This whole chronic pain thing has been quite the path to navigate over the past 5+ years, and I have discovered a lot of things along the way. I’ve learned a lot about pain science and a lot about the art of living with pain. I’ve learned that pain is incredibly complex, just as people are incredibly complex. But I’ve also learned that despite the complexity of pain it’s still something we can all understand a bit better. And once we understand it a it better, we can take steps toward managing it better and living a bit better. We just have to make the time to learn it, to know it, to live it. Easier said than done, I know, I’ve been there, but definitely doable.
I’ve written a lot about pain science education, the reason I write about it so much is because I believe it lays the foundation for successfully managing pain and getting back into our lives. Pain science education unlocks the door to so many other beneficial strategies and ways of managing, and overcoming, pain. It paves the way toward moving more and moving less fearfully; toward being more self-aware and mindful, toward being more self-efficacious and confident; toward being ok with expressing ourselves and being able to communicate our pain, both to ourselves and to others. It paves the way toward acceptance, toward living a full, valued, meaningful life right now, not waiting for the pain to be gone, not waiting ’til we get back to our old selves.
Some things I’ve learned
I’ve learned along the way, through my own pain science education, that biomechanics and the state of our tissues aren’t everything when it comes to experiencing or managing pain. This was a shocker to me, it required some much different ways of thinking on my part. Yes, movement and moving through postures are important, but that doesn’t mean that poor movement or poor postures are singular causes of pain, nor are ‘correct postures’ or ‘correct movement patterns‘ definitive solutions for pain; I don’t even think they exist in any definable way.
Before this realization, I was squarely in the faulty movement/poor posture causes pain camp, so much so that I went back to grad school to earn my M.S. in Human Movement (now the program is called kinesiology, but I like ‘human movement’ more, so I stuck with it on my diploma) in order to figure out how how I was moving wrong so that I could move better and get myself out of pain.
It starts with understanding pain science a bit better
Thankfully, during my time in school I was also exposed to a great many pain science folks, many of whom I was able to meet in person at the San Diego Pain Summit earlier this year, including my pain mentor, Lorimer Moseley, whose book Explain Pain is a must read for anyone who experiences pain, works with people in pain, or loves someone who has pain. Through that education I learned that movement is just part of the picture, an important part, a big part, but still only part, and that I needed to widen my lens if I wanted to really get a handle on understanding, managing, and overcoming pain.
As I’ve said over and over, movement is life. Moving often, moving through all sorts of postures and patterns, and moving without fear are instrumental to successfully managing pain. So while I’m still movement driven, as evidenced by my numerous posts, past and future, on the topic, I also want to take a few posts (well, more than a few as you’ll see below) to talk about some of the other stuff in the picture, some of the stuff I realized when I widened my lens, some of the stuff I’ve learned by doing, by applying what I’ve learned, that has been just as important to my successful pain management as movement.
They’re symbiotic, all these pain management strategies I’m going to talk about. They’re all interrelated and work together to help us manage our pain and get on with life, or they can work together to make our pain worse. That’s why it’s so important for us to widen our lens, to see the bigger picture, so that we can approach our pain from multiple angles and live as fully as possible. The more things we can do to increase what helps our pain improve, and decrease what makes our pain worse, the more successful we’ll be. (Lorimer Moseley and David Butler refer to these as DIMS and SIMS, ‘danger in me’ and’ safety in me’, respectively. Check out their Protectometer handbook for Explain Pain to see these principles laid out more fully. And beautifully – there’s awesome artwork in there, too.)
So the upcoming posts will be on all the things I can think of that have helped me with my pain issues. But because my pain is the pain I know best and what I’ll be writing most about, this is in no way a conclusive list or a ‘here’s what to do to get you out of pain!’ manual. There is no one right way, no universal solution that works for everybody. We’re all different and we’ll all be drawn to different strategies, we’ll all respond better to different things, and we’ll all have different goals, meanings, paths forward.
But we all face a lot of similar struggles, too, we all have common ground. That’s where I hope we can all come together: a place where the struggles, the difficulties, the suckiness of pain is understood, where it can be talked about, where it can be dealt with effectively, where it can be overcome.
