Reframing
Reading Time: 5 minutesThe more one focuses on a particular interpretation of a situation, the more this is held stable and becomes “the reality.” – Anette Prehn Have you ever noticed that two people can tell the same story in two very different ways? Not only do the points of view vary, but variations in details and how it ends may convince you these two people were not at the same event. Reframing is similar to telling a story another way. It’s like putting a new picture frame on an old picture. The picture is still the same, but it has been updated to better fit the décor. Reframing allows us to change the way we think about a situation or memory, and by doing that we gain control of the way it affects us. It is called cognitive reframing—a way of thinking in a different way. The stories we repeat to ourselves every day are the stories that drive us forward or backward, convince us of our current status, and affect our chronic illness. This is why reframing becomes an important tool in our toolbox. Reframing is a way of changing the way we look at something. It helps us alter our perceptions of stressors, and this goes a long way in relieving stress. Wellness coach, Elizabeth Scott describes it this way: “reframing is a way of changing the way you look at something and, thus, changing your experience of it.” Do you recall the story in lesson #1 about the difference between soldiers and citizens injured in World War II? A medic, observing that injured civilians needed more pain medication than soldiers did, concluded that residents felt trapped by circumstances beyond their control, while the soldiers were relieved to get off the front line—both sustained the same wounds but viewed the personal tragedy in different ways. Elizabeth explains that intentional reframing can turn an unfortunate event either into a major trauma or a challenge to be overcome, can be the difference between a bad day being a tragedy or a mildly low point in an otherwise great life, and can mean a negative situation becomes a learning experience or a life wrecker. “In pain or stress management, it’s a method of viewing what happens in ways that create less stress and promote a greater sense of peace and control.” What is Reframing? Reframing what is a reality is not positive thinking or burying our heads in the sand. It’s a personal choice to interpret an experience or situation for ourselves. Reframing is a human intellectual ability that allows us to change the way we think about a situation or memory, and neutralize any emotional charge related to it. In our lessons about automatic negative thoughts and how to improve them, we set the stage for reframing. Brain science has discovered that situations associated with emotion create stronger memories than those lacking emotion. So, our feelings play a huge part in determining how our brain utilizes input from our senses—what we hear, see, touch, smell, and taste. Just as choosing to see a cloudy day as simply a cloudy day, rather than a bad day, we can teach ourselves to consciously replace tired old negative thinking with more accurate descriptions and associations. How Does Reframing Affect Stress and Pain? Remember how negative and hostile thoughts create tension in the body and increase stress? Reframing what we experience is a powerful tool for decreasing stress. It gives our parasympathetic nervous system permission to be in charge of our body—creating a calmer and more organized system than when the sympathetic nervous system (fight-fight-flee) is in charge. Agitating and angry thoughts keep us in a state of mind that allows the sympathetic nervous system to dominate—essentially shutting down any body function not needed for dealing with an emergency. Over the long term, staying in the fight-flight-flee mode keeps our body from normal housekeeping and repair. Would you rather live in a body that resembles a well-kept house, or one that’s been hit by a tornado? How Does Reframing Work? A few techniques help us learn reframing. If you practiced improving negative thoughts, you might already be very good at this; if not, this is a beneficial practice for everyone. Thinking Patterns: Educate yourself on negative thinking patterns that increase stress levels. Each of us has a practiced way of telling ourselves (self-talk) and others about what has happened to us—whether it’s a simple comment about going to the store or a story about what happened to us during things. See if you recognize yourself in these negative explanatory styles. Becoming aware of thinking patterns and how they affect us enables us to understand where we are and change what we want to make better. Notice Thoughts: We must be aware of something if we want to change it. Being mindful (observing) of our thoughts will help us catch negative thinking. The goal is not to judge or label our thoughts—it’s just to become an observer. In the process, we discover that thoughts are just thoughts; they are not the living, breathing us. They are a product of the way we’ve learned to respond to life from our earliest days —what we’ve been modeled and choices we make every day. Challenge Your Thoughts: It’s not a requirement to continue thinking the way you’ve always thought. Here’s your chance to be in charge! A simple question is all it takes—is that really true?…if I’m honest with myself, do I truly believe that?…what percentage of that is true and what percent is total rubbish? …is that thought uniquely mine, or something I picked up from someone else? Make this a game at first, and you’ll find it gets easier the more you do it. Replace Negative Thoughts with More Accurate Thoughts: Negative thoughts are often inaccurate—at least partly. So just giving them the truth test is the first step to reframing an event or thought. Through a more objective approach—less emotion-driven—we are more likely
