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How Stress Becomes Pain in Fibromyalgia Part II: the Autonomic Nervous System

  [ 10 votes ]   [ 1 Comment ]
By Cort Johnson • www.ProHealth.com • August 17, 2017


How Stress Becomes Pain in Fibromyalgia Part II: the Autonomic Nervous System
Reprinted with the kind permission of Cort Johnson and Health Rising 

“The Autonomic Nervous System is the interface between the mind and body.” – Martinez-Lavin

This is the second in our series of blogs overviewing Dr. Martinez-Lavin’s short primer Fibromyalgia:  How Stress Becomes Real Pain. (Note that Dr. Martinez-Lavin has a very specific view of Fibromyalgia, and his is one among many.)

Martinez-Lavin believes the development of Fibromyalgia is ‘related’ to physical, infectious, or emotional agents (illness, divorce, broken arm, etc.) that produce stress.  He doesn’t appear to be saying the infections, psychological stress, etc., cause FM, but that the stress response system plays a critical role in this disorder.
 
His major focus is on the autonomic nervous system, one of two stress response systems in the body. (The HPA axis is the other.)
 
The Autonomic Nervous System (ANS)
 
Martinez-Lavin takes some time to describe what is a surprisingly complex and pervasive feature of our bodies.  Originating at the base of the brain, the ANS is kind of a master controller.  Its job to maintain homeostasis – the healthy functioning of our body.
 
The ANS:
  • Controls basic functions such as blood pressure, pulse rate, breathing rate, and temperature
  • “Harmonizes the functioning” in all our internal organs
  • Enables the body to respond to stress, and after the stress, returns the body to rest and recovery mode
  • Works closely with the HPA axis – the other major stress response in the body and an important immune regulator
  • Regulates the immune system.
The ANS has two branches: the sympathetic nervous system (SNS) or ‘fight or flight’ side which gears the body up to respond effectively to stressful situations, and the parasympathetic nervous system (PNS) or ‘rest and digest’ side which helps the body recover from them.
 
These two branches of the ANS exist in a kind of yin-yang relationship: when one is up, the other is automatically down.  A third branch – a non-adrenergic, cholinergic branch which utilizes nitric oxide and affects the gut and the lungs – is also present, and a fourth branch (see link below) has been proposed.
 
The SNS primarily uses epinephrine (adrenaline – produced by the adrenal glands), norepinephrine, and dopamine to do its work, but Martinez-Lavin calls the last two the true sympathetic transmitters. The PNS, on the other hand, primarily uses acetylcholine to do its work.
 
Stress Redefined
 
Martinez-Lavin redefines ‘stress’ as we ordinarily know it when he notes that, from the body’s perspective, the simple act of standing – moving the body from a resting position to an upright position – is a stressful act. During that act, the ANS takes many actions to keep gravity from driving our blood into our feet and out of our head.  The fact that most people are able to stand without any issue at all doesn’t mean the act of standing is not inherently ‘stressful’ to the body.  After all, even a healthy person has trouble standing still for long periods of time.
 
Portraying standing as a ‘stressor’ helps us redefine our notion of stress.  ‘Stress’ is anything that takes the body out of a restful, inactive state.
 
Digestion, then, is another stressor – one that very well demonstrates the yin-yang nature of the ANS.  When activated, the ‘fight/flight” branch of the ANS, the SNS, inhibits gut movements and gut secretions in order to provide energy for more immediate concerns. In turn, the ‘rest/digest’ (PNS) branch promotes peristalsis and gut secretions once the SNS quiets down.
 
Given that the ANS regulates basic aspects of our body’s functioning, it’s not surprising that it in turn is regulated by the organs lying deep in the more primitive areas of the brain that are responsible for some pretty primitive responses.
 
Because the fight or flight system is responsible for removing us from danger, it needs to have
  1. a lightning quick response, and

  2. a straight shot to those areas of the brain that will produce emotions that make us move and act quickly; i.e., those parts of the brain that produce emotions like fear and anger which propel us to quick action in the face of danger.  

