Winning at Fibromyalgia

Hello Hello Hello!

I am excited to be back for an episode # 8 of Winning At Fibromyalgia podcast!

Title of today’s episode is: “How I reached breakthroughs on my own fibromyalgia journey”

I shared during an earlier episode on the podcast that I have fibromyalgia back pain. It is mostly in my upper and mid back. I have had it since 2010 or so. It has been really frustrating at times to figure out what works. I have been to PT, massages and even had a trigger injection by one of my Orthopedic colleagues. It helped for about 2-3 months then the pain returned.

I did not have my Winning at Fibromyalgia method when I experienced my first breakthrough with my own pain. I did somatic tracking, WHILE ON MY LUNCH break, and my pain went away. It came back the next day but went away during meditation in the evening. And it has happened several times since then, my pain comes back but is less severe and one day I think it will stop coming back.

So it was AFTER my breakthroughs that I mapped out the 5 step WAF method. I introduced the 5 steps in the last episode. They don’t have to be in the sequence I presented and here I share how they came to me.

Months before I started researching the neuroplastic pain concept in detail I signed up for the Whole health Medicine institute course for physicians organized by Dr. Lissa Rankin. It was organized online for the first time which made it immediately attractive to me. For a brief overview, Dr. Lissa Rankin is a leader in approaching health issues by digging in to find the root cause. I like her approach because she is NOT an anti-science or anti-medicine. Quite the contrary, she personifies the approach that I love – which si to combine the best of the best approaches – the best of the western medicine and everything else including harnessing the power of our brains and inner healing energy.

The first online retreat happened in 7/2021 and Dr. Rankin introduced the concept of IFS (internal family system) approach to healing. It basically says we as humans have many parts within us, frozen in time, living inside our minds/hearts or memories. Like when you say “part of me wants to go (to a party but another part just wants to sit home and study… (or something similar). We have our responsible, reckless, fun loving, sad, angry parts. Any time our beliefs were formed in childhood or feelings hurt or anytime our worldview was shaped, our memory has an imprint of that part. Those that have been there since childhood are part of our subconscious mind. Richard Schwartz is the founder of this healing therapy method, and he has been perfecting it for over 30 years now. There are schools and courses to get trained at this and demand is super high.

I realized that I had so much sorrow and pain hidden in my past that was connected how I acted and behaved in my daily life, years after my adverse childhood experiences and traumas. And when I say traumas I don’t mean anything super vicious like abuse. Adverse childhood experience is anything that does not allow a child to feel safe. You can put literally anything from verbal to physical to sexual abuse. But it does not have to be physical. Bullying is a good example. For the first time ever, truly ever, I knew I could “heal” my soul, all the past wrongs, and traumas. It was truly transformational. And from that experience came my everlasting hope for my own healing.

As a Rheumatologist I have been trained to view the fibromyalgia pain as central pain volume problem – that the pain is augmented in the brain or spinal cord due to various possibly even genetic factors. Factors that are out of our control. Meaning you can’t do anything about them.

And That is not entirely true. Fibromyalgia pain is linked to emotions and chronically activate stress reaction, basically representing a chronic/perpetual body mind syndrome. And because of that (the link to emotions and chronic stress reaction, chronic activation of the sympathetic nervous system), WE CAN do something about it, if we CHOOSE.

It took me a while to fully sink in – that my emotions – past and present, and stress (again past and present) could be causing my back pain. I was telling myself – the back trigger injection worked so it MUST be coming from my back at least to some degree right?!

When you look at all the research, literature showcasing how emotions can bring on painful sensations, it is clear that the factors that affect pain are mostly WITHIN our control.

And this is NOT to say that humans who have fibromyalgia are somehow personally responsible. NO! Not at all. All it means is that the pain is the message from the brain that it is not feeling safe.

As soon as I did, and that would have been September 2021, amazing things started happening.

When I did somatic tracking the first time, I actually did not know it was called somatic tracking, or what the purpose was – my former coach told me to just basically “check in” with my body and check for any body sensations or emotions, and bring on a feeling of a warm light filling up my body, as if from the “Source”. It made me feel safe, and really cozy (the point of falling asleep). I do not remember whether it affected my pain at that time so I assume I did not have much pain around the time when I first did (January 2021). The method how this feeling of safety is brought on is different for different people, many people feel this way during a prayer. But the universal message this state of the mind and body it creates is the message of safety for the brain.

The purpose of somatic tracking is to focus on breathing, and ANY physical sensations one has in the body, including pain, and just observe it, without judgement and communicate a message of safety to the brain. Something like this: ”Brain I know what you are doing, I know you are sending this physical sensation of pain to me, and I know my body is ok, my body is healthy, and I want you to know I am safe”. You need to FEEL safe inside, you don’t have to say these things aloud, just to feel it and let the brain know that you know.

I do somatic tracking daily, usually in the morning and at bed time, and also during my midday walk. Especially the midday walk time is special because I take a half an hour off after my morning clinic, I walk outside, and actively bring on relaxation response. It has now happened numerous times that even if I feel any tension in my jaw or my neck or upper back, it goes away during the walk.

When my back pain first came back after disappearing during the meditation, I realized I needed to look “within”, find out what was going on that set my brain on high alert. It has now happened several times that I am able to make my pain go away with meditation and soothing messages, and it comes back. And instead of freaking out, or being annoyed or frustrated, I feel curiosity and start “investigation” of what is happening inside me that causes this “high alert” mode in my brain sending the pain message to me in form of back pain.

My back pain comes on during driving. I just don’t like driving on highways between Cape Cod and Boston. Especially in the evening. I feel like I have to be on high alert. So I slow down. I feel better then. I also should mention that my back pain is less severe now when it comes back than it used to be even just 3 months ago. It is really incredible.