Pain Control: Self-Management
Reading Time: 4 minutesMay your choices reflect your hopes, not your fears. – Nelson Mandela You are one of the few people in the world who is now equipped to manage your pain so it doesn’t keep ruining your life. On a planet of over 78 billion people, this is a small group at this point, but it’s expanding by the day as health professionals discover the potential of patients motivated to become self-managers of their pain, instead of the patients they used to be, seeking only to be cured of their pain or illness. Discovering what we can do to reduce our pain was a shock to many of us. Yes, we’d already heard that not sleeping well causes a myriad of health problems, that stress is damaging, and that exercising is a must. It might have been startling, though, to learn that pain isn’t just a feeling but an experience we have some control over, how stress increases our sense of pain, and why some pain medications seem to put us on a roller coaster of fuzzy-brain-more-pain. When we learned how our thinking impacts pain, some of us were skeptical. But when we practiced observing and reframing our thoughts, we saw improvement in our pain levels‒even emotional stability‒we hadn’t expected. We gathered new tools for calming our nervous system‒humor, imagery, scents, and music. We learned to recognize behaviors that increase our pain‒lack of boundaries, anxiety, and anger; and we learned how self-compassion helps us heal, how to help our families cope with our pain, why cardiovascular exercise lowers our pain, and how pacing ourselves improves our productivity, not just our pain. We may have begun to view goal-setting as a friend instead of a taskmaster, and gained new appreciation for the sun’s role in our health and well-being. What are some of your biggest aha! moments and most effective pain-management tools? How will you continue on this new path to physical and emotional health? If you’re afraid to “go it alone,” now is the time to create a game plan where you’re both the Coach and the Coached. Some people have the luxury of a personal coach. Most of us will have to figure out how to create an environment that supports and motivates us physically, emotionally, socially, and spiritually. If we don’t, we run the risk of slipping back into our previous habits and patterns where we weren’t thriving. As you utilize your own pain-management strategies, you will encounter challenges and setbacks‒that’s life. Let’s look at a few things that can discourage or stall us and how we can use the skills we learned to stay on track: Not setting ground rules with family and friends. This fits into the category of personal boundaries. It’s so easy to slip back into our previous lifestyles without realizing we run the risk of re-entering the environment we have worked to change. Have you asked your family not to pamper you or focus on activities you didn’t use to do? Since we teach others how to treat us, they will learn to respect our need for independence and self-reliance. Let them know you will ask when you need something. Putting off something we want to improve. Most of us have put off starting an important project a time or two in our lifetime. More of us don’t have enough fingers to count them. And a few might ‘fess up to being a full-blown “procrastinator.” No matter. Procrastinating isn’t a label; it’s a symptom—usually of fear or a need to control something or someone we view as an authority (a boss, a parent, even ourselves). There are benefits to putting some things off: safety and avoiding knee-jerk actions. But mostly not getting started on something can signal to us our discomfort with the results or the process (boring, overwhelming), possible criticism from ourselves or someone else, or fear that what we start we won’t finish. What can we do to avoid this pattern? Neil Fiore says in his book, The Now Habit, that we don’t procrastinate just to be ornery or irrational. We “procrastinate because it makes sense, given how vulnerable we feel to criticism, failure, or our own perfectionism” (paraphrased). To help ourselves see these “put-offable” tasks or projects differently‒stop being harassed by guilt and have-to/should stress, feeling like a victim, and being in conflict with ourselves‒Fiore suggests that we rephrase the negatives that are stopping us into self-talk that doesn’t condemn or criticize: Replace I have to with I choose to. Replace I must finish with When can I start? Replace This project is so big and important… with I can take one small step now. • Replace I must do it perfectly with I can be perfectly human. Replace I don’t have time to play statements (I can’t because…I have to finish this project…I’m busy tonight…) with I must take time to play. Then, intentionally schedule your play and leisure time so the tasks you’ve been putting off have a stopping point and a reward built in to each day. Negative self-talk. Those ANTS (automatic negative thoughts) that crawl into every unguarded moment are the most insidious pests! It takes persistent awareness to spot them and intentional extermination efforts to rid our headspace of them. But remember that extermination efforts are less effective than replacement efforts, because something has to live in there! Test the negatives for absolute truth Edit them to be more truthful Reframe the fact For example,(1) My whole body hurts! (2) I hurt everywhere but my little pinky toe. (3) Pain is a gift, because without it I wouldn’t know how blessed that little toe is! For many of us, managing our pain will be a lifelong endeavor. Let’s embrace what we can control and practice our pain-management life skills every day. Coaching ourselves to live our best life possible empowers our personal strengths and motivates us to be what we envision.
