You can almost smell it, you can certainly sense it – this toxic manifestation of stress, forming a big black cloud of fear over us – the pandemic. For almost a year Covid-19 has been in everyone’s thoughts, with worries over our own health and that of others, an expanse of collective consciousness that hangs in the air, heavy with uncertainty, anxiety, desperation and despair.
I don’t suppose anyone of us this time last year could begin to imagine we would be in such uncharted waters where devastation, stress and the constant threat to our lives would become part of our daily life, affecting not only our physical but mental health too. I feel like I’ve been sucked into an abyss and how does this affect you if you have fibromyalgia?
It’s an understatement to say that fibromyalgia can change a person, not only physically but psychologically as well. For those who suffer already know that fibromyalgia is an unpredictable syndrome akin to riding an emotional roller coaster and that can only be stressful to live with. It has the power to hijack your mind-set and bring about so many changes to the life once known for the sufferer. In doing so it creates new neural pathways that become so deeply entrenched into the subconscious part of the mind, heightening your sensitivity to things others simply can’t understand, including your triggers of stress and you end up living your life in a state of hypervigilance.
Over recent years expert studies involving sophisticated brain imaging of fibromyalgia patients have revealed some relatively strong evidence indicating that a functional disorder of the central nervous system, known as central sensitization, is the key mechanism behind fibromyalgia.
Central, in this context, refers to the central nervous system comprising of the brain, spinal cord and nerves and together they regulate how the body responds to signals from the rest of the body. The causes of central sensitivity are yet to be defined but thought to be due to a combination of factors such as:
- Dysfunction of the body’s central stress-response system (HPA axis), a term used to represent the interaction of the hypothalamic, pituitary and adrenal glands
- Inflammation of the nervous system
- Dysregulation of neurotransmitters (chemical messengers in the nervous system)
- Irregularities in the function of the autonomic nervous system
Sensitization refers to a gradual change in the body’s sensory processing system where intensified activity in the nervous system is triggered where the brain registers the signal and then amplifies the effects which increases the sensitivity.
This is known as the “wind-up” phenomenon of the nervous system. Neurons, (nerve cells) in the spinal cord are repeatedly subjected to nerve impulse activity, or gradual excitation from a nociceptive stimulus which does not shut down on removal. Nociception is communicated through the peripheral and central nervous system where stimuli include temperature, mechanical (strain, stretch and exertion), also bright light, sense of smell, taste and touch. This gradual “wind-up” continues and eventually results in chronic wide-spread pain.
Intractable pain (chronic) essentially means that it is non-responsive and difficult to treat or control with standard medical treatments. The focus of conventional treatment usually involves reducing the discomfort but that only leaves the patient having to cope both emotionally and physically with flare-ups. Inevitably this compromises the health of the nervous system and triggers a constant state of stress for the patient.
People with fibromyalgia tend to have a heightened sensitivity to stress which causes them to live in a state of hypervigilance. It is well documented that when stress is accumulative, it becomes an illness in its own right and it makes stress management a number one on the list of fibromyalgia self-care.
As well as the “wind-up” (central sensitization), studies show there are irregularities in the pain blocking receptors, or lack of pain inhibiting signals which gradually result in the inability to filter out irrelevant sensory information from the environment such as light, noise, smell and touch. You only have to notice your increased intolerance to these during a flare-up to know when your heightened sensitivity is at its peak and this may be the reason why the symptoms of fibromyalgia fluctuate on a regular basis.
On top of this, both psychological and emotional factors also become heightened, causing you to feel teary, have mood swings, or overthink and catastrophise. You also have the chronic pain to cope with and the outcome is that you connect the sensation of pain to negative thoughts and emotions.
Simply put, we attach negative thoughts and emotions to the pain which is then built up in the mind with images and reinforced by a running commentary based on information you have taken in and from the stored memories deeply rooted within the subconscious part of your brain.
In essence, we are wired to run our own internal documentary which is our own “conditioned” response to pain based on our experiences, but the one thing that most of us will have in common is that our documentary has its roots based on fear.
When we worry about pain, we are in fear of the pain and the brain interprets this as a threat to our survival. It causes the mind to go off in all dead-end directions where we apply all our energy to the resistance of pain to avoid the fear. Fear is the trigger of the stress-response and when this is on repetition default, this is the point when accumulative stress triggers what I call the fibromyalgia-stress loop which leaves you in a state of hypervigilance.
