Objectives

• Most of us are under the impression that you must first solve your chronic pain before you can move forward and enjoy your life.
• It is actually the opposite scenario. You have to fully engage in life in order to move away from your pain.
• Fully engaging in today, with or without the pain, is your only option. To change your brain, you have to direct your attention to where you want to go and keep doing it.
• You also must use tools to lessen the impact of mental and physical pain. These are critical in that you can’t move forward without letting go.
• To have a good life, you have to live a good life; It requires practice.

“Life is like riding a bicycle. To keep your balance, you must keep moving forward.”

Albert Einstein

The goal of The DOC Journey is not to rid yourself of your pain. In fact, there is no goal because there is no beginning or end to it. The only “goal” is to live your life fully today with the deck of cards you have been dealt – with or without your pain. You must keep moving forward to move through and past your pain.

Understandably, everyone wants to be free of pain. But that isn’t life. The brain treats emotional and physical pain in a similar manner and the body’s physiological response is the same. So, even you were to be rid of your physical symptoms the quality of your life would not change as much as you might think. The emotional circuits will keep firing in response to day-to-day stresses.

Historically, I felt if I surgically relieved a specific symptom caused an identifiable structural problem, the degree of relief would be so compelling that it would propel him or her out of chronic pain and back into a full life. I could not have been more wrong. Unrelenting anxiety, which essentially is the pain, was intolerable and it didn’t improve with surgery. I was shocked as normally the pain should have been easily relieved with the operation. What was also disturbing was that even if the pain resolved with surgery, another body part would frequently light up.

I now understand that research has documented that if you have surgery in the presence of untreated chronic pain, you can induce pain at the new site between 40-60% percent of the time. Five to ten percent of the time it will be a permanent problem.¹ Of course, you can worsen the original pain.

Moving on

So, if you can’t fix yourself and there is no “goal”, what can you do? The patients who were successful in regaining their lives just moved on – with or without their pain. Paradoxically, there was a much higher chance they would leave it behind. Your incredibly adaptable brain develops wherever you place your attention. One metaphor is that of diverting a river into a different channel. There is initially a small amount of water flowing in the new direction, but eventually the volume of water will create its own channel. There are many ways to re-direct. Some include:

• Not discussing your pain – ever with anyone.
• Mindfulness – active meditation
• Meditation
• Visualization
• Engaging with family and friends in a meaningful way.
• Awareness – simply watching where your attention is focused allows you to re-direct it.
• Play

Visualization

 A friend of mine, who may have been the first DOC success in 2006 sent me this email that suggested a different take on visualization. My take on the following quote is that people age because their dreams are crushed by anxiety. You will note that this quote has been used several times in The DOC Journey.

Hi David,

Great quote from your latest post:

“It is not true that people stop pursuing dreams because they grow old. They grow old because they stop pursuing dreams.”

Gabriel Garcia Marquez

To your quote about anxiety crushing dreams and the ability of dreamers therein, I’d add that pushing through the anxiety and daring to dream, regardless of how you feel, creates an inverse effect of calming the anxiety, because sometimes, just having something to believe in, as simple as that, takes us out of our anxiety momentarily enough to see clearly, and thus move forward to a better place.

It works for me as a visualization tool to break the “anxiety cycle” as I call it. And if someone doubts this protocol, they only need to buy a lottery ticket. For the cost of $1, you walk out of that store and start visualizing what you’ll do with the money, and in that very moment, you’re not anxious. Instead, you find yourself, calming, your breathing slows, as you really indulge, if for only a few moments, how you’d be with all that extra cash on hand. It’s an amazing, albeit temporary salve, a balm to the anxious heart. And here’s the trick: We can recall that feeling over and over again and build on it, finding new ways to create the lives we want, just by using this tool of positive visualization. As our mind uses this, our thinking becomes stronger and we can begin to avert the waves of anxiety and in the spaces between, create constructive, positive events, in which to build the life of our dreams. Ironic that what starts with a fantasy – a one-dollar lotto ticket – can actually become reality, with positive visualization techniques tasked toward constructive events in real life context. And hey, we can use every tool we can find along the way, as I see it! Even for a buck!

