When “You’re Fine” Doesn’t Feel Fine
Reading Time: 3 minutesBy: Kili Preitauer, CEO of Override Have you ever had a doctor tell you your scans are clear? That everything looks normal? That they can’t find the cause of your pain? And yet… you’re still in pain. For many people, hearing “you’re fine” doesn’t feel reassuring. It feels dismissive. It can make you question yourself, your body, and whether anyone is really listening. Let’s start here: Your pain is real. You’re not imagining it. You’re not exaggerating it. And you’re certainly not alone. So, Why Does This Happen? Our healthcare system is very good at finding structural problems, things like tears, fractures, or inflammation, you can see on a scan. But pain is more complex than that. Sometimes, even after the body has healed, the pain doesn’t go away. A Different Way to Understand Pain Think of your nervous system like a security guard whose job is to keep you safe. When everything is working well, the guard only reacts to real danger. But after an injury or a long period of pain, that system can become overprotective. It may start reacting to normal movement or everyday activity as if something is wrong. It may sound the alarm even when there’s no longer a real threat. The system isn’t broken. It’s trying a little too hard to protect you. Pain Can Be Learned Here’s something most people are never told: Pain isn’t just a signal from the body. It’s also something the brain can learn. Your brain is constantly adapting. This ability is called neuroplasticity, it allows you to learn new skills, build habits, and form patterns. But it also means your brain can learn pain. The more those pain signals fire, the more the brain reinforces them. Neurons that fire together, wire together. Over time, your nervous system can become more sensitive, making pain show up faster, stronger, and more often, even when the original injury has healed. What the Science Shows Researchers have studied this by following people with back pain over time. At the beginning, patients looked very similar, same level of pain, similar injuries, similar experiences. But over time, about half of them recovered, while the other half developed long-term pain. The difference wasn’t just in their bodies. It was in their brains. Two areas became more strongly connected in people who developed chronic pain: The medial prefrontal cortex, which helps with meaning, emotions, and how we interpret experiences The nucleus accumbens, which is involved in motivation, reward, and how we respond to threat This increased communication between these regions could actually predict who would still be in pain later. In other words, for some people, the brain had started to reinforce the pain experience, even after the body had healed. So What Does This Mean for You? If you’ve been told “everything looks fine,” but you’re still in pain, it doesn’t mean it’s all in your head. It may mean that your nervous system is still on high alert. Your body may have healed, but your brain is still working overtime to protect you. And that’s something that can be addressed. Why Traditional Approaches Don’t Always Work Treatments like medications, injections, or adjustments can be helpful, especially early on. But if the nervous system has become sensitized, those approaches alone may not fully resolve the problem. Because at that point, the pain isn’t just about the body anymore. It’s about how the brain and nervous system are processing signals. A More Complete Approach to Pain At Override, we believe in treating both the body and the nervous system. We work with patients to: Calm an overactive nervous system Retrain how the brain interprets signals Gradually rebuild trust in movement and activity Address the physical and functional aspects of pain Because lasting relief doesn’t come from addressing just one piece of the puzzle. You’re Not Alone If you’ve felt dismissed, frustrated, or stuck, you’re not alone. We’ve worked with thousands of patients who have heard the same thing: “You’re fine,” while still living with daily pain. We hear you. We believe you. And there is a path forward.
From Burnout to Purpose: Why Lifestyle Medicine Is Changing How Clinicians Practice
Reading Time: 2 minutesBy: Kili Preitauer, CEO of Override I run a multidisciplinary telehealth group practice with more than 40 clinicians across pain medicine, psychology, physical therapy, and coaching. One pattern we consistently see is clinicians coming to us after feeling burned out in more traditional models of care. They often describe feeling rushed, reactive, and disconnected from meaningful patient progress. Many are looking for a different way to practice, one that allows them to address root causes, spend time on education and behavior change, and work within a team. When clinicians shift into that model, we often see not only improved patient outcomes but also a noticeable improvement in their sense of purpose and professional satisfaction. That’s why these findings on lifestyle medicine and burnout resonate with me. 1. Initial Thoughts on the Findings I’m not surprised by the findings. Burnout is frequently tied to moral distress and a sense of ineffectiveness. When clinicians are able to practice in a way that addresses the drivers of chronic disease, sleep, stress, movement, nutrition, and social connection, they often feel more aligned with why they entered medicine in the first place. In our practice, we see clinicians regain a sense of impact when they can work upstream instead of simply managing downstream complications. 2. Why Lifestyle Medicine May Improve Clinician Wellbeing There are several likely mechanisms. First, lifestyle medicine shifts the clinical encounter from reactive to proactive. That shift increases a clinician’s sense of agency. Second, it often allows for longitudinal relationships. Seeing a patient’s pain improve because they are sleeping better, moving more, and regulating stress differently creates visible progress. That reinforces professional efficacy. Third, lifestyle-based approaches tend to be collaborative and team-oriented. In a multidisciplinary setting, clinicians are not carrying the entire burden of change alone. That shared responsibility reduces isolation, which is a significant contributor to burnout. We regularly see clinicians report greater satisfaction when they can work within a biopsychosocial framework rather than feeling confined to brief, procedure-focused visits. 3. What Lifestyle Medicine Is Lifestyle medicine is an evidence-based approach to preventing and managing chronic disease by addressing modifiable behaviors and social determinants of health. Core pillars include: Nutrition Physical activity Sleep Stress management Social connection Reduction of harmful substances It complements traditional medical therapies. It is not an alternative to evidence-based medicine, but an expansion of it to address the underlying contributors to disease and dysfunction. 4. Broader Benefits of Reduced Burnout Reducing burnout has system-wide implications. Lower clinician burnout is associated with improved communication, better safety outcomes, lower turnover, and stronger patient trust. From a leadership perspective, clinician well-being is not separate from patient outcomes. When clinicians feel effective and supported, care quality improves. The two are tightly linked. 5. Limitations Lifestyle medicine is not a cure for systemic burnout. Administrative burden, productivity pressure, and EHR inefficiencies remain significant drivers. It should be viewed as one piece of a broader solution that includes organizational change, workflow redesign, and access to mental health support when needed. No single clinical philosophy can compensate for structural dysfunction. 6. How Clinicians Can Use These Findings Clinicians experiencing burnout can reflect on whether their current practice model allows them to work in a way that feels aligned with their professional values. In some cases, small shifts toward more education, prevention, and longitudinal engagement can increase meaning. In other cases, it may require larger structural changes in the practice setting. Importantly, the principles of lifestyle medicine apply to clinicians themselves. Sleep, movement, stress regulation, and social connection are not just patient interventions; they are protective factors for clinician health as well.
