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
The Experience of Pain & Choosing Our Words Wisely
Reading Time: 4 minutesExpect to learn the following throughout this article: How words can change our pain experience Why overly focusing on pain can create more of it How to take one step towards relief from chronic pain One of the most common complaints people seek health care for is pain. Now is the time to begin to rethink pain so that we can redefine our lives and the way we live them. According to the International Association For The Study Of Pain1, Pain is “An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.” Experiencing Pain & Words Do you remember the old saying “Sticks and stones can break your bones, but words can never hurt you”? Well someone very clever also wrote,”Sticks and stones can break your bones, but words can never hurt you, well unless you believe them, then they can destroy you.” This sums up why and how words5 can be intimately connected with our experience of chronic pain. In a research article published in the journal of Pain in 2009, titled “Do words hurt? Brain activation during the processing of pain-related words6,” the researchers explored how words directly contribute and change our experience of pain. These researchers were very clever because they measured this by using fMRI imaging which measures the amount of neuronal activity within regions of the brain associated with pain processing such as the dorsal ACC (dACC), left anterior IC, bilateral inferior frontal gyrus, & dorsolateral prefrontal cortex. Why This Study Matters in Chronic Pain The scientists involved placed subjects in two distinct groups and subjected the study participants to 3 types of pain-related words: neutral, negative affective, and positive affective words. These three categories of words were chosen because of the known link between emotions and pain processing7. The subjects were placed in two main categories: The imagination group The distraction group Imagination group: This group was presented with 1 of the 3 types of words on a screen (neutral, positive, and negative), and were instructed to imagine an experience or situation that may involve the word displayed on the screen in front of them. For example, if they saw the word “destruction” they would imagine a building collapsing, or if the word happiness appeared, they may recall an experience in their life that brought them immense joy. The Distraction group: This group was presented with a specific task to perform, such as counting back from 10, and throughout the performance of this task, words such as destruction and happiness were flashed in the background. What Researchers Found Can Help You with Chronic Pain Remember the fMRI tool that measures brain activity during specific tasks we mentioned earlier? Well, when the researchers examined the brain activity of the two groups, the regions of the brain well-known to be involved with processing pain had higher levels of activation in the imagination group compared to the distraction group. As we promised in the outline of this article, this is something that we can harness in our every day lives in order to modulate and change our experience of pain. If we focus 100% of our energy, life, and effort on “fighting” the pain, these regions of the brain can become highly neuronaly active and produce more pain as a result. If you have experienced persistent pain such as fibromyalgia, chronic lower back pain, or persistent facial pain8, you know this all too well…… How many times has your medical provider asked you about your pain level from a 0-10 scale? This is an example of being in the “imagination” group because we can become hyper-focused on pain, and in turn experience more of it. Hyperfocusing on pain can lead to destructive habits and rapidly decrease our quality of life. Creating some type of “distraction” group within our own lives can be very helpful throughout the journey of chronic pain. Some examples of this include learning a new skill, taking up a breathing practice, reaching out to old friends, or learning a new physical movement. This does not mean we are ignoring our pain, it simply means that we are prioritizing what we know about science and the brain to live a more fulfilling and meaningful life. References Definition of pain: https://www.iasp-pain.org/publications/iasp-news/iasp-announces-revised-definition-of-pain/ Pain & The Neuromatrix https://pubmed.ncbi.nlm.nih.gov/11780656/ Neurosignature https://icog.group.shef.ac.uk/the-frustrating-family-of-pain/ Bioplasticity https://www.iasp-pain.org/publications/relief-news/article/time-to-embrace-bioplasticity/ Words Hurt https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6749494/ Do Words Hurt? https://pubmed.ncbi.nlm.nih.gov/19846255/#:~:text=When%20subjects%20were%20instructed%20to,words%20compared%20to%20other%20words. Link between emotions and pain processing https://www.hss.edu/conditions_emotional-impact-pain-experience.asp Persistent Facial Pain https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8192736/#:~:text=Persistent%20idiopathic%20facial%20pain%20(PIFP,teeth%2C%20without%20any%20structural%20correlate.
