Fibromyalgia - The Phantom Pain Condition
by Richard Boyd, Body Mind Psychotherapist, Energetics Institute, Perth, West Australia
There are a number of illnesses and conditions that modern medicine has struggled to understand, define, diagnose and treat. Conditions such as Chronic Fatigue, Restless Legs Syndrome and other related conditions such as Fibromyalgia are real and debilitating to those who suffer from the bodily symptoms which then create suffering in the mind of those afflicted.
Fibromyalgia has several definitions. One definition is Fibromyalgia syndrome which is described as pain felt in soft or connective tissue with no obvious signs of trauma. The term “no obvious signs of trauma” means that there is no obvious cause at the physical level such as strained muscles, injury or accident as a precedent or cause to the condition.
The presence of Fibromyalgia is a low or mid level chronic condition that persists over time and the discomfort then goes on to create bodily discomfort which in turn creates fatigue and sleep deprivation. The long term effects of this condition can be to cause Depression in the sufferer as there is a known link between long term sleep disorders, pain in the body, and the resulting onset of Depression.
As a result of the combination of Fibromyalgia and the possible linked sleep deprivation and tendency towards Depression we find that sufferers start to show headaches, muscle stiffness, postural issues, and dull or impeded mental or cognitive processing. Statistically it appears that more women than men suffer from Fibromyalgia.
The pain symptoms are also different across individuals. Some report a dull ache and individual muscle sensitivity, others report stabbing pain, others movement triggered pain and discomfort, others still find a burning sensation or a throbbing effect. These may all be isolated to one limb or area of the body, or across the entire body, and the areas may change or shift over time.
In some sufferers we see a constant background presence of pain whilst others experience triggers such as movement, exercise, exertion or heavy muscle leverage dynamics (e.g. lifting), bodily fluid shifts due to weather changes from cold to hot temperature, or from dry to humid weather, or night versus day.
Other sufferers have some form of relationship to their immune system as the onset of illness, flu’s, colds, infections, and viruses seem to trigger an attack, which compounds whatever other illness they have. The presence of stress and anxiety appears to be a trigger as does the emotional repression of anger and rage in the body by people who report being “too nice” to express their emotions.
This last dynamic which centres around the emotional life of the person appears to be a causal factor rather than a symptomatic trigger, based on our work with Fibromyalgia sufferers in therapy. It is the opinion of the Energetics Institute that Fibromyalgia has as one of its causes the presence of unresolved trauma in the life of the person, and/or a poor relationship between the person and their own emotional life.
Sufferers report different long term outcomes. Some report getting worse and the onset of additional or secondary symptoms over time, while others do not get worse or better over time, while others go into remission over time. There is no atypical design for this condition which makes diagnosis and treatment difficult.
We have had a number of Fibromyalgia sufferers present for therapy to deal initially with the Depression caused by their Fibromyalgia. In seeing the Depression as a symptom of both their Fibromyalgia, and also where applicable, as symptoms of old developmental or episodic adult trauma, or a poor emotional expressive life, we have found Fibromyalgia often resolves itself over time by treating it as a symptom based on one of these 2 causes.
Sufferers have previously or currently been undertaking pain medication, exercise routines, chiropractic and massage treatments, nutritional supplements, naturopathic detoxes and yoga in an attempt to heal their condition, but have reported only limited benefits from such treatments.
Research shows that Fibromyalgia sufferers often have a cluster of conditions which may when viewed holistically serve to point to a systemic issue in one of the body's pathways or signalling systems(nerves) which may present a reason why sufferers have symptoms that lack physical indicators or drivers.
Interestingly the related conditions also show up in some trauma sufferers and so the link between trauma and Fibromyalgia would be a good thesis or research for someone to pursue. The common clusters include some of:
- Chronic neck or back pain
- Chronic fatigue syndrome
- Generalised Anxiety Disorder(GAD)
- Adrenal Fatigue
- Hypothyroidism or an underactive Thyroid
- Lyme disease
- Irritable Bowel Syndrome(IBS)
- Sleep disorders
- Arthritis(may be misdiagnosed Fibromyalgia)
- Joint inflammation
- Soft Tissue Injury from unknown cause
- Panic Attacks
- Cognitive disorders
If the condition persists over time then a list of secondary onset issues may arise. These include:
- Painful menstrual cramps in women
- Jaw problems including TMJ and Bruxism
- Vision problems
- Nausea and dizziness
- Weight gain
- Chronic headaches
- Skin, hair and nail problems
- Muscle twitches and feelings of weakness
One of the issues that sufferers face is their attempts to use their logical rational “front brain” to apply Cognitive Behavioural Therapy (CBT) techniques to deal with their negative and depressive thoughts and focus on something other than the pain. From a trauma perspective this approach tends to fail due to the fact that the onset of pain and discomfort is a body centric condition and causes “bottom-up high-jacking” of the mind and brain of the sufferer.
