How Not to Solve Chronic Pain

posted in: Stage 1: Step 1 | 0

The core pattern of human behavior to ensure survival has revolved around avoiding unpleasant body sensations, especially anxiety. The limited choices aren’t effective over time. We instinctively use two methods.

  • Control
  • Rigid structured thinking.

Control takes the form of either escaping or controlling the situation creating distress and it works. However, since many circumstances (and people) aren’t controllable, you are the mercy of them and often upset. I am not going to even begin to list the ways we exert control but everyone has “control issues”. Escaping or avoiding unpleasant situations is the method of choice but it also becomes increasingly stressful avoiding stress. When all else fails, there is always anger to bail you out.

Rigid structured thinking also decreases anxiety for a while by creating patterns of thinking that avoid anxiety reactions. It also works but it blocks awareness of the needs of those around you and has a suffocating effect on relationships. Unfortunately, it creates much societal angst by imposing ways of thinking and living onto others who also have a valid perspective. Both rigid thinking and control crush awareness. With the key to problem-solving any arena being awareness of the details, this is a problem. So what is the actual solution?

 How not to solve chronic pain

I was in the deep Abyss of chronic pain for over 15 years, although in retrospect my pain began with severe migraines when I was five years old.  I was raised in an abusive environment, which, of course, I thought was normal. My coping skills centered around extreme religious and political beliefs and also disguised anger in the form of guilt and perfectionism. I recall my brother around age 11 telling me, “David, stop kicking yourself. Some of the anger was expressed in the form of cognitive distortions such as “labeling” and “should thinking”. (1)

Around age 15, I somehow figured out that my life wasn’t quite right and I decided to move on. I metaphorically shut the door on my childhood and worked on creating an identity. I added on the additional skills of accomplishments and experiences. I worked on being smart, athletic, social, mentally tough, cool, and the list went on. The energy behind this drive was almost immeasurable. At one point in college, I was taking 21 hours of credits and pulling off a 4.0 GPA, playing intramural sports, had an active social life and was working 10-20 hours a week doing heavy construction. What I didn’t do was sleep much. That energy was what made me “successful.” I thought I had it figured out and was having a great time, especially compared to my past life at home.

 

campus-1818084_1920

 

During my first year in residency, I dropped out of the church of my youth. The reasons aren’t important but it did mark the beginning of my demise. I was never happier than when I had every life question answered, including the afterlife. I had close friends and a sense of community. I respect those friends who have remained in the church but it wasn’t a good fit for me. I had a vague sense that this wasn’t going to go that well. I became more aware of issues of those around me and that of the world. My rigid thinking began to crumble and I noticed some odd thought patterns occurring. My feet began to burn and my ears started to ring. I tried to compensate by increasing control, which eventually cost me my marriage. Shortly after my separation from my wife, I developed extreme anxiety and an internal form of OCD (Obsessive Compulsive Disorder). Eventually, as I was less successful exerting control, my final defense was disguised anger in every form. Everyone recognized it except me. By 2002, I was actively suicidal and crossed the line to permanently move on. I am not quite sure what stopped me. I have been essentially free of pain since 2003. I was lucky.

It took me a while to figure out how I ended up in this mess and even longer to understand the solution. Although, I had made major strides in evolving my process by trial and error, I had my major breakthrough in 2009, while hearing a lecture by Howard Schubiner on the Mind Body Syndrome (MBS). I had invited him to be my keynote speaker for a course I was chairing, “A Course on Compassion: Empathy in the Face of Chronic Pain. As I heard him list the clinical symptoms, I recognized that I had experienced at least half of them and my story began to make sense. I am grateful to many mentors who have deepened my understanding of the body’s response to the environment. Now the recent neuroscience literature is clarifying what many of us have clinically witnessed for decades.

The solution – solving the unsolvable

So control and rigid thinking don’t work in long run. So what works?  It is learning to become comfortable with uncomfortable feelings and sensations, especially anxiety. It isn’t solvable and anxiety is necessary for survival. Chronic pain is solved by separating and moving away from it. It can be likened to diverting a river into a different channel. As you turn your attention elsewhere, these unpleasant emotions will lose their power.

 

river-bed-1081967_1920

 

Anxiety is part of the unconscious nervous system, which is a million times stronger than your conscious brain. Trying to solve or control any form of anxiety inadvertently places more neurological attention on these patterns of circuits and you’ll reinforce them. It’s also is a gross mismatch and your rational brain has no chance. As you quit fighting your unconscious brain, you’ll quit wasting time and resources beating your head against the wall. Then you will experience more energy to move forward with or without your pain.

So how can you accomplish this? How can you learn to live with feelings and sensations that you are programmed to avoid? It is a learned skill. Chronic pain is curable by utilizing a structured self-directed approach. There are three aspects of the solution:

  • Awareness
  • Addressing all of the variables simultaneously
  • The patient takes control of his or her own care

Each of these categories has many aspects to it but none of it is difficult once you understand the core concepts. We now know that you can stimulate your brain to physically change by creating new connections, reinforcing patterns by stimulating formation of myelin (insulation around nerves), and growing new neurons. The term for this process is “neuroplasticity”. You have a choice in how you want to respond to the environment and create a new reality. The DOC process is one of the alternatives.

I have essentially free of pain since 2004. I am currently dealing with a new set of challenges with arthritis in both of my knees but I am not in The Abyss. It’s only pain. It was the additional layer of unrelenting anxiety that destroyed me. I feel lucky to enjoy my life at a level I never thought was possible and I feel even more fortunate to be able to pass on what I have learned to my patients, family and friends.