On a 4-mile run the other the day I ran my fastest first 2 miles in over 7 1/2 years. My fastest first mile, too. And I did it on asphalt and concrete in heavy sneakers I didn’t buy with the intention of running in. Factors that would have made me avoid running in the first place just 6 months ago.

And I’m fine. I’m more than fine, I’m awesome. Of course I’m a bit sore, but ‘my pain’ wasn’t affected at all. No flare-up. Not even a niggling reminder of it while I was running.

All this during a somewhat stressful time that in years past may have derailed me. No, that would have derailed me.

My best little buddy Buster is recovering from emergency surgery, which he had 3 weeks ago after suddenly becoming paralyzed. My best bud - a balm in times of stress

It was terrifying and heartbreaking

He’s ok now, recovering well. He has a lot of restrictions and I’m pretty much with him 24/7 because he doesn’t understand restrictions. He’s deaf, so even if I could explain it to him it’d be no use.

Needless to say (at least for dog lovers, or Buster lovers) it was stressful. The sudden paralysis and pain, the meeting with the surgeon, the MRI and immediate surgery, the 3 days that followed – Buster in the hospital with no humans to sleep with.

And Buster isn’t the only thing on my mind. My husband was diagnosed with skin cancer right before all this happened. He had melanoma removed from his chest the week before the Buster situation started and a basal cell carcinoma removed from near his eye last week.

It’s been a doozy of a summer. (Both my boys’ prognoses are good, no need for you all to worry.)

But somehow, my pain and anxiety have been ok

My pain didn’t flare-up and my anxiety didn’t spike despite all the worry. I’ve been good, able to take care of my two boys. And still run at that. Not just run, but run faster than I have in 7 1/2 years on surfaces I wouldn’t have dreamed of running on out of fear just 6 months ok.

I tend to think when I run and got to thinking about why that is.

My conclusion: I have the capacity to do this right now. I’m able to give them my full attention because my bucket isn’t overflowing. Pain is barely on my radar these days, let alone sapping all my energy and attention as in years past. And I have strategies in place to help me manage what life dishes out now that I didn’t have back then.

Stress

It got me thinking about an article I read recently on stress: “When is stress good for you? The subtle flows and toxic hits of stress get under the skin, making and breaking the body and brain over a lifetime“. It’s an excellent read, I highly recommend it.

Not all stress is bad, of course. Like with most things it falls along a continuum. Some stress is actually quite good for us. The kind of stress that allows us to grow, learn and adapt or to take chances on the things we want to do. Running is a good stress for me. So is writing.

Some stress isn’t good, per se, but it’s tolerable. We feel equipped and capable of handling it, even if we didn’t plan for it. Hitting publish on my blog posts is a tolerable stress for me. As has been this summer of unexpected surgeries for my boys.

Both good and tolerable stress are short term, impermanent. They come and they go, mediated by a whole host of physiological and behavioral responses. These responses are collectively called allostasis and it’s what helps us to maintain homeostasis, or balance, in all our systems.

Toxic stress

Some stress is toxic, though, to use the term from the Aeon essay.  It’s the kind of stress that comes but doesn’t go. And the physiological and behavioral responses that help us effectively cope with good and tolerable stresses stick around, too, but now they’re no longer useful and can even be harmful. This is referred to as allostatic load and it leads to disruptions in homeostasis. Things get out of balance. Or out of whack, as I prefer to refer to it.

My early years of pain were essentially years of toxic stress. I was way outta whack. Here’s some stressors I was not equipped to handle (for more deets, go here).

