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Pain and Stress in Fibromyalgia: Let's Talk About What You're Trying Not to Think About


Disclosure: I only recommend products I would use myself and all opinions expressed here are my own. This post may contain affiliate links that at no additional cost to you, I may earn a small commission. Read the full privacy policy here.

Pain

Pain is one of the most prominent and puzzling features of fibromyalgia. Most of us Spoonies have at some point in time been given a Pain Diagram at a doctor or therapist's office to fill out. We are supposed to mark a nondiscriminatory body blob with tiny symbols that denote different types of pain—a triangle for burning, three wavy lines for stabbing, dots for aching, etc. There's more space underneath the body to describe when this pain started, how often it occurs, and space to list anything that has helped. The first time I was handed this list, I wanted to burst into tears. Then, I remember just wanting to take the pen and write in the body blob —all of the above, all over, most of the time.

When you have an accident, and there's a giant gash in your leg, no one asks you to describe the pain; the source is obvious. Likewise, if you come in with appendicitis, a torn ACL, or a sinus infection, they understand; no body chart is needed.

But our pain is invisible, and the source is unknown. Sure, most, if not all of us, probably have a tight neck, shoulders, back, and/or hip flexors and tight muscles throughout the peripherals (arms & legs). One of the fibromyalgia criteria is pain in multiple quadrants of the body. We are also commonly riddled with trigger points, which can be active and latent. The pain can radiate from this point, or it may be referred elsewhere.

We also suffer from neuropathy, skin sensitivities, migraines, IBS, Interstitial Cystitis, & Asthma. All of which are painful conditions and tend to flare with the rest of the body. So, when we are in pain, it can feel like every conceivable description of pain throughout. For example, the pain in my neck, well, it aches, burns, and can be shooting simultaneously. Same with my hands, shoulders, and legs. The pain level depends on whether I am in a flare or not and how bad it is. Depending on how long we push ourselves, flares can last from 3 days to 3 months or until we stop counting how long it's been.


So, when someone hands us a chart and asks us to describe how we feel our pain when my hand, arm, shoulder, and neck are already tired from driving, it feels insurmountable.



But what if the pain is there because we have chosen to ignore it?


What if the pain is not something to be against but rather an experience to move through?


What if the pain existed because we won't stop fighting?


It's like a woman fighting frantically in the water, trying to escape drowning, only to be told to stand up because she's only in three feet of water. We need to listen to the pain, and we need to learn to describe it. Then, we need to get to the root cause. It is not a symptom to be alleviated, but an alert to pay attention to. We need to reframe pain from something to be feared and avoided to a healthy response from our bodies for support.

If the body map overwhelms you as it did me, it's okay. You need to break it down into smaller quadrants and learn to work your way from there. But don't ignore or block it out.

Blocking it out often feels like the best option. Disconnect. Push through to prove how tough you are. Refuse to let pain stop you. But eventually, it wins. Why? Because we need to pay attention.


The pain gateway is dysfunctional in people with fibromyalgia, which means we experience increased pain levels. As a result, things that others may not feel can be excruciating to us. More on that later. So yes, it can be tough to feel the extent of what we Spoonies have to feel at times. But we have to acknowledge it and check in on ourselves periodically.


We begin by reframing the way we view our pain. Pain connects us to our bodies, conscious thought, and unconscious operations. It forces us to dissect ourselves mentally, physically, and spiritually to repair and rebuild. While pain is often caused by the physical such as the case of a gash in the leg, or inflamed, infected sinuses, with fibromyalgia, it's something else. It's multifaceted.


Typically, you reach fibromyalgia or chronic fatigue diagnosis after ignoring stress responses for far too long or after an extremely traumatic gigantic stress overload. Now stress conveys many different images to people, so let's dig deeper there.


Stress

Stress was first defined in 1936 by Hans Selye as,

"Non-specific response of the body to any demand for change."

