Monday, February 18, 2019

From Pain to Equilibrium: Resources

I've been working my way up to posting a huge tome about best-practice methods for managing chronic myofascial pain but, truly, it's a massive topic that's so close to home, once I'm done living it, I'm scarcely motivated to continue the conversation.

Having said this, I've written at length about this sort of pain, over many years, so I would recommend - if this post is resonant - that you use the handy search field at the top of this page and type in your subject of note. Chances are high that I've spoken about it (at some length) before...

At the end, this post includes a repository of those methods and mechanisms for peeps who are interested to learn about what works best for me. The potential benefit here, from the perspective of one trying to understand how to manage his or her own chronic pain, is that I've tried just about everything - and many things I'd never be able to come up with on my own - to move the yardstick from pain to "normal". So there's a lot to go through in this blog. If I haven't covered the subject - the internet is vast and I recommend that you put on some good music and get googling :-) because knowledge is power, my friends!

Here's the thing: there is no one definition of chronic pain. What it feels like in my body - and what triggers it - is unique. It's that way for us all, though few practitioners will disclose this (they do need a raison d'etre) - and, statistically, few support practitioners wade through the chaos of chronic pain in their own lives. So the first thing I have to say is that your only way out is YOUR way out. While they may support in many meaningful contexts, it's very unlikely that your sports med doc and your GP and your rheumatologist and your psychiatrist (these peeps do know drugs) and your physiotherapist and your massage therapist and your pain clinic and your cardiologist and your acupuncturist and your yoga therapist and your INSERT NEXT DOCTOR HERE are going to provide you with the answer. Just ask anyone with chronic pain.

To drive this point home again... Put 2 people in a room, both suffering from the after-effects of a concussion, and you will almost certainly find yourself looking at 2 totally different presentations of pain and other symptomology. It's just that way with all chronic pain - myofascial, fibromyalgic, neuropathic and so on. What's the common denominator? A dysregulated central nervous system. As a macro, this intel is very useful. On the micro-level, it's almost meaningless.

I will also disclose, at this juncture, what with my being a fully-formed middle-aged person who can no longer be bothered to hide behind social mores, that I have experienced so many bizarre symptoms and forms of pain at this point, I scarcely know how to quantify them - except to say that I hid many of them from most of my medical practitioners for years because - you heard it here first - those symptoms freaked me out so significantly.

I think you'd agree, I don't come off as the kind of person who hides things cuz they're too scary to think about.

Chronic pain is also, 9/10 times, accompanied or defined by a series of co-morbid conditions that overlap - again, cuz central sensitization occurs at the centre - the CNS - spiraling out in a series of metaphoric floral motifs (what? I need to find some creativity in this topic). We might as well call it "one really nasty outcome of CNS dysregulation" because it never is one thing - it's everything. Which is why you can't fix it like a UTI.

But back to my special format: myofascial. In layperson terms, a swirly vortex of pain likes to inhabit various different zones in my body, almost like a poltergeist. That pain can be extremely intense, coming on like lightning and lasting mere moments to weeks, or dull and systemic, also lasting moments to weeks. It can be notably neuropathic (migraines, "sciatica") to utterly muscular (that phenomenon I refer to as "turtling" where every muscle within a certain zone becomes observably as hard as steel). Sometimes it tangos, elegantly, with SVT, producing an otherworldly sensation. I've also got some joint pain due to that lovely, early-onset osteoarthritis and all of the inflammation it brings to the fore. In some ways, the most problematic sensation isn't full-on pain but mass inflexibility. Though no one would define me as anything other than physically flexible, I feel internally stuck in a way that makes me want to tear at my skin so that I can be liberated from its confines.

For me, right now, fascia - that lovely layer that covers everything in the body, so it's got real estate - isn't functioning "normally". The fibers are unyielding, so replete with nerves that, for the "right" person, alighting the nerve response is like shooting fish in a barrel. Hilariously, I'm hyper mobile in certain ways. For example, in my years of fancy-ass yoga practice, I managed to bypass all of the myofascial triggers that warn me of an impending pain flare. And I suffered. Just cuz something looks pretty doesn't mean it isn't causing harm. And natch, just because it causes harm in one person in one time period, doesn't mean that it will in the next. Note: My yoga practice, in as much as it's brought on pain, is likely the thing that's saved me from the very ebb - so nothing is simple.

Believe it or not, while age has given volume to the pain, my management plan is so utterly sophisticated at this point, I'm faring far better than I did a decade ago. Of course, a decade ago, I wasn't having to manage it as constantly or fervently. And a decade ago my life had not spiraled into the complex landscape that it is today.

As I re-read this post, I imagine that you must be thinking: Lord, Kristin must be freaking out about the unknown end state of all of this. In case that's crossed your mind, let me assure you that I am not. I don't have that luxury and - mercifully - I don't have that mindset. Miraculously, I'm able to view this through the prism of experimentation. I believe absolutely in the power of my mental flexibility. To me, everything is a game, a puzzle. Pain management is how I occupy my time when I'm not doing all of the other things (or in lieu of, on occasion, suboptimally). Say what you will, I am incomparably fortunate to have this natural propensity. Other than money and my awesome husband, this is my strongest protective factor. These three things are a worthy triumvirate.