Sleep
Reading Time: 4 minutes“A well-spent day brings happy sleep.” -Leonardo da Vinci Time warp…mid-1800s: You live in the country—no electricity, and lamp oil is a valuable commodity. So, when the sun starts to go down, you begin to relax and prepare for bedtime. Your brain starts producing sleep hormones. You then fall asleep and stay that way until the sun comes up in the morning. This is how it was done before the invention of the light bulb. The 21st century: You get home from work and rush to get things done. You barely notice the sun going down because your home is full of artificial light. You keep going until you just want to sit down‒a natural reaction to being up for 16+ hours. So, you plop down in front of the TV. Finally, you force yourself to bed, and hopefully sleep. Unfortunately, a high percentage of us—especially when we live with chronic illness—struggle with getting to sleep and staying asleep. Here’s why: sleep is regulated by the production of sleep hormones, such as melatonin, and enhanced by other internal logic that relaxes our conscious mind and body for a good night of sleep. The brain doesn’t start the production of melatonin until it is dark and the body is relaxed—up to a two-hour process. Consider how a typical routine—of rushing and working hard before “relaxing” in front of the TV’s blue light, high-throttle programming, and news full of the latest world and local woes—impacts your ability to sleep. Sleep deprivation affects behavior, mood, ability to cope, thinking, the immune system, and our experience of pain. While adequate sleep is essential just for us to feel good, it also allows the body to produce substances that fight infection and inflammation. It is during our sleeping hours that many body functions are renewed and supported—even the production of chemicals that enhance deep sleep and communications with organs such as the stomach (a connection that helps prevent mindless eating and food cravings during the day). Jim Horne, PhD (Director of the Loughborough University sleep research laboratory), notes that complex brain work, such as updating working memory, planning, attention, sense of time, and verbal fluency, are functions most likely to suffer with sleep loss. “…what seems to be happening is that the functional part of the brain appears to be working even harder …to no avail.” In order for the nervous system to work properly, it needs to be restored each night. When we get too little sleep, we are less equipped to deal with stress. We can be irritable, get drowsy during work hours or while driving, have difficulty concentrating, become forgetful, and lose physical coordination. If sleep deprivation goes on long enough, it can cause wild mood swings and even hallucinations. Adequate sleep is essential to the management of chronic pain. If your night is during the day, your challenges to good sleep are more complex. Routine, a cool darkened room, and undisturbed sleep are must-haves. You may find that white noise (a fan or a recording of water, wind, or rain) overrides the sounds of traffic and others in the house, available in the form of machines and smartphone apps. How much sleep do we need? Consider how much sleep it takes for you to: □ feel rested □ concentrate and stay focused □ get out of bed easily □ maintain a happy mood □ avoid drowsiness the next day Schedule Consistent Sleep Schedule: Our bodies are regulated by a circadian clock‒a timepiece that requires regularity to maintain its rhythm. The more regular your schedule, the stronger your clock will be. Going to bed at the same time each night and waking at the same time every morning provides regular production and utilization of melatonin. Naps: While there are benefits to napping, those who have trouble sleeping at night may find that napping only makes regular sleep more difficult. If you need a nap, limit it to 10-20 minutes (as your sleep schedule improves, you can cut back on napping until you no longer count on it as a supplement). If you experience ongoing problems getting to sleep, avoid naps altogether. Environment and Activities A Relaxing Ritual: We get so busy that it’s easy to keep going until we hit the bed. To prepare for sleep, try winding down with some reading (from a book instead of an electronic device), listening to soothing music, or light stretching 30+ minutes before bedtime. Reduced light and a calm atmosphere prepare our bodies to produce melatonin, which in turn, helps us sleep. Make a list of things that relax you, and avoid the TV and computer (the light and the stimulation keep the brain from relaxing) an hour or two before bedtime. A Relaxing Place: It’s important to keep stress out of the bedroom. It should be a welcoming, restful space—ideally cool and dark. The best rule: nothing but sleep and sex in the bedroom. Planned Worry: If worry is something that keeps you awake, make a plan for taking care of those thoughts before bedtime. Try keeping a pad of paper and a pen handy, then write your worry list just before turning out the light. Or, if a worry pops into your head when you’re trying to sleep, write it down and promise to deal with it the next day. Exercise: If you don’t feel like you are able to exercise due to your illness, don’t sweat it. Your coach has probably already offered to share his or her courage with you until you’ve built your own. In the meantime, learn everything you can about what your body can handle and keep an open mind on how to lessen its impact on your life. If exercise is something you’d like to try, start slow and easy. Talk to your doctor or physical therapist, and work with your coach to set goals and track successes. Read more. Eating and Drinking Caffeine: Caffeine can cause a disruption in your sleep, since it can stay in your
Intuitive Eating
Reading Time: 6 minutes“When you’re focused on food (or not eating food), you can’t focus on living your life.When you focus on living your life, food becomes much less important.” -Michelle May, MD Although we think of ourselves as super-intelligent, we do quite a lot of what we do instinctively. We walk upright, we are alert to danger, we communicate with words and gestures, and we get sleepy when it gets dark. But when it comes to eating, our instincts are sometimes frustrated by someone else’s advice or our own failure to do what comes naturally. If we observe healthy animals in nature, they do everything they do by instinct—what we might call intuitive living: eating, resting, drinking, birthing, fleeing from danger, fighting to preserve their species. But notice that when they live near a touristy spot, their eating habits change, and their fear of humans disappears—they are conditioned to alter their instincts for some benefit. Every car door that opens signals a chipmunk to dart into view for a cracker or peanut; in captivity, animals move closer to the fence when they smell visitors’ food; the household pet races to its dish when anyone walks near the feeding area. Along