pain, enhance sleep, and improve energy[12].
Use botanical or other natural compounds that can normalize stress hormone function and help sleep naturally.

Summing up, the new data about biome changes in fibromyalgia support the role of dysbiosis and intestinal permeability in fibromyalgia. It doesn’t yet help us diagnose fibromyalgia. More research is needed to definitively understand these issues. In the meantime, evidence from small clinical trials, basic science, and much anecdotal evidence support a multifactorial approach to correcting underlying physiologic issues, and improve symptoms and quality of life in fibromyalgia.

I’ll be discussing this approach to “heal the gut and reduce inflammation”, as well as other aspects of fibromyalgia management in future blog posts. You can sign up to get notification of future posts by clicking here.

[1] “Altered Microbiome Composition in Individuals with Fibromyalgia:” PAIN 160, no. 11 (November 2019): 2589–2602. https://doi.org/10.1097/j.pain.0000000000001640.

[2] “Altered Intestinal Permeability in Patients with Primary Fibromyalgia and in Patients with Complex Regional Pain Syndrome.” https://doi.org/10.1093/rheumatology/ken140.

[3] “An Insight into the Gastrointestinal Component of Fibromyalgia: Clinical Manifestations and Potential Underlying Mechanisms.” https://doi.org/10.1007/s00296-014-3109-9.

[4] Intestinal permeability – a new target for disease prevention and therapy. https://doi.org/10.1186/s12876-014-0189-7

[5] Intestinal Permeability and Its Regulation by Zonulin: Diagnostic and Therapeutic Implications. https://doi.org/10.1016/j.cgh.2012.08.012

[6] Increased serum IgA and IgM against LPS of enterobacteria in chronic fatigue syndrome (CFS): Indication for the involvement of gram-negative enterobacteria in the etiology of CFS and for the presence of an increased gut–intestinal permeability. https://doi.org/10.1016/j.jad.2006.08.021

[7] Cytokines, Inflammation, and Pain: https://doi.org/10.1097/AIA.0b013e318034194e

[8] Neuroinflammation and Central Sensitization in Chronic and Widespread Pain. https://doi.org/10.1097/ALN.0000000000002130

[9] Mast cells, glia and neuroinflammation: partners in crime? https://doi.org/10.1111/imm.12170

[10] Reduced Pro-Inflammatory Cytokines after Eight Weeks of Low-Dose Naltrexone for Fibromyalgia. Biomedicines 5, 16. https://doi.org/10.3390/biomedicines5020016

[11] Palmitoylethanolamide in Fibromyalgia: Results from Prospective and Retrospective Observational Studies. Pain Ther 4, 169–178. https://doi.org/10.1007/s40122-015-0038-6

[12] Mind-Body Medicine: State of the Science, Implications for Practice. https://doi.org/10.3122/jabfm.16.2.131

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Heal Your Pain With Your Mind? What Does The Science Say?

Posted on December 25, 2019March 3, 2024 by Andrew David Shiller, MD

Can You Heal Your Pain With Your Mind-Body Connection? What Does the Science Say?

Today we’re going to review this research article:

Mind-Body Therapies for Opioid-Treated Pain: A Systematic Review and Meta-analysis JAMA Intern Med. 2019; doi: 10.1001/jamainternmed.2019.4917 November 4, 2019

Why is this paper so incredibly important right now?

Every day 130 people in the US die of opioid overdose[1]. There appears to be similar issues in other countries. Many of the people who lost their lives, started down a torturous road of dependence and addiction after being prescribed opioid drugs like oxycodone, morphine, and fentanyl for chronic pain. It’s pretty darn important that we find effective non-drug solutions for chronic pain.

This research article supports the perspective that mind-body therapies can reduce pain and reduce opioid use.

Let’s talk about the research and why it’s relevant for people with pain, whether they use opioid medications or not.

Meta-Analysis? What and Why is That?

Meta-analysis is a research tool to help clarify the meaning and understanding of previous studies. The idea is that all research studies can be biased and have errors. So in a meta-analysis, they use carefully-designed rules to pool data from multiple studies, to try to clarify what’s really happening. In this meta-analysis, the researchers carefully analyzed 60 previous research studies comprising 6404 participants, in research studies that evaluated the effectiveness of mind-body therapies in reducing pain and opioid use.

This research is also significant to people with pain who are not on opioids. People get prescribed opioids because they are having severe pain that won’t go away. If there is a therapy that works for people with pain so severe that they get opioid drugs, its likely to be useful in people whose pain is less severe, but still a source of significant suffering.

So, back to the research report….

It was a well-done meta-analysis. There are various methodological issues that need to be carefully addressed to yield a meaningful result in a meta-analysis. They do certain tests on the data to make sure that the analysis doesn’t introduce more error. I won’t go into the gritty details, but they did a thorough job. The studies they tested evaluated meditation, hypnosis, relaxation techniques, guided imagery, therapeutic suggestion, and cognitive behavioral therapy (CBT). With reasonable certainty, their data showed overall positive benefits to pain reduction, and reduction of opioid use for mind-body therapies.

