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    • Dec 29, 2023
    • 10 min read

Fibromyalgia Keeps the Score

Episode 25: Alcohol Use Disorder, Psychotherapy & Fibromyalgia: the Healing Path


Therapy in Session


Make no bones (or muscles, or fascia, or tendons) about it! My Fibromyalgia let's me know when it's about to flare. It is keeping score. And I think perhaps it is my only compass to let me know that I will be soon or have already overdone it. It's like it is secretly, inside of me, marking off - tick mark by tick mark - what I have done and decides on it's own what is too much and BOOM - I'm down! I can do nothing but sit, sleep, curl up with the pup and wait for everything to calm down.


If you have been reading my blog, you know that this is an on-going and ever-surprising disorder that seems to upend my daily existence. I write about: managing stress, diet, rest, and movement as the medicine to be able to live a quality life with fibromyalgia. However, I have not managed to fully grasp how to do all this and how to "get my life back". How to "think" about my life as a person with fibromyalgia is the biggest and most frustrating challenge. Yet, through all of this, I have neglected to mention the treatment to which I am most dedicated: psychotherapy.


I have been in therapy on and off for much of my adult life, but intensely and consistently for the past 2 years. Interestingly, my fibromyalgia symptoms didn't seem express themselves until I started dealing with my childhood trauma. It had been there the whole time, but when I started dealing with the trauma and the post traumatic stress disorder, or PTSD, from that trauma, I had my first recognizable "fibro-flare". I woke up one morning and my body hurt from head to toe. I had been sleeping in a guest cabin in the north woods of Minnesota and had had a particularly difficult online session with my therapist. I woke up the next morning thinking the problem was a bad bed and I thought all would be well when I got home - but nope! It wasn't the bed; it was me. Did therapy cause my fibro-flare? Or did it just prove to me that "the body keeps the score"?


LET'S BACK UP!

But, I need to back up a few months. There were other factors, besides therapy, that could have heightened my susceptibility to that first fibromyalgia flare-up. In March of 2022 I made the decision to cut down on drinking wine. This was one of the best decisions I have ever made. I had been a wine drinker most of my adult life and at this point, I was a 6 pm sipper until bedtime. By exactly one month later on April 20th, 2022 I had gone completely alcohol-free; and for 3 months I felt GREAT. I could think more clearly, I had more energy, I was naturally happier, things were more real, and life was grand!


But then the hammer fell. I'm trying to figure out why I had a major fibro-flare, one that made me realize something was wrong with my body, three months after quitting alcohol. The only thing I can come up with is that 1. I had a stressful therapy session, 2. I was in a time-crunch for the musical I was choreographing, and 3. perhaps, after three months of alcohol-free living, my central nervous system finally woke up from its nightly wine ritual. According to newer research, my wine consumption could have been keeping the fibromyalgia pain and other symptoms at bay. It appears red wine, especially, "decreased pain, tenderness, and anxiety levels. In addition, ...[there were] improvements in sadness, depression, and overall quality of life". Perhaps, this instance of self-medication was actually working, but unfortunately, not in a wholistic manner.


ENTER ALCOHOL

Alcohol use for me was a symptom of greater and more detrimental problems in my life that required... requires therapy. I used alcohol to mask the pain from emotional, physical, and sexual trauma I sustained as a child, and as teenager and young adult. Drinking wine felt good! It helped with anxiety, sadness, and pain, and made me feel happy and free. But, of course, it is well known that long term use of alcohol has harmful effects.


So here we are at the crux of this whole blog; I am alcohol-free, I have consistent and painful fibromyalgia flare-ups, and I need therapy.


I think I can safely answer the question above: "Did therapy cause my fibro-flare? Or did it just prove to me that the body keeps the score?". To answer the first question, therapy did not cause my fibro-flare. It may have contributed to the stress of the moment and thus added to the probability of having a flare-up but, by itself, it did not cause that first fibro-flare. As to the second question, I believe , as the author of "The Body Keeps the Score" Dr. Bessel Van Der Kolk would say, my body was keeping the score. The alcohol was keeping the monster that is fibromyalgia at bay, and without alcohol, my central nervous system finally unleashed its fury as a result of my long time suppression of trauma.


Let's be clear, the fibromyalgia was always there. I had signs and symptoms dating all the way back to my pre-teens from "phantom pains" that put me in the hospital, to malaise that, after emotional or physical exertion, would have me in bed for days on end . I was labeled a hypochondriac as a teenager, and as a young adult, I would just tuck myself away, kind of check out of life, for a few days until I felt better so I wouldn't have to talk about it with anyone. Enter alcohol... and the pains mostly went away. But the unresolved trauma-drama that was my young life did not. Alcohol didn't necessarily exacerbate the emotional turmoil, but it didn't help me deal with it either.


THERAPY THERAPY THERAPY

As I stated earlier, I have been in and out of therapy most of my adult life. I have had limited success until recently with my newest therapist who is a "trauma-informed" practitioner. For the first few months we didn't talk about physical pain, alcohol, or even my PTSD. Mostly, we talked about my negative self-talk, my perfectionism, and how to simply get through the day. In these first few months, therapy became my week to week lifeline and without it, I felt like I was falling off a cliff.


So did I go from one dependency to another? Did I shift from wine as a lifeline to therapy as my savior. No. It is because of therapy that I realized I was struggling to feel the full range of emotions and I was unable to uncover the rot in my soul that was killing me. Six months into weekly sessions with my therapist, it dawned on me that I was only living half of my life and I was unable to access my deeper feelings because of emotional blunting, in all probability caused by alcohol use.


Emotional Blunting: "is a term used to describe having a limited or muted emotional response to events...With this symptom, you may also have difficulty accessing the full range of emotions that you’re used to." It is "the inability to experience both positive and negative emotions fully. It may also involve detachment, which refers to feeling distant from or not caring about others" or yourself.


