So, the question is, do you want to hold that beach ball under the water, or would you rather be able to deal with it effectively in the moment? This is a question we often need to ask ourselves when we deal with painful emotions and sensations.
As always, I hope this helps you to keep making the most of it!
Learning to make room for physical pain sensations has really helped me lead a more fulfilling life and has enabled me to do more of the things I want to do. A big part of this was utilizing my mindfulness practice to make room for these sensations. If you have chronic pain or a chronic illness that causes you sensations you don’t like, starting these types of practices can be very helpful for many people. That way you too can keep making the most of it!
Option A: you never have to feel pain again. No physical pain. No sadness. No anxiety. No guilt, fear, or anger. But… you can also never feel physical relaxation. No joy. No happiness. No love, pride, or serenity.
Option B: you still have to feel pain, both physical and emotion. But you also get to feel relaxation, joy, happiness, love, pride, serenity, etc.
What do you choose?
I know Option A is super tempting, but I’ve found that most people choose option B, because no one wants to permanently get rid of the things that make us feel “good.”
When it comes to pain – and throughout this post when I refer to pain, I mean both physical and emotional – we tend to try to block it or avoid it at all costs. Literally, people will drink alcohol, take illicit drugs, take prescription drugs and over-the-counter drugs, mindlessly scroll on their phones for hours, and so on, just to avoid or get rid of the uncomfortable things we really don’t like to feel. Here’s the problem: when we do this it tends to make all the pain much, much worse. (And yes, there has been a TON of research done on this).
PAIN X RESISTANCE = SUFFERING
This formula has been said by meditation teachers, such as Shinzen Young, psychologists, such as Tara Brach (who is also a meditation teacher), and researchers, such as Kristin Neff. And I’ve found both personally and through my work as a therapist, that it’s true. I’m literally in more pain when I resist it, avoid it, distract from it, push it away. And when I just let it be, I’m okay. This morning I woke up with so much anxiety. Anxiety about finances, anxiety about work, anxiety about my life and things I could have done. At first I did try to resist it. I instinctively grabbed my phone and scrolled. I decided I wasn’t going to have a workout and that I’d eat an extra waffle for breakfast while I watched YouTube videos about horror movies. But none of that made my anxiety go away…
Here’s the thing about emotional pain specifically, it can actually lead to several additional problems (or increase the intensity of them if you already have them):
Increase risk of heart disease
Autoimmune Disease Flares
We experience all types of pain for a reason. If we didn’t need our emotions (both the ones we like and dislike) and if we didn’t need physical pain, then we would have evolved without them. Our ancient ancestors needed them to stay alive. To protect us from life and death danger. To keep us safe. Instinctually, our brain and bodies still try to keep us alive the same way, it’s just that we encounter a lot less life and death situations now. And yes, all this applies to chronic pain too. Our bodies are telling us something is wrong, it’s just often not what we think. We think it’s telling us to stay in bed and not move and give in or up on all that’s important to us. In reality, it’s often telling us that we might need to stretch and move our bodies. To do something meaningful with our day – not as distraction but as a way to bring meaning and value to our lives.
…This morning when I decided that I was done resisting my emotional pain, I sat down to meditate. I did my full 20 minutes (meaningful activity) and then I went for an hour walk (moving my body, and a meaningful activity). Then I did my workout that I had put off from the morning. I didn’t do all of this with the intention of distracting myself from my pain (emotional or physical) but to make room for it. I used some practices that I help my clients use to: like observing my pain, breathing into it, expanding around it, and just allowing it to be there WHILE I did things that were important to me. Guess what happened? Not only did it no longer control me, but it actually lessened a lot – to the point where it’s barely noticeable. I also noticed that my drive and creativity and all these things that I’ve been lacking lately came back full force. My suggestion to all of you is to make room for your pain, just to help you make the most of it.
Pain – both physical and emotional – are parts of life. They are also inevitable with chronic illness and chronic pain syndromes. The more we try to fight or resist our pain, the more it comes at us. So, let’s talk about why that is and what to do about it. Because, really, we can’t keep making the most of it if we struggle. Check out this podcast episode for more about this.
It’s common to get overwhelmed by your emotions, and equally common to get overwhelmed by sensations when you have chronic pain or chronic illness. I know, because I’ve been there with you. Today I’m giving some psychoeducation on these storms and one way you can learn to deal with them so you don’t get swept away.