with Mother’s advice to eat this, not that, we’ve all listened to enough news and advertising to know that eating is important to our health. Trouble is, information and environment complicate what was once an intuitive activity to save us from starving to death. Today, our options for food are almost unlimited—no longer driven by location, seasonal availability, cooking techniques, and preserving methods. When we live with chronic illness, the things we do intuitively may change—perhaps more sitting or lying down, discontinuing a sport or favorite activities, fearing certain movements. Instinctual functions are impacted by our emotions, other people’s activity, complex schedules, and the myriad of options we live with. Media constantly barrages us with suggestions that we should try this food, drink this beverage, take this medication, fear this condition, go on this diet, compare ourselves to this model—until living moves completely away from a natural (intuitive) function, and enters the realms of competition, imitation, avoidance, and self-medicating. It’s almost like changing the question, “What do I want to eat?” to: What do I want to avoid? What should I eat to feel better? Who do I want to imitate? How can I eat less (or more) than she does? In the ‘60s, Twiggy changed our view of “sexy” to mean “skinny.” And changes in family structures, community sizes, working hours, and food manufacturing turned eating three meals a day at home as a family into fast-food drive-thru meals, TV snacking, supplement shakes, and dieting. Yes, environment and emotions have a lot to do with how we eat. The Diet Trap It’s so easy to buy into instant results in our on-demand culture. Diets are one of those temptations. A movie star lost 20 pounds in one week so she could fit into her Oscars dress…therefore, so can I. He says his secret to building muscle is eating protein, not carbs, so I’m going to stop eating carbs altogether. Registered dieticians and numerous scientific studies warn us that dieting doesn’t provide long-term health or weight loss. Instead dieting: makes the body think it’s being starved, so it starts hoarding fat reserves by slowing the metabolism; causes us to experience increased cravings; may play a role in binge eating and eating disorders; increases weight loss resistance with every dieting episode; shifts the body into a survival mode that matches weight loss with weight gain; contributes to low self-esteem—either from “failing” or from the belief that I am defective. So what is the alternative when we want to be a healthy weight? Being in Control vs. Being in Charge Dieting may provide the worst gambling payout, ever. Yet we let the ads, books, and magazines convince us we can control our appetite and impulses. Let’s think about how controlling ourselves feels (whether we succeed or not): tense, guilty, fearful of failing. Not exactly the best way to relax or care for ourselves, is it? If we are going to live successfully with chronic pain or illness, it’s essential to switch tactics. Trying to be in control of something that isn’t fully understandable (body, mind, universe, spouse, or kids) can make us feel a little crazy. Being in charge of elements within our capacity to direct and choose helps us to: acknowledge personal responsibility and values, and work with universal laws and widely-accepted principles. Respecting what we can’t change—the law of gravity, for instance—demonstrates intelligence. Acknowledging our limitations—to multitask or lift 50-pound boxes—is what we do once we choose not to argue with reality. Working with our body and mind (a team) is a lot more productive than engaging in warfare, the driving principle of dieting. Our bodies are incredible machines, built to seek and maintain homeostasis (metabolic equilibrium and biological balance). This doesn’t mean that everybody is built to look like some lithe supermodel or to pole vault 20 feet. It means that—aside from physical limitations—my body will seek homeostasis if I give it the tools it needs. Physical Hunger vs. Emotional Hunger Hunger is a natural, instinctive body signal to satisfy hunger and feed the body’s nutritional needs. Instead, we tend to plan our social lives around food and drink. Then, when emotions and stress get in the mix, eating takes on a lot of behaviors: overeating, non-nutritional eating, calorie-heavy snacking, bingeing, or starvation dieting. Can you identify your feelings around any of these actions? Is food filling an emotional deficit, healing a wound, taking the place of friends, dulling pain, or has it become the enemy? What is Intuitive Eating? Intuitive eating “relies on your internal cues and signals,” explains Michelle May, MD.* Because it can be hard to tell the difference between wanting to eat and needing to eat, a system for checking in with body, mind, and heart will bring eating into an intuitive realm, she explains. Focusing
Self-Compassion
Reading Time: 5 minutes“Taking good care of yourself means the people in your life receive the best of you rather than what is left of you.” -Lucille Zimmerman One of the most common emotional responses to life’s pressures is a lack of self-compassion. Despite connective technology, we often find ourselves isolated, obsessed with our own self-esteem or spending most of our energy on others: taking care of children, aging parents, spouses or friends. In this over-full lifestyle, it’s easy to turn our backs on ourselves. We become self-critical and judgmental, especially when our lives have unfolded in ways that we couldn’t have imagined. Americans devote Valentine’s Day to showing love and compassion to others, but how often do we give that same love and compassion to ourselves? Worse yet, we’re often our own worst critic. This tendency leads to negative self-talk and behavior patterns that increase the stress response. Self-criticism and inwardly-focused judgments can lead to anger, depression, and even physical illness. And this is not helpful in our journey to manage chronic illness. What is Self-Compassion? Dr. Kristin Neff, leading researcher on the topic, defines self-compassion in her book: “Having compassion for oneself is really no different than having compassion for others. Think about what the experience of compassion feels like. First, to have compassion for others you must notice that they are suffering….Second, compassion involves feeling moved by others’ suffering so that your heart responds to their pain (the word compassion literally means to “suffer with”)….you feel warmth, caring, and the desire to help the suffering person in some way. Having compassion also means that you offer understanding and kindness to others when they fail or make mistakes, rather than judging them harshly. Finally, when you feel compassion for another (rather than mere pity), it means that you realize that suffering, failure, and imperfection is part of the shared human experience.” So, proposes Neff, “instead of mercilessly judging