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Understanding fibromyalgia and ways to help yourself

by | Mar 21, 2024 | Fibromyalgia | 0 comments

One thing we know about fibromyalgia and that most medical experts agree on, is that we don’t really know what it is or what causes it.

This is frustrating for the many people who have the condition which is thought to be as many as 1 in 20 adults.

What is also frustrating is that fibromyalgia covers such as wide range of symptoms and degrees of severity so that people at one end of the spectrum experience typical symptoms of fibromyalgia but are still able to work, exercise and generally get on with life. While those at the other end of the spectrum with severe symptoms are unable to hold down a job or enjoy much of a social life.

In addition to the wide range of symptoms and effects these have, there is as yet no clear specific test for fibromyalgia. Nor is there one medical discipline that ‘owns’ the condition. Depending on their predominant presenting symptoms on an initial GP visit, people may typically be referred to either a rheumatologist or a neurologist, or sometimes both.

Diagnosis

The diagnosis of fibromyalgia is then quite subjective. Yes people will be tested to rule out anything else, yes they may be checked for pain felt in all 4 quadrants of the body over a 3 month period, and yes their overall medical history will be taken into account. But in the end fibromyalgia is often a diagnosis of last resort when everything else has been ruled out.

Diagnosis is only one part of the jigsaw. There are many and varied symptoms that people may experience and ways in which these may be managed. Although we still know very little, it has been recognised that fibromyalgia may be triggered by a major life event such as an illness, accident, bereavement or other emotional trauma.

Symptoms typically can include:

Pain – usually described as diffuse pain this means it is felt all over the body. It can vary in location and it can vary in intensity from achy burning pain to sharp electric pain. For most people, pain is a constant part of their fibromyalgia.

Fatigue and poor sleep – although people may have a need to sleep more than usual, they do not get enough deep restorative sleep where the body can repair itself. Instead they can get stuck in a cycle of REM or dream-state sleep which leaves them tired and stiff when they wake up. This leads to fatigue where they constantly feel tired and which can suddenly overwhelm them.

Increased sensitivities – these are usually to environmental factors such as noise, bright lights, smells, smoke, weather – and can also lead to new allergies to many everyday things.

Digestive problems – poor gut health which can develop into irritable bowel syndrome (IBS) or Crohn’s disease.

Brain fog – difficulty concentrating, remembering or thinking clearly, sometimes combined with dizziness and/or physical clumsiness.

Anxiety – an increased tendency to experience stress symptoms such as anxiety and depression.

As people can suffer from a combination of any or all of these symptoms at any time, treating these medically can be tricky. People may be given medication such as antidepressants to help with mood, sleep and pain; they may be referred for talk therapies such as cognitive behavioural therapy (CBT) to give them better coping tools; they may be recommended a programme of activity including stretching, cardiovascular exercise and relaxation techniques.

The physiology of fibromyalgia

All of these can certainly help. What can also help is a better understanding of what is going on physiologically to sustain fibromyalgia symptoms and therefore why certain activities can be more effective than others.

To explain the physiology very briefly, there is a part of our nervous system called the autonomic nervous system (ANS) which functions without our conscious control and is there to maintain balance in our body systems.  It has two parts that normally work in opposition to each other – if one is switched on, the other is largely switched off. They are the ‘fight or flight’ or stress response, and the ‘rest & digest’ repair response.

In people who have fibromyalgia, the rest & digest response, which is predominant when we are asleep, is not functioning well and instead the fight or flight response is switched on for the majority of the time. When we look at typical fight or flight responses these are very familiar:

Increased heart rate – to pump more blood to muscles which can result in high blood pressure and anxiety;

Increased rate of breathing – mostly in the top part of the lungs creating a pattern of shallow breathing and tightening muscles in the chest, neck and shoulders;

Impaired immune response – this can lead to a pattern of ongoing inflammation, which is the body’s way of triggering repair, but with no actual injury to repair;

Reduced digestive function – this can lead to not only IBS, but also to a reduction in our feel good chemicals. Although they affect the brain, 90% of serotonin and 50% of dopamine are made in the gut. If the digestion is not functioning properly, then production of both of these chemicals is reduced which can contribute to depression.

Tighter muscles – if muscles remain tight and ready for action for sustained periods this will start to create micro restrictions and stiffness in the tissues leading to pain.

Poor sleep – if all of the above happen for prolonged periods then it becomes difficult for the body and the brain to switch off enough to stimulate deep restorative sleep.

The nett result of all of these symptoms is a nervous system that is in overdrive and oversensitised. This helps to explain why something that may feel like an ache to someone else becomes intense and unbearable pain for someone with fibromyalgia.

Fibromyalgia and the vagus nerve

The problem is that the rest & digest function is not able to work properly. It is controlled by the vagus nerve which originates from the brain and travels through the body to enervate many of the rest & digest areas – immune system, heart, lungs and importantly, digestion. It is the vital connection between the gut and the brain. Fibromyalgia symptoms which all belong to fight or flight can switch off or impair the function of the vagus nerve.

An additional tool for managing fibromyalgia therefore is to focus on activities that stimulate the vagus nerve. These include:

Meditating or relaxing – this doesn’t have to be daunting as it can be as simple as taking some time out to listen to a relaxation download.

Deep breathing – either as part of your relaxation or as a separate activity, consciously breathing into your diaphragm can help. To do this, place your hands half on the bottom of your ribs and half on the top of your tummy. Focus on making your hands move as you breathe and, if it feels comfortable, make your out breath slightly longer than your in breath.

Humming or singing – not only are they enjoyable but they both create a vibration in your throat which helps to relax your body and reduce blood pressure.

Walking in nature – if you can, spending a few minutes walking or standing barefoot on grass can also help to relax your whole body. Or, if you don’t fancy that, try going for a walk in nature. In fact any gentle cardiovascular exercise is good, which includes walking, swimming, cycling, yoga, tai chi or qigong..

Stretch – gentle sustained stretching is great for relaxing your mind and body. For a really relaxing approach try myofascial exercises. These are stretches and exercises held for a sustained longer time which helps to release tension in the soft tissues of the body – the muscles and the fascia, the main connective tissue.

 

For more information about myofascial stretches why not visit our YouTube channel – Pain Care Clinic – where there are lots of short informative myofascial exercise videos.

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