What Did The Research Say?

The greatest pain reduction effect shown in the research was for meditation. Most of the meditation-based research was focused on chronic non-cancer pain. And most of the hypnosis, relaxation, and imagery studies were done in people having procedural, acute, or cancer pain.

The bottom line is this: if you’re an individual human being who is suffering with pain, the results tell us that meditation, CBT, hypnosis, therapeutic suggestion, and relaxation techniques are likely to be helpful. Just how helpful each of these will be for an individual varies per person. Most important is what it does tells us and that is, it is worth trying mind-body training.

That’s a positive result and should give you confidence around doing mind-body training if you have chronic pain. But this kind of research is merely touching the tip of the iceberg of how mind-body therapies can help. I’d like to share some perspective based on other research and a few decades of clinical experience

The Things I Hope You Never Know About Chronic Pain

This paper looked at the outcomes of pain and opioid use. From a clinical point of view, it’s relevant to think more broadly about the experience of pain and how to work with it.

There is a whole constellation of challenging issues associated with chronic pain from the point of view of someone who is suffering.

My patients often say things like:

Doctor this pain is killing me!
My other doctor gave me these medications and I’m concerned they will have side effects and hurt me.
The pain started in my lower leg, and then my back, and now my shoulder is involved.
I’m getting so darn depressed and anxious from the pain!
The pain keeps me from sleeping and I’m exhausted all day
The pain keeps me from doing the things that are important to me
I’m smoking and drinking more alcohol than I should to deal with the pain.
I’ve lost my sense of meaning and purpose because the pain is taking over my life
Pain is having a bad effect on my relationship at home, at work, and with friends.

Most chronic pain experts who actually listen to their patients will agree that the items in the list above can conspire in positive feedback loops, and create a vicious cycle that feeds into itself and can really “bring someone down” into a cycle of disability, depression, and worse[2].

Pain reduction and decreased opioid use are relatively easy to measure and very important outcomes. But I’m sure you can see that there are broader issues that are important, in dealing with chronic pain. Mind-body medicine is also helpful for some of these.

Did You Know That You Have Inner Healing Superpowers?

In my experience, the power of mind-body treatment goes way beyond reducing pain scores and medication use. In the right context, mind-body practices can help address the other aspects of the overall experience of pain and suffering. They can help you move toward living a more happy and meaningful life, with or without pain. Indeed much of the research in mindfulness and other kinds of meditation are teasing out the benefits on other aspects of the pain experience.

Other benefits shown in research include[3][4][5]:

Better mood[6]  
Increased sense of control  and decreased sense of helplessness
Activation of the relaxation response, with all of its physiologic benefit  
Improved sleep  
Reconnecting with purpose and meaning in life
Cultivating forgiveness, gratitude, and genuine humility, which can cut through toxic emotions like guilt, shame, anger, and grief[7]

Healing Chronic Pain at Its Root With Mind-Body Training

Science is revealing that people with chronic pain have physiologic changes in the brain and spinal cord that amplify pain transmission[8][9]. That process of amplification appears to be integrated with all the systems of the body including hormones, intestinal biome and barrier function, nutrients, and cellular energy production[10]. These variables are an outcome of your genetics and life experience. Most people have the potential to make lifestyle choices (nutrition habits, mind-body skills, activity, and so on) that can shift the entire web of relationships that affect pain processing and experience.

Mind-body training has a crucial role in shifting this complex web of relationships.

The neurohormonal changes of deep relaxation and positive emotional states can influence all of the body systems[11][12][13][14]. And the enhanced learning and sense of empowerment make mind-body training a great foundation for other lifestyle changes that can make a huge impact on the disease process and quality of life.

I encourage you to learn more about mind-body medicine. Start looking into your local care organizations like hospitals and clinics. There may be private mental health practitioners in your area who offer group training in mind-body medicine. There are also many online opportunities to work with reputable providers of mind-body skills, and research supports the effectiveness of online programs for people with chronic pain[15][16].

I hope to talk about these issues in more detail in other posts. So check back at my site or look around there. If you want to get notified about new postings, please click here

Until then, I’m wishing you all the best.

[1] https://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis

[2] Platts-Mills, T.F., Dayaa, J.A., 2017. Musculoskeletal Injures in Older Adults Preventing the Transition to Chronic Pain and Disability. North Carolina Medical Journal 78, 318–321. https://doi.org/10.18043/ncm.78.5.318

[3] Hearn, J.H., Finlay, K.A., 2018. Internet-delivered mindfulness for people with depression and chronic pain following spinal cord injury: a randomized, controlled feasibility trial. Spinal Cord 56, 750–761. https://doi.org/10.1038/s41393-018-0090-2

[4] Ma, S.H., Teasdale, J.D., 2004. Mindfulness-Based Cognitive Therapy for Depression: Replication and Exploration of Differential Relapse Prevention Effects. Journal of Consulting and Clinical Psychology 72, 31–40. https://doi.org/10.1037/0022-006X.72.1.31

