10 years in a wheelchair

Jane, a woman in her early 60s, was exactly such a patient. She’d lived with severe scoliosis all her life. Then, in 2001, she was rear-ended while driving, and the following year, she had a bad fall while grocery shopping. By the time she came to see me, she had severe pain everywhere. She’d been using an electric wheelchair for nearly a decade. She was taking over 200 mg of morphine per day and high doses of anti-anxiety drugs.

When I examined her, she was tilted forward and to the left, barely able to stand. Her spinal curve was severe enough that I recommended surgery but I warned her that the treatment had a high rate of complication.  Because of this, it was unsafe to do the operation until her medications were stabilized, her pain significantly diminished, and she was more mobile. The term we use is “prehab” or rehabilitation before surgery to optimize the outcome.

I gave her my book, Back in Control and referred her to a colleague to coordinate her care. She was not that interested and they mutually agreed to not continue care. Eight months passed and I saw her on my schedule. I was curious because I knew the size of her curve and the severity of her pain. High-dose narcotics makes it all the more difficult because they sensitize the nervous system. I did not have high expectations…

Out of the wheelchair

I was shocked when I walked into the room and there was no wheelchair, walker, or cane. She was standing up to greet me. She was off all of her medications, had no pain, and was working out in the gym three times per week. She was animated, smiling, and engaging. I ended up an hour behind in schedule, as I wanted to find out what had turned her life around.

Jane admitted that she had spent the last 10 years sitting alone in her house stewing over all the wrongs that had been done to her. She only went out when necessary. After understanding the linkage between anger and the pain pathways, she decided to forgive. She forgave her ex-husband, the person driving the car that had hit her, the people involved in her legal battle, and the medical system that had not helped her. This process took several months to work through – but within weeks of doing so, her pain began to abate.  She still had scoliosis but as her pain diminished, she stopped stooping over protectively to guard her back. She now could stand up straight and tall.

Reconnecting through forgiveness

Forgiveness researchers, such as Dr. Fred Luskin, have shown how rumination and anger influence central and autonomic nervous system function and impair functioning of the hypothalamic-pituitary adrenal cortical axis (stress system). While forgiveness is seen as a coping mechanism that helps to relieve the stress of anger, it also has direct and indirect effects on health and nervous and endocrine function.

It has been my position that anxiety-induced anger is the driver of chronic pain. The manifestations of unrelenting anger are profound and one of them is becoming socially isolated. Now you have all the time in the world to think about your pain and all the ways you have been treated badly. You body is full of adrenaline, which decreases the blood supply to the frontal lobe (thinking area) of your brain. Indeed, it is well-documented that patients’ brains shrink in the presence of chronic pain. Between the adrenaline and not using the creative part of your brain, that would make sense. Fortunately, your brain will re-expand with resolution of the pain. (2) Anxiety, anger and adrenaline

Social isolation

Besides moving too fast, our modern societal structure does not encourage us to interact with each other in a meaningful way. I read a US News & World Report article several years ago, which reported that the average number of close friends that person in the US had was 2.2. That means that many people have essentially no close friends.

I am a pretty social person but when I was in the midst of my own burnout I became isolated. It wasn’t that there weren’t people around. I had so many intensely negative thoughts about myself whirling around in my head that I couldn’t believe that anyone would want to hang out with me. The loneliness was crushing. When I arrived back in Seattle in 2003, a close friend invited me over for a barbeque and I was shocked. I have not forgotten that day and it was the beginning of my re-entering life.

People being with people

We have held three five-day Omega workshops and this year we will be putting on a weekend seminar with Dr. Bernie Siegel, author of Love, Medicine, and Miracles. My priority was to create a safe environment where people could be with other people and share experiences. One of the most effective ways to re-connect is play and as people began to relax and laugh their pain would disappear. Of course it, returned when they returned to the real world and their triggers. But most of the participants learned the skills to consistently remain out of pain. The more satisfying aspect of the process though was that as the pain abated many re-engaged with their lives in a much more powerful way. Play

As we presented our material throughout the week, I realized that we did not have to do much. It was the participants being with other people that created healing. It was remarkable. Dr. Louis Cozolino wrote an exhaustive review in his book, The Neuroscience of Human Relationships. (3) He points out that humans evolved by interacting with other humans. Therefore, the consequences of becoming isolated are consistent and often severe. Studies out of Australia have shown that there are damaging mental health effects when workers become disabled and out of the workflow of the day. Sitting around the house without a sense of purpose is not a great way to thrive. (4)

One of the first Omega participants sent me this video link. She experienced profound healing after being in pain for over 35 years and has been a true inspiration. TED talk: Our lonely society makes it hard to come home from war

This Fox segment was filmed with another one of our Omega participants. She has a great story amongst many others. We never anticipated the power of people healing people.  Video: Write your way out of pain

Jane was in a wheelchair for over 10 years and on high dose narcotics with a severe spinal deformity. It was by her working past her anger, getting out of the house and re-connecting with her friends did she heal. No medical treatment can replicate the power of the body to heal itself. Anger disconnects – play connects.