and criticizing yourself for various inadequacies or shortcomings, self-compassion means you are kind and understanding when confronted with personal failings—after all, who ever said you were supposed to be perfect?” What Self-Compassion is NOT As important as Dr. Neff’s study of what self-compassion is would be her study of what it is not. She draws a distinct line between self-compassion and self-pity. When we feel self-pity, we are focused on our own problems and forget that others have similar challenges. We tend not connect with others, feeling that we’re the only ones in the world who are suffering. Elements of Self-Compassion According to Dr. Neff, there are three elements of self-compassion: Self-kindness — Rather than ignoring our discomfort or “beating ourselves up” with self-criticism, self-compassion involves warmth and understanding toward ourselves when we suffer, fail, or feel inadequate. Self-compassionate people accept that being imperfect, failing, and experiencing difficulties is unavoidable, so they tend to be gentle with themselves when confronting painful experiences. We cannot always be or get exactly what we want. When we argue with reality, suffering increases in the form of stress, frustration, and self-criticism. Common humanity — “Self-compassion involves recognizing that suffering and personal inadequacy are part of the shared human experience—something that we all go through, rather than being something that happens to ‘me’ alone.” Mindfulness — Being mindful of our feelings—neither suppressing nor exaggerating them—allows us to observe negative thoughts and emotions without judgment. Studies show that ignoring or denying our feelings and emotions actually creates confusion in the brain’s emotional/memory process. It’s best to consciously choose to learn from our feelings and focus our attention on something we desire or value. Principles of Self-Compassion The basic principles of self-compassion are likely not new to us. We’ve experienced compassion for another person or animal at some time in our lives, but directing the same tolerance or gentleness inward can be uncomfortable. Here are some practical ways to cultivate self-compassion in our daily lives: Be more mindful — Self-care and self-compassion aren’t necessarily the same thing. We implement self-care by exercising more or eating healthfully, and we can also be tuned into the way we talk to ourselves. Mindfulness practices vary widely: creating space to calm mental chatter and exploring ways to practice self-compassion help us stay tuned into the present moment, instead of rehashing the past or worrying about the future. Write it out — Writing can be an effective way to tap into our inner dialogue and catch negative self-talk. Write a loving letter to yourself in the same way you would to a friend who might need encouragement. Or have a written conversation with the part of you that’s struggling, using curiosity to explore vulnerable feelings freely and without judgment. If you are your own worst critic, log your negative self-talk and do a “truth” test on the things you tell yourself (Is this accurate? Is it a 100% truthful statement? Is this something I would say to anyone else?). Acknowledge your feelings — We tend to view our feelings as our reality and to place judgments of right or wrong on them. Feelings are fluid and should guide us like a compass rather than weigh us down like an anchor. Instead of judging your feelings, try recognizing them and the clues they might be giving you about what you need. Suppressing (denying) our feelings isn’t healthy, but we can choose our responses to situations that are not bringing us the joy or results we desire. Admitting our humanness, respecting our feelings, and taking appropriate action to meet our own needs are acts of true self-compassion. Learn to focus on what’s important to you — This takes practice, especially when the brain’s alarm is going off due to pain, illness, symptoms, or stress. But it’s important for a balanced brain that we acknowledge our stressors and then choose what’s most important to us at the moment—focusing on that rather than perseverating about the thing that’s set off the alarm. Think about ice skaters or gymnasts competing in the Olympics. Pay attention to their demeanor
Cardiovascular Exercise
Reading Time: 4 minutes“Lack of activity destroys the good condition of every human being, while movement and methodical physical exercise save it and preserve it.” -Plato The Body in Motion Consider the human body. It is obviously made to move. But most of us move far less than we ride, sit, lie, and recline. Some estimates report the average American watches TV for over two hours each day—usually from the sofa or in bed. Many of us have desk jobs, drive long distances to work, and use machines and labor-saving devices to do our work for us. Let’s look at the benefits of exercise and how our bodies respond to being inactive. A Motionless Body A study in the 1990s showed that every day after surgery without exercise results in 1-3% muscle atrophy (loss). It follows that even when we’re healthy, immobility can cause loss of muscle tone. People in chronic pain do become deconditioned when they’re afraid to move. The interesting thing is that losing muscle tone may contribute to increased pain. How Exercise Looks Inside the Body & Mind While we may say I dread exercise or I hate to sweat, that’s our pre-conditioned mind talking. Our body and mind are actually begging for a work-out—a little stretching, toning, sweating, a muscular challenge, and some extra heartbeats. Think about buying a new car, driving it off the showroom floor at 10 miles per hour, and never going any faster than that for its entire life. Denying your car the privilege of performing to its specifications will result in a weak and inefficient engine. All parts of a car are designed to go fast, heat up, cool down, and work hard. And so are all parts of your body. BUT, you say, when I exercise or do too much, I hurt. With my chronic pain, I just have to avoid exercise. How Exercise Benefits the Body: Increases oxygen to the brain and body tissues—a result of increased heart rate and deeper breathing Increases energy level, because exercise “charges your battery” Increases bone strength & keeps joints healthy (cellular replacement is enhanced when muscles are strengthened and large bones experience impact) Lowers inflammation in the body (an active body is more efficient at flushing out the bad stuff) Has a calming effect (a warm body is more relaxed than a cold body) Helps digestion (activity assists peristalsis—the progressive, wavelike movement of intestines that moves food through the digestive process) Reduces obesity, which puts stress on joints & back (just 8 pounds extra weight is like carrying a gallon of milk around) Assists in weight management by increasing calorie burn Strengthens the cardiovascular system (lower stress on the heart lowers tension in the entire