“The Autonomic Nervous System is the interface between the mind and body.” – Martinez-Lavin
This is the second in our series of blogs overviewing Doctor 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.
- 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.
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 it 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
- a lightning quick response, and
- 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.
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 flight 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.
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 overactivation 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.
By opening and closing blood vessels it determines which organs and tissues are going to receive blood.