I want to make it clear that I do not like feeling angry, or sad or frustrated. But I am so much better at mastering the awareness of them, which then allows me to respond rather than react to them – which makes me behave more calmly.

I have not mastered the entire range of my emotions and that’s why I think my pain comes back. However, the main message of this last point is that being aware of my emotions and breathing through them/my reactions to my circumstances has been one of the most pivotal parts of my healing journey.

I will dedicate more time to the topic of emotions in the future episodes.

Connect with me via facebook at my fb name martina lenartova or on my website: https://www.martinaziegenbeinmdcoaching.com

Welcome to Episode 7 of the (best ever) Winning at Fibromyalgia Podcast!!!

I am Dr. Martina Ziegenbein, a Rheumatologist and your Fibromyalgia expert and guide, bringing you news and all the things Fibromyalgia.

Timur and I spent some time with good friends in Boston and It was cold! I guess it is time for me to accept Cape Cod gets winter weather!

In the last episode, I talked about the 5 steps of my Winning at Fibromyalgia method. Today, I am talking about how do you know that you are winning, actually?

Your first response might be – well, I have no pain or less pain – and that is nice but it is only PART of having made good progress. What?? Yes, you heard me right. There are other “markers” or signs that tell you that you are succeeding with your efforts in setting yourself free from fibromyalgia forever. Here they are:

Listen my friends, knowledge truly is power. It is not just a saying. Having knowledge is empowering and studies have shown that this fact alone can make some people feel better.

For the sake of rehearsal, I will summarize it here again. Neuroplastic pain is a result of misfiring neuronsthat are mis-interpreting signals from the body as dangerous and are putting the brain at alert mode/danger mode which in turn activates the pain (and other symptoms such as headache, IBS etc). The pain is a message from the brain that it is not feeling safe. Sometimes the reasons are obvious, sometimes less, but understanding that it is the danger signal that sets the pain off gives you a roadmap for investigation and curiousity. The brain has learned pain subconsciously, without you giving permission, and now the pain neurons are “wired”. The great news is that this pain can be RE-WIRED or UNLEARNED. And THAT part, my friends, is the good news and makes all the difference – that the pain can be UNLEARNED and pain pathways REWIRED!

Consistently, every day. Imagine brain is Like a little child that is scared. It needs to be soothed and reassured. You achieve that, as we discussed, with somatic tracking or meditation or relaxation response and sending reassuring messages to the brain. Your brain literally learns how to feel safe and how good it feels to feel safe. It responds. I promise you, it does.

You no longer feel that the pain must consume and dominate your life.  You know you can get better, and you believe you will. The hope changes at some point to having certainty, the feeling of inevitability, that your pain gets better.

I want to share my own breakthrough moment I recently had when I was doing a somatic tracking on myself. My upper back pain, that can be severe and annoying, just simply went away after I recognized the emotion I was feeling (I felt a lot of anxiety about an important meeting I had at work). It was glorious. It came back, but the moment made me realize I can and will get better.

The reason it was glorious is twosome – I felt better/the pain got better (yay)! But perhaps more importantly, I knew I DID it, and that means I can do it AGAIN. I can bring on that feeling myself.

This does not mean that all emotions are pleasant. NOT AT ALL. Quite the opposite. But you are able to RECOGNIZE the emotion now, ALLOW yourself to FEEL it, and then soothe yourself/reassure yourself – by self-compassion or self-love or just by breathing.

I had a beautiful experience yesterday in my office. A patient came in, really upset about her knee pain. It was clear to me there was a lot of anxiety surrounding this pain. I was able to guide the patient through somatic tracking and then have the patient recognize she was feeling anxious, in her chest, and through the calm breathing and reassuring messages she was able to make it go away during our session. We were able to identify what is behind the anxiety (in her case, she lives alone and is concerned about not being able to get help should something happen to her).

When it comes back or gets worse, you are able to say (even aloud): “Oh, ok, brain, I see what you are doing, you are sending me a message again. But it will be ok. It is just pain. I will be ok.

Now I have to say – this one I wish was easier. My back pain keeps coming back during driving – and I think I stress a bit especially on highways when I drive fast. I try to reassure my brain but it does not seem to respond very well.

That’s it for tonight my friends.

Connect with me via facebook or on my website: https://www.martinaziegenbeinmdcoaching.com

In this episode I introduce the 5 core steps of my Winning at Fibromyalgia Method. I have worked hard to distill it to just the main 5 so that it is short and simple. 

Today I am bringing you episode #6! It is so far my longest episode and possibly the most exciting.

I am explaining my “Method” how I approach fibromyalgia in my practice. It incorporates and summarizes things I learned from multiple years of rheumatology practice, attending, and listening to lectures on the topic of fibromyalgia, and attending courses of providers who treat (and often cure) chronic. It is a method I use on myself, as I have a mild to moderate case of myofascial or fibromyalgia pain in my back. I have worked hard to distill it to 5 basic steps and I will be sharing them with you in this episode.

Before I dive in, I want to mention that I do not talk about any medications that are frequently used in patients with fibromyalgia. The reason for this is that in my coaching practice, I do not prescribe medications. They CAN help but are rarely a long term solution on its own. I only rarely see cases when a medication works on its own, without the person doing any extra work. It does happen, but not that often. So I will not spend any time on medications today.