So, I cut down, and then I quit. How easy that was for me is for another post. But 1 month after deciding that perhaps my wine habit was impeding my growth, I was done. I was free of 30+ year habit which opened the doors to a flood of emotions, a new level of healing, and ... the pain and exhaustion of fibromyalgia.


HOW DOES THERAPY HELP?

If now I have pain because wine isn't muting the fibromyalgia symptoms, how is therapy making a difference? Well, it is a whole-new-level of body awareness. Therapy taught me the "Spoons" theory (or maybe that was TikTok) for managing my energy, it taught me about catastrophizing and how that elevates stress, it has taught me to "reality check" my self-talk, and it taught me how to breathe in a manner that calms the heart rate and lowers stress. These are just four of the numerous techniques that I have worked through with my therapist. So how do they work:


The Spoon Theory

The Spoon theory is a way to describe the limited energy a person living with a chronic illness has each day. It was a theory identified and described by Christine Miserandino, a woman living with lupus, when trying to explain her available levels of energy to friends at a dinner party, hence the "spoons". Each spoon is a visual representation of the energy that could be expended. As energy available each day differs, so does the number of spoons. Each activity a person does requires a specific amount of energy, or SPOONS. For example: I need to take a shower. I have 7 spoons available for the entire day. It takes 2 spoons to complete the act of showering; that leaves me with 5 spoons for the rest of the day. It may seem limiting, but for those with chronic illnesses like lupus or fibromyalgia, managing daily tasks with a finite amount of energy is a practical reality.


Catastrophizing

To catastrophize is to imagine the worst possible outcome of an action or event. To clarify, catastrophizing is not the same as over-exaggerating; it can be a symptom of anxiety, depression, or chronic pain, all of which I have been diagnosed. But, before working with my newest therapist, this was my go-to strategy to deal with any and all possible events in my life. Yes, this had served me in the past. If I had imagined the worst, then when it wasn't that bad, I felt better. However, it has also heightened my levels of anxiety and depression, adding additional stress, and creating a vicious cycle.


Reality Testing:

Reality testing is: "the ability to see a situation for what it really is, rather than what one hopes or fears it might be". It challenges my tendency to catastrophize and fear the worst outcomes. It opens up the possibility that the world isn't as dangerous as I've believed, and each specific situation won't determine the rest of my life. This process alleviates pressure from my perfectionist tendencies and reduces my self-inflicted stress.


Breathing for Relief

As my students and I do at the beginning of each class, we deep breathe to engage the parasympathetic nervous system and help our bodies and minds know that we are calm and safe. This directly combats the sympathetic nervous system (both part of the autonomic nervous system) in its fight or flight response. Deep breathing has many benefits for everyone, but especially for a person like me with PTSD, anxiety, depression, and a chronic illness like fibromyalgia. According to the Cleveland Clinic, "In general, anything that increases your stress can trigger a flare-up". But, deep breathing eases stress and the benefits are immediate and lasting. Along with that, it can slow the heartbeat and lower blood pressure. Deep breathing is a simple, effective, and affordable intervention that can be performed anywhere at any time.


RECAP: My Roadmap to the Healing Path

  1. Fibro-Flare Insights: Fibromyalgia acts like a body signal, flaring up when I've pushed myself too hard. It's like an internal warning system, telling me to slow down when life gets overwhelming.

  2. Therapy's Eye-Opener: Dealing with fibromyalgia involves more than just managing physical symptoms. I found that exploring past trauma in therapy unexpectedly brought on fibromyalgia symptoms, showing how my emotions can affect my body.

  3. Alcohol's Role: Giving up alcohol was a big decision. It turned out that while alcohol made me feel better temporarily, quitting revealed the true extent of the fibromyalgia challenge. It was like taking off a mask and seeing what's been hidden underneath.

  4. Moving from Dependency to Strength: Quitting alcohol wasn't about swapping one crutch for another. Therapy became a tool for self-discovery, uncovering deep feelings buried by years of relying on alcohol. It's about understanding myself better.

  5. Therapeutic Tools for Fibromyalgia: Therapy isn't just talking; for me it is about learning practical tools. Things like the Spoon Theory (a way to manage daily energy), recognizing when I'm imagining the worst (catastrophizing), checking if my fears match reality (reality testing), and using intentional breathing can help me cope with fibromyalgia's challenges (deep breathing). It's like having a toolkit for navigating fibromyalgia's (flare) ups and downs.



Karen Palmen, EdD

If you enjoyed this post, share it with your friends and colleagues, and consider becoming a subscriber. If you have any tips or suggestions about how to better cope with chronic pain, leave a comment. I would love to hear from you!


Karen Palmen, EdD is a veteran educator in Saint Paul, Mn. She teaches Dance and English at Saint Paul Central High School. She has an active TikTok page that features humorous, political, mental health, and educational content (kickin it with karen2). And a a dormant YOUTUBE channel with the same name, featuring fermented foods and other cooking oddities.


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SOURCES


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Chan, Karmela. Fibromyalgia, American College of Rheumatology, Feb. 2023,


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Cleveland Clinic, Cleveland Clinic, 1 Jan. 2022, my.clevelandclinic.org/health/diseases/4832-fibromyalgia.


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Miles, Joshua. “What Is Reality Testing and Why Is It Important?” Counselling Directory,


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News Today, MediLexicon International, 11 Jan. 2023, www.medicalnewstoday.com/articles/315646#overview.


Pietrangelo, Ann. “Effects of Alcohol on the Body.” Healthline, Healthline Media, 16 Feb.


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Van Der Kolk, Bessel. “The Body Keeps the Score: Brain, Mind, and Body in the Healing of


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