I am somewhat beside myself regarding several aspects of her story.

• Mainstream medicine is overlooking the basic physiology that we all learned in high school. When you feel threatened, your body goes into flight or fight and you experience physical symptoms. When this state is sustained, your body will break down, and you’ll develop serious illnesses. (1)
• The medical profession took away her hope. It has been documented in the neuroimmunology literature that hope/optimism directly lowers inflammatory markers. Taking it away does the opposite.(2)
• You may consider her story unusual or a “miracle.’ What is a miracle is life and the body’s capacity to heal. What if broken bones couldn’t mend as strong as they were before? What about cuts and deep wounds? What if your body couldn’t fight off infection? What kills patients in cancer treatment is often infection because strong drugs that kill cancer cells often compromise the immune system.
• Every day, I take a moment to consider how my heart can beat 60-80 times a minute with the only rest being between beats. It doesn’t make any rational sense.
• But what I find especially upsetting is the story of her early family life, of which variations occur on over 35% of American families.(3) How can this continue to be? We know better and it all keeps happening. The effects of an abusive childhood have been documented to last the rest of your life.

Here is her story of hope and what keeps me moving forward.

I am an unwanted child who was abused by her family. I do not remember ever being healthy. At 13, I started getting migraines.

5 years ago, at age 52, I broke my ankle and had horrible pain after surgery. Even though the most prominent pain doctor in our country diagnosed me with CRPS (chronic regional pain syndrome), physical therapists and the physiatrist didn’t believe it. I tried my luck at another great centre for PT, but it was the same. After each session I could not live for days because the pain was so bad even though I was on opiates.

I reluctantly decided I would re-learn to walk by myself. I had to go excruciatingly slowly, but in a few months I was able to walk with almost no pain. I got off opiates without a problem. Getting in touch with anger that I repressed all my life was extremely beneficial. Even though both my surgeon and the pain doctor were mad at me for giving up on PT, they each wrote that the PT was “a bit too harsh” after they saw me walk again.

Everything was going quite well until I got herpes zoster. When I recovered I was very keen to go walking. I pushed myself to walk for the next few years, but each step I took was painful. In the midst of it, I convinced the surgeon to remove the hardware, which did not help. In the last few months I finally gave up on walking longer distances even though I love to walk.

I have been writing JournalSpeak/expressive writing for 2+ years. It has been a great way to get the anger and other repressed feelings out. In the first 4 months, I got rid of my lifelong insomnia, and my chronic depression was way less. I was able to slowly lower the dose of antidepressants. I am able get rid of my migraines with writing the anger out, and I also need to validate my feelings. While writing down my feelingsI discovered I was scapegoated and gaslit by my family. I see others and myself in a completely new way, and do not feel so helpless anymore.

I was incredibly lucky to discover Dr. Hanscom on the Trauma Superconference. No matter how much anger I got out in writing, I could not get any relief from ankle/hip/back pain. I was eager to try his advice: no listening to the news, no criticising, no talking about pain, and using another virtual desktop on my computer without pain being discussed. He also gave me “permission” to focus on happier things like planning for things I would love to do and am able to do instead of trying to make sense of the past.

I realize that I have pushed myself too hard all my life. I can walk the same distance, but if I push myself, every single step is painful. If I say to myself, “I am going out and will walk as much as I can,” I can walk the same 1.5 km with little to no pain at all. If the pain returns, my nervous system is calm enough now that I can believe myself when I say, “I am safe. My ankles/hip/back are OK” – and the pain goes away!

The fact that the pain doctor said in an interview only a couple of years ago that nothing much can be done for chronic pain, incredibly saddens me. Two of Dr. Sarno’s books(4) were translated to our language years ago. A psychologist that works with people with chronic pain has a 3+ years waiting  list for her groups. She recently said in a lecture for rheumatoid patients that they need to talk about their pain. Even though one patient insisted that people ignore or do not believe her, the psychologist insisted they continue to talk about pain. I know firsthand this does not work. A couple of years ago I joined an online support group for chronic pain, and just reading about pain made my pain so much worse that I had to leave.