“Bottom-Up High-Jacking” is a trauma and Neuroscience term to describe the involuntary process of our older primitive reptilian brain initiating a survival response mode to the rest of the brain. In this mode we find that the front logical and rational brain function shuts down and goes “off-line” and the person retreats into the realm of emotional and reactive thinking and being.
The learnt behaviours and responses that modalities such as CBT teach when a person is otherwise stable and using their “front brain” then in turn shutdown and become ineffective when the body in pain then signals that to the lower and older reptilian sub-cortical brain areas. We all have evolutionary mediated response of our body centric, “lower” limbic and reptilian brains which activate when our body experiences discomfort and signals pain.
Simply put these strategies cannot override the pain body and the bottom-up high jacking that is initiated once we are in pain. An eastern Siddhi or meditation guru may be able to enact control of body, brain and pain processes but this is not the case for the average person in the street. CBT and cognitive strategies will fail to help a person in the pain moments as the brain which effectively enacts these CBT strategies is disabled.
What is worse is that sufferers have expectations that these CBT strategies will work and when they appear to fail them then often despondency sets in. I find that sufferers start to blame themself as a failure instead of understanding that the context for using valid CBT strategies is wrong and not them or the CBT process.
Pain bearers already have low self esteem and negative thoughts as a consequence of their pain and so the perception that they cannot do what is asked of them may lead them into giving up, and becoming a victim to their pain and Fibromyalgia. This is not helpful.
Medical science has uncovered some pointers towards the causes of Fibromyalgia. Mainstream medical attention has focussed on a malfunction of the central nervous system which is medically known as central sensitisation and relates to the idea of a nervous system becoming hyper-sensitive for as yet unknown reasons.
What has been discovered in recent years within Neuroscience and in particular by Stephen Porges (2010) is the Polyvagal theory. This Polyvagal theory concerns neural or brain regulation of our Nervous systems and the neuroception of sensory information about dangers, threats and safety “out there” in our environment. This theory explains how our evolution has provided us with a hierarchy of responses to environmental stimuli which enable us to detect, respond and adapt to both positive and negative objects, events and experiences.
The theory shows how the “Vagus” and Autonomic Nervous Systems (ANS) are an interconnected network of sensing and responding to these positive and negative objects, events and experiences. These systems are embodied and include the head, trunk, limbs and viscera of the body as sensing and responding points. The pathways through the nervous systems of the body reach most points of the body and include the musculature.
The process known as neuroception mediates this way of being. Neuroception is bodily perception and is “the detection of features in others or the environment – without conscious awareness – that dampens defensive systems and facilitates social behaviours OR promotes defensive strategies of mobilisation (fight/flight) or immobilisation (shutdown, dissociation)” (Porges:2011).
There is evidence that trauma compromises this “Social Engagement System” or movement toward others from a place of being safe. Trauma victims do not feel safe and their Neuroception process is compromised to keep them stuck in an unconscious “I am not safe” loop and triggers defensive reactions in the person and breaches of their ANS window of tolerance of stimulus.
There are three key Vagus nerves which can be affected by trauma. They are the Myelinated Vagus nerve system, the Sympathetic-Adrenal system, and the Unmeyelinated Vagus nerve system. These work in a hierarchy and the higher order nervous system arrangements inhibit or control the lower ones, but bottom up high jacking can occur where the higher order are rendered functionless, and the lower systems rise in activity.
Metabolic demands, stress, trauma and illness can cause this to occur, as can a detected threat from the outside environment. The highest order system that is compromised by these events is the Social Engagement System and the Limbic and frontal brain areas. The symptoms of a compromised Vagus system can look like many of those noted for Fibromyalgia, including cognitive fuzziness, inability to sleep, Irritable Bowel Syndrome, lethargy, Adrenal issues, Depression, Anxiety etc.
Research shows that we each possess a “Vagal brake” that can modulate the Ventral Vagus nervous system that oversees much of the 3 key Vagus nerves. Breathing is a key process that turns on and off the Vagal brake. Inhalation or breathing in turns off the brake and leads to such things as the heart rate increasing and the signalling of stress if an organic and complete breath exhalation is not performed.
Exhalation turns on the Vagal brake and so the heart rate decreases which can down-regulate the stress indicators in the body. Deep organic breathing becomes a key therapy to exercise and regulate the Vagal brake and establish homeostasis or health in the body and its systems, whilst allowing for accurate survival responses when interrupted breathing signals a threat in the environment.