Medication
Reading Time: 6 minutes“It is easy to get a thousand prescriptions but hard to get one single remedy.” – Chinese Proverb Nobody likes to hurt. It’s why moms give kids a kiss and a bandage for scuffed knees, and the reason we go to the medicine cabinet for everything from a headache to arthritis pain. If we live with chronic illness, our dilemmas and options can be complex. Besides the pain, we may have stressed family relationships, emotional drain, and fears of never getting better. In the last 100 years, pain control has advanced enormously. If over-the-counter medications don’t provide enough relief from pain, we can ask for something stronger. Our physicians have two groups of medications they usually choose from first: analgesics and adjuvants. Analgesics, drugs specifically used to treat pain, include opioids, non-opioids, and combinations of both. Doctors often recommend starting pain treatment with topical formulas (lidocaine or diclofenac patches, capsaicin), non-opioids (aspirin and acetaminophen), and nonsteroidal anti-inflammatory drugs (NSAIDS) to address the inflammation that adds to many types of pain. Their generic names include ibuprofen, naproxen, anaprox, and celecoxib; and they block prostaglandins, a chemical that produces pain at the site of injury or inflammation. Adjuvants are substances that can be used to enhance pain medications even though their primary purpose is for something other than pain (i.e., antidepressants, muscle relaxants, and anticonvulsants). Another category of pain control includes opioid-containing drugs. Opioids first came from opium—a strong, habit-forming powder made from poppy flower seedpods. Since the mid-1900s, they have been used to provide relief from pain due to cancer and other life-ending diseases. For patients who were dying, the worry about dependence or addiction seemed a moot point. With more attention given to pain control came the practice of prescribing opioids for patients whose pain couldn’t be alleviated. It worked like magic because opiate compounds have very effective pain-relieving properties. This may be your experience. But for many people, opioid use has complicated life with dependency, tolerance issues, addiction, and overdose. Many people also lose social connections and the ability to participate in life. Heads are fuzzy, and controlling the pain is all that matters. This may be your experience. There isn’t necessarily a right or wrong when it comes to pain control. What matters is whether or not you are living a life that satisfies you. What matters to your family and friends is that you aren’t taken away from them—mentally or physically. While Take Courage Coaching® doesn’t evaluate or advise client medication use, oftentimes the knowledge and skills of self-managing pain spur clients to reduce or eliminate the use of narcotics. Long-term studies and patient observations offer good statistics on opioid use. While much of the data casts a shadow on this magic pill, the value of knowing how a drug works is priceless. Just a few things medical scientists and physicians have learned about opioid use: The term dependence is widely used to identify the need for a drug for improved function (physical dependence); whereas addiction signifies dependence without functional improvement. Patients with chronic illness on long-term use of opioids often experience tolerance issues and increased pain, emotional dependence, and strong withdrawal symptoms. Many physicians concur that evidence is weak for the long-term effectiveness of opioids in relieving pain and improving functional status. This conclusion comes from studies showing that long-term use of opioids confuses the body and brain, in a sense—interfering with the body’s production of natural pain killers. This is especially the case for patients who develop hyperalgesia (more pain)—a common response to opioids where the brain becomes more aware of and more sensitive to pain. Patients who experience this side effect to opioids are caught in a never-ending cycle of increased pain and heavier drug use. While hyperalgesia can be a horrible complication of opioids, other negative effects are also common—blurred vision, reduced respiratory rate, nausea, constipation, itching, and anxiety. Some patients practice the dangerous use of opioids in combination with other substances such as alcohol, sedatives, sleeping pills and stimulants. Many patients develop “tolerance” to a drug—an adaptation to a drug which necessitates heavier and heavier doses to get the same amount of relief. What’s new to this topic since this lesson was written in 2014? In 2016, the CDC published findings and guidelines on opioid prescribing to reduce medication-related complications and deaths from overdose. Researchers at Veterans Affairs (VA) and Kaiser Permanente health systems reported at the end of 2016 on a study based on dosage and patient-reported effects of opioid use—pain perception and intensity, anxiety and depression, function, beliefs and behaviors related to misuse of pain medication. Researchers Dr. Morasco and his colleagues found patients in the higher-dose group reported greater pain intensity, more impairments in functioning and quality of life, poorer self-efficacy (effectiveness) for managing pain, greater fear avoidance, and more health care utilization. Physicians have responded to the study by pointing out the need for multidisciplinary treatment methods, rather than reliance solely on pain medications for the chronic pain patient. Patients who don’t adapt well to opioids or who are on heavy doses may no longer be doing what they once enjoyed, feel fuzzy-headed, appear to be in a stupor, and miss out on interactions with family and friends. Instead of being helped by these magic drugs, they have become prisoners of the medication(s). The solution has become the problem. If you are taking opioid-containing medications for pain, you or a family member may be able to judge whether the drugs are helping you cope with pain or whether you have moved to a dependent state. Ask yourself these questions and have a supportive family member answer them, too: Is my life dictated by my medication—what I do, when I do it, or if I do it? Am I frequently in a “fog”? Am I constantly thinking about the next time I can take my medication? Questions that can shed light on addictive states include: Do I take my medication to feel euphoria? Do I take my medication