Another comment or disclaimer I need to mention is that The pre-requisite for working with me (whether privately or in my clinical practice) or applying this method on your own is that you do have a confirmed diagnosis of fibromyalgia. Which is best accomplished, IMO, by a rheumatologist. Reason for that is that as rheumatologists, we are uniquely trained to recognize and weed out all different sources of pain. So that’s a really important step “0”, ground 0, so to speak, before you can dive in the deep work of “Winning at fibromyalgia” method we will discuss here.

So, Are you ready? Here it is 

The 5 steps of my unique WINNING AT FIBROMYALGIA method are:

That’s it. 5 steps. Simple.

Let’s dive in each one.

Step #1: Be open to learning the concept of neuroplastic pain.

I have had many patients tell me that just the mere act of explaining the concept of neuroplastic pain literally lit the bulb in their head and they understood for the first time how their emotions are related to the pain. As a brief summary – neuroplastic pain means the pain you feel is REAL but is not caused by the injury or structural damage of tissues that are hurting (whether it be back, or arms or legs or any other body part). It is caused by misfiring neurons. Misbehaving neurons. Neurons that are misinterpreting neutral or safe information from the body as unsafe and translating it into pain. Brain is making a mistake.

WE ALL Know that stressful situations can cause symptoms – e.g. blushing in certain people (including me) when embarrassed, tightness or knots in the stomach when nervous, heart beating fast and sweaty palms – we accept those as normal and physiologic. We also accept that the symptoms described above are brief and resolve on their own.

But many people balk at the idea that physical PAIN ALSO can be a physiological response to stress. As if it was something to be embarrassed about. But guess what? It IS. Research has shown this. Pain in patients with fibromyalgia is facilitated through the SAME MECHANISM – of activating the “flight or fight” response. The difference is that it does not turn off. The neurons connections of pain pathways loops do not turn off, their pain volume is turned up.

Many people talk about pain in FM as just the pain volume control problem. It is volume control problem DUE to chronic stress, unprocessed emotions and all the past hurts dating as far back as our childhoods. Our memories, every single experience of our life is stored in the billions of neurons that compose our brain. Some of them are wired together through similar painful experiences, they created a NEURON SIGNATURE. And that gets activated when the “critical” threshold has been reached.

And as I mentioned many times before, the pain IS REAL, as documented by multiple studies with fMRIs (functional MRIs).

Understanding of neuroplastic pain, where it comes from AND THE FACT THAT IT IS NOT PERMANENT/it does NOT HAVE TO BE permanent, brings about a breath of hope. Because pain pathways CAN BE REWIRED 100 percent. Which brings me to #2 point.

Step #2. Believe you CAN and DESERVE to get better.

This has been arguably the toughest part for me on my own journey. And I have found to be the case with many of my female patients. Believing we CAN AND DESERVE to get better.

We often carry various burdens, sometimes dating way back to our childhoods, that we are not deserving of good things in life, or good health, or whatever good. It has been shocking to me to discover that I myself struggled with it, and MANY other women, including women physicians, have the same issue. At the same time, becoming aware that it might be your problem is a source of hope. Because believing one can get better is written all over the research studies and demonstrated by multiple success stories. Women with pain DO get unburdened from their pain, IT is a fact hence it is ok to believe it is possible for you too.

Believing we are DESERVING is separate from believing in a possibility of getting better. I struggled with this a lot and had a breakthrough in this belief (or rather, dis-belief) after hearing a comment of one of the prominent life coaches in my recent coaching program. It went something like this: “our innate essence, our pure SOUL, is inherently lovable”. The light went off in my brain, and I felt an instant relief.

How to go about this in general? IMO, it helps to identify where the idea of not being deserving comes from. My lack of belief in being deserving came from all the past wrongs I did (usually related to uttering hurtful words to family, or coworkers). I believed all the things I done wrong in my life made me undeserving. Nothing could be further from the truth. We are all humans and we all make mistakes. Hurting other people feelings does not make us undeserving, it means we have some faulty thought processes or beliefs that we need to work on. It makes us human. And forgiveness is available to each of us. If we give ourselves compassion, like we do to other people we love, we are able to see that making mistakes is human, it does not make us undeserving. Eventually my “disbelief” was released when I believed that I can forgive myself for all the past hurtful things I said.  It is a process though, and it does not happen overnight.

Believing is a HUGE step in getting better and I cannot overstate the importance of this. Power of belief has been written about by many authors, Dr. Bruce Lipton and Benson just to mention a couple. There is now scientific evidence that the power of belief can heal. Or harm. Our mind is very powerful and if we believe we can get better we usually do.

Step #3. Deliver messages of safety to the brain!

Another important one! Here belong the somatic tracking, fierce self-compassion and any other technique, of mindfulness or meditation that installs stillness and feeling of safety and calmness. It is also referred to as relaxation response.

We talked about how neuroplastic pain is a result of chronic irritation/activation of the flight or fight system (sympathetic nervous system) of which main hormones are the adrenalin and dopamine and cortisol. The brain needs to be calmed down, and it is achieved by activating the PARASYMPATHETIC nervous system.

We deliver messages of safety by calming our breathing, our thoughts, observing the sensations/pains in our body and telling brain – “it is ok, it is just pain, and we know where it is coming from. I am ok, my body is ok, you are ok, brain, it will be ok”.

I heard a very helpful comparison to what it means to activate a parasympathetic nervous response. The person explaining the process compared it to imagining you need to calm a scared child or scared self when you were little. You would soothe the child with calm voice, hugging and talking in a low voice and giving messages of safety and reassurance that everything will be ok. And our brain is behaving like a scared little child sometimes.

This is where FIERCE Self Compassion comes in also – recognizing all the emotions or difficult situations we are going through and giving ourselves love and compassion like we would to a good friend or someone we love.

