Psychologist, Tara Brach approaches therapy using mindfulness as the foundation to healing; she does this through a blend of westernized therapy and eastern buddhist practices. Her website www.tarabrach.com, has hundreds of free recorded talks, videos, and articles where she investigates different facets of the human experience; pain being one of them. In the video The Dance with Pain that I attached below, Dr. Brach explores the relationship between emotional and physical sensations when dealing with acute and/or chronic pain and discomfort. Dr. Brach reminds us when humans feel pain - they tend to contract against the pain, they judge the pain, and blame themselves, others, and/or the pain. However, this fight and resistance tends to create more physical and emotional pain/discomfort. Dr. Brach then goes on to clearly teach us ways in which we can mindfully inhabit our bodies and learn how to listen and respond to the pain with awareness and compassion.
Here are 5 amazing stories from 4 people who have struggled with some form of a disability. Each of their stories is unique, and presents the challenges they faced and the different experiences they had in accepting and growing beyond them. Apart from their differences, it becomes clear that they each grew to have something in common; a desire to live their lives to their fullest potential, regardless of the circumstances they found themselves in. Please take some time and listen to their stories, which are both courageous and inspiring.
Nick Vujicic was born with tetra-amelia syndrome, a rare disorder characterized by the lack of all four limbs. In this video Nick talks about his struggle with his disability until he was 17 years old, when he fully accepted his condition and started his non profit organization: Life Without Limbs. Nick now presents motivational speeches around the world, where he focuses on what is is like living with a disability, finding ones purpose and being hopeful throughout all of our challenges.
This video tracks the progress of Arthur Boorman - a disabled veteran from the Persian Gulf War (1990-1991) on his quest to regain control of his life. When Arthur decided to take control of his life choices he was 297 lb., was using crutches, leg braces, needed to wear a back brace, and had sleep apnea as well as other symptoms of poor health. With a ton of hard work, mindful dietary decisions and support, in less then 6 months Arthur lost 100 lb. and gained back his strength. Watch Arthurs transformation which has inspired so many people to take control of their life - no matter what situation they find themselves in.
Phil Hansen talks about his difficult journey with art after he developed a tremor in his hand that limited his ability to use the pointillism technique which he loved, and used to depict his own artistic style. Hansen had to make a tough choice; abandon art or to embrace the shake and go beyond it.
Aimee Mullins who has broken records at the Paralympic Games in 1996, and now has created a career in the realm of acting, modeling and activism gives a talk about her experience wearing prosthetic legs - and the ways they have helped her make the many achievements she has.
There are three types of chronic pain problems:
Our bodies experience pain through a combination of chemical messengers, emotions and the thoughts that communicate through pain pathways.
Pain signals can change depending on how quickly or slowly the messages are being sent. There is also a possibility for pain signals to be fired after an individuals injury has been treated or removed. This means that the magnitude of the tissue damage may not be compatible with the experienced sense of pain. Some of the reasons healed tissue can remain sensitive (thus leading to chronic pain) may be due to: post surgical scar tissue, inflammation, nerve irritation and muscle spasms. There are also certain individuals who experience pain even if there is no tissue damage left due to a misfiring of a pain signal in the nervous system; this is due to the nervous system having been “conditioned” to continue sending pain signals (ex: phantom limb pain).
Gate Control Theory:
Pain is processed separately by the central nervous system (consisting of the brain and spinal cord), and the peripheral nervous system (outside the brain and spinal cord). Our peripheral nerves detect pain, touch, vibration, and temperature. These detections are then send down a pathway through our spinal cord and then to our brain. The brain then tries to make sense of the messages in order to decide how to respond to the pain. However, before the messages get to the brain, the pass down the spinal cord which has “nerve gates”. These gates can either open which would allow the messages to move freely to the brain, or the gates can close, which would inhibit the impulse going to the brain. As you can imagine, if the impulse is inhibited and the gates close, the result would be a decrease in pain sensation. Just the same, if the gates are open and the messages flow to the brain, then a person will experience more pain.