[5] Morley, S., Williams, A., 2015. New Developments in the Psychological Management of Chronic Pain. Can J Psychiatry 60, 168–175. https://doi.org/10.1177/070674371506000403

[6] Sephton, S.E., Salmon, P., Weissbecker, I., Ulmer, C., Floyd, A., Hoover, K., Studts, J.L., 2007. Mindfulness meditation alleviates depressive symptoms in women with fibromyalgia: Results of a randomized clinical trial. Arthritis Rheum 57, 77–85. https://doi.org/10.1002/art.22478

[7] Oman, D., Shapiro, S.L., Thoresen, C.E., Plante, T.G., Flinders, T., 2008. Meditation Lowers Stress and Supports Forgiveness Among College Students: A Randomized Controlled Trial. Journal of American College Health 56, 569–578. https://doi.org/10.3200/JACH.56.5.569-578

[8] Cagnie, B., Coppieters, I., Denecker, S., Six, J., Danneels, L., Meeus, M., 2014. Central sensitization in fibromyalgia? A systematic review on structural and functional brain MRI. Seminars in Arthritis and Rheumatism 44, 68–75. https://doi.org/10.1016/j.semarthrit.2014.01.001

[9] Dodick, D., Silberstein, S., 2006. Central Sensitization Theory of Migraine: Clinical Implications. Headache 46, S182–S191. https://doi.org/10.1111/j.1526-4610.2006.00602.x

[10] Zhang, J.-M., An, J., 2007. Cytokines, Inflammation, and Pain: International Anesthesiology Clinics 45, 27–37. https://doi.org/10.1097/AIA.0b013e318034194e

[11] Black, D.S., Slavich, G.M., 2016. Mindfulness meditation and the immune system: a systematic review of randomized controlled trials: Mindfulness meditation and the immune system. Ann. N.Y. Acad. Sci. 1373, 13–24. https://doi.org/10.1111/nyas.12998

[12] Rosenkranz, M.A., Davidson, R.J., MacCoon, D.G., Sheridan, J.F., Kalin, N.H., Lutz, A., 2013. A comparison of mindfulness-based stress reduction and an active control in modulation of neurogenic inflammation. Brain, Behavior, and Immunity 27, 174–184. https://doi.org/10.1016/j.bbi.2012.10.013

[13] Morgan, N., Irwin, M.R., Chung, M., Wang, C., 2014. The Effects of Mind-Body Therapies on the Immune System: Meta-Analysis. PLoS ONE 9, e100903. https://doi.org/10.1371/journal.pone.0100903

[14] Bower, J.E., Irwin, M.R., 2016. Mind–body therapies and control of inflammatory biology: A descriptive review. Brain, Behavior, and Immunity 51, 1–11. https://doi.org/10.1016/j.bbi.2015.06.012

[15] Rini, C., Porter, L.S., Somers, T.J., McKee, D.C., DeVellis, R.F., Smith, M., Winkel, G., Ahern, D.K., Goldman, R., Stiller, J.L., Mariani, C., Patterson, C., Jordan, J.M., Caldwell, D.S., Keefe, F.J., 2015. Automated Internet-based pain coping skills training to manage osteoarthritis pain: a randomized controlled trial. PAIN 156, 837–848. https://doi.org/10.1097/j.pain.0000000000000121

[16] Friesen, L.N., Hadjistavropoulos, H.D., Schneider, L.H., Alberts, N.M., Titov, N., Dear, B.F., 2017. Examination of an internet-delivered cognitive behavioural pain management course for adults with fibromyalgia: a randomized controlled trial. PAIN 158, 593–604. https://doi.org/10.1097/j.pain.000000000000080

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Can You Really Fix Your Pain or Emotional Distress?

Posted on March 16, 2019November 23, 2020 by Andrew David Shiller, MD

How Do I Fix This Pain or Emotional Distress?

We’re around half way through the Inner Healng Mastery™ course and many are asking the question, “Doc, how do I fix or change this persistent physical or emotional pain or negative thought pattern that I keep experiencing?” We all experience this issue. And it always comes up in class at some point.

It’s a natural question to ask, “How do I fix this problem”.

But it’s the wrong question to ask.

Trying to “fix” inner pain and suffering usually makes it worse.

That doesn’t mean you’re going to suffer forever.

But we’re talking about inner transformation.

Fixing is the wrong outlook.

Inner Transformation is about healing.

Healing comes from a deeper place than the part of you that wants to fix it.

What’s Wrong with Trying to Fix Myself?

When I’m trying to fix something, I’m confronting it as if I’m going to make it change according to my will.

That “will to fix” is an agenda. There’s a part of all of us that doesn’t want to tolerate unpleasantness. We want to push away the pain. And usually when we try to push something away, we unknowingly pull it close to us.