When our breathing and heart rate slows down and blood pressure is lowered by eliciting the relaxation response, during somatic tracking or practice of self-compassion, our brain gets the messages of safety and reassurance. The practice of activating the parasympathetic nervous system literally activates the healing response. Chemicals produced by neurons during the relaxation response literally counteract the toxic effects of the chronic stress response. Your body starts healing DURING the practice of mindfulness, self-compassion and somatic tracking.

Step #4. FEEL and PROCESS all of the emotions.

So this is the step that is equally important to all the other steps. I talked a little bit about the importance of addressing emotions in the last podcast. People with chronic pain often have a lot of emotional distress, related to the pain but also to the current and past charged interactions or events in their lives. Often times the emotions were not being able to dealt with for one reason or another so the person suppressed them and just bottled them up.

Unprocessed emotions can manifest in myriad of ways, of which pain is just one. I don’t mean to talk about all the ways unprocessed emotions are detrimental to us. The most common examples are chronic irritability, or eating or drinking as ways of coping with unpleasant or difficult emotions.

I want to zero in on emotions as they pertain to chronic pain. Anger, guilt, resentment, all of them have a role in chronic pain. Mutliple studies have shown that processing and releasing the emotions leads to improvement in pain and overall life quality.

Possible avenues for release include EAET (emotional awareness expression therapy), IFS (internal family systems) and literally ANY THERAPY that allows for processing of the emotions related to current and past pains and hurts.

It can happen whatever way you know that works for you. I have searched many years to discover that IFS (internal family system) method is the best for me. It may be the same for you or something else. We will explore together what are your ways of coping and what would the most suitable step to engage in if you have not discovered your preferred method yet.

The bottom line of this step is to go back to the upsetting event, feeling the things you felt in the moment and REWRITING the story, in your imagination, of how you would have preferred to handle the upsetting event. It is/has been truly transformative for me.

Step #5. Get In touch with your intuition And let it guide you.

Your inner core self, your intuition, is like the all knowing guide that will tell you where you need to go. It is that little voice that you often feel, but many times don’t listen to, that knows what is best for you.

Dr. Lissa Rankin refers to it in her WHMI course as the inner pilot light.

Sometimes we call it gut feeling.

Steve Jobs had the best quote on this. He said: “"Have the courage to follow your heart and intuition. They somehow already know what you truly want to become.”

IN essence, our core self is calm, wise, curious, compassionate, loving, and having a lot of clarity.

Our inner self what is best for us and where it would like for us to go.

If we listen, amazing things happen.

If we don’t listen, interesting things happen. Sometimes we have pain, sometimes we feel uneasy or we can tell something is off.

The reason I mention intuition here is that following our inner wise or core self has implications on how we perceive our lives. If we live out of integrity with our core true beliefs, we often find ourselves feeling frustrated or stuck or irritated or angry or all of the above. And often we can experience pain.

Our inner core self can make us bold things, that sometimes others would judge or disapprove of. I am talking about people pursuing their dreams by changing careers, signing up for a school, or new course, asking for a promotion, asking for a raise, speaking up on behalf of others, becoming an activist. Or it can be ditching an old friendship if it does not feel it is serving us. Following our intuition can have MANY forms and it looks different for each of us.

I suspect we will talk more about this step in some of the future episodes but I considered it important enough to incorporate as one of the 5 core steps of my program.

I do need to mention one other disclaimer here at the end.

I DO NOT consider winning at fibromyalgia being pain free. What?? Yes, you heard me right. I do not believe that in order to live a good full life, free of fibromyalgia burden means being completely pain free. Don’t get me wrong, it IS nice to be pain free but I have found it is NOT required to be pain free in order to feel good. So how do I DEFINE a successful end to my method? For me personally, success means feeling good, healthy, strong, strong enough to do things I need to do and to enjoy life on my terms. Some pain is not a deal breaker – if it does not consume me.

So these are the 5 steps of my method (WINNING AT FIBROMYALGIA).

Shoot me a message if it piqued your interest.

Book a call with me on my website.

I would love to hear from you.

More good stuff to come from me in the future 

https://www.martinaziegenbeinmdcoaching.com

Hello and Welcome everyone to episode #5!

Today I am going to talk about another part of pain reprocessing therapy - Emotional Awareness and Expression therapy

Let me first briefly summarize the main teaching points of prior 4 episodes 

Today I will talk about a psychological therapy referred to as emotional awareness and expression therapy (EAET). It is SOMEWHAT new approach but HAS been studied with SUCCESS in patients with fibromyalgia. Some case studies even suggest it can lead to RESOLUTION or REMISSION of the pain in some people! This is why I am so excited about this technique and have started using it in my practice in selected patients in whom I deemed it safe to proceed.

We already touched upon how the stress and emotions from the stress, can trigger, worsen or maintain our pain. Focus of EAET is the trauma, stress and relationship problems found in many people with chronic pain. Even more precisely, it focuses on thoughts and feelings.

So how does it work? It is done in individual or group sessions, anywhere from 8-12 sessions.

After educating my patients about the role of stress and emotions in their pain, we talk about the traumas or conflicts in their lives that appear to drive their pain. Some patients have told me upon initial discussion that they did not have any repressed emotions or no past trauma. As we start talking more, it turns out they have been through so much emotional pain and charged experiences, but they just did not associate them with their physical pain. We talk about it and I ask them to express emotionsthey have been avoiding or blocking related to the trauma or stressors, especially anger, but also guilt, sadness, love and self-compassion.

Because EAET is rather new, there are few providers who have been trained specifically to deliver it. Many psychologists and other mental health providers have training in trauma-focused therapies and "exposure-based" therapies that help patients overcome their fears.