1. Eisenberger N. “The neural bases of social pain: Evidence for shared representations with physical pain.” Psychosom Med (2012); 74: 126-135.
2. Seminowicz DA, et al. “Effective treatment of chronic low back pain in humans reverses abnormal brain anatomy and function.” The Journal of Neurosci­ence (2011); 31: 7540-7550.
3. Cozolino, Louis. The Neuroscience of Human Relationships. Norton and Co. New York, NY, 2014.
4. Waddell, G and Kim Burton. Is Work Good for Your Health and Well-Being? TSO. London, England, 2006.

Listen to the Back in Control Radio podcast Social Isolation and Chronic Pain

The taste of freedom – Omega 2017

Social Isolation and Chronic Pain

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It’s the sensation created by elevated levels of stress chemicals.

• Adrenaline – increases sensitivity and alertness
• Cortisol – mobilizes energy stores/ inflammation
• Histamines – immune system/ inflammation
• Endorphins – modulates the stress response

Anxiety is an automatic survival response. The unconscious brain is estimated to process 11 millions bits of input per second whereas the conscious brain deals with 40 per second. It is a huge mismatch. That is why it’s not subject to rational psychological interventions alone.

Decreasing your body’s level of stress hormones causes anxiety to drop.

There are two ways of accomplishing this:

• Relaxation strategies
  • Mindfulness, meditation, “active meditation”, forgiveness, play, medical hypnosis, biofeedback and many more.
• Stimulating the brain to change (neuroplasticity), so there is less reactivity to stress.
  • Learning to “be with your pain”.
  • Not discussing it with anyone.
  • Expressive writing
  • Moving forward with your life with or without your pain.
  • “An enjoyable life”

There are two more critical concepts:

Since anxiety is a unpleasant deeply seated core survival reaction, you’ll do almost anything to avoid it. Essentially, anxiety is the pain. The basic intent of it is to cause you to act in a manner to diminish a threat (control) and move on.  When you can’t escape a mental (thoughts) or physical threat, your body will secret more stress hormones to increase your chances of survival. The sensation generated is anger. Anger is anxiety with a chemical kick. It’s even less subject to rational interventions.

Not only are there strategies to decrease the stress hormones, there are powerful ways, to stimulate increased levels of relaxation (play) chemicals, such as:

• Oxytocin – bonding, the “love” drug
• Dopamine – reward
• Serotonin – mood elevator
• GABA hormones (the body’s equivalent of Valium).

This dramatically different chemical environment generates a deep sense of well-being.

Your capacity to enjoy your life depends on your skills in minimizing your levels of stress hormones and stimulating your “play” chemicals. Modern neuroscience has documented why “Laughter is the best medicine”.

Explanation of anxiety: Converstion with David Elaimy

Wake the fun up

Listen to the Back in Control Radio podcast Anxiety Basics.

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Perception versus reality

But our minds are tricky. We are continuously scanning the environment for danger. Your brain is your own personal brain scanner, always looking for danger. Basic issues are oversimplified and threats are magnified. In spite of the mass shootings we actually live in the safest era in history. One of my friends sent me this article pointing out the sharp decline in violent deaths since 1980. Human history is essentially one of violence and power. The vast majority of police officers are remarkable role models and frequently perform acts of heroism. Just walking out the door in a uniform, knowing that he or she could be a sniper target from 200 yards is an act of courage. Massive decline in gun violence

However, the media visually dramatizes stories and focuses on the negative aspects. Every violent act is captured in detail on smart phones. We are helpless to enact common sense social changes due to major political and corporate interests blocking the efforts. This feeds into a collective state of anxiety regardless of how safe we really are and also our tendency to blame others. We have more material possessions and comforts than any society in the history of the world. Shouldn’t that calm us down? What is the problem? Why are we so angry and reactive? The DOC starting point 

It’s anxiety. The root cause of our societal angst is relentless anxiety, which is the driver of anger. Unfortunately, the medical profession treats anxiety as a psychological problem when it is really the body’s chemical response to unpleasant sensory input. It is a universal physiological reaction that enables living creatures to survive on this planet. Here is how it goes.

The neurophysiological basis for emotional and physical pain

Your unconscious brain processes 20 million bits of sensory input every second. Each sensation, sound, touch, taste, smell, vision has to be interpreted by your brain as pleasant, neutral or unpleasant. It continuously interprets the sum total of this input and directs your organs to secrete hormones that are relaxing and enjoyable (dopamine, GABA, oxytocin), or signal danger (adrenaline and cortisol). When you feel anxious or afraid you are experiencing the surge of these chemicals in your body.

Any stress, real or perceived, signals danger and your reaction will always be this survival response. The effects of adrenaline and cortisol include sweating, rapid breathing, shortness of breath, hyper-attentiveness, tightness in your stomach, urinary frequency, and a rapid heart rate. Anxiety, anger and adrenaline

The curse of consciousness

The curse of the human experience is that thoughts are also sensory input that cause the same chemical reactions as a physical threat and are competing for sensory attention. The problem with thoughts compared to the other senses is that you cannot escape them. You will consciously or unconsciously act in a manner to avoid unpleasant physical sensory input. Although you can try to suppress or mask disturbing thoughts, they will keep coming at you and will become progressively more intense with repetition. It is also a problem that is made worse by the fact that our lifespans are now about 30 years longer than in the early 1900’s.