Joy
Reading Time: 5 minutes“We either make ourselves happy or miserable. The amount of work is the same.” – Carlos Castaneda Many of us have let problems get in the way of living a joyful life. There are varying opinions on whether our brains are designed for happiness, but watch a baby learn to laugh, and you have to wonder if we aren’t wired for happiness. Life hands each of us challenges and disasters—in our case, chronic illness—so how can we live a joyful life in spite of problems? This lesson explores the bone structure of happiness and how we can reinstate it where chronic illness has interfered. What is happiness? Experts on the human mind—psychiatrists, neuroscientists, behavioral specialists, psychologists—say it’s being satisfied or content rather than bursting with glee. But it’s easy to slip into a mindset that says if only ____, I’d be happy. Being happy is more about the way we respond and think about life than it is about things (possessions, relationships, career, or money) making us happy. Unlimited wealth and fame are no protection from depression, addiction, poor health, or unhappiness. Catherine Weber describes joy as a system-wide (brain, heart/emotion, body) state of being that thrives on positive emotions. Think about joys that are brain-driven: passing an exam, finding the perfect word to express a thought, solving a puzzle, inventing something. Heart-inspired joy might include affection, being grateful, the pleasure of sharing life with a pet, volunteering to help someone else succeed, a loving relationship, the peace and strength gained through religious or spiritual beliefs and practices, and being aware of the beauty around us. Joys involving the body might include physical exertion, engaging in something creative, getting a massage, sharing an activity with someone, or getting a good night’s rest. What gets in the way of happiness or joy? • Worrying about the future or regretting the past — Right now is the best time to experience happiness. • Expectations — Thinking things should be a certain way can set us up for disappointment or frustration. • Automatic negative thoughts — Framing thoughts in the negative can become an unintended habit that causes us to focus on everything except what brings satisfaction and happiness. We associate many conditions and emotions with unhappiness: disappointment, anger, fear, discontent, poor health, losing a loved one; and you may be including your chronic illness. But there are millions of people who live through all those things and are still enchanted with life. In his book, Learned Optimism, Dr. Seligman credits negativity for increases in depression, lowered immune systems, and overall misery—all elements that can also accompany chronic illness. So how does a made-for-happiness brain overcome obstacles and stay happy? In his book, The Happiness Trap, Russ Harris suggests that living in the moment affords us the best chance at happiness. This doesn’t mean we experience no adversity, but that we spend our time focused on the best parts of now. Harris reminds us that joy is not the absence of pain or difficulty. Popular conceptions of happiness can set us up for a “struggle against reality,” because they don’t acknowledge that real life is full of disappointment, loss, and inconvenience. In her inspirational book, A Thousand Gifts, Ann Voskamp journals her transition from hating life to treasuring it—from being overwhelmed and afraid to discovering that being grateful for small things increased her joy. Barbara Fredrickson suggests making a habit of balancing a negative thought with three things that are good or worth being thankful for, especially if they relate to the negative thought or experience. Learning to live joyfully isn’t a limitation on feelings, says Carlin Flora. Happiness would be meaningless if not for the contrast of sadness. Frustrations point us to what we want to change. How do sadness and joy affect our pain? Have you ever noticed how your body reacts to being upset or angry? An argument at dinner virtually shuts down digestion and causes a stomachache. A verbal fight can make sleep almost impossible. Depression alone can slow our body functions, contribute to tension, and keep us from moving. An ancient saying may be pointedly accurate: “You will not be punished for your anger. You will be punished by your anger.” Tal Ben-Shahar shares in his book, Happier, that rates of depression are 10 times higher today than they were in the 1960s, and the average age for the onset of depression has dropped from 29 to 14 in the same time period. A study of college students shows that nearly 45% of students are depressed enough they have difficulty doing everyday activities. And this is happening when levels of wealth are on the rise. Ben-Shahar’s summation that “even though our generation…is wealthier than previous generations, we are not happier for it,” should intrigue us enough to explore our own level of contentment and find ways to increase our joy. Dr. Amen concludes that “negative thought patterns change the brain in a negative way.” Think about the flip side—being joyful and content: the body relaxes, heart and lungs assume a rested rhythm, digestion is efficient, and sleep comes easier. Contentment and joy are decidedly easier on our bodies than being disgruntled, angry or depressed. Picture how much “happier” your body is when you are enjoying life and sharing it with happy people. In his book Flourish, Martin Seligman, PhD, writes about his Master Resilience Training program for military personnel with post-traumatic stress disorders. One of the exercises, “Hunt the Good Stuff,” works to enhance positive emotions. “Our rationale is that people who habitually acknowledge and express gratitude see benefits in their health, sleep, and relationships, and they perform better.” If “hunting the good stuff” can draw a war veteran out of the debilitating experience of PTSD, might it not have value for those of us dealing with chronic illness? Dr. Amen’s extensive research on the brain’s ability to change with various inputs leads to this recommendation: “Write down five things you are grateful for every day.
