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Fibromyalgia pain: Issues with tissues?

Man with fibromyalgia who cut off his own hand

Fibromyalgia and pain

It’s not uncommon for those with Fibromyalgia pain to feel defeated following a doctors visit, as over the years pain has been somewhat of a blind spot for doctors, with most having a difficult time treating even the most common types of pain. In one study looking into this very topic, it was found that 82% of graduates lacked basic competency in this area, if you also factor Fibromyalgia pain into this equation, then it’s likely to get even more complicated.

Let me start by saying that pain is a very real experience, it destroys lives and it certainly doesn’t discriminate who it chooses. However, much like what I just wrote, we tend to anthropomorphize pain. We assign negative human qualities to it, as at times it feels like it’s malicious in its very nature. I know that at the moment it may feel like it’s you versus your fibromyalgia pain, battling every day with this omnipotent foe, but the pain isn’t malicious. Pain is your brain trying to keep you safe, it doesn’t mean your body is damaged or that you are ready for a knackers yard, as some of my favourite clients have put it.

In the studio, we often find that one of the most prevalent fears around Fibromyalgia pain is that most believe it means they are damaged. However, if the last few years of research into pain has taught us anything, it’s that this statement is simply not true. In fact, most people with Fibromyalgia can attest to this, as after countless imagining and other tests, there is nothing seemingly wrong with their nerves, bones, or muscle.

It is understandable as to why people can feel like pain does mean damage though, after all, pain is one of our most primal protective responses, and if it didn’t instil fear and force us to worry then it wouldn’t be of much use.

Those with Fibromyalgia are subjected to multitudes of tests, including, blood tests, imaging, and nerve conduction test. However, as is often the case, those individuals are given a clean bill of health once those test results come back normal, despite still being in pain. As I mentioned before, after a plethora of tests to find the reason for your pain come back normal. it can easily leave people a little deflated. I can personally testify to this.

After being diagnosed with Fibromyalgia, having tests conducted, and being told nothing is wrong, it leaves people wondering just what the hell is actually going on.

 

A history of pain

Pain is defined as: An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.

The definition of pain has remained untouched for many years, but was finally updated in 2020 to add in “resembling that associated with”. Even after all these years we still seemingly struggle to define pain, and rightly so. Pain is ridiculously complex, and we will never truly understand it in its entirety, at least not until we can fully explain consciousness. And even then, we are most likely still going to struggle.

The science of pain has come a long way since we first started to try to understand pain. So, before we get into this, let’s take a little history lesson on pain and see where we have come from, and where we are going.

Aristotle (384 BC – 322 BC) pushed that pain was caused by evil spirits entering the body during injury, and because he was considered a fairly smart guy during his lifetime, his theories seemingly stuck around, for a very long time.

Rene Descartes (1596 – 1650) introduced and eventually solidified the Cartesian Model of Pain (CMP) into history and ultimately medical science. The CMP explained pain as being created in the tissues that would send pain signals to the brain. Even in 2022, a plethora of medical treatments are still being used based on the CMP where people receive nerve blocks, have nerves burnt or are given cortisone injections in an attempt to relieve their pain. However, we now know this model, like many before, has pieces missing, yet is still largely practised. Keep in mind also, that this theory was created back in a time we were burning people at the stake because we thought they were witches, so there’s always that.

The Gate Control Theory (GCT) by Melzack and Wall was the next kid on the block. This theory explained how the spinal cord acted as a gatekeeper, choosing what dangerous and non-dangerous messages were sent to the brain. Even after some of the greatest minds had come together to help explain pain, the GCT could still not explain how people could be in pain without any messages being sent to the brain. Think of when amputees still feel pain in the limbs that they no longer have(which we are going to look at a little bit later), or in our case much closer to home, when we feel pain despite the lack of tissue damage. If the GCT is to be believed, the pain we feel in these cases is not possible and we all know that’s not true.

We then had the Neuromatrix Model of Pain, followed and updated by the Cortical Body Matrix, which was heavily supported by evidence and built upon the principles of the formation of neurotags. But, alas, even in these later theories of pain, pieces were still missing.

