Saturday, November 8, 2014

Pain: A Primer

Apparently, in the subjective landscape which is pain perception, I have a very high tolerance (and threshold). To wit:
  • When I broke my foot 4 years ago, a fracture which presented with tissue damage, I managed on an occasional Advil. Moreover, I walked around on it till they confirmed (with secondary scans) that the foot was actually broken.
  • When, at work, I sustained a sizable third-degree burn on my hand (microwave soup accident, people), which my doctor friend Hilary saw afterwards and responded to with horror, instead of going to the hospital (recommended by peers, I should confess), I attended a briefing with a bag of frozen peas to take down the swelling.
  • When I had a baby with no medication, at home, and there were unforeseen complications, I was one of the 2 per cent of midwifery patients to require an episiotomy. Following this, my midwife reached inside my body (while paramedics were on the way to my house to take me to the hospital) and unwrapped the cord around my baby's neck (it was wrapped 3 times) while pulling her out fast. I needed 36 stitches and it's only by dint of my midwife's long-standing in the community that they didn't take me to the hospital to do this. (Note: They did freeze the area before stitching, which I found hilarious given that I'd basically just had surgery without medication.)
The interesting thing about these three examples (and I have a few others, but those are the flashy ones), is that they chronicle a pain response to immediate trauma. Effectively, my body responded to nocioceptive pain (that of injury to skin, tissue and bone) in a reasonably sanguine fashion.

Did I feel the pain? Oh, yes. But, more to the point, was I able to distinguish it from the trauma I was experiencing? Yeah.

That quality is probably what's saving my ass right now as I experience an extreme instance of chronic neuropathic pain. This is the kind of pain that comes from a seemingly endless, fucked up conversation between your brain and your body. It's not in response to trauma, but it can produce the symptoms of it.

To wit, apparently, the current degree of scar tissue in my upper back (left side) is consistent with that produced in a serious car accident or a fall from a high height. It wasn't there 3 years ago (before my pain began in earnest). I can only imagine how badly off I'd be at this point if I didn't do yoga all the fucking time.

The latest practitioner to look at what's happening, asked me what narcotic I was taking to manage the pain. When I told her I was subsisting on the occasional Advil gel-cap, yoga and another natural treatment I won't discuss here, she was shocked.

Technically, I think we can consider this the outcome of myofascial pain syndrome, though I've resisted definition for a long time. I know that the only thing my allopathic doc can do is offer me some drugs that I'll acclimate to, all too quickly. I also know what's been going on from the vantage point of the person who lives in my body. I've told y'all for years that this is about hyper-tension of muscles and spasm. What I didn't realize is that I've likely been dealing with peripheral nerve excitability (something concerning that I don't feel like linking to), a condition that requires me to exert effort to prevent my body from twitching in a weird rhythmic fashion.

That's what I've got to deal with first and foremost because it's the sign of damage and, unchecked, it will continue to contribute to it. Note: I intend to fix this with body-work, not drugs.

For those of you interested in myofascial pain - and I urge you not to be - I'm like the poster child. It usually arises out of the comorbid experience of TMJD, migraines, tension headaches, anxiety, noise and light sensitivity and mitral valve prolapse. Stress doesn't help. I experience all of these in force.

I'm telling you this by way of connecting with the broader universe - those who are pain sufferers and those of you who have known me for some time.

This is not an easy moment. The last 4 years have not been an easy moment but occasionally things seem very hard and this is one of those times.

I can't type easily right now. It takes a toll and I need to be judicious. Work is getting the bulk of my energy because it pays me. I will write when I can though, for reasons of life insanity and, well, pain management, I won't be writing as regularly for the next while. My body and mind are, frankly, exhausted.

Mind you, with silly definitions out of the way, next time we chat I can tell you about how I'm managing things. I can assure you that this pain isn't me, which is likely why I'm managing at all.

But in the meanwhile, I'd so love to hear from you. What's your experience of pain? Is it chronic? Are you oblivious to it? Do you have a terrific story of recovery? Can you provide advice - pain-havers and regular peeps alike. Let's talk!

15 comments:

  1. I've had pain in the back of my neck on the right side for years (decades?) It gets better. It gets worse. Computer use affects it. Diet affects it. Stress affects it.

