Does Living with Chronic Pain Make Us Brave?
Reading Time: 2 minutesI was getting an annual checkup the other day. While we were talking about my chronic pain, the doctor looked me in the eye and said, “you guys are the bravest of the bunch.” She said in a way that made it clear she really meant it, like she wouldn’t wish chronic pain on her worst enemy. I kept repeating the phrase over and over in my head for the next few days. What really is bravery? I’ve always thought it was funny that people refer to other people on their deathbed, suffering with cancer, or experiencing the debilitating chronic illness as “brave.” Why? What’s brave about it? It wasn’t a choice to be dealing with these things. To me, bravery always seemed like an innate characteristic that made you choose certain things – certain things that fear would’ve prevented you from doing. After all, I think that the opposite of bravery is fear. For instance, being brave to me is enlisting in the military, running into a burning building, having a difficult conversation with someone, embarking on an adventure, taking a big risk. But getting sick or experiencing pain don’t fit in that category. They aren’t something that any of us chose. Being brave and chronic pain Here’s what I decided about bravery and living with chronic pain: the way that some people with chronic pain live their lives is brave. I don’t think it can be applied to everyone with chronic pain. I don’t think that the very nature of having chronic pain makes someone brave. But I do think bravery applies to people who look their pain boldly in the face, spit at it, and tell it that it’s not going to stop them from living their best life. Better than that, they can tell the pain that they are not scared of it. (That part is easier said than done.) The reality is that it’s usually not this binary. Most people with chronic pain aren’t “brave” all the time. And that’s okay. Most of us with chronic pain go through darker periods where we are totally defeated by it, where we feel sorry for ourselves, where we hide in our beds or in front of the TV for days, and where we wish everything would stop. Bravery comes into play when we decide to pick ourselves back up. It’s when we decide to go to that in dinner or party we really don’t feel up to going to, force our bodies to move even when there’s a lot of protest from within, laughter tears, love with her whole heart, do something for other people, or enroll in a new pain program even when the last 15 haven’t worked. It’s when we dare to have hope that one day things will be better. To me, that’s bravery.
Types of Chronic Pain and Why it Matters
Reading Time: 2 minutesLiving with chronic pain can be a daily battle, affecting not only your physical well-being but also your emotional and mental health. Chronic pain is a complex condition that can manifest in various ways, and understanding the different types of pain is crucial for receiving appropriate treatment. In this blog post, we will explore the various types of pain and explain why identifying your specific type of pain is essential for effective management and relief. Nociceptive Pain Nociceptive pain is perhaps the most common type of pain. It results from the activation of nociceptors, which are specialized nerve endings that detect harmful stimuli such as tissue damage or inflammation. Nociceptive pain can be further categorized into two subtypes: Somatic Pain: This type of pain originates from the skin, muscles, bones, and joints. Conditions like arthritis, fractures, and muscle strains often lead to somatic pain. If you have this type of pain, you can usually point to where it hurts with 1 finger. Visceral Pain: Visceral pain arises from the internal organs and can be caused by conditions like irritable bowel syndrome, endometriosis, or gallbladder disease. This pain feels duller and vaguer. It’s hard to pinpoint the location of pain with 1 finger. Neuropathic Pain Neuropathic pain is the result of damage or malfunction in the nervous system itself. Unlike nociceptive pain, neuropathic pain does not serve as a warning sign of injury, but rather persists long after the initial cause is gone. Conditions such as diabetic neuropathy, post-herpetic neuralgia, and sciatica fall under Mixed Pain Mixed pain is a combination of nociceptive and neuropathic pain. It often occurs when a chronic condition causes damage to both the tissues and nerves. For example, in conditions like complex regional pain syndrome (CRPS), patients experience both burning and throbbing pain (nociceptive) as well as numbness and tingling (neuropathic). Central Sensitization Central sensitization occurs when the central nervous system becomes hypersensitive to pain signals, amplifying pain perception. This type of chronic pain is common in fibromyalgia, where the brain’s processing of pain signals is altered, causing widespread pain, fatigue, and sleep disturbances. Why Identifying the Type of Pain Matters Understanding the specific type of pain you have is essential for several reasons: Tailored Treatment Plans: Different types of chronic pain respond differently to treatments. Knowing the underlying cause and pain type allows healthcare providers to develop personalized treatment plans that target the root issue. Medication Selection: Certain medications, such as anti-inflammatories would be better for nociceptive pain whereas nerve pain medications are more effective for neuropathic pain. Accurate diagnosis helps in selecting the most appropriate medication. Lifestyle Modifications: Lifestyle changes, physical therapy, and coping strategies can vary based on the type of pain. For instance, therapeutic modalities that improve pain in central sensitization would not help a person who only has nociceptive pain. Understanding your pain type empowers you to communicate effectively with healthcare providers, leading to more successful pain management strategies. Conclusion Pain is a complex and personal experience, with various types that require tailored approaches to treatment. By working closely with healthcare professionals like Override’s multispecialty chronic pain specialists to identify the type of pain you have, you can pave the way for more effective pain management and ultimately improve your quality of life. You don’t have to face chronic pain alone – seek the support and guidance from specialists to better work towards relief and recovery.
