Fibromyalgia Pain Science Education - Stress part 3

Episode 9 - Fibromyalgia Pain Science Education - Stress part 3
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This episode continues pain science education of fibromyalgia. 

We continue the discussion about how pain and stress are related.

You need to understand that thoughts and beliefs influence the degree of pain, severity, and coping with pain. 

Automatic thoughts – frequently occurring, situation-driven, thoughts often happen without our input or consciousness. They are automatic, without awareness, but influence the ultimate selection of the coping strategy. 

We have beliefs about pain – the nature of pain, the cause of pain, and appropriate treatment, these beliefs influence distress and disability. 

We also have acquired beliefs about our control of pain. We have many beliefs about our ability to cope with it, our ability to control pain, how effective we are in our own self-management of pain, and self-efficacy. 

Our brain uses automatic thoughts and beliefs to cope with pain stressors and reduce the stress effect. Based on these thoughts and beliefs, we may have good and maladaptive coping behaviors. 

Negative automatic thoughts generally worsen our mood, negatively affect our actions and increase the pain and other symptoms. 

You can see the full transcript:  https://www.buzzsprout.com/1890983/9953813

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Transcript

Welcome back, my friends, to another episode of Mind your Fibro Podcast. 

 Today we continue to discuss pain science education and continue with one of the probably most important topics of stress and stress response of your body and its' connection to pain and fibromyalgia.

So during the last episode, I explained about the primary appraisal of stress – a judgment by the brain of a situation or a sensation, such as pain in terms of loss, threat, or a challenge. 

 The most common way the brain in patients with fibromyalgia and other chronic pain conditions appraisers stress or pain is as a threat. There is an increased focus on pain, diminishing attention, worsening memory, and concentration; it increases anxiety and fear and promotes avoidance. 

 The loss is often associated more with the consequences of chronic pain – loss of function, loss of income, relationships; it focuses our thoughts on what we cannot do, these thoughts increase the feelings of grief, and sadness, decreasing our motivation to try things, that might be useful in managing pain situation. The goal, though, is to learn how to see pain as more of a challenge, something you can cope with that does not overwhelm the body and mind. 

          Recently I spoke with a patient about her fibromyalgia pain and the stress it caused on her marriage. She was diagnosed with fibro a year ago. The chronic pain and other fibro symptoms affect her daily life. She complained about increased anxiety fear about the pain, thinking that fibro will ultimately cause her to become disabled. 

When she talked about her husband, she spoke of his anger. She thought he was angry at her all the time. 

We spoke about the chronic pain and how it was causing stress to both her and her husband. But the stressor was apprised by their brains differently. 

She was appraising the fibro pain as a threat – the most common way patients think of pain – it was a threat to her abilities. There was a potential of disability, the fear of not being the person she used to be. 

Her husband, on the other hand, likely was appraising her fibromyalgia, not as a threat but as a loss. His reaction to fibro was anger, not fear. Thoughts of a loss –the consequences that resulted from the pain – loss of time together doing things they love because she is in bed due to pain; loss of her happiness because she is more depressed now. Anger that his wife is in pain was his major emotion, due to loss, not threat. 

 So just to review: 

The stress response is biological, emotional, cognitive/thoughts, and behavior (action) response. 

Chronic pain is itself a stressor. Non-pain-related stressors can trigger pain flares up. 

How we judge stress – stress categories of threat, loss, or challenge – can shape what we think, feel, do about our stress. These judgments affect our physical well-being and our pain. 

So today, we are talking about the next step your brain does when faced with a stressor – the secondary stress appraisal. Secondary stress appraisal is the brain's thoughts after the primary or initial appraisal, meaning after the brain decides if the stressor is a threat/loss or challenge. 

During this process, the brain decides what coping options are available. 

There are 2 types of thoughts during this time – automatic thoughts and acquired beliefs. 

Automatic thoughts, just like the name describes, are automatic – they arise automatically with anticipation of pain or in response to pain. You may or may not be aware of these thoughts. It's like a running commentary or images that come up on the preconscious level in response to a particular event, sensation, experience. 

The second type is the acquired beliefs – these are the beliefs about the pain or medical condition and yourself, other people, and the world. 

Automatic thoughts and beliefs interact and influence each other, influencing coping and adaptation to pain or illness. They may or may not be factual. Just because we have a thought does not mean they are a fact or true. 

You need to understand that automatic thoughts and beliefs influence the degree of pain, severity, and coping with pain. 

 So let's talk more about our automatic thoughts. 