    I've tried to figure it out - muscle strain, inflammation, all of these? I just really need to focus on fixing it.

    Hope you get some relief from your pain issues soon.

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  2. So sorry to hear that, Kristin. Aside from birthing and one episode of back pain I'd be terrified to experience again, I have a few little issues that are fine if I take care of them and myself. I have to keep my neck wrapped warmly and good posture at all times or I'll not be able to move for a week or so. If I move daily and do varied exercise, and my lower back will be fine. I have to consciously relax so that my hands and jaw which I tend to cramp up during sleep will be alright. I'm so thankful! Sending lots of good vibes and thoughts your way, get better soon and take care!

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  3. I'm sorry it's getting so bad. I too have had car accidents and a work place (someone else's) accident leaving me with bad shoulders, neck and thoracic back pain. I started doing yoga about 22 years ago for it and then saw a specialist yoga teacher/osteopath from he UK a few months after starting when he came out here to teach yoga teachers how to modify yoga and make programs for broken people. I have been doing it every morning and I am surprised that every morning I'm flexible but still stiff. I don't take pain meds either unless it is so bad I can't function but I don't want to be pumping stuff in and then not feel if it's changed or different. I want to know what's going on.
    Good luck and good health to you. I'll be bending and thinking of you!

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  4. Do take care of yourself, Kirstin! Hope things improve for you soon.

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  5. I wish you could see my chiropractor--Len Ershow in Princeton, NJ. He practices Active Release Technique which breaks up or releases the scar tissue which is pulling on your joints/nerves and causing your pain. I was in terrible lumbar back and knee pain from Jan 2009 until I started seeing him in June 2009. He was able to help my knees immediately--walked up the stairs without pain for the first time in 5 years after his first treatment. The relief lasted for 24 hours and then lasted longer and longer after each visit. The back took longer to feel relief but I can say that now, more than 5 years later, I am about 98% recovered, it is SO much better and I am SO grateful.

    So I went to Len about 2x a week for a few months, then 1x a week, then as needed. I haven't seen him since Feb and that was for some random jaw pain. Haven't seen him for my back in probably more than a year.

    You might need to give up the yoga, it might be too much. Have you tried using a tennis ball on that area to massage it? If you can find an ART practioner (their website seems to be down right now) in your area and they can recommend the stretches you need to do.

    Additionally, I started acupuncture 1x a week in June 2009, went to that about 1x a week for a few months, then every other week, then as needed.

    I got a really good massage therapist and started going to her in the spring of 2010. I saw her about once every three weeks and now I just see her as needed.

    I also practice mindfulness meditation. I started that in the spring of 2011. See if you can find an MBSR class in your area. I practice at least once a week with a group in town and do meditation challenges from time to time online.

    I also love the affirmations by Louise Hay, in particular her book "I Can Do It", it comes with a CD that you can play anytime, track 2 is about health, it is amazing.

    I also was using the guided imagery for pain CD from Belleruth Naparstek, that is a good one too.

    For a long time I journaled too whenever I was upset or frustrated, but would also include 5 things I was grateful for and also my "worry bucket" of things I was worried about.

    Also try reading Spontaneous Healing by Andrew Weil, lots of good things in there about avoiding negative people, negative news, buying yourself flowers, what to eat to feel better.

    I want to say that I went through a dark time when I thought my pain never would get better but I believe a combination of all the above got me on the right path. I had to give up sewing and the gym for a while just to focus on myself, my health and healing but I am back to the gym and the sewing. I feel some pain somewhere each day but it is not as intense, as painful or as terrifying.

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    1. Kyle: What an awesome comment. Thank you! I have a great chiro who does active release. I would rarely see her in the past, not having recognized what's going on "fascially" till recently. I just saw her last week and the work was incredibly useful. I've also decided I need to recommit to massage and acupuncture - two modalities I've had a lot of experience with in the past (but less so recently, stupidly - given everything I'm feeling?!) I also do a lot of meditation - more than ever. So much meditating!

      I so appreciate your taking the time to share your experience and I'm so thrilled for you that you have reclaimed your health!