How the People and Environment Play into Your Chronic Pain
Reading Time: 5 minutesWhen we think about pain, we often focus on the biological or physical aspects—what’s happening in our bodies. But what if your environment, both the space you’re in and the people around you, could make your pain better—or worse? The biopsychosocial model of pain suggests that your surroundings, both physical and social, play a big role in how you experience and cope with pain. Here’s how everything from your friendships to the sunlight streaming through your window can impact your pain—and what you can do about it. Your Social Circle: A Double-Edged Sword Pain is lonely—especially when it’s “invisible.” It’s hard to explain to others who don’t live with it, and the isolation can feel suffocating. Here’s the good news: strong social support can work wonders. Studies* show that people with chronic pain who feel supported by their loved ones experience less pain, distress, and depression. It’s like having an emotional cushion to soften the blow. But not all support is created equal. Sometimes, well-meaning loved ones overdo it—constantly checking in or showing too much sympathy. This can backfire, magnifying the perception of pain and disability and making it harder to move forward. The key? Balancing compassion with encouragement for independence. The flip side of that is people who love you and mean well just don’t know how to relate to what you’re dealing with and unintentionally distance themselves from you – making you feel more alone and less like your old self. Even outside close relationships, community matters. Sometimes a community that has nothing to do with pain is most helpful – like a church choir group or a book club. For others, joining a support group for chronic pain and connecting with others who “get it” can be a game-changer. Shared experiences foster understanding, and hearing how others manage their pain can inspire your own path forward. Cultural Norms and Pain Perception Think back to when you were a kid. Were you told to “shake it off” when you fell, or was your pain met with concern and comfort? These early messages can shape how we approach pain as adults. In some cultures, expressing pain is seen as a sign of weakness, while in others, it’s considered essential to healing. Gender expectations play a role, too. Men might hesitate to seek help because of societal pressure to “tough it out,” while women’s pain is often dismissed as exaggerated or hysterical or said to be “all in their heads.” These cultural norms don’t just affect how we talk about pain, as well as how we experience pain and how it affects us. Your Physical Space: More Important Than You Think Your immediate environment doesn’t just set the mood—it can also set the tone for your pain. Take your home, for example. Is it cluttered and chaotic? That mess might be stressing you out without you even realizing it. A tidy, organized space not only reduces anxiety but also minimizes risks like falls or injuries that could worsen pain. Let’s not forget about nature. Research shows that natural light and greenery can significantly reduce pain levels.** Patients in sunny hospital rooms use less pain medication, and simply looking at images of nature can soothe post-operative discomfort.*** So, open the blinds, bring in a houseplant, or add some calming landscape photos to your space. Noise and air quality matter, too. Chronic exposure to loud sounds or polluted air ramps up stress and strains your body and nervous system, likely making pain feel worse. Creating a calm, clean environment isn’t just about aesthetics or setting a move—it’s about giving your nervous system a calm environment in which to relax. The Brain’s Memory Trap: When Pain Becomes a Habit Sometimes, pain isn’t just about what’s happening now—it’s about what’s happened before. Our brains are excellent at connecting environments with experiences. If you’ve experienced pain in a specific place, your brain might automatically crank up the pain signals the next time you’re there—even if there’s no actual threat. Take the story of Australian pain expert Professor Lorimer Moseley. After being bitten by a venomous snake, he later experienced excruciating pain in the same environment—only to realize it was just a harmless twig brushing his leg. His brain remembered the trauma and overreacted. This memory effect can happen in everyday life, too. A chair where you’ve felt pain before might trigger discomfort just because your brain associates it with past pain. Or returning to a movie theater where you felt pain before might trigger it again. Often there is something about people’s parents’ homes that cause a pain flare. Recognizing these patterns is the first step toward breaking them. (And no, that does not mean you should avoid them all.) Take Control of Your Environment You can’t change everything about your environment—your family, your job, or