When I am working with patients with either acute or chronic pain, they are, often, surprised to discover that the stress that they are harboring, is exacerbating their pain. Chinese medicine recognizes that stress is the catalyst for sluggish or stagnant movement of the body's vital energy, Qi and the circulation of blood throughout the body. By definition, pain, within the concept of Chinese medicine, is a disharmonious flow of Qi and Blood. As a result, it should come as no surprise that stress will affect pain or actually cause pain to arise. Stress aggravates pain by creating more stagnation of Qi and Blood. In the case of Fibromyalgia, stress can overwhelm a patients painful regions.
Fibromyalgia (FMS) is a chronic pain condition that affects at least 2% of the population. Chronic widespread pain is the defining feature of FMS. Patients also describe a number of nonspecific symptoms such as anxiety, depression, fatigue, weary sleep, headaches and gastrointestinal complaints such as irritable bowel syndrome. These concomitant symptoms are often exacerbated by exertion, stress, lack of sleep and weather changes. Although there has been a lot of research done on FMS, the mechanisms underlying the causes of pain have not been elucidated, however evidence suggests that various components of the central nervous system (CNS) are involved, including the hypothalamic-pituitary-adrenal (HPA) axis and pain-processing pathways. Sympathetic nervous system (SNS) overactivity within the autonomic nervous system (ANS) is also implicated. From a Chinese medical perspective, (FMS) results from a systemic shutdown of Qi and Blood flow to specific body regions and a hyper-toxicity state of the Liver, Spleen, Intestines and Kidneys.
What does the research show?
Research demonstrates the following in patients with FMS:
* Evidence of abnormal stress reactivity, including blunting of the HPA and increased ANS responsiveness.
* Anxiety, stress and depression are present in 30 to 45% of patients.
* Decreased cortisol secretion, suggesting increased sensitivity to glucocorticoid feedback.
* Exaggerated noradrenaline (NA) responses as well as delayed Adrenocorticotropic Hormone (ACTH) release, are observed among female FMS patients compared with agematched female controls. Delayed ACTH release in FMS is consistent with a defect in HPA function. Exaggerated NA release may reflect abnormal regulation of the sympathetic nervous system, perhaps secondary to chronically deficient hypothalamic Corticotropic Releasing Factor (CRF).
* FMS patients had significantly higher sub-scale scores for somatisation, obsessive-compulsive disorder (OCD), medication used for sleep, and fatigue. 87% of FMS patients reported a stressful event and 42.3% had symptoms indicating post-traumatic stress disorder.
* Women with FMS who reported a history of physical or sexual abuse had lower cerebrospinal fluid CSF levels than women who did not report such a history.
* The cytokines IL-1, IL-6 and IL-8 are unregulated in FMS. Therapies directed against these cytokines may be of potential importance in the management of FMS.
HPA and SNS activity
Different stressors elicit different patterns of activation in the HPA and SNS. As Clinicians, we know activation of these systems eventually involves the entire mind/body of the patient. With stressful stimuli the two stress centers of the brain are activated the hypothalamus and the locus coeruleus (LC). These two components of the nervous system promote a cascade of hormonal, neurotransmitter and cytokine activity that supports our fight or flight response. The LC is the master switch for the SNS and stimulates adrenaline and NA production, increasing cardiovascular performance. The hypothalamus signals the pituitary gland, which in turn signals the adrenals to produce cortisol. Normally the cortisol feeds back to the hypothalamus to switch off the stress response and inflammation. However, with chronic unmanaged stress, the body doesn't return to normal and the patient develops progressive heightened neural and neuro-endocrine reactivities. Research suggests that chronic stress will eventually result in a hypo-functioning of the HPA, manifesting as low cortisol and impaired ability to shut down the stress response.
Chronic stress causes pain
In addition to these neuro-endocrinological changes, the stress reaction up-regulates the production of inflammatory cytokines such as IL-1, IL-6 and TNF-alpha, as well as increasing cellular oxidation. The presence of these inflammatory and oxidative substances increases pain and fatigue and sleep disturbances. Additionally, with the ongoing stress, substances such as serotonin, that help us deal with pain, are reduced and contribute to further sleep disorders, depression and anxiety. Through other mechanisms, the stress reaction and its downstream effects also impair energy production.
What can we do? In summary, up-regulation of the HPA and SNS, due to stress, results in inflammation, pain, fatigue, depression, anxiety, sleep disturbances and all the concomitant symptoms often described by our FMS patients. It would make a lot of sense then, that prescribing traditional Chinese herbal formulas that have a calming effect on the SNS and a regulating effect on the HPA will have long-term benefits for our FMS patients recovery.
In addition to various acupuncture strategies for the pain, most FMS patients require herbal, dietary, lifestyle and nutritional strategies to focus on addressing imbalances in specific endocrine organs: pancreas and adrenals, as well as regulating Qi and Blood circulation. Patients can also benefit from participating in stress reduction exercises, such as Qi Gong and Tai Chi, as well as, meditation and yoga. This is the most robust approach for moving patients from a diseased and painful state to a healthy and vibrant life.
Meridian Harmonics
