Breathing and Mindfulness in Fibromyalgia
Breathing, Mindfulness in Fibromyalgia – Retraining your breath and brain without Drugs
Did you know, you can retrain your breath, make your brain healthier and defeat fibromyalgia naturally?
What is Fibromyalgia?
Fibromyalgia affects muscles and soft tissues. Fibromyalgia is a disorder of unknown cause, characterized by widespread pain, abnormal pain processing, sleep disturbances, fatigue and often psychological distress. People with fibromyalgia may also have other symptoms, such as morning stiffness, tingling or numbness in hands and feet, headaches, including migraines, irritable bowel syndrome, sleep disturbances, cognitive problems with thinking and memory or “fibro fog”, problems with thinking and memory, painful menstrual periods and other pain syndromes
It is not a true a form of arthritis, though fibromyalgia is considered an arthritis-related and rheumatic condition. However, fibromyalgia can cause significant pain and fatigue, and it can interfere with a person’s ability to carry on daily activities. Fibromyalgia is prevalent in about 2 – 4% of population. Between 80 and 90 percent of fibromyalgia patients are females, but men and children may also be affected. Most people are diagnosed during middle age and prevalence increases with age. Fibromyalgia has been associated with lower levels of health-related quality-of-life and work-productivity loss.
People with certain rheumatic diseases, such as rheumatoid arthritis, systemic lupus erythematosus (commonly called lupus), or ankylosing spondylitis (spinal arthritis) may be more likely to have fibromyalgia, too. Average yearly direct medical costs/person range from $3400 to $3600. Total annual costs per person is $5,945.
Causes and/or risk factors for fibromyalgia are unknown, but some factors are loosely associated with disease onset: stressful or traumatic events, such as car accidents, post-traumatic stress disorder (PTSD), repetitive injuries, illness (e.g. viral infections), certain diseases (i.e., SLE, RA, chronic fatigue syndrome), genetic predisposition, obesity etc.
Problem is with the perception of pain stimuli. People with fibromyalgia react strongly (abnormal pain perception processing) to things that other people would not find painful. Researchers believe repeated nerve stimulation causes the brains of people with fibromyalgia to change. This change involves an abnormal increase in levels of certain chemicals in the brain that signal pain (neurotransmitters). Two neurotransmitter chemicals– glutamate and substance P, which increase the transmission of pain signals, are high in people with fibromyalgia. Serotonin, nor-epinephrine, and GABA (gamma-aminobutyric acid), which decrease pain transmission, are low in people with this condition. Brain imaging studies show that when patients with fibromyalgia are given a mild pressure or heat stimulus, the pain-processing areas of their brains light up. In people without fibromyalgia, they don’t. In addition, the brain’s pain receptors tend to develop a memory of the pain and become more sensitive, meaning they can overreact to pain signals.
New findings suggest that people with fibromyalgia have abnormalities in the peripheral nervous system, but even proponents of peripheral involvement now agree that the central nervous system plays an important role.
One may have two or more coexisting chronic conditions. Such conditions can include chronic fatigue syndrome, fibromyalgia, inflammatory bowel disease, endometriosis, interstitial cystitis, temporomandibular joint dysfunction, vulvodynia etc. Whether or not they share a common etiology, is not known.
Diagnosing fibromyalgia can be tough. Standard laboratory tests fail to reveal a physiologic reason for pain. American College of Rheumatology guidelines suggest certain criteria: a history of widespread pain lasting more than 3 months, and other general physical symptoms including fatigue, waking unrefreshed, and cognitive (memory or thought) problems. Moreover, doctors often check for certain tender points on the body.
Common symptoms of fibromyalgia, also known as fibromyalgia syndrome or FMS, may include:
- Concentration and memory problems
- Irritable bowel syndrome
- Morning stiffness
- Painful menstrual cramps
- Sleep problems
- Numbness, and tingling in hands, arms, feet, and legs
- Tender points
- Urinary symptoms, such as pain or frequency etc.
Some more common symptoms of fibromyalgia are:
Muscle Aches: Many people complain of a deep, aching muscle pain that cannot be massaged or stretched out. It can feel like you’ve pulled a muscle, but it could also be a burning or aching sensation. Muscle aches can act up on some days more than others.