I am so incredibly grateful to Dr. Hanscom for saving my life. All the advice and information he shares, allows us to help ourselves even if we live on another continent.

This is not about me

I would like to emphasize that the healing journey is based on deeply-documented interventions. The DOC (Direct Your Own Care) Journey is simply a framework that presents them in organized and accessible manner. There are a growing number of practitioners that understand the human need to feel heard, validated, and safe. Each of them has their own style of educating their patients, implementing effective treatments, and helping patients access their own capacity to heal. Some of the main principles are that chronic disease is complicated, multiple aspects of it must be simultaneously addressed, and the patient must take responsibility for his or her own care.

One interesting aspect to her story is that belonging to a pain support group carries a poor prognosis in that most them are focused on discussing the pain, medical care, and how badly they have been treated.(5) Although they may be correct, these discussions place your brain on the problems and not moving into the two-part solution – letting go and moving forward.

Some other effective interventions include:

• PRT – Pain Reprocessing Therapy(6)
• EAET – Emotional Awareness and Expression Training(7)
• ISTDP – Intermediate Short-Term Dynamic Psychotherapy(8)
• ACT – Acceptance and Commitment Therapy(9)
• Mindfulness-base Stress reduction(10)

She found way out on her OWN 

Again, each of these must be framed in an overall treatment approach. As much (most) of it is self-directed, not a lot of resources are required. When needed, they can be plugged into the bigger picture. I liken it to doing a jigsaw puzzle that is not that difficult. They key is persistence.

Note, that although the framework provided by Back in Control helped her move forward in a powerful way, she had already done a lot of work. I have never seen or corresponded with her. She truly pulled herself out of the hole and entered into a new life! For many who heal, this is the way it often happens.

References

1. Holmes TH, Rahe RH. The Social Readjustment Rating Scale.J Psychosom Res (1967); 11:213–8. doi:1016/0022-3999(67)90010-4
2. Dantzer R, et al. Resilience and Immunity. Brain Behav Immun (2018);74:28-42. Doi.10.1016.j.bbi2018.08.010
3. Felitti VJ, Anda Rf, Nordenberg D, et al. The relationship of adult health status to childhood abuse and household dysfunction. American Journal of Preventive Medicine (1998); 14:245-258.
4. Sarno J. The Mind Body Prescription. Warner Books, New York, NY, 1998.
5. Friedberg F, et al. Do Support groups help people with chronic fatigue syndrome and fibromyalgia? A comparison of active and inactive members. J Rheumatol ((2005); 32:2416-20.
6. Asher YK, et al. Effect of pain reprocessing therapy vs. placebo and usual care for patients with chronic back pain. JAMA Psychiatry (2021).doi:10.1001/jamapsychiatry.2021.2669
7. LumleyMA, Cohen JL, Stout RL, Neely LC, Sander LM, Burger AJ. An emotional exposure-based treatment of traumatic stress for people with chronic pain: preliminary results for fibromyalgia syndrome. Psychotherapy (Chic) 2008;45:165–72.
8. Abbass Allan, et al. Intensive short-term dynamic psychotherapy to reduce rates of emergency department return visits for patients with medically unexplained symptoms: preliminary evidence from a pre-post intervention study. CJEM (2009); 11:529-34.
9. McCracken LM and Vowles KE. Acceptance and commitment therapy and mindfulness for chronic pain: Model, process, and progress. Am Psychol (2014); 69:178–87.14. Hann KEJ,
10. Cherkin DC, et al. Effect of mindfulness-based stress reduction vs. cognitive behavioural therapy or usual care on back pain and functional limitations in adults with chronic low back pain. JAMA (2016); 315:1240-1249. doi:10.1001/jama.2016.2323

The post “My Way Out” (of “The Abyss”) – One Patient’s Story first appeared on Back in Control.