Every human faces this problem. If you come from a difficult background or are trying to meet unrealistic expectations, physical symptoms and illness will begin earlier. If you have a great upbringing you may make it through your entire life without too much trouble. I had a rough beginning but thought I had figured it out until I began having panic attacks and extreme anxiety in my mid-30’s. I achieved my “success” through extreme suppression of my thoughts and did not have any sense of anxiety or anger. My body (brain) knew better.

Since you cannot escape your thoughts, you’ll be under a greater or lesser degree of constant chemical assault. Your progressive anxiety may become disruptive. I was in this state for over 15 years, with the last seven of them being intolerable. My battle with NPD Even in the presence of physical pain, most of my patients tell me that they can deal with the physical pain better than the constant worrying and anxiety. Am I operating on your pain or anxiety? What does all of this have to do with the current societal angst and ongoing violence? Anxiety and anger are the same entity.

Anger = anxiety with a chemical kick

Anger occurs when you have lost control. When you do not have the ability to alter an anxiety-producing situation, your body will secrete even more adrenaline in an attempt regain control. Anger is anxiety with a chemical kick. Anger = loss of control

With the correct diagnosis and treatment approach, relentless anxiety is eminently treatable with remarkably simple strategies. It involves:

• Stimulating the formation of new neurological pathways.
• Shifting onto more functional and enjoyable brain circuits.
• Decreasing the adrenaline rush by training yourself to chill out in presence of stress.

Anxiety is a public health issue

These are easily learned skills that should be part of the basic learning curriculum in elementary school. With the added stresses of over-population, etc. it is rapidly becoming a skill that needs to be learned by every one of us quickly and especially by the medical profession, who society has entrusted with its healing. Societal disintegration – untreated anxiety

This conceptual framework is the basis of the second edition of my updated book. We are not going to solve any of this planet’s problems until we address the root problem of sustained anxiety and anger as a major public health issue using the correct therapeutic approach.

The DOC starting point 

Listen to the Back in Control Radio podcast Neurophysiological Basis of Pain

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Trapped

When the real or perceived threat persists we feel trapped. This, of course, causes the secretion of even more hormones and the feeling of being angry. Anger and anxiety are similar entities. Many reactions occur in your body, which include:

• Shift of blood supply to skeletal muscles, which enables you to flee danger.
• Decreased blood flow to your brain – especially to the frontal cortex where most thinking occurs.
• Increased blood pressure
• Faster heart rate
• Sweating
• Rapid breathing

Adrenaline also effects every cell in your body with each organ systems manifesting its own unique response. There are four categories:

• Smooth muscles – control the digestion, bladder emptying, and diameter of blood vessels and lung airways.
• Skeletal muscle – muscles used for motor function including heart muscle
• Central nervous system – is intended to protect you and one starting point is to amplify danger signals from the environment such a pain
• Conversion reaction – a given organ system will just shut down.

Adrenaline/ Cortisol

There are over 30 symptoms that can occur with this sustained “adrenaline bath” from the different organ system reactions. They include:

Smooth muscle

• Migraine headaches
• Irritable bowel
• Spastic bladder
• Sweating
• Pounding sensation of your heart

Skeletal muscle

• Back pain
• Neck pain
• Rapid heart rate
• Fibromyalgia
• Chest pain
• Tendonitis

Central nervous system

• Burning sensations throughout the body
  • Can feel like peripheral neuropathy
• Itching
• Skin rashes
• Insomnia
• Extreme anxiety/ depression
• Obsessive thought patterns
• Tinnitus or ringing in the ears
• Eating disorders
• Obsessive compulsive disorder (OCD)
• PTSD

Conversion reactions – whole systems shut down

• Paralysis
• Blindness
• Weakness

Your body – a cell culture medium

Dr. Bruce Lipton is a world-renowned cell biologist formerly from Stanford. He has authored several remarkable books including, The Biology of Belief and The Honeymoon Effect. My wife and I had the pleasure of meeting him and his wife. He succinctly pointed out that when he places human cells in a culture medium that contains adrenaline and cortisol that the cells shrivel. When placed in a culture dish that contains oxytocin and growth hormone they flourish. The difference isn’t subtle. Oxytocin is the hormone secreted at birth and is felt to be significant in a mother bonding with her infant. It is also nicknamed “the love drug.”

He also points out the human body is essentially one big culture medium contained by skin. BTW, there are about 50 trillion cells in the body. Therefore, as adrenaline is in contact with every cell the effects are profound. The way you think does affect your body chemistry. What chemical environment do you want your cells to be exposed to on a daily basis? You do have a choice.

Anxiety, anger, and adrenaline OR awareness, forgiveness, and acceptance.

Anger – The “Continental Divide” of Chronic Pain

Listen to the Back in Control Radio podcast Anxiety, Anger and Adrenaline

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