My Ten Year Pain Anniversary
Reading Time: 5 minutesDuring my first few years of pain and unsuccessful treatment, doctors tried to give me hope by telling me about people who had 10 or more years of pain before finding relief. In my early twenties, 10 years of pain was impossible to imagine. Living even a few more months in the type of pain that I was experiencing seemed unfathomable, let alone 10 years. Yet, 10 years later, I am still in pain. And I am still here. The 10th anniversary of my second head injury – after which pain invaded my life – is filled with grief for what I have gone through and a sense of loss of what my life might have been like had I not been in the wrong place at the wrong time. This is not a happy anniversary, yet I’m certainly proud of my perseverance and strength. I hope that my story might inspire others who are suffering to keep going as well. What happened? 10 years ago, I went to Israel to compete as a member of Team USA’s women’s tennis team at the 2013 World Maccabiah Games. Held once every four years, this international event draws world-class Jewish athletes from over 60 nations to compete in over 40 sports. It had been my dream to compete in this event since I was a little girl. You see, my late grandfather – who I adored – dreamed of competing in the Maccabiah nearly 75 years earlier. The rise of the Nazi regime derailed those plans and his entire life as a Jewish teenager living in Hamburg, Germany. He fled to New York by boat in 1939. His day-to-day life became learning English, struggling financially, and assimilating to an entirely new way of life. His own Maccabiah dream was never realized. At 90 years old, he bought a ticket to Israel and watched his 20-year-old granddaughter compete at one of the most beautiful tennis facilities in the world, built on the hills of Jerusalem. Unfortunately, I had a tough draw, and after first round wins in the women’s singles event, women’s doubles event, and mixed doubles event, I (and my doubles partners) faced the #1 seed in all three draws. We lost. I was knocked out of the competition. Without competition on the schedule, I spent the next day at the hotel pool, making friends with athletes from all over the world. Engrossed in a conversation with an Australian soccer player, I (along with likely 50 others at the pool) ignored the volleyball being kicked from one end of the large pool to the other. If I had any conscious thought about the volleyball, it was probably something like: These are world-class athletes with good ball control. What are the chances that anyone, let alone me, gets hurt? Despite the improbability, I was the one who got hurt. The kicked volleyball crashed into the left side of my head causing a whiplash effect, damage to the left side of my neck, and a major concussion that was compounded by another head injury that I had sustained only 13 months prior. The aftermath I flew home to Philadelphia. The concussion symptoms were severe, much more so than with the first incident. I quit my summer job and spent hours lying in a dark room, willing a friend to call me since having conversations was one of the only things I could do. My vision and disorientation were to the point that I couldn’t take walks safely since I could not judge the speed of cars accurately. Television, texting, and reading were discouraged. I was sensitive to light and sound. I slept unnaturally deep sleeps for 14 hours a night. My mother took care of me. When the symptoms didn’t resolve but rather morphed into insomnia, mood swings, and anxiety, I saw a doctor who diagnosed me with Post-Concussive Syndrome. I was put on a specific exercise protocol and did see improvement over the coming months. But after the concussion symptoms seemed to resolve, pain arrived as a very unwelcome visitor. First in my neck, then quickly thereafter to my lower back. Shoulder pain followed, as well as eventually pain in multiple other parts of my body. Writing today, I easily have ten different symptoms bothering me at a given moment. Some days, it is worse than others, but regardless of the day, I try not to let it win. How I manage As co-founder and CEO of Override, a comprehensive, virtual treatment program for chronic pain, I am very transparent about still being in pain. Yet, people seem to believe what they want to believe. When I give presentations (to investors, customers, patients), my audience sees a confident, ambitious, and put-together woman. They often conclude that I have overcome my pain and say, “I’m sorry for what you went through,” despite my pain experience being described in the present tense. Others do hear me say that I’m still in pain, and instead ask, “How do you manage your pain?” What they really mean is: “You seem to have your pain figured out, so tell us how you do it.” I always swallow hard and struggle with this question. I’m not sure that anyone ever gets used to being in pain, especially when it’s unpredictable and ever-changing. There have been periods of my life where pain has beaten me. I’m not cavalier enough to say it won’t ever beat me again. Today, not letting pain consume me on a day-to-day basis takes hard work and commitment. For me, it means: ● Finding purpose and meaning – in my work, my relationships, and the future I hope to build; ● Regular exercise, stretching, and physical therapy exercises – movement is the best medicine ● Breathing – it’s easy to forget to breathe with chronic pain, and deep breathing calms the
What’s Your Kindness Quotient (KQ)?