The post “My Way Out” (of “The Abyss”) – One Patient’s Story appeared first on Back in Control.

My wife, Babs, and stepdaughter, Jasmine, and I have done these workshops together since 2013. Each year, we are energized and inspired by the shifts in mood, outlook, and physical symptoms that occur within a just few days. We have been perplexed for years why this is such a consistent outcome and the last few years of neuroscience research has now explained what happens. It revolves around experiencing threat versus safety.

Fight or flight/ rest and digest

Any mental or physical threat, real or perceived, fires up your body’s flight or fight response through the sympathetic nervous system. The reaction includes stress hormones, inflammation, and elevated metabolism (fuel consumption); and you are on alert, anxious, and agitated. If the perception of danger is prolonged, then your body will respond with many different symptoms and often illness. Chronic stress (threat) keeps you in this heighted state and has been documented in many studies to be deadly. (1)

The essence of the solution lies in finding safety, which creates a “rest and digest” state that allows you to regenerate, drop inflammation, and slow down your metabolism; you feel relaxed with less pain. There are many ways to induce this state of safety. The workshop creates an atmosphere that allows this to happen. Dr. Robert Dantzer and several other researchers wrote an extensive review looking at the interaction of social factors influencing inflammation (pain) and how the inflammatory condition impacts your behaviors. (2) The main ones with most impact are:

• Social connection
• Positive affect (emotional state)
• Sense of control
• Optimism/ Hope

These workshops address all these issues and each of them is calming and directly anti-inflammatory communicated through the Vagus nerve (10^th cranial nerve). Dr. Stephen Porges, through his research and writing on the Polyvagal theory, has nicely laid out the afferent input into the midbrain and its efferent output allows safe human interaction. (3)

Social Connection

There are few times and places where you can feel safe with others. Life is competitive and it’s challenging to get a break. School has many layers of stress. Bullying is rampant. Close friends often turn on each other. Social media has intruded on privacy and quiet time. Research has shown that only about a third of families are relatively free of chaos. Other stressful arenas include sports, music, the arts, employment, and social status. Where’s there a place to rest?

We quickly realized that we didn’t have to do much after we set up the weekend. Participants in a safe and structured setting healed each other. It was also a remarkable experience for us being in the presence of those who are so supportive of each other. Oxytocin is a bonding hormone that is secreted in safe and social situations and is anti-inflammatory.

Positive affect/ play

The  weekend is also focused on re-connecting people with each other by sharing enjoyable experiences. Many of the activities are held in small groups of four or five. Participants can feel safe and it’s remarkable how quickly healing occurs. Much of the weekend is spent in play, which is a great venue to feel safe.

Babs and Jasmine are important contributors by leading you in rhythm, song, relaxation exercises, and sharing.

 Sense of control (The “ring of fire”)

There are many tools that allow you to regulate your own body’s neurochemistry and responses to threats. Just this sense of control is anti-inflammatory. Additionally, understanding the nature of chronic mental and physical pain will enable you to personalize solutions.

Awareness of your current state of being is the first step and we use a tool called, “The Ring of Fire.” Being aware of which color you are in at the moment, allows you to choose your direction. The green center is where you rest and regenerate. Blue is “life.” The red ring of anxiety and frustration is an inherent part of life that must be navigated skillfully. The goal is to be able to exist in any part of the “circle of life” on your own terms.

Hope/ optimism

People in chronic pain lose hope. The loss of hope contributes to the actual pain by increasing inflammation by speeding up nerve conduction. We will be sharing many stories of hope with the group. Regaining hope is powerful.

Comments from prior classes

“I’m still high from the weekend. And off all pain meds (even Advil) after 10 years on opioids…………..    Interesting how the class responded to my hooping (hula hoop). I can see Babs and Jaz doing a session, maybe a half-hour?  What do you think? Neuroplasticity, endorphins, fun!  Whether people catch on right away or not, laughter will be a result.  It could take practice, just like learning the cup song.  And for any resistant males, emphasize that it will improve their sex lives!”