My need to fix myself is usually coming from a place of fear, or anger, or sadness or other negative mind state. I have an issue with the issue that’s bothering me. I’m scared that I’m angry or I’m angry that I’m scared. When I take the desire to fix, which is rooted in a sense of brokenness and suffering, and push and pound on another aspect of my body-mind suffering, I create more noise, more tension, more pressure, more suffering.

It’s like two unhappy kids in the classroom. Bobby is convinced that Richie is doing something bad, so he starts to shoot spitballs at him or make fun of him or argue with him and maybe push him around. But Bobby is acting out his own aggression and unhappiness. So they create a bunch of noise and turmoil, and everyone in the room is affected by it.

It’s a simple metaphor. But there are actually good reasons why this is true, that are starting to be clarified by neuroscience. And it fits the map of our consciousness discussed by our sages, that they shared to help us transform our baser nature into something that is generous, kind, loving, and holy.

But lets keep this practical.

The main thing is I invite you to think differently.

To get out of ‘fixing’ mode and into healing mode.

Drop The Fixing Agenda and Rest Into Healing

I invite you to think and feel like a enlightened teacher in the classroom rather than two students pushing each other around. The enlightened teacher is not invested in the drama. The teacher is able to bring his caring and maturity. He understands the children and their needs. He intuits the root of their misbehavior. He creates boundaries for them, and nourishes them emotionally. So they become harmonious. He helps them grow up.

This fits well with the work of the Inner Healing Mastery course. We started by practicing being present to the flow of experience, including our unpleasant experiences. We are focussing on developing mindfulness, which lets us be with ourselves and start to see whats really happening.

There are three main steps that we are learning. 1. Naming the experience, 2. distinguishing the physical, emotional, and cognitive parts of the experience, and 3. acknowledging and agreeing to its existence in the moment.

The Power of Naming

First lets talk about naming or labeling the issue.

When we label the emotional tone of the thing, it’s often helpful to use one of three choices: pleasant, unpleasant, and neutral. If it’s pain or suffering, it can be helpful to name it as “unpleasant”. It’s a fairly uncharged word. It accurately describes pain, but it gives room for the pain to evolve. If I label something “horrible pain” or “intolerable” then I’m already activating circuits of suffering in my brain. We want to relate to it with acceptance and love like the enlightened teacher. So name it ‘unpleasant sensation’

The Power of Making Distinctions

Then I want to distinguish the physical sensation, from the emotions arising, and the thoughts and stories and judgments that are arising.

If there is physical pain I notice it’s qualities. Intense sensation. Unpleasant. Sharp, or dull or tingling or numb. It’s location. It’s shape. Noticing it and staying anchored in my breathing.

Sometimes there are emotions connected to the physical feeling. Perhaps I first just feel pain, but I ask ‘what emotion am I feeling?’ and I see that its fear (or anger, or whatever I am experiencing). Yes and there is also sadness. So I acknowledge and welcome the fear and sadness. I accept that this is what’s happening.

Sometimes there are all kinds of stories, judgements, rationalizations, explanations. “I’ll never get better. It’s all her fault. It’s all my fault. This is intolerable. I can’t live like this” These are judgements and stories that are often generated by my emotions. They are usually about the future and past. We want to relate to the reality of what’s happening in the present. So I acknowledge the thoughts, I name them ‘thinking’ or ‘judging’ or ‘catastrophizing’ and let them go. They may come back. But I don’t invest in them or hold on to them. And I don’t try to push them away. Like clouds on a sunny day I observe them while I stay anchored in my breathing or other pleasant present-moment experience.

When I make those distinctions, I’m getting more clear on what is really happening. What may have been a sense of overwhelming chaos and storm becomes a more clear understanding of the aspects of the suffering. I start to see cause and effect. I can see the stories and judgements that keep me from healing. it helps me see what is true and what is false. What is useful and what is counterproductive. It empowers me to let go of what is not serving me, and to bring compassion and forgiveness to the parts that need it. I’m giving myself options for how to work constructively with the situation.

Accept, Agree, and Be

So after acknowledging and labeling, and distinguishing the physical, emotional, and cognitive parts, agree with the experience. You could also use the word “accept’.

That doesn’t mean agree that it’s going to be forever. Agree that its what is happening now. Because it is what’s happening now. And I have no idea what the future is going to bring. So staying with the now. “I agree that I am experiencing unpleasant sensation and emotion and mind states, now.”

When I agree, I’m dropping my agenda. I’m dropping the cruel pressure to make things different than they are, The pressure to fix things, that we almost reflexively add when we react to something that hurts. In the metaphor of the classroom, the agenda to fix is like Bobby, the other kid in the class, whose irritated by Richie’s pain. Bobby doesn’t have much skill, and he wants to come in and force Richie to shut up, and thus feeds the chaos and noise. When I agree with my experience, I disengage my resistance. I stop interpreting my experience. I let go the tendency to develop drama and other emotions about my experience. I’m dis-indentifying from the fighting children, and identifying with the role of enlightened teacher.

While doing these three steps, we sit and stay anchored in some pleasant experience like our breathing or sense of the body, and we give that unpleasant experience some but not all of our attention, and we wait.