In experiments on laboratory animals, he noticed that when he exposed them to varying, acute, unpleasant physical and emotional stimuli, they all experienced physical changes such as stomach ulcerations, shrinkage of lymphoid tissue, and enlargement of adrenals. Interesting, right? He also discovered that constant, prolonged exposure to these same stimuli led to chronic conditions in the animals, such as heart attack, stroke, kidney disease, and rheumatoid arthritis.

Unfortunately, the word stress had already been taken by the realm of physics to describe elasticity. The stress, described by Hooke's Law as the magnitude of external force, is the pressure responsible for physical deformation or strain and is therefore energy. An object's ability to absorb or reflect stress depends on its current state, stress levels, and chemical/physical makeup. Stay with me.

While there are many parallels between the physics definition and the physical experience, unfortunately, this left Selye without a good definition that translated across languages. As a result, stress became synonymous with distress.

Distress is defined in the Merriam-Webster dictionary as,

"a state of danger or desperate need."

It became the household term for any difficult, uncomfortable, or even unpleasant situation. While some of these situations are genuinely stressful, stress can have both negative and positive sources and result in negative and positive changes and respective outcomes and can vary significantly in strength. For example, going on vacation can be relaxing and fun, but traveling is also stressful. Winning a race is stressful, but it's a happy type of stress. Hans Seyle titled positive stress eustress.


Human stress is subjective. One's ability to cope with stress depends on the person's constitution, past exposure, and current state, so the impact is highly varied. Some are more resilient than others. Therefore, you cannot define the degree of impact uniformly.

Based on my experience and research, I would define stress as,

"Emotional, mental, or physical pressure both internal and external, either real or imagined, resulting from changes in expectations and sense of control, experienced as feelings of tension and strain on the body. The duration and source define stressors. They can be either acute, episodic acute, or chronic."


To break that down:


Stress is conveyed through our nervous system, and that system can be overloaded. So as you can see, there are many sources of stress, which is why it can be challenging to identify triggers in fibromyalgia. So let's break down each area further.


Changes in Expectations/Sense of Control

Have you ever noticed that when "things are going your way, it's difficult to be angry or upset? But, when faced with circumstances that challenge your expectations, we think about or vocalize how disappointed we feel. We lament how much better it would be if only things were different. We fixate on the fact that things aren't going our way or the way we expected. Sometimes this feeling lasts only a short while because we accept and move on, or the event or situation comes and goes. Still, other times, such as in situations that do not change easily or are forced to endure long-term, we find ourselves stuck in constant regret and wishing for something that wasn't. Within those long-term experiences, when we focus on things we cannot control, we start to develop a victim-mentality that translates physically into tension and strain.

SPOONIE FACT

The way we view our control over our pain can influence the intensity. For example, catastrophizing or a constant stream of negative thoughts and emotions associated with anticipated or actual pain increased pain intensity in a study of over 1,100 women.


Mental Stress

Mental stress is caused by how we perceive an internal or external event that impacts our thoughts and psychological state, causing anxiety and distress. Common triggering events of mental stress include situations where we strive to meet a certain criterion, are being evaluated socially, and interpersonal interactions. The anxiety and stress created by our perception cause emotional stress.


SPOONIE FACT

A study published by the European Journal of Pain found that when fibromyalgia patients were subjected to low-level mental stress for an hour, their physiological responses that help the body handle the stress were lower than the healthy control group. Therefore, even slightly stressful mental events can significantly impact us Spoonies.


Emotional Stress

When we experience something traumatic, or upsetting, our nervous system becomes activated. If we do not feel like we can meet internal or external demands, we can get stuck in these experiences. These feelings can take time to subside and sometimes lead to depression and anxiety. In addition, if we do not healthily process these situations, we can also internalize thought patterns that impact our reaction to future events. For example, people with PTSD often have an overactive nervous system because non-threatening but similar sensory stimulation can trigger extreme reactions to a previous threatening stimulus. While this reaction is normal and healthy acutely, when our body stays stuck in a fight/flight/freeze response, it can have detrimental consequences physically.

Emotions are felt in different types of the body depending on what the emotion is. Research has shown that negative emotions are felt in the body almost instantly and show up in the eyes and jaw with repeated stress contributing to shorter neck and shoulder muscles. Emotional stress can also cause tightness in the brow and hips. Yoga is a great practice to check in with the body to become aware of the tension and release it before it causes long-term problems.


