“Within you, there is a stillness and a sanctuary to which you can retreat at any time and be yourself.”
Chronic widespread pain (CWP), which includes the conditions of fibromyalgia (FMS) and central sensitisation, is one of the most difficult pain conditions to treat due. In any one individual a specific cause can rarely be identified. Individual specific, effective therapies remail elusive.
CWP is a multifactorial pain condition characterized by prolonged pain that lasts for 3 months or more in multiple regions of the body.
It is often associated with significant psychophysiological distress in the form of anxiety, anger, frustration, depression, insomnia, and social isolation.
CWP is very common. One in every ten adults with this disorder and the societal cost is more than that of cancer and diabetes combined.
Health practitioners have difficulty recognising CWP and FMS as a valid diagnosis as the assessment of chronic pain does not rely on the traditional signs and symptoms of acute pain. It is a disorder of pain pathways which cannot be objectively seen or measured.
Research studies confirm through brain imaging and other techniques, that chronic pain (which persists long after the physical injury that originally caused the pain has healed), is a type of neurological learned behaviour that can be “unlearned” through a variety of non-medical interventions.
The brains of individuals with chronic pain can develop abnormal neurological networks and connections which can be embedded when individuals repeatedly focus attention on pain and/or anticipation of pain. This unwanted rewiring of networks is called a “learned response”.
In addition, stress and anxiety about all aspects of living with CWP can enhance the experience of pain by altering the balance of brain hormones (neurotransmitters) such as norepinephrine and serotonin. These neurotransmitters modify the experience of pain. When the emotional reaction to pain is one of stress or anxiety, the experience of the pain intensifies.
Treatment
None of the most-used pharmacological, psychological, medical, or surgical treatments are reliably able to remove the experience of pain or to significantly enhance physical and emotional functioning. These therapies can have, as a downside, the potential to create unwanted effects.
Non-pharmacological treatments that involve the active participation of patients, such as exercise and mind- body techniques, have been shown to be more effective than treatments which only involve passive physical measures (i.e. massage, medications, injections and operations).
The most effective treatments for CWP combine evidence from the fields of psychology and neuroscience. Research in these areas demonstrate that it is possible for individuals with CWP to learn to avoid focusing on their pain and memories of the injury that originally caused the pain.
In separating the thoughts and memories from the experience of pain the learned pain response can be extinguished.
Extinction of pain
In order to accomplish extinction of the unwanted learned pain response it is helpful to be guided in how to control pain-provoking thoughts and anxiety associated with pain. This re-conditioning can significantly reduce suffering and enhance function. Research confirms that this re-conditioning occurs in parallel with changes in the structure and function of the brain’s neural networks.
Techniques to unlearn pain
The practice of mindful breathing coupled with specific mindfulness/ meditation exercises creates a different relationship with the experience of chronic pain. From one in which pain is feared into one where the sensations can be observed without an adverse reaction. This is the process of unlearning pain.
Mindful breathing
Individuals diagnosed with FMS have been shown to have a respiration rate of around 12-14 breaths/min. Pain can cause faulty respiration such as hyperventilation and breath-holding and this effect is mediated by the autonomic nervous system. A measure of this is called heart rate variability ( HRV). Those with pain have lower HRV measurements.
Diaphragmatic breathing (DP) at a controlled rate of between 4.5 to 7 breaths per minute ( resonant breathing) stimulates the vagus nerve as measured by an increase in HRV.
DP plus mindfulness exercises can reduce pain in those with CWP. It has been shown that fibromyalgia patients who breathe at half their normal rate are able to decrease pain and depressive symptoms more than when they are breathing normally. Breathwork provides individuals with a self-managed way to modulate pain and suffering.
Summary
CWP occurs when the structure of the brain neural networks change in response to the mind-body impacts of persisting pain.
This unwanted learned response can be unlearned.
Using breathwork and mindfulness combined can rewire the brain to reduce pain.
Learning these techniques of mindfulness and resonance breathing as a treatment for chronic widespread pain is a skill.
If you would like to learn and practise these techniques The More Than Meditation course is directed at teaching these skills in a supportive environment.
