“Within you, there is a stillness and a sanctuary to which you can retreat at any time and be yourself.”       

Hermann Hesse

 

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 to an unknown aetiology and a lack of specific effective therapies.

It 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 estimated to have a global prevalence of about one in every ten adults with a societal cost 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.

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 learned behaviour that can be “unlearned” through a variety of non-medical interventions.

Studies are showing that the brains of individuals with chronic pain can develop abnormal neurological networks and connections when these 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 pain can enhance the experience of pain by altering the balance of brain hormones (neurotransmitters) such as norepinephrine and serotonin. These neurotransmitters usually reduce pain but when the reaction to pain is anxiety-provoking the experience of the pain intensifies.

Treatment

None of the most-used pharmacological, psychological, medical, or surgical treatments is reliably able to remove pain or to significantly enhance physical and emotional functioning. These therapies have, as a downside, the potential to create unwanted effects.

Non-pharmacological treatments that involve the active participation of patients, such as exercise and psychotherapy, 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 necessary 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.