FIBROMYALGIA AND CHRONIC PAIN

1. FIBROMYALGIA AND CHRONIC PAIN It’s all in your head

2. FIBROMYALGIA • Doctors don't know what causes fibromyalgia, but it most likely involves a variety of factors working together. These may include: • Genetics. Because fibromyalgia tends to run in families, there may be certain genetic mutations that may make you more susceptible to developing the disorder. • Infections. Some illnesses appear to trigger or aggravate fibromyalgia. • Physical or emotional trauma. Post-traumatic stress disorder has been linked to fibromyalgia.

3. Sleep Disorders Always Accompany Fibromyalgia THE 5 STAGES OF SLEEP

4. THE 5 STAGES OF SLEEP • Usually sleepers pass through five stages: 1, 2, 3, 4 and REM (rapid eye movement) sleep. • These stages progress cyclically from 1 through REM then begin again with stage 1. • A complete sleep cycle takes an average of 90 to 110 minutes. • The first sleep cycles each night have relatively short REM sleeps and long periods of deep sleep but later in the night, REM periods lengthen and deep sleep time decreases.

5. STAGE 1 • Stage 1 is light sleep where you drift in and out of sleep and can be awakened easily. • This is considered a transition period between wakefulness and sleep. If you awaken someone in the stage, they might report that they weren't really asleep. • During this stage, many people experience sudden muscle contractions preceded by a sensation of falling.

6. STAGE 2 • Stage 2 is the second stage of sleep and lasts for approximately 20 minutes. • Eye movement stops and brain waves become slower with only an occasional burst of rapid brain waves. • Body temperature starts to decrease and heart rate begins to slow.

7. STAGE 3 • Deep, slow brain waves known as delta waves begin to emerge during stage 3 sleep. • Stage 3 is a transitional period between light sleep and a very deep sleep.

8. STAGE 4 • Stage 4 is sometimes referred to as delta sleep because of the slow brain waves known as DELTA WAVES that occur during this time. • Stage 4 is a deep sleep that lasts for approximately 30 minutes.

9. REM STAGE OF SLEEP • In the REM period, breathing becomes more rapid, irregular and shallow, eyes jerk rapidly and limb muscles are temporarily paralyzed. • Brain waves during this stage increase to levels experienced when a person is awake. Also, heart rate increases, blood pressure rises, and the body loses some of the ability to regulate its temperature.

10. REM STAGE OF SLEEP • This is the time when most dreams occur, and, if awoken during REM sleep, a person can remember the dreams. • Most people experience three to five intervals of REM sleep each night.

11. DELTA SLEEP • Stages 3 and 4 are referred to as deep sleep or delta sleep, and it is very difficult to wake someone from them. • In deep sleep, there is no eye movement or muscle activity. • This is when some children experience bedwetting, sleepwalking or night terrors.

12. DELTA SLEEP • Delta Sleep is associated with: • The production and release of Growth Hormone necessary for tissue repair • The production and release of Serotonin which is a neurotransmitter necessary for reducing a persons perception of pain

13. FIBROMYALGIA: Linked to Sleep Disorders • In 1975, two Canadian physicians and researchers, Harvey Moldofsky, MD, and Hugh Smythe, MD suspected sleep disorders as a factor in Fibromyalgia. • They conducted sleep studies to prove their theory

14. FIBROMYALGIA: Sleep Disorders • Using an EEG they measured the brain waves of fibromyalgia patients when they slept • The EEG can demonstrate when a person moves in and out of Delta sleep • In the study it was found that the patients with Fibromyalgia were unable to go into Stage 4 sleep

15. FIBROMYALGIA: Sleep Disorders • Another one of their studies involved awakening healthy people and disrupting their sleep pattern as they entered Delta sleep. • They found that the healthy subjects developed fibromyalgia symptoms when their sleep was disturbed, but the symptoms subsided when they were permitted to sleep undisturbed.

16. FIBROMYALGIA: Sleep Disorders • They concluded that many of the symptoms associated with fibromyalgia were related to the disrupted sleeping patterns and the inability to enter deep sleep

17. Muscle Abnormalities Linked to Fibromyalgia

18. FIBROMYALGIA: Muscle Abnormalities • As we go through the coarse of the day our muscles are constantly experiencing micro traumas. • Walking, bending, sitting still for too long creates muscle damage which is repaired each night when we sleep • Growth hormone which is important in muscle maintenance and repair, is secreted during Delta Sleep

19. Muscle Abnormalities of Fibromyalgia are Linked to Sleep Disorders • Robert Bennett, MD, analyzed the connection between sleep disorders and muscle damage. • The research of Dr. Bennett indicates that most fibromyalgia patients have a growth hormone deficiencydue to the inability to enter Delta Sleep • Recall that Growth Hormone is produced and secreted during Delta Sleep

20. Muscle Abnormalities of Fibromyalgia are Linked to Sleep Disorders • Low levels of Growth Hormone due to the inability to enter Delta Sleep results in an inability to repair the micro traumas that occur to the muscles each day • This effect is cumulative resulting in the muscle abnormalities and disorders typically observed in Fibromyalgia • These abnormalities and disorders are a primary source of pain

21. Muscle Abnormalities of Fibromyalgia are Linked to Sleep Disorders • According to this research, the primary goal in addressing the muscle pain of Fibromyalgia should be to re-establish proper sleeping patterns that allow the patient to enter Delta Sleep