I know a little bit of the science behind pain. I know a lot about what the experience of chronic pain is like. And I know that there is a way to be successful, a way to manage pain rather than be managed by pain, a way to be in control rather than having the pain take control. I know it’s possible to live a full, valued, meaningful life. I know it’s possible to overcome pain altogether.
So I want to share what I know, what I’ve learned, what I’ve lived, and what I don’t yet know, what I have yet to learn, yet to live. And I hope you’ll share, too.
My hopes for the blog
So I hope that this blog can become a resource for you, one that can be a starting place from which you can think about your own pain issues, your own goals, your own likes and dislikes, your own values – your own meaning – and figure out what may work for you and your life. I hope that you’ll start dabbling a bit in some of these strategies that have worked so well for me, tweaking them to your liking, your situation, your needs. I hope it can provide not only some ideas for how to manage your pain, but also some ideas for how to communicate your pain to others, how to express yourself, how to pursue what matters to you, how to live your life now, whether there’s pain or not. No more waiting.
If you’ve never had pain, I’m sure you know someone who has. I hope this blog is still valuable to you in helping you understand those folks a bit more, be it a partner, a family member, a friend, a co-worker, an employee, or the sometimes cranky barista at your local coffee shop. Millions of folks have chronic pain issues, some days they’re going to feel good and you’ll ‘get’ them and all will be rosy with the world, some days they’re going to be over their pain threshold and just trying to manage and you may feel baffled at their change in behavior. The world is the same for you on those days, but it’s not for them. I hope this blog helps you to understand and be able to communicate with people who are experiencing pain a bit better.
If you’re a health care provider or fitness pro who works with folks who have chronic pain, I hope this blog can be a resource for you to understand those patients and clients a little bit better, to see things from their perspective a little more readily, to communicate a bit more effectively, and to perhaps define success a bit differently, for both you and the person in pain. Sometimes success isn’t the eradication of pain, it’s living a full, valued, meaningful life in the presence of pain. That can be hard to accept, not least of all for those who treat pain. I thank you for all that you do, I know it’s not easy to be on that side of the table, either.
There’s going to be science behind much of what I’m going to write about, but there’s going to be a larger dose of just my humanness, so it’s going to be fallible, though I hope still valuable. To give a preview of things to come, though they may change as I actually get to the writing, I’ve included a rough outline here. This is kind of a thought dump so bear with me.
Working outline of things to come
- Self-expression and creativity. This will probably be one of the first posts as it’s a topic I’ve touched upon in previous posts. It is something I didn’t realize the importance of until the Pain Summit, where there were very interesting discussions on variations of self-expression, from being able to fully express our pain to clinicians to being able to express ourselves through movement. Not all expression has to come in a clinical setting though, it doesn’t have to be ‘therapy’, though it is likely to be quite therapeutic. Self-expression and embracing creativity can be incredibly beneficial outlets for our thoughts, feelings, ideas, beliefs, desires, goals; it’s a way to tell our story, even without words, when sometimes words won’t do. Creativity can come in many forms, be it through the written or spoken word, through artwork or images, through song or dance, through craft or design, through work or play. And anyone can be creative, it’s accessible to all of us.
“I want freedom for the full expression of my personality.” ~ Mahatma Gandhi
- Acceptance. This is a biggie and a toughie. This might well lead and conclude my book because it’s so important but also so hard to get to. For a long time I said I accepted the pain, but I didn’t, really. It was just words I was supposed to say. But I finally realized that acceptance doesn’t mean giving in to the pain, it doesn’t mean resigning yourself to a life of pain, it doesn’t mean giving up hope that one day the pain will be gone. Acceptance became possible for me when I understood pain science a bit more, when I learned what pain was and what it was not. Acceptance became possible when I believed that living a full, valued, meaningful life in the presence of pain was possible. When I was confident I had the skills and abilities to manage my day-to-day pain stuff and successfully handle flare-ups. When I felt like I was in control. The awesome thing I discovered was that once we can accept the pain, we can really get on with living. Once we stop focusing so much on the pain and start focusing on what makes our lives meaningful, the pain gets better, our lives get better.
