My chronic pain began with a long day pruning a huge bougainvillea. I ignored the warnings of the acute pain I felt in my elbow by lunch time and worked the whole afternoon. By the evening my elbow really hurt. When it didn’t get better in a week or so I started visiting physicians and physical therapists. As the pain in my elbow got better, my left shoulder started to hurt! Then my right shoulder.
Five years later I had a diagnosis of bursitis and was seeing a physical therapist weekly and doing 15 minutes of physical therapy a day – pushing myself through the pain in hopes of recovering sooner rather than later. When my chronic shoulder pain was at its worst, I tried to “protect” myself by sitting in a recliner with pillows under each arm. I would not lift anything over my head, not do any machining (which I love) or gardening (about which I have mixed feelings!). I slept with 5 pillows and had to wake each time I turned over to rearrange the pillows, interfering with my sleep.
A downward spiral of pain/inactivity as discussed by Daniel J. Clauw, M.D., in his YouTube video “Chronic Pain – Is it All in Their Head?”
Pain caused me to limit my activity (good for acute pain, bad for chronic pain). I had more time and fewer distractions from experiencing pain, which lead to further restrictions on activity and more perceived pain. I fell into a downward spiral. Pain leads to inactivity. Without the distraction and mental resources needed for activity, the brain gets better and better at what it can do: pain, which leads to more profound inactivity which leads to more sensitivity to pain, etc.
My general experience is, unfortunately, typical. After experiencing chronic pain for an extended period of time, a person feels pain at levels of stimulation far less than what would cause a “normal” person pain. This is called sensitization. A great deal of research has been done on sensitization right down to understanding it at the level of single cell neurobiology. An overview of this research will be presented in a later section devoted to the science of chronic pain. For now, it is sufficient to note that you will feel pain even from stimuli that do not put you at risk for injury. If you restrict your activities to avoid all pain, you will continue the downward spiral of pain/inactivity.
Understanding the problem was very important, but the real work involved finding ways to reverse the downward spiral and gradually add more activity while experiencing less pain. To get the confidence to undertake this work, it is important to assure yourself that working through some pain to add activity and start to reverse the downward spiral will not affect you detrimentally. This includes visits to doctors and specialists until it is clear that nothing can be fixed. The problem, no matter how it started, is now how to get rid of the chronic pain.
In my case, all of the body based therapies I tried did not really help. Part of the problem I now realize was because of my misunderstanding of how to do physical therapy exercises at home. My physical therapist had told me to just move until the point of pain. With 20/20 hindsight, I now realize I should have heard this as, “You should not have the experience of pain during your home practice.” Instead, I wanted to get better faster so I went to the point of pain and a little beyond in most exercises. This, unfortunately, kept my brain very well practiced in generating the experience of pain in association with physical movement! Better ways to increase physical activity are discussed below.
Finally, on the advice of a wonderful man, Brian Chang, I discontinued the exercises and put my arm in a sling for three weeks, which gave the inflammation in my shoulder time to subside. Meanwhile I was reading the books of John Sarno, M.D., and becoming convinced that my real problem was not with the tissue of my shoulder, but with my brain. While reading his book, “The Divided Mind,” I was sitting in a recliner with pillows under each arm to minimize my chronic shoulder pain when I suddenly noticed pain in my right elbow. Now, I knew that I had done nothing to damage the tissue in my right elbow that day. I found myself saying to my brain: “YOU’VE GOT TO BE KIDDING!” “CUT IT OUT!” The pain in my elbow disappeared immediately.
This breakthrough marked the beginning of the next phase of my recovery from chronic pain. It was the first time I knew for sure and at a very deep level the basic idea that the source of my pain was my brain, and that my brain could be retrained. I was not totally free of pain, but my pain was very much diminished and I could begin the next phase: working toward the elimination of chronic pain.
But it still took about six months until I could do my normal activities with nothing more than temporary tinges of pain. A really helpful practice for me, also suggested by Brian Chang, was Qigong (pronounced chee gong). Qigong movements are graceful and resemble those of Tai Chi, which he also suggested as an alternative. Tai Chi and Qigong both came from China, Tai Chi from martial arts and Qigong from healing arts. I was lucky enough to encounter a wonderful Qigong guide, Joyanna Maria, for a few classes at a retreat, and then started using her DVD (you can get one of hers at joyqiyoga.com or find some gentle movement class or video that appeals to you). I would feel momentary pain during some of the exercises, but it was gone by the end of the session, in part because of the distraction of all the different, gentle types of movement. It took about six months until I was basically pain free for normal activities including reaching over my head to get things from shelves and using power tools. Recently, about 12 months after my breakthrough, I was able to try standing paddle board for the first time and experienced no shoulder pain!
Though this particular discussion has been in terms of general concepts and my story, there has been some serious and systematic work in this area that will be discussed below.