Play

Play circuits are also permanent and are present to a greater of lesser degree in everyone. Re-connecting with them, with or without your pain, is a powerful way out of pain. These circuits do get buried under the weight of life stresses, but you can create a shift back onto them with specific tools and repetition. This does not mean obsessively engaging in play to distract yourself. Rather, it is a mindset of wonderment and curiosity. Your body chemistry will shift to safety hormones and an anti-inflammatory state, your brain will be less sensitized, nerve conduction improves, and your pain can dramatically decrease or resolve.

It is not logical to think that if your pain was gone that you could enjoy your life. There are too many ways to experience pain. You have to first learn to enjoy life regardless of its challenges, understanding there are days that you will enjoy it more than others. A positive outlook, which has been shown to lower inflammation, with a sense of play will move you moving forward.²

An old song returns

One example I often used in clinic is that any time you do not spend time practicing a skill, you will eventually lose it. My wife played guitar in her 20’s and became proficient in a picking style of performing. Two years ago, she began to take lessons from an extraordinary Bay Area guitar teacher. About six months into her lessons, parts of some old songs began to return in her head. One day she sat down and played a complete piece that she had not thought about for decades. The memory was still there. Pain, anxiety and anger circuits will atrophy, if you turn your attention elsewhere. But they will never completely disappear since these are also necessary survival emotions.

Recap

Nurturing the part of your brain that enjoys life is a learned skill. That is why it is so critical what you choose to program it with. If your default state of mind is that of being agitated and upset, that is what will evolve. As you trigger the same response in those close to you, then there is no end to this universal ping pong game. Conversely, if you choose gratitude and joy, the same phenomenon will lift you upward.

There is a lot to be angry about and also much to enjoy. What is your choice? How and when are you going to move forward?

Two Wolves

Questions and considerations

1. Life is challenging in many ways for all of us. It never stops and solving problems tends to be the default program of our brain. Consider how much of your life is spent solving or thinking about problems compared to purposefully enjoying yourself.
2. It would be great not to have pain, but how long would you survive without its protection. People born without pain sensors don’t live past 10 – 15 years of age.
3. When pain becomes chronic, it is permanent and memorized and does not serve a protective function. The more you try to get rid of it, the stronger it will become.
4. It is by separating from it, moving on, connecting with enjoyable circuits, and leaving it behind that allows your brain to heal.

 References

1. Perkins FM and H Kehlet. Chronic pain as an outcome of surgery. Anesthesiology (2000); 93:123-33.
2. Dantzer R, et al. Resilience and immunity. Brain Behav Immun (2018); 74:28-42. doi: 10.1016/j.bbi.2018.08.010

Listen to the Back in Control Radio podcast Moving Forward with Your Pain.

The post Moving Forward with Your Pain first appeared on Back in Control.

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Hard times

Life doesn’t always go as planned. He hit some difficult personal circumstances and began to underperform. One incident was a high-speed fall where he missed hitting a tree by just a few feet. His left ski hit a small rock throwing him forward. He landed on this left shoulder and dislocated it. He felt for the first time that was going to die, as he hit the snow. He began to ski “not to lose”, which can’t work at a world-class level of competition. The harder he worked the worse it seemed to get.

He began to work with a performance coach in Seattle, David Elaimy in 2006. He was 22. I sponsored him and his best friend, Holt, to work with David over the next several years. Nick climbed to 5^th in North America on the NorAm circuit. Holt went on to win the National Championship in 2007. It was a tough competition for Nick, as he did not make finals after a fall on the top jump.

Injuries

In 2008, Nick had good shot at the National Championship. Our whole family and David Elaimy were watching Nick warm up on a tough course in Killington, VT. He appeared to be one of the few skiers who was mastering the steep course with firm snow. Suddenly he pulled over and sat down. With a very slight twist his anterior cruciate ligament in his left knee popped. He rehabbed quickly after surgery to ski the next season. Then he popped the cruciate ligament in his other knee. He again worked hard enough to compete the next season. Then he partially tore his ankle in practice as he over-rotated on a back flip in heavy snow. His next injury was a ruptured the disc in his lower back between his 4^th and 5^th vertebrae. There wasn’t much pain but it weakened his left quadriceps. He had already experienced nine concussions. You get the idea. He wasn’t giving up easily.

