Noise? Light? Smells? Pain?

Think you’re going nuts? Too much noise? Light too bright? Your doctors telling you that it has nothing to do with your Fibro?

Research has indicated that FM sufferers have an increased sensitivity to painful stimulation (Scudds et al. 1987) – Really? In 1993, it was formally hypothesised that FM involves a generalised pattern of hypervigilance, marked by increased attention to a variety of external and internal sensations (Rollman and Lautenbacher 1993)

Our brains become overly aware of things, which can include painful stimuli, noises, bright lights, and general activity. It is possible that the nature of the condition itself may augment hypervigilant behaviour (McDermid et al. 1995). Pain is the hallmark symptom of fibromyalgia (Rollman 1989) – again, really?

BUT clinical data suggests that the pain is widespread and intense, not limited to the tender points – 59.5% of FM sufferers reported that they had pain in 15 or more body regions and 68.8% experienced ‘pain all over’ (Wolfe at al. 1990). This could explain why our bodies react so strongly to sensation that most people wouldn’t experience as painful. ,

But what about the heightened responses we experience from other sensory stimuli? Things like sensory symptoms, tinnitus, and aggravation of symptoms by noise, lights, stress, posture and weather? Findings suggest that FM sufferers find a variety of bodily experiences to be aversive (Yunus et al. 1989) – do you want to say it this time? It was in 1986 that the term ‘Irritable Everything Syndrome’ was coined (Smythe 1986).

With hypervigilance, not only do we notice things more readily, we are likely to be unable to divert our attention from them. These diversions – things that are in everyone else’s background but, for some reason, seep into our foreground – are perceived as a threat by our fixated brains, and our physiological response is far more extreme than it should be.

With ‘normal’ people, their brains absorb a lot of information about their surroundings, of which they are not particularly conscious. With FM sufferers, too many signals are considered a threat, and thus get extra attention.

Perceptual amplification of pressure stimuli occur across a wide range of physical intensities, from those that are gentle and innocuous to higher levels that are strongly unpleasant or painful. The unpleasantness of stimuli does not appear to be the factor that determines whether they will be amplified.

The studies showed that FM patients had significantly lower threshold and tolerance values than the RA patients, who in turn, had lower values than the normal control subjects. The results of the psychological questionnaires revealed that the fibromyalgia and RA patients preferred lower levels of external stimulation than the control subjects. The outcome of this study supports that FM patients have a perceptual style of amplification – see? you’re not going crazy!

But what is the critical factor? So far, there does not appear to be a singular answer BUT it is proposed to combine two popular views into a unified model (Crombez at al.2004). Specifically, that hypervigilance begins as a cognitive process, in which an individual is concerned about, and therefore closely monitors, particular types of sensations— especially those that, while not necessarily unpleasant in themselves, accompany or warn of impending pain. Further, that sustained direction of this affect-charged attention to a particular form of stimulation produces, over time, an increase in the perceptual gain for all stimuli of that type. (eg: in FM, firm pressure on the skin routinely leads to pain; hence all pressure sensations, even gentle ones that pose no risk of pain, come to be amplified). If (and to the extent that) attention is habitually focused on sensations of a particular type, their amplification increases and becomes autonomous.

But let’s forget the science, sometimes, the symptoms of hypervigilance are hardest to deal with because they’re constant. They don’t have to increase to be a bother; the same level of intrusion day after day is enough to make us lose it!

References

Crombez G, Eccleston C, Van den Broeck  A, Goubert L, Van Houdenhove  B, Hypervigilance to Pain in Fibromyalgia: The Mediating Role of Pain Intensity and Catastrophic Thinking About Pain. Clin J Pain. 2004;20;98-102.

Hollins M, Harper D,Gallagher S, Owings E W, Lim P F, Miller V, Siddiqi M Q, and Maixner W, Perceived Intensity and Unpleasantness of Cutaneous and Auditory Stimuli: An Evaluation of the Generalized Hypervigilance Hypothesis. Pain. 2009; 141(3): 215–221.

Lautenbacher S, Rollman GB. Possible deficiencies of pain modulation in fibromyalgia. Clin J Pain. 1997;13:189–196.

Lautenbacher S, Rollman GB, McCain GA. Multi-method assessment of experimental and clinical pain in patients with fibromyalgia. Pain. 1994; 59:45–53.