I am part of the pain reprocessing therapy course led by Dr. Schubiner who is one of the leading minds in the field of chronic pain and utilization of pain reprocessing therapy. He shares with us many successful stories and demonstrations of this techniques in his practice, the success and often immediate improvement is astounding.

A Therapist has patients revisit important conflicts or traumatic experiences that involve other people and helps patients "express the unexpressed" feelings to those people. This can be done with writing exercises but also involves "talking to" an empty chair where the imagined other person sits.

Patients are encouraged to activate and express their emotions fully, using their words, voice tone, and bodily expression (arms, face). Patients are helped to express the full range of avoided emotionsThey usually go through a range of emotions with guilt following anger, then sadness. Then they are guided by a therapist to love and self-compassion. This is all done with just imagining the other person.

Finally, patients are encouraged to plan and role play how they would like to be in real life with people who have been a source of stress or conflict. Such communication depends on the type of relationship and may involve healthy assertiveness and setting boundaries, and often includes being open, vulnerable, and expressing intimacy. Throughout therapy, patients are encouraged to work on emotional awareness, writing exercises, emotional expression, and healthy communication as homework. Successful EAET is typically associated with substantial reductions or even elimination of pain as well as improvements in functioning, mood, and relationships.

EAET and related approaches are associated with greater risk than CBT and other psychological treatments for chronic pain. EAET encourages patients to disclose and emotionally express experiences and feelings that may have been avoided for many years and that often are quite upsetting. It is not uncommon, therefore, for patients to become temporarily more upset (e.g., anxious, depressed, angry) as they start to deal with memories and feelings that have long been avoided. Pain and other physical symptoms sometimes increase temporarily. Because patients are encouraged to communicate and interact differently in their relationships, these relationships might change in ways that are unexpected. Practitioners of EAET believe, however, that such emotional and relationship changes are important to make, and even though they may be difficult in the short run, such changes can be healthy and lead to pain reductions in the longer-term.

EAET may not be appropriate for certain patients, especially those who have difficulties regulating their emotions, who have trouble thinking when they are emotional, or who tend to hurt themselves or others when memories or feelings are activated or intense. This would be all assessed during early sessions and decisions would be made how to best proceed.

That’s it for today’s session.

Please share or leave a review if you found it helpful. I would really appreciate it.

In the next episode, we will start tying all of these individual parts I have spoken about so far, together. A Winning at fibromyalgia approach is slowly emerging 

Until next time 

In this episode I continue to delve into components of pain reprocessing therapy. The basic outline of this process include: 1. confirming the dg of Fibromyalgia, 2. being open to the concept of neuroplastic pain, 3. practice of self-compassion, somatic tracking, and emotional awareness and expression therapy. Today we talk about somatic tracking.

In this episode I give a summary of my approach to fibromyalgia pain. It has 3 main steps and we talk about the first two and one substep of the 3rd step :-)

Hello there!

Welcome to Winning at Fibromyalgia Podcast

Episode #3: What can be done about fibromyalgia pain?

I am Dr. Martina Ziegenbein, the executive producer of the podcast. I am so excited to be here today.

In the first two episodes, I talked about what is fibromyalgia pain – that it is neuroplastic type of pain which comes from misfiring neurons of the brain pain centers and pain pathways.

IN the second podcast How does the fibro pain come to be, I explained that it is believed that certain emotions, including past traumatic events, current or past stress all increase cortisol levels in our system which sends danger signals in the brain and that CAN PRODUCE PAIN in the body!

I also stressed several times that the PAIN of FIBROMYALGIA IS REAL. You feel it is real. The reason it has gotten a lot of negative “press” in the past is that women were felt to be making the pain up or that the pain was “in their heads”.

The pain is REAL but it is caused by the brain. It is NOT a product of their imagination!

Today, I will summarize my framework of approaching this problem.

As a way of disclaimer and disclosure, I would like to mention my resources and where I go for information. I am a board certified Rheumatologist and my basic and first understanding of fibromyalgia was from reading all kinds of articles, resources and attending numerous lectures on fibromyalgia organized by ACR (American college of rheumatology).

In that regard, I follow work and available resources from the team of Dr. Daniel Clauw at University of Michigan who has been leading Fibromyalgia research for decades. His is the group that was among first to CONFIRM with fMRIs that the pain was real.

I also recently became acquainted with work of Dr. Alan Gordon whose book Way out talks about all kinds of research related to brain pain/neuroplastic pain and what to do about it. I will talk about his PAIN REPROCESSING SYSTEM In the coming episodes.

I integrate ALL of this information when I work with patients and am currently putting a course together for women in an online format.

So, in summary, there are only THREE BASIC steps that one has to follow in order to get started on the journey of improvement from fibromyalgia pain. They are:

Let me elaborate on the first two.

It is of crucial importance to have the diagnosis confirmed by a Rheumatologist. This is not just to plug for myself or my profession. I truly believe, and there is data to support this, that Rheumatologists are uniquely trained and positioned to diagnose the condition. Why you ask?

We are trained to look for clues on your history (meaning what you tell us, what your symptoms are) and your exam, that may point to the diagnosis of an inflammatory or autoimmune process. Fibromyalgia symptoms MAY LOOK LIKE inflammatory symptoms of someone with RA or other inflammatory condition. We, the rheumatologists are the ones who help you distinguish that.

The reason it is important is that RA, Lupus and other inflammatory conditions get treated with medications that suppress immune system and decrease inflammation. Fibromyalgia does not get treated with these meds. So it is of crucial importance to distinguish.

