Mind Your Fibromyalgia Podcast

Fibromyalgia Pain Science Education - Fear & Pain Cycle

February 07, 2022 Olga Pinkston MD Season 1 Episode 11
Mind Your Fibromyalgia Podcast
Fibromyalgia Pain Science Education - Fear & Pain Cycle
Show Notes Transcript

Episode 11 - Fibromyalgia Pain Science Education - Fear & Pain Cycle
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This episode continues pain science education of fibromyalgia

In fibromyalgia, the normal pre-wired by nature to feel fear or danger signals is dysregulated. The nervous system is more sensitive and gets activated more frequently into a danger state, the flight or fight response; it experiences a fear whole lot more often and longer than someone who has a more balanced nervous system. 
Additionally, how the brain reacts reinforces the experiences as dangerous or safe. 
So our brain is pre-wired to view pain as dangerous, as a surviving mechanism. When we react to pain with fear, it reinforces that experience as dangerous. 

The more you fear pain, the more it puts the brain in a state of danger or high alert, activates the nervous system to fight or flight, the more fear you get. The more fear we have, the more pain we feel. The more pain you have, the more fear you feel, which leads to more pain. The brain is stuck in the fear–pain cycle or loop.

You can see the full transcript: https://www.buzzsprout.com/1890983/10031959

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Welcome back to the Mind your Fibro Podcast, episode 11. 

The last episode was dedicated to neuroplasticity and neuroplastic pain.

Just to review, neuroplasticity is a general umbrella term that refers to the brain's ability to modify, change, and adapt in structure and function throughout life and response to experience. The brain cells and neurons can make the circuit and network changes resulting from learning a new ability, environmental influences, practice, physical and psychological stress.

Brain cells are "neurons that fire together, wire together." If we do something repeatedly, the brain develops a routine, a route for the neurons to do their job automatically or easier. 

When your brain experiences pain over and over, the neurons responsible for dealing with pain are wired together. The more pain you have, the better these neurons, the brain cells responsible for pain processing, fire together. 

Your brain can unintentionally learn how to deal with pain incorrectly. The pain gets stuck, like a bad habit. 

This pain type, the learned pain, we call neuroplastic pain. Neuro means brain, plastic means adapted, modified, developed. So neuroplastic pain is pain produced when the brain changes in a way that reinforces this pain. 

 

 So today, we are going to talk more about neuroplastic pain. Why does the brain make this mistake and get stuck in the way that reinforces pain? How can the brain misinterpret pain? 

We talked a lot about the stress and stress responses in the previous episodes. In episode 8, I explained that the most common way the brain appraises stress or pain is as a threat. 

Every time our brain processes any type of a threat or danger signal, the feeling that we get is fear. 

Our brain was pre-wired for safety. When humans lived in caves, the brain was pre-wired to sense threats or signals or danger as a survival mechanism. And to be afraid, live in fear. Suppose you were not scared but too brave or careless. In that case, you could not survive- you would have been eaten by an animal, gotten lost in a forest, eaten something new, and died of food poisoning. If you feel afraid, you will stay in your cave with other cavemen and eat safe foods, warm and alive. 

Although with time, humans evolved, the pre-wired brain functions remained. The thinking brain, the cortex, evolved a whole lot with time, became more analytical, can overwrite the treats. Still, the experiences must go through the primitive parts of the brain, then the midbrain, up to the cortex. 

So every experience, including stressors and pain, is 1st processed by your primitive pre-wired brain – the one that defaults to fear. 

If you think of the feelings you have – when you lose a job, miss a bus, get sick with an infection, lose your wallet, take a test, get a new haircut or eat too much cake – the initial brain's reaction is very often fear. Fear that you will not have enough money, die from infection, someone will get your credit cards from your wallet and go on a shopping spree, fail a test, no one will like your hair cut, or the cake will make you fat… we are not talking about fear now of being eaten by a tiger or starve in a cave being afraid of the lightening. We are talking about the daily experiences surrounding us and being processed by our brain, often as fear. This is normal; expected; initiated by the primitive pre-wired brain to keep you safe. Once the thinking brain starts actually thinking, we may stop being afraid of many things – you may start viewing losing a job as an opportunity so you can get a better job, you may actually like your hair cut, or enjoy the cake. The way we react reinforces either the sense of danger or sense of safety. If you eat cake often enough, the fear of weight gain may diminish, but you may start feeling more guilty. If you start getting the same haircut month after month because there is no longer a fear of this familiar style, but more fear of a different, untried haircut - is this how people get stuck with a mullet? 

So how we react reinforces our experiences either as dangerous or safe.  

The primitive brain is organized to ACT and FEEL before it THINKS. 

One more time – our brain is organized to act and feel before it thinks. This makes sense. You don't want to think too long before being attacked by an animal or burned by a fire. Your primitive instincts, the pre-wired brain, needs to act and feel, feel the pain before it can think. So we feel pain before we can think about pain. The danger signals activate the nervous system before the thinking brain can analyze. 

However, as a protective, safety mechanism, this should only apply to danger signals, new pain, or a new unsafe sensation -  like a burn from hot coals, bite from an animal, bone fracture, or whatever is about to kill us. 

