When you find that something you love, like dancing, can be reworked to stimulate chronic pain relief, it makes sense - based on recent scientific discoveries about which parts of the brain carry, amplify, and suppress chronic pain. We know that when neural pathways have been activated repeatedly, nerve signals travel quickly and easily over the synaptic connections that make up the pain pattern, like a train over a well-used track.

New brain research shows that while acute pain appears in areas of the brain that are connected to tissue damage, chronic pain lives in other areas of the brain - the prefrontal cortex and limbic system, which the brain uses for memories, especially emotional ones.

So in some cases, especially when the pain from damage has not been treated effectively, or perhaps (we don’t know this yet) when the emotional components of the pain have not been treated effectively, the pain lives on long past the time when the body tissues have healed. The pain lives as facilitated neuronal pathways in the brain - though the sensation is still experienced in the body.

Specialists have long tried to relieve chronic pain suffering through…

• pharmaceutical medications (which all have their limits and adverse effects)
• physical interventions - physical therapy, acupuncture, bodywork
• neurological interventions - nerve blocks, stimulators, etc.

All of these methods can help. They are best implemented through a mutli-disciplinary approach involving the patient in rigorous physical, mental, and emotional activity. Because at the core of the healing process, the chronic pain patient needs to expand her/his life and activities - facilitating new, healthy pathways in the brain, rather than reinforcing the pain pathways.

To this end, it is likely that through reframing and refocusing the relationship to one’s pain, the Dancing with Pain® methodology activates the nervous system in new ways that alter, suppress, or potentially even replace the “stuck” pain pathways.

If the new, healthy neurological pathways are activated frequently enough, the pain pathways become deactivated. If sustained over a long enough period of time, the old pain pathways become slower and less likely to activate, then eventually disappear.

Of course, this approach is very easy to talk about but challenging to implement. The process takes a long time, and every setback can feel both frustrating and discouraging. What’s more, since pain and depression pathways are often tightly intertwined in the brain, every setback may also trigger depression - making it that much more difficult to pull oneself out from the physical, emotional, and spiritual rut of chronic phase pain.

If the pain patient can learn to take this cycle less “personally” - spending less time in self-blame and discouragement, and getting back to her/his new, preferred activities as soon as possible - the extinction of the pain pathway will happen most efficiently.

Pain, however, has a way of demanding attention. In addition, there is a gravitational pull involved in repeatedly describing pain in interminable and repetitive detail. Pain psychologists discerned this phenomena years before brain research became available.

Accordingly, they advised that patients not to focus pain behaviors and descriptions, and that practitioners not ask patients how their pain is doing, etc, but rather focus on new behaviors and on living a happy life with or in spite of the pain. While this approach could seem unsympathetic or even cruel, it turns out that neurologically, it is probably the wisest orientation.

As scientific advances enable us to determine which parts of the brain are activated by what types of mental, visual, and physical activity, people will better understand which behaviors suppress the pain pathways and which stimulate the pathways.

Meanwhile, the Dancing with Pain® methodology is utilizing a feedback system that is far more sophisticated than even the finest MRI, because it encourages people to tune into their bodies - a challenging task for those in pain, who are generally trying to focus elsewhere.

The discovery that you can imagine pain as energy, mentally “distill” it, then send it back to the pain source as healing energy, demonstrates that you are hooking into the neurological networks that can bring relief or even recovery from pain.

The general medical opinion is that chronic pain doesn’t resolve. I don’t think we know enough about it yet, however, to say that we won’t be able to completely resolve it in the future - perhaps even the near future - with courageous and creative explorers offering us possibilities like the Dancing with Pain® methodology.

In my work, I have found it takes courage to focus on healing pain - to explore the edges of personal empowerment and responsibility, without falling into the traps of self-blame, judgment, and despair. Patience is essential, because there are so many advances and retreats - precious gains that disappear again into painful losses. Perseverance is essential, because the methods we discover may sometimes work and other times not.

The reason for this inconsistency may be the phenomenon of state-dependent memory, which I may address in a later post. In any case, an attitude of curiosity, determination, and focused intention is of course tremendously helpful. To this end, there are numerous guided imagery approaches that not only can bring immediate pain relief but also can encourage personal exploration of how to heal this pain over the long haul.