Additionally, the emotions and thoughts that the brain attaches to the experience of a sensation will determine how the pain is processed and even experienced. If the brain chooses to pay a lot of attention to the pain, then it will send signals to the spinal cord to open the gates which will amplify the pain. If the brain decides to ignore the pain, then it will send signals to the spinal cord to close the gates which will result in the decrease of pain.
Which Factors Cause the Pain Gates to Open?
Sensory Factors: extent of injury and/or degenerative changes, extent of scarring and other physical reactions to the original injury even after healing (ex: inflammation), muscle tension, re-injury, inactivity/de-conditioning, long-term narcotic use, poor body mechanics, poor pacing of activities.
Cognitive Factors: degree of focus on the pain, boredom, beliefs and attitude about the meaning of pain (ex: heart attack vs indigestion), perceived lack of control over the pain, focusing on the pain, having no outside interests, worrying about the pain, thinking about all the bad things associated with the pain, negative beliefs about your future.
Emotional factors: depression, anger, anxiety, stress, frustration, sadness, hopelessness and helplessness.
*At times of anxiety or stress, the descending messages from the brain may actually amplify the pain signal and the nerve gates as it moves up the spinal cord.
Which Factors Cause the Pain Gates to Close?
Sensory Factors: increasing your activity, short-term use of pain medication relaxation training and meditation, and aerobic exercise.
Cognitive Factors: outside interests, thoughts that help you cope with pain, and distracting yourself from the pain.
Emotional Factors: having a positive attitude, decreasing depression, being reassured that the pain is not harmful, taking control of your pain and your life, and stress management.
Understanding the biology of pain as well as the mind-body connection, gives us an opportunity to gain perspective on the mechanisms that are happening inside of our body. Understanding the mechanisms that produce sensations such as pain, as well as the ones which help decrease it, can help us make mindful decisions about how we can respond to our bodies.
"We are living in an age when sleep is more comfortable than ever, and yet more elusive.”
-David K. Randall
We all know the difference a good nights sleep has on our mind and body; we are eager to start the day, our senses are awake, and things that usually stress us out seem to be less problematic. Even though someone who is asleep appears to be seemingly lazy, a shut-eyed-organism is surprisingly filled with trillions of cells working to restore, rejuvenate, detox, and heal the body. Simultaneously, sleep also aids the mind in storing and processing memories, consolidating newly learned information, and helping with focus, creativity and decision making skills when awake. It’s no wonder then that humans, and every single other animal, needs restful sleep.
In his book Dreamland, David K. Randall informs us of how our quantity and quality of sleep underlies all of the decisions we make throughout the day, sleep also significantly impacts our emotional intelligence. Randall emphasizes that if we don’t get enough sleep, our body will keep score of the debt, and feel emotionally and physically fatigued until we get proper rest we need. “Humans need roughly one hour of sleep for every two hours they are awake, and the body innately knows when this ratio becomes out of whack. Each hour of missed sleep one night will result in deeper sleep the next, until the body’s sleep debt is wiped clean.”
Sleep is mandatory for our well being, especially when we are suffering from chronic pain — unfortunately, pain is also one of the leading causes of insomnia. Studies have shown that two-thirds of the people who suffer from back pain have insomnia; studies have additionally shown that disrupted sleep also worsened back pain. Insomnia and pain clearly influence each other, when one is impacted it seems that the other is as well. Another finding from the NSF 1996 survey, showed that people who experience pain AND sleep problems scored significantly lower in general mood, physical health, ability to handle stress, ability to get up and go, and their ability to concentrate compared to people who didn’t experience pain and sleep problems. The good news is that we have some control over our sleep habits, but first we need to learn which habits promote sleep and which ones obstruct it.