Our brain produces between, on average, 60 million thoughts per day. 

Most thoughts are automatic because they happen without effort and almost reflexively to a triggering event, such as a circumstance or sensation. Most of them are subconscious; it's an ongoing dialog, a running commentary, or running documentary, a movie, or images of our brain. We are not aware of them unless we purposefully pay attention or if a particular thought grabs you emotionally, you may catch yourself thinking the same thing over and over. 

Out of 60 million thoughts per day, about 80 % are negative. So, if we average 60,000 thoughts per day, 48 million are negative, and most of these negative thoughts are subconscious. It is evolutionary - the cave man's brain was wired to be negative and afraid - wired to survive.

And this is an average person, not counting any chronic conditions like fibro or chronic pain. 

Research shows that if a person has chronic pain and the more negative automatic thoughts, the greater person's report of pain, dysfunction, depression, and poor adjustment to a chronic pain condition. 

This makes sense - when automatic thoughts are negative, they lead to negative feelings and maladaptive or poor coping behaviors.

Most of the thoughts are judgments about ourselves and the world around us. 

Can you think of an exampale of automatic thought? 

Let's practice some automatic thoughts. I will give you a word or sentence; you catch your first automatic thought… 

Sunny and hot beach with blue ocean….   Icy sidewalk.. Spilled drink…Fancy Umbrella drink

Dark street with broken streetlight…Puppies and kittens playing together in a basket …

Halloween costume …Hot bread is just taken out of the oven …  Happy birthday song 

Dentist …Giggling baby trying to walk… 

Didn't this feel like your Facebook or other social media feed… do you ever notice your thoughts as your scroll through social media or news? Fleeting thoughts, running together, some too brief to recall…. Did you notice a mood change as you thought of dentist, dark street or spilled drink, vs. sunny beach or puppies?

So, your thoughts automatically create emotions. Happy thoughts create happy emotions. Painful thoughts, painful emotions. 

So, when your brain automatically produces thoughts about pain, they have the tendency to be more negative. The more negative the thoughts, the more pain you experience, greater distress, more medication is used, more loss of function, more disability… 

So 1s step is to learn how to be aware of these thoughts. 

Now let's talk about beliefs. Just like thoughts, we all have beliefs. Beliefs are our opinions, inner knowledge, something we hold on to, often without questioning. If you think a thought over and over, it becomes permanent thought or belief. 

We have acquired beliefs – something we came up with, to help us deal with a situation. For example, to help make sense of your medical condition, you may formulate ideas about the cause of the condition, the pain, and how it should be treated. 

You may not have those ideas all your life, but as you learned about fibro, you started accumulating these ideas and beliefs. We acquire a particular viewpoint about appropriate and inappropriate responses to pain. For example, I need to stop and rest so the knee does not get reinjured. I need to take a nap, or my headache will worsen. You may believe that rest helps knee pain, or a nap helps to relieve a headache - you acquired these beliefs from your experience or someone else's idea. 

We also hold beliefs on how much control we have over our medical condition, if we can do something about it, how we can cope with it. As you imagine, if you believe there is nothing that can be done about your medical condition or pain, your thoughts and emotions will reflect that. Compare this to a belief that you are in charge of your health and can influence your pain level. 

Often the acquired beliefs have an underlying "should" or "must" or "ought" messaging. "I should rest," "I must take this medicine to feel better"… I got a cold, hot tea with honey, and wool socks are in order. It's cold outside; I must wear a hat, or I will catch a cold. 

Patients with chronic pain or fibromyalgia hold numerous beliefs about the cause, meaning, and appropriate treatment of their pain. 

It undoubtedly influences the treatment that patients seek, as well as the willingness to engage in treatments that are counterintuitive to their beliefs.  

If you don't believe that physical therapy will help you, or you may believe that it may actually hurt you or worsen pain, it would be harder to convince you to try it. 

If, on the other hand, you had a great experience with physical therapy in the past – say you saw a great benefit of physical therapy after your mother had a knee replacement, you may be more willing to try it.  

People around us also hold beliefs and influence others in believing. 

I often hear that relatives of the patient with fibromyalgia believe that fibromyalgia is not real, that the pain is "all in your head" – it is an example of an acquired belief that person holds, but it also influences your thoughts, your beliefs, it may produce negative beliefs, negative self-talk, and emotions. 

So we discussed the acquired or new beliefs that we develop through life as we live and think. If we think something long enough, it can become a belief. If something strongly resonates with us or we develop an understanding of something, we can start believing it rather quickly. 