Today researchers are studying individuals who are exploring pain from the inside-out. I hope that the hard-earned lessons of Dancing with Pain® will become easier and more consistently effective for everyone, as we understand them from both experiential and experimental perspectives.

Dr. Rossman is a medical doctor and board-certified acupuncturist who has worked to help people in chronic pain for nearly 40 years. He is Director of the Collaborative Medicine Center in Greenbrae, California; is a Clinical Faculty Member of the University of California San Francisco Medical School; and is a leading international teacher of Mind/Body Medicine for patients and professionals alike. Check out his award-winning books and guided imagery CDs for self-healing.

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Loolwa Khazzoom: What launched the onset of your chronic pain?

Brad Lemley: A bad car accident at age 17 - broke my left femur and put me in traction, took me about three years to stop limping. Within about a year, I began to have awful pain on the left side of my head, probably due to chronically tightening the muscles on that side of my body.

LK: How did struggling with chronic pain impact your life?

BL: The major impact was that it simply sapped a good deal of my energy. I often felt that I could go at most things at roughly 50%, the other 50% of my mental and physical capacity being required to simply keep myself from curling up in a ball.

I also, frankly, think I wasted a fair amount of time looking for a spiritual meaning for it all. I now think that pain has no ultimate meaning. That sounds depressing, but it’s actually liberating.

LK: Please say more about trying to function when half your energy is sapped by fighting pain.

BL: I sort of had a “normal Joe” job throughout that period. I would go to work 9-to-5 someplace and hold it together for that time, trying as much as I could to just sort of be unconscious of the pain. I wasn’t interested in letting anybody know that I was dealing with it.

Talking about it just wouldn’t have done any good. It makes you look unproductive, and if you’re trying to climb up the ladder, it’s not anything you really care to share.

By nature, I’m extremely averse to taking drugs of any kind. I’m 52 years old, and in the last 30 years, I have taken prescription drugs for about a week and a half total.

I did, however, used to take extra strength-Excedrin at work now and then. It would give me not only some pain relief but also a shot of energy - it contains caffeine - to overcome that tendency to not have energy because you’re fighting pain.

Then I would get home, and that’s when the pain would really strike me. I’d get my ice pack out of the freezer and put it on the back of my neck, on the left side of my head, and that would sort of help.

LK: Can you elaborate on the issue of how discussing your pain might make you look unproductive?

BL: Well I think the first thing you need to do is make a gender distinction. I think that generally speaking, men talk about what’s bugging them a lot less than women do.

There’s almost no advantage for a man to ever share any story of any weakness whatsoever. It doesn’t get you anywhere, so you become accustomed to not doing it. So I just didn’t.

Other than not, I would cut the world some slack on not being understanding, because frankly, if the situation’s reversed, I’m not terribly interested in hearing somebody tell me about the awful pain they’re in. Particularly if I’m in a managerial role, I want them just to get their work done.

I don’t expect people to have more compassion than I show on a daily basis. Everybody in the world is trying to strike a balance between taking care of themselves and caring for other people. And everybody falls in a different place on that continuum.

Some people are more self-absorbed than others. Some people are more compassionate than others. There are people who are quite compassionate. My wife was amazingly patient about this whole thing, it always used to amaze me - more patient than I would have been if the situation was reversed. I always appreciated that.

But I understand that everybody is in a different place on that spectrum, and you can’t just sort of share willy-nilly your problems and expect everybody to be sympathetic. Some people are, some people aren’t.

Also, I’m a real guy about this kind of stuff. Even if somebody was going to be compassionate, I wasn’t interested in it. That’s just not how I cope. It’s not how I get through things. I would rather just deal, and that’s what I always have done, and that’s what I did in this case.

LK: Where do you see that ideology fitting in with issues of disability and accessibility?

BL: I think it would be really nice if people were more compassionate about the disability that comes with chronic pain, but it’s a very complicated thing. I really have a trouble getting my mind around it because I also believe very strongly in what Larry Dossey wrote about denial being a surprisingly effective mechanism:

People who brushed off their cardiac problems as indigestion actually had better survival profiles than people who thought that they were really having a heart attack.

I used to just, to the greatest ability that I could muster, get past it and never really ask anybody else to be compassionate about it. And I think this is something weird about me. I think other people need more support than I need.