McDermid AJ, Rollman GB, McCain GA. Generalized hypervigilance in fibromyalgia: evidence of perceptual amplification. Pain. 1996; 66:133–144.

Rollman GB, Gillespie JM. Disturbances of pain perception in temporomandibular pain syndrome. In: Lautenbacher S, Fillingim RB, editors. Pathophysiology of pain perception. New York: Plenum; 2004. pp. 107–118.

Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL, Tugwell P, Campbell SM, Abeles M, Clark P, Fam AG, Farber SJ, Fiechtner JJ, Franklin CM, Gatter RA, Hamaty D, Lessard J, Lichtbroun AS, Masi AT, McCain GA, Reynolds WJ, Romano TJ, Russell IJ, Sheoin RP. The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis Rheum. 1990;33:160–172.

Yunus M, Masi AT, Calabro JJ, Miller KA, Feigenbaum SL. Primary fibromyalgia (fibrositis): clinical study of 50 patients with matched normal controls. Semin Arthritis Rheum 1981; 11:151–71.

Pilates Pleasure

Yesterday, I downloaded my FREE 14 day pass to the local gym (which is very local – it’s about 500 metres down the street!) and went to have a chat to a lovely lady about my condition and what her gym could do for me. We talked about the yoga and Pilates sessions; and we talked about what would happen after the 14 days was up. (I had to explain that I was absolutely broke and had to be very careful about where I chose to invest my limited funds.) Firstly, she gave me an extra week on my pass. Then she said that, if I find the classes are working for me, she could work out a special price so I could attend just those classes and not have to pay for the use of the entire gym. WOW! Nice lady!

To today:

Getting out of bed early, so my body will be functioning (not necessarily well), for a 9.20am Pilates class is not easy, but I’m motivated and I promised you guys a report…

So, I just got out of the shower (yes! I had a shower) after cooling down from the session. And I gotta say: Whoo Eee! (that’s a shout of glee!)Am I feeling energised! Already my muscles ache – but it’s a different sensation than the FM pain. It’s the pleasurable awareness that all my muscles are there and have been stretched and manipulated. (For those who don’t have sex very often, it’s sort of like the day after feeling…yeah, you feel tired and achy but hey! It was worth it and let’s do it again!)

Now I didn’t do that kind of stuff!

We did Mat-based Pilates (not so easy to get up off the floor at the end, though) – this is a series of exercises performed on the floor using gravity and your own body weight to provide the resistance. The central aim is to condition the deeper, supporting muscles of the body to improve posture, balance and coordination. By focusing on your core strength, you (supposedly) enhance the little muscles in the body so you’re better able to support the larger ligaments, tendons and joints. Pilates is a very intense stretching class that incorporates workouts for your abdominal, leg, arm and back muscles – I found the stretching remarkable (it was like my poor, exhausted muscles could finally open up and take a breath of fresh air) and it’s nice to know that I still have some flexibility. Strength-wise? I have none! Anything that involved holding up my own body – even standing on my tippy-toes – was challenging. But it’s only the beginning of my learning curve…

Pilates encourages you to think about how you perform everyday movements. It heightens your body awareness; it helps you ensure your body is working at its optimal level all the time. Pilates will give you more of a holistic result than most other exercises regimes. It will make you focus on your breathing which is great for improving circulation and relieving stress. It is alleged to be a fantastic way to balance out your health and wellbeing.

Pilates is actually great for people with injuries, weak muscles and particularly bad posture because it encourages you to strengthen your problem areas in a relaxed and low impact way. (NB: It is advisable that anyone with serious injuries consults their doctor or physio though. Pregnant women should also get the okay from their doctor before proceeding.)

Now, tomorrow (or maybe even later on today) I know I’m going to hurt – I’m hoping it is the spent muscle type of hurt and not the FM hurt (but I may be kidding myself – I’ll let you know then).

Joseph Pilate

But I’ll know exactly who to blame: Joseph Pilates developed the yoga-like moves to rehabilitate Second World War soldiers. He then modified the style for injured dancers and so the modern-day method was born.

I’m looking after the beautiful Z tomorrow too, so I had better not hurt too much – playing with Z involves at least one walk to the park and a lot of kicking (then chasing) a ball around. I then have hydrotherapy so the warm water will soothe my tired, spent, exhausted, weary, drained, fatigued, wiped out body.

From just sitting on the couch last week, I‘ve suddenly got a REALLY busy schedule!