Reading Time: 2 minutesThe Importance of kindness quotient (KQ) in challenging times We’ve had a very tough last few years. COVID-19 has claimed over 6 million lives worldwide. Hamas attacks on Israel have horrified the world. Mass shootings have turned schools into war zones. Climate change has exposed itself to be even more worrisome than we feared. The list continues. The challenge to develop a COVID-19 vaccine tested our scientific community’s intellectual intelligence (IQ), and many have adapted to new ways of living and working during the pandemic in part due to their emotional intelligence (EQ). But what about a person’s kindness quotient (KQ)? A KQ is how a person responds to others experiencing difficulty and suffering. We believe that this is the time that our KQ matters most. How do you measure your KQ? There is a quick five question test or a longer more detailed test here. Here are the five questions: 1. If you saw a person at work dealing with a personal illness or a family situation, would you offer to help? 2. If someone was on the street and needed food or shelter, would you offer to help? 3. If you know of someone who is socially isolated, would you reach out to them? 4. Do you spend any time volunteering or helping others in your community? 5. Do you perform random acts of kindness? If you answered “yes” more than 4 or 5 times, you have a high KQ. If you answered “yes” 2 or less times, you have a low KQ. When I think of KQ, I also think about all of the medical providers and behavioral health specialists whose kindness and empathy towards their patients vary significantly. Every person with chronic pain has one or maybe several stories of leaving an appointment in tears – dejected and beaten down – after being told something thoughtless and fear-inducing. Examples include providers saying things like, “The pain is all in your head,” “You’ve already tried everything,” “You’re out of options,” “You’re just going to have to live like this,” and “I don’t have anything that can help you.” Override’s approach to patient care This is why Override is picking our interdisciplinary team members (physicians, psychologists, physical therapists, coaches, and more) so carefully. We are not only looking for practitioners with excellent training, experience, and skills, but we are also looking for practitioners that understand human suffering and the all-encompassing impact of living with persistent pain. In other words, we’re exclusively recruiting people with high KQs. Because we know from experience – both our own and our patients’ – that kindness matters.
Pain Recovery Highs & Lows
Reading Time: 2 minutesIn The Messy Middle, Scott Belsky writes: “We love talking about starts and finishes, even though the middle stretch is the most important and often the most ignored and misunderstood. We don’t talk about the middle because we’re not proud of the turbulence of our own making and the actions we took out of despair. (…) Every advance reveals a new shortcoming. Your job is to endure the lows and optimize the highs to achieve a positive slope within the jaggedness of the messy middle — so that, on average, every low is less low than the one before it, and every subsequent high is a little higher.” The quotation can be applied to so many different areas in life – from building a startup to training for a marathon. We at Override saw this chart and not only thought about building Override but also about pain recovery. What is pain recovery? While it’s different for everyone, most people don’t see immediate and steady improvement when they start embarking on a pain recovery journey. Most people don’t just turn the corner, get the hang of it, and then continually improve until they are completely in remission from chronic pain. We wish it were that easy. Sometimes it may feel like you’re really getting the hang of applying pain science principles, feeling and moving better, and taking control of your own condition without outside help from medications or interventions, but then you experience a pain flare! Maybe even a really bad one. And it can feel like you are right back at square 1. You ask yourself and your coach, “Have I made any progress at all?” And you think, “I’m just as bad as ever. This isn’t working for me.” It may even be tempting to give up. The ups and downs can be exhausting and emotional. Especially the downs. And it’s a lot easier to notice the downs than the ups! It’s difficult to recognize and appreciate the absence of discomfort or a pain sensation. It’s far easier to notice when pain is sounding the alarm in your brain and trying to force every ounce of you to focus your attention on the pain. Pain recovery is not linear Recovery from chronic pain is neither a quick nor an easy process. It requires a lot of determination to make the real functional and behavioral changes needed to combat the learned neural circuits of living in a sustained period of chronic pain and forming new ones. Pain recovery is not a linear process. So how do we focus on the ups – even the slight and minor victories? Of pain being just a little less loud… Of being able to move just a little bit more than last week … Of doing something you enjoy and actually being able to enjoy it…? Retraining the brain to treat chronic pain That’s one of the challenges in both life and in pain recovery. As we are retraining pain – learning how to “unlearn” the pain we’ve gotten used to being in – we have to create new neural pathways in the brain that focus on the more neutral sensations, the more positive moments in life, and even the smallest victories we experience. Sometimes it may feel like you’re not improving or progressing, and that’s heart wrenching. But in reality, your pain recovery journey may just look more like the picture above.
