Fibromyalgia and Panic Attacks: Cognitive and Somatic Sensitization

“If you are experiencing strange symptoms that no one seems to be able to explain, they could be arising from a traumatic reaction to a past event that you may not even remember”, Peter A. Levine

Two words that are now often coined in conjunction with fibromyalgia are cognitive sensitization and somatic sensitization. I have been exploring the research in this direction for the past couple of years and have recently had another ‘aha’ moment. I am not sure which comes first but with regard to ‘cognitive sensitization’, because of the excessive degree of empathy for others and fear/anxiety for ourselves there is vivid brain activity in the amygdala. People with fibromyalgia worry excessively and our attention to health related information is extremely high. The meaning that pain has for ourselves, the sufferer, or for others whom we perceive to suffer, poses increased threats which affects ‘somatic sensitization’, that is, increased reactivity of the nervous system. In turn this lowers the pain threshold and affects pain tolerance; the consequence is that the fibromyalgia syndrome develops. The two are interrelated but what does that mean in simple language? One hears, in fact seeks out, health related information, subsequently anxiety and fear develop (the amygdala is over reacting to perceived threat) increasing the overstimulation. Then a low tolerance for pain develops. Accompanying this pain is a myriad of other symptoms. But is this too simply stated? What can this cognitive sensitization actually produce within ourselves? This is a process within the brain as it receives cues that bring about arousal from a past traumatic event, that becomes an actual sensitization of the neuro system. In what ways then does this anxiety/fear invade our brains?

“The result, sadly, is that many of us become riddled with fear and anxiety and are never fully able to feel at home with ourselves or our world”, writes Peter A.Levine (p.21) Waking the Tiger. With the nervous system being in a state of hyper-arousal, we become overly sensitive to light, sound, weather conditions among other environmental factors that can cause pain, itching, tightening of the muscles, fatigue. We have difficulty with sleep, stressful situations, our startle reactions and we are hyper-vigilant. Often this dis-ease with our sensitive nervous systems results in heightened anxieties that become panic attacks.

Social neuroscience has explored the brain activity of many types of people and yet very little has been done with the over activation of those of us with fibromyalgia. Our tendency to interpret and be in tune with verbal and non verbal cues of others and be usually in a state of hyper-vigilance is worthy of intense research. it seems as though many of us with fibromyalgia are in caregiving roles such as nurses. We are addicted to giving care to others, too much empathy with the resultant over stimulation. Central sensitization seems to be the view of the researchers on fibromyalgia, that is the central nervous system is usually on high alert and overly sensitive. The sudden surge of extreme fearfulness, heart pounding, shortness of breath, tingling sensations, feeling of being in danger can develop anywhere and at any time. This is how a panic attack feels. We are chronic worriers for ourselves and for others leading to catastrophic thinking and being afraid of fear itself is what leads to panic attacks. When did these symptoms first begin to take shape in our psyche?

As Levine and Scaer have written (see other blogs on this topic) we have been subject to psychological trauma that produces bodily sensations that appear to be a bona fide disease, instead of the dis-ease of the scars from these traumas. Whether or not these lifelong traumas have developed even in utero or in childhood, it seems as though our hypersensitivity has lead us down this path. We can change those brain pathways if only those who were quick to medicate us or find a cause that is not psycho-social in nature were supportive in our quest to find ways to heal ourselves. Both Levine and Scaer (among others) are pioneers in this respect and their work brings hope to those of us with this central sensitization.

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