The final straw seemed to be a golf injury. He was driving the cart with his left leg hanging out the side. He was relaxed and not paying too much attention to driving. He caught his foot between the cart and a railway tie as he crossed a small wooden bridge. His ankle snapped requiring yet another surgery. After a lot of conversation we all decided that continuing to ski did not seem like a good idea. I was personally relieved. He was finishing school and had a great job lined up.

Competing again?

He decided to compete again. I was not supportive, but at age 29 it was clearly his decision. It was not only risky, it seemed as if he didn’t have much of a chance. To qualify for a US ski team spot and a World Cup spot he had to finish a combined first or second over two days at a national qualifying event. He lined up a sponsor and began training in September for the December competition. He traveled to Australia, Europe, and Canada, working extremely hard. The first week while in Canada the rope tow was not open. He climbed the hill over 150 times just to practice one jump.

Fear of failure

But another major problem had evolved in addition to his injuries. He had lost his consistency and every year would ski poorly under the pressure of the national qualifying competition. It became a head-trip and even the pattern of failure became predictable. His top jump was an impressive backflip with a full twist and he would ski a great top 2/3 of the run. On the bottom jump he would over-rotate, sit back just a little, and immediately be out of the competition. For three years in a row, it was the same mistake. It didn’t seem to matter how many times he practiced the jump or how well he did in the warm-up runs. He wasn’t laying down winning runs under pressure. He only had the first two runs of the season to finish in the top two and that was it.

It is always tricky when giving your children advice when they haven’t asked for it. Although Nick is mentioned throughout my book, Back in Control, he hasn’t quite gotten around to reading it. (Nor has my wife or daughter). I suggested that he engage with the expressive writing exercises, which is the foundation of the DOC project. It is the tool that begins to break up the cycle of racing thoughts. He politely listened without a response, but actually began to implement it. He had also done the Hoffman process a few years earlier and had continued to use some of the visualization and somatic tools.

Selections 2013

Every December the national qualifying event is called “Selections”. The top two finishers are guaranteed spots on the US ski team. This year it was held in Winter Park, CO. It is a two-day event held on Thursday and Saturday.

On the first day of competition he qualified 13^th out of a field of 75. As the top 16 skiers get a second run he made finals. There is no carry-over from the first run and he finished 6^th, which kept him in the hunt for a top-two finish.

On Saturday he qualified 11^th. It was an excellent accomplishment and was a great run. But anything less than a first or second on the final run was not going to cut it. He finally did it!! On the finals run he missed a first place finish by one hundredth of a point. He skied the run of his life under intense pressure.

They took the top six skiers for a “super finals” and he did it again – he finished second by the smallest of margins.

Making the US Ski Team – Not

For all of us that have watched him compete it is hard to describe how great it was to see him pull this off after years of so much focused effort. His overall standing for the two days was 3^rd. It wasn’t quite a guarantee but often a 3^rd spot opens up on the US ski team and he had clearly elevated his game. Then his dream came true.  A 3^rd spot opened up. But the coaches gave it to the 4th place finisher who he had soundly beaten.

Five years ago he would have been out of his mind for weeks. Making the US ski team had consumed him for over half of his life. And he was upset – for about two days. By the time he told me a week later he had let it go and had enjoyed a wonderful holiday with his girlfriend and friends. I flew over the next weekend to ski with him and he really had moved on. We had a great few days together. The elephant’s noose

I asked him how he had raised his level of skiing to almost winning the event. That is when he told me he had been doing a lot of the expressive writing and immediately destroying it. I was surprised and pleased that my son had actually listened to his father’s advice. He had increased the writing a lot during the competition week. A friend of mine asked him about the Hoffman process. Nick started thinking about the events and reminisced that he actually had used many of the Hoffman tools during the competition.

Before his final “almost-winning run” he was dealing with his fears of failing under pressure. In the starting gate he took his ski pole and wrote the word, “fail” in the snow and then used his skis to bash it. Hoffman graduates will recognize it as one of the basic tools of the process. He proceeded to ski the run of his life.

“The Winning Run”

From my perspective his “winning run” was letting go of being passed over for a US Ski team spot. He seemed to move past it far quicker than I did. Dealing with adversity is maybe the one most important traits that will allow you to live an enjoyable and productive life. I realized that my son had grown up.

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