We want you to know, beyond any doubt, you deserve everything your heart desires.
The love that you withhold is the pain that you carry.
– Ralph Waldo Emerson
In our new book, Integrated Health, I took the opportunity to share my personal story about being diagnosed with Fibromyalgia. Writing this book which focused on trauma-informed care was then personal to me because I knew that there was a connection to chronic pain syndromes due to trauma exposure. Upwards of 90 percent of women with fibromyalgia syndrome have reported trauma events either in their childhood or adulthood. Also, 60 percent of women who have arthritis report a trauma history (Walker, et al. 1997). As evident, when compared to the general population, patients with chronic pain will tend to have double the rates of trauma in their past. So, trauma does not typically cause chronic pain in a direct way. However, the high rate of trauma in people with chronic pain suggests that it has some relationship to the development of chronic pain. This result includes the impact of vicarious trauma/secondary trauma, which has also shown a correlation with chronic pain syndromes.
Considering the area of vicarious/secondary trauma, it has the same potential to place an individual in a state of constant “fight-or-flight” state. The adrenaline connection happens when the autonomic nervous system works to release adrenaline from the adrenal glands – ongoing high levels of anxiety, “the perfect storm,” exacerbate this state of reactivity for an individual vulnerable to a chronic pain condition. Patients who have a history of highly stressful careers, typically in the area of social work, police officers, nurses, and front-line emergency responders, are likely to present with a chronic pain syndrome, i.e., fibromyalgia. Working in crisis situations will keep the body in a perpetual state of the fight-or-flight response.
Here is my story:
My personal story shares what I experienced when my doctor told me that I have Fibromyalgia. When I first heard this diagnosis, I immediately began to panic with thoughts whirling around in my mind: How can I continue to work? How can I live with this full-body pain 24/7? My reaction was possibly stronger than other patients, only because I had worked with so many patients over the years that had Fibromyalgia. I had watched them deteriorate and fight for their life just to have a sense of functionality. Many of them ended up with severe depression and had difficulty walking. Some were in wheelchairs or walking with assistance from a cane/walking sticks. Now, I was the one to experience firsthand the impact of being told you will live the rest of your life with chronic full-body pain.
In my private practice, I listened with an open heart to my patients describing the ongoing severe widespread body pain through their tears. I would document the increased levels of anxiety and depression that followed. I utilized various interventions, i.e., biofeedback and guided imagery, which reportedly helped some, but the chronic pain was relentless and dealing with it was overwhelming for the patient. Most of them had a difficult time with the prescribed medications reporting that the medications were making them sick with symptoms of nausea, headaches, increased anxiety, shaking, and extreme drowsiness.
In my lived experience of over thirty years working in the social work and counseling fields, there is a high correlation for diagnoses of fibromyalgia based on repeated exposure to high stressors, which contribute to this diagnoses. I had the education and work experience to understand the impact of trauma on chronic pain syndromes, however, as my primary care physician told me, it is time to be the patient. I have no regrets about my work, and I have been honored to help others that were reflected by compassion satisfaction. I had convinced myself I can be strong as long as I work hard to help others. I know now that I should have paid attention to my body and my mind as they cried out, “it is time to rest now.” When you are on-call 24/7 and children and families lives stirred by your interventions, somehow, you forget how to rest. I know what it means now by “self-care” being critical. I hope that others learn from my mistakes. (McFeature, C.)
“If your compassion does not include yourself it is incomplete.”
-Buddha
Research has shown that when people transition from an acute injury or illness to chronic pain, it is due to central sensitization (Arendt-Nielsen, et al., 2003). Central sensitization is associated with chronic pain in which the nervous system becomes stuck and in a state of heightened reactivity. In central sensitization, the sensations of pain can be more intense even to the sensation of touch or massage. Central sensitization maintains the pain after an initial injury or illness heals. Trauma and its resultant anxiety is also a condition of the nervous system that is persistent in a state of reactivity. Trauma leads to anxiety, physiological arousal, the release of stress hormones from the traumatic event; wherein the nervous system is shifted into the fight-or-flight response. The “fight or flight” response relies on dopamine, a chemical messenger which is designed to keep us from feeling pain during the fight for our lives. Research conducted by Dr. David Dryland revealed that the combination of pain and not sleeping well continues to keep the adrenaline level continually elevated to such an extent that the fight or flight response is activated all the time, depleting valuable supplies of dopamine. The pain receptors are no longer functioning correctly and are unable to help with the pain. Fatigue and confusion are also common when the adrenaline isn’t cycling properly.
A plan of care may address symptoms of poor, interrupted or non-refreshing sleep; sleep apnea; stress, anxiety and panic disorders; depression; PTSD; Bipolar disorder/manic-depression; schizophrenia or other serious psychiatric disorders; severe osteoarthritis or painful inflammatory diseases; painful trauma, such as a car accident; restless legs syndrome; and, hypermobility (Dryland, D., 2005). Some of the activities which may be helpful for the patient would be walking/light exercise, massage, acupuncture, stretching, ice/heat, breathing exercises, yoga, meditation, and craniosacral therapy. Also, others things that may help the patient keep his or her mind off the pain include crafts, coloring, reading and helping others in some capacity. The patient must be the one to consider what is realistic, affordable, and doable for them, and must be something they enjoy.
Learning to “pace” yourself is probably the biggest challenge when managing chronic pain. When you can have calm days and learn to rest between chores, you can keep the pain managed some. Since becoming a patient with fibromyalgia, I have learned how important it is to listen to your body. It will speak loud and clear when you overdo something, as you “crash and burn.” When you can pace yourself, you can avoid the inevitable increased pain and severe fatigue.
References:
Arendt-Nielsen, L. & Graven-Nielsen, T. (2003). Central sensitization in fibromyalgia and other musculoskeletal disorders. Current Pain & Headache Reports, 7, 355-361.
Dryland, D., with Mark Scarpaci, (2005). The Fibromyalgia Cure. Self-Published. Printed in the United States.
McFeature B. & Herron-McFeature C. (2017). Integrated Health – HeartPath Practitioner Assessment and Intervention for the Trauma-Exposed Patient. Melbourne, FL: Motivational Press
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