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    2. I understand what you mean about not doing things like massage and acupuncture when you're already in pain. It just seems like adding even one more thing to your life is just too much - even if it will help in the long term.
      I know I ship;d be taking even more vitamin D and extra fish oil now, but it feels like it's taking everything I have just to keep doing what I'm doing.
      Even though I feel really bad right now, the fact that I was better when I was off work gives me a strange ray of hope. It is possible to feel better - I just have to figure out a way to do it while still working a 40 hour week. :)

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  6. p.s. another thing that helped is to stay away from other people talking about their pain/negative news. I think I could only read this post because I am so far along in my pain recovery and maybe the universe was saying it was time for me to share my advice now.

    And I never read medical websites and certainly not the message boards. Just focus on your own recovery.

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    1. Also great feedback. Alas I had a little moment a few days ago where I did do some "web research". A very depressing undertaking, really. I'm staying away.

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    2. I read a few sites for updates on research, but I try to stay away from message boards too. My opinion is that people who are well and functioning are to busy doing stuff to be online posting about their condition.
      Years ago, I din't do that. Then I 'met' a poster who was seriously convinced that her illness was made active when
      'people take illicit drugs and think about you'. At that point I figured out that having a chronic illness does not prevent a person from having other issues. :)

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    3. I try to avoid online medical research and message boards/forums. I work in healthcare, so I am able to 'talk to the source' as it were. :)

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  7. I'd say a few things about the kind of pain you experience so severely (I'm on the occasional, lighter end of it, and much has to do with soft tissue and joints and tension), but I'm trying to manage the other side of that equation today, some really low mood stuff. Just didn't want to go away without sending you a heartfelt virtual hug. Take care. xo

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  8. First, I appreciate your blog....I read it quite frequently, and never comment. I felt compelled to respond to your most recent post. I am a physio that was in long term pain until I learned some new to me techniques at a class long ago. Took me a while to get better. That was years ago, and as a result I started a pain treatment center with like minded health care practitioners. I would recommend contacting the Institute of Physical Arts in Steamboat Springs, CO. They keep track of all of the people that take their classes, and they can find a practitioner near you. Greg Johnson and Vicky Saliba run the Institute, and they are GIFTED beyond belief. The people they train change my life both personally and professionally. The pain is not in your head. We believe that pain is just a signal that there is something in your life you need to pay attention to. You cannot go around it, but you need to move through it. Please take care!

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  9. "TMJD, migraines, tension headaches, anxiety, noise and light sensitivity and mitral valve prolapse." Oh dear. Add Crohn's and arthritis and here I am.

    After wearing a jaw splint (like a retainer) for 6 months my jaw was realigned and now I wear a bite splint at night. Find someone who specializes in TMJD and have one made - if you don't have one already. It's worth going to a specialist as they can fine tune the splint to a position where your jaw cannot clench with as much force. You'll still clench and grind through the appliances regularly but the force maintained all night will be greatly decreased as will the pain.

    If there is something that you find calming (tea, meditation, etc.) make it a practice before bedtime. Avoid stimulation like TV, work - anything that will cause you stress.

    I have found that taking a 400 magnesium supplement every day has decreased the frequency and severity of my migraines. Dramatically.

    Other than that I agree with most of the advice offered. Therapeutic massage will help break up the scar tissue as well as relax you. If acupuncture works for you go for it. You can judge if you need to scale back the difficulty level of your yoga practice but keep up a stretching routine.

    I also agree with the opinions about support groups both online and off. There are people who define themselves by their illness and that is the focus of their lives. On the other hand having someone who can actually understand what you are going through can relieve stress and depression.

    Hang in there. Your readers understand and while we'll miss you we'll be waiting when you return.

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  10. Like you, I dealt with trauma and trauma-related pain with alacrity. I had a severe 3rd degree burn on my left thigh that was treated with Polysporin and burn bandages. I had 26 stitches after birth and my epidural had worn off by the time they started stitching. Did I feel each one? Yep.

    Psoriatic arthritis pain is different. It's an insidious little bugger that starts out quietly and then suddenly jacks up the volume to Olympic proportions. I hate it. I berate myself for not being able to deal with it in the same manner as my previous trauma/trauma pain experiences.

    It wasn't until I read your post that my delayed brain realized that I don't deal with it in the same manner because its NOT THE SAME PAIN.

    Duh.

    Chronic pain is awful. Nothing else really describes it better, I think. I'm having difficultly blogging, sewing, and knitting because of my pain, but I will still plod onwards. To give up is to let the pain win.

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