For those of you who are against yoga, because some random person said to you once, “But have you tried yoga?” when you were telling them about your pain or illness, just stay with me for a second. No one likes unsolicited advice, but I’m guessing that if you’re here, reading this blog post or looking at this blog at all, it’s not really considered unsolicited. There is actually a lot of evidence that yoga can be helpful for pain, and I have personally found a huge difference after beginning to practice restorative yoga at the beginning of the pandemic (circa April 2020 is when I began).
Let’s start off by reviewing some of the research as to what yoga can help with and if it actually is beneficial. Guess what? The research is overwhelming a yes, yoga is helpful for chronic pain. There are tons of studies on it but I just picked three for the purpose of this post. Tal, Unrah & Dick (2011) found that pain patients in their study were able to “reframe what it is to live with chronic pain.” What does that mean? Well, not all of there patients actually decreased in the pain itself, but most found that the pain bothered them less. In other words, it was less interfering in their daily lives. Skip ahead to 2019 where Uebelacker et al. found in their study that pain patients who did yoga saw their moods improve, decrease in their anxiety levels and decrease in their pain levels. That same year, Schmid et al. (2019), found that pain patients who engaged in yoga had better occupational performance (they could return to work, do well at work), were more engaged in their regular daily activities, and had less depressive episodes.
This research is all well and dandy but the original intent of my post was to look at the meaning of the word “yoga” and how that in itself shows how it can be helpful to us chronic pain warriors. Yoga is derived from the Sanskrit word “yuj” which means to unite (or unity). This describes unity between the individual with the universe, person with nature, and importantly, mind with body. This is likely why we see things like mood improvements and decreases in anxiety in people who practice yoga, which is mindful movement. A yogi is someone who is self-realized and self-realization leads to freedom. Linking back to the research, freedom to work, freedom to engage in activities, and freedom from pain being “bothersome.” Finally it’s important to note that health (both physical and mental) is a natural result of practicing yoga, for all of the above reasons. Do you have to practice yoga? No. But I also don’t see the harm in trying (assuming you have consulted with your healthcare team).
I hope this brings some insight. Keep making the most of it!
Long title, I know. But nonetheless I thought I’d share some of my tips with you, plus a few other evidence-based ones I found online as I’m trying to get through this. I’m writing this exactly one week before it will be published so fingers crossed that it’s over by the time you’re reading it, but if not, then I’ll just have to accept it as it is. My flare is likely caused by a few things. First, I recently moved and moving is stressful (even a relatively easy move like I had) and stress can cause a flare. Second, I moved from a dry climate in the interior of British Columbia to the wet, lower mainland of BC. I always notice my symptoms, especially pain gets worse when it rains… but then I knowingly moved to a rainy climate (*face palm*). All jokes aside, my symptoms are increased pain, increased fatigue, really bad jaw pain, my left foot is super veiny and sore (my calf is fine though so unlikely anything super serious). How the heck can I manage all of this?
Acceptance. Yes, I know some of you are rolling your eyes or saying that this is ridiculous or unlikely to work. But I find it does. I accept that my pain is here, while knowing that the intensity changes hour by hour, sometimes even minute by minute, and I know that when my flare is over I’ll go back to baseline. Acceptance is helpful. I’ve been doing body scans and other mindfulness activities to help with the acceptance, but honestly just acknowledging my experience without getting wrapped up in it is helpful. Check out this acceptance practice.
Exercise, Movement and Stretching. If you read this blog regularly you know that I like to exercise. And I still pace myself by trying to stay consistent with what I do. I definitely increase my stretching during flares. Particularly I focus on the areas that seem to hurt or need it the most. For example, my jaw is the worst today as I write this, and I’ve made sure to do jaw stretches throughout the day. For more on jaw pain specifically, check out this podcast episode with Dr. Shirazi.
Warm Baths. I LOVE my baths. I literally take a bath 4-5x a week in the winter months. And with the rain, I’m definitely needing them. They help relax my muscles, keep me warm, and are very relaxing. Trust me when I say I could never (and would never) live in an apartment without a bathtub. Knowing what is vital to your self-care is essential to dealing with a flare. Check out this podcast episode on it.
Dressing Warmly and in Layers. Vancouver, if you’ve never been, is a city where everyone dresses in layers. It will likely rain at some point during the day, though you never know exactly when. It could also start off cool and warm up, or vice versa. So I’ve been making sure to put on 3 layers when I go out, and have a pair of mittens on me. I need to remember a hat and/or an umbrella, but I’m working on it!