But it should not apply necessarily to the ongoing pain, neuroplastic pain. If you had back pain for 10 years, your brain should get a clue that you are not going to die from it; there is no injury. If you had fibro pain on/off for years, the brain is sending the danger signals somewhat incorrectly, don't you think? The brain can misinterpret safe signals as dangerous. 

 

I have a patient who got a diabetic ulcer, and the infection led to, unfortunately, amputation of his foot. The toe that had the infection was extremely painful. The brain, after months of treatments, learned that pain. So even after the toe was gone, amputated along with the foot, the brain continued to remember the pain. It is called phantom pain. Phantom pain is pain that feels like it's coming from a body part that's no longer there. Doctors once believed this post-amputation phenomenon was a psychological problem, but experts now recognize these real sensations originate in the spinal cord and brain. The brain is stuck in the pain cycle. 

I was surprised to learn that his therapy included looking at the leg with a mirror - showing his brain that there was no toe. 

 So, many will be surprised that the brain can make mistakes. 

 So we should be afraid to survive until the thinking brain overwrites the primitive brain and calms us down. But why doesn't it do it?? Why do patients with fibromyalgia experience the exaggerated activation of the danger signals? Why do the nervous system, brain, and spinal cord misinterpret safe signals as if they were dangerous? 

In patients with fibromyalgia, the nervous system is dysregulated. 

Brains have sets of regulatory networks, or neural systems, that originate in the primitive parts of our brain and spread through the brain to the whole brain, to the cortex or thinking part of the brain, to work together to keep us regulated in the face of various stressors. 

The long-term effects of stress are determined by the pattern of stress activation. 

If the stressors are predictable, low to moderate level, controllable – we develop tolerance to stress, resistance. Examples of controllable stress would be challenging situations that we can cope with – schooling, sports, performing, some mild illness, happy but stressful occasions like a vacation or a wedding.  

If the stress pattern is unpredictable, extreme, or prolonged, the nervous system becomes overly reactive, overactive, sensitized, dysregulated. Examples will be abuse, trauma, hunger, poverty, financial insecurity, illness or hospitalization, medical trauma, ongoing job stress, dysfunctional marriage, etc. 

In 1st episode of this podcast, we talked about triggers of fibro -who gets it – the fibro triggers are often – trauma, abuse, infections, prolonged hospitalizations, recurrent injuries – any severe, unpredictable, or prolonged stress. 

So, in fibromyalgia, the normal pre-wired by nature to feel fear or danger signals is additionally dysregulated. Now the nervous system is more sensitive and gets activated more frequently into a danger state, the flight or fight response; it experiences a fear whole lot more often and longer than someone who has a more balanced nervous system. 

Additionally, how the brain reacts reinforces the experiences as dangerous or safe. 

The more we fear something, the more the brain associates that something with fear. Like a toddler and the tantrums, if you ignore the 1st tantrum, the may be no tantrums in the future, but if you give in and address the tantrum, the feedback is given to the toddler that tantrums will give attention, and tantrums get reinforced and continued. The more you give attention to tantrums, the more tantrums you get as a result. 

So our brain is pre-wired to view pain as dangerous, as a surviving mechanism. When we react to pain with fear, it reinforces that experience as dangerous. 

The more you fear pain, the more it puts the brain in a state of danger or high alert, activates the nervous system to fight or flight, the more fear you get. The more fear we have, the more pain we feel. The more pain you have, the more fear you feel, which leads to more pain. The brain is stuck in the fear–pain cycle or loop. 

 

Now some people, over time, may let go of the fear but replace the feeling of fear with something else, anger, frustration, guilt, sadness, etc.. but the loop or cycle remains – pain activates an emotion that puts the brain in a high alert state, that leads to more pain, that activates brain farther and so on. What you practice makes it stronger. 

 

So the dysregulated nervous system is stuck in the fear-pain loop. The brain learned that pain, and over time, the nervous system is even more sensitized by stress, pain, fear, and additional symptoms emerge- sensitivities, overstimulation, more pain, more fatigue, etc. 

But what was learned can be unlearned. 

So if we look at the fibro, there are areas that we can target for treatment. 

As if we were repairing a malfunctioning device, we can troubleshoot and look at what areas we can target and repair. The main areas of responsibility for pain are the dysregulated nervous system, which is super sensitive, and the fear-pain cycle. 

 So to summarize, 

Today's main point is to learn that our brains are not perfect and can make mistakes. The brain can misinterpret safe signals as dangerous. The fear promotes pain, making pain worse. The pain promotes fear, leading to more fear, to more pain. The fear-pain cycle promotes activation of the nervous system's fight or flight response. The dysregulated nervous system gets stuck in the overdrive of the danger signals, leading to more pain and other fibro symptoms. 

The good news - what is broken can be fixed, what is learned can be unlearned. Just like a scary movie or a magic trick, once you understand this scary stuff is not real, it becomes way less scary. 

 

The next episode will show you how to get out of the fear-pain cycle using somatic tracking. 

 
 # neuroplasticity, Alan Gordon, Howard Schubiner