Here is a list of bad habits that you may need to get rid in order to get a better nights rest:
- Do not consume any caffeine in the late afternoon or evening. Caffeine is found in coffee, certain teas, soft drinks, chocolate and cocoa. Furthermore, here is some medicine that may also include caffeine:
- allergy, anxiety, depression, epilepsy, nausea, thyroid medicine
- cold, cough and decongestants
- Do not consume any tobacco products which contain nicotine not only stimulate the body and promote wakefulness, but they are also bad for your health.
- Do not drink Alcohol before going to sleep because it interferes with feeling rest due to blocking your REM sleep.
- Do not eat before going to sleep, it can cause indigestion, acid reflux and overall decrease the quality of your rest because your digestive system will be hard at work.
- Do not exercise during the 3-4 hours before going to bed. Try exercising in the morning, afternoon or during the early evening.
Creating an optimal sleep environment will also help you fall asleep and stay asleep. Here are some tips for doing so:
- The temperature of your bedroom should be on cooler side, not cold and not hot.
- Your bedroom should be quiet. If you have noisy pets or a partner who snores, try using earplugs, downloading a noise app (I like using a free app called Rain, Rain), or getting a white-noise machine to help mask other sounds.
- Your bedroom should also be dark, try covering your bedroom windows with dark curtains. You could also try wearing a sleeping mask.
- One of the most important things to consider is the comfort of your mattress. If you
are experiencing pain, it is really important to buy a mattress that suits your needs.
Create soothing bedtime rituals to ease your mind and body at the end of every day. Here are some rituals and activities you can experiment with before you go to sleep:
- Try to meditate, journal, or read something that helps you unwind.
- Listen to soothing music or a podcast.
- Do not watch TV, eat, pay your bills, send emails etc. in your bed. Create an intention to use your bed as a sleep sanctuary. (Having sex in bed is also ok).
- Try to go to sleep at the same time every single night, make sure your schedule is consistently the same 7 days a week!
- Try using an essential oil diffuser, a few oils that are known to promote calming and soothing effects on the mind and body are lavender, cedar wood, chamomile and bergamot.
- Drink teas that promote sleepiness, such as chamomile, lemon balm, lavender or Sleepy-Time tea blends.
- Take a hot shower or a nice bath before going to bed. Add episome bath salts to help relax any muscle soreness.
Whatever you decide to do for your last bedtime activity, try to keep in mind that it should promote calmness. Invest your time in figuring out what activities your body responds well too— and stick to those habits, your body will thank you!
NPR did a great piece on an integrated program that treats patients with chronic pain using exercise, nutrition and education. Sound familiar? The program is sponsored by Kaiser Permanente in response to the opioid epidemic and the growing concerns around using opiates as "front line" treatment for pain complaints. Restore Fx is proud to say that we have been providing this type of integrative care for the past 12 years! Listen to the podcast and we think you will see the similarities -- not only is their program interdisciplinary (as is ours) but it has all of the practitioners/healthcare providers in the same location functioning as a team (again, like ours!). Kudos to Kaiser for making this program available to its clients in Colorado. We hope that other insurance providers take note and start to offer this kind of care to their clients.
We all get angry sometimes because we don’t live in a perfect world; in fact, we live in one that is constantly changing moment to moment. This means that our environment, our communities, our friends, our family, our bodies, are all under this influence of change and thus we are having to respond to that change; in ourselves, and in those around us. If you don’t like a change that has happened to you, or around you, the natural emotional response may be to feel anger. Living with chronic pain is a hard change to endure, not only physically, but emotionally, and spiritually. Because of this inner struggle, there may be times when anger seems like a distraction from the pain,sometimes it may even seem reasonable to be angry at the diagnosis, your doctors, those who don’t understand, etc. Even though anger may feel good in the moment, there are many negative consequences that it can have on your physical health, mental health, and your relationships with others.
Anger is inevitably felt when we feel we are under threat, being treated unfairly, or when we feel that an injustice has occurred. Someone who is experiencing chronic pain is likely to be feeling mild to severe stress in their body already, which can make it even harder for them to manage their anger. Learning anger management techniques can help you avoid the negative effects anger may have on your health, and your relationships. Knowing how you express your anger, can help you to prevent destructive patterns and build a more positive foundation for communicating your anger. Here are three of the most common ways that people express their anger.