SPOONIE FACT

Emotional Awareness and Expression Therapy (EAET) is a psychological intervention that helps fibromyalgia patients process emotional experiences from the and resolve interpersonal and internal conflicts. Compared to educational programs focused on helping fibromyalgia patients understand and cope with their symptoms and cognitive behavioral therapy, another psychological therapy focused on reframing thought patterns and developing coping mechanisms. Participants in a recent EAET study noted, "psychoeducation, work on defenses and anxiety regulation (i.e., targeting self-criticism with self-compassion), and writing about stressful life events were especially helpful. The treatment was deemed challenging and time-consuming, and confronting pain, and painful emotions in interpersonal relationships was difficult."


Physical Stress

Physical stress results from either an acute injury or overuse. It can be caused by exercise and daily tasks at work performed with improper posture, including sitting at a desk. Physical stress can also come from fasting, unhealthy eating patterns, exposure to extreme or oscillating temperatures, pain, and infection. These physical conditions can all be due to decreased immunity, mobility, and energy levels due to mental and emotional stress. That’s why it’s important to stay in moderation on what we can, like what and when we eat.


SPOONIE FACT

Sitting for long periods is also not good for you, but it’s not as dangerous as smoking as some articles claim. However, it can create tight hip flexors, and if sitting with poor posture, which is the case for many, a lot of pain and tension all over your body, which is the last thing a Spoonie needs!


Check out this great video on setting up your computer desk properly.


STRESS IS DEFINED BY DURATION

Some stressful events are quick blips that happen only once; some are reoccurring, while others seem to drag on and become the new normal.


Acute Stress

We have all had these sudden bursts of panic. We realize we forgot to pick our kids up from school, we almost hit the person in front of us, and we have a disagreement with our significant other. Our kid decides to throw a tantrum in the middle of the grocery store. Small events that mildly peak our stress response are quickly recovered from. Depending on the subjective response, stress can trigger physical symptoms, including a racing heart, rise in blood pressure, chest pain, stomach pain, headache, or migraine. These events can also cause anxiety, sadness, or irritability. When our minds continue to dwell on past or future acutely stressful events, we can extend the stress reaction, but eventually, we recover as time passes.


Episodic Acute Stress

This can occur when you have reoccurring burdens and stressful events, causing a constant state of panic and tension from worrying, leaving your body tight and angry. Sometimes we take on too much, or maybe we are in a poorly managed situation involving difficult interpersonal relationships like a boss or spouse. In these instances, we need to learn to physically and emotionally release the stress with healthy coping mechanisms like exercise or counseling or changing circumstances like getting a new job or reevaluating our relationship. Unfortunately, this type of stress accumulates if not dealt with properly and leads to chronic health issues.


Chronic Stress

This type of stress is unrelenting and stems from social issues like poverty and racism, dysfunction from traumatic childhoods, abusive relationships, and physical disorders.


It's important to identify which category stressors fall into. This can help us gain perspective on acute situations that we tend to magnify (like flares) and bring better clarity to issues we might have been ignoring (like unhealthy emotional processing).


STRESS OVERLOAD

As you can see, one type of stress cascades into the next and can also be experienced simultaneously. Again, this is healthy and normal if you move through and your body relaxes and returns to homeostasis. In fact, stress is unavoidable and can be beneficial. We normally experience stress when we push ourselves beyond our limits, which is required for growth and helps develop resiliency or protection against similar stressful events by lowering the response magnitude. Stress and anxiety also help us avoid dangerous situations. So non-reactivity or a constant state of bliss is not the answer.


American Institute of Stress

This chart from stress.org illustrates the positive relationship between stress and productivity until stress levels become too high, affecting productivity adversely.

However, as I mentioned, sometimes we get stuck in stress response, and we begin to stuff our emotional and mental stress into our bodies. The system shuts down from overload and begins to malfunction. When the stress becomes too much to handle, such as chronic stress, we risk altering our nervous system response.