body) Regulates insulin/glucose balance Elevates the stress threshold (chronic pain is a stress) Reduces depression, which, in turn, may reduce the risk of dementia Boosts the immune system (chronic pain depresses the immune system) Builds T-cells (key to fighting cancer) Activates cells that repair inflammation of injured tissues Cardio-exercise “dissipates” stress hormones (think of it as an exhaust system) Improves sleep (release of stress hormones results in deeper/better sleep) Reduces pain (endorphins, the body’s “morphine,” are released; this blocks pain signals to the brain) Strength building improves balance (more on this in the lesson on Strengthening) Reduces pain in fibromyalgia & rheumatism Exercise and the Brain Exercise also benefits us mentally by: Regulating our mood (the reason depression can be reduced or alleviated) Relieving anxiety (neurotransmitters are released into the body during a good workout) Increasing self-confidence as we meet exercise goals Improving self-confidence as we learn complex movements Based on these known benefits, consider how a long-term investment in exercise might help you manage your pain. When we say we’re stressed, we often mean overwhelmed, overloaded, and anxious. It has been observed that prolonged periods of stress are most damaging to the hippocampus (the region of the brain that plays an important role in long-term memory) in ways that simulate post-traumatic stress disorder. In simple terms, chronic stress causes the hippocampus to atrophy (shrink) and can be a factor in depression and dementia. The good news is that regular exercise bolsters neurons by making proteins that repair this damage. We might think stress is only caused by a high-octane job or major traumas, but many of us live with elevated stress when we are filled with anger, focus primarily on the negatives, get too little sleep, or are controlled by our pain. On its website, Mayo Clinic documents that exercising 30 minutes, 3-4 times weekly, may reduce depression. And Dr. John J. Ratey has dedicated an entire book to the scientific and evidence-based impact of exercise on the brain (SPARK—The Revolutionary New Science of Exercise and the Brain). The book’s cover summarizes how impressed he is with the benefits of exercise: “Supercharge your mental circuits to beat stress, sharpen your thinking, lift your mood, boost your memory, and much more.” While his research is far too lengthy to cover in this lesson, his conclusion is that inactivity is shriveling our brains and allowing stress to become toxic—both of which can be reversed with regular exercise. What Stops Us From Starting or Staying with It? A few seconds with this question, and you will probably have several answers. A few common barriers: Attitude (it seems too hard or too complicated, or we just don’t know where to start) Feeling tired (lack of sleep or lack of movement…but remember the benefits of exercise?) Planning (prioritizing) Being depressed (mentally paralyzed) Commitment (staying motivated) Family members (if they give us guilt messages or remind us of past failures) What Can Motivate Us? Mental roadblocks keep us from starting and break our momentum. After a few unsuccessful starts, we declare ourselves a failure and go back to being inactive. Some people use the following tools to provide initial or renewed motivation: Make a personal challenge: I’m going to walk/run in a 5k in 3 months. Journal/chart progress and feelings Log weight, inches lost
Visioning
Reading Time: 4 minutes“If you don’t have a vision, nothing happens.” -Christopher Reeve Christopher Reeve, an actor who had played Superman, was thrown off his horse during a competition and became paralyzed from the neck down. Could you try to imagine his post-accident life—total immobility, the rhythmic gasp of a ventilator, feeding tubes? It turns out that being banned from a vibrant physical life wasn’t the end of this Superman, however. With unfathomable bravery, Chris compared life’s unexpected and overwhelming challenges to being adrift in an ocean storm where the beam of a lighthouse is the only hope. “…we must cling to it with absolute determination,” he said about hope. “When we have hope, we discover powers within ourselves we may have never known—the power to make sacrifices, to endure, to heal, and to love. Once we choose hope, everything is possible.” A vision is born from hope. And visioning is that vision in action. A vision summons us, reaches beyond our sense of sight, and beyond this moment. Visioning is the ability to experience with our mind what is as vivid and credible as an image before our eyes. How is this possible? Perhaps you’ve participated in the exercise of imagining a lemon without having one in your hand. You touch its waxy skin and pay attention to the shape. In your imagination, you cut the fruit open and touch your tongue to the sour sweetness. What just happened? If you didn’t experience a gush of saliva, you may have at least felt the ache in your parotid glands—the salivary glands behind your jaw. Imagination is that powerful. As we learn to manage our chronic illness, visioning becomes a valuable tool that allows us to mentally step into what we want, imagine the details, or “try on” a new strategy. How to Vision There is no recipe for visioning, but it helps to find a meditative environment away from the hustle of life, where we can give full attention to our imagination. As kids, we naturally had pretty active imaginations. Life and adulthood can erode that ability, but creativity and imagination are just like muscles—the more we use them, the stronger they get. Athletes often use visioning skills by “seeing” themselves make the perfect play, ski the tightest course, or exert the greatest strength, and it’s a practice that sharpens performance as much as actually doing it. The brain’s neuroplastic nature enables us to get better at something simply by practicing the activity in our mind. “Because the use of any circuit strengthens that circuit, rehearsing a performance in the imagination can prepare mental circuits in ways similar to the real performance.” Creating a vision: Consider what you want in your life right now—a change in attitude, behavior, or performance. How does it look or function? How does this change make you feel? How does it improve your life, your relationships, and your chronic illness? Be detailed in your vision. Start with generalities and give them details—like you would paint a landscape: broad strokes to create a background, shorter strokes, color variances, and textures to bring the details into focus. What are the details in your vision? What are you wearing—color, texture, style? What about your environment—location, activity, other people and animals, temperature, humidity, smells, sounds? What do you do, and how do you do it? Focus on your picture. A vivid picture engages all the senses—sight, sound, smell, taste, touch. It is through these senses that new connections in the