Neuroplasticity and Pain
Reading Time: 2 minutes“In chronic pain, the neurons get stuck in a rut of abnormal patterns of activity, becoming underactive or overactive.’” – John J. Ratey, MD Why the focus on how lifestyle choices impact the brain? The brain senses “ongoing danger and the pain pathways are reinforced instead of inhibited…the pain signaling has relentlessly wired the brain to enhance pain pathways”—keeping the pain turned on. It’s now an accepted fact that “we only experience pain when the electrical signals reach the thinking part of our brains.” This is why neuroscientists subscribe to the idea that pain takes place in a person’s mind. Before it was given any credibility, Dr. Brand believed that if we can learn to control the thinking stage of pain, “we will most likely succeed in keeping pain in its proper place, as servant and not master.” So, what is the mind’s secret to pain control? At least 16 places in the brain have been identified as pain-signaling sites, 9 of which are in the “thinking” part of the brain. Only about 5% of nerve cells normally process pain sensations, but in chronic pain, 15-25% of the cells are dedicated to pain. The chronic-pain brain has “learned” pain and devoted more pathways for pain perception. This is “neuroplasticity”—a change in the brain’s anatomy. Logically, the same principles of neuroplasticity that make the brain more “sensitive” to pain can be used to change brain pathways back to normal function and anatomy—essentially un-devoting pathways to pain perception. By using thoughts, images, sensations, memories, soothing emotions, movement, and beliefs to harness the power of our brains, we can “use the conscious part of our brain to modify the experience of our lives.” As Dr. Ratey says, “practice makes new brain.” What fires together wires together The more we do something in a particular way—speak a foreign language, practice a piano piece, remember to floss, focus on gratitudes—the more neurons are devoted to strengthening those connections. And the more the neurons fire together, the more likely it is they will fire together in the future. It’s why young children seem to effortlessly learn two languages simultaneously and why we never forget how to ride a bike. It’s also how we get into habits—good or bad—and why we choose to make lifestyle choices that help us manage our pain.
The Mind/Body Connection
Reading Time: 4 minutes“A sad soul can kill you quicker, far quicker, than a germ.” – John Steinbeck What if you could understand a connection between your brain and your body that is the key to managing your chronic illness? For example, pain has long been considered a physical reaction to an injury. But while the injury may cause pain, it is never the only reason we hurt. Science teaches that pain is felt when the nervous system responds to tissue damage: an injury occurs, a message goes to the spinal cord, and on to the brain, which registers the pain. This understanding of pain as only a response to tissue damage is incomplete. We now understand that our bodies and our minds work in tandem, and there is more to pain than the physical feeling. Deb Shapiro writes in her book, Your Body Speaks Your Mind, of having an upset stomach when she was a child and being asked by her grandmother if she was having a problem at school. “What she knew instinctively, we are at last beginning to prove scientifically: there is an intimate and dynamic relationship between what is going on in your life, and your feelings and thoughts, and what happens in your body.” We come from the “factory” with an array of responsive mechanisms in our body and brain. One prepares us for coping with sudden, frightening, or dangerous events: the sympathetic nervous system. Its role is to mobilize body resources for danger—the fight or flight response. When the SNS is dominant, certain body functions are restricted (salivation, digestion, and gut motility), while others are given extra resources (adrenaline production is stimulated, the heart rate is increased, blood vessels are constricted, air passages are dilated, and sweat glands are stimulated). The other responsive mechanism is the parasympathetic nervous system—the rest system. When it’s dominant, the heart rate slows, blood pressure falls, digestive organs work smoothly, and the immune system is optimized. The sympathetic nervous system mobilizes our body & mind for emergencies, offers those same resources for ongoing stress, and maintains the “household.” The parasympathetic nervous system calms our body and complements the sympathetic nervous system. It’s easy to see that when the sympathetic nervous system is on high alert (hyper-tension) for an extended period of time—as it can be when we are in chronically stressful situations—there is less time and energy for the body to be at rest. Here’s our reality check: chronic illness automatically puts the body in chronic stress. But some situations we describe as stressful turn out not to stress the mind or body unless we think of them as negative or fearful. Have you ever anticipated a future event with dread and become anxious just thinking about it? It hasn’t even occurred, and your sympathetic nervous system is responding—producing adrenaline, increasing heart rate, constricting blood vessels, dilating air passages. Wow! You might be saying, the relationship between the mind and body is a powerful one. Dr. Christiane Northrup compares our control over physical issues with being on a turbulent flight. “You have no control over the winds, or the skills, or the mental state of the pilot flying the plane. But you do have the power to minimize your discomfort. You can decide to read a book, strike up a conversation with the person next to you, wrap up in a warm blanket, sleep, listen to music, or watch a movie. Alternatively, you can listen to every engine noise and allow yourself to be debilitated by worry the entire flight. It’s your choice.” As you can see, the mind-body connection has huge