New criteria proposed for diagnosing fibromyalgia

Fibromyalgia: pain perception and recollection

Pain perception has a lot to do with how we cope with pain. It is just a fact. Pain has an emotional factor to it. We are limited in our capacity to function. And as a result, we develop ideas about our pain experience. But remember this always, pain memory is fallible. Someone with temporary pain, years later, cannot truly remember the feeling of that level of pain. And likewise, our pain memory isn’t always clear or accurate. In the Now yes. In the Now, we know our level of pain and its impact. Pain a year ago? Not as much. It is influenced by the perception of our functionality at that time and the emotional impact the pain had on us. And for that, we can be thankful. To not remember in detail the level of pain at every moment in our lives. But it seems with fibromyalgia we are very aware of the fact pain is variable. And that we have a baseline pain. And this is congruent with my experience of fibromyalgia.

Fibromyalgia: Pain perception and recollection

So here is the Study. 

The goal: To look at our recollection of past pain experiences over time. Basically, our own assessment of our pain may affect how we remember the pain.

572 women with FM were included in the study. Of course, it is an issue that men were not in this study as we feel pain differently.

Increasing research suggests that memories of painful experiences are “more powerful predictors of future pain than the actual previous pain experiences,” researchers said.

“These findings engender questions of what pain recollections truly reflect, how pain recollection differs by populations, what factors moderate pain recollection accuracy and how they operate similarly across differing populations,” they stated. Fibromyalgia News Today

We know that our pain perception, our pain story, impacts how we think about future pain. And I know depression skewed that for me such that I thought future pain would be unbearable due to past painful experiences that were high. Yet, knowing pain is variable and we have coped in the past can help us predict we will cope in the future.

They studied EP (experiential pain)- an assessment of our pain at the moment that was recorded over a year five times.

HPP (Historical Peak Pain)- they were asked to record the highest level of pain they had ever experienced

And, HVP (Historical Valley Pain)- when the pain was the lowest historically

This was compared to other pain rated. Like worst abdominal pain. Worst whatever pain historically.

What they found:

The authors found that pain recall in FM patients changes over time, with a tendency for a decrease of all FM pain experiences, which didn’t happen when patients were asked to recall other non-FM pain experiences.

Moreover, momentary pain experiences of those with FM are systematically closer to their lowest levels of pain than they are to their highest levels of pain.

So historically if asked about our pain in the present we are more aligned with our lower pain levels in the past. In other words, our baseline pain. That is just what it is. The pain we always feel opposed to the flares of pain that come with the variability of fibromyalgia. And I do think our perception of pain and recollection follows that path. Whereas other pains I have had, are more distinct to me.

The depressed people’s experience intrigues me since I had depression for a decade or so and it did change my perception of pain due to the suffering.

the accuracy in recalling pain levels was lower among depressed FM patients — this set of patients seems to have a tendency to inflate past peak pain levels and momentary pain, but not so with lowest pain levels. “Depression does not relate to inflations of all pain, but only peak recollections and present pain experiences,” the authors wrote.

So we do not exaggerate or inflate all pain when depressed, but we do inflate high pain historically and present pain. And this is because, of course, with depression, negative events are Easier to remember and we magnify things. We have a lot of emotional suffering and symptoms we deal with that make the pain experience so much harder to cope with. I recall these episodes of the worst pain I had when I was depressed easily, but I am aware that my FM had a baseline that existed all the time. In my case, the unmanaged migraines are what I remember the most. Because that was like torture to me. And why I had a hard time coping with working and functionality.

Other factors that influenced our recollection of past pain was our level of functionality and our lack of sleep. If we are immensely fatigued from the lack of sleep, our functionality will suffer and then we may perceive the pain as being more because we couldn’t do much. And when we cannot function we do tend to blame the pain and not other symptoms that can impact us severely. Or it was a bad day, but for other symptoms. Or a bad day with a lot of symptoms.

And this is the most fascinating part:

Over the year that patients were asked to recall their current FM pain compared to past FM pain experiences, all of them said their pain experience levels decreased. This suggests that the act of recollection might help FMS patients cope with their momentary pain levels.

Because current pain levels were always closer to lowest historical pain, it seems that “asking patients to report their average pain on ‘good days’ (pain at its least) might be a good reflection of their typical daily pain experiences,” researchers said.

Moreover, these results suggest “that memory related to pain might be a worthwhile target for intervention,” the study concluded.

Current pain tended to reflect our historical lows. And we often say, yeah, it is good right now. And really flares of pain are things we remember, but we know our baseline is relatively stable. So this doesn’t surprise me. What does surprise me is that we are not catastrophizing. We are not magnifying the entire pain story we have. Which is often a thing people think we do. But we are instead correlating present with historical lows. Aware we have a baseline pain. But the study is about being aware of this consciously I think. We have to know every day isn’t a bad day.

And this pain recollection aligns with the long-term study on pain severity with fibromyalgia. Where pain levels generally were consistent over time but other factors like sleep or symptoms could increase over time.

Obviously, comorbids skew these results. I know my baseline pain has stayed relatively the same over time. With an increase back when I was younger, but then fairly stable and then of course much worse with flares and allodynia. But add in chronic migraines and my pain load was too much. And I coped poorly with the combination of these two. And my pain recollection is very much all about these completely unmanaged migraines while trying to function at work. And how depressed it made me feel.

And I think we know our perception of past pain influences our present pain and our perception of future pain. And pain perception is influenced by things like mood, other symptoms, fatigue, functionality and so many other things. This doesn’t invalidate the actual pain experience though. We are in pain. We are limited. We do have to pace. The only real effect from this is that our perception of pain can influence our coping with current pain and our emotional suffering from pain. And the largest indicator I have had in my life that exemplifies this is depression. I was suffering more, I was dealing with the fatigue of the depression overlapping the fatigue of the migraines and fibromyalgia, I had low motivation and a lot of guilt, and very low functionality. My perception of the current pain and my future life of pain was grim indeed.

Without that immense level of emotional suffering my perception of pain is more aligned with my actual pain. I understand the variability of it. I understand the baseline of it. I understand the future will continue on as is unless compromised by another pain condition. I understand I cope well with baseline fibro pain as long as I pace. But there will be flares. And there will be really bad migraine days. Well, there will be migraines period. And coping is a difficult process at the best of times. But acceptance of the status quo enables me to live within my limitations. Of course, right now with the vertigo those limitations are severe, but that won’t last forever. I don’t think. But there is the point that symptoms can really do a number on us. Fibromyalgia isn’t just pain. Fatigue can be killer too. Lack of good restorative sleep is exhausting as well… Like you are dragging your body through the day.

Just know the story you tell yourself about your pain will influence your perception of pain past, present, and future.

See more:

The fire inside: What triggers flares?

Remission in fibromyalgia?

Research shows fibromyalgia and migraines, can worsen depression

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2 comments

  1. I have the hardest time explaining my level of pain…it’s so subjective. I completely agree “that our perception of pain can influence our coping with current pain and our emotional suffering from pain”. I try to take it one day at a time, but it’s easier said than done. Hugs to you Nikki!

    Liked by 1 person

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