Hydration. I tend to drink a lot of water. Admittedly more when I’m working. Staying on top of my water intake is so important to managing my flares and really my health! I’m trying to drink 5 full glasses of water a day minimum. I basically keep a glass of water next to me all day and every time it’s empty, I refill it. Listen to my podcast conversation with Beau Berman about gut health and how important drinking water is to him.
Omega-3’s and Vitamin D. I typically try to get these from the foods I eat. Lots of fish mostly (rich in both), as well as mushrooms, spinach, avocado and tofu and really a variety of others foods are rich in vitamin D. These are really important for reducing inflammation naturally and honestly are just really good for you! Also, Vitamin D is a way to combat with the “winter blues” (which I often get) and the more severe, Seasonal Affective Disorder.
So those are the 6 things that I am doing, but what are the 5 things that I’m not but probably should be?
Acupuncture. This is actually an evidence-based and recommended treatment for chronic pain. I’ve had it in the past and I’m hoping to start back up with bi-monthly sessions next month. Listen to the podcast episode on recommended treatments for chronic pain for more info.
Massage. I miss getting massages. It’s been nearly a year since I had one, and this is also a service I used to get bi-monthly. I’ll likely also start these back up soon as well. Clearly I need to. The benefits of massage can be heard in the podcast episode with Danielle Potvin.
NSAIDs. I’m not a fan of these drugs to be honest. They can cause stomach problems when on them long term. I’ve drastically cut back on them and only take them to supplement the more natural medications I take (i.e., CBD). If you’re aware of the risks and find them helpful then this can be a helpful solution.
Natural supplements. The only natural supplement I currently take is magnesium bis-glycinate which is a muscle relaxant (and I mainly use it when I’m menstruating). Other recommended supplements are fish oil, ginger (which I sometimes have in food and/or tea), turmeric (which I sometimes have in tea), and gingko. These are definitely worth checking out to use in addition to some of the other suggestions.
Limit Stress. Oh I can’t wait until I’m passed the stress of the move and starting up new counselling practices. The truth is there is always some kind of stress in our lives and it really comes down to how we manage stress. I typically do a good job with mindfulness, meditation, yoga, and relaxation practices. So this might just be a reminder to do a bit more of that. And also, if you are able to avoid stress then that’s a good plan (I do not plan on moving again for quite some time!).
So that’s it! 11 ways in total to manage a flare. Keep making the most of it everyone!
This past weekend I attended the World Pain Summit ’21, which is put on by the Pain Society of Alberta, and has speakers and attendees from around the world. I attended as an Allied Healthcare Professional with Lived Experience (the options were: Physician, Physician with Lived Experience, Allied Healthcare Professional, Allied Healthcare Professional with Lived Experience, and Person with Lived Experience). By the way, this was free to attend for non-healthcare professionals with lived experience (only about 150 people with lived experience only attended out of 1600ish attendees). The summit was 3 days, had incredible expert physicians/allied healthcare professionals/researchers, giving the latest and important information on treating chronic pain and chronic pain research. I attended a lot of sessions, so I decided to make this into 3 posts so that I could relay as much as possible. Part 1 is a recap of Day 1 of the summit.
Social Media & Pain. There were 3 presenters on this one – a researcher, a physiotherapist, and a person with lived experience. Much like last week’s blog post, they went over the good and the bad of using social media, both as a person with lived experience and as a healthcare practitioner. The good includes learning, community knowledge, knowledge construction, combatting isolation, raising awareness, and validating common experiences, among others. Again, they recommend not using social media for medical treatment and to be careful when sharing personal information online. The part of this that I want you to take away is when they talked about this: “Pain is normal. If you expect to be outside of pain 100% of the time, you’re wrong.” Because that’s impossible. Pathologizing pain to the extent we do (especially online) is like pathologizing blinking. It’s not something we necessarily can (or need to) fix but rather live alongside. We need to view our normal responses to an abnormal situation (chronic pain) as just that.
Head Injuries & Migraine/Migraine Disease Management. These were 2 separate sessions, with some overlapping content so I decided to talk about them together. Post-traumatic headaches from head injuries often resemble migraines, and migraines themselves can be considered a disease because there are changes in both brain structure and function. There are some non-modifiable risk factors for migraines (female, low SES, head trauma, genetics/epigenetics, childhood abuse) and some modifiable ones (these are important): obesity, medication overuse, caffeine overuse, and depression/anxiety. There were several recommendations for treating migraines, using the acronym BRAINS. Biobehavioral therapy/biofeedback/mindfulness/CBT/physical therapy; (which includes coping sills like self-monitoring, pacing, relaxation, self-talk, connection, and treatment of trauma/mood/cognition). Risk factor modification and lifestyle (diet, exercise, sleep). Adjunctive therapies (neuroceuticals, neurostimulation). Injection therapy/onabotullnumotoxin A/extracranial nerve blocks. Neuropharmacology. Support and Education. AND SLEEP HYGIENE is important (check on my podcast on that here.)