To sum up, when I do these steps of acknowledging, distinguishing, and agreeing, I’m shining light into the experience of suffering. I’m unpacking it without emotional charge. When it is unconscious, the suffering is a vicious cycle of ripples in the integrated emotion/though/body system. When I shine the light of my consciousness into it, I’m uncoupling or disconnecting the reactive parts of the vicious cycle. I’m making space for something else to happen.

Watching the Flow of the River of Life

We shared a metaphor of the stream of life experience flowing along. And the practice of working with difficult experiences is to sit on the bank of the river, to be anchored on the bank of the river, while being aware of the river of unpleasant or pleasant experiences flowing past. So when an unpleasant emotion or physical sensation comes along, we note it, acknowledge it, but stay anchored on the bank of the river, by attaching to our breathing and present-moment awareness.

We try not to get sucked into the river. That means we don’t give the unpleasant experience too much of our attention. We don’t get emotionally activated by it. We notice that it’s happening. We care about the suffering with compassion, like caring for small child is crying. We agree to its existence, because here it is. But we don’t dive into it.

Sometimes we fall into the river. It happens. We get sucked in emotionally. Or we are staring at the pain our shoulder and wanting it to change, so we generate a bunch of muscle tension and the physical pain gets worse. So sometimes our old habits win and we fall in. And hopefully we forgive ourselves for being human and climb out maybe go for a walk and dry off. And then we sit back down on the bank of the river.

Activating The Power of the Heart and Soul

More recently in the course we’ve started generating positive mind-heart states. For instance, we started a practice where we find and generate a heart-full intention for the good of myself or another person. And I meditate on the intention and develop a heart-full energy of lovingkindness. It can be a very pleasant experience.

Soon we’ll also work with generating and developing a felt sense of connection to the Source of Life, or G!d if you are comfortable with that language.

Whether its a heart-full good intention, or a more spiritual sense of possibility, intention, and connection to G!d, what we are creating is a another kind of anchor. It’s another kind of ‘riverbank’ that we can attach ourselves to. We bring a positive, loving, energy of possibility and joy and sit in it, while we are also aware of that difficult emotional/physical/mental state.

So we take the three steps of labeling, distinguishing and agreeing while being present to them and turn on the high beams. When we connect to a higher state of heart-mind, it’s kind of like taking the 3rd step of “agreeing” and energizing it with sweetness and love.

Said differently, when I access a connected living mindbody state, I generate biochemistry of healing. I connect to an energetically charged integrated mind-body-emotion state, and also give some attention to the pain. I sweeten the pain and start to transform it.

The main thing is to practice.

To notice and label the experience as unpleasant

To distinguish it’s physical, emotional, and mental manifestations,

To agree to the reality of its existence in this moment

And to anchor ourselves gently and confidently in a state of heart/mind that is open, stable, receptive, loving, and sweet.

To give some attention to the existence of the difficult body-mind state, but not too much. Being aware that it’s there, while we rest into a place of of pleasantness.

And see what happens.

I encourage you to keep practicing.

You can watch the video here

Please comment and share this post.

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Here’s Evidence That Fibromyalgia Has an Immune Basis, and LDN Can Help

Posted on January 18, 2019March 3, 2024 by Andrew David Shiller, MD

Has Your Doctor Been Lying About Fibromyalgia?

Modern medical science has been saying for years that we don’t understand the basis of fibromyalgia. Some doctors even claim that it doesn’t exist or it’s “all in your head”. Both statements are false. They’re not lies. But they are misinformation. Modern science has moved forward and shown us much about what’s going on inside people with fibromyalgia.

Immune Dysfunction Is Part of the Problem

Fibromyalgia is related to immune dysfunction. There are other physiologic dysfunctions too, but this post will focus on immune dysfunction. Many people with fibromyalgia have increased levels of various pro-inflammatory chemicals called cytokines. And its well known that people with auto-immune diseases like rheumatoid arthritis, lupus, and others have a disproportionate incidence of fibromyalgia. Furthermore, interventions that reduce auto-immunity often result in improvement in fibromyalgia symptoms. Click Here to see more about that in a recent research report.

Evidence for Immune Dysfunction

Here’s What You Can Do About Immune Dysfunction in Fibromyalgia

Functional Medicine

The best thing is to see a doctor who practices functional medicine. It’s a comprehensive approach to discovering the underlying physiologic dysfunctions that make you feel horrible. And it’s a research-based way to treat those dysfunctions with lifestyle: diet, exercise, mind-body techniques, physical treatments, and nutritional supplementation. Functional medicine takes time and costs money, and some folks don’t have those resources available.