Generally speaking, once we are confident in our diagnosis, we don’t usually follow fibromyalgia patients longitudinally in our practice. I do so because I specialize in helping women with fibromyalgia. General rheumatologists specialize in seeing patients with inflammatory conditions. There is no harm, in my opinion, to check in with rheumatologists every 3-5 years, or if there are any new symptoms that worry you or your primary care physician.

For the first visit, we generally want to see, or check ourselves, several labs including blood counts, liver, kidney, inflammation, muscle test and thyroid. Sometimes we check vitamin D level. IF these are all normal and exam is normal, we don’t usually look further. In some instances, if the labs are normal but the exam is not completely normal we look further. That is why you want to see us first.

So I hope I helped explain this topic 

I usually just start by asking my patients to being OPEN to the idea of neuroplastic pain. They don’t have to believe it or accept it right away. Because you can start taking steps to feeling better even without believing it fully.

But it IS important to start being OPEN to the idea of neuroplastic pain. Acceptance changes something in our brain that allows learning and new information to settle in.

I would like to touch upon the practice of Self compassion and mindfulness daily today.

I have to dislose something here. Up until today, this item only included practicing mindfulness. And as serendipity would have it, I had the privilege of listening to Dr. Kristin Neff speak earlier today. Dr. Neff is the leading researcher on compassion, self-compassion and its effects on mental health. I am part of the Empowering Women Physician coaching program and she was a guest speaker today. It was truly transformational for me to hear her confirm what I have suspected for so long. Mindfulness is important and is actually part of having and practicing self-compassion for ourselves.

So what does it mean, you might ask, to practice selfcompassion? It means CARING about the pain and suffering of others and YOUR OWN.

I mentioned in the earlier episode that stress activates our “flight or fight” response. That sends danger signals to our primitive brain and increases cortisol levels in our body. Increased cortisol levels can directly lead to pain through increasing tension in the back muscles (and other muscles in the body) or just increasing sensitivity of the neurons to pain signals.

Practicing self compassion lowers blood pressure, heart rate and INCREASES levels of oxytocin in our body. Oxytocin is the “feel good” hormone that is released when the mothers first bond with their newborns, or anytime we have somebody touch us with care and kindness.

A practice of selfcompassion does not have to be complicated. It has three main components (kindness, awareness and the sense of common humanity) and literally means the following steps:

Selfcompassion is not sugarcoating things. It is also NOT letting yourself off the hook. It is OPENING YOURSELF TO PAIN WITH KINDNESS. If you made a mistake, and you feel guilt, with kindness you can commit to doing your best not making the same mistake again. Rather than feeling shame you feel resolved not to make the mistake again.

When your brain gets kindness in response to frustration, anger, anxiety, something changes in the way you are able to deal with stress and pain. Your chemistry changes.

Everyone has THEIR OWN flavor of suffering. I have rheumatoid arthritis and some chronic aching in my back, other person has back pain, and yet another person has history of significant trauma. Everyone has some flavor of pain and the amount is different and the way it manifests is different.  THE HUMAN EXPERIENCE is about CHALLENGES. That’s what it means to be HUMAN. There is not a single person alive who does not have some pain or difficulty.

When we remember that truth, what happens is that instead of feeling all alone in our suffering and isolated in our struggles, we feel more connected to other people. The sense of CONNECTEDNESS gives us a sense of strength and coping and feeling we can handle this because this is a human condition.

So the main three components of self compassion are mindfulness/awareness of our pain, kind warm response to the pain and remembering that everyone has struggles.

I am going to leave you with that thought.

If you like this or found it helpful, please leave a comment or review. You can find me at Fb as Martina lenartova. Or on my website at: https://www.winningatfibromyalgia.com.

I look forward to chatting with you in the next session.

Hello there my friends and fibromyalgia warriors! I mean warriors in the most loving way.

Welcome to episode #2 of my podcast Winning at Fibromyalgia. I am Dr. Martina Ziegenbein, a rheumatologist and an executive producer of the podcast  Today’s episode title is: How does fibromyalgia pain come about?

One of my girlfriends just emailed me asking about the follow up episode to the first one. Thank you Sandi, I am a few hours behind on recording  I was told in the past I sometimes talk too fast and I am a little self-conscious about not being a native speaker. So I think about the BEST or OPTIMAL way to express myself and it may have caused a little paralysis  But here I go.

In the first episode last week, I explained the difference between acute and chronic pain, with the biggest contrast being that the former comes from the neurons in the injured tissues and the latter, also referred to as NEUROPLASTIC pain, comes from misfiring neurons in the brain. BOTH pains are processed in and by the brain, however. In the case of neuroplastic pain, brain changes in a way that reinforces chronic pain. The neurons in the brain are misinterpreting safe (or neutral) signals from the body as if they were dangerous.

BOTH PAINS feel the same AND ARE REAL. I feel It is important to stress this again. The PAIN of fibromyalgia, and any chronic pain for that matter, IS REAL. However, based on our current knowledge, there is no damage to the tissues that are hurting in patients with fibromyalgia. So what is going on?

I will give you short answer and then explain it: stress, emotions and especially fear.

It is common knowledge that stress can cause physical reactions. My face turns red when I am embarrassed. That’s because my emotions cause the autonomic nervous system to increase blood flow to the face. For somebody else it can be sweaty palms when they are nervous or upset stomach. These are not signs of disease, just normal physical reactions to stressful events and the mechanisms of BODY MIND SYNDROME. Stress causes emotions that cause our bodies to react by producing physical symptoms. The symptoms are real.

