Stage Zero: The Foundation

Before we can address the causes of chronic pain, we have to learn to observe ourselves  honestly, compassionately, and without flinching.

By Brehan Crawford, MAcOM, LAc  ·  Crawford Wellness

Fibromyalgia Protocol Series:  Stage 0  ·  Stage 1  ·  Stage 2  ·  Stage 3  ·  Stage 4  ·  Movement

What fibromyalgia is — and what it is not.

Hello and welcome to our fibromyalgia program. My name is Brehan Crawford — I'm a licensed acupuncturist with over 15 years of training and experience helping people overcome chronic health conditions. In this series, we're going to unpack the different causes of the chronic pain and fatigue that often get labeled as fibromyalgia, how to address those underlying causes, and how to find lasting relief from symptoms.

Many of these concepts will also apply to people struggling with conditions that are comorbid with fibromyalgia — chronic fatigue, irritable bowel syndrome, long-haul COVID — or that share some of the same underlying causes, like certain autoimmune conditions.

Fibromyalgia is a diagnosis of exclusion. It has no set diagnostic criteria. When you receive this diagnosis, it basically means that you're in pain but your provider doesn't really know why. There is a lot of research into various causes — tests like FM/a, hypotheses around autoimmunity, toxicity, genetics — but despite this, no comprehensive understanding of all the pathomechanisms exists, and there's no single effective treatment in the conventional medical sphere.

As a result of this confusion, patients often get gaslit by their providers into believing the pain is made up or "all in their head" — and are frequently shuffled out the door with a prescription for an antidepressant or a referral to a specialist who offers only more questions and no solutions. Maybe a script for drugs that come with undesirable side effects and may not even be effective at controlling all of the pain.

"If we take a step back from the hamster wheel of industrialized medicine, we're able to corroborate the biomedical evidence with a mature paradigm of holistic understanding — a whole-systems approach that allows us to identify multiple causes and walk each one out of your body."

— Brehan Crawford, MAcOM, LAc

Why We Address Fibromyalgia in Stages

The context is everything. Some causes may apply to you, some may not. Two people who present with the same symptoms may have different underlying causes — and two people with the same underlying cause may have different symptoms. Take what applies to you and leave the rest behind.

This is why we work in numbered stages. Not everyone will need every stage. But this article is called Stage Zero because it is foundational to all the others. The therapies across this series fall into four categories:

What Fibromyalgia Is NOT

It is not all in your head. As we unpack the various causes of chronic pain through this series, you'll come to understand why depression is often associated with fibromyalgia but separate from it. You'll understand why a positive mindset is helpful but needs to be grounded in reality.

The desired outcome: a life free from pain and full of energy and opportunity. The understanding of your own history and the ability to write a new narrative for your life going forward. Making the necessary changes takes physical, mental, and emotional capacity — and you may already be overloaded. Most of my patients with fibromyalgia are when they come to see me for the first time.

So the first thing we're going to do is help you take a breath of fresh air.

Observing Your Breath

Because we address fibromyalgia in stages, we need to know which stages apply to you. One of the ways we differentiate them is by observing your breath. Sit still in a comfortable position — you can lie down if you want to, just make sure you don't fall asleep.

Close your eyes and turn your gaze inward to notice when you breathe in and when you breathe out. Later on in this series, we'll teach you to breathe in specific ways to change your physiology and your body's perception of pain. But before we can go there, I'd like you to just take a minute to tune into your own body and notice how you are breathing.

As you continue to notice your breathing, you may notice that it starts to get easier. Yes, you are probably subtly interfering with it while you listen — that's both inevitable and okay. Watching without acting is a practice that takes time, but it will develop your ability to trust your subconscious and your own intuition. It connects your active mind and your body's innate animal intelligence.

The key point: Observe and accept your inner state — including all of the pain you may currently experience — without immediately jumping in to try to change it. Notice how you're breathing. When you're breathing in. When you're breathing out. When you're holding your breath and not breathing at all.

You may notice areas of pain. If you're holding part of your body tight, you don't have to try and let it go just yet — but notice where it is. Give that pain a quality. Is it sharp? Dull? Burning? Electrical? Does the pain wander around, or is it fixed in place? It's okay for it to be more than one of these. We will address each of them in time.

Understanding the Basics: Nitric Oxide and Your Staging

Very often, the first time people practice the breathing observation exercise, they begin to feel very uncomfortable — like their pain is actually getting worse. Believe it or not, this is normal and it means you're actually doing it right. In each stage of this process, we'll get more deeply involved in the tools you can use to directly relieve the states of infection, inflammation, disease, or disharmony in your body. But we have to start with these basics first.