LDN (Low Dose Naltrexone)

Low dose naltrexone is an easier approach. You can read more about it in other articles on the site. Briefly, it’s very safe medicine that triggers your body to boost is natural pain blocking chemicals (enkephalins and endorphins) from the inside out. Another result is a subtle immune modulating effect. It’s not as intense as taking steroids (prednisone) or other strong immune modulating agents. But it has been shown to reduce the concentration of pro-inflammatory chemicals in the blood of people with fibromyalgia, and to improve their pain and other symptoms. Click here to see the video series about LDN

Diet, Exercise, and Mindbody Self-Care

Don’t Forget About The Big Picture

Immune dysfunction is a big part of what causes pain, fatigue, and other symptoms of fibromyalgia, but it’s not the whole picture. The symptoms of fibromyalgia are driven by vicious cycles among several, correctable dysfunctions that vary depending on the person. You can read more about that here In brief, it’s vitally important that you find out which of the main issues are part of the vicious cycle for you. Possibilities include:

Sleep Dysfunction
Hormonal Dysfunction
Intestinal Permeability (Leaky gut)
Immune Dysfunction
Stress System Dysfunction (hypothalmic-pituitary-adrenal axis)

Other posts will discuss these in depth. Please share this post if you know someone who would find it interesting. And please make sure you signed up for the newsletter to get more helpful information about taking your life back from chronic illness and chronic pain. Click Here To Get The Newsletter

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What is The Most Powerful Way to Heal Fibromyalgia, Pain, Inflammation and Fatigue? You Already Have it.

Posted on December 15, 2018March 3, 2024 by Andrew David Shiller, MD

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Summary:

If you’re suffering from fibromyalgia, chronic pain, or chronic illness, you might be curious about the importance of the mind body connection. If you’re not curious, you should be! Get curious!

Simple Techniques That Can Help You Feel Better

Because the fact is that that simple easy techniques of mind-body healing have a good chance of helping you feel better and function more effectively. The can include less pain, better emotional state, and more energy. In some cases, the actual disease process can shift or improve when you activate deep relaxation, and transform stress and emotional pain. These aren’t just my words. They’re supported by substantial body of research showing the importance of mindbody variables in chronic pain and chronic illness, and showing that mindbody techniques often help many people improve and feel better. For example, research tells us that we can use our mind to generate the relaxation response. The relaxation response is a well-documented restful state of mind and body, that helps with all kinds of things like better sleep, less suffering from pain, better learning and memory, lower blood pressure, decreased heart attacks, and so on.

Where Modern Science and Ancient Spiritual Wisdom Meet

This is an area where modern science and ancient spiritual wisdom agree. Modern science is showing us about how we can activate physiologic healing responses and transform negative emotions and trauma. And the worlds spiritual traditions speak about the same principles. We have a body, and an aspect of ourselves that is “above” the body. Lets call that the soul. The soul shares vitality, creativity, purpose, and meaning with the body. In the Torah tradition the soul is constantly irrigating the body with energy and life. It contains the “blueprint” of who you are an why you came to the world. So it has the capacity to help your body and emotions heal, and to realign itself with life, meaning, and purpose. These are incredibly valuable in your healing process. If you don’t believe in the soul, you can call it, “the powers of the mind”. The process of healing is the same, regardless of your belief system. Rebbe Nachman of Breslov (luketei Mohoran 22:5) shares an interesting understanding of the process. He points out that the mind and soul are dynamic and flexible, and have access to insight, wisdom and understanding, regardless of the state of the body. He suggests using the powers of the mind and soul to have compassion on the body, and thus purify and elevate the body. And then the body will be elevated to the place of new insight. When we condition the body with insights and wisdom of the soul, the body is purified. He’s talking about a healing process. About returning to ourselves and revitalizing our sense of purpose and connection in the world. The language he uses is exquisite. He says, “Using the insights and awareness of the mind to have compassion on the body”. It’s a beautiful phrase!

Why Do We Need to Have Compassion on the Body?

It’s so easy to develop an antagonistic relationship with the suffering of the body. In my practice caring for thousands of people with chronic pain and illness, there is a recurrent theme. For many people, pain, trauma, fatigue, paralysis, and disabilty generate toxic beliefs and emotions. Frustration, anger, blame, shame, hopelessness, overwhelm. Suppose you’re dealing with chronic pain or illness. You’re exhausted all the time. It’s hard to get out of bed. Maybe there has been a neurological injury and you can’t use your arm or leg or both. You can’t function. It’s so natural and easy that those physical feelings generate frustration, anger, helplessness, fear, overwhelm. And it’s not your fault. And all of those painful mental/emotional states generate biochemistry that can worsen the pain, fatigue, weakness, inflammation, insomnia, etc. That is well-established scientific fact. It’s a vicious cycle. Physical pain and dysfunction that generate mental/emotional distress; that feeds physical pain and dysfunction. And so on…. The Rabbi Nachman suggests, “Using the insights and awareness of the mind to have compassion on the body”.

The Power of Compassion

Compassion is a deep principle. Compassion is when I see what’s wrong, and I choose to care and love anyhow. Compassion is a powerful opening of the heart to suffering, loss, and pain. Compassion means developing a degree of acceptance. It doesn’t mean I agree to suffer forever. It means I agree that indeed this is the reality right now and I make a powerful choice to transform it. Have compassion on the suffering of the body. Activate the higher intelligence of your mind, and your heart to create a wave of compassion and relaxation on your body. That’s a powerful step in healing. That’s how you empower your mindbody system to heal yourself. You choose it.

