Potsdam Fibromyalgia Support group Newsletter May, 2005 Pain in the Media Pain is now considered the ‘5 vital sign’ – vital information to track and treat. This is also the ‘Decade of Pain.’ It is not surprising, therefore, that pain has been in the media a lot recently, making the cover of Time Magazine this Spring and motivating a whole week-long series in USA Today and on ABC News (http://usatoday.com/news/health/painseries.htm). The word ‘pain’ derives from the name of the Greek goddess of revenge: Poine. According to Greek mythology, Poine was sent to punish mortals who had angered the gods. Many people still feel that pain must be a punishment for something – but pain is seldom ‘just.’ Acute pain is usually a warning of real or potential tissue damage. It is a protective reaction to get us to avoid situations that are dangerous. Acute pain is usually localized and proportional to the amount of tissue damage. Most causes of acute pain can be identified and addressed. Chronic pain is more than just pain that has lasted for a long time – the physiology of chronic pain is actually different than for acute pain. There are different neural processes at work when people experience chronic pain. Although chronic pain is often initiated by the same kind of tissue damage as acute pain is, eventually the pain is no longer linked to actual tissue damage. As a result, it is not always possible to find a current ‘cause’ for chronic pain. Therefore, there is not always a ‘diagnosis’ or ‘cure’ for chronic pain like there is for acute pain. The potential lack of relationship between tissue damage and chronic pain is key to managing chronic pain effectively. One things occurring in chronic pain is the body’s ‘memory’ of pain. An activity, image, or thought can therefore trigger ‘remembered’ pain just as a memory of a fearful experience can make your heart race and your hands sweat. Just as remembered fear causes real changes in your heart rate, remembered pain causes a real experience of pain – your nerves and brain act as though you are really experiencing the same painful event. th Although remembered pain is not ‘all in your head,’ you can train your body to respond differently to pain memories, just as you can train your body not to react with fear to fear memories. Another aspect of chronic pain is that the mind and body are not two separate entities. Your brain and nervous system are made up of neurons. The question of whether ‘thought’ is more than just the sum of nerve impulses may be metaphysical – that is, beyond what we can prove in the physical world. Nonetheless, there is no doubt that physical experiences affect thoughts. There is also no doubt that thoughts affect physical experience – remember the racing heart during fear, or the sick stomach during anxiety, or the flushed face when you are embarrassed. There are many examples of how your thoughts and feelings affect physical experience. The relationship between mind and body is particularly important in chronic pain. Stress, anxiety, depression and fear actually increase the body’s transmission of pain information. This is not imagined pain, but real pain based on physiological changes in the body. Another important aspect of pain is that when pain is interpreted in negative ways, it becomes ‘suffering.’ You are probably familiar with the muscle ache experienced after vigorous exercise. But this ache probably did not cause suffering – it may have had the opposite effect of making you feel good about your athletic accomplishment. Even now, you may experience pain when someone massages a tight muscle – but recognize this as ‘good’ pain indicating you will feel better later. These are two examples of pain that does not cause suffering. The difference is sometimes how you interpret the pain: is it good, bad, or neutral? Since negative emotions can aggravate pain, decreasing negative emotions can also change the pain experience. Stress management and thought restructuring are therefore important in pain management. Most of us have experienced a time when we did something pleasurable and stopped thinking about our pain. As a result, it is important to do activities that you enjoy rather than sit and think about your pain. It is also why you should think about things you can do (positive thoughts) rather than thinking about things you cannot do (negative thoughts). Pain is not ‘all in your mind’. But how you think affects both your perception and your interpretation of pain. So, rather than let pain constantly drag you down, turn this to your advantage. Try the following suggestions: Make a list of things that make you happy and refer to that list when you need a lift. Make a list of activities you enjoy and can do; make sure you do a few things from this list every day. Remember the positive aspects of activities that might increase your pain rather than focusing on the pain; for example, think about how amazing your grandchildren are, or the beautiful flowers you see on your daily walk. Play music and sing songs that make you cheerful. Call or visit a friend and talk about upbeat things. Smile; the act of smiling raises endorphin levels and can decrease pain. Resources for more information about pain: The American Chronic Pain Association at www.theacpa.org/. The American Pain Foundation at www.painfoundation.org. The National Pain Foundation at www.nationalpainfoundation.org May Potsdam Meeting: The May 26th Potsdam meeting topic will be “What is pain? A presentation describing the physiological and emotional components of pain." The presentation will describe how pain perception is altered in FMS, as well as how various treatment options impact pain. The meeting is at 6:30 at 59 Main St, in Clarkson Hall. June Massena Meeting: The Massena Fibromyalgia Support Group’s June 14th meeting will be “What Can You Do About Stress and Anxiety?” The meeting is at 6:30 at Massena Memorial Hospital. For more info, contact facilitator Maxine Dodge, at 769-5778 or [email protected] Sleep We all know that sleep has a big impact on FMS: it causes fatigue, trouble concentrating, and muscle pain. How much do you know about sleep? There are 5 phases of sleep: Stage 1 – Drowsiness, where we drift in and out of sleep and can wake easily. We may have muscle contractions. Stage 2 – Light sleep, where eye movement stops and brain waives slow. Stage 3 – Deep sleep, and Stage 4 – Slow-wave deep sleep where extremely slow brainwaves appear and it becomes very difficult to wake. Rapid eye movement, or REM sleep, where breathing becomes rapid, irregular and shallow, heart rate increases and muscles become temporarily paralyzed. You dream during REM. It takes about 1½ hours to go through all the cycles of sleep. At the beginning of the night we spend more time in deep sleep and later in the night we spend more time in REM and stages 1 & 2. People with FMS have particular trouble with Stage 4 sleep, which is when growth hormone is released, resulting in less growth hormone to stimulate body healing processes. The above information is from Medline Plus at: http://www.nlm.nih.gov/medlineplus/tutorials/sleep disorders/nr249101.pdf. They also have a tutorial on sleep disorders at: www.nlm.nih.gov/medlineplus/tutorials/sleepdisord ers/htm/index.htm. You can test your knowledge about sleep by doing a quiz at: www.nhlbi.nih.gov/cgi-bin/tfSleepQuiz.pl The National Sleep Foundation also has information, including self-assessment questionnaires and quizzes of your knowledge about sleep at: www.sleepfoundation.org/ This newsletter is a joint effort of Clarkson University and Canton-Potsdam Hospital. If you would prefer to receive these newsletters electronically, please send your email address to [email protected] You can access current and previous Potsdam Fibromyalgia Support Group Newsletters on our web site: www.people.clarkson.edu/~lnrussek/FMSG.