Hitting The Brick Wall With Chronic Pain: A Patients Guide.
Why the title? Because that is often how my patients are feeling. They have tried everything and gone as far as they can go on their own. Like a marathon runner hitting the wall and finding a way to go through it. That is more profound than crossing the finish line.
A vast majority of my patients are chronic lower back cases. Chiropractors and other healthcare professionals are seeing chronic pain cases with more frequency than ever before. As a population we are becoming more sedentary, we can get most of what we want with a couple of clicks. We are consumers, materialistic and much less active than we used to be. When working with people we are not only working with pain, but working with the patient as a whole being. Mind, body and the soul if you like. No we are not in a dark room with candles and yoga music. We are living in a real world with real emotions, pain, suffering and turmoil. Every human has experienced pain of some kind and we associate it with negativity in most cases (unless you are one of those who like it). Many great philosophers believe that suffering is an important part of life, it makes us grow stronger, deal with difficult situations and build character. This may be true, but the suffering many people experience is shorter lived than many chronic pain patients. 1 year, 5 years, 10 years, try 40 years! Being in pain for a long time is not only physically tiring but emotionally tiring too. Here are some tips to help you along.
1. Taking action: The time zone
It’s much easier to do nothing. Having time to think about pain actually increase levels of discomfort because we focus on it like a laser pen. Getting active even if it hurts a little is unlikely to cause any damage and take your mind away from it also. It will also increase confidence in movement and drive you to want to do more. The action of doing beats any other way to overcome procrastination. I call it the art of doing. Think of it as a time zone. You have a limited time to actually start doing it before it just stays a thought. When it stays a thought that thought can become guilt, frustration and in turn, increased pain levels. Lets say we have this idea to get the ball rolling, “right I'm going for a 20 minute walk”. Now lets look at a common thought cycle and the upheaval it causes in just one day.
- Right I'm going for a 20 minute walk, this will help me I know it will (good feelings)
- A pause, no action, new thoughts kick in
- It looks a little cold out there, it might cause a spasm in my lower back (hesitance)
- I have to send so and so an email before I go so I better do that now
- I should really do the dishes too (questioning ones self and complicating things)
- I’ll wait another hour and see how I feel then, that's when i'll send the email and do the dishes too, i'll be really active then! (subconsciously preparing not to do a damn thing)
- I’ll have something to eat first actually i'm a bit peckish (ding goes the microwave)
- I don’t need a 20 minute walk, maybe just a 10 minute one, but walk quicker (that ready meal does not give energy in fact the opposite)
- Ooh i’ll watch Eastenders on IPlayer quickly I have to see what Sharon did (game over)
- Hmm I don’t really feel like it now, I'll go tomorrow, it's a bit late in the day
- My back is feeling a little sore now actually, maybe it's not the best thing right now (stress response activated)
- I.Should.Have.Just.Gone (guilt)
- I do this all of the bloody time (remorse)
- Why can’t I just do what I say (self pity)
- I don't know why I just didn't go for a stupid walk! (frustration)
- I am never going to get better like this (feelings of defeat)
- It's too painful to do anything now, i'll take a Tramadol (catastrophizing)
- I feel tired and disappointed with myself
- I'll just get into bed and relax for a bit, hopefully it eases off (the need for safety)
- I have a message from a friend but after today's failure I don't feel like talking to anyone (social isolation)
- Now my back is really hurting, it just seems to be getting worse and worse, maybe i'll see the doctor tomorrow and get a scan or something, I can't live like this.
- I can't sleep, I'm knackered yet cannot sleep. (lack of physical exercise and over mental stimulation)
- I'll take another sleeping tablet just for tonight............
And It continues into feeling bad about yourself because you didn't go for a simple but healthy and confidence building 20 minute walk (feel any more guilt?). The complexities increase as the time zone goes on and finishes. The stress increases and thus the pain levels. It does not have to be this way. The next time you have an awesome idea, check in and realise that there is a time zone. When that time zone is up then so is your idea. Think of the time zone as your way to feel good about yourself. And always remember that the awesome idea has to be achievable for you. The catch is it’s not easy, it takes effort and it takes that first step. Everything in life comes from practice. As a child you took those first steps and it was hard, you probably fell down and then with all of your might dragged yourself back up and kept trying. When you made it you smiled along with your parents. This is what we have done all of our lives. So just think Awesome idea = time zone = feeling good = less pain.
2. Do the things you enjoy:
When chronic pain has a grip nothing might seem pleasurable. You might think how can you enjoy anything when you are in such pain. Read number 1 again. If you cannot think of anything you enjoy right now, think about what you used to enjoy. When we are in pain, generally people find it hard to be in the present moment. When we try and think of something, our thought processes are on the pain, only the pain and how it’s affecting the now and how it’s going to affect the future. This is stressful and understandable too. No matter what your upbringing, personality or what you have been through, we all have something we enjoy. Focus on it, imagine doing it and then try it. Getting into nature, fresh air and escaping the monotony is refreshing and grounding for all of us. We as a western culture do so much inside now compared to what we used to. A lot of us, myself including spend too much time on social media watching other people live their lives that we can get lost in things that do not matter. Live your own life, start photography, painting outside, anything creative is food for the soul. So this should be food for thought. You could start with just lying on your back and bringing your knees closer to your chest. Simple movements are best and then building on to something more dynamic.