Below are two charts from an article on Somatic Experiencing (SE) published in Frontiers in Psychology: Consciousness Research by Payne and colleagues that depicts a mild stress response (normal) in contrast to a chronic stress response. As you can see, the parasympathetic activation is underperforming. I highly recommend you read this article when you have some time.


Figure 3. Acute (mild) stress response. Payne et al. 2015.

Described as "In response to a mild stressor, the ANS (and the whole CRN) responds with sympathetic activation, accompanied by a reciprocal lessening of vagal (parasympathetic) tone. Usually, this activation will support an appropriate response to the stressor; this response will be accompanied by proprioceptive feedback that the response has been successfully completed. Sympathetic activation then diminishes, vagal tone returns to normal, and the whole CRN resets to normal resilient functioning."

Figure 4. Chronic stress response. Payne et al. 2015.

Described as, "If the stressor is above a certain intensity or duration, the sympathetic response is more intense; if there is an inadequate defensive response, the system as a whole may fail to reset to normal functioning, remaining “tuned” to excess sympathetic and deficient parasympathetic activation. This state may persist indefinitely, giving rise to a state of “chronic stress,” where the system responds inappropriately to environmental challenges with excess activation. Note that this is not “allostatic wear and tear,” but an altered (dys-)functional state; such a chronic state is a major contributor to allostatic over-load. Through appropriate intervention, the system can be returned to a normalized, fully functional state; but without such intervention the dysfunctional state may last indefinitely."


Essentially this is theoretically what happens in fibromyalgia and chronic fatigue syndrome, causing our central sensory processing system to malfunction. Also, in fibromyalgia, our pain processing signals increase.


Gate Control Theory of Pain

Now, I want to introduce you to the Gate Control Theory of Pain that I mentioned earlier. Start with this short video that gets a little sciencey. You don't need to remember this, but an overall gist of what is going on in your body is important.


If you've ever bumped your knee or elbow, felt the shock of pain, and then automatically started rubbing it to make it feel better, you are already familiar with manipulating this system. Basically, non-painful signals can override and reduce painful signals sent to the brain.


One theory of fibromyalgia etiology (causation) is that malfunctioning in the sensory pain system is a cause of the increase in pain levels and several other deficiencies in our neurochemical functioning. A systematic review of studies on glutamate levels in fibromyalgia patients found that 7 of the 8 studies found higher levels in the brain's posterior cingulate gyrus, posterior insula, ventrolateral prefrontal cortex, and amygdala, and one study found lower levels in the hippocampus when compared against healthy controls. Glutamate is a neurotransmitter than carries information between neurons in the nervous system, binding to their receptors and increasing excitability. In a small trial, acupuncture decreased pain levels, corresponding to significant decreases in glutamate.


Polyvagal Theory

The vagus nerve is believed to be a significant contributor to fibromyalgia symptoms. The vagus nerve is the longest cranial nerve in our body, connecting our mind with over 80% of communication with internal organs. It is the system that regulates the nervous system response, which impacts our heart rate, lungs, diaphragm, as well as chemical reactions. It tells the body to fight, flight, or freeze. Interact with the environment or disassociate. Having a higher vagal tone means we can relax faster to stress. Research suggests that low vagal tone found in fibro patients may be responsible for lowered heart rate variability reducing anti-inflammatory responses, and poor emotional expression and social engagement. So our nervous system does not operate independently. We interact with the nervous systems around us, trying to connect and feel safe together.

The vagal nerve is continuously checking for signals to decide if the environment is safe or not. There are more than just two ways to move through the world; instead the nervous system is constantly changing. You can read more about Polyvagal Theory and its role here. The polyvagal theory is also explained in more detail in the book Waking the Tiger below. Trauma and abusive or unhealthy interpersonal relationships, especially with parents, can impact our vagal tone. Here's a quick 4-minute video by Dr. Stephen Porges, the creator of Polyvagal Theory:


The good news is that we can strengthen our vagal tone by regularly stimulating our parasympathetic nervous system and when we are stressed. Parsley Health recommends breathwork exercises like yoga or alone, meditation, gratitude journaling, spending time in nature, playing with pets, or anything that vibrates your vocal cords, such as chanting, singing, humming, laughing, or even gargling with your mouthwash for a minute every morning. In fact, a study published in the Association of Psychological Science found that anything that makes you feel positive helps strengthen vagal tone and increase physical health.