The ANS, Dr. Martinez-Lavin believes, is the interface between the mind and body.
 
A Holistic Approach to Fibromyalgia
 
“Our working hypothesis was that every manifestation of fibromyalgia could be explained by an alteration in the autonomic nervous system.”
 
Dr. Martinez-Lavin believed it was possible that every aspect of FM could be explained by autonomic nervous system problems.  He began assessing ANS functioning through the use of heart rate variability analysis – a means of determining ANS functioning.
 
His studies revealed people with fibromyalgia had an “incessantly hyperactive sympathetic nervous system” that was particularly hyperactive during sleep.
 
Paradox
 
But a paradox emerges when we dig a bit deeper. Constant sympathetic nervous activity should stimulate the heart and put the squeeze on our blood vessels, resulting in high blood pressure – which is rarely seen in either FM or ME/CFS.  Instead, low or lowered blood pressure is the norm.
 
How does one explain low blood pressure in disorders characterized by a hyperactive fight or flight response?  By the ‘cry wolf’ syndrome.  In the face of a system which has apparently been stuck continuously on - crying wolf all the time - the body simply begins to ignore the signal by turning the receptors for the SNS off.  That causes the blood pressure to slide instead of increase.
 
Asking FM patients to stand up after 15 minutes of lying down also revealed that their sympathetic nervous systems – which are turned on during ‘rest’ – under-responded when prompted to respond during standing.
 
Dr. Martinez-Lavin suggests that having the SNS essentially ‘on’ all the time has burnt it out. That sets the stage for constant fatigue and, of course, poor sleep and feeling ‘beaten up’ and tired upon waking.

Martinez-Lavin’s next step was particularly interesting given the Stanford ME/CFS EEG studies soon to be published.   His EEG studies found high levels of ‘startle’ and awakening in his sleeping FM patients.  (The Stanford EEG studies will suggest people with ME/CFS are in a kind of sleep mode when they’re awake and vice versa.)

Dr. Martinez-Lavin believes that sympathetic nervous system hyperactivity is essentially ‘startling’ people with FM into poor sleep.  Poor sleep, by the way, is highly correlated with increased pain sensitivity, even in healthy people.
 
A Common Theme Emerges in the Pain and Fatigue Disorders
 
We know a similar kind of SNS hyperactivity is present in ME/CFS, but it’s also present in two other mysterious pain disorders:  irritable bowel syndrome and interstitial cystitis (IC). All have similar heart rate variability findings, and people with these disorders display a similar SNS collapse when faced with stressors.

IC is characterized by burning and pain when urinating (but no sign of infection). Because IC, in contrast to ME/CFS and FM, has a localized occurrence, it offers a window into its pathophysiology that ME/CFS and FM do not. Increased epinephrine (adrenaline) levels in the urine and increased sympathetic nervous system fibers in the bladder wall appear to set the stage for a twitchy, over sensitized urinary system in that disorder.
 
The same Th1/Th2 immune system imbalance (Th1-low/Th2-high) that appears to occur in ME/CFS also appears to be present in FM, according to Dr. Martinez-Lavin.
 
Sympathetic nervous system hyperactivity tends to inhibit the Th1 (antiviral) branch and upregulate the Th2 (allergy, bacterial defense) branch of the immune system – precisely what’s seen in ME/CFS and FM.
 
Martinez-Lavin is even able to tie in the gender imbalance with ANS dysfunction. Women, he reports, tend to have a ‘higher basal sympathetic tone’ than men, and after trauma tend to develop more ‘irregular connections’ between pain pathways and the sympathetic nervous system.
 
Conclusion
 
Dr. Martinez-Lavin believes the autonomic nervous system is ground zero for FM.   Not many would go that far, but the ANS clearly plays a role in both FM and other pain and fatigue disorders that mostly plague women.
 
We haven’t gotten to the heart of Martinez-Lavin’s hypothesis that SNS over-activation is key in FM, however. That’s coming up shortly as we watch him dig into the very nerves that are responsible for pain in Fibromyalgia.