Stress, Hypervigilance and Fibromyalgia
Under normal circumstances, (pre-pandemic), we all experience a state of hypervigilance, it’s part of our survival mechanism. This is our built-in stress response that kicks in when we perceive danger or if a threat is imminent, a warning for us to prepare for fight-or-flight and which should switch off when the threat is over.
However, many people with fibromyalgia and heightened sensitivity, (central sensitization syndrome) and chronic pain, are all constant signals of impending threat to the brain which keeps you locked in a state of hypervigilance. Here, the stress response remains switched on, ticking silently away, waiting in the background and can be described as a state of having heightened awareness of your environment and situations in your life, feeling on edge, constantly on guard or tense, sound familiar?
When you think of the constant messages our brains are having to cope with because of fibromyalgia on a daily basis and most of these messages are not even in our immediate awareness but deep in our subconscious, then add:
“Wear a mask” “Keep your distance” and “Stay safe” – it’s no wonder we remain hypervigilant and for sure, at times we need to be, but there are also times when you can let your guard drop and rid yourself of this tense and self-destructive state.
When you’re safe at home, (and I hope you are), you can shift your focus away from the wider picture and all its doom, gloom and uncertainty. Instead narrow your vision, do something you enjoy that takes up your full concentration, escape in a book or a film, your hobby etc. Mindfully re-ground yourself in the present moment and remember to register how this makes you feel in your body and your mind – feel the sense of relief.
I have to mention though that I’m a believer that a bit of stress is ok, there will always be stuff that push my buttons, that’s part of life, right? But the secret is once in a while to press the pause button and just simply observe it from a distance. The moment I feel I’ve let the stress grow out of control and it’s effecting my health, that’s the time I know I’ve entered the fibromyalgia-stress loop and it’s time to take action.
Mindfulness and meditation are my fibromyalgia medicine and if you’re not into this, then maybe try a body scan. Notice where you hold your tension, then let it go and give yourself positive messages, “I am safe here, I am calm” take a few deep breaths and express your gratitude to this as often as you can – believe me this really works! It’s so simple yet it sends a vital signal to your brain that all is ok and then it rewards you by building your resilience – it’s simple but it really works!
The body can’t repair and heal whilst it’s stressed, holding tension in the muscles and zapping your energy and you can’t be stressed and calm at the same time, so when stressing out becomes your only past time you need to take action. Overtime continuous attention to the stressors in life create elevated levels of cortisol, (the stress hormone), which actually causes damage to the brain, killing off neurons and preventing new cell growth in the hippocampus, the area of the brain essential to memory. In doing so it causes the amygdala, (the fear and emotional centre in the brain), to increase in size and activity, where the outcome makes it harder for your brain to learn and remember new information, (brain fog).
Stress impacts on your general health, it compromises your immunity and gut efficacy, just two things we need to keep in tip top condition when you have fibromyalgia. Stress management is at the root of self-care for anyone with fibromyalgia and more so if it’s disturbing your sleep.
Insomnia and other sleep disorders are common factors of fibromyalgia. A lack of un-refreshed sleep not only leaves you drained and tired, but it also affects mental clarity, cognitive ability and causes an increase in pain levels. Sleep deprivation is a highly researched topic with growing evidence of the connection between sleep and how it effects many systems of the body, including appetite, weight management and how we experience pain and respond to the stress in our lives. Our body’s need quality sleep to recoup and repair, (check out the blog on Insomnia), one way to improve your sleep is to tune down your stress response.
Tuning Down the Stress-Response
Your stress-response is designed to keep you alive, yet for so many when it becomes dominant it’s more or less killing you off, but the good news is that you can tune it down and return a balance to life and it’s all down to your autonomic nervous system.
The autonomic nervous system (ANS) is the control system that works below the level of consciousness, mediating involuntary control of internal organs, blood vessels, heart and respiratory rate, perspiration, salivation and digestion, pupil diameter and tears, sexual arousal and urination. Most of its actions work involuntary without conscious thought, while some such as breathing can also be controlled by conscious thought. The ANS comprises of two subsystems, the parasympathetic nervous system (PNS) and the sympathetic nervous system (SNS), both vitally significant in the treatment of fibromyalgia.