The Painful Implications of Psychological Trauma. There is, as I’ve written before, a strong correlation between trauma and chronic pain/illness. This was an important session for my as a psychotherapist. Mental health treatments for chronic pain & trauma should include healthy coping skills, CBT for pain, radical acceptance, trauma-focused therapy/exposure therapy, mindfulness, trauma processing, body awareness, somatic treatments, and behavioural activation. Two really important pieces came out of this. The first was for physicians: the most powerful thing you can say to clients is “I believe you.” I hope that they take that seriously. The second is for those of us with lived experience: pain is a psychological phenomena but that doesn’t mean it’s not real. The example given was how temperature is experienced by different people differently (for example, my mom is always hot and my dad is always cold). Our brains are involved in everything we think, feel, sense, etc. But all of that is also real.
How Our Brains Make Unconscious Judgments and What We Can Do About It/Social Innovation on Equity and Diversity Inclusion. There were 3 sessions in the afternoon. I attended two of them and watched the Q&A. This session was presented by a trans woman. The other two were by Indigenous peoples. This was the social justice, diversity, and inclusion part of the weekend. There was so much great information that I hope all healthcare practitioners learned from. The part of this particular session which is helpful for everyone are the strategies to reduce our bias (because we ALL have bias – unless you literally without a brain). Avoid blame or guilt. Focus on the impact, not the intent. Choose a positive attitude. Recognize bias in action and take action. Micro-affirmations. Active listening. Be intentional. Avoid generalities. Question the reliability of sources. Treat people as individuals, avoid assumptions. Get to know people who are different than you. Practice the Platinum Rule – do unto others as they wish to be treated. The last session had to do with patterns of change and what some healthcare organizations are doing to make these changes.
Okay, so that was a lot of information (and that was just Day 1). I will likely be doing more individual posts and/or podcast episodes about some of this information in more detail as it might be relevant to chronic pain/illness warriors. If you have any requests from anything from this post, let me know by commenting or DM-ing me on Instagram. Part 2 comes next week. Keep on making the most of it!
If you’re anything like me, you may have wondered why pain medications aren’t working well. Aren’t giving the relief we’re told they should. I’ve been taken off NSAIDs because they hurt my stomach – has this happened to you to? I’ve been offered opioids after surgery but decided against it for fear of addiction even though I’ve been in a lot of pain – do you relate? I’ve also tried lowering doses of medications and found they’ve been as effective on a lower dose as they were on a higher one, because I’ve added holistic approaches to pain control – what about you?
There were some interesting recommendations out of the National Institute of Health and Care Excellence (NICE) in the UK that came out of a meta-analysis (review of scientific studies) on treatments for pain/pain management. The part of the study and recommendations that really blew my mind what was that not a single pain medication was said to have enough evidence to support its effectiveness for treating chronic primary pain. Now, I will say that they reviewed about 22 studies per type of pain management – each medication and each holistic approach – that they looked at, so not super extensive but definitely enough to be a good indicator. I’m going to do a podcast episode on the 5 suggested treatments (exercise, acupuncture, 2 types of psychotherapy, and anti-depressants) for pain so stay tuned to the podcast for that episode in a few weeks. On the blog this week, I thought we’d talk about what they said about all these pain meds that we take!
Opioids – I know that these are commonly prescribed, and as a mental health professional, I also know that there is an opioid crisis in North America (that being said, just because you take opioids does not mean you’ll become addicted as we need to look at other biopsychosocial factors). NICE states that there is not enough evidence that shows long-term opioid use actually helps with chronic pain, plus they note the risk of addiction (for some people) in the short- and long-term. Conclusion: Maybe not a good idea.
Benzodiazapines and NSAIDs – also commonly prescribed, and as I said, I used to be on strong NSAIDs that hurt my stomach, now I have a less strong one that I’m to take “as needed.” Benzos were cautioned as not being effective for chronic pain, AND leading to poorer functioning. And NSAIDs, these were said to also not improve pain, distress, or quality of life and increase the risk of gastrointestinal bleeding. Conclusion: Maybe not a good idea either.
