Episode 7 - Fibromyalgia Pain Science Education - Stress part 1
This episode continues pain science education of fibromyalgia.
We start the discussion about how pain and stress are related.
Many of my patients tell me that they experience fibro flares when they are under a lot of stress. Stress is a situation that is difficult to cope with, and that creates a reaction in the body – physical, mental, emotional, and behavioral.
Different people cope with circumstances differently and have different reactions to a similar situation.
Pain is a major ongoing stressor. It produces every type of stress response – biological/physical, emotional, behavioral, and mental changes.
You can see the full transcript: https://www.buzzsprout.com/1890983/episodes/9852821-fibromyalgia-pain-science-education-stress-part-1
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Many of my patients tell me that they experience fibro flares when they are under a lot of stress. In the last two years of the pandemic, I have seen more flares, not only fibro but also other conditions I treat. At the beginning of the school year, I see fibro or RA flare and increased migraines, for example, in teachers. I had a call from the patient who was on vacation and flared after nearly missing her flight.
I remember an elderly patient who flared her autoimmune condition after riding a roller coaster – she thought she would die from a heart attack! Two days after riding it, she complained of swollen joints in my office. She described the distinct fear she experienced, her body feeling paralyzed, chest tightness, heart-pounding, dizziness, and nausea as she was going up and down the turns, not expecting to survive. The experience stressed her out both physically and emotionally.
I can relate. I rode two roller coasters in my life. The first one, a conscious decision - I had never been on one before, and after a few seconds, I decided it would be the last time I rode a roller coaster. The second one was the Big Thunder Mountain Railroad in Disney world. Somehow, I did not understand it was a roller coaster, thinking it was a harmless train. When I finished standing in line and saw the roller coaster, I felt too embraced to turn around and leave. It was just as stressful as the first ride. I still cannot understand how anyone can find roller coasters entertaining.
We all have examples of stress. So what exactly is stress? One of the Merriam-Webster dictionary definitions: “a physical, chemical, or emotional factor that causes bodily or mental tension and may be a factor in disease causation.”
This definition focuses on stress, as most of us think of it – the causes of stress.
We all can list the stressors of our lives –work, relationship, finances, health, politics, etc.; we are surrounded by the experiences that stress us out.
But there is another way of looking at stress. Stress is a situation that is difficult to cope with, and that creates a reaction in the body – physical, mental, emotional, and behavioral.
Different people cope with circumstances differently and have different reactions to a similar situation. Think of the variety of ways people react to being stuck in traffic. Or they are getting fired from a job. Or they are missing a flight.
Any trigger of stress can create a unique stress reaction in our body, and it is composed of four parts - physical, mental, emotional, and behavioral.
The physical or biological reaction is wired in our nervous system. They are automatic. The sympathetic nervous system is responsible for the “fight-flight” response. It activates to protect us from the dangers -fighting or running away from an attacker, a tiger, for example, in the wilderness. Our body quickly responds by increasing blood pressure, and the heart is pounding faster, breathing rate goes up, blood flow is being diverted from our digestive organs to the muscles so we can fight or run away. This is the typical physical response to a stressor, the fight/flight, primitive response common in all living – from people to animals; wired to keep you alive.
Behaviors change under stress. “Stress eating – drinking - shopping,” lashing out, avoiding activities or people, sleeping too much, or tossing and turning all night. Some actions may serve us, while others are maybe not so helpful or even harmful.
Stress can produce an emotional response – think of all the emotions you’ve ever experienced under stress –anger, sadness, feeling ashamed, nervous laughter, etc. We just had holidays; what emotions came up for you with holiday stress – probably a mix of them, some happiness, some nervousness, excitement, worrying.
Cognitive or mental reactions, comprised of thoughts, are among the most powerful modifiers of stress. Not only can our thoughts create a stress reaction on their own, but they can also amplify stress and diminish our ability to cope with it. The thoughts are the coping mechanics we have and use. I witnessed my thoughts worsen the stressful situation by adding negative thoughts, thinking about what others will say or do. Thoughts are very imaginative and can reduce or add to the stress.
Your thoughts produce feelings that create action or inaction and induce some of the emotional, behavioral, and physiological changes in our bodies under stress. Isn't it fascinating? I remember nearly missing a flight on vacation with kids; the thoughts of being stuck in the airport with four kids, at night, no luggage, was terrifying to me. My heart started to pound, mind racing for solutions – do I rebook, do I run to the terminal- I started to sweat, feel a bit dizzy, feel irritated, snappy, and feel anxious and afraid. My body was experiencing all the stress reactions a primitive man would experience if he saw a tiger next to the cave. There was no life or death situation, except for me, but an unpleasant, unpredictable situation.
I also want you to look at pain as a major ongoing stressor. It produces every type of stress response – biological/physical, emotional, behavioral, and mental changes.
Depending on if the pain is acute or short-lived – like a stubbed toe, fracture, or a bee sting, or chronic, recurrent experience over and over- joint arthritis, back pain, migraines, fibro, your body will have a different reaction to it. Pain induces physiologic reactions – high blood pressure, for example, and other biologic changes depending on the duration and severity of pain. Behavior – you may cry, or be snappy, stress eat. Stress drink alcohol; go to bed, your coping with pain behaviors, emotional – sad, overwhelmed, frustrated you are in pain yet again; mental or thinking – you likely have recurrent thoughts about your pain experience – here we go again, how much can I take, this is unbearable, you may analyze your pain, ruminate over the cause of it, think extreme thoughts – is this cancer? Do I have an infection?
I want you to take time and journal about your pain experiences. How does your body react, how do you behave, what do you feel, think? We are going more in to think- feel- do cycle later, but I want you to start acknowledging that your pain has a pattern, you believe and do certain things when you are in pain, you likely have predictable behaviors and coping things to get through the pain. This is normal. This is expected. But it may not serve you.
What you practice makes it stronger. What you practice makes it stronger.
Next week we will continue talking about stress and the specific connection between fear and your pain and fibromyalgia.