The Connection


Therefore, I want to be crystal clear about something vital to understanding the relationship between stress and fibromyalgia.


It is not a psychological condition. It is not a physical condition; it is malfunctioning in the mind-body communication, which disrupts the nervous system, causing an increased stress interpretation and an overly sensitive response resulting in mental, emotional, social, and physical symptoms.


So, to feel better, you need to treat all levels of stress while also rewiring your change in expectation and sense of control. Sounds easy, doesn't it?


Of course, it's not easy. It takes an incredible amount of dedication and self-care, but the good news is that we can fix the chronic activation. But it is a multifaceted approach that relies on support in all areas. It also requires you to identify your sources of stress.


So how do we fix it?


Reconnect with the body, stimulate the parasympathetic nervous system, rewire thought patterns, and increase mindfulness.


Emotionally/Mentally


EAET- Emotional Awareness and Expression Therapy (discussed earlier)

An internet format was tested just last year that found, "almost one-quarter of the sample (23.1% or 12/52) achieved a 50% or larger reduction in somatic symptoms from pre-treatment. The large within-group reduction in somatic symptoms was fully maintained (even slightly increased) at 4-month follow-up."


Tapping (Emotional Freedom Technique EFT)

Tapping is an evidence-based mind-body practice that involves confronting difficult feelings or situations and accepting them while tapping on different acupressure points on the face and body. It has been proven to be effective by the American Psychology Association for treating anxiety, depression, phobias, and PTSD (Posttraumatic Stress Disorder). EFT has also been shown to improve resting heart rate and blood pressure, decrease cortisol, increase happiness, and increase immune system functioning. Best of all, it's super easy! You can learn to tap at home, establish a regular practice for long-term benefits, and have it at your disposal for any acute stressful events.

Here is an excellent video on EFT:


Brad Yates has several youtube tapping videos for every situation and even for kids and teens.

EMDR

Eye Movement Desensitization and Reprocessing technique is a type of psychotherapy used to help people with distressing life experiences, anxiety, depression, panic disorders, and PTSD. It has been proven effective by the American Psychological Association, American Psychiatric Association, the World Health Organization, and countless other organizations. Prince Harry and Sandra Bullock have both publicly shared their experience. Here is a short 10-minute introductory video from the EMDR International Association:





Cognitive Behavioral Therapy

Cognitive Behavioral Therapy can be done with workbooks and a therapist, or even an app, like MoodFit or Noom(for weight loss). CBT has been found effective for depression, anxiety disorders, alcohol and drug use problems, marital problems, eating disorders, and severe mental illness. By targeting unhealthy thinking and behaviors, new coping mechanisms can be learned.


Mind-Body Connection


Yoga

Purposeful movement and breathwork that research shows help to influence the sympathetic nervous system, hypothalamic-pituitary-adrenal axis regulation, and decreases blood pressure, heart rate, cortisol, and cytokine expression, which means improving mood and stress resiliency. I found this to be the case in my own life, so I created the Spoonie Yoga Program for fibromyalgia.


Meditation/Prayer

A component of yoga, but a practice in and of itself. Meditation can be performed in so many different forms. You can explore walking meditation, guided meditation, chanting, or simply focusing on the breath. In the Stress and Relaxation Workbook below, there are several guided meditations that you create and record in your own voice. I found that telling something to myself was incredibly powerful, despite having to overcome the awkwardness of hearing your own voice. Here is a guided meditation video that's great for beginners. You don't have to meditate for long to experience the benefits. Just try to make it a regular practice once or twice a day or anytime you feel yourself needing to ground.