Antiepileptics (Gabapentinoids) and Pregablin – these are only shown to be effective for neuropathic pain and CRPS. However, NICE cautions that they can be highly dependent and are known to be addictive. Again, one needs to consider biopsychosocial factors, but if you have other risk factors for addiction, possibly not a good choice. Conclusion: Depends on your condition and your risk factors for substance misuse.
Local anaethetics – Short-term use indicates they may actually make things worse, except for CRPS. So again, this might come down to your specific diagnosis. Luckily there was nothing mentioned about them becoming addiction. Conclusion: A go for CRPS but not anything else.
Paracetamol, ketamine, corticosteroids, anaesthetic/corticosteroid combinations and antipsychotics – again there is insufficient evidence for all of these, and NICE cautions that harm could actually come from taking these, though they don’t specify what the harm is. Conclusion: Maybe not a good idea.
So, what have I done to supplement lowering my pain medications (which may not be that effective anyway) so that I can continue to have better quality of life and well-being? A lot of the recommendations made by NICE and some others. I exercise daily (any movement is good movement if you’re starting out), I eat healthy, I use approaches such as acupuncture, chiropractor, physiotherapy, mindfulness, etc., and I have been to psychotherapy (and I currently use psychotherapy to help others). You can check out NICE’s study here. ALWAYS, check with your physician and healthcare team before changing medications or doses or adding holistic care to your plan. I started by adding holistic approaches first, and then cut back on meds. We are each unique individuals and this information is for psychoeducation/health education purposes only.
This week’s podcast episode is on nutrition for chronic illness – check it out: Apple, Spotify, Web. Everyone, keep making the most of it!
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I don’t know if you’re familiar with quicksand, but probably most of us have seen it in the movies or on TV. Our hero is on an adventure in some kind of jungle and they (or someone in their party of merry men and women) falls into what turns out to be quicksand. And they struggle and struggle and sink faster and faster. Usually in the movies the hero saves the day. Struggling in quicksand is a lot like what we do with our pain – both physical and emotional. We fight against it, struggling more and more, sinking deeper and deeper. But do you know how to actually get out of quicksand in real life? Like if you fell in it? Struggling makes you sink, and doing nothing – literally putting yourself into the floating position (arms and legs out, with zero resistance) will help you float to the top. From there you can take very slow, gentle strokes and get yourself out.
What the quicksand metaphor shows is that if you do the opposite of what you think you should do, you can often get to safety. In the case of pain, it means looking at it differently, changing your relationship with it. So that brings me to the question, what are your pain taught you? The answer can be many things. Maybe it’s taught you something about yourself. Or your relationships. Or your values/what’s important to you. Maybe it’s taught you something about the meaning of life. Or helped you set goals. Before straight off answering this question, really take a moment and ponder it. Because often the immediate answer is NOTHING! or THAT LIFE SUCKS! or something to that extent. But is that true? Is that all it’s taught you? Those answers often take us back to the struggle. You’ve fallen in quicksand by responding quickly with the first thing that comes to mind, rather than taking some time to really explore if there is something more you can get out of your experience.
I’m going to use my experience as an example. And trust me, there was a time I was struggling in the quicksand and those would have been my answers. But here is what it has actually taught me, when I’ve taken the time to think about it:
I’m stronger – both physically and emotionally – then I thought I was, but it took a lot of work to get here.
Being treated with love and respect in romantic relationships and friendships is incredibly important to me.
I can do anything that I put my mind to, even if that means I have to adapt some things to what I can do.
Loving myself is the most important thing to me.
I want to have as many life adventures as possible despite chronic pain.
Everything I need is in the present moment, and sometimes the present moment isn’t great and sometimes it is, but that is how life is for everyone.
I’ve probably learned more lessons than that from my chronic illnesses and chronic pain, but should give you a picture of what it can teach you. Your answers will likely be different from mine. This is a key piece to acceptance, and if you can’t accept, you can’t really improve your well-being and quality of life. I want to make a few additional things clear with this post. First, I am not saying that your loss of health is a blessing or that you should be grateful for it. Sometimes as we move through illness grief, gratitude does appear, but that doesn’t mean you have to start looking for it. Also, meaning is not found in loss – it’s what you do after the loss. So the things I listed, are really about things I’ve done after I got sick. This is also not an exercise I’d recommend if you’ve just been diagnosed, because you won’t have had a chance to go through enough to be able to do it.
If you’re interested in contacting the present moment, check out my YouTube channel. This week’s podcast episode is on externalizing language, which can also be quite helpful – find it on Apple, Spotify, and everywhere else you get podcasts. Until next week, keep making the most of it!
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