Are you debilitated by chronic persistent pain? Turn the volume down with osteopathy

chronic persistent pain

Turn the volume down on chronic persistent pain

When persistent pain is part of daily life

It is only recently that the complexities of chronic pain have been the subject of investigation. As a result, pain medicine is moving into a new era with the deeper insights that are emerging from this research. See the resources listed below.

If you are debilitated by persisting pain, Sandra’s* experience may resonate with you.

Collision course

Sandra brought a multitude of investigations, images and tests to her first osteopathic appointment. As Sandra’s personal story unfolded, it became clear that she had been living with such pain and disability that it had taken over all aspects of her life.

It began when Sandra was 20 years old. She was involved in a car accident as a passenger in the front seat. The collision left her with severe lower back pain. Scans at the time did not indicate structural damage. Her injury significantly improved over the years although there were occasional episodes of acute sharp pain if she sat too long or bent a certain way.

Early last year while skiing, some 2 years after the motor vehicle accident, Sandra fell onto her back, re-aggravating her lower back pain. Ever since that fall her pain would not settle easily. The only way she could get some relief was with strong prescribed pain medication.

Sandra was no longer able to exercise or work full time due to her now persistent pain. She was also unable to have a refreshing night’s sleep. An MRI indicated spinal arthritis and disc herniation in the lower back.

She had been to see “everyone” with no improvement. Her doctor told her it was all in her head. Surgery was recommended by a specialist.

Understanding chronic pain

After a more detailed history and a routine physical movement assessment, it was explained to Sandra that all signs were pointing to the fact that she was suffering from persisting, chronic pain. This is very different to acute pain and therefore requires very different treatment. Continued persisting acute pain signals confluence with our past experiences, cultural underpinnings and meaning of pain to affect changes to the spinal cord and brain. These signals lead to plastic changes to the central nervous system which is the mechanism behind chronic persisting pain.

Turning the volume down

Sandra’s reduced engagement with the world due to her now chronic persistent pain, such as cessation of exercise, cutting back her work hours along with her poor sleep, is common in those suffering from chronic persisting pain, but was also contributing to turning the volume up on her symptoms.

So, in the osteopathic consultation, strategies to turn down the volume on pain were outlined and discussed. These involved continued self-education on chronic pain, returning to paced / dosed general exercise and building her “support dream team”. A support dream team, for example, could include a GP, an acupuncturist to help with pain management, an osteopath to keep the muscles free of spasm and joints mobile and a psychotherapist to explore barriers to the road to recovery.

Was the persistent pain all in Sandra’s head?

When her initial doctor said: “It is all in your head”, he was partially right and partially wrong. It is right in one regard as discussed above, as plastic changes do occur in the central nervous system, but he was incorrect to say “it is all in your head” without contextualising, as it infers blame. Blame does not enable change.

Through pain education, pain management, improved sleep, dosed exercise and building a recovery support team, the outcomes are much more powerful and positive.

Sandra is now swimming and bushwalking again. And though she has bouts of pain, she feels she has the tools now to turn down the volume on her pain and so in doing, turn the volume up on living again.

Vincent King. Osteopath at Wholistic Medical Centre

* Name has been changed

This case study is for educational purposes only. Results may vary due to individual circumstances.

RESOURCES

1) The pain toolkit

www.paintoolkit.com

Great starting point and practical strategies for implementing the road to recovery plan.

2) Tasmanian Persistent Pain Booklet

http://knowpain.co.uk/wp-content/uploads/2014/05/TazzyPersistentPainBooklet.pdf

3) Pain Australia

Education hub for patients and health professionals on the emerging research of pain.

4) Ted Talk: “Why things Hurt” by Lorimer Moseley

https://www.youtube.com/watch?v