Somatic Experiencing

This is another one that needs to be done with a licensed practitioner. Somatic Experiencing helps you connect with your body to release stuck emotions, particularly trauma, and highly stressful events. Here is a quick video about Somatic Experiencing from its creator, Dr. Peter Levine, author of Waking the Tiger. I highly recommend you read it if you haven't already.


Myofascial Release


One of the easiest and most cost-effective ways to keep your fascia healthy and address restrictions is self-myofascial release. It can be done with a roller, a lacrosse or tennis ball (my personal favorites), or any tool that helps you apply gentle pressure on the "knot" until it softens. Too much pressure can be bad, and you can end up tighter and sore. Place the roller or the ball in the painful area and slowly move around until you find the most tender spot. Hold for 30 sec to a minute with pressure that feels good to you. Use your body weight to apply more or less.

For even more help, I highly recommend you try myofascial release therapy. Developed by John Barnes PT, uses sustained pressure to help relax connective tissue or the fascia, and release restrictions that cause pain and hinder mobility. Our fascia system runs throughout our entire body and holds our muscles, bones, and organs together like a structure. Physical and emotional trauma causes the fascia to become rigid and taut. So poor posture, injuries, stress, and traumatic experiences all show up in our fascia. Myofascial restraints can cause up to 2,000 lbs per sq inch of pressure resulting in a lot of pain! Through myofascial release, the fascia regains pliability. Check out his site here for more information and to find a therapist in your area. Research has shown that myofascial release therapy (MRT) effectively reduces pain and improves mobility.


Physically

Get a GREAT doctor!!!

The body definitely needs to be supported medically to heal from fibromyalgia and regain health. You have a chronic condition, meaning you require regular care and maintenance from a professional who understands the extent of this illness, not one that spends 15 minutes and then writes you a few drugs to manage the pain. Multiple systems can be impacted and must be treated. I highly recommend Dr. Tietlebaum as a medical expert you can learn from to help navigate the medical system and inform your doctor, who is usually not up to date with the latest research. You need to learn to advocate for yourself with fibromyalgia. Check out his book From Fatigued to Fantastic below. I also highly recommend finding a holistic doctor who has been trained in both western medicine as well as natural therapies. It can take some time to find someone good but do not give up. This is a vital piece of the puzzle.


Massage

Massage therapy is excellent for relaxing muscular tension and toxin release. Find a therapist who is familiar with fibromyalgia. There are many different styles, so I always suggest finding one that feels best. Some like the firm pressure of deep tissue, while others may find more relaxation from a Swedish massage. There is also rolfing, Graston Technique, and trigger point massage, which you can even do on yourself.


Chiropractor

Many fibromyalgia patients also find relief from chiropractic work. Often insurance companies will help with the costs of these treatments, so it may be worth giving it a shot to see how you respond.


Acupuncture/ Dry Needling

There are different forms of acupuncture available today, including electronic and sham (which uses pressure on acupuncture points but not an actual needle). Research shows that it may be helpful for pain and stiffness, sleep, and fatigue. In addition, regular sessions can help lower levels of glutamate in fibromyalgia patients and lower pain which may be responsible for increased pain. Dry needling is similar to acupuncture, but it uses a different technique and targets different areas, specifically trigger points or hard knots of taut muscle that are easily irritated. Some insurance plans will cover acupuncture and dry needling treatments, with or without a physical therapy plan.


Self-massage


There are many massage tools on the market, and several items you may already own or can buy cheaply can be used as massage tools, such as tennis and lacrosse balls. I have even used dog toys! You might also want to try the Thera cane, which effectively targets trigger points throughout the body.





Gentle exercise

Walking, swimming, biking, hiking, Tai Chi, dancing, or whatever exercise you enjoy that doesn't encourage you to overdo it is excellent for your physical and mental health. If it's something you can get together with friends and do, you get even more bang for your buck, reaping the good feelings from socialization.


Environment

Create safe healing spaces. If you live in an unsafe, unclean, or stressful place, it is most likely impacting your health. Sometimes, we can do things to improve our environment easily, and other situations may take longer to get better. For example, if your house is cluttered or you are having trouble maintaining it, consider your options. Can your family help more with regular cleaning? Do you need to clear out the clutter? Do you need more organization? Can you hire someone? Should you start looking for a new place to live? What would you need to move?