Headaches: About half of all fibromyalgia sufferers also suffer from chronic headaches or migraines. A chemical imbalance in the brain may be to blame. Headaches can come on suddenly, and may be triggered by other muscle pain.
Tender Points: Experts have located 18 specific tender points on the body that are triggered by fibromyalgia. These are found at the back of the head, between the shoulders, front of the neck, top of the chest, elbows, tops of the hips, and inside of the knees. There are 18 points (9 pairs) which can be painful when pressed, and may spread pain to other body parts.
Fatigue: Chronic, daily, debilitating fatigue is present. The muscle pain and joint stiffness can make it difficult to sleep, and conditions like restless leg syndrome and sleep apnea have been known to occur alongside fibromyalgia. A sleepless night leads to a lethargic day, and a lack of sleep can even make you more sensitive to pain.
Sleep Disturbances: Insomnia, difficulty falling asleep, and frequent waking during the night are common side effects. Not surprisingly, this fibromyalgia insomnia feeds the fatigue, and can further impair concentration and memory.
‘Brain Fog’ or ‘Fibro fog’: Fibromyalgia patients may also find that certain physical symptoms can lead to other pains or even mental distress. For example, physical pain can have a big effect on ability to think clearly and solve problems – a cognitive problem commonly known as “fibro fog.”
Conventionally, multidisciplinary treatment is recommended, including screening and treatment for depression. Scientific evidence for effective therapies includes pharmacotherapy, aerobic exercise and muscle strengthening exercise, education about disease process, relaxation therapy in a primary care setting, cognitive behavioral therapy etc.
It is important to find a doctor who is familiar with fibromyalgia. Fibromyalgia treatment often requires a team approach, with your doctor, a physical therapist, possibly other health professionals, and most importantly, yourself, all playing an active role. Yoga Therapy or Therapeutic Yoga has a big role to play.
Medications can help reduce the pain of fibromyalgia and improve sleep. Common choices include:
Pain relievers: Over-the-counter NSAID pain relievers such as acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve, others) may help; prescription pain relievers such as tramadol (Ultram, Conzip) may be required. Narcotics are not advised, because they can lead to dependence and may even worsen the pain over time.
Antidepressants: Duloxetine (Cymbalta) and milnacipran (Savella) may help ease the pain and fatigue associated with fibromyalgia. Amitriptyline or fluoxetine (Prozac) may also be prescribed to help promote sleep.
Anti-seizure drugs: Anti-epileptics are often useful in reducing certain types of pain. Gabapentin (Neurontin, Gralise) is sometimes helpful in reducing fibromyalgia symptoms, while pregabalin (Lyrica) was the first drug approved by FDA to treat fibromyalgia.
Talking with a counselor can help strengthen your belief in your abilities and teach you strategies for dealing with stressful situations.
Lifestyle and Home Remedies
Self-care is critical in the management of fibromyalgia.
Reduce stress. Avoid or limit overexertion and emotional stress. Allow yourself time each day to relax. People who quit work or drop all activity tend to do worse than do those who remain active. Try stress management techniques, such as deep-breathing exercises or meditation.
Get enough sleep. Getting sufficient sleep is essential. Practice good sleep habits, such as going to bed and getting up at the same time each day and limiting daytime napping.
Exercise regularly. At first, exercise may increase your pain. But doing it gradually and regularly often decreases symptoms. Stretching, good posture and relaxation exercises are helpful. Exercise boosts brain levels of nor-epinephrine and helps reduce stress.
Pace yourself. Practice moderation – means not overdoing it on your good days, and not self-limiting or doing too little on bad days.
Cognitive Behavioral Therapy (CBT). Fear of pain can make things worse. This form of ‘talk therapy’ helps patients learn new ways to think about how they feel, and that affects brain function and can reduce pain. CBT is effective in fibromyalgia. CBT can help change how the brain interprets pain signals.
Maintain a healthy lifestyle.
Eat healthy foods.
Limit your caffeine intake.
Do something that you find enjoyable and fulfilling every day.
Meditation and yoga, have been practiced for thousands of years, but their use has become more popular in recent years. Many practices remain unproved because they haven’t been adequately studied.
Yoga. Yoga combines meditation, slow movements, deep breathing and relaxation. This has been found to be helpful in controlling fibromyalgia symptoms.
Tai Chi. Also called Chinese Yoga, this has benefits similar to Yoga.