All I really needed was my wife. I didn’t want the world at large to be sympathetic to my case.

What I wanted, more than anything, rather than sympathy, was just to get rid of the chronic pain. That’s what I really, really wanted and that’s what my focus was always on: solving the problem however I could.

Stay tuned for Part II of this interview!

Brad Lemley is the editorial director of DrWeil.com, Andrew Weil’s website. Previously, Brad worked as a television reporter and anchor, a radio reporter, and a freelance writer for The Washington Post, Life, Discover, and other leading periodicals, and he co-authored two books, including It’s Not What Happens to You, It’s What You Do about It. In his spare time, Brad is a woodworker, house renovator, and dedicated fitness enthusiast. While he may sound like a hard-head and tough guy in this interview, he is really a big marshmallow who adores his family and two cats.

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Very rarely do the things I want to do and the things my body will allow me to do correspond, and nowhere is this conflict more evident than in my career. While the competition between the needs of the body and the desires of the spirit is one that has lasted a lifetime, recent events prove I’m not nearly as enlightened or reasonable as I’d thought I’d become.

Let’s rewind things a few years. When I was in college, I took five courses a semester, worked on the campus newspaper 30-40 hours a week, interned another 15 hours a week, and was also pretty social. I was also routinely hospitalized for weeks at a time. Coincidence? Not so much.

In fact, it was a fairly straightforward relationship:

The more time I pushed myself and logged hours that would drag down even the healthiest person, the more time I inevitably spent in the hospital because my respiratory infections and exacerbations were so hard to contain. It was a vicious cycle, this “I’ll take on as much as I can to prove it doesn’t matter that I am sick” game I insisted on playing, and I never, ever won.

At twenty-seven, I should be older, wiser, and much less prone to these control issues. Right? Well, I am…mostly. I am much less intense and stubborn than my college self.

Partly this is because I have matured a bit. It’s also because my diseases have progressed and between that progression and finally getting more accurate respiratory and autoimmune diagnoses, I’ve been forced me to take a hard look at my choices and my baseline health status.

I’ve reigned in the acute hospital crises, and I’ve come to see that I pay a price for living in the extremes of overly committed or completely bedridden that extends far beyond a week in the hospital or an acute flare.

I cannot always control my health, but I can try hard to control the factors that make my health worse. (Say it out loud. Repeat as needed.)

Juggling multiple chronic conditions and the pain, fatigue, and various unpleasant symptoms they entail takes a lot of work. Add to that a job in academia, a freelance writing career, a book that’s coming out in a few months, and spending quality time with my husband, family, and friends, and it seems like I am always negotiating and prioritizing.

Of course my natural inclination is to say “yes” to every opportunity that comes my way because I’m building a career, but if I want to maximize my health, I have to set limits.

I’ve worked to create a schedule with built-in flexibility: I work from home two days a week. My courses are bunched together so I have less commuting back and forth and I can get my daily chest physiotherapy in the morning. I stagger freelance assignments so they are not all due at once.

I rest more often, and if I’m feeling terrible, I snap the laptop shut and pay attention to my body’s signals. Even on a workday. My college self wouldn’t recognize such sanity.

And then I got a respiratory infection a few weeks ago that really knocked me over. I’d already been sick for over a month when this new infection hit, despite lots of medications, plenty of rest, and lots of sacrifices. I was so frustrated that I’d done all that and still got even sicker, and all my time management skills and reason went out the window.

My laptop followed me to the couch and the bed, where I set up camp because I was too weak to sit at my desk, and instead of resting, I typed on the computer that rested on my stomach. As my fever increased and my oxygen decreased, I became increasingly incapable of saying “no.”

Before I knew it my schedule was more packed than ever and I was overwhelmed, anxious, and stressed out. It was a cycle I knew all too well, one I thought I’d escaped. It made my recovery longer, and made accomplishing all those tasks I’d signed on for much harder.

Ah, control. I try to do the right things. I make financial and emotional sacrifices for my health but sometimes I get sick anyway, and I can’t always control that. It’s an occupational hazard of being chronically ill that we all face, and it’s a tough one.