implications for those of us with chronic illness. We have a choice of how we react to stimuli. Our actions—thoughts, activity, daily habit patterns —can either increase our perception problems or lessen their impact. It doesn’t mean we pay no attention to it, and the pain subsides. It’s about making choices that influence brain chemistry, which in turn controls our experience. What surprises many of us is how our mental status either increases our pain or helps to lower our perception of it. After becoming aware of the body’s reaction to emotion, many people see a connection between their depression and chronic pain, anxiety, and a pain flare. Taking personal responsibility for managing our pain can prevent us from falling into the hopelessness and depression often associated with chronic pain. Thoughts are processed in the cerebrum, and feelings are “layered” with thoughts in the cerebrum’s limbic system. The hypothalamus gland acts as a bridge between these areas. So, when we have a negative thought or when pain or stress is experienced, the hypothalamus stimulates the pituitary gland to release the hormone adrenaline. Look at the list of body responses to adrenaline release: increased heart rate elevated blood sugar suppressed immune system increased breathing rate a rise in blood pressure stomach acid secretion constricted blood vessels increased muscle tension. All of this from just a stressful thought! This is the fight or flight system turned inward. When the body is continuously flooded with adrenaline, organs are under chronic stress. Instead of the body addressing daily requirements, it is reacting to an ongoing emergency (likely what happens in post-traumatic stress disorder (PTSD). The mind-body connection in action: think negatively about our pain, and a negative emotion is produced. Do you identify with some of the following examples? Thought Emotional Experience I just can’t live with this pain one more day! fear, anger, hopelessness Why doesn’t my doctor figure out what’s making me hurt and get it solved once and for all?! anxiety, helplessness I wish I could go back to before this illness started—when I was healthy. sadness, remorse, grief Beverly Thorn observes: “Since the brain processes our thoughts and emotions, it makes sense that thoughts and feelings could also have an influence on the experience of pain. And there is mounting research evidence that thoughts and feelings have a direct physical impact on the way the brain processes pain.”
Rest and Renewal
Reading Time: 5 minutes“Sleep is that golden chain that ties health and our bodies together.” – Thomas Dekker After several months of experimenting with sleep practices and routines, you have undoubtedly increased the amount of shut-eye you get on a regular basis. But it’s easy to fall back into old habits, let others interrupt good intentions, or simply forget the tools we use to manage our chronic illness. Let’s visit some principles and review practices that can improve our sleep. Principles Know what makes you tick—the physical, emotional, mental, and spiritual. Each of us is unique in each of these areas, so knowing how things affect us and finding ways to create balance is a skill that complements every strategy in chronic illness management. Focus on what gives you pleasure and peace, not on what creates fear or dissatisfaction. Sleep is our soft spot, so a gentle approach is more effective than disciplined inflexibility. A plan to fit the season, temperature, and environmental factors heightens the likelihood of a good night’s sleep. Practices Day in, day out. Adopt a consistent schedule for bedtime and waking. Your body and mind can’t create regularity out of chaos. Exercise your right to sleep. OK, it’s a pun, but exercising early in the day will produce better sleep at night. That said, anything that requires the body or mind to work hard—eating, drinking cold beverages, environmental chaos, fear, or anxiety—prevents the body from going into sleep mode; so it’s a good idea to protect the two-hour zone prior to bedtime. Slowly but surely. Adopt routines and rituals that support restfulness. For one person, it might be a cup of herbal tea and a good book. For someone else in a warm climate, it could be a leisurely walk through the park. It’s easier to stop a vehicle that’s moving slowly than one that’s speeding. There’s a lesson in that for us. Go out like a light. Darkness is essential for the natural production of melatonin, the sleep hormone. Dim the lights and turn off TVs and computers 30-60 minutes before hitting the hay. Chickens tuck their heads under a wing at dusk and are clucking with first light the next morning. While it might not work for us to function with that schedule in the winter, when darkness takes up to 14 hours of the 24 hours in a day, it’s important to recognize how sleep is impacted by environmental elements. Rest assured. Thinking about things in the past or future can produce anxiety or guilt in the middle of the night. Have you noticed that what we fret about are often things we fear we’ll forget? Consider a nightly ritual of writing down concerns and problems before bedtime. If you wake in the middle of the night, add insomnia-producing thoughts to the list so you can let go of them. Focusing on gratitudes and breathing can calm the mental roar and allow you to fall asleep again. Do electronic readers interfere with sleep? New research supports older studies, which have found that screen time before bedtime can affect sleep. In the latest study, iPad readers took longer to fall asleep, felt less sleepy at bedtime, and had shorter REM sleep compared to those who read a print book. Those reading an electronic device also secreted less melatonin and felt more tired the following day, even if they got a full eight hours of sleep. Sleep deficiency—not getting enough sleep or obtaining poor quality sleep—has been linked to a plethora of serious health problems. If you MUST use an electronic reader before bedtime, several