How Fear Makes Pain Worse

Everyone experiences pain. There are no exceptions to this. In graduate school I often heard a well-worn phrase, "everyone's pain hurts." That was brought to teach us not to judge our clients, to accept that everyone has a different ability to tolerate pain, and so we should never think we would tolerate someone else's pain better than they do. One difference in the various degrees to which people tolerate pain seems to be the amount of fear the client engages in response to the pain.

This is a sophisticated partnership. As soon as the brain receives the pain signal, the fear instinct kicks in. This is a beautiful thing, as the signal for pain tells the primitive basic survival instinct that the body is in danger. The fear reflex brings with it a series of mechanisms that assist the fight or flight instinct, many of which are recognisable: muscles tense, breathing becomes rapid and shallow in order to increase oxygen flow to the muscles, and the mind shifts its focus to become hyper aware of the painful sensations it wants to avoid.

The problem with allowing the fear reflex to take over is that it prepares us for something that never comes. The experience of pain that is not being induced by a lion's jaw clamping down on our thighs is exacerbated by the stress reaction. In other words, once the fear kicks in, bringing a host of physical and psychological responses with it, all of that preparedness just sits there, making us anxious. And, this makes the pain even worse!

So, what do we do if the body is NOT in danger?

We can stop the pain-fear reflex from happening.With mindfulness and other meditation techniques, we can unlearn this primal pattern of pain-fear and undo the process of gearing up for fight or flight. We can learn to talk ourselves down from the hyper-alert readiness state, and relax our bodies. Once we unwrap all the layers of fear and stress, an amazing thing happens: The pain hurts less.

As it turns out, fear is far more painful than just pain. The pain we experience with Fibro will not do us any actual harm. We have nothing to fear from this pain. It's just pain. It's not dangerous. When we allow this message into our deeper being, we hurt less. I encourage you to try it.

Need help managing your chronic pain or illness? Contact me to set up a Skype counselling session. Email me Sarahalevi@gmail.com

Open the Jar

Clearly, pain is in the body. So when people tell Fibro sufferers "it's all in your head," it's not only unhelpful but it's offensive. Truly, pain is in your body — and in your head. Nerve centers are responsible for carrying pain signals to the brain, which, of course, is in your head. The mind-body connection is not optional, it's all-encompassing and real. We Fibro heroes and heroines know better than anyone that pain affects both the body and the mind. In other words, just because it's in my head doesn't mean it's not also in my body.

The question I am often asked is:

"Can I affect the pain in my body with my mind?"

My answer is a resounding "YES!"

Don't believe me? Try opening a jar. If you strain to open the jar and fail, your hand hurts. If you apply the exact amount of effort and then succeed in opening the jar, your hand does NOT hurt. Why is that? Here's what happened: When you succeeded in opening the jar, your brain gave a little "hurray!" and released a little endorphins. That took care of any bit of pain that might have remained from the effort. Was that a physiological response? No. It was cognitive. Your mind told your body how to handle the situation. That is exceptionally good news. You have the power to affect your pain.

Now, I'm not saying you should be pain free just by thinking differently about your pain, but I do believe it is possible to significantly improve your quality of life by addressing your cognitive process. We start with learning to listen to the messages we tell ourselves. Let's start today by having a few little "hurray!" moments, celebrating even the smallest victories.

Next time: Mind the Pain

The Fibromyalgia Dialectic: Finding the Balance Between Rest and Move

One of the most confusing aspects of Fibro is that often the person suffering does not know whether to rest more or to move more. These two ideas seem to be diametrically opposed. The truth is, they are both right. And that’s the confusing part.

There is a new and growing trend in treatment called DBT — Dialectical Behavior Therapy. The dialectic addresses two states of mind that seem to be opposites, but actually coexist: the need to accept wherever we are in the moment and the need to change. For the ideal therapeutic result, both the therapist and the patient must understand that they are both true, and operative in the moment. For Fibro patients, they are often caught between the body’s desire to stay still — as interpreted through the amount of pain being perceived, and the knowledge that motion may relieve pain.

It is no secret that exercise helps Fibro, and in fact helps all kinds of chronic pain and illness. The problem with the Fibro sufferer is that they are thinking two things at once:

Mind says, “Go to the pool! Take a walk! You’ll feel so much better!”

Body says, “Accept me where I am! Listen, I’m telling you to rest!”

This is often followed by, “If you go for that walk/swim/yoga class you’ll pay a price. You’ll feel worse later. You’ll over do it. And the pain will be worse tomorrow.”

Pain is then multiplied by the added layer of fear, and motion no longer seems possible.

The therapeutic goal is to recognize that these ideas can and do exist together in the mind, and that does not mean you stay stuck. The secret to successful treatment is to find the balance, and not allow fear to dominate the internal conversation.

Acknowledge pain. Move gently. Allow for healing as a possibility. Be a warrior.

A Better Model for Treatment of Fibromyalgia

It is estimated that over 5 million Americans suffer from Fibromyalgia, most of them women, the vast majority of those over 40. Fibro is clinically defined as pain in a number of points throughout the body, and symptoms can also include fatigue, sleep disorder, nausea, headaches, memory loss and depression. Pain and other symptoms can range from mild to severe, and from acute to chronic. While a number of medical treatments have emerged in the last few years, no one treatment helps everyone, and in some cases, treatments that work for a while stop being helpful.