There is a ton of research now that shows the practice of mindfulness meditation has positive benefits. It also helps with the anxiety and depression that can accompany chronic pain. So how is it done? Follow the link and you can learn all about it. Mindfulness is about being in the present, letting thoughts pass and not holding on to them. Feeling your body, only focusing on your breath or an object. It’s not voodoo, it’s been around for longer than we know. Some people actually do it naturally, some people live in the present most of the time. Others are deep thinkers in a positive way, some are deep thinkers in a predominantly negative way. Balance is the key. When in a negative thinking state we need to challenge our self because it can be hard to get out of. Don’t get me wrong, everyone has negative or unwanted thoughts and that is completely normal. It is how we react to those thoughts that counts. Give it a go 10 minutes everyday at the same time for one month. You will see a difference in stress/pain levels and calmness.
4. Sensitivity reduction:
Chronic issues take time to resolve. Think of it as a journey in the right direction. The increased pain people feel is associated with soft tissue sensitivity. Sometimes just gently brushing the skin can cause alarming pain with severe symptoms. Getting up from the sofa, walking up the stairs, answering the door. These are the little things we take for granted. Simple things that when we struggle with are often the triggers of negative emotions. We don’t need to say what those are again. So what can we do about them? Do more, do it again and do it anyway. We know that pain is like an alarm system pointing out that danger is present with certain movements or situations. We also know that even though there feels like danger ,you are actually ok even if you feel like you are not. The more we do the more this alarm system fades into the background, only engaging again when real danger approaches. The key is grading this exposure to pain. We don’t get you run as hard as you can to the shops and back, we start with a few steps if that’s all you are ready for. We take it gently and slowly where it does not increase the pain levels too much and increase movement at a level that is appropriate. It’s important to push past your boundaries but doing it in a controlled way. If anyone has ever told you that your pain is in your head, ignore them. Any pain anyone feels is real and unique to to that person.
There are other techniques like tensing your muscles (as long as it’s not dramatically increasing pain) noting how it feels and then relaxing. What this does is engage your muscles, sending a signal to the brain that the muscle is there, working and increasing it’s load. It helps with pain levels because the muscles tend to go in a more relaxed state than before after contraction. It’s also good for muscles to contract for nutrition, blood flow and move ability. If you think our blood system is like a river system in many ways. We need plenty of flow to provide blood to all of the muscles, organs and brain. The more stagnant we become the less flow we have.
When muscle contraction is tolerated then muscle stretching can be introduced. We are not looking for anyone to do the splits but we do want people to be able to pick up that piece of paper they dropped without pain. Stretching feels wonderful, relaxing and stimulating. If we can get people to enjoy physical activity rather than fear it then the fight is already over and pain levels start to tail off.
5. Deep breathing:
This ties in with mindfulness but it is unrealistic to meditate all day every day. Chronic pain sufferers whether consciously of unconsciously hold there breath. A wave of pain comes and the diaphragm contracts until that wave of pain is gone. Holding the breath creates tension like a balloon inflating in your tummy. We want relaxation. When the next wave of pain comes, try and breath through it. Click here to see what I think is the best technique, you only need to do it once a day. A muscle spasm can feel like you are being torn apart from the inside, I mean serious debilitating pain. The more we can reduce the tension the less the frequency and intensity of the spasms.
6. Try therapy
Sometimes we need that human touch and interaction. Social isolation is common with chronic pain patients. Having an ear to listen to is a huge emotional off lift. The act of describing pain, where it is and how it’s affecting everyday life is therapeutic. Here in Cardiff we are referring to more CBT therapists than ever before. Complimentary therapists, health shops and Facebook support groups. It’s easy to take medication and hope for the best. It’s hard to take therapy and put the hard work in when often people already feel defeated. It’s OK to ask for help, 20 years ago it was much harder. For starters there is a mental health movement now where it’s fine and OK to ask for help. We are living in an age where life is more complicated than it used to be. It’s moving fast and hard. We have so much choice it can be confusing and overwhelming. Yet the quality of life as a whole has improved dramatically over the last 100 years. Most people have the luxury of shelter and food, holidays, social interaction, no war, sanitary facilities etc yet chronic, pain, anxiety and depression are at an all time high. To explain that further would need another blog!
Our chiropractic clinic in Cardiff looks at the mechanical causes of chronic pain but that is not enough so we take into account mental state, emotional causes, sleep, diet and activity levels. We are not psychologists but understand enough to know whether we can help or if a referral is needed. I work with CBT therapists in Cardiff to give the best possible care to patients.
I hope this has helped in some way, I am always looking for new ways to improve my treatments. Reach out you might just get that relief that you need.
Till next time
Matthew Corbin D.C