22. Fibromyalgia and Pain Perception

23. FIBROMYALGIA: Pain Perception • Pain signals are generated by tissue damage in the body • The muscle damage of Fibromyalgia creates electrical signals that are transmitted to the brain and perceived as pain • The more of these electrical signals that make it to the brain, the more painful the experience

24. FIBROMYALGIA: Pain Perception • The human nervous system can modify these electrical signals reducing the number of these signals that make it to the brain. • This modification of the signal reduces the patient’s perception of pain • This is why some people are more tolerant of pain than others

25. FIBROMYALGIA: Pain Perception • In order for the nervous system to do this it needs a neurotransmitter known as Serotonin • Serotonin reduces the intensity of pain signals in the nervous system. • Serotonin is related to Delta sleep • As a person goes into Delta sleep, serotonin is released in the nervous system

26. FIBROMYALGIA: Pain Perception • If a person is unable to enter Delta Sleep their levels of Serotonin are reduced resulting in an inability to reduce the pain signals and a heightened perception of pain • The disrupted sleeping patterns of a Fibromyalgia patient may result in low levels of Serotonin and may explain why these patients seem to be in constant pain

27. FIBROMYALGIA Tying it all togerther

28. TYING IT ALL TOGETHER • Sleep studies have demonstrated that people suffering with Fibromyalgia are unable to enter Delta Sleep • Delta Sleep is responsible for the production of: • Human Growth Hormone; and • Serotonin • Therefore, the sleep disorders associated with Fibromyalgia result in decreased levels of these substances

29. TYING IT ALL TOGETHER • Human Growth Hormone is responsible for repairing the tissues of the body damaged by micro traumas associated with daily activity • Without Human Growth Hormone these micro traumas go unrepaired resulting in muscle abnormalities and disorders commonly associated with Fibromyalgia • These muscle disorders are a primary source of pain

30. TYING IT ALL TOGETHER • Serotonin is a neurotransmitter produced during Delta sleep and responsible for reducing a patient’s perception of pain • Low levels of Serotonin caused by the inability to enter Delta Sleep cause a heightened perception of pain such as what we see with Fibromyalgia

31. TREATING FIBROMYALGIA The primary goal in the treatment of Fibromyalgia is to normalize sleeping patterns allowing the patient to enter Delta Sleep

32. FIBROMYALGIA AND NEUROFEEDBACK WITH BRAINCORE THERAPY • Neurological Dysregulation of brain waves may be the cause of the disrupted Delta sleep as well as the abnormal levels of serotonin and human growth hormone • Neurofeedback teaches the patient how to regulate their brainwaves resulting in a more balanced pattern

33. RECENT RESEARCH • Neurofeedback in fibromyalgia syndrome.Kayiran S, Dursun E, Ermutlu N, Dursun N, Karamürsel • Kocaeli University, Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Kocaeli, Turkey.

34. Neurofeedback in fibromyalgia syndrome • “We applied a NFB protocol on three patients with Fibromyalgia Syndrome (FMS). • Most of the symptoms were decreased after ten sessions. • There was also improvement in all of the scales after the treatment.”

35. NEUROLOGICAL DYSREGULATION Abnormal Brain Wave Patterns

36. NEUROLOGICAL DYSREGULATION • Brainwave Imbalance • May be caused by: • Variations in brain structure • Drugs • Toxins • Poor Nutrition • Subluxation • Trauma • Stress – both physical and emotional

37. NEUROLOGICAL REGULATION • The ability of the brain to regulate itself • Mental states are associated with specific brainwaves • These brainwaves include: • Delta • Theta • Alpha • Beta

38. DELTA BRAIN WAVES • Produced during deep sleep • Associated with the release of Human Growth Hormone and Serotonin

39. NEUROFEEDBACK • Neurological Dysregulation of brainwaves may result in disruption of the sleep cycle making it hard for the person to attain the Delta state. • Neurofeedback is directed at teaching the patient how to regulate and balance their own brainwaves

40. BRAINCORE THERAPY

41. THE BRAINCORE APPROACH • Painless • Drugless • Non-Invasive • And Has No Side Effects

42. THE BRAINCORE EVALUATIONA Window To the Brain • The EEG evaluation begins by placing surface sensors at specific sites on the scalp • These sensors detect brain waves and display them on the computer screen

43. THE BRAINCORE EVALUATIONA Window To the Brain • During the course of the next 10 minutes the patient is asked to perform several tasks while the BRAINCORE software monitors the brainwaves • A report is generated demonstrating imbalances associated with Insomnia

44. THE BRAINCORE TRAINING • Based on the patient history and the BRAINCORE EEG Evaluation results, a customized training program is designed for the patient • The training program is different for each individual case but typically it involves either training the patient to produce more of a certain brainwave or less of a certain brainwave

45. THE BRAINCORE TRAINING • During the training session the patient is connected to the EEG using the surface sensors and the patient’s brainwaves are displayed on the computer • On a separate monitor the patient is watching a movie that is being controlled by the patient’s own brainwaves

46. THE BRAINCORE TRAINING • The movie will only play if the patient’s brain is producing the desired brainwave • During the course of 20 training sessions, the patient’s brain learns how to produce the desired brainwave • This new ability is associated with the alleviation of the insomnia symptoms

47. THE BRAINCORE TRAINING • The best part is that the changes experienced by the patient are permanent! • It has been demonstrated that after 20 or more BRAINCORE training sessions, the brain actually remodels itself – a process known as Neuroplasticity

48. BRAINCORE THERAPY QUESTIONS

49. A GIFT