But other things also help immeasurably (and in no particular order):
  • MELT Method (a type of myofascial bodywork done with a special roller)
  • Yoga / Bodywork: For me it's traction and therapeutic, for the most part, these days (Note: I'm a teacher with 30 years of experience. Don't try this at home if you don't know what you're doing. Just look up by a couple of paragraphs and you'll see why.)
  • Acupressure mats and pillows: I call these my head and bed of nails
  • Body scrubbing: for those with fucked up fascia, this is way more useful than you might imagine. It takes a while though and it requires a certain amount of flexibility.
  • Massage
  • Acupuncture: combined with massage, this is extremely effective in a time-limited fashion
  • Nutrition: I follow a Primal Lifestyle diet and avoid all grains, processed foods and sugar. We're all unique but this particular diet-style seems to work for lots when it comes to pain management.
  • Supplements: You should talk to your naturopath about which ones are best for you. Magnesium glycinate and vit D are usually good for everyone.
  • Sleep: improvement by whatever means necessary. Arguably, this is the most important one of all if you read through the studies.
  • Extremely moderate exercise: (Is that even a thing?) Walking, but not as much as you'd like. Yoga or cycling - but not so much that you hit a limit. Managing pain is all about understanding the parameters. This has been my biggest challenge because I'm not moderate. People have been telling me for years to do weight work. Every time I do it, I end up in pain. For me, the optimal weight work is in using my own body in certain modified yoga poses I've spent years honing. Peeps with chronic pain often produce that pain with exercise not because exercise is bad but because those peeps have a dysregulated CNS, symptomologically exacerbated by certain exercise. Remember, everyone is unique.
  • Meditation and CBT: At some point, you're going to have to wade into the depths of grief caused by pain that doesn't appear to be going away according to your timeline (or that dictated by your sanity). You're also likely going to be awake for that dark night of the soul. Learn these by whatever means possible. Bonus: Everyone should be doing this so you'll just be extra-sassy and ahead of the curve!
  • Any functional neuroplastic method you can find or make up: And yeah, you can totally make it up. Seriously, if you can fake knitting, you can fake neuroplasticity until you get there!
  • Pharmaceuticals: Ain't gonna wade into this topic, which is vast and laden with landmines. But if you've had chronic pain, chances are you've gone down this path. For myofascial pain, muscle relaxants that work on the brain (i.e. cyclobenzaprine) can be very helpful, if they work. Drugs can be long-term or short-term. Aim for short-term because the consequences are usually more tolerable.
  • Medical cannabis: Another vast topic... One day I'll start a blog on this topic. Note: Most doctors don't know what the hell they're doing on this topic. I have to assume this will change.
  • Trigger avoidance: Alas, you need to know what these are in order to utilize this method.
  • Getting the co-morbid conditions under control: For example: If you have anxiety disorder that's contributing to your CNS dysregulation, consider an SSRI. Or, if you have structural TMJD, get a mouth gizmo. If you can't sleep, you MUST figure that shit out. Nothing will improve till sleep does.
  • Learn by books and blogs: I won't lie. There aren't a ton of good pain blogs out there. This cohort isn't at its snappiest much of the time. I only hope that, if we consider mine a pain blog at this juncture, it isn't boring and it is helpful. There are a lot of studies out there to become acquainted with. speaks of them at length. (This blog is sometimes useful but often strident, be warned.) Also, there's a great book that provides tremendous insight and practical support re: the relationship between CNS dysregulation and pain: The Fibro Manual by Ginevra Liptan. You don't need to have fibromyalgia to benefit from this book. It pertains to all pain and sleep disorders. It's also written by an MD who lives with fibromyalgia so it's got some street cred. It's neither allopathically nor "alternatively" focused. It takes a multi-pronged approach, really, the only one works. I also recommend Healing through Trigger Point Theraapy: A Guide to Fibromyalgia, Myofascial Pain and Dysfunction by Starlanyl and Sharkey.
  • A collegial relationship with as many of your doctors as possible: Note: When you need them most, that's when your ability to maintain and develop collaboration will be at its weakest. These people need to see you in good times and in bad.
  • DNA testing, but not if you aren't one of those peeps who likes to learn about gene-coding and then to figure out science.
  • Friends / Family / Pets: (though not if you need to care for these on your own) Don't discount the magic of community. When you can do nothing else, you can accept love and support from those who care about you - and give it when you see pain in your midst. Pain's one optimistic trait is the compassion that it brings to the fore. May we all leverage this to our advantage.
  • Knitting: No joke, I am currently sane because of yarn an needles (and not just the acupuncture kind). You can swap in anything that brings you tactile joy, that soothes your soul, that creates beauty and that can be done anywhere. And then do it cuz it doesn't work otherwise.
It's amazing to me that this is just part of the daily regimen that helps me and is by no means an exhaustive list of everything I've tried to date - or will try in the future. Hope it provides a starting off point for anyone who may be able to benefit from my insight thus far.


  1. Thank you for this, and I look forward to looking up previous entries on your blog. I’ve had chronic fatigue/chronic pain/insomnia from hell since 1990 and especially since 1997 and over the years the helpful information I’ve found has nearly never been from health professionals. I’ll have to look up the books you mentioned. Two books that have saved me are The Trigger Point Therapy Workbook by Clair Davies and Conquering Carpal Tunnel Syndrome and other repetitive strain injuries by Sharon J. Butler. Thanks again.

  2. Have a look at
    if you haven't already - it's the most amazing, sometimes wise, often beautiful, often just "aha" blog of living with pain.

  3. I needed this. Thanks for sharing.

    One suggestion - you might want to give up dairy for 5-6 weeks to see if it helps. That's been a big source of my inflammation.

    I also do acupressure on my reflexology points (palm and feet) depending on where the pain is. IT provides temporary relief., but nonetheless some relief!