where you live might be out of your immediate control. But small tweaks can make a big difference. Cultivate relationships that uplift you. Spend time with people who make you feel good, not those who amplify stress. Incorporate nature. Open the blinds, take a walk outside, or add a plant to your workspace. Declutter and organize. A clean, safe home can improve both your mood and your physical health. Listen to your brain’s signals—but don’t let them control you. If certain places or situations trigger pain, remind yourself it might be a conditioned response or a memory effect, not a current threat. Your environment shapes your pain experience more than you might realize. By being mindful of your surroundings—and making small, intentional changes—you can create a space that supports your well-being and helps you reclaim your life from chronic pain. Ready to start making changes? Look around your environment today. The path to pain relief might be closer than you think. *M.P. Jensen, D.M. Ehde, A.J. Hoffman, D.R. Patterson, J.M. Czerniecki, L.R. Robinson. Cognitions, coping and social environment predict adjustment to phantom limb pain. Pain, 95 (2002), pp. 133-142; López-Martínez AE,
Setting Boundaries to Prioritize Your Healing
Reading Time: 2 minutesThere’s an old saying: “Good fences make good neighbors.” It’s a simple truth—without clear boundaries, it’s easy to step on each other’s toes, creating friction and stress. For individuals living with chronic pain, boundaries aren’t just about maintaining peace; they’re about survival and healing. Chronic pain comes with unique limitations: how long you can walk, work, or even socialize. These constraints aren’t just physical; they’re emotional too. Boundaries protect your energy, giving you the space to rehabilitate and recover. The Power of “No” Saying “no” is hard—especially when it’s to the people or activities you love. But every “no” creates the opportunity to say “yes” to something more restorative. It might be a physical therapy session, journaling, or simply resting. Boundaries are the foundation for making intentional choices about where your energy goes, ensuring it’s directed toward what truly matters. Signs You Need to Set Boundaries If you feel angry, resentful, or stressed after agreeing to something, it’s a signal: your boundaries might need adjustment. For some, chronic pain itself becomes the loudest voice pointing to discomfort. Your pain may “speak” when you’re doing something your mind or body wishes you’d declined. Listen to it, reflect on it, and let it guide you—not dictate—to healthier choices and what you want to do. Types of Boundaries to Protect Your Energy Boundaries come in many forms, each serving a unique purpose in preserving your physical and emotional well-being. 1. Time Boundaries Example: Limiting how long you stay at an event Example: helping your brother move out of an apartment for 30 minutes, then resting (this is also an example of time-based pacing) 2. Physical Boundaries Example: Choosing not to be hugged or avoiding environments that exacerbate pain, like smoky bars. 3. Social Boundaries Example: Limiting time with energy-draining people or attending fewer late night trivia nights at the bar with friends. · Even deferring decisions can be a boundary: “Let me think about it and get back to you.” 4. Psychological Boundaries Example: Refusing to discuss emotionally taxing topics, including potentially your pain, or limiting difficult conversations to a specific time frame. Tip: Set boundaries with yourself, too, such as not dwelling on upsetting memories beyond a certain point . The Challenge of Boundaries Boundaries are deeply personal and often hard to maintain. Knowing where to draw the line starts with understanding your limitations, values, and what fuels you versus what depletes you. It’s not uncommon to falter—especially with loved ones or ingrained habits. Fear of guilt or rejection often keeps us from holding the line. You might overextend yourself to avoid feeling “lazy” or endure a toxic relationship out of fear of being disliked. But remember: it’s okay to feel guilty. It’s okay to disappoint others. It’s okay to let them down. These feelings are natural as you start setting boundaries, but they often fade with time. And every “no” is a step closer to saying “yes” to self-care, growth, and pain management. You need to take care of yourself first and foremost. What Healthy Boundaries Look Like Communicating your values and limits clearly. Sharing only what feels comfortable. Allowing yourself to change your mind. Saying “no” without guilt. Respecting when others say “no,” too Setting boundaries is an essential part of managing chronic pain. It’s not selfish; it’s survival. You deserve the time and energy to heal, grow, and thrive—and you don’t need to apologize for it. By protecting your energy, you’re prioritizing the most important part of your recovery: you.