My allostatic load list ;)

  • Worsening, unexplained pain
  • The worry and fear surrounding the uncertainty about the pain and my future, anxiety
  • A couple years worth of unsuccessful treatments by a multitude of professions and professionals (that I “failed”, in healthcare vernacular, they never failed me, mind you)
  • Lack of sleep
  • Social isolation, loneliness and depression
  • Being inactive and not engaging in any meaningful activities
  • Relationship strain and financial insecurity (my husband was laid off soon after I went off work on comp)
  • Eventually losing my career and with it my identity and sense of purpose and feelings of worth
  • Insurance hassles and feeling doubted and disbelieved by healthcare providers, work comp adjusters and even some in my own department (devastating and shameful blow)

I didn’t have the resources to navigate all that, or any of it, really. Even little things we’re too much for me to handle because my bucket was overflowing in a deluge of  all of the above. I was lost, scared, worried, anxious – in allostatic overload, homeostasis out of whack, systems shutting down.

Does everyone have the same list? Of course not. But we all have a list.

Would everyone respond the same way? Certainly not. Some would have handled it much better, I’m sure. Perhaps some might have handled it worse (I hope not).  We’re all different. Some of us experience more stress than others and some of us perceive stress more than others, and that matters, too. Even our perception of stress affects our mortality. (Our perceptions are biology, too. For help changing stress perception, check this out.)

Real biological consequences

Toxic stress affects our biology and behavior over time. To learn more about the physiological effects of stress, give Robert Sapolsky, a former student of the guy who wrote the Aeon essay (cool right?) a listen. Here’s a recent lecture of his on Why Zebras Don’t Get Ulcers.

These effects of toxic stress happen across our lifespan. Even toxic stress as a child, even stress in the womb, can affect us in adulthood (this appears to be true for pain, unsurprisingly).

Epigenetic switches are flipped.  Endocrine (hormone) responses and immune function are affected, which in turn affect cardiovascular and digestive functions. Behavior and mood change. Neuroplasticity becomes maladaptive: dendrites atrophy, synapses are lost and the hippocampus shrinks (the hippocampus is associated with mood and memory); neurons in the amygdala become larger, a structure linked to anxiety and aggressionl and changes take place in the prefrontal cortex, an area related to self-regulation of mood, vigilance, impulse-control, working memory and cognitive function.

Our brains and bodies CHANGE. Homeostasis is affected under allostatic load, under toxic stress. This is surely related to and would affect, and be affected by, persistent pain. Ongoing pain can be particularly distressing, after all.

Downward spirals

There is much we can do to positively influence some of the effects of allostatic load and toxic stress and influence adaptive bioplasticity. But the hitch is that all of the effects listed above make it pretty damn hard to do the things we need to and can do.

When pain, fear and anxiety are up and mood and cognitive function are down, it’s not tough to see that engaging in anything can be hard going. When your bucket is overflowing, sometimes it’s all you can do to just keep yourself from drowning in the deluge.

It’ sucks that just when we need to engage in proactive approaches that could disrupt the cycles of stress and pain most, they’re often not even on our radar.

It’s not just about willpower and motivation. It’s not so simple as that.

There is so much I read in that article that I could see in my own experience. Pain, especially when it didn’t make sense and there seemed no end in sight, was very distressing. Everything that tends to come packaged with pain is pretty damn stressful, too.

Pain and stress aren’t two separate processes occurring independently of one another. I think it an error to look at anything going on in our human experience, not just pain, as being separate from every other part of our experience. It is all interrelated and all relevant (to varying degrees across time and across people, of course).

What I didn’t know back then

Pain – or stress or any human experience – is not in the brain or in a body part or in a single process, it’s in all of it. It’s in the person. Even more accurately it’s in the life of the person. We all exist within a social environment that has effects on us, too.

I had no idea how much a role stress was playing in the early years of my pain experience (hell, even in recent years). I wish I’d been clued in sooner. Instead, my stress ran amok – pain and anxiety along with it – wreaking havoc in body and mind, disrupting homeostasis, disrupting my life.

But hang in there folks! It’s not all doom and gloom. There’s good news in all this. I feel like I’m back in whack these days. Balanced. Homeostatic ;)

We DO have the ability to foster adaptive neuroplasticity and restore some balance in our bodily systems, even if it may be hard to start down that road. It’s a beautifully awesome thing. We have some power, some agency, over all this. Over our stress, our pain, our lives.