1. Passive Aggressive Anger: One form of anger that is relatively common, is passive aggressive anger. This form is expressed as a subtle behavior, and may occur in individuals who think it is wrong to directly express their anger. Instead they mask their anger with an affectation of passive aggressive behaviors such as sullenness, withdrawal, procrastination, and stubbornness. For example, if you were to ask a passive aggressive coworker if something was wrong, they would most likely reply “nothing”. However, they may be exhibiting signs that something is clearly wrong by giving you the silent treatment, subtly insulting you, or not finishing a task they were given.
2. Aggressive Anger: Aggressive anger is much more direct. Aggressive behavior can be manifested physically, verbally and/or emotionally, and the person who is on the receiving end usually feels abused, bullied, and/or threatened. Aggressive anger can permanently damage relationships because it may arouse strong fear, mistrust, and violence. Considering that aggressive anger is emotionally charged with
intense stress or fear, it can cause the “fight, flight, freeze” response in those involved.This creates a situation where effective communication and the ability to resolve tension is no longer an option.
3. Assertive Anger: Assertive anger positively acknowledges negative feelings and allows for constructive communication. Assertive anger arises out of a core belief that both oneself and the other person(s) involved in the conflict should be respected. The goal with assertive anger is to create healthy boundaries within that relationship. A way to picture what assertive anger looks like is to imagine yourself setting an assertive boundary. Assertive boundary setting could be directed at others, or even oneself (as
silly as that may seem). However, when you think about it, we are in a lifelong relationship with ourselves, and assertive boundary settings can be beneficial in sticking to new personal goals, stopping yourself when you notice negative self-talk, and ultimately being kind to yourself. If you aren’t used to setting boundaries, it is important to remember that this act is ultimately done for the benefit of all people who are involved — setting boundaries with others explicitly teaches them about your needs in a safe, respectful way. For example, if someone is experiencing chronic pain, and has a family member who persistently asks them to do physical activities beyond their comfort level, It is completely fair and healthy to create an assertive boundary and say: “No, I absolutely can not do that, please stop asking me. I will let you know when I feel better and am able to take part in that. If you want to spend time together let’s do something that is easier for me to approach right now”. It is easy to get angry and feel helpless when we are in pain and feel that people don’t understand us. This is why it is important to be able to clearly explain our boundaries and feelings. Before practicing assertive boundary setting, we need to identify the distorted beliefs that may push us towards a more passive aggressive or aggressive style of anger management. By identifying distorted beliefs, we can look for these distortions in our own patterns of thinking and therefore challenge these thoughts when we experience them. These underlying irrational and distorted beliefs prevent us from having healthier, constructive discussions about our feelings by undermining our efforts to regulate conflicts.
Some of our common irrational beliefs are to: “awfulize” situations, or take part in “I-Cant-Stand-It-Itis”, “blaming” or “feeling entitled because of the pain we are experiencing”. When we use these irrational and distorted beliefs as scapegoats for our anger, it can escalate our negative emotions and prevent us from finding a more appropriate way to solve our problem. An example of a irrational belief is: “If someone
does something that hurts me, they must be a bad person”. This sort of black-and white thinking may happen very quickly, and thus distort the way we perceive the situation we are in. If we are able to mindfully pause when we are riled up, we can try to question the validity of our underlying beliefs. For example: “If I believe someone who does something to hurt me is a bad person, then that also means that only good people can perform good acts, and good people would never do anything bad. I am
also assuming that bad people can only perform bad acts.” Checking for the validity of our beliefs can show us the assumptions we are making when we are emotionally triggered with anger and help us calm down and respond more appropriately.