If you've ever studied a traditional discipline — martial arts, a musical instrument — you'll remember your teacher saying that advanced practice is merely repetition of the basics. You can learn all the fancy flips or chords in the world, but if you cannot stand and walk with a root or practice your scales, you cannot advance. We are covering the basics first because in medicine, it's really easy to get lost in the weeds of complexity.

Ultimately, we are using nitric oxide as a signaling gas to determine the perception of pain. Your body needs to hit a sweet spot of nitric oxide to function correctly — too much means no pain signal; too little means excessive pain.

Take Notes on the Following

✦   Are you holding your breath until you think about breathing, or do you naturally breathe in and out easily?

✦   When you breathe, do you tend to yawn more (breathing in more than out) or sigh more (breathing out more than in)?

✦   What kinds of pain do you currently feel? The most common types with fibromyalgia are: wandering pain, dull achy pain, electrical/burning pain, and sharp stabbing pain.

"The most complicated disease states often take many years to develop to a place where they can be concretely diagnosed. But learning the basics now can make it so that you never get the diagnosis — and in fact you stop seeking one out, because your symptoms are going away and you've healed yourself to become truly well again."

— Brehan Crawford

The Practice of Gratitude and Compassion

I know this can sound hokey or new-agey — but there is solid evidence behind it. It's also very well grounded in medical traditions spanning thousands of years. Having worked with thousands of patients over the last decade, I can say with complete integrity that this is a foundational step for everyone. If you have already developed a robust practice of meditation, compassion, or gratitude, this will probably come easy for you — but please try it anyway, because this method is probably framed a little differently than you've done it in the past.

If you're watching this, there's a good chance you are suffering and have been for a long time. But as we know, it can always be worse — and in many cases, we've been so afraid of things getting worse that we imagine ourselves living in that future where our health, our lives, our relationships have degraded even further. That fear causes tension and dissociation, which cause us to make ill-informed, fear-based decisions — which then create the dystopian future we've been dreading the whole time. And all the while, we've been missing out on the good stuff.

If it can always be worse, it can always be better too. This is where we point ourselves toward better.

The Journaling Practice

Take out a pen and a sheet of paper. You're going to do this for several days in a row, so you might want to start a special journal for it. I like to look back at what I've written over the years — notice how things have changed, how my priorities have shifted, how what I wanted to come true has, and how my perspectives have matured.

A Note on Emotions

Emotions will often come up as we dig into old wounds and fears — and this is good. They're usually feelings we've been keeping locked down inside ourselves for a long time. As we become stronger, more open, more resilient, we're able to grieve for what we have suffered and lost — and then to be free from those wounds as we choose a new path for ourselves.

I used to think that when my mind was calm, I would be completely without emotion and find peace. I would get very frustrated when I experienced disappointment and felt anger or grief. My mentor used to tell me that old emotions in your body were like a constipated bowel movement. As we eat food and break it down, our body in its best state of health keeps what it needs and eliminates the rest. Some people can eat junk food and seem healthy because they detoxify efficiently. The same is true of life experience.

When we're able to feel the grief, sadness, anger, or fear that our bodies create from everyday life — really acknowledge it and let it go — we hang on only to what we need to mature, grow, and become more grounded. The emotional backup has real physiological effects. This practice will help you unpack and release any of that sludge that's holding you back.

Tracking Your Progress

Now that you've completed these two foundational exercises — the observation of your own breath and the practice of gratitude and compassion — you're ready to get started with Stage 1 or whatever stage is appropriate for you. Make sure to incorporate these practices every day as you move through the rest of this series.

Use your journal to track your symptoms daily. Note:

We're not looking for massive or immediate improvement — that does happen with fibromyalgia, but it's unusual. We're also not looking for a straight line back to vibrant health. It's very normal for this to be a two-steps-forward, one-step-back kind of thing. Just be consistent and persistent. Consistency and persistence over time is usually what wins.

It's normal to have setbacks or flares in symptoms — these can be triggered by new causes of inflammation like a viral infection, a new injury, periods of prolonged stress, or even very strong acute stresses. When this happens, come back to Stage Zero. Work your way back through any applicable stage again. It'll usually go back into remission much faster the second time around.

Ready for the Next Step?

Continue to Stage 1: Wind & Dampness

Now that you have the foundation, it's time to address the first pathological factor behind fibromyalgia wandering pain — chronic infections, Epstein-Barr virus, and biofilm.

Full Series:  Stage 0  ·  Stage 1  ·  Stage 2  ·  Stage 3  ·  Stage 4  ·  Movement