What is not common knowledge is that stress and emotions can create the neural pathways that can cause chronic and often severe physical symptoms. The cure for such chronic pain or other symptoms is not a drug but rather to identify and treat the underlying cause of the pain.   For most people, the underlying cause is that the emotional reactions to stress trigger neural circuits that create physical pain.

During times of stress, the emotion-based network sends signals to active the autonomous nervous system (ANS) and produce hormones of cortisol and adrenalin which turn on the “fight or flight” reaction. That’s a system that directs blood flow to muscles to get our body ready to run or do battle, and it causes our bodies to react instantly before we are aware of what is going on. We have this system to protect us from danger and improve our chances of survival. When we see a squiggly thing that looks like snake on the ground as we walk in the woods, we jump back, we don’t investigate what it might be.

The autonomic nerve system controls the nerve fibers that affects every area of our body. Studies have shown that emotions such as anxiety or anger cause increased tension in the back muscles of people with chronic back pain. This muscle tension, which can occur WITHOUT our conscious awareness, can cause severe and real physical pain. Often we are not aware of the emotions that are triggering these automatic physical responses.

The autonomous nervous system can produce a large variety of physical symptoms in humans in response to stress and emotions. They include: tingling, numbness, burning sensation, dizziness, tinnitus, anxiety, abdominal pain, heartburn, diarrhea, constipation, pain, itching…you get the idea, the list goes on.

The brain has complex mechanisms to handle pain that involves many structures. One part of this mechanism is anterior cingulate cortex (ACC). Emotional responses increase activity in this area, causing pain to be amplified. MRI studies show that when ACC is activated the pain is generally increased.

Emotional experiences in childhood are imprinted in the brain. Human infants are exposed to repeat blood drawing within the first few weeks of life have increased pain when they have medical procedures several months later. Adults who are exposed to traumatic events in childhood such as emotional, physical or sexual abuse have a much higher chance of developing chronic pain.

Chronic stress produces increased sensitivity to pain in the brain, the spinal cord, and the nerves. Certain cytokines are released during the times of stress, and these cytokines cause cells and nerve endings to be more sensitive to pain.

At least one study showed that adults with chronically elevated cortisol levels are more likely to develop pain. This further cemented the relationship between chronic stress and chronic pain.

Our brains have trouble dealing with chronic stresses of modern life. When stress becomes chronic and we feel trapped in situations for which there is no easy way out, we can easily develop a set of neural circuits that are painful.

Many patients I have worked with started experiencing pain shortly after or during a stressful situation in their lives. Big life changes, positive OR negative, can generate feelings of stress. With many of my other patients, it Is their past experience of exposure to physical or emotional or sexual abuse, that predisposed them to chronic pain. Certain behaviors, such as worrying, self-criticism and putting pressure on ourselves can also set up stage for chronic pain by putting our nervous system in the state of high alert (or chronic flight or fight reaction).

So how does an acute injury evolve into chronic pain in the setting of stress?

It can be a sprain, fracture or strain. Most injuries heal within several weeks. After that, if the pain does not go away, something else is usually going on. Many times, patients feel that the injury never healed or that there are “misalignments” that continue to cause pain. This is not really supported by research. Even if there is a scar tissue, scar tissue does not cause pain. The injury triggered a series of events that lead to the vicious CYCLE of pain.

In the setting of stressful life circumstances occurring around the same time as the injury, NERVES that carry danger signals from the site of injury to the brain are activated for prolonged time. They become SENSITIZED, meaning they are more likely to fire and send more danger signals with lesser amounts of tissue activations.

These small nerves learn to react to even very minor changes, such as tense muscles, which are EASILY triggered by an overly active ANS (autonomous nervous system) and ACC (anterior cingulate complex) – part of the brain that is closely connected to emotions.

These tiny nerves eventually start affecting the brain, through communications to the brain with other neurons. The areas of painful sensation in the brain also become sensitized. They continue to experience pain. Bam, this is where the scientists used the term of neuroplasticity (or brain reorganization= the brain ability to create NEW pain pathways).

The term BODY MIND SYNDROME (TMS) is used to express the connection between the reactions/symptoms in the body and the brain. One of the best examples of Mind Body syndrome is Phantom limb syndrome – people who had their limbs amputated continue to feel pain in an extremity that is no longer attached/present. That’s because brain re-organization and nerve sensitization happened.

Going one step further, a group of researchers tried to determine whether the brain could actually CREATE Pain. It is described in books by Dr. Alan Gordon in his new book WAY OUT and Dr. Schubiner’s book unlearn your pain: A study at University of Pittsburgh looked into hypnosis and pain. Researchers placed subjects in an fMRI machine and administered pain with a hot probe. The pain regions of the participants’ brains lit up. Then the scientists took the same subjects and HYPNOTIZED them, and induced pain through suggestion. The exact areas of their brains lit up on fMRIs. WHETHER THE PAIN WAS INDUCED PHYSICALLY OR THROUGH HYPNOSIS, THE SENSATION WAS THE SAME, as far as the brain was concerned.

This was the first evidence that the brain can CREATE PAIN that is indistinguishable from pain caused by stimulation of nerves in tissues! Real pain can be caused by either physical disease states OR by neuroplastic processes that create learned neural circuits. The fact is that ALL pain is experienced in the brain. We cannot have pain without activation of the pain pathways in the brain.

The pain is NOT in the HEAD, it IS IN THE BRAIN!

This concludes our second episode. If you liked it please share with friends or write a review. If you are interested to learn more, or have feedback please head on to my website martinaziegenbeinmdcoaching.com and click on “contact”.

I look forward to speaking with you next week again! 

In this first episode, I explain the difference between acute and chronic pain, or in in other words between the "regular" pain and "neuroplastic" or "brain" pain. The pain is always real, but it differs of where it comes from.