- Fears/anxiety/worries/catastrophisizing thoughts. These are all often packaged up with pain, even when we’re not aware of it. I’m an introvert by nature, I’ve always felt a bit socially awkward, I’ve been a worrier my whole life, I tend to imagine the worst thing possible happening so I can prepare for it; it never affected my life all that much before pain (that I realized, anyway), but after pain, boy, did they have some effects. I’ve talked about the fear of movement but there are other fears, too, fears that arise from test results, fear that we won’t be believed, fears of appearing weak or foolish, fear that we won’t be able to do the things we want to do, from hobbies to careers, fear of being in pain for the rest of our lives. There are plenty of worries, too, worries about the future, about the pain, about relationships, about finances, about work, about familial responsibilities, about treatments not working, about our abilities to manage not just our pain but our day-to-day. All these negative thoughts can do a number on our psyche, our pain, our relationships, our confidence, our identities. But we can change them. I still have fears or worries, everyone does, but I’m aware of them now, I see them from a different perspective, I can think differently.
- Nature. Getting outside (I love me some nature!), or at least getting out of our pain space, can do wonders for our stress levels and our pain. Our worlds can become very small when we’re in pain, so expanding that world, even just a little bit, can help immensely by changing the contexts we’re interacting within and giving our nervous system some much needed changes in stimulation. Being in nature can also change our thoughts, our mood, our perspective. It can help reduce stress. It’s pleasant. It helps us to shift focus from our pain to the world around us. It’s worth the effort.
But in every walk with Nature one receives far more than he seeks. ~John Muir
- Self-awareness of our bodies. This will probably include some meditative components, some mindful movement components, some overlap with other topics. Becoming aware of the sensations in our bodies, all of the sensations in all of our body, not just the pain or the part that hurts, is an important part of the whole process, especially as we add in more movement. Being able to shift our focus from just the painful area to the painful are within context of our whole being helps us to perceive things a bit differently, feel things a bit differently, move a bit differently. Tai chi, yoga, and qigong all come to mind when I say mindful movement but any movement we enjoy can become mindful, from lifting weights to walks in the neighborhood. But those more formal forms of mindful movement are awesome if you enjoy them.
- Self-awareness of our minds and throughts. Being more self-aware and mindful of our thoughts, our interactions with others, our triggers, our soothers, our beliefs about pain, our expectations, our goals, our limitations, our values…our meaning. Being more mindful in general helps us a great deal, not just with pain but with life, with living now, in this moment. It’s all we’re guaranteed, you know?
- Stress management. This topic is also very much related to the self-aware/mindful posts, which can help to manage stress, but stress is deserving of it’s space and discussion because it, too, is complex. Stress itself is not a bad thing, we actually benefit from a bit of stress, but as with anything, too much stress can be a bad thing, too. And bad stress can be huge contributor to the experience of pain, or can become overwhelming as a result of experiencing pain. It can become a vicious downward spiral: pain -> stress -> more pain -> more stress. There’s a lot to talk about here.
The greatest weapon against stress is our ability to choose one thought over another. ~William James
- Meditation. Meditation has been one of my most successful and beneficial pain management strategies. Trust me, this surprises the hell out of me, too. So please don’t scoff at it just yet and assume it’s not for you, it wasn’t ‘for me’, either ;) Just 10 minutes a day makes a HUGE difference for me. HUGE. I mean it, HUGE. Not just for my pain levels but for my life. I know what you’re thinking, I was skeptical, too, but trust me on this one. At least give the post a read when it comes out.
- Sleep. I’ve done a quick post on this before but it kind of sucked, so I’m going to revisit it. The causal relationships between sleep deprivation and chronic pain are unclear but the very clear link is that there’s a link: many many many folks with chronic pain also have sleep issues. And many many many folks with sleep issues have chronic pain. I’ve been there. One of my worst pain episodes imploded about three years ago when I hadn’t slept for two weeks. Two weeks may not sound like a long time but when you’re not sleeping at all, it’s an eternity. I lost the ability to function as a human being for a bit, more so than at any other time since my pain started over 5 years ago. It was awful. It was probably the time I felt the most helpless and most hopeless. So sleep is important.