Perhaps there are short-term changes you can make to make you happier. Create some motivational artwork for the walls, and buy a few house plants to bring some life to your space. Paint the walls a calming color. Invest in an essential oil diffuser or tabletop fountain for some natural ambiance.


Interpersonal

Work on difficult relationships or let them go. Focus on the people that bring you love, support, joy, and ease- not stress. This is hands down one of the most important things next to self-image, which I will discuss next. If you are in a relationship that constantly brings you down, you will not get better. If you are in an abusive relationship, please seek help.


Interpersonal Violence

This is a topic near and dear to my heart. A research study of over 18,000 women found that exposure to intimate interpersonal violence nearly doubled the rate of developing fibromyalgia and chronic fatigue syndrome. The CDC defines interpersonal Violence (IPV) as:

"Abuse or aggression that occurs in a romantic relationship. “Intimate partner” refers to both current and former spouses and dating partners. IPV can vary in how often it happens and how severe it is. It can range from one episode of violence that could have lasting impact to chronic and severe episodes over multiple years."
How Serious is Interpersonal Violence (IPV)?

CDC.gov "How Big of a Problem is IPV"
What Does Interpersonal Violence (IPV) Look Like?

Adapted from CDC.gov

Self-Image Narrative

Body Image Work- Many, many women struggle with body image. Our society is just starting to correct some of the marketing issues that have caused so many health problems. Body Image issues begin young and persist throughout. As a mother, one of the best things we can do for our daughters and sons is to create a healthy example of self-love. If you are struggling in this department, the good news is that you can change the way you think, feel, and see yourself when you look in the mirror which can have profound effects. Body image dissatisfaction has been associated with poorer physical health, quality of life, and psychosocial functioning.


One-on-One Therapy & Support Groups

If you know that you are struggling, don't wait to reach out. Talking with a mental health professional and joining support groups are excellent ways to diffuse stress and protect against depression, PTSD, and addiction. Handling things on our own is not a show of strength. Reaching out and asking for help is. There are many different options so you can find what is best for you—virtual, in-person, or within a group. There are even treatment centers if you need more support. Find a therapist or center here:



Book/Workbook Recommendations

We tend to stuff difficult emotions inside our bodies and, as a result, continue traumatizing ourselves and prohibiting experiencing the present. So this was an excellent tool for me when I started unpacking my past and helped empower me to face difficult situations with confidence.


The Stress and Relaxation Workbook by Martha Davis


The Stress and Relaxation Workbook is excellent to help identify daily sources of stress. The exercises can be painful to work through and difficult at first, but you will feel less tension and look forward to these new habits with practice.




The Anxiety and Depression Workbook by Michael A. Tompkins Ph.D. ABPP & Judith S. Beck Ph.D.


This is a good workbook if you are struggling with anxiety and depression. Utilizing CBT (Cognitive Behavioral Therapy) techniques help you to confront limiting beliefs and learn to cope with difficult emotions.



Unlearn Your Pain by Howard Schubiner MD, & Michael Betzold


This book explains how our pain is connected to repressed emotions. By learning to express these emotions and be easier on ourselves, we find the key to lessening our pain. Negative thought patterns can cause reoccurring microtraumas that accumulate over time and contribute to chronic pain.



The Way Out: A Revolutionary, Scientifically Proven Approach to Healing Chronic Pain by Alan Gordon LCSW


Alan Gordon, the founder of the Pain Psychology Center in Los Angeles, developed Pain Reprocessing Therapy (PRT), a psychological therapy based on neuroscience that helps rewire the brain and break the cycle of pain.




Waking the Tiger by Dr. Peter A Levine with Anne Frederick

Waking the Tiger normals the trauma response and explains how humans, unlike animals, get stuck in our trauma responses when we do not fully process the intense emotions. These emotions get stuck in our bodies, and through connecting with movement, we can learn to complete the nervous system response, letting go of the trauma.



From Fatigued to Fantastic by Jacob Teitelbaum M.D.