Marma Therapy. Marma points or the Indian pressure points, help restore balance in energy. This acts through changes in blood flow and levels of neurotransmitters in the brain and spinal cord. Good Marma Therapy plan can go a long way. Effect of Marma massages have not been studied in the west, but it is believed that they are quite effective.
Acupuncture. Derived from Marma Therapy, acupuncture is a Chinese medical system based on restoring normal balance of life forces by inserting very fine needles through the skin to various depths. Some studies indicate that acupuncture helps relieve fibromyalgia symptoms, while others show no benefit.
Massage therapy. Yoga and Ayurvedic massages, based on Marma points, have wonderful clinical effect. Even western massages – deep tissue massage, or Swedish massage, can reduce your heart rate, relax your muscles, improve range of motion in your joints and increase production of your body’s natural painkillers. It often helps relieve stress and anxiety.
Fibromyalgia is a chronic condition, but it is not progressive. It is never fatal, and it will not cause damage to the joints, muscles, or internal organs. In many people, the condition does improve over time.
Newer Research on Fibromyalgia
Some promising research now being conducted is on understanding pain. Research suggests that fibromyalgia is caused by a problem in how the body processes pain, or more precisely, a hypersensitivity to stimuli that normally are not painful. These studies include:
- Role of neurotansmitters, called cytokines, that regulate immune cell function.
- The use of imaging methods to evaluate the status of central nervous system.
- Role of immune cells in triggering a cascade of events leading to the activation of nerve cells, chronic pain, and the dysregulation of the effects of analgesic drugs against pain.
- An intensive evaluation of twins to assess role of genetics or environment.
- A study examining the use of cognitive behavioral therapy in pain patients.
- The Patient-Reported Outcomes Measurement Information System (PROMIS) initiative. The PROMIS initiative is researching and developing new ways to measure patient-reported outcomes (PROs), such as pain, fatigue, physical functioning, emotional distress, and social role participation that have a major impact on quality of life across a variety of chronic diseases.
Yoga and Ayurveda in Fibromyalgia
From Ayurvedic point of view, it is described as ‘Mansa Dhatugat and Mansavrut Vata‘ disease. Broadly speaking, fibromyalgia is perceived as a Vata imbalance. Vata is the main imbalance and aggravated Vata destabilizes the nervous system and can create hypersensitivity leading to pain and tenderness. Accumulation of ‘ama’ (toxins) and shrotorodha are also contributing factors. This is accompanied by weak digestion, constipation, and effects of chronic stress should also be tackled.
Pre-purification Measures namely ‘snehan‘ and ‘swedan‘ are very useful to balance ‘Vata‘ and to loosen the toxins. Snehan is the Herbalized Oil Massage. This oil is applied to the entire body with a particular type of massage. Swedan is sweating and is given immediately following the snehan. A herbal decoction may be added to the steam to further enhance effect. This also provides a deeply soothing and balancing effect to the entire nervous system. The motion of massage creates heat and friction which enhances circulation and helps cleanse.
Diet and Nutrition
Fibromyalgia and CFS patients should have:
- Vegetable juice and soup
- Carrot, cucumber, beetroot juice
- Cooked vegetables like squash, zucchini and pumpkin
- Spices like cumin, coriander, ginger, asafoetida, garlic, fennel and turmeric.
- Green salad with a dressing of lemon juice and a little salt
- Khichadi (recipe made by cooking rice and mung dal)
- Desi Ghee (clarified butter) or Olive Oil.
The following should be avoided:
- Eating hot, spicy and fried foods, sweets, foods like brinjal, cabbage, cauliflower, spinach, broccoli, okra and potatoes.
- Too much tea, coffee, alcohol, white sugar, chocolate, cocoa.
- Sleeping during the day and staying up late at night
- Too much worry, anxiety, fear, stress and grief.
- Decoction of the roots of ten herbs (Dashamularisht) should be given in the dose of 30 ml., twice daily.
- Daily use of ‘Triphala choorna’ is recommended for colon cleanse.
- Half a teaspoon of turmeric powder with warm water or milk, taken twice a day, helps to reduce pain and inflammation in fibromyalgia.
- Garlic enhances immune system function and helps detoxify.
- Guggul is a very helpful herb for relief of pain.
- Licorice root supports the glandular system. It should be used only up to seven days in a row. Avoid it if you have high blood pressure.