brain are formed as the image becomes “real.” Vision as a destination A vision is not about where you want to go. It is thought or written as if you’ve reached the place you want to be—in the present. For example, I am volunteering at ____ or I am learning how to _____; I do…, I have…, I achieve…, I enjoy…. It’s a visual of the best possible outcome—not an impossible reach or the arduous journey to get there, but the very best result we can hope for. Instead of focusing on the long flight to the coast, picture the beach, palm trees, and surf. It’s the vision of everything that makes the journey worthwhile. Building a vision Image: How does it feel to be at your destination? What do you see, smell, touch, and hear? Motivators: What are the values that drive your vision? What matters most? What emotions do you feel? Strengths/Values: Which of your values are reflected in the vision? What personal strengths are involved as you pursue your goal? Supports: What people, environments, systems, or beliefs support your vision? Conversely, what in your life doesn’t support this vision? How can you remove those obstacles in order to proceed? When we experience the challenges of complex chronic illness, visioning is a great way to break the brain habits that bind us to what’s unsatisfactory in our current situation. Goals are great complements to our grand visions, and provide daily steps toward our best futures, but visions are the propellers on our dream boat—pushing us toward what we desire the most. Just like the producer of a movie, we can view the sets, scenes, characters, and plot twists of our own life feature film. Visioning can help us in our journey to recover from the losses of chronic illness by: Generating hope and increasing self-confidence in our ability to move ahead. Providing an emotional connection to our hopes and dreams. Re-creating an identity out of what we have, rather than lamenting our losses. Helping us see the fruits of our labor before we experience them—keeping us motivated. Allowing us to practice maneuvers so that we know how we’re going to get around the obstacles. Creating new neuronal pathways (brain change) so that a new way of living becomes more automatic. Rather than getting stuck in a yo-ho-heave-ho dirge—where life becomes a drag, try visioning your best life, happiest day, most successful project. Effects of setting goals on the brain… The neuroplastic nature of the brain enables us to get
Goal Setting
Reading Time: 4 minutes“Never lose the opportunity of urging a practical beginning, however small, for it is wonderful how often…the mustard-seed germinates and roots itself.” -Florence Nightingale Setting Goals: Not Just More Items on Your To-Do List. You might be thinking the subject of goal setting has nothing to do with your pain. Life is already overwhelming, especially when we are tired, stressed, or in pain. So, if your internal voice says something like I need another thing to do, like I need a hole in my head, that’s understandable. After a few months working with a coach, a patient summed up goal setting, something like this: “Setting goals means I’m living; not setting goals means I’m dying.” And when you think of it that way, languishing looks a lot like dying. We don’t move, we stop caring about what used to pump us up, don’t communicate well with those we love, and we limit ourselves to thinking about what we can’t do. That’s a bleak existence. Here’s the thing that keeps us stuck: it’s especially easy for a person with a chronic illness to become dependent on doctors and family members to fix their issues. In reality, the only person who can guarantee success in managing your symptoms is YOU. And, we all make more progress when we have a plan. Setting goals–in small, manageable steps–is essential to success. We can do this by shifting our view from who can help me? to how can I help myself? You might have a discouraging history with goal setting or resolutions. But research shows that people who set goals perform better, exhibit increased self-confidence, are happier with their performance, and suffer less stress and anxiety. We have all decided to do something, started, stopped, and declared ourselves failures. When goals are viewed as pass-fail tests, we shun them. If you hope to one day flourish in spite of your symptoms, it may be helpful to reframe goal-setting as a familiarization process. What we refuse to consider or look at cannot help us. Goal setting expands our horizon. How Do I Set Goals Without Setting Myself Up for More Failure? Our goals will pull us forward if they fit our identity—what we believe about ourselves. If I were an avid quilter, but because of my symptoms, I haven’t touched my sewing machine for 2 years, I may no longer identify with being a quilter. To set a goal of constructing a king-sized quilt in 90 days does not fit who I believe I am. James Clear suggests we think of small actions as “votes” for who we are. If you want to return to being a quilter, setting up a system to feed that identity can increase your success. In the beginning, setting a goal of merely showing up at your machine regularly, and doing so, will cast a vote in favor of the quilter—rebuilding the belief that you are a quilter. Learning effective strategies can help us avoid this failure-oriented repetition. This is a variation on the S-M-A-R-T way to set goals: GSpecific Keep goals simple and specific. I will walk for 40 minutes. (I will exercise more is too general.) Measurable How will you know you’ve reached your goal? Make goals measurable enough to appreciate milestones and completions. Attractive What are the benefits of attaining this goal? Are the benefits attractive enough that you will stick with it? What motivates you? Realistic It’s important to strike a balance between challenging and realistic. Setting a goal you’ll fail to achieve is possibly more demotivating than setting a goal that’s too easy. Time-framed Identify frequency, start times, duration, project beginning, and end dates. Goal statement To get ready for my hike in the Tetons, I’ll hike at least two miles 4 times this week, starting tomorrow, and will have my walking shoes on at 7:15am. What Triggers the Pursuit of a Goal? Heidi Grant Halverson, PhD, says that things in our environment serve as prompts and reminders of what we want to do. Healthy snacks in the cupboard can remind us to stick with our nutritional goals. A picture of a garden might motivate us to plan our own and order seeds. Driving past a gym can stimulate our resolve to start an exercise regimen. Touching a piece of fabric can rekindle our passion for quilting. An “X” marked on every day of the calendar we show up to pursue our goal is a well-documented tactic for keeping us on track. Remarkably, the goals of people we don’t even know can be goal triggers. Psychologists have referred to this as goal contagion—because at an unconscious level, we automatically adopt and pursue a goal that is implied by another