Catastrophizing One's Physical Limitations?

[Paw]

Here's a new weird little study. Researchers learned that people with FM who report higher levels of pain and fatigue are more likely to perceive themselves as less functional in life.

Obviously, the results of the study are underwhelming. What caught my eye was the researchers' insistence on rating functionality, not as an objective fact, but merely as a perception in the mind of the patient. Subjects who "catastrophize" their pain are most likely to catastrophize their overall functionality.

The researchers did not find this same correlation when the subjects were experiencing higher levels of pain and fatigue while at rest. It was only when they reported high pain and fatigue while active that they perceived their functionality as especially limited.

The study may or may not yield some helpful insights into future "interventions" for lowering perceived pain and fatigue, and elevating functionality, but it seems to me that if the researchers understood what living with FM is really like they could frame their research in more useful ways.

Until recently, most of my FM pain was the burning type. But for some reason, about six months ago, my muscles and tendons and tissue got so severely involved I thought I was experiencing an acute injury. I could barely even get into a car, because the pain and limited mobility was so intense. Often, while standing, I would feel certain joints or muscles suddenly give out on me, and I had to catch myself from falling. It took me awhile to realize that doctors were treating these symptoms mainly as my own perception. Since they could find no mechanical cause, they probably thought I was catastrophizing.

I'm still coping with the same pain patterns, but I'm much more functional now. What turned me around was a couple months of physical therapy, where the therapists (who attributed all my pain to FM) convinced me that stretching and exercise would not make my condition worse, even if it was very painful. Prior to that, it felt crazy to push myself -- like doing so would cause real damage. But after getting their permission to work through the pain as much as I could tolerate, I gradually began to improve. So, in that sense, I had successfully lowered my fear of the pain, which got me out of the vicious cycle that made the pain and limitations worse and worse. That meant less depression (with fewer visions of me being bed-bound for the rest of my life), and more confidence that I could still improve my functionality.

So, based on this experience, I think it would have been more accurate and helpful to frame the study, not in terms of "perception" of one's functionality (which makes it sound like less-functioning people are simply more hysterical), but in terms of measuring how much pain and fatigue one can sustain while trying to improve functionality.

As for the pain and fatigue while at rest, I have found that moderate, targeted exercise, stretching and massage can reduce that pretty significantly. So, paradoxically, the more I'm suffering while lying down, the more I'm becoming motivated to get up confront my pain (which sort of supports the research findings).

Of course, if one has ME in addition to FM, all this gets more complicated.

 

[Shannon]

Wow, how very interesting. I am one of those who feel like if I push through my pain I'm doing more damage. Intellectually, we know that if something hurts, you avoid doing whatever it was that hurts. So, by that same frame of thought, I feel like if I'm hurting all the darned time and push through pain I'm doing myself some further damage.

When really, we know (or it is thought to be known) that FM pain is amplified pain that either is minor or doesn't really exist to begin with. Our bodies are on hyper *everything* and so we feel everything *more*. My simplified look at it anyway.

This severe pain I experience really screws with my head sometimes. So yes, I am also one of those people who doesn't want to go out on those very bad pain days because I feel I am limited to what I can do. Though, having recently left a 15 year abusive relationship, I am now finding out how much more I really CAN do simply because I must. There's no one but the cats and I now. And the cats, without opposable thumbs, can't carry much. Maybe I should look into getting a service dog lol

 

[Paw]

Wow, how very interesting. I am one of those who feel like if I push through my pain I'm doing more damage. Intellectually, we know that if something hurts, you avoid doing whatever it was that hurts. So, by that same frame of thought, I feel like if I'm hurting all the darned time and push through pain I'm doing myself some further damage.

When really, we know (or it is thought to be known) that FM pain is amplified pain that either is minor or doesn't really exist to begin with. Our bodies are on hyper *everything* and so we feel everything *more*. My simplified look at it anyway.

This severe pain I experience really screws with my head sometimes. So yes, I am also one of those people who doesn't want to go out on those very bad pain days because I feel I am limited to what I can do. Though, having recently left a 15 year abusive relationship, I am now finding out how much more I really CAN do simply because I must. There's no one but the cats and I now. And the cats, without opposable thumbs, can't carry much. Maybe I should look into getting a service dog lol

Yeah, and I hope I'm not coming across as authoritative about pushing through pain. Just sharing what my physical therapists say about it, as well as my own experiences. It might be exactly the wrong thing for some people.

I've actually been using a gravity-inversion table several times a day for the past month or so, and it's been very helpful -- and educational. I can feel the areas of my body that have been chronically compressing and recoiling as they cling for dear life against anything that would lengthen them. But, very slowly, with considerable pain, they can be encouraged to let go. And that brings significant relief.

What's actually occurring? Is trapped lactic acid being released? Am I learning to relax muscles and tendons that have been chronically contracted in some sort of self-protection syndrome? I don't know. My neurologist over-simplistically equates FM with small-fiber neuropathy (which I have). Are nerve signals failing to convince my muscles to relax normally?

Regardless, it sure doesn't feel like it's solely a problem of over-amplification. That might ring more true when I'm feeling burning, but the aching muscular system feels and behaves more physiologically, even if the syndrome might have started with over-amplification.