How to Optimize Your Circadian Rhythm When You Have Chronic Pain
Reading Time: 3 minutesHave you ever wondered why you feel alert and energetic at certain times and sluggish at others? This cycle is governed by your circadian rhythm, a natural, internal process that regulates the sleep-wake cycle and repeats roughly every 24 hours. Understanding and optimizing your circadian rhythm isn’t just about better sleep—it can also play a crucial role in managing chronic pain. What is Circadian Rhythm? Your circadian rhythm is like your body’s internal clock, influenced by environmental cues like light and temperature. It regulates essential bodily functions, including hormone release, digestion, and body temperature. The master clock, known as the suprachiasmatic nucleus (SCN) in the brain, coordinates these rhythms to maintain balance. When your circadian rhythm is disrupted—by poor sleep, inconsistent schedules, or environmental factors—it can affect your physical and emotional health, exacerbating chronic pain conditions such as fibromyalgia, arthritis, or neuropathy, among others. Circadian Rhythm and Chronic Pain Chronic pain is deeply connected to the body’s biological rhythms. Here’s how: Inflammation Cycles: Inflammatory responses, which often contribute to pain, are regulated by circadian rhythms. Disruptions can lead to heightened inflammation and discomfort. Pain Sensitivity: Research shows that pain sensitivity fluctuates throughout the day, often peaking in the morning and declining in the evening. Sleep and Recovery: Poor sleep, a common issue for those with chronic pain, can further disrupt circadian rhythms, creating a vicious cycle. Optimizing your circadian rhythm can help break this cycle, reducing inflammation, improving sleep quality, and enhancing your body’s ability to manage pain. Tips to Optimize Your Circadian Rhythm for Chronic Pain 1. Create a Consistent Schedule Go to bed and wake up at the same time every day, even on weekends. Consistency reinforces your internal clock and improves sleep quality, which is vital for pain management. 2. Embrace Morning Light Exposure to natural light in the morning helps regulate your circadian rhythm. Spend 10–15 minutes outside or by a sunny window shortly after waking up. 3. Limit Evening Light Exposure Blue light from screens can interfere with the production of melatonin, the hormone that helps you sleep. Use blue-light-blocking glasses, dim the lights, and power down devices at least an hour before bed. 4. Incorporate Movement Regular exercise, especially in the early part of the day, helps stabilize your circadian rhythm and reduces pain by releasing endorphins. Be mindful of the timing, as vigorous exercise too close to bedtime can interfere with sleep. 5. Mind Your Diet Eat meals at consistent times to regulate your body’s internal clock. Avoid large meals, caffeine, or alcohol close to bedtime, as these can disrupt your rhythm and exacerbate pain. 6. Prioritize Sleep Hygiene Create a sleep-conducive environment by keeping your bedroom cool, dark, and quiet. Use calming activities like meditation or gentle stretching before bed to relax your body and mind. 7. Align Medication with Sleep Schedules Work with a healthcare professional to align your medication or therapy schedule with your circadian rhythm. For instance, some pain medications may work better when taken at specific times of the day. Medications also may have side effects of making you sleeping or energizing you; knowing which to take or not to take before bed will help or hurt your sleep. The Bottom Line Your circadian rhythm is a powerful tool for managing chronic pain. By aligning your lifestyle with your body’s natural rhythms, you can reduce pain intensity, improve sleep, and regain control of your health. If you’re struggling with chronic pain, consider incorporating circadian-friendly practices into your daily routine. Small, consistent changes can make a big difference in how you feel. What steps will you take today to support your body’s natural rhythm and live with less pain?
How Expressive Writing Can Help You Lower Stress and Manage Chronic Pain
Reading Time: 3 minutesWriting can evoke a range of emotions — excitement, hesitation, or even fear. Much like public speaking, the act of putting your thoughts on paper can feel intimidating. However, writing can be used as an effective tool to alleviate symptoms of pain and anxiety. You’re about to learn about a specific type of writing that is recommended for people with chronic pain, called “expressive writing.” Expressive writing doesn’t involve grammar, punctuation, or even legibility. It’s a deeply personal exercise — one that no one else needs to see. In fact, you can destroy it as soon as you’re done! Writing as a Tool for Stress and Symptom Management Writing has long been associated with stress reduction and health benefits. This particular form of writing isn’t about crafting a masterpiece; it’s about exploring your thoughts and emotions, which can be therapeutic. For many, managing stress and symptoms is a personal journey. Medical experts recognize that repressing emotions can manifest physically, leading to symptoms like muscle tension, fatigue, digestive issues, and sleep disturbances. Expressive writing allows you to confront these emotions by giving them a voice. This process can reduce the physical toll of unspoken thoughts and feelings, creating a pathway to healing. Releasing Repressed Emotions Trauma, whether stemming from job loss, chronic pain, or other life challenges, often triggers emotions like anger, shame, and fear. While it’s natural to want to discuss these feelings, many people hold back for fear of judgment or alienation. Instead, they “stuff” their emotions down, which can exacerbate stress and pain. Research shows that avoiding traumatic emotions and memories activates the body’s fight-or-flight response, keeping individuals on edge and prone to overreacting. Writing offers an outlet for these repressed feelings, reducing their grip on your mental and physical well-being. There are several prominent clinicians and thinkers in the field of pain management, like Nicole Sachs