Thursday, November 10, 2016

The Painful Body

Image source: ThinkStock
Everybody has stubbed their toe at one time or another. When my horse stepped on my foot and would not move, it was excruciating.  Now take that moment of pain and envision it never ending. Did that just send a shiver up your spine?  There are people who live that nightmare. I have met a lot of people lately battling chronic pain.  I am under the care of a pain specialist myself. Everyone I ask seems to have a story.  Each seems to handle it in a unique way, some better than others.  My saga started 30 years ago.
I had a hip replacement at the rather young age of 42, a result of a childhood disease gone untreated.  This occurred while I was working at a small law firm.  A week or so after my return to work after six months of recuperation and therapy, a young associate said with a smile “I had no idea how much pain you must have been in.  You’re so much nicer now.”  I hadn’t noticed a change but others obviously did.  I had put off that surgery for about a year.  It just never seemed like the “right” time to be laid up for six months.  I was oblivious to how my pain affected others around me.  A few years ago chronic pain again crept into my life, into my other hip and leg, to be exact.  The pain hit a crescendo last fall when I could not use stairs one foot after the other, or put on my socks. I set out to find what was causing what felt like a constant charley horse, and treat it.  
In the course of things, I found out who really cared for me.  I remember saying to someone, as a defense for my personality changes, that I was in constant pain.  Their response - “nobody cares”.  That resulted in a house cleaning of sorts regarding my circle of friends.  Real friends are with you for the ride - ups and downs.  I know who my real friends are now.  I would have rather not endured the pain but I guess good can flow from any source.
The painful mind/painful body connection has been investigated a lot recently.  I was surprised to learn that constant pain actually can change the circuitry of the brain.  Dr. Dante Chialvo, an associate research professor of physiology at the Feinberg School of Medicine authored a study showing that people with chronic pain have a portion of the brain that is always active: the region associated with mood and attention. This constant activity rewires nerve connections in the brain and leaves chronic pain sufferers at greater risk for mental problems. The brain may not be able to attend to other tasks as well or as quickly because it is preoccupied with the pain signals.  The rewiring forces their brains to allocate mental resources differently to cope with everyday tasks — from mathematics, to recalling a shopping list, to feeling happy. This holds implications for the sufferer on many levels.  It also holds implications for those who care about the sufferer.
body-pain.jpgOf course, some of us genetically have a higher tolerance for pain. A study at the Cleveland Clinic found that a metal disc heated to 120 degrees and placed on a forearm will be experienced as barely uncomfortable by some and excruciating by others.  Functional brain imaging at the time of the experiment confirms that those who report severe pain actually have greater activation of several areas in the brain that process pain, while those who feel little pain have little brain activation. Thus doctors conclude that, “unless other factors interfere, pain is whatever the patient tells us it is.”  Some of us are able to “cowgirl or cowboy up” better than others.  So if a person you know speaks about their constant pain either accept that as gospel, or avoid the issue.
Pain is a complex experience. Pain is depressing, and depression causes and intensifies pain. People with chronic pain have three times the average risk of developing psychiatric symptoms — usually mood or anxiety disorders — and depressed patients have three times the average risk of developing chronic pain.  When depression is treated, pain often fades into the background, and when pain goes away, so does much of the suffering that causes depression.  Almost every drug used in psychiatry can also serve as a pain medication. But there are other ways to approach the issue.
Cleveland Clinic has some suggestions:
Acceptance: Acceptance does not mean giving up; it means taking charge and having the fullest life possible, despite the pain.
Fitness: Yes, it hurts at first, but trust me, if you stick with it you will see a difference. I did. But don’t expect quick results.  I still need help putting on my right sock but I can sit at a restaurant without putting my leg up on an adjacent chair.  
Stress reduction: Relaxation training, yoga, guided imagery, self hypnosis, and biofeedback training will help harness your ability to learn to regulate the body’s "fight or flight" response that tends to increase pain.  Cognitive therapy can also help, especially if your beliefs about life, yourself, other people or your health situation have become liabilities, interfering with your quality of life more than helping it. For anyone that follows my blogs, you are aware that my journey to find pain relief has figured prominently in what I am interested in and researching--Shamanism, Reiki, plant based medicines, meditation, hypnosis.  Your journey may be different.
Staying active: Sicilian-American anesthesiologist, John Bonica, is known as the founding father of the study of pain management. After years of wrestling caused severe osteoarthritis that he spent his medical career studying and healing from, he noted that patients who have something better to do don’t seem to hurt as much. The converse of this is that if your life is empty, pain will fill it up. When you keep active, you are less aware of pain.  Instead of working less with horses and special needs kids because of the pain, I have tried to work more.  Don’t let pain be your guide, let life be your guide.
Interpersonal support:  The best response for those who love you is to accept that the pain is real, that they can’t take it away, and that you aren’t sick and don’t need to be treated like a child.
Mutual help: Does it feel as though no one can really understand? Not true.  There are several organizations of people with chronic pain that provide education and support. The American Chronic Pain Association  provides a great deal of education to patients and families about pain, how to deal with it, and various treatments for it.

I am about 90% pain free now.  I can sit without pain.  I sleep better.   I am more active than I have been in a long time.  I even started dog agility with my puppy.  After I stopped physical therapy I started my own program, and adjusted it as I saw what helped me and what didn’t.  It has been a long road to get even here and there’s more work to be done.  I am fortunate to have been on a more metaphysical path when all this transpired, so I rely mostly on non-medical treatments for pain relief.  I haven’t become reliant on pain medications as some do.    
I want to remind people that pain is in the mind of the beholder and that the physical body affects mood, depression and vice versa.  Don’t judge until you walk in someone’s shoes.  They may pinch.
Vera Remes

Vera's Rave'n - The many aspects of Shamanism

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