Do It Now. Over and Over Again.

You could start to do it right now. Stop what you’re doing. Do this on your own or follow the instructions in the video. Clear distractions for 5-10 minutes. Put your phone on ‘airplane mode’ and set a timer if you want. Sit down and contact your breathing. Notice the feelings of inspiration and expiration. Don’t try to do anything except be aware of your own breathing. Decide to let go of what you were doing before and what you will do later. Just let your mind float in and out of your body on the waves of your own breathing. Like gentle waves on the beach, on a warm sunny calm day. Let yourself dwell in that space for 10 minutes. Your soul is speaking to the body with compassion. Your brain is generating biochemistry of healing. And your body receives it, and appreciates it. That is an initial step.

Commit to the Process to See Results

There are many techniques for evoking a calm, present, happy, resourceful state of mind, and of sharing it with the body. And there are other techniques for intentionally generating the emotional energy of compassion, forgiveness, and love. Those energies can transform the judgement, shame, frustration, anger, and other forms of pain that often accompany us, especially if our body is suffering. It is an art to find what works for you and learn to apply it in your life. “Apply it in your life” means to do it regularly. The mind is flexible and powerful. But it is gentle and soft, when compared to the body. Mindbody techniques can help you feel better right away. But long term lasting results come from substantially shifting your physiology. Your body learned the habits of pain, fatigue, insomnia, distress. Your body can learn the habits of comfort, energy, good sleep, joy, purpose. But remember it means shifting something heavy (your biochemistry) with something light (your mind). But water dripping on a rock can dig a hole over time. Your body isn’t as hard as a rock. It “wants” your mind to heal it. But success comes from regular practice over time. That’s what we do in the Inner Healing Mastery program. We teach the mind to access new insights and possibilities. We learn techniques to empower the transformational loving energy in our own hearts. And we bring the mind and body together so that the mind can have compassion on the body. People who learn and practice these techniques often are able to reduce pain, anxiety, confusion, frustration. They often develop the capacity to generate positive thoughts and emotions, and bring those to their body pain, illness, an so on. You can too. If you want more information about the program please click below

Inner Healing Mastery Program.

If the program isn’t for you, don’t worry, there will be more free content. Some people want a systematic structured program that will help them develop self-healing skills and potency. And for some it’s not the right time for that. I’m here to support you either way, as best I can. Next post in this series: many of my patients have a very hard time evoking the relaxation response. Their body is so uncomfortable, or their mind is so busy and tense, that when they try to meditate they get more tense. What to do then? Please feel free to share this post with the social media buttons below, or email it to a friend.

Don’t Forget the Big Picture

Healing is multifaceted. When we align our mind/spirit/heart with our highest good and heal the negativity that we have absorbed from life and its challenges, we make a powerful step toward healing. For many people with fibromyalgia, fatigue, chronic pain, and chronic illness, there are other aspects to the process. There are “Three M’s”, which are three windows into your physiology. They are “windows” because they are access points for understanding what’s going on, and access points for doing things that can help us heal. This series is talking about the “Mindbody” window. You can enter the Mindbody window and understand much, and you can do things with your Mindbody connection to heal yourself. In my experience, that is foundational, and often makes the other parts easier. There is also a Metabolic window, which is all the biochemical processes, including nutrition, detoxification, energy production, hormones, etc. And there is a Mechanical/Movement window, which is the structure and functional aspects of your body. These are also powerful places to shift your physiology toward healing and will discussed in other posts. Wishing you all the best. Andrew David Shiller

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Chronic Pain and Illness? Find The Flowers Among The Thorns, and Choose Health.

Posted on October 31, 2018May 15, 2020 by Andrew David Shiller, MD

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:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4079606/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4679419/

https://www.ncbi.nlm.nih.gov/pubmed/12665179

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Healing Chronic Pain and Illness with LDN (Low Dose Naltrexone) Part 1

Posted on August 16, 2017March 3, 2024 by Andrew David Shiller, MD

For more videos subscribe to our YouTube channel here

Summary:

Here’s Part of the Solution to Chronic Illness and Chronic Pain

If you continue to suffer from chronic pain, fibromyalgia, chronic fatigue syndrome, colitis, arthritis, chronic headache, or other chronic illnesses and pain, you know that conventional medicine rarely has the whole answer. And you may have discovered complementary therapies that offer benefit, but often give only temporary help. So what’s the answer?

I don’t pretend to have an easy answer.

Healing is a journey. You need to find what works for you. Often it involves a number of tools and lifestyle choices.

Low Dose Naltrexone (LDN) is often very helpful where conventional treatments fail. It is a great complement to the natural healing choices, like nutrition, exercise, and mindbody therapies, that often help with chronic pain and illness. It’s inexpensive, it’s very safe with few side effects, and many people find it to be life-changing for the better.