LCSW, who advocate for expressive writing or another form of journaling as one of the key components of recovery. How to Begin Expressive Writing Dedicate 5 -10 minutes to writing about an issue, experience, or feeling. Handwriting is preferred, as it fosters a stronger connection between your brain and body. Don’t worry about structure, coherence, grammar, spelling, or legibility. Just write continuously for the entire session until the timer goes off. The quicker you can write — so that it matches your stream of consciousness — the better. Your writing focus can be: How an event affected you Its impact on your relationships How you wish you had reacted What you were thinking but didn’t say Any stream-of-consciousness thoughts When you’ve finished, destroy what you’ve written! Tear it up, crumple it, drown it in water, or throw it away. This act symbolizes transferring your burdens to the paper and releasing them. Some people like to burn the paper as the ultimate symbolic act, but if you choose this method, please do it in a sink and run water over it afterwards to ensure the flame is completely extinguished.If you want to delve deeper into this, there are more complicated and structured methods to expressive writing. Consider this method specific to overcoming trauma and decreasing its grip on you, recommended by Andrew Huberman. The Proven Benefits of Writing Research reveals significant health and behavioral benefits from expressive writing. These include: Health Benefits Fewer stress-related doctor visits Enhanced immune function Reduced blood pressure Improved lung and liver function Fewer hospital days Improved mood and psychological well-being Reduced depressive symptoms and PTSD-related avoidance Social and Behavioral Benefits Reduced absenteeism Quicker re-employment after job loss Improved memory and academic performance Better social interactions If you’re ready to explore this tool, commit to writing for a week and observe its impact on your life. Perhaps it will become part of your daily routine as a way to wind down before bed or start your day. Or maybe it will be an occasional tool you pull out when you are feeling particularly anxious or angry or in pain.By giving your emotions a voice, you can begin unburdening your mind to allow yourself more space to heal from chronic pain. Here are some Microsteps to try. Set aside five minutes to write about something you are finding stressful today. Write without editing or worrying about grammar. This is just for your benefit and the practice can relieve stress and help lower anxiety. At the end of each writing session tear up your piece of paper or shred it. Discarding your paper acts as a release and can help you let go of the worries you’ve been writing about. Pair your expressive writing session with a calming ritual. Light a candle or prepare a soothing cup of tea to create a safe and comforting environment. If you find you are overwhelmed with emotion during your writing session, step away and do something else. Engaging in a comforting activity like listening to music or cuddling a pet can help you relax. Before you go to sleep, write down three things you are grateful for. Keeping a nightly gratitude journal can support you in building a gratitude practice, which can help you maintain a positive perspective and reduce stress.
The Power of Diaphragmatic Breathing for Chronic Pain
Reading Time: 4 minutesBreathing is one of the most natural and automatic processes of the human body. Yet the way we breathe can significantly impact our physical and mental well-being. If you have chronic pain, a simple shift in how you breathe can calm your nervous system, reduce pain, and unlock a host of other health benefits. While there are many different breathing techniques, let’s explore a relatively simple one: diaphragmatic breathing. Diaphragmatic Breathing Many of us — even those of us without pain — take shallow breaths from our chest, engaging the shoulders and upper chest muscles. This “chest breathing” is common in adults, but it’s not how we were born breathing. If you’ve ever watched a sleeping baby, you’ll notice their stomach gently rising and falling. Their breath comes from deep within their body, not just the chest. This natural way of breathing is known as diaphragmatic or belly breathing. And this is how we’re supposed to do it. Diaphragmatic breathing involves taking deep, full breaths that come from the bottom of the ribcage and abdomen. It’s a simple and effective tool for stress and pain management — accessible anytime, anywhere. The Impact of Stress and Pain on Breathing Chronic illness and pain often lead to chest breathing. Stress, fear of pain, and heightened nervous system activity make chest breathing the body’s default response. This stress-induced breathing pattern can contribute to increased muscle tension, anxiety, and even headaches. Additionally, many people with chronic pain unconsciously hold their breath or take shallow breaths, which can worsen their symptoms. The next time you feel tense or pain, notice your breathing. You may experience tightness in your chest or catch yourself taking an extra-deep breath that feels and sounds like a heavy sigh. These shallow, short breaths rely on neck and chest muscles, which are less efficient at bringing oxygen into the lungs. This can create imbalances in the body and intensify pain symptoms. Why Diaphragmatic Breathing Works The diaphragm is a dome-shaped muscle at the base of the ribcage that acts as the body’s most efficient breathing muscle. Using it to breathe deeply brings more oxygen into the lungs, eases muscle tension, and counters the biochemical effects of shallow breathing. Science has shown that deep breathing activates the parasympathetic nervous system — your body’s natural “rest and digest” mode. This reduces stress and anxiety, improves cognitive function, and lessens pain. How to Practice Diaphragmatic Breathing Get Comfortable: Sit with your feet flat on the floor or lie on your back. Use Your Hands as a Guide: Rest one hand on your chest and the other at the top portion of your abdomen. Notice the lower hand on your abdomen rising and