This is a tricky question, one you may have heard others ask of you, or doctors tell you. It’s all in your head. You, of course, are the one feeling the pain. You know it is real.
I had a patient on Wednesday who described her pain as floating from place to place, where one day her legs would hurt, and the next day her left arm, and then it would be her neck and shoulders on fire. Some days her body hurt all over like the flu. She told me that she didn’t know how pain could move around like that and be real. Clearly this woman felt defeated, because she was fighting an enemy that couldn’t be seen objectively on something as clear as an MRI, and something that didn’t make sense according to what she had been told her entire life.
For her, it is interesting. She is a clear Type 1 in the fibromyalgia spectrum, Immune Hypersensitivity. Her pain feels like she has a flu, and in a way, her body has been stuck in the mode of an immune reaction to environmental stress for way, way too long. It has gotten to the point where all of her resources are being drained by the body constantly trying to fight off pathogenic factors. In any immune reaction there is some sort of inflammatory response, and with that response there is collateral damage to clean up afterward. Her body doesn’t get a chance to rest though, because it is constantly at war. The lymphatic system is getting pummeled and still trying to send resources to different areas of the body, diverting resources until her organs are suffering the consequences and the downward spiral continues.
Often this immune hypersensitivity type can be layered or a result of another primary factor. This may be the case if you have strong seasonal allergies, those floating pains, and a very stiff back of the neck. For this type, whether it is the primary cause or an additional layer, sweating is very good, but hot tubs are not that great. Icing or cooling parts of the body is especially damaging, as it further prevents the already taxed circulatory and lymphatic system from operating. Certain types of massage can be good, such as a percussive sort of “beating” massage, but certain massage types that drive blood further inside, such as deep tissue are going to be detrimental.
So is her pain real? Absolutely. Everyone feels some version of that pain when they catch a bad flu (although most people only get a glimpse of what she has been through). Just because it does not show up on an MRI does not mean it is not real, it just means we are not looking at the right criteria.