LDN stimulates the body-mind to boost its own natural healing chemistry. LDN has caused life-changing improvements for many people with conditions such as:

Chronic Pain States: Fibromyalgia, Complex Regional Pain Syndrome (Reflex Sympathetic Dystrophy), arthritis, trauma, neuropathy, traumatic brain injury, spinal cord injury, etc.

Auto-immune diseases: Ankylosing Spondylitis, Behcet’s Disease, Celiac Disease, Chronic Fatigue Syndrome, CREST syndrome, Crohn’s Disease, Dermatomyositis, Dystonia, Endometriosis, Fibromyalgia, Hashimoto’s Thyroiditis, Irritable Bowel Syndrome (IBS), Myasthenia Gravis (MG), Nephrotic Syndrome, Pemphigoid, Primary Biliary Cirrhosis, Psoriasis, Rheumatoid Arthritis, Sarcoidosis, Scleroderma, Sjogren’s Syndrome, Stiff Person Syndrome (SPS), Systemic Lupus (SLE), Ulcerative Colitis, Wegener’s Granulomatosis.

Chronic or Degenerative Illnesses: ALS (Lou Gehrig’s Disease), Alzheimer’s Disease, Autism Spectrum Disorders, Hereditary Spastic Paraparesis, Multiple Sclerosis (MS), Parkinson’s Disease, Post-Polio Syndrome, Post-Traumatic Stress Disorder (PTSD) ⇒, Primary Lateral Sclerosis (PLS), Progressive Supranuclear Palsy, Transverse Myelitis.

Other diseases: Emphysema (COPD), Interstitial Lung Disease, Pulmonary Fibrosis, HIV/AIDS, Depression (Major; and Bipolar), Lyme Disease (LATE Stage).

If you are interested in trying LDN, please click here.

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

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 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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Did You Know:

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Summary:

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

Did You Know:

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Heal the Roots of Unresolved Pain and Chronic Illness

The Thigh Bone’s Connected to the Hip Bone

Here’s Why Your Doctor Can’t Help Your Fibromyalgia

You Can Understand and Heal Fibromyalgia and Fatigue Through an Integrative Holistic Approach

Did you know?

Join my email community and get notified about new content and transformative self-healing skills.

Join my email community and get notified about new content and transformative self-healing skills.

Join my email community and get notified about new content and transformative self-healing skills.

Can You Diagnose Fibromyalgia Through A Stool Test?

Here’s Why It’s Dangerous To Read Headlines….

Perhaps I can give clarity to this article…

What Did The Research Really Prove?

Does This Mean You Can Diagnose Fibromyalgia in My Poop?

What’s The Good News In This Study?

How Does This Study Help Us Understand and Treat Fibromyalgia?

My Life Is a Wreck from Fibro. What Can I Do Now?

For instance, recommendations commonly include:

Join my email community and get notified about new content and transformative self-healing skills.

Can You Heal Your Pain With Your Mind-Body Connection? What Does the Science Say?

Why is this paper so incredibly important right now?

Meta-Analysis? What and Why is That?

What Did The Research Say?

The Things I Hope You Never Know About Chronic Pain

My patients often say things like:

Did You Know That You Have Inner Healing Superpowers?

Healing Chronic Pain at Its Root With Mind-Body Training

Mind-body training has a crucial role in shifting this complex web of relationships.

Join my email community and get notified about new content and transformative self-healing skills.

How Do I Fix This Pain or Emotional Distress?

What’s Wrong with Trying to Fix Myself?

Drop The Fixing Agenda and Rest Into Healing

The Power of Naming

The Power of Making Distinctions

Accept, Agree, and Be

Watching the Flow of the River of Life

Activating The Power of the Heart and Soul

Join my email community and get notified about new content and transformative self-healing skills.

Has Your Doctor Been Lying About Fibromyalgia?

Immune Dysfunction Is Part of the Problem

Evidence for Immune Dysfunction

Here’s What You Can Do About Immune Dysfunction in Fibromyalgia

Functional Medicine

LDN (Low Dose Naltrexone)

Diet, Exercise, and Mindbody Self-Care

Don’t Forget About The Big Picture

Join my email community and get notified about new content and transformative self-healing skills.

Summary:

Simple Techniques That Can Help You Feel Better

Where Modern Science and Ancient Spiritual Wisdom Meet

Why Do We Need to Have Compassion on the Body?

The Power of Compassion

Do It Now. Over and Over Again.

Commit to the Process to See Results

Inner Healing Mastery Program.

Don’t Forget the Big Picture

Join my email community and get notified about new content and transformative self-healing skills.

Living in The World of Brokenness

Living in the World of Wholeness.

The Timeless Need for Wholeness

How do You Cultivate Wholeness?

Join my email community and get notified about new content and transformative self-healing skills.

Summary:

Here’s Part of the Solution to Chronic Illness and Chronic Pain

Did You Know:

Related Posts:

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