 

[Shannon]

No you didn't come across that way at all. No worries.

I'd love to have access to an inversion table. I've heard it does good things for you, regardless of having chronic pain.

 

[Cort]

What a superb account Paw...That at times it's appropriate to push through the pain - to do the opposite of what your body is telling you to do - is just astonishing but I've heard that several times. The body is a strange thing - a really strange thing.

I remember reading part of Judy Foreman's book...She had horrible neck pain and one part of getting better was exercising her neck.....

I would love to learn why it works...Do the muscles kind of lock down in a pain state?

I'm so glad that you are feeling better.

Here's a new weird little study. Researchers learned that people with FM who report higher levels of pain and fatigue are more likely to perceive themselves as less functional in life.

Obviously, the results of the study are underwhelming. What caught my eye was the researchers' insistence on rating functionality, not as an objective fact, but merely as a perception in the mind of the patient. Subjects who "catastrophize" their pain are most likely to catastrophize their overall functionality.

The researchers did not find this same correlation when the subjects were experiencing higher levels of pain and fatigue while at rest. It was only when they reported high pain and fatigue while active that they perceived their functionality as especially limited.

The study may or may not yield some helpful insights into future "interventions" for lowering perceived pain and fatigue, and elevating functionality, but it seems to me that if the researchers understood what living with FM is really like they could frame their research in more useful ways.

Until recently, most of my FM pain was the burning type. But for some reason, about six months ago, my muscles and tendons and tissue got so severely involved I thought I was experiencing an acute injury. I could barely even get into a car, because the pain and limited mobility was so intense. Often, while standing, I would feel certain joints or muscles suddenly give out on me, and I had to catch myself from falling. It took me awhile to realize that doctors were treating these symptoms mainly as my own perception. Since they could find no mechanical cause, they probably thought I was catastrophizing.

I'm still coping with the same pain patterns, but I'm much more functional now. What turned me around was a couple months of physical therapy, where the therapists (who attributed all my pain to FM) convinced me that stretching and exercise would not make my condition worse, even if it was very painful. Prior to that, it felt crazy to push myself -- like doing so would cause real damage. But after getting their permission to work through the pain as much as I could tolerate, I gradually began to improve. So, in that sense, I had successfully lowered my fear of the pain, which got me out of the vicious cycle that made the pain and limitations worse and worse. That meant less depression (with fewer visions of me being bed-bound for the rest of my life), and more confidence that I could still improve my functionality.

So, based on this experience, I think it would have been more accurate and helpful to frame the study, not in terms of "perception" of one's functionality (which makes it sound like less-functioning people are simply more hysterical), but in terms of measuring how much pain and fatigue one can sustain while trying to improve functionality.

As for the pain and fatigue while at rest, I have found that moderate, targeted exercise, stretching and massage can reduce that pretty significantly. So, paradoxically, the more I'm suffering while lying down, the more I'm becoming motivated to get up confront my pain (which sort of supports the research findings).

Of course, if one has ME in addition to FM, all this gets more complicated.

 

[Cort]

Wow, how very interesting. I am one of those who feel like if I push through my pain I'm doing more damage. Intellectually, we know that if something hurts, you avoid doing whatever it was that hurts. So, by that same frame of thought, I feel like if I'm hurting all the darned time and push through pain I'm doing myself some further damage.

When really, we know (or it is thought to be known) that FM pain is amplified pain that either is minor or doesn't really exist to begin with. Our bodies are on hyper *everything* and so we feel everything *more*. My simplified look at it anyway.

This severe pain I experience really screws with my head sometimes. So yes, I am also one of those people who doesn't want to go out on those very bad pain days because I feel I am limited to what I can do. Though, having recently left a 15 year abusive relationship, I am now finding out how much more I really CAN do simply because I must. There's no one but the cats and I now. And the cats, without opposable thumbs, can't carry much. Maybe I should look into getting a service dog lol

It is really hard to tell when to push and when not to...and how to push correctly.

 

[Tony L]

Here's a new weird little study. Researchers learned that people with FM who report higher levels of pain and fatigue are more likely to perceive themselves as less functional in life.

Obviously, the results of the study are underwhelming. What caught my eye was the researchers' insistence on rating functionality, not as an objective fact, but merely as a perception in the mind of the patient. Subjects who "catastrophize" their pain are most likely to catastrophize their overall functionality.

The researchers did not find this same correlation when the subjects were experiencing higher levels of pain and fatigue while at rest. It was only when they reported high pain and fatigue while active that they perceived their functionality as especially limited.

The study may or may not yield some helpful insights into future "interventions" for lowering perceived pain and fatigue, and elevating functionality, but it seems to me that if the researchers understood what living with FM is really like they could frame their research in more useful ways.

Until recently, most of my FM pain was the burning type. But for some reason, about six months ago, my muscles and tendons and tissue got so severely involved I thought I was experiencing an acute injury. I could barely even get into a car, because the pain and limited mobility was so intense. Often, while standing, I would feel certain joints or muscles suddenly give out on me, and I had to catch myself from falling. It took me awhile to realize that doctors were treating these symptoms mainly as my own perception. Since they could find no mechanical cause, they probably thought I was catastrophizing.