devices offer a blue-light blocker app, and filter screen protectors can be found for other products by typing “blue light screen filter for [device]” into your internet browser. Medication There are times when life produces new challenges or extra anxiety, and your physician may suggest the use of medications. Here’s a short wrap-up on how the most common prescriptions and over-the-counter meds work: Most sleeping pills are “sedative hypnotics” and include benzodiazepines, barbiturates, and various hypnotics. Xanax, Valium, Ativan, and Librium are anti-anxiety medications. While these drugs may be useful in the short term, all benzodiazepines are potentially addictive. Halcion is an older sedative-hypnotic that has largely been replaced by newer medications. Barbiturates depress the central nervous system and are usually limited to anesthesia. Newer medications (Lunesta, Sonata, and Ambien) help reduce the time it takes to fall asleep and are less likely than benzodiazepines to be habit-forming. Sleeping pills have side effects like most medications, but individual response varies. Some medical conditions, such as asthma and COPD, require careful oversight because sleeping pills slow breathing. When taking medications, any changes in digestion, headaches or heartburn, shaking or weakness should be reported to your physician immediately. Most over-the-counter sleep aids are antihistamines. They can induce sleepiness, but can also cause next-day drowsiness. Care should be taken not to take them with other drugs containing antihistamines (like cold or allergy meds). Any sleep aid should be taken only when 7-8 hours of sleep time is ensured because they can cause significant drowsiness. Over time, some medications cause dependence, where sleeping becomes difficult or impossible without the drug. As with any medication, discuss dosage and use with the doctor or pharmacist, and utilize your knowledge of sleep practices to minimize your need for drugs. Read more. Natural Remedies The use of natural sleep aids is helpful to some. Be aware that these are not regulated by the FDA and our bodies all respond to supplements in different ways. The following guidelines are published by WebMD. Melatonin is a hormone produced in the pineal gland in the center of your brain. Some people may not produce enough, and most of us get in the way of production. If used, 0.1-0.3 milligrams may be sufficient to promote sleep. Some users report going to sleep faster, but waking in the middle of the night; others feel groggy or depressed. Supplements can be used to jump-start a
Could Low-Dose Naltrexone Help With Chronic Pain?
Reading Time: 2 minutesBy: Christina Le-Short, MD If you live with chronic pain, you may have heard about low-dose naltrexone, or LDN. It has been getting more attention because it is a non-opioid medication that may help some people with chronic pain, especially when the nervous system has become overly sensitive. LDN is usually prescribed in very small doses, often around 1 to 5 mg daily, and is used off-label for pain.¹ What makes LDN interesting is that it may work differently from many traditional pain medications. Rather than simply dulling pain signals, it may help calm some of the inflammatory and sensitization processes involved in chronic pain. That is why it is often discussed for conditions like fibromyalgia and other pain states where the body’s alarm system seems stuck in the “on” position. The evidence for LDN is most encouraging in fibromyalgia. Reviews and meta-analyses suggest that some patients experience improvement in pain and related symptoms, and that LDN is generally well tolerated. At the same time, the studies have been small, so more research is still needed. For patients, one of the biggest appeals of LDN is that it is not an opioid and is usually not sedating. Some people who respond to it report improvement not just in pain, but also in fatigue, sleep, brain fog, and flares. It is not a cure, and it does not work for everyone, but it can be a reasonable option to discuss as part of a broader pain treatment plan.² LDN is generally considered well tolerated, but side effects can happen. The most commonly reported ones include vivid dreams, trouble sleeping, headache, nausea, and stomach upset. One important caution: because naltrexone blocks opioid receptors, LDN is usually not a good fit for people who are taking regular opioid pain medication unless there is a very specific clinician-guided plan. It can also complicate pain control around surgery or acute injuries if opioid medication is needed.³ The bottom line is that LDN is a promising non-opioid option for some people with chronic pain, especially those with fibromyalgia, widespread pain, or pain sensitization, but it works best when it is part of a larger plan that may also include movement, pacing, sleep support, rehabilitation, and behavioral strategies. Interested in whether LDN could be right for you? At Override, we take a whole-person approach to chronic pain. We look at the full picture, including your symptoms, goals, medical history, nervous system sensitivity, sleep, stress, movement, and what you have already tried. If you are interested in whether LDN may be a fit for you, our team can help you think through the potential benefits, risks, and how it fits into a broader plan to help you feel and function better. ¹ Aitcheson, N., Lin, Z., & Tynan, K. (2023). Low-dose naltrexone in the treatment of fibromyalgia: A systematic review and narrative synthesis. Australian Journal of General Practice. ² Vatvani, A. D., Patel, P., Hariyanto, T. I., & Yanto, T. A. (2024). Efficacy and safety of low-dose naltrexone for the management of fibromyalgia: A systematic review and meta-analysis of randomized controlled trials with trial sequential analysis. Korean Journal of Pain, 37(4), 367–378. https://doi.org/10.3344/kjp.24202 ³ U.S. Food and Drug Administration. REVIA (naltrexone hydrochloride tablets USP) 50 mg, Opioid Antagonist. FDA label, 2013.