falling, while you should feel little to no movement coming from the chest. This is how we retrain “chest breathing” into “diaphragmatic breathing.” Inhale Deeply: Breathe in through your nose, letting your stomach muscles relax and expand outward. Your upper chest should remain relatively still. Exhale Fully: Exhale through your nose, first passively, then actively using your abdominal muscles to push the air out. As you exhale, relax your face, shoulders, neck, and chest. Take 60 seconds now to focus on your breath. Making it a Daily Practice Deep breathing is a versatile tool you can use during moments of stress, pain flares, or simply to relax. It’s best to start practicing this every day, regardless of whether you are in pain or not. If you wait until you are in pain to try it, you may be less able to concentrate on your breath and relax through it. The more consistent you are, the more automatic and beneficial it will become. Many people use diaphragmatic breathing as a tool to try to relax if they have trouble falling asleep. Others prefer to start their day with some breathwork. It’s up to you when and for how long you want to practice. Here’s a selection of Microsteps to support you in making diaphragmatic breathing part of your daily routine. As soon as you wake up, take a few deep breaths, inhaling and exhaling through your nose. Starting your morning with diaphragmatic breathing primes your body for relaxation and sets a calm tone for the day ahead. Take two minutes to mentally scan your body from head to toe, noting areas of tension or discomfort. Acknowledging any stress of pain without judgment, can help you consciously relax those areas. Whenever you feel stressed during your working day, pause and take a couple of minutes to breathe. Taking a breathing break and activating your diaphragm can prevent stress from escalating and keep you centered. In the evening spend a few minutes practicing diaphragmatic breathing with your partner and kids. Sharing the practice and technique can be a bonding experience and can support your family in staying calm as you build this healthy habit together. If you’re experiencing pain, pause and use your hands to guide your breath. Feeling the rhythm of your abdomen rising and falling as you breathe in and out through your nose may reduce discomfort making your pain more manageable. Take a few minutes to visualize your diaphragm rising and falling as you breathe. Visualisation can support you in making diaphragmatic breathing a calming and peaceful part of your well-being routine. You could also picture rhythmic beach waves as you inhale and exhale, or a flower gently opening and closing. Take a few deep breaths at night to wind down and relax. Practicing diaphragmatic breathing in bed is a great way to end your day. Breathing deeply before sleep can ease tension, making it easier to drift off to sleep.
From a Prestigious, Academic Medical Center to Chronic Pain Startup: Why I Joined Override
Reading Time: 4 minutesBy Christina Le-Short, MD, Founding Medical Director When I was a second-year medical student, my house burnt down. It was a tragic, life-changing experience that eventually led me to the field of pain management. On the winter morning of the event, I awoke to find I had missed dozens of calls. You know that feeling when your stomach hits the floor and you know something isn’t right? “There was a fire. Your sister and roommate had to jump out of the second-story window. They’re at the hospital now. Your sister needs surgery.” I had stayed at a friend’s that night and immediately rushed to the hospital to greet my smoke-covered sister before she underwent emergency surgery. She had suffered a lumbar vertebral burst fracture and a severe crushed foot injury from landing on a pile of cinder blocks. Thankfully, her spinal cord was unharmed, but the doctors didn’t know if she’d regain normal functioning of her foot. Over the next few years, I watched as my sister underwent 9 subsequent surgeries and recuperated from each one. Every surgeon sold the hope of improvement in her function and pain, yet none delivered. Some surgeries worsened her pain and needed to be reversed. After the 9th operation, my sister still had ongoing daily pain and was still told by surgeons that there might be another surgery that could help her. But she decided she was done. She had been through numerous steroid injections, stem cell treatments, physical therapy, electrostimulation, and a variety of medications. None of which were very helpful. At the time, I was completing my medical student rotations- going through the varying medical specialties to find the one that I would dedicate my career to mastering. It was a natural fit when I discovered the field of anesthesiology and pain medicine. I could help patients like my sister manage their pain during surgery, throughout the recovery process, and beyond. After 9 years of medical training, I was privileged to be hired as an Assistant Professor at the #1 cancer hospital in the world, MD Anderson Cancer Center. There, I was lucky enough to work with and learn from experts in multiple disciplines, all of whom I would consult with for the care of my patients (i.e. pain psychology, physical medicine & rehabilitation, emergency medicine, neurology, palliative care, integrative medicine, radiology, neurosurgery, and physical & occupational therapy). However, even at one of the top hospitals in the world, with innumerable resources at my fingertips, I still felt that my team and I were not incentivized to care for patients in the most effective way. We were not immune to the pressures of our problematic healthcare system in which physicians are incentivized to do highly-reimbursable procedures and disincentivized from giving patients much of what they also need to heal: time, guidance, empowerment, peer support, and pain education. Prescriptions and procedures outnumbered interdisciplinary care, health literacy, and group coaching. I was fortunate to join the Override team whose mission is to raise the standard of care for chronic pain patients. Interdisciplinary care is a proven and more effective model for chronic pain