Understanding our anger and learning how to manage it is important because at some point in our lives, we are bound to experience people treating us unfairly, not getting our way etc. If we respond to stress and conflict in a mal-adaptive way we can actually worsen things, make ourselves miserable, increase our stress, and find ourselves in a repetitive and exhaustive cycle of being either passive aggressive or too
There are many ways to help yourself when dealing with anger, these are some of the approaches and activities that can help you calm down when experiencing anger:
In conclusion, anger is a natural human emotion that we aren’t supposed to suppress, or get overly attached to. Instead, the goal is to learn from it. If we investigate our anger there is always an underlying need that is not met. When we can identify that need through awareness and compassion, we are more likely to be able to communicate that need, set appropriate boundaries, and feel more in control of our
life. In order to learn how to use assertive anger and boundary setting, you need to practice those skills. It may surprise you to see how people tend to respond well to this form of expressing oneself — they may even admire the courage you are displaying by taking greater care of yourself and of your relationships. When you channel your anger in a healthy manner, you will have greater mental clarity, emotional ease, and physical calmness that will allow you to actually approach your chronic pain and listen to your body with care, kindness and wisdom.
“Each time you meet an old emotional pattern with presence, your awakening to truth can deepen. There’s less identification with the self in the story and more ability to rest in the awareness that is witnessing what’s happening. You become more able to abide in compassion, to remember and trust your true home. Rather than cycling repetitively through old conditioning, you are actually spiraling toward freedom.”
― Tara Brach, True Refuge: Finding Peace and Freedom in Your Own Awakened Heart
There has been a lot of research coming out on loneliness as a risk factor for health and longevity. Some studies have even gone as far as to say that loneliness is a higher risk factor for mortality than cigarettes. So what does social support (or it’s inverse, loneliness) have to do with chronic pain?
Well, there have been studies done on this subject and the results probably won’t surprise you. For example in one study of almost 200 patient, people who described their families as being supportive reported significantly less pain intensity, less reliance on medication and greater activity levels (Jamison,R., Virts, K. The influence of family support on chronic pain. Behaviour Research and Therapy. 1990. Volume 28, 4, 283–287). Several other studies have found that a lack of social support is associated with higher levels of depression and poorer pain adjustment (Campbell, Clauw & Keefe, 2003; López-Martínez et al., 2008; Romano, Turner & Jensen, 1997; Tsai et al., 2003).
So what can be done with this information if you are living with chronic pain? Check your social support network. Who do you see every day? Who can you call if you need help or a favor? If your social circle has dwindled down to one or two people then it’s probably time to expand it. Thanks to the internet there are all kinds of “Meet-Up” groups one can find, for everything from learning to macramé to people who love poodles. Or consider checking out a church, synagogue, mosque or temple. Religious and spiritual communities can be a great place to meet others and feel supported. Volunteering is another great way to meet new people as well as take the focus off of yourself. You can check out volunteer opportunities in Austin at www.volunteermatch.org or http://www.austin360.com/entertainment/night-life/austin-volunteer-opportunities/d73i07tUhqIJcz63ZPD74I/. Or contact your favorite charity—The American Red Cross, American Diabetes Association, American Cancer Society, Easter Seals…the list is practically endless. Even if your chronic pain keeps you from working you can probably find a volunteer situation that would work for you. It may be sitting for an hour stuffing envelopes for a charity drive or taking calls on a help line. Or sorting donations for a church garage sale. The opportunities can be one-time or repeating. You would be surprised at how much you can get out of giving back to others, even when you yourself are not feeling so great.
I hope that this topic inspires you to do a wellness check on your social support and take action if it is lagging. Your pain will be less and your spirits will be better!
Yours in health,
The following article is from Shreveport Times and is a great overview of the problems with treating pain in this country. The opiate epidemic has clearly shown that throwing medications at pain patients is short-sighted and ineffective. It's time to mainstream Functional Restoration programs like Restore Fx and make them the gold-standard for patients with persistent pain problems.
If opioids aren’t the answer for treating chronic pain, what is?
Krista Jordan, Ph.D., ABPP