- Ginger tea relieves minor aches and pains. Steep 1 teaspoon of the grated root in 8 ounces of hot water for 10 minutes. Strain and add honey to taste, if you like. Alternatively, take 1 to 2 grams of powdered ginger (saunth) a day with food.
Generic preparations available in market such as Dashamularisht, Triphala, Guggul, Maharasnadi Kwath, Vata Vidhwans Rasa etc. can be taken under the guidance of an expert Ayurvedic physician.
Retraining your Brain through Therapeutic Yoga, esp. Breath, without Drugs
Yoga has always had a lot to offer. I’ve always called it a science beyond nano-science! Effective treatment for fibromyalgia is possible through Yoga Therapy and we offer world-class Yoga Therapy services at SAVY under Dr Jitender K Sahdev. The real route to fibromyalgia recovery lies in non-drug approaches that retrain the breath and thence brain. The primary source of fibromyalgia pain is not in the back, neck, head, stomach or legs, where the pain is typically felt, rather it’s in the brain! And that points to the real solution. Lifestyle, and mind-body approaches that help with fibromyalgia have something in common – they all help restore a balance of neurotransmitters in the brain and central nervous system. They literally change the brain! Brain imaging studies also show that these approaches can affect brain function. They are not just as effective as medication, but almost always safer and much less expensive.
Fibromyalgia is often worsened by stress, anxiety and mental fatigue. There are hormonal changes and other biochemical responses to stress that can aggravate the condition. Sleep disturbances increase fatigue. Efforts should be made to increase the Sattvic quality of mind.
A significant study published in the journal Pain suggests that yoga can help improve fibromyalgia symptoms. Researchers at Oregon Health & Science University in Portland, Oregon randomly assigned 53 female patients with fibromyalgia either to a yoga program or standard medication treatment (control group) for eight weeks. The Yoga of Awareness program included gentle yoga poses, meditation, yoga breathing (pranayama), yoga coping instructions and yoga group discussions.
The researchers found that the yoga group had significant improvement in fibromyalgia symptoms including pain, mood, fatigue, poor sleep, memory problems and coping strategies. Furthermore, the yoga group had a 24 percent decrease in pain, 30 percent decrease in fatigue and 42 percent decrease in depression.
Deep stretching is known to have a positive effect on fibromyalgia. Some helpful poses are:
- Badha Konasana
- Shavasana or Yoga Nidra
More of Vata reducing routines will be helpful. Regular practice of different postures should be done. Progressive deep relaxation, i.e., shavasana (corpse pose) brings about relaxation. At SAVY, we offer specialized Yoga routines very well-suited for fibromyalgia.
According to Vedic scriptures, there is no disease which cannot be conquered through breath. Pranayama also creates a state of restful alertness in mind and body. Pranayama exercises like:
- Kapaal Bhaati,
- Anulom Vilom
are some of the exercises which can help in fibromyalgia. All this must be undertaken strictly under proper guidance. Some clinical studies done in India have shown very positive results. Dr Sahdev’s Breathe and Heal Therapy, is one of the most effective and the safest breathing and mindfulness Yoga program specifically designed by a doctor for therapy.
Hasta mudras attack the very root of problem; they address the issue of imbalance of five elements. Done for a minimum 45 minutes a day, they can be very effective.
These are some of the representative mudras:
- Gyan Mudra
- Vata-nashak Mudra
- Anjali Mudra
- Apana Mudra
- Apana-Vayu Mudra
- Prana Mudra
You should be able to notice the difference within a week. Mudras of the body, base, tongue, eyes etc form an integral part of our Yoga Therapy program. You can also join a specialized course on Hasta Mudras.
The six detoxifying procedures of Yoga:
- Kapaal Bhaati, and
if done with proper technique, can be very helpful. Learn these under expert guidance at SAVY.
Lifestyle and Daily Routine
One of the most important factors is to have a lifestyle that does not disturb the natural body rhythm. When we eat, sleep and exercise in fluctuating and disturbing patterns, the body loses its natural cycle. Regularity in daily life can be extremely effective in reducing Vata imbalance. Expert Yoga Nutrition guidance is available at SAVY and should be availed.
Visit us at SAVY Studio for your individualized Therapeutic Yoga guidance and overall well-being.
You can book your appointment here.
Dr Jitender K Sahdev
HEALING THROUGH BREATHING
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