There is evidence now that both trauma victims and most personality disorders show a flattened/dead effect in breathing which relates to a traumatised Vagal regulation system. This can lock a person out of social engagement and exploration/play modes of being, and instead promote a more or less constant state of hypo or hyper-vigilance and living in safety/survival mode with its various fight/flight/immobilised strategies.
Trauma of the Vagal system will affect some individuals such that they have difficulty in regulating their own states in the presence of others and in certain environments. They will be easily triggered by others and/or some environments. They may live in a constant quest for safety.
There is evidence emerging that Fibromyalgia represents the malfunctioning of the Vagal sensory feedback system across the 3 key Vagal nerves. The sensory part is interrupted or is not activated properly. Pain signals are re-sent and may amplify to become excessive and may become activated either in “burst” mode or as more or less a chronic background condition.
Pain studies have shown that incomplete pain signals in the body can cause them to be re-sent and even amplified. Fibromyalgia sufferers appear to have a pain signalling problem that is of this nature. The Vagus nerves have been shown to have “communication problems” when traumatised. This is conjecture but a possible framework under which Fibromyalgia exists without showing causes and origins. It may turn out to be a nervous system “network” problem.
If the Vagal brake does not apply itself in the exhalation phase of breathing then the calming response will not kick in. Clinically this has been found by Porges (2011) and other researchers to be the case for those with developmental trauma, PTSD, and some episodic trauma. They measured the respiratory sinus arrhythmia (RSA) in formal trials of trauma and non trauma sufferers to establish this outcome.
Researchers have established deficits in Vagal regulation in both perpetrators and victims of abuse. Documentation has shown that Vagal regulation of the heart, both in terms of the level of cardiac vigil tone and the efficient regulation of the Vagal brake, is related to processes such as emotional reactivity, social engagement, and reactions to stress (Porges:2011).
The symptoms of Fibromyalgia also show correlation to the 3 Vagus nerves as well as the overall Autonomic Nervous System (ANS). Trauma has been shown to cause misfiring of nerves and systems in the body. The aspect of the hypertonic muscles and the survival response of hyper tense but immobilised state may also have a bearing on the musculature nature of Fibromyalgia.
This may also be true that the hypotonic or flaccid muscle response that some people have as a “collapse” or feigned death survival response may also have a bearing on the musculature nature for those people with Fibromyalgia. Muscle tone and state are both central to survival responses in humans. Muscular pain is also central to Fibromyalgia.
Fibromyalgia patients experience firm knots in their muscles, often causing restricted movement and radiating pain. This is similar to the chronic holding posture of the hypertonic fear/immobilised response that we all potentially have as a survival response. The Vagus system may be activating this type of response in an uncoordinated way. Possibly trauma caused “noise” floods the Vagus system nerves and activates muscle contractions, pain, twitches, cramps, and other signals. It is conjecture but is plausible.
Given that there typically are no identifiable triggers or causes and the sufferer appears OK to outsiders then an internal misfiring signal as a cause makes a degree of sense. Apart from the fact that blood and saliva tests typically no causes, and physical checkups often return a blank, then sufferers are often labelled as Hypochondriac. The inability to diagnose produces its own forms of frustration, anger and helplessness in the sufferer.
We at the Energetics Institute have found that deep organic breathing techniques which are integrated into body mind postural and bioenergetics routines work to restore what appears to be temporary Vagal brake regulation. The exercises when done as a daily routine have been reported by clients to allow them to live what is subjectively described as a more normal Parasympathetic state where they feel “safer”, grounded, present and oriented towards social interaction rather than survival fight or flight preoccupations.
This creates the space for these clients to examine whatever childhood developmental trauma and abandonment/neglect issues they often seem to have, and/or classic abuse or developmental trauma in their personal history. The sensor motor trauma resolution work we undertake with clients, as articulated by Pat Ogden’s pioneering work, further assists in lessening the Fibromyalgia symptoms over time.
In fact we often find that the Fibromyalgia symptom of pain or bodily sensation, when isolated and focussed on, may be tracked back to a blocked and incomplete survival response initiated perhaps as early as childhood, but was frustrated, discontinued or overwhelmed by trauma. Resolution of these blocked impulses appears to assist in the lessening of the Fibromyalgia onsets, duration and severity of symptoms. In this context Fibromyalgia appears to have a relationship to trauma.
These body psychotherapy and trauma principles and treatments offer a potential way forward for Fibromyalgia sufferers.
Please contact us for further information or to book in to have an assessment conducted and treatments explained in further detail.
Contact the Energetics Institute for more information about Depression, Anxiety, and other body-mind states of being that affect yourself or someone you love and interact with.
Richard Boyd is an experienced Body Mind Psychotherapist and the Director of the Energetics Institute in Perth, Western Australia
Mob : 0407577793