Many doctors feel defeated by Fibro. It’s complicated to treat and Fibro patients are frequently ill. Many physicians are now referring Fibro cases for CBT. This is a great step and can be the key to successful management, even cure. So, how does it work? Let’s take a look:

Now, all of these treatments can be helpful. A combination of these treatments may be the ideal cocktail for lifelong management of Fibro symptoms. However, if the patient is like most of mine, they are not in either a mental or physical state to pursue any treatment that involves getting up out of bed. As it is presented, this treatment model overwhelms the Fibro sufferer with guilt, as they now know how many things they are not doing to help themselves, in addition to being in constant pain. This compounds depression and keeps people in bed.

So, practitioners would be more effective if they learned to think about the treatment model differently. The central goal is to improve the person’s quality of life, which begins with increasing basic level of functioning. When a person is in extreme pain, can’t sleep, and is also depressed, it is not likely that person will be able to get to the gym. So, here is my alternative treatment model:

In this model, the therapist focuses on helping the patient recognize destructive patterns of thought and behavior that keep them stuck.

People often ask me if I believe Fibromyalgia is “all in your head.” I don’t. I think pain and suffering in the body are real. I do believe that there is an emotional/psychological component though, and often the gateway to successful treatment is through the thoughts and feelings. This is also why traditional western medicine is not very successful as a treatment model.

Fibromyalgia is a complex condition, but it can be treated and managed well. A word of caution, though: If someone tells you they have the one cure that works for everyone, try someone else. It’s just not true. But we’ll keep at it until we find one that works for you.

(this post first appeared on Get Help Israel)

Depression with FMS and CFS

Depression can be viewed as both a symptom of fibro and a co-morbid condition. Often when a teenager is finally referred to me for fibro he will report a long-standing depression. Childhood onset depression is slippery and often overlooked. Interestingly enough, symptoms of depression in children and teenagers can include vague aches and pains,[1] particularly headaches and back pain often associated with fibro. As a co-morbid condition, depression is virtually indistinguishable from fibro. Chronic pain and illness are depressing. The question may be whether fibro is a symptom of depression or depression a symptom of fibro, or whether they are simply partners. In either case, it is important to note:

-       Fibro symptoms are known to be alleviated in many cases by SSRIs (like Prozac), SNRIs (like Cymbalta) and other anti-depressant groups[2]

-       SSRIs can cause detrimental side effects and suicidal ideation

-       While psychodynamic therapy might help adults with depression, it is not a good therapeutic choice for an adolescent. Go with CBT.

-       Ritalin can cause or exacerbate depression in teens[3]

-       A severe depression may require hospitalization

 In every case, depression should be taken seriously; it's a serious matter.

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[1] http://www.mayoclinic.com/health/teendepression/DS01188/DSECTION=symptoms Your adolescent - depressive disorders. American Academy of Child and Adolescent Psychiatry. 

[2] http://www.scientificamerican.com/article.cfm?id=new-study-antidepressants-fibromyalgia

[3] Talking Back to Ritalin, Revised : 
What Doctors Aren't Telling You About Stimulants and ADHD
by Peter Breggin, M.D.  Perseus Books, 2001

Diagnosis: Sick of It

Boundary issues

There are a few common themes with young fibro patients, and this is one: Weak boundaries. They tend to be very caring, very empathic with their friends, siblings, parents. They are the family peacemakers, the one the other family members count on to be solidly supportive at all times. Parents see them as very intelligent, caring, hard working, intense. This is the child who cannot let it go. Often the phenomenon of adolescent onset illness can be attributed to a specific stressor; SATs, death of a loved one, illness or absence of a parent; the teen is unable to stop the stressor at the surface and allows it to penetrate her actual physical being. It can also be triggered by an upcoming event; adulthood. This sounds oversimplified. More often than not, however, I see a young woman, 17 years old, in the prime of her life, bright, talented, friendly, pretty, now lying in bed for months at a time. This is simply not a coincidence. The responsibilities of adulthood are daunting enough; for the particularly sensitive adolescent, the competition and drive required to succeed can be so emotionally overwhelming that they manifest physical symptoms. A child will not achieve his developmental task of individuation while lying in bed, needing his parents’ care and attention! This is a complex psychological and medical picture. If your teenager is so stressed out that she is making herself sick, CBT is a good place to start.

Building Trust With Practitioners

I recently treated a teenager who had learned to mistrust her doctors. Though she clearly was suffering from a severely debilitating case of Fibro, many of the physicians she had consulted had been derailed by her obesity. Instead of viewing her weight as a symptom (one of many) of Fibro, the doctors had decided the presenting pathology was obesity. Not only was this unhelpful to the diagnostic process, it delayed treatment and was humiliating and harmful to the already suffering child; somewhere between insensitive and negligent, at the very least it was not good medicine.

As with all things adolescent, trust is imperative in the treatment of Fibro/CFS. The more information the doctors have, the more effective the treatment process will be. The key to gleaning pertinent information from the adolescent patient is good listening. If she feels heard and taken seriously, she will tell you what you need to know. If he feels stupid or judged, he will shut down. In the famous words of Sean Covey (adult son of "7 Habits" author Stephen Covey): Listen more than you talk. You have two ears and one mouth. Duh!