person’s successful behavior. Advertisers use this principle when they show us beautiful people using beauty products and happy kids eating certain foods. Boost Your Success Become aware of what you say to yourself internally about yourself and your intentions. Ask yourself how well this goal fits what you believe about yourself. Do you need to work for a while to re-establish the identity you desire (small actions that are a “yes” vote)? Utilize triggers (reminders) in your environment to spur goal setting. Feel free to fail and start over again. Failing is just a signal that your goal needs revision so it’s more realistic. Be honest about how important this goal is to you. If it’s low in importance, you will focus on things that mean more to you than the goal. Ask yourself how ready you are to start, engage, and make it to the finish line of this goal. Gauge your confidence in reaching your goal. If you immediately jump to your fear of failure, your confidence is low. Review the benefits of achieving the goal, and identify barriers to reaching it (naming them can help you identify solutions and workarounds). Work with a coach on goal setting. Accountability to another person often helps us stay the course long enough to generate success. Even
Struck Down and Rising Back Up
Reading Time: 5 minutesOnce I dreamed that I had to learn to wrap a boa constrictor around my neck in a controlled way without panicking or provoking it. I had to avoid being suffocated by this slimy seven feet of pure terror while still calmly permitting it to wrap its whole body around me. Awaking from the nightmare, I understood the metaphor immediately. My chronic pain syndrome is my boa constrictor. It’s been my living nightmare for about eight years. Every day I’ve played by the boa constrictor’s rules: Do not provoke it or it will squeeze the life out of me. The dance between me and this snake has been a delicate one; it’s challenged every ounce of patience and courage I can muster. Some providers have recommended playing dead, while others have suggested beating it, shocking it with electricity, poisoning it with dangerous medications . . . you get the point. Refusing to give up on pain relief, I tried hundreds of pain treatments and procedures. Yet the snake was only provoked and continued to thrive. I became increasingly trapped. Over the past eight years of living with chronic pain, I kept trying new and different treatments and procedures, thinking that if I just searched far and wide enough, I would eventually pick the right lock and find my cure. During just the first year of the COVID-19 pandemic, for example, I endured: a five-day lidocaine infusion in Philadelphia, exosome injections in New York, a gabapentin course (that made me gain eight pounds in a week), 13 weeks of a specialized pain rehab clinic in Arkansas, specialized low-level laser therapy in Toronto, three weeks of intermittent steroids infusions, several IVIG infusions prescribed by a doctor in Boston, and more. I put my all into each of these treatments and forced myself to be hopeful (which is important, because pessimism and hopelessness can actually counteract and defeat chemical and therapeutic effects of treatment). Yet none of them provided any relief. Some of them made me worse. When I’m forced to accept that a treatment or procedure hasn’t worked, I crumple under the weight of the crushing disappointment. I have to accept the loss and the terrible letdown: I won’t be getting my cure here. And the prospect of relief feels even more elusive. I dread breaking the news to my friends and family that yet another treatment failed and imagine them thinking, “How is it possible that nothing helps her?” Shame and embarrassment take over, even if I don’t wholeheartedly believe it’s my fault. It bothers me that even though nothing has worked before, my friends and family still seem surprised that yet another treatment didn’t help me. And while I should be the last one to be surprised that the latest treatment didn’t work, a part of me always goes into a new treatment thinking that it could finally been my breakthrough! It stings terribly to accept that it’s not. Every time a treatment or procedure fails restarts something akin to a mourning process. I have to mourn the loss of another option crossed off my list. Each failure means one fewer option that could bring back my pain free self and turn my life around. The crushing weight of another treatment failed is then compounded by all of the letdowns that came before it. My mind spirals back to the past several years of failed attempts and I’m inconsolable for a period of a few days to a few weeks while I’m processing it all. This is particularly challenging when my body is also fighting side effects from the most recent treatment and struggling to return to its pre-treatment condition. My emotional state is overwhelmed by hopelessness, anger, a sense of unfairness, and fear for the future. The physical acts of having to pack my bags, say goodbye to the medical team treating me, pay my sometimes exorbitant bills that health insurance often won’t cover, and leave empty-handed leave a bitter taste in my mouth. Each subsequent defeat feels harder and harder to swallow. — During times like these, I try to summon the inner strength and determination I found within myself as a child and teenager playing on the national junior tennis and squash circuits. One time when I was 11, I lost the first game of a first-round squash match (the winner must win the best out of five games). During the 90 second break between games, my momager (i.e., mom-manager) was spitting strategy at me while I guzzled Gatorade that quickly turned my upper lip red. I stared past her, not listening to anything she said, until I finally said matter-of-factly: “Give me a minute to mourn the last game and then I’ll move on.” She looked at her 11-year-old, stunned into silence. I took a minute to myself, let go of the last game, collected my thoughts, and went on to win the next three games to win the match. Mourning was a key step to my success that day and has been ever since. After being struck down by each failed treatment or procedure, I’ve mourned for a time before rising up again. Just like that squash match when I was 11, I’ve understood that my match against pain isn’t over. — I won’t give up on having a better life, and now I’m pursuing a new strategy: neither playing dead nor trying to kill the snake. Instead, and learning to coexist with it and calm it until it’s ready to release its grip on me. I’ve immersed myself in pain neuroscience education, pain psychology, and pain coaching that have opened my eyes to how chronic pain affects the brain and the central nervous system and how we can best combat the process. Research tells us that when you exist in a sustained period of chronic pain, the brain actually changes. It forms a difficult to break pain cycle and continues to perpetuate pain even in the absence of tissue damage.