- Loving and being loved. I got this one from an interview with Lorimer Moseley and it’s so incredibly important, yet it’s not often talked about. It’s hard to love ourselves when we’re in pain, and if it’s hard for us to love us, it’s hard for others to love us, too. And it’s hard to love others. So this is a big one. I didn’t always love myself, but I was fortunate to always be loved by a very supportive husband. And a pretty awesome dog. Pets count, too :) Acceptance is a first step toward being able to love ourselves, pain and all.
One word frees us of all the weight and pain in life. That word is love. ~Sophocles
- Communication. I’ve talked a bit in the past about how important language is in our ability to heal, to live healthfully, and to love ourselves. I’ve talked about how it’s ok to talk about chronic pain. But the communication gap between folks in pain and folks not in pain can be a hard one to bridge, so it’s worth talking about some more. There’s often gaps between patients and practitioners and between people in pain and their loved ones, friends, coworkers, and employers. It can be an awkward topic we don’t know how to approach or put into words. It can lead to feelings of vulnerability, ineptitude, weakness, frustration, and anger, but it needn’t. We can talk about pain and make some headway toward ending the stigma too often attached to it.
- Social connections. This one is related to the two above but is also deserving of it’s own space. Relationships and social connections are important to health in general, and pain in particular, particularly because it can be hard to maintain social contact when we’re in pain. But feelings of isolation are very common with chronic pain, especially for folks who are unable to work or play their sport or engage in their former social activities, which often leads to a separation an distancing from the communities they had grown to be such a part of.
- Movement. Even though I’ve talked about it extensively, there will still be plenty more posts on movement (including one where I recommend some pain-savvy fitness folks, for those of you who’d like some actual workouts instead of just my words). I start everyday with a short movement routine and move throughout the day. I become the Tin Man if I don’t. Or a penguin. If you see me walking like a penguin, it’s a bad pain day.
- Human touch*. Human touch is nice, hugs can feel really good, as can human caresses and the light touch of a loved one. (although in certain pain conditions this can be quite painful, so take care to do what feels good for you.) And massages or manual therapy feel good, they are an awesome augmentation to our pain management strategies and to our lives in general. It’s just going to be a matter of framing it right, so that we understand why human touch is beneficial (because it is, just maybe not for the reasons so many of us believe) while also understanding that there is no singular massage or manual therapy technique that will wholly fix us. This is the could require seeking the services of skilled and knowledgeable practitioner, that makes me nervous because I’m not one, so I may rely on some guest bloggers who can speak to this more eloquently than I can, folks who come at it from the other side of the table.
- Pain science education. I will largely leave the pain science education to folks better qualified than I, though I’ll continue to reference and link to those folks and resources extensively as I write about how I’ve applied what I’ve learned to the successful management of my own pain and ability to live a meaningful life in it’s presence. I also hope to get some folks from the pain science education sphere to make some guest contributions, too.
I’m sure there’s stuff I’m missing (shocking, with the length of this beast), but I’m also sure it will get added as I get going. As you can see, I have no shortage of places to start. This is what used to overwhelm me, leading me to not start at all. But I realize now that it doesn’t have to all get done at once, as much as I’d like for that to be possible.
I think this also gives a sense of how complex pain is, how pain affects all areas of our lives. That can seem overwhelming, too. But….
We have the power and the ability to do this thing
Because it is all connected, that means we have plenty of entry points to making pain more manageable, to make life more enjoyable and more meaningful. It means that there are many areas we can start making progress in today that just might help us overcome our pain altogether. I have hope this will happen for me and for all of us. We have the power to take steps in all areas of our lives that can help us to manage our pain a bit better, live a bit more fully, and be our best selves.
As these posts are written, I’ll link to them here, too, so you could always come back to this post to go to a specific area of interest. And if there is something in particular you’d like to see me write on, please let me know. It may be out of my purview but I might at least be able to point you toward some useful resources or folks in the know.
As always, thanks for reading my post, folks! Especially because this one’s so damn long. Brevity, Jo, brevity. One of these days. I know this one is more of an outline for things to come but I hope it’s piqued your interest and got you thinking about some things. It’s also going to help me keep on track with future posts.
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