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.
"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!
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
Then I looked at the research on gratitude and health. And I have to say I was IMPRESSED! Here are some amazing facts about gratitude. If these don't convince you to start a gratitude practice I don't know what will! When people tell me that they "don't have time" for things like going to the gym or doing yoga I often recommend a gratitude practice. While it won't lift your butt or make you bend like a pretzel it does have a lot of the benefits of exercise plus a few more!
1. 2-minute exercise
Think of three things that you are grateful for: that benefit you and without which your life would be poorer.Then, if you’ve got time, you can think about the causes for these good things.
And that’s it.
2. Simple steps
Try one or more of these grateful steps to happiness to take the 2-minute exercise a little further. They include:
Go ahead and give it a try. All you have to lose is pain and suffering.
Yours in health,
There is a lot of debate in the medical literature about which came first, anxiety or chronic pain? It's one of those chicken and egg situations. To me all that matters is that I can tell you, if you have been living with pain for more than 6 months you probably have some anxiety. It is not as important to me to know which came first because you are now living with both. And anxiety increases pain and pain increases anxiety, creating what I can a "death spiral" where without help the person just gets sucked farther and farther down into misery.
So let's assess the problem:
Anxiety is defined as 'A negative reaction of a person to stress, often leading to over arousal'
'An emotional state, similar to fear, associated with arousal an accompanied by feelings of nervousness and apprehension'
What is an anxiety disorder?
Anxiety disorders are a unique group of illnesses that fill people’s lives with persistent, excessive, and unreasonable anxiety, worry, and fear. They include generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), panic disorder, posttraumatic stress disorder (PTSD), social anxiety disorder (SAD), and specific phobias. Although anxiety disorders are serious conditions, they are treatable.
What chronic pain conditions and diseases commonly occur with anxiety disorders?
Arthritis —The amount of anxiety and mood disorders (such as depression) is higher in individuals with arthritis than in the general population. Some studies have found anxiety disorders are even more strongly associated with arthritis than is depression.
Fibromyalgia —In a recent study of 336 adults, published in the Journal of Clinical Psychiatry, those with fibromyalgia were almost 7 times more likely to have suffered from an anxiety disorder than those without the disorder.
Migraine —Migraines (and chronic daily headaches) happen a lot in people with anxiety disorders, as well as in those with mood- and substance-abuse disorders. Many studies have found that generalized anxiety disorder and panic disorder are particularly associated with migraines or other types of headaches. As with fibromyalgia, researchers have suggested that there may be a common tendency to develop anxiety disorders, depression, and migraine headaches.
Back Pain —Anxiety disorders and back pain often co-occur; back pain is more common in people with anxiety and mood disorders than in those without them.
Does chronic pain complicate the condition of a person who also has anxiety disorder?
An anxiety disorder and a co-occurring chronic pain disease can make a person’s health more difficult to treat. But a variety of treatments and lifestyle changes can offer relief. Possible health complications are noted below:
Chronic pain sufferers who also have an anxiety disorder may have lower pain tolerance or a lower pain threshold. People with an anxiety disorder may be more sensitive to medication side effects or more fearful of harmful side effects of medication than chronic pain suffers who aren’t anxious, and they may also be more fearful of pain than someone who experiences pain without anxiety.
What treatment considerations are made when someone has co-occurring conditions?
Many treatments for anxiety disorders may also improve chronic pain symptoms. Usually a comprehensive plan with a number of treatment types is necessary. Below is more information about some treatment options for anxiety disorders and chronic pain.
So don't be surprised if you find yourself worrying more, or even feeing symptoms of panic if you have been in pain persistently for six months or more. That is pretty common. But DO take anxiety seriously as it can have detrimental effects to your health (lower immunity, poor quality sleep, increased pain and crabby mood to name a few!). There is treatment for anxiety available so make it a priority. You will be surprised by how much lowering your anxiety level can also lower your pain.
Yours in health,
Adapted from: “Anxiety Disorders and Chronic Pain,” by Anxiety Disorders Association of America. http://www.adaa.org/gettinghelp/MFarchives/MonthlyFeatures(july07).asp
America is clearly embroiled in an opioid crisis. And the roots go back to over-prescription of pain medications by doctors who were either poorly informed, sadly deliberately mis-informed by Big Pharma or lacked the ethics to consider the long-term consequences of continuing to prescribe these dangerous medications. We at Restore Fx are committed to helping patients learn to manage their pain in ways that are SUSTAINABLE.
How can you determine what is a sustainable treatment for chronic pain?