“The program has been enormously helpful, and I can only conclude that it’s helping me to live in a more authentic way, which I feel makes my unconscious happy! I think when you have an abusive parent you have to suppress your feelings so much that suppression, avoidance and denial become your coping mechanisms. But as you know, it’s no way to live your life.

It’s possible I may still need surgery eventually, but if so, I feel that thanks to following the program, I’d be able to do it in a conscious and aware manner. Before, I felt very strongly that It would be a mistake.”

“………….  My family and co-workers are amazed at my progress. I am especially committed to no longer talking about my pain and to writing on a regular basis. I am getting (have gotten) my life back!”

Several commented, “I feel like I just spent a weekend away at camp.”

Reconnection to you

We have always been aware that when returning home, the pain will recur. But tasting freedom from pain is powerful. Every cell in your body is created to survive and thrive. If you allow yourself to be open to possibilities, it is a matter of time before you find your way to healing. Many participants have leveraged these workshops to a more enjoyable life.

References:

1. Rosengren A, Orth-Gomer K, Wedel H, Wilhelmsen L. 1993 Stressful life events, social support, and mortality in men born in 1933. Br. Med. J (1993); 307:1102–1105.
2. Dantzer R, et al. Resilience and immunity. Brain Behav Immun (2018); 74:28-42. doi:10.1016/j.bbi.2018.08.010
3. Porges, Steven. The Polyvagal Theory. Norton and Co., New York, NY, 2011.

Ffvb

through the Vagus nerve (10^th cranial nerve).

The post Experiencing Safety: Solving Chronic Pain: An Immersive Weekend Retreat first appeared on Back in Control.

The post Experiencing Safety: Solving Chronic Pain: An Immersive Weekend Retreat appeared first on Back in Control.

For some, the holidays are synonymous with a strong sense of familial closeness and love. However, this is not the case with many family gatherings, where relatives trigger each other, and chaos quickly ensues. If this describes your experience with the holidays, then this article is for you.

I’ll never forget one Christmas break during my second year in medical school. I hadn’t been home for two years because of study and work demands. I was excited to see my family. Within five minutes, my mother launched into a fight that had started two years earlier. She picked it up almost to the sentence. I was both dumbfounded and upset. This wasn’t part of my vacation plans.

This isn’t an uncommon occurrence.  You’ve waited all year to be with those who you love, and people aren’t getting along. It goes both ways in that loneliness is also magnified. The medical wards are usually full because many patients have increased problems around drugs and alcohol. It doesn’t make sense, except it does if you understand the mismatch between the conscious and unconscious brain and the nature of triggers. So what happens?  Happy holidays – not

Triggers

Any time you are anxious or angry, you’ve been triggered. Your nervous system has connected a current situation to a similar unpleasant past event. It doesn’t matter if the present or prior event represented a true threat. It just has to be perceived that way and the body will secrete stress hormones in its effort to resolve the problem. The sensation created by these chemicals is anxiety. Anxiety is the result of the reaction, not the cause. When you can’t solve the issue, more hormones are secreted, and you’ll become angry.

The reason why family dynamics can be so volatile, is that most of your reactions are programmed by your parents during the first 12 years of life, especially the first two. It matters little what your parents teach or preach; it’s their behaviors and attitudes that become embedded in your nervous system. If you have come from an abusive family, your reactions to the present will be intense, although the present “danger” might be minimal. It is well-documented in the ACE (adverse childhood experiences) studies that the incidence of chronic pain, anxiety, depression, obesity, heart disease and suicide are higher than the norm. You needed to be hypervigilant as a child and it doesn’t change as you age. You are and will continue to be hyper-reactive out of proportion to the circumstance. All of this is exacerbated in families dealing with chronic pain.

