Five Steps to Managing Chronic Pain: Step 1
KNOWLEDGE
Chronic pain is a debilitating illness that affects a staggering 19% of the European population according to the European Journal of Pain. [1] If we agree that European life and Canadian life are similar, then we can assume 19% of the Canadian adult population suffers at the same rate. One out of five people have chronic pain and most of them will not seek treatment, or will have treatment that fails them.
First, most people turn to over the counter medication. Most often, this band aids the problem, but with time, chronic pain returns stronger than ever. Next, people will see a doctor, chiropractor, acupuncturist, physiotherapist, massage therapist and more. They will pay thousands of dollars, and get partial relief. The chronic pain never fully goes away, so they seek more and more treatment. All of this is a recipe for frustration and anger.
I followed this exact same path, because I was looking for a cure for chronic pain, but also the reason for the pain. I discovered both, but 15 years would go by before I did.
My chronic pain was all over: shoulders were the worst, then neck, and back. From there I had migraines that lasted for months. The worst one was five months straight. Every. Single. Day. I remember vividly driving with sunglasses on at night during a snowstorm because the oncoming headlights and the swirling snow sent daggers into my skull and felt like my head was going to explode. I also remember looking at my elbow one day and wanting to smash it with a hammer, just to feel different pain somewhere else. Yes, that is irrational, and possibly mentally ill, but people who have survived chronic pain will tell you this is real.
By the way, for people familiar with my writing and story, this was a full decade before my brain aneurysm rupture, and before I developed the brain aneurysm. I know this because a brain aneurysm grows approximately 1 mm a year. Mine was 6mm when it ruptured.
After that, pain travelled all through my body: both arms, both legs, back, knees and ankles. There were days I would stumble out of bed and walk as if I were 80 years old. I would cry because it hurt so much to get up, put on a bra, bend over to get into pants. Everything hurt. It would take a pain specialist to discount what was going on in my body for me to get angry and demand to see a psychiatrist. Being an analytical, rational, logical thinker, I assumed my pain was emotional due to childhood trauma, and I was determined to fix it.
It only took a half hour. He looked and me and said, “You are okay. There is nothing wrong with you, other than you have Fibromyalgia.” He wrote me a prescription and within three days I was pain free. I still remember that day of getting up and nothing hurt. It was a miracle as far as I was concerned. Ten years later, I still take meds for Fibromyalgia and my body lets me know when I have missed a day. Unfortunately, my chronic pain story does not end there. If it did, it would be too simple and I never would have researched pain science.
In 2009 the headaches came back. They wouldn’t last days, but would come and go. Sometimes they would be a 3 out of 10 on the Pain Scale[2]. The horrible ones that were a 9 out of 10 happened twice; once on September 13, 2009 and then October 23, 2009. I did not realize I had a brain aneurysm, and that it had ruptured, sealed, leaked and ruptured again in October. It continued to leak for five months. I had chronic exertion headaches, headaches that ripped through my skull every time I coughed, laughed, sneezed or bent over.
The thing with brain aneurysms that rupture is the intense pain that sears through your head. It is unlike anything I have ever felt in my life. It is often referred to as an ice pick headache, because it feels exactly like someone has stabbed you in the head with an ice pick. The other pain is the agonizing, debilitating neck pain.[3] This lasted six years. Six, long, excruciating years. And of course, with the neck pain, it affected my headaches, my shoulders, and my back. I was miserable. Not only did I have brain surgery, but now I was dealing with severe neck pain, chronic insomnia (I did not sleep for five months straight other than 20 minute cat naps once a day), and depression.
I went back to work too early and did not take the time to properly heal because I did not have enough vacation time to stay home. That caused a host of other issues to crop up including my second brain aneurysm that is currently being monitored.
I would go to work, come home and sleep. Broken, non-restful, restless sleep, and then go back to work. I existed this way for five years. I LIVED for vacation and summer where I could finally relax and be pain free. That usually kicked in around week two of vacation, then I would be back to work to get back into the stress and anxiety mode.
A year ago I discovered yoga, quite by accident. I had practised it off and on for a decade, but quit when I could not bend over without getting nauseous. I really enjoyed the simple movements and the flow from one pose to the next. I did not realize it at the time, but my life was going to drastically change for the better.
When you have lived with chronic pain, you hold yourself differently for fear of setting off more pain signals. When you limit your range of motion, the connective tissue shortens and tightens. In this state, a simple range of motion you could do three months ago now has become more limited. I use Paul Grilley’s[4] example of grandma with a broken wrist. For eight weeks grandma has her arm in a sling to immobilize her wrist while the bone mends. Older people need longer to regenerate osteoclasts (the process of healing bone) in order to mend the bone, hence the eight weeks of immobilization. Finally, the sling comes off, and guess what? The pain grandma feels now is in her shoulder. Why? Because the connective tissue has shrunk. I think of it as becoming brittle and dry due to lack of movement. Now we have an entire new issue. Getting movement in a joint that has atrophied from lack of movement. The first time you introduce any range of motion in that area it will hurt. BUT with continued, limited range of motion exercises, or therapeutic yoga, it will soften, lubricate and become useful again, without pain.
The funny thing that happens in the brain with people in chronic pain, is that the brain becomes way more sensitive to pain. Any pain. And builds up sensitivities that trigger the pain alarm sensing a threat before an actual threat has happened. The person feels this and freezes. Now, instead of the pain signal firing off at, let’s say 120 degrees of motion, it sets it of at 80 degrees of motion...just in case. The next time, it could be 60 degrees, thus limiting your range of motion over time.[5]
Chronic pain changes the way your brain works, but it can be rewired to allow you have a better quality of life.
[1] Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment.
Breivik H1, Collett B, Ventafridda V, Cohen R, Gallacher D.
[2] http://compass.rehab/patient-resources/medical-pain-scale
[3] http://www.mayfieldclinic.com/PE-AneurUn.htm
[4] http://www.paulgrilley.com
[5] https://www.facebook.com/notes/the-wild-thing-yoga/pain-and-the-brain-connection/1364713546923857