Most recently, we have moved towards the Biopsychosocial (BPS) model of pain. This was first put forth by Dr George Engel in the 1970s. The Biopsychosocial model of pain considers all the biological, psychological and social factors which can influence pain. The Biopsychosocial model explains how pain is created and modulated by the brain, how pain can be influenced by tissue damage or created in the absence of tissue damage. It describes how pain is a multifactorial, personal experience. It is ultimately the BPS model of pain that helped me understand my own personal pain experience and help me ground my method in solid, evidence-based science.

Given the current body of research we have on pain to date, the BPS model of pain is the only model that can stand up to criticism.

 

Fibromyalgia pain does not mean damage

Despite having imagining showing no damage to tissue, bone, or nerves, it can still be hard for individuals to truly believe they are not damaged. After all, it’s hard not to when your muscles and bones ache to such an extent it limits what you can do every day. So, to help hammer home this point of pain not meaning damage, I managed to find some brilliant examples to help show you how pain can exist with or without damage. One such example is that of people around the world who don’t even feel pain!

This is known as “congenital analgesia” and for those with this rare medical condition, their life expectancy is drastically reduced. After all, how would you know if your appendix was about to burst if you couldn’t feel pain? Or how would you know if you were walking on a fractured leg? Well, the truth is you wouldn’t.

There’s a reason we experience pain and it’s not about damage, it’s about protection. In fact, we don’t even need a body to feel pain. There’s no shortage of people with pain in legs and arms that were amputated decades ago, suffering what is commonly referred to as phantom pain syndrome.

Pain is 100% real, but it is also a subjective experience, which means we have no real way of knowing if everyone feels the pain the same way. As I mentioned before, If pain is made in the brain, then we don’t even need a body to feel it. A great example regarding phantom limb pain is the example is of  Mark Goddard back in the late ’90s, who fell off his motorbike and began to suffer intense pain in his hand as a result. Mark had multiple x-rays, MRI’s and even nerve conduction tests, and every time, they came back fine. After a while, Mark asked the NHS to amputate his hand, as he felt that he would rather not have the hand if it meant no more pain. After a long drawn out argument with the NHS about the ethics (because he was asking them to amputate a hand with perfectly healthy tissue), they said no.

After being told no by the NHS, Mark had reached the end of his tether and decided that he would take matters into his own hands. Over the next two weeks, he built a guillotine in his shed. Mark waited until his wife went out of the house and he chopped his own hand off! He threw his hand into a bucket and set it on fire so that it could never be reattached, and after a whole year of not having his hand, Mark still had hand pain….despite not having a hand. If you want to read about marks story, you can read his press article here.

I myself have seen this in the studio over the years, as clients report that joints hurt, despite the fact they have had a full knee replacement years ago! They were feeling pain in a piece of metal, which again, is a great way to show you that you experience pain in the brain and not the tissue. Pain is complex, it needs emotion, beliefs, context, and so much more to exist.

Mark is the perfect example that pain isn’t about damage, as he had healthy tissue, but also had pain, then he had no tissue after he removed his hand, but he still had pain. Pain is for protection, it’s not just about damage. In the studio, we see clients every day who have spent decades afraid to even move, in fear they with hurt themselves.

So, if somebody can have no damage and still have pain, can somebody have damage and experience no pain? In short, absolutely!

Take for example Federico who was involved in a shark attack. Fed was out surfing one day when he was attacked and sustained a bite to the arm. After being rescued and pulled to shore, he realised he had also been bitten on the leg and he had never even felt it. You can read about Fed here.

Then there is a great story about Julia, a Russian woman who was walking home one day from work and encountered a mugger. She was unknowingly stabbed in the neck, but took over an hour to realise that the knife was still in there! You can read her story here.

I hope this short article has helped you dispel some of the myths around pain as a result of damage and has encouraged you to do more, and let your brain slowly begin to start trusting your body again.

-The Fibro Guy Team

 


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