The Sympathetic Nervous System (SNS)
The functions of the SNS (arousing), includes the maintaining of homeostasis, (the body’s self-regulating process to sustaining a relatively stable internal state). This includes the body’s survival mechanism (stress response) which prepares the body to fight-or-flight in response to threat or danger, imagined or real!
The SNS is a system designed to enhance the voluntary muscle activity whilst de-mobilizing all non-essential functions, such as digestion and immune system. Other functions of the SNS and homeostasis effecting fibromyalgia include the regulation of body temperature and the cardiovascular system, both a common problem of fibromyalgia.
Body Temperature: When functioning healthily, the SNS regulates the body’s temperature by either stimulating the sweat glands to cool the body down or mobilizing fat reserves to enhance heat. Many people with fibromyalgia find that they have little or no control over their body temperature, either fluctuating from feeling intensely cold to feeling uncomfortably hot from one moment to the next.
Cardiovascular: In relation to the circulatory system comprising of the heart and blood vessels, the SNS is responsible for regulating the cardiovascular functions of carrying the nutrients and oxygen to the tissues of the body, vitally important for muscle health if you have fibromyalgia. It also regulates the minute changes to the cardiovascular system where a change in posture, for instance from sitting to standing or rising from bed, the cardiovascular system output has to make alterations to allow for this. Many people with fibromyalgia complain of postural dizziness, a symptom of dysautonomia, referring to a disorder of the autonomic nervous system and influenced by an imbalance of the SNS or PNS.
The Parasympathetic Nervous System (PNS)
The PNS, (calming), broadly speaking, is responsible for the stimulation of “rest-and-digest”. Only when the body is calm can it begin to restore, heal and undo the work of the sympathetic division. Under normal circumstances, the PNS stimulates peristalsis, the involuntary contraction and relaxation of muscles involved in digestion, also decreases respiration, the breath and heart rate return to their normal rhythm and the body and mind can enjoy the benefits of relaxation and calm.
The Vagus Nerve
Originating in the brain stem, a cranial nerve named after the Latin word vagus, meaning “wandering”, made up of two parts, it forms the longest nerve in the nervous system and makes up the main component of the parasympathetic nervous system, (rest and digest), responsible for overseeing a majority of crucial bodily functions such as:
- Brain: Controls mood, combats anxiety and depression and opposes the sympathetic division’s response to stress.
- Blood vessels: Lowers blood pressure and decreases vascular tone.
- Gut: Responsible for gastrointestinal (GI) motility, the movement of food through the digestive tract through peristalsis.
- Heart: Decreases heart rate and vascular tone following arousal of the sympathetic division’s response to stress.
- Inflammation: Suppresses inflammation by way of cholinergic anti-inflammatory pathway.
- Liver: Regulates secretion of glucose homeostasis, needed for stabilizing blood sugar.
- Mouth: Responsible for the gag reflex, swallowing, sneezing and coughing, as well as transmitting taste signals via the cranial nerves and phonation, (producing vibration and speech sound).
I find it really useful to keep a journal to track my symptoms which show if there are any emerging patterns where I noticed morning times I found I had difficulties swallowing, a sure sign of low vagal tone!
Low vagal tone is associated with illnesses including fibromyalgia, chronic fatigue syndrome, depression, migraine, autoimmune disease, chronic inflammatory states and many more. The health of the nervous system, particularly vagal tone, is crucial to the health of a fibromyalgia sufferer.
There are numerous ways to improve your vagal tone and help to return a balance between the divisions of the autonomic nervous system, such as breathing exercise, healthy diet, intermittent fasting, meditation and chanting that increase vocal vibration laughter, singing and music and last but not least cold exposure (hot and cold showering) eeeek!
For more on breathing exercise: https://thefibroclinicsouthwest.co.uk/fibromyalgia-and-the-benefits-of-breathing-exercise/
In the meantime, whilst the pandemic continues, it’s just crazy to think that we mustn’t feel stressed, of course we will! It’s normal under the current situation, but be aware of the time, attention and the thoughts that you give to it. Be mindful of how stress impacts on your health both physically and emotionally, also how these affect your thoughts, behaviour and any unhelpful habits. Be mindful of how stress affects your fibromyalgia, so make sure you bring some balance back into your life and do what’s good for your soul.
For further information you can reach me on the Contact Page, thanks for reading and keep safe.
Author: Jok Saunders, founder of the Fibro Clinic South West