Things I Learned by Accident & Contagious Courage
Reading Time: 5 minutesEverything I know about pain I learned by accident. In 2005, 14 miles from Wisdom Montana, I feel asleep at the wheel, over corrected and rolled violently down the barrow pit. Sitting in the wreckage of my car partially paralyzed from the neck down and gradually suffocating from two punctured lungs might seem like an unlikely way to get an education, but that’s how it was for me…. My accident landed me in the ICU in Butte with a broken neck, fighting for my life. After I had been taken off of the ventilator, I was finally able to ask one of my neurosurgeons a question that had been weighing on my heart. “What’s my prognosis doctor?” He flipped through my chart and said, “Well, you’ll NEVER be normal!” That answer, while supremely accurate, was devastating. The next day, his partner, the neurosurgeon who actually did my surgery came in and I asked him the same question. His answer was different. With bold confidence he smiled and looked me in the eye as he said, “You’re going to walk again.” At that moment I had a choice: I could be psychologically paralyzed by the discouraging voice, “You’ll never be normal,” or I could embrace the courage and hope of the second voice. Both statements were true, but the decision was mine. Refusing to believe the discouraging voice I tackled the next two years of rehab and recovery with a vengeance. I relearned to sit up in a chair, to stand, to walk, to regain movement, and write my name. But even as I recovered my physical function, burning nerve pain from my neck down gradually took over my life. The pain brought back that distant voice from the past, “You’ll never be normal!” Pain has a way of getting our attention, and it got my attention fully! I measured it on a scale of 1-10, I fought for a solution, an answer, a cure. But the more I focused on my pain, the worse it got. Pain expert, Dr. Michael Moskowitz in his book, “Neuroplasticity: Changing the Brain in Pain” uses this graphic to illustrate the regions of the brain that experience pain. When a person experiences acute pain, these key regions of the brain are activated. But as acute pain is experienced and focused upon it becomes memorized, more brain cells are recruited to the experience and pain amplifies and takes on a life of its own. Like a constant screaming siren that doesn’t go off, chronic pain is LOUD, and hard to ignore. An old neurological adage says, “What fires together wires together.” What we focus on, we empower and enlarge. Bit by bit, day by day, the brain builds connections that define what we know, and how we feel. In my experience, my brain defined my pain and it was excruciating. I’m not saying it’s all in my head, my pain is real, it has a real cause; a fluid filled cyst called a syrinx at the level of my injury. But the fact is that pain is an experience of the brain. I discovered this by learning about phantom limb pain. How do you explain pain that is experienced in a limb that’s not even there? Many answers have been offered, but today’s best science has found that while the limb may be missing, the portion of the brain dedicated to that limb still exists, and if the brain says the missing limb hurts, then it hurts! Dr Ramachandran developed a mirror box that tricked the brain into thinking the missing limb is actually there, complete, healthy and whole. This is me using the mirror box. When I see my paralyzed hand as if it is working, my pain goes away. My accidental discovery of this fact led me to a powerful realization: How I see myself could completely transform my experience of pain. Seeing myself as whole and complete I could unlearn pain by focusing not on what is wrong, but on what is right. This was my first step in taking courage by the hand and walking into a whole new life. But what can you focus on when you have burning nerve pain from the neck down? You focus on the neck up. You focus on what is good, what works, and what is going right. And so that’s what I did. Every time the pain started to scream, I deliberately turned my focus toward healthy tissue, and healthy thoughts, the positive, not the negative. And it worked. My overall experience of pain decreased, I felt like I was getting my life back. I started doing the things my doctor told me would help me manage my pain; exercise, relaxation, sleep, and began cutting back my pain medications. I was beginning to find my new normal. But a woman I had met at a pain clinic wasn’t doing as well. She couldn’t see past the pain, she needed someone to walk beside her, to do for her what Dr. Sorini did for me, to say to her “You’ll walk again.” So, I became her coach and she got her life back too. I call this “Contagious Courage,” the ability to pass on my victory over pain to someone else. To walk alongside and let them borrow my courage until they have some of their own. I become their mirror box. To give them hope, sharing the words they need to hear to see themselves whole and complete. My favorite coaching question is, “What went well this week?” At first this really throws them off! They expect the opposite question, “So what’s wrong,” or “How’s your pain?” Most of them stammer as they try to turn their brain around and process the question. It’s as if I’m asking them to make a giant U-Turn. And I am. There are 116 million people in the United