management and needs to be better adopted by the pain medicine community. Numerous studies have shown that a team-based approach not only improves patient outcomes, but also saves health system dollars by decreasing the use of expensive diagnostic imaging, the number of unnecessary procedures, and hospitalizations.1-5 By streamlining the clinical process and making it available virtually, Override is able to exponentially increase access to much-needed pain management care. The majority of people with chronic pain don’t need another stimulator or minimally invasive spine surgery to regain their quality of life. They need the commitment of a dedicated team, empowering them to take control of their own health. This mission is why I joined Override and I am thankful for the opportunity to play a role in changing the way chronic pain is treated in this country. What has worked for my sister since her accident 13 years ago is staying active and living a healthy lifestyle. She eats nutritiously and exercises daily. She is at her best when she goes on 3+ mile hikes in the woods with her loyal golden retriever, soaking in nature. She still has pain every day, but it doesn’t stop her from living an enriched life full of adventures and exploration. My sister is one of the many examples of how pills and procedures are rarely the answer. We can do better for people with chronic pain. References Maeng DD, Baylor K, Bulger JB, Han JJ. Impact of a multidisciplinary pain management program on patient care utilization and cost of care. J Pain Res. 2018 Oct 18;11:2375-2383. doi: 10.2147/JPR.S177231. PMID: 30425550; PMCID: PMC6204849. Marchand, W., et al. The Veterans Health Administration Whole Health Model of Care: Early Implementation and Utilization at a Large Healthcare System, Military Medicine, Vol 185, Issue 11-12, November-December 2020, Pages e2150–e2157. Mahrer NE, Gold JI, Luu M, Herman PM. A Cost-Analysis of an Interdisciplinary Pediatric Chronic Pain Clinic. J Pain. 2018 Feb;19(2):158-165. doi: 10.1016/j.jpain.2017.09.008. Epub 2017 Oct 17. PMID: 29054492. Murphy, J. L., Palyo, S. A., Schmidt, Z. S., Hollrah, L. N., Banou, E., Van Keuren, C. P., & Strigo, I. A. (2021). The Resurrection of Interdisciplinary Pain Rehabilitation: Outcomes Across a Veterans Affairs Collaborative. Pain medicine (Malden, Mass.), 22(2), 430–443. doi.org/10.1093/pm/pnaa417. Oslund, S., Robinson, R., Clark, T., et al. (2009) Long-Term Effectiveness of a Comprehensive Pain Management Program: Strengthening the Case for Interdisciplinary Care, Baylor University Medical Center Proceedings, 22:3, 211-214, DOI: 10.1080/08998280.2009.11928516
Group Coaching Is One of the Keys to Success with Chronic Pain
Reading Time: 4 minutesWhen I think about my own health journey, I now realize that the greatest health pearls I uncovered often didn’t come from renowned experts. Instead, they were uncovered through personal trial and error, curiosity about health challenges, interactions and conversation with peers, and a practical connection to personal values. The approach is rugged and adventurous, and I’ve found it to be key to unlocking long term health benefits. It is a blend of exposure to new information from those around us and a commitment to personal responsibility in the lifestyle changes we seek. Group coaching fosters an environment for exactly this exploration and exposure to others’ wisdom. Here are just a few of the many reasons why group coaching is so critical on a journey to better manage chronic pain: Group coaching is creative. Individual coaching sessions are one-on-one with a client and a specialized pain coach; they allow the pair to really dig into the client’s individual issues and problem solve together on a molecular level that isn’t possible during group coaching sessions. Group coaching, however, is led and facilitated by a specialized pain coach and incorporates 3-6 other people with chronic pain. It allows the client to be exposed to so many more thoughts and perspectives. It’s like the age-old saying, “two heads are better than one.” Well, five or six heads are sometimes better than two. During group coaching sessions, each client shares what the guiding weekly topic means to them and how they can best implement the lesson in their own lives. They also share what doesn’t and hasn’t work for them and help other participants to avoid those same mistakes. This dialogue between many people struggling with similar issues stimulates creative problem-solving in each individual as to how to best adapt a concept to one’s own circumstances. Each client becomes skilled in developing his or her own creative ways of handling problems. As coaches, sometimes we wish we could be more instructive, more of an educator. Yet we know that this approach robs the client of autonomy and self-efficacy. It stifles their creativity and prevents a shift in thinking that leads to long term behavior change. Instead of being the final authority on knowledge, the coach creates a space where learning is a product of curiosity and collaboration. Group coaching lessens isolation. In a world that is increasingly distant and isolated, group coaching connects people that are facing similar challenges and who also want to experience a shift in thinking. Chronic pain is inherently isolating. Even when surrounded by loving family and friends – which many are but many are not – most people feel like people without chronic pain cannot understand or relate to what they experience. People with chronic pain are tired of hearing their friends and family tell them to “stay positive” and “be grateful it’s not worse,” for example. Unless you experience chronic pain, you don’t get what it’s like to live with it day after day. In groups, clients are exposed, sometimes for the first time, to other people who are struggling with similar health challenges. This is a deep connection that many have really needed but couldn’t find elsewhere. Group coaching fosters this continued connection throughout our program. Some groups decide to take the connection beyond the structured group coaching sessions, and we love that! I’ve led groups where the individuals form a