Dr. Jacob Teitelbaum M.D. is a fibromyalgia survivor himself. He found himself homeless on a park bench, unable to continue with medical school. Devoting his career to helping people recover, I was lucky enough to work with Dr. T, and he was instrumental in my recovery. Unfortunately, he is retiring this year, but his books give you everything to take to your doctor to help support you physically. You can also find more information on his website at EndFatigue.com.




What We Learned About Pain and Stress in Fibromyalgia

Pain and stress are related
We need to learn to manage our stress to decrease our pain
Stress can come from many sources
Reducing stress and changing our reactivity patterns create lasting changes in our health
We can learn techniques and utilize many tools to help ourselves heal

It's not about managing or accepting your fibromyalgia; it's about supporting your system holistically and learning to deal with past emotions and traumas while rewiring your stress response. We all have different sources of stress, and it is up to us to seek help to manage it. You don't have to do it alone. If you'd like help creating a personalized plan to reduce the stress in your life and work towards healthier habits, send me a request for a






References

1) Stress and Your Health. Medline Plus. March 2022. https://medlineplus.gov/ency/article/003211.htm



3)Stress. Cleveland Clinic. January 2021. https://my.clevelandclinic.org/health/articles/11874-stress


4)Somatic experiencing: using interoception and proprioception as core elements of trauma therapy. Frontiers in Psychology.


5)Mental Stress. Encyclopedia of Behavioral Medicine. N.D.


6)Measuring Glutamate Levels in the Brains of Fibromyalgia Patients and a Potential Role for Glutamate in the Pathophysiology of Fibromyalgia Symptoms

A Systematic Review. The Clinical Journal of Pain. October 2017.


7)Pain In Fibromyalgia Is Linked To Changes In Brain Molecule. University of Michigan Health System. March 2008.


8)The role of the vagus nerve in fibromyalgia syndrome. Martins et al. Neuroscience & Biobehavioral Reviews. December 2021.


9)Pain Catastrophizing Moderates Relationships between Pain Intensity and Opioid Prescription: Nonlinear Sex Differences Revealed Using a Learning Health System. Anesthesiology: Pain Medicine. July 2017.


10)The Three Types of Stress


11)Why Stress and Anxiety Aren't Always Bad


12)What is Cognitive Behavioral Therapy?


13)More than just body weight: The role of body image in psychological and physical functioning. Wilson et al. Body Image. September 2013.


14)Intimate Partner Violence. CDC. October 2021.


15)What is Somatic Experiencing? Somatic Experiencing International. https://traumahealing.org/se-101/


16)Dr. Ida Rolf Institute.


17)Graston Technique


18)Pressure Pain Sensitivity and Insular Combined Glutamate and Glutamine (Glx) Are Associated with Subsequent Clinical Response to Sham But Not Traditional Acupuncture in Patients Who Have Chronic Pain. Harte et al. National Library of Medicine: Medical Acupuncture. April 2013.


19)Acupuncture for treating fibromyalgia. Deare et al. May 2013. National Library of Medicine.


20)Clinical EFT (Emotional Freedom Techniques) Improves Multiple Physiological Markers of Health. Bach et al. Journal of Evidence-Based Integrative Medicine. February 2019.


21) Polyvagal Theory Infographic. Integrated Listening Systems.


22)Effectiveness of myofascial release: Systematic review of randomized controlled trials. Ajimsha et al. Journal of Bodywork and Movement Therapies. December 2013. https://www.sciencedirect.com/science/article/abs/pii/S1360859214000862


23) Intimate Partner Violence and the Risk of Developing Fibromyalgia and

Chronic Fatigue Syndrome. Chandan et al. Journal of Interpersonal Violence. December 2019.


24) How Positive Emotions Build Physical Health: Perceived Positive Social Connections Account for the Upward Spiral Between Positive Emotions and Vagal Tone. Kok et al. Association of Psychological Science. May 2013.


25) 5 Ways Stress Hurts Your Body, and What to Do About It. Marlynn Wel. PhD JD. Psychology Today: Stress. May 2015.




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