Article #1 - Turning Stress into Pain: A Fibromyalgia Primer by Dr. Martinez-Lavin
Article #3 - The Fibromyalgia Mimics – When Your Pain is Not Due to FM:  How Stress Becomes Real Pain #3


About the Author: ProHealth is pleased to share information from Cort Johnson.  Cort has had myalgic encephalomyelitis /chronic fatigue syndrome for over 30 years. The founder of Phoenix Rising and Health Rising, he has contributed hundreds of blogs on chronic fatigue syndrome, fibromyalgia and their allied disorders over the past 10 years. Find more of Cort's and other bloggers' work at Health Rising.




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Article Comments Post a Comment

Interesting and Applicable!
Posted by: MaschelleMEcfs
Aug 17, 2017
I'm fascinated how separate diagnosis I live with are popping up in ME-CFS and Fibromyalgia patients involved in studies over the past few years. I have been diagnosed with Fibromyalgia and
ME-CFS. I'm mostly bedridden and I am affected neuro-cognitively at a infuriating level. I fall asleep with the slightest attempt to concentrate. ..for instance; I will start falling asleep, then startling awake as I try to finish composing this comment. If I stop working on it and put my tablet and it's tray off of my lap and get it out of view... I will be able to stay awake. I can't read very long either, but I digress.

I have been complaining to my doctor about the hyper startle reflex I have when trying to sleep. If someone says my name I wake to a huge "KahWUMP!" in my chest from my heart reacting to what I assumed was the unnecessary release of adrenalin for a diagnosed
"fight or flight" response when no danger is present. When startled awake while sleeping, as I was explaining, my body does the most ridiculous things all at once... my arms and legs start flailing rapidly, I let out a long exclamation of nonsense vocalizations that are not even words, and I rise up off the bed a bit. I HATE this. It's very unpleasant and I can't have a relationship because I experience this everytime my ex even shifted his position in bed. He'd start talking b4 entering the room and awake or asleep, I experience the hyper startle effect. Or flick the light on... My body goes insane and I proclaim my fear in a string of gibberish. I can't handle it.
The awake when asleep... I had a sleep study done and my brain woke 48 times while I was "sleeping". It also skipped the 2 restorative stages of sleep. Plus I have CNS apnea.
When awake, I fall asleep with no advanced notice. I have taken a sip of coffee and suddenly am woken by the coffee falling out of my mouth.. I had fallen asleep before I could swallow my sip of coffee. This happens with solid foods too. I gave up driving long before my ME-CFS became as severe as it is now because if I was driving on a straight stretch of road I'd fall asleep at the wheel! I can't watch a TV show, so I record everything I watch so I can rewind when I startle awake and find I missed 5 minutes of the show. I cannot read for pleasure, and that's torturous for a bookworm like myself. I also cant read for research and my own education. Point is.. I'm living the sleep issues, and startle effect insanity, as stated in the research this references. And my sleep seems reversed. I wake suddenly from flight or flight trigger when sleeping, and cannot function during the day because I fall asleep for short bits with zero warning.
I have Irritable Bowel Disease and the cramping is hideously painful. Plus, mysteriously, I suddenly began having a "twitchy" bladder (as you put it). I suddenly feel the urge to "go" and I can't hold it long enough to get to the bathroom! Out of the blue I became incontinent! I also received the gift of a paralyzed sphincter muscle. It was right before my Fibromyalgia dx that this nonsense started. Imagine being a normal person, then suddenly losing your bladder and/or bowels in the grocery store? I am still totally incontinent and am not elderly.
To see these unexplained conditions I live with being associated with ME-CFS and Fibromyalgia is amazing. This is a disease where the community of patients are too ill to be interacting online and have not really comparing notes. I have no idea what other patients go through. But, more and more, many seemingly random conditions I have are popping up in ME-CFS research... and my fellow sufferers have these symptoms too?! Both validating and clinically interesting!
Now that I've given myself a blinding headache trying to put words together in order to comment, I think I'll give us both a break.. and stop composing this already too long comment.
Reply Reply
 
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