 We also have Core beliefs. Your core beliefs are ideas or philosophies that you hold very strongly and very deeply. These ideas are usually developed in childhood or early in adult life. We often think of them as our inner knowledge; it can also be part of our personality. It's also our worldview. 

 Core beliefs aren't always negative. Good experiences of life and of other people generally lead to developing healthy ideas about yourself, other people, and the world. 

Negative core beliefs may be stored in your brain and not activated unless an adverse life event triggers them.  

Since chronic pain or pain in general and the associated stressors is often viewed as a negative event, it will most likely activate the previously developed negative core beliefs. Sometimes, the negative core beliefs formed during childhood can be reinforced by later experiences, confirming their validity. 

All thoughts, beliefs -acquired or core beliefs, although they feel real and factual, actually may or may not be facts. We may strongly believe something and think of it as a fact, but in reality, it is something we learned or believed for a long time. 

 So we talked about automatic thoughts, acquired and core beliefs. 

Now let's talk about why these concepts are so crucial if you have chronic pain or fibromyalgia or are healthy and listen to this podcast to support your loved ones. 

 How we cope with adverse life events, medical conditions, or pain includes coping responses that are both thoughts and behaviors produced by our brain to lessen the stress or pain.  

The thoughts – automatic thoughts, acquired beliefs, and core beliefs - we use to cope with a stressor, such as chronic pain, will influence the behavior or action we take to deal with this pain – the pain can be anticipated pain or actual ongoing pain. 

Here is an example of coping with pain. 

Rest. Many people believe that rest can help with pain or prevent pain. Some patients with pain will use this coping method to deal with pain. They may use it too much, and over-reliance on resting as a coping strategy can lead to deconditioning of muscles and general weakness. That person has more fear of pain, the stressor is pain, being judged as a threat, and the thoughts that lead to inactivity are more negative, coming out of fear. 

Someone else may use rest also as a coping method to help with pain but will be alternating rest periods with activity, also known as pacing, which is a healthy way to incorporate rest. The thoughts that lead to this coping are different, resulting in more positive. 

Another example of coping. 

Exercise. Appropriate exercise and stretching can have numerous benefits for people with chronic pain. It helps with muscle strengthening, conditioning, weight, mood, etc. 

But the opposite will be over-activity. Just like too much rest, over-activity can be just as problematic as avoidance of activity for some people. Some people who routinely completely ignore pain push to get things done. They push to get things done, just to crash after. This pushing and crashing cycle is very common in patients with fibro. It is a coping behavior in patients with pain but is often not recognized as a coping method. I just push to get things done; I crash, rest after. 

If you would backtrack the thoughts and record them before pushing, you may find them maladaptive.  

I will have a more in-depth discussion of all the concepts we discussed today in the later episodes. 

 In Summary:

Automatic thoughts – frequently occurring, situation-driven, thoughts often happen without our input or consciousness. They are automatic, without awareness, but influence the ultimate selection of the coping strategy. 

Acquired beliefs arise from experiences and often start with "should," "must," "ough."  

We have beliefs about pain – the nature of pain, the cause of pain, and appropriate treatment, these beliefs influence distress and disability. 

We also have acquired beliefs about our control of pain. We have many beliefs about our ability to cope with it, our ability to control pain, how effective we are in our own self-management of pain, and self-efficacy. 

Our brain uses automatic thoughts and beliefs to cope with pain stressors and reduce the stress effect. Based on these thoughts and beliefs, we may have good and maladaptive coping behaviors. 

Negative automatic thoughts generally worsen our mood, negatively affect our actions and increase the pain and other symptoms. 

 So here is the homework for you. Notice your thoughts. 

For example, if you drive a car or use public transport, notice your mind wander. What do you think about? Do you notice things around you, do you daydream, do you see your thoughts come in and out, like clouds, passing by. Does your mood change with these thoughts? Can you connect the thought to your emotions? Notice your automatic thoughts. Do you catch that about 80% of them are negative? 

Start noticing your beliefs? Core and acquired? Do you believe in things your parents or grandparents believed in? Like wearing a hat when it's cold, so you don't catch a cold? Or some other beliefs about your health, wellness, or mental health? Judgments, stereotypes? 

Awareness of your thoughts takes practice. It may be uncomfortable, sometimes even painful. Start from the place of curiosity, not judgment as you think about these topics, be kind to yourself. You are working on healing. You are minding your fibro.   

 
tags:
Cognitive behavioral therapy