Nature is a refuge from stress for me

Rocky Mountain National Park – nature has always been my refuge 

Upward Spirals

Long before running was on my radar again I had days when getting out of bed was a success. When taking a shower and maybe helping decide what we were going to have for dinner (not even actually making dinner) were monumental achievements.

Back then I had little capacity for anything other than just getting through the day. My bucket was overflowing. Pain was all I knew, all I thought about, all I paid attention to.

Bit by bit, I started paying attention to things other than pain gain. And  I noticed that while I was attending to those other things, I wasn’t wholly attending to my pain.- a little adaptive neuroplasticity action right there. And that little bit opened up the possibility for more little bits.

It took me years to stop planning my life around my pain and start living my life with pain.But pain was always there, whether I was living my life or not. And to live life, I knew I had to stop spending so much time, energy and resources on fighting pain and wishing for a different reality. Accepting what was and making space for pain afforded me ability to pursue strategies that have been shown to help alleviate the effects of toxic stress.

Strategies

Over time I was able to start paying attention to the things that mattered to me. I  fed the good wolf, over and over and over again.  And my pain, fear and anxiety began to subside. Eventually there was less in my bucket, freeing up more capacity to engage in things that mattered. My body and mind became more balanced. My life more full.

Mindfulness and movement

Meditation and breathing practices can reduce toxic stress – or at least making it more tolerable – and help us restore homeostasis. Mindfulness practice can reverse some of the changes that take place in the amygdala, hippocampus and prefrontal cortex in the presence of toxic stress. It can also help us respond differently to stress, pain, anxiety and discomfort, which I find particularly beneficial.

Walking every day – or any kind of physical activity, really, is also associated with neurogenesis in the hippocampus. Walking (and now running) is where I do my best ‘writing’, too ;) It’s what helps me boost my creativity and productivity, helps me calm my monkey mind, gets my blood flowing and joints lubed, and gets me into my favorite place in the world – outside.

Movement and mindfulness practices are the two strategies I use most (they can literally be done anywhere, anytime)  and that I feel I gain most benefit from, particularly when I combine ’em.

Sleep and socialization

Good sleep is important, too. So are meaningful social interactions. We become so withdrawn and isolated when we’re in pain, which exacerbates the effects of toxic stress and pain. Socializing with friends and family again, reconnecting with people, places and experiences that mattered to me, made such a huge, though gradual, difference for me.

All of these things lead to adaptive neuroplasticity and beneficial physiological changes. They can reverse some of the effects of toxic stress and allostatic load. They’re all things I do daily now, and I wholly believe they have contributed to my improving pain and overall health over the years.

Letting some out of the bucket

The strategies listed above, all mentioned in the Aeon essay, also help increase the capacity of our buckets.

But we don’t have endless capacity. This one wasn’t mentioned in the essay but I believe it’s a crucial one. Sometimes we plain just need to let some stuff out of the bucket. We need to lighten what load we can.

I’ve done that this summer. Many of my projects have been on hold these past few weeks, and that’s ok. As much as I’d like to do everything, right now taking care of my boys, getting a run in a couple times a week, and doing a bit of writing seems plenty enough.

Somehow I have the capacity and confidence to get through this summer of surgeries and stress without my bucket isn’t overflowing. Without pain and anxiety.

Wowsa.

I’m shocked sometimes to look back and see how far I’ve come

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2 Responses to "Stress, allostatic load, homeostasis, attention and pain"

  1. So happy to hear that things are looking up for you. I’m 1.5 years into my chronic abdominal pain and I needed to see something like this. Still fighting for a diagnosis as well.

    • Thanks so much, Jon, I appreciate your kind words. I know how difficult it can be to not have a diagnosis, the uncertainty is the hardest part sometimes. I hope things ease up for you on your path to making sense of things. There is hope! All things are impermanent, and I hope things change for the better soon.

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