I cannot always control my health, but I can try hard to control the factors that make my health worse. (Say it out loud. Repeat until balance has been restored. Remember how good that feels. )

***

Laurie Edwards runs A Chronic Dose, an award-winning blog about life with multiple chronic illnesses. In addition, she has written for periodicals including Glamour and Boston Globe Magazine; she is the author of Life Disrupted: Getting Real About Chronic Illness in Your Twenties and Thirties (Walker and Co., July 2008); and she teaches writing at Northeastern University in Boston, MA.

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Everything is ultimately vibration, so anything that’s physical is basically made up of these fundamental wave forms. What we perceive as physical is just a mask — a mask of matter on top of this field of energy and information. (more…)

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My abandonment issues began in 1969, when my father jumped off of a bridge to his death. I was the middle child of five and quickly began to play a “mother” role to my siblings. I believe it was in part the trauma of my father’s death that brought me to my life partner, John. John’s commitment has remained absolute for nearly 28 years. I’ve always known that he would never abandon me, no matter what, and I joyfully admit that I love being the center of this extraordinary man’s universe.

Before my illness, my family was unusually close and loving. I forever felt cherished by my mother, sister and brothers, along with the endless circus of friends who marched through our house. There was nothing more important to me than the connectedness of family and community.

I never would have believed that any family member, or to a lesser degree friends, would abandon me for any reason. It’s been perhaps my most painful lesson to experience the abandonment of most of these people, due to my chronic pain illnesses (CRPS and later FMS as well.)

I attribute this shattering abandonment to several things:

Many of those near and dear couldn’t handle the life-altering change that came with my illness. I think some of them suffered survivor’s guilt, and perhaps feared that it might happen to them, an unpleasant reminder of their vulnerability and mortality.

Or maybe they didn’t want be around someone so sick and angry. I was once happy-go-lucky Cynthia. Then I became the always-in-pain, mystery-horror-that-won’t-go-away sibling/friend.

I now realize that my family and close friends were also “collateral” victims of my HMO’s abuse and lack of care, as they too didn’t have the dignity of my diagnosis for nearly 14 years. They were all told I was nuts!

Perhaps nature and our culture dictate that we leave the sick ones behind, particularly here in America — where community and family are not cherished (e.g., we warehouse the elderly, our families are spread out geographically, etc.) Also, in our culture, the ill are supposed to get better or die. Most invisible diseases don’t follow that ” rule.”

While my head understands the rationalization of this abandonment, the resulting pain has not lessened in my heart. Twenty-five years into my illness, I’m still in shock, profoundly hurt, at times extremely angry, forever sad.

Severe chronic illness seemingly mandates isolation, which is the worst part of the pain experience for me. I’m a person who thrives on social interaction and personal connection, and I have more love inside of me than I know what to do with.

I now realize absolutely that having people stay by my side, supporting me, is what I’ve needed most to survive. I can embrace the “innocent” disease, but I still fight to forgive the willful abandonment of those near and dear.

I’ve always felt as though I’ve committed a crime, my punishment being like prison’s solitary confinement. I thought I would be exonerated and forgiven when I received my first diagnosis. I was wrong.

I am now so fearful of abandonment, it’s difficult to let anyone in, to truly trust. I believe that if someone should come into my life, and I present the crushing reality of it, they will most certainly run for the hills. The full-blown CRPS experience is just too much for the human animal to witness, though I’m certain there are phenomenal human beings who are exceptions. Certain, only because I know two of them.

I could never have discovered the super-human strength of John and my mother if I had not survived such devastating illness. Also, I could never have fathomed the depth of their love for me. And It is that forever love, strength and support that holds me up and pushes me forward.

I have an absolute certainty that I will never be abandoned by John or my mother. I believe very few people in this world can ever truly trust a single person completely. I don’t have words to express how blessed I am to have not one, but two of these angels in my corner. This is one of the essential reasons I have been able to survive a quarter of a century with life-altering pain.

Cynthia Toussaint is the founder of For Grace, a nonprofit organization raising awareness about gender bias in treating chronic pain. As a leading advocate for health care reform in California, she has been featured in media including The New York Times, The Los Angeles Times, Public Broadcasting System (PBS), and National Public Radio (NPR). Cynthia has Reflex Sympathetic Dystrophy and fibromyalgia. Prior to her illness, she was a professional dancer, actor and singer.

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