At Restore Fx we have what we call the "pocket test": is it FREE? Because if it isn't you may not be able to continue to afford it at some point; is it PORTABLE? Because chronic pain follows you throughout your day-- to your work site, to the family reunion, to the church picnic and to your kids soccer game. So if you can't bring your treatment with you wherever you go, it's not of much use to you; and is it SELF-ADMINISTERED? Because if you have to go see someone to administer the treatment (i.e. massage, chiropractic, injections, surgeries or even renewing a pain medication prescription) what are you going to do when it's 3AM and your pain is through the roof? You need to be able to SELF-TREAT pain, wherever, whenever and even if you are alone at that moment. So if it doesn't pass the "Pocket Test" you may want to reconsider having it be a mainstay in your management of chronic pain. Imagine depending on chiropractic visits and then going on a family trip to another state. You wake up in terrible pain and have no other tools for managing the pain because your "go-to" is the chiropractor. I have no problem with chiropractic care, or massage therapy, or physical therapy or other treatments administered by other professionals. They can be great additional resources once you have some good "pocket-tested" tools.
What tools would pass the "pocket test"? At Restore Fx we teach mindfulness meditation, yoga, Pilates, stretching, self-massage, appropriate use of heat and ice, self-correction techniques, cognitive-behavioral therapy, nutrition and appropriate self-administered exercises. All of those things can be done on your own, without paying any money or seeing a professional. If you are not familiar with these tools you may want to look into our services or find a local provider who can teach you.
Wishing you health and wellness in your journey living with pain,
Dr. Jordan recommends the following article: http://www.foxnews.com/health/2014/10/21/write-your-way-out-chronic-pain/?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+foxnews%2Fhealth+%28Internal+-+Health+-+Text%29
Dr. Jordan recommends the following article that appeared in a recent issue of AADEP Advisor.
Bulging discs vs. herniated discs
from PRWeb via Digital Journal
With back pain causing more lost work productivity than any other medical condition in the United States, who hasn't heard the complaint, "Oh, my aching back?" But many people don't know the difference between bulging discs and herniated discs, two of the most prevalent spinal conditions triggering acute and chronic back pain, according to Praveen Kadimcherla, M.D., an orthopedic spine surgeon at Atlantic Spine Center....
Continue to the the full article here: http://www.digitaljournal.com/pr/2230077#ixzz3X8JnOVx3
Dr. Jordan recommends the following article that appeared in a recent issue of AADEP Advisor.
Fibromyalgia linked to decreased brain connectivity
from Medical News Today
Fibromyalgia syndrome is a common and chronic condition of unknown cause that mostly strikes in middle age, although symptoms can often present earlier. Sufferers typically experience fatigue with long-term pain in several areas of the body, plus tenderness in soft tissues such as the muscles, joints and tendons. We don't know why, but while men and children can also have it, the vast majority of those diagnosed with fibromyalgia are women.
Continue to the full article here: http://www.medicalnewstoday.com/articles/283346.php
For those of us who work in chronic pain it’s easy to see that patients who have persisting pain for more than 6 months almost always struggle with depression. And research has also shown that those who had depression before they developed pain are much more likely to have that pain become chronic. But the mechanisms linking these two disorders have not always been fully understood.
At Restore Fx we aim to provide the most research-based and current treatments for chronic pain. Our staff constantly reviews medical journals to inform our treatments and improve care for our patients. Just today I came across an interesting article that may help to explain the link between depression and chronic pain on a brain level. Researchers were able to stimulate increased release of serotonin (a neurotransmitter/brain chemical) in mice and found that it significantly reduced their sensitivity to pain. They did this through a clever use of light-sensitive neurons that produce serotonin. For more detailed information on their study please see:
Optogenetic Recruitment of Dorsal Raphe Serotonergic Neurons Acutely Decreases Mechanosensory Responsivity in Behaving MiceGuillaume P. Dugué, Magor L. Lörincz, Eran Lottem, Enrica Audero, Sara Matias, Patricia A. Correia, Clément Léna, Zachary F. MainenResearch Article | published 22 Aug 2014 | PLOS ONE
This may help to explain why taking an antidepressant helps in reducing pain. It’s also good to note that exercise, which is helpful in painful conditions such as arthritis, also reduces depression. So what’s good for your depression is probably also good for your chronic pain.
Stay tuned for more scientific advancements on understanding chronic pain and how to best treat it.
Wishing you well,
Krista Jordan, Ph.D., ABPP
Program Director, Restore Fx
Restoring Functional Life
Krista Jordan, Ph.D., ABPP