I'm still coping with the same pain patterns, but I'm much more functional now. What turned me around was a couple months of physical therapy, where the therapists (who attributed all my pain to FM) convinced me that stretching and exercise would not make my condition worse, even if it was very painful. Prior to that, it felt crazy to push myself -- like doing so would cause real damage. But after getting their permission to work through the pain as much as I could tolerate, I gradually began to improve. So, in that sense, I had successfully lowered my fear of the pain, which got me out of the vicious cycle that made the pain and limitations worse and worse. That meant less depression (with fewer visions of me being bed-bound for the rest of my life), and more confidence that I could still improve my functionality.

So, based on this experience, I think it would have been more accurate and helpful to frame the study, not in terms of "perception" of one's functionality (which makes it sound like less-functioning people are simply more hysterical), but in terms of measuring how much pain and fatigue one can sustain while trying to improve functionality.

As for the pain and fatigue while at rest, I have found that moderate, targeted exercise, stretching and massage can reduce that pretty significantly. So, paradoxically, the more I'm suffering while lying down, the more I'm becoming motivated to get up confront my pain (which sort of supports the research findings).

Of course, if one has ME in addition to FM, all this gets more complicated.

Interesting that when you put yourself into the hands of somebody who listened and believed that you were in real pain from your physical symptoms, these were treated in an appropriate fashion and your situation has thankfully improved.

As for the paper and the reference to perceived pain/functionality. Well I think we can all push ourselves beyond what our bodies say is safe/comfortable/likely to cause increased pain, harm etc. Nothing new in that. I don't know if many have improved long-term or recovered using that approach. Most of us know that there is a price to pay, eventually.

I think my problem with this kind of science is that it is taking a small number of FM sufferers and treating a complex disease in a very simplistic manner which could not just have adverse implications for those taking part but for other patients given a label of FM whose symptoms may already or later perhaps overlap into ME/CFS. It is simply feeding the prevailing dogma that psychological elements are key to perpetuating a state of chronic disease.

In how may other conditions are we advised to ignore what our body is saying, that what we feel is an unreliable indicator of our state of health and what we are really capable of ?

 

[Paw]

I think my problem with this kind of science is that it is taking a small number of FM sufferers and treating a complex disease in a very simplistic manner which could not just have adverse implications for those taking part but for other patients given a label of FM whose symptoms may already or later perhaps overlap into ME/CFS. It is simply feeding the prevailing dogma that psychological elements are key to perpetuating a state of chronic disease.

In how may other conditions are we advised to ignore what our body is saying, that what we feel is an unreliable indicator of our state of health and what we are really capable of ?

Yeah, it seems like lazy research by researchers unable to see beyond their initial biases.

However, the findings obliquely confirm some of my own recent experiences -- if I ignore all their psychological references. My interest is entirely in what's happening physically. The severity of my mobility restrictions, pain, cramps, muscle binding, etc, is simply not psychological. That's utterly obvious to me. But my realization that -- in my particular case anyway -- the more I rested and avoided the pain the worse I was getting, led to a treatment breakthrough. Instead of relying on past exercise methods that, in effect, contracted the already brittle, clinging muscular system, I had to find ways to lengthen and soften the system.

One of the therapists one day did a violent "distraction" maneuver on my hip that caused me to scream so loud the entire gym came to a standstill. But it gave me a half hour of solid relief. That's when I started seeking out "traction" possibilities, because it gave me some confidence that certain types of pain were, indeed, the pathway to relief.

As for other conditions that we have historically been advised to go against our bodies' warnings? I'm thinking of when polio victims had to wear those horrible steel braces, which were, apparently, unbearably painful, but seemed to help patients avoid slipping so quickly into a vicious cycle of total debilitation.

 

[Mary Hamilton]

Yeah, it seems like lazy research by researchers unable to see beyond their initial biases.

However, the findings obliquely confirm some of my own recent experiences -- if I ignore all their psychological references. My interest is entirely in what's happening physically. The severity of my mobility restrictions, pain, cramps, muscle binding, etc, is simply not psychological. That's utterly obvious to me. But my realization that -- in my particular case anyway -- the more I rested and avoided the pain the worse I was getting, led to a treatment breakthrough. Instead of relying on past exercise methods that, in effect, contracted the already brittle, clinging muscular system, I had to find ways to lengthen and soften the system.

One of the therapists one day did a violent "distraction" maneuver on my hip that caused me to scream so loud the entire gym came to a standstill. But it gave me a half hour of solid relief. That's when I started seeking out "traction" possibilities, because it gave me some confidence that certain types of pain were, indeed, the pathway to relief.

As for other conditions that we have historically been advised to go against our bodies' warnings? I'm thinking of when polio victims had to wear those horrible steel braces, which were, apparently, unbearably painful, but seemed to help patients avoid slipping so quickly into a vicious cycle of total debilitation.

I'm new to this group but have had fibro and CFS for 29 yrs. I really need to think about this. At the moment it doesn't make sense to me.