Diaphragmatic Breathing
Reading Time: 3 minutes“Diaphragmatic breathing is my secret weapon against pain.” -Becky Curtis Breathing is a natural process we don’t think about much. Because it is so automatic, we just assume we’re doing it right. But there are two different ways to breathe. One is shallow chest breathing, high in the chest. The other is diaphragmatic breathing‒deep breathing that expands the rib cage. As we learn to pay attention to our breathing, we will discover a wonderful stress management tool that can be used any time or place. Chest breathing is considered shallow breathing and is the automatic way we breathe when stressed. The next time you are tense, notice your breathing pattern. You may feel tightness in the chest and realize you occasionally “catch up” with an extra-deep breath (one that sounds like a heavy sigh to those around you). If you pay attention, you may feel like you’re not getting enough air, and will notice how shallow and short your breaths are–all because the neck and chest muscles are less efficient than the diaphragm at bringing fresh air into the lungs. Chest breathing can create both chemical and structural imbalance (tension) in the body. We live in a stressed-out society where tension seems to be the norm. And stress takes its toll on the body, causing: Headaches Shoulder and neck pain Low back pain What is Diaphragmatic Breathing? The diaphragm is a dome- shaped sheet of muscle that extends across the bottom of the rib cage. It is the strongest and most efficient breathing muscle. Utilizing the diaphragm to breathe will: Bring increased oxygen into the lungs Decrease muscle tension Regulate body metabolism Ease and reverse the biochemical effects of shallow breathing (that engage the sympathetic nervous system) Strengthen the diaphragm for increased efficiency What Diaphragmatic Breathing Does For Stress Reduction and Pain Management: Those of us with Chronic illness are often chest breathers. Because we fear more pain or are stressed, we take small, shallow breaths. This only makes things worse, however, as chest breathing increases muscle tension—thus increasing the pain. What can diaphragmatic breathing do for you? Help to relax tense muscles. Be a great distraction tool. Because our brain can only concentrate on one thing at a time, a focus on breathing takes the mind away from the stress and pain. Reduce physical symptoms of anxiety and stress—especially through slow, deep breathing. Improve circulation, which improves clear thinking and relaxes body tissues. All these reactions ease tension and, thus, reduce stress and pain. How to Do Diaphragmatic Breathing: To begin, sit with your feet flat on the floor or lie on your back. Place one hand on your high chest and the other over your rib area (above the abdomen). As you breathe deeply, your upper chest should be still. You will feel your entire torso (rib cage and abdomen) expand as you fully inflate the lungs. Now exhale completely, pushing the air out with the abdominal muscles. As you exhale, relax your face, shoulders, neck, chest, back, and anything else that is tense. This will become easier with practice, until you automatically engage the diaphragm—not just while sitting or lying down. Try deep breathing several times per hour until it becomes a natural part of your life. You should begin to feel less stress and tension. This is a secret weapon to use against pain flares, too—anywhere, anytime you need it! When you have mastered diaphragmatic breathing, you may want to practice and use Dr. Andrew Weil’s instructions for a little extra calming. Place the tip of your tongue against the ridge behind and above your front teeth and keep it there through the whole exercise. Inhale deeply and quietly through the nose to a count of 4 (with your mouth closed). Hold your breath for a count of 7. Exhale completely through your mouth (making a “whoosh” sound) to a count of 8. Repeat steps 2, 3, and 4 for a total of four breaths. Practice this exercise at least twice a day and whenever you feel stressed, anxious, or off center. Adjust the approach so it works best for you. Why This Works: The autonomic nervous system (responsible for involuntary functions like heart rate and digestion) can be divided into two subsystems—sympathetic and parasympathetic. The first keeps us safe; the second relaxes us and keeps the body in balance. Think of the sympathetic nervous system as the rapid-response system that engages our fight-or-flight response. Things that increase sympathetic tone include:
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.