During the Holidays, you are around the sources of your triggers from your parents, siblings, children and other relatives. No wonder they can be problematic. Landmines are everywhere.

How did this happen? I watch parents with babies and young children laugh, hold and play with them. It’s a precious time and they would do anything for them. Yet by five or six years-old, there is often a lot of arguing and fighting between parents and children. Suffering from chronic pain doesn’t help. I don’t have to detail what frequently happens during the teen years. The household can be a battlefield — a war without any hope of an end. I don’t how common this scenario is, but I am seeing it frequently in my practice. I only need to ask a few questions and be observant. Many family situations are intolerable.

Learned behaviors

The problem is that we program our own triggers into our offspring. They watch their parents become upset with them or each other and they learn their own behaviors in response to similar stressors. Then they become the cause of deep reactions in their parents. Why else would you yell at this person who used to be this incredibly wonderful child you brought into this world? But you are the adult and you are now in the same boxing ring as your 12-year-old. It’s your role and responsibility to provide a safe environment where your family can feel safe and nurtured. Only then can your child connect with his or her creativity and thrive.

You also may be critical of them. Really?? Anytime you are critical of someone, you have projected your view of you onto them. Remember that you are the one who taught them these behaviors that are now upsetting to you. It is remarkable the number of friends we have whose parents continue to be incredibly critical of them well into adulthood. The negativity is often intense and occurs in the face of the son or daughter doing the best they can to help and be supportive. The intensity of the verbal barrage is unbelievable to me and seems to worsen with age.

So, you have planted your own landmines. Would you yell at a stranger with the same intensity that you talk to your child or spouse? How do you think you appear to them when you are upset? Is that what you want your children to see?

Now it’s the Christmas season, and these deep triggers are coming back into your world. You have missed your family and want to be with them. What are you going to do? How are you going to handle being triggered, because it is inevitable you will be set off at some level. The two faces of Christmas

Here are a few suggestions, most of which I have learned the hard way.

• Remember the problem with the strong familial triggers and concentrate on enjoying your family. Play may be challenging, but it’s also the reason you want to be with them.
• Don’t give any unasked-for advice. They have survived the year without you and have you ever heard of a child listening to a parent’s criticism at any age?
• Remember that when you are volunteering advice, you are really saying, “You aren’t good enough the way you are.” That is probably what your parents did to you when you were young. It’s also why most of us have the “not good enough” voice in our heads.
• Visualize yourself being angry and what your family is seeing when you’re in that state. Be the person you want others to be.
• If you get upset, quickly leave the room. Nothing is ever solved in a heated argument.
• Be curious and genuinely interested in what your family is up to.
• Don’t discuss your pain, medical care, politics, religion, or complain – about anything. After all, it is the season of joy regardless of your belief system.
• Read Parent Effectiveness Training by Dr. Thomas Gordon. It is a classic and the most influential book that I have ever read on any topic.

I want to re-emphasize the powerful irrational nature of being triggered. It is only you and not them that is responsible for your anger. (I well-know that it still feels like it is him or her that upset you). Own it. It is yours.

You’re the one who created the behavior in your child that is now upsetting you. Own that too! Remember how excited you were when they came into the world. Remember the good times and don’t spend time on past differences. Why? It’s done.

A Cigna insurance study in 2018 demonstrated about 40% of Americans feel socially isolated.(1) During my pain experience, loneliness might have been the one most crushing aspect of my ordeal. It was brutal. Connect with gratitude and remember how lucky you are to have friends and family. If you are someone reading this who is socially isolated, work on finding a way to re-connect with someone or give back. I am aware how terrible a feeling this is, and I’m really sorry. The Holidays do make it worse. But by being aware of the impact, you have a higher chance of dealing with it.

Make a commitment to enjoy your holiday season and if you detonate a landmine, use the situation as an opportunity to practice your own tools of staying connected and centered. Become the source of Holiday cheer!

1. Cigna U.S Loneliness Index (2018).

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