Hello there!

I am super excited to introduce you to my first Podcast ever called Winning At Fibromyalgia!

 Episode #1: Where does the pain of fibromyalgia come from?

 My name is Dr. Martina Ziegenbein, I am a board-certified Rheumatologist. For those of you who are wondering and do not know, Rheumatology is a field of Medicine that deals with all kinds of arthritis but also autoimmune conditions like lupus, vasculitis, myositis.

 It is October 15th 2021 at the time of the recording. The reason I am excited about this podcast, is because I believe a solution for women with pain from ibromyalgia IS available! And I want to share it with every woman who suffers with fibro. But first let me explain a little bit.

 Fibromyalgia is NOT considered an inflammatory condition at the time of the recording. It has many definitions in literature. It can be most simply described as “pain all over” that is often accompanied by slew of other symptoms including, but not limited to: brain fog, overwhelming fatigue, irritability, inability to concentrate, headaches, jaw or TMJ pain, IBS, vaginal or bladder pain (sometimes also referred to as interstitial cystitis). Many times patients with fibromyalgia also describe weird tingling or burning sensations in their hands or feet. Fatigue and pain are the most overwhelming symptoms and literally rule the life and make it miserable for many women who are unfortunate to suffer from it. Women are more often affected than men, and in summary, no one is really sure what is causing it. Genetic reasons, prior trauma (whether physical, emotional, or psychological) are all suspected causes. At the time of this recording, autoimmune origin was raised as a possibility in one recent research study but for the purposes of this podcast and discussion about fibromyalgia in general, the origin of the fibromyalgia pain is not believed to be autoimmune.

 Rheumatologists usually see a patient with fibromyalgia for the initial consultation, to confirm the diagnosis and then generally the patient is returned to the primary care doctor with recommendations on what to implement in treatment plan.

 I have been fascinated by fibromyalgia for a long time. I have been avoiding following these women regularly in my clinic initially, to give you a full disclosure. Reasons were several but mostly – the solution to pain felt too elusive and out of reach. Many times no matter what I tried for these patients, the pain would not remit or not remit consistently. Plus, I was reasoning, patients with Rheumatoid arthritis, psoriatic arthritis, gout and all the other diagnoses that also cause pain and suffering needed me more.

 This has changed recently. I moved from Wi to Cape Cod in March 2021. I have been re-evaluating my career and I realized that I truly, really, want to steer toward helping women with fibromyalgia. I studied more materials, immersed myself in all things fibromyalgia and I am happy to report that I think solution IS AVAILABLE. Which is the reason for my excitement to start this podcast and share with all the women with fibro 

 So the rest of this first episode is focused on the origins of the pain. What is causing the pain? First of all – PAIN IS REAL. In the past, many women felt not believed or dismissed because the pain was referred to as “psychosomatic” which for some reason meant that it was not real. Let me tell you – the pain IS REAL. You feel the pain, it hurts – the pain is real. However, the pain is not believed to be coming from the injured tissue or body – but rather from the brain or central nervous system! Let me explain.

 When we sprain our ankle or burn our hand on the stove – the pain is referred to as acute. The pain recetors in the tissues that are injured communicate the information through neurons into spinal cord and from spinal cord the information goes into the brain. Brain tells us to stop doing whatever we were doing that injured us. We limp for a while, we have a burn on our hand, we heal and the pain resolves. I will refer to that pain as “plain” pain or “regular” pain. There is nothing exciting about it. It is a survival mechanism and was meant to alert us to danger. So far so good? Acute pain = plain or regular pain

 Fibromyalgia pain on the other hand, is chronic, happening on daily basis and fluctuating in severity. It is a juicy and very exciting topic. There is nothing regular about it. Through rigorous and extensive research studying functional MRIs of the brain of patients with pain, it was discovered without any doubt that the chronic pain of fibromyalgia is basically a conglomerate of misfiring neurons. It is a mistake of the brain who is mis-interpreting regular signals from the body as “danger”. I just mentioned above that brain interprets pain as danger and that it is a survival mechanism. We are wired to interpret pain as danger. Danger is meant to put us on high alert. High alert means augmentation of our senses which can lead to (or even create) more pain. More pain leads in turn to more danger signals – which leads to more high alert messages to the brain which leads to more pain. It is referred to as NEUROPLASTIC or BRAIN PAIN. Chronic pain – neuroplastic pain. That means the fibromyalgia pain is brain pain, it comes from the pain.

 I feel it is important to stress again that the pain IS REAL. There is nothing imaginary about the pain. But the origin of the pain is basically brain centers that are full of misfiring neurons that are dealing with faulty information.

 As a side note, there are cases when chronic pain is NOT neuroplastic, for example patients with cancer or patients with severe damage to tissues that cannot heal – these patients have chronic pain that is not neuroplastic. OR they have a combination of acute and neuroplastic pain.

 One other way (though not a perfect way) to distinguish between acute and chronic pain is response of the patients to usual medical interventions or surgeries. Acute pain tends to respond well to meds. Chronic neuroplastic pain usually does not.

 The most exciting feature of the chronic pain is that it CAN Be made better. Our brains are adaptable. Neuroplasticity means that the brain pain pathways that are misfiring, CAN be rewired. And that Is why I am excited to start bringing this knowledge to all the women with fibromyalgia who have not been able yet to improve their pain consistently. It can be done and I will show you how.

So in summary, in this episode we covered the difference between acute or plan/regular pain and chronic pain of fibromyalgia that is also referred to as “neuroplastic pain” or brain pain. Stay tuned for next episode where I discuss how it comes to be. 