text group, call each other, and encourage each other to exercise and help each other through flare ups. One group even formed a walking group where the individuals decided to talk to each other in a group via conference call during each walk they planned. Group coaching is a great opportunity for new and deep connection. Group coaching softens skepticism. A surefire way to build someone’s skepticism is to tell them what to do. I learned this the hard way. Many of our coaching clients are very skeptical when they come to us. And who can blame them? Almost without exception, each of them has a story about how the system failed them. Their world revolves around failed surgeries, mountains of complex diagnoses, habit-forming medications with miserable side effects, clinicians who have told them they are out of options, careers they are no longer able to pursue because of pain, etc. Understandably, when clients are referred to us, some automatically think, “this won’t work for me, I’ve tried it all.” And when they meet their pain coach, they fear interacting with yet another ineffective pain expert who will say “it’s all in your head” or “mind over matter.” We know that to be effective, we have to break the mold and use a different approach. The Greek philosopher, Plutarch, said, “The mind is not a vessel to be filled but a fire to be kindled.” Group sessions are a great way to soften skepticism because the objective isn’t to fill the client’s mind with information, but rather to stoke their fire. Group coaching is proven to be effective. Over the past decade, we have found group coaching to be one of the keys to success for our clients with chronic pain. Clients have consistently reported high satisfaction with the structure and benefits they receive from the group coaching. We definitely aren’t the only ones who have found it to be so effective. In the US Department of Veterans Affairs’ Whole Health model that is now being rolled out across the country, peer support was one of the central keys to the success of the program for people with chronic conditions. In my experience (both personally and as a coach) and in the VA model, we see that peer support ultimately helps people to take charge of their own chronic pain. Group sessions are approached from this perspective: The coach is knowledgeable in the subject matter being discussed, but ultimately the client is the expert and in control of his or her own fate. This
Why Mental Health Providers Should Consider Referring Patients to Comprehensive Pain Services
Reading Time: 2 minutesChronic pain and mental health issues are deeply connected, often fueling a cycle that is hard to break. Mental health providers typically focus on emotional well-being, but when emotional distress is linked to chronic pain, addressing both physical and mental health becomes crucial for improving patient outcomes. The Pain-Mental Health Cycle Chronic pain not only affects the body but also has a profound impact on brain function, often worsening conditions like anxiety and depression. In turn, mental health issues can heighten pain perception, creating a vicious cycle. Chronic pain leads to emotional distress, which intensifies pain, trapping patients in a feedback loop of discomfort and mental strain. Traditional Mental Health Treatment Isn’t Enough While therapy and medications are vital for mental health, they often don’t address the physical or “biomedical” roots of chronic pain. By integrating pain medicine, physical therapy, and behavioral health into treatment plans, you can help patients break the cycle and improve their quality of life. Numerous companies are emerging that specialize in pain psychology, often centering on “Pain Reprocessing Therapy” (PRT), a relatively recent therapeutic approach. While PRT shows promise, particularly for individuals with “nociplastic pain” (also known as “primary” or “neuroplastic” pain), it may not be sufficient on its own for most people experiencing chronic pain. Many patients benefit from a more comprehensive treatment plan, as chronic pain frequently involves overlapping pain types. For these patients, a multidisciplinary approach addressing both the psychological and physical components of pain may be essential for effective, sustainable recovery. How Comprehensive Pain Services Enhance Mental Health Treatment Pain Medicine: Appropriate diagnosis is paramount. Medications can be effective in reducing physical discomfort, allowing patients to engage more fully in therapy and emotional healing. Physical Therapy: Home exercise programs – specifically designed for chronic pain – boost mobility, strength, and independence, increasing activities, improving mood and reducing anxiety. Coaching (separate from licensed behavioral health services): Individual and group coaching provide practical pain management strategies, increase accountability and program adherence, and enhance patients’ resilience and emotional coping skills. Benefits of an Interdisciplinary Approach Patients who receive care from both mental health and pain specialists report better outcomes—lower pain levels, improved mood, and enhanced daily functioning. Feel free to reach out to Override Health to explore our outcomes of our interdisciplinary care model. And for providers, referring patients for pain services reduces the strain of managing complex cases and fosters more effective collaboration across disciplines. Refer a patient to Override through Override’s secure referral form or fax a referral to 866-301-4910. When to Refer Patients Consider a referral when: Pain is a main driver of mental health symptoms. Traditional therapy isn’t enough to achieve pain breakthroughs. Pain significantly limits the patient’s daily functioning or emotional progress. The Path to Better Patient Care Mental health and chronic pain are interconnected, and treating them together ensures better outcomes. By referring patients to comprehensive pain services, you can help them manage their pain and achieve emotional well-being. Addressing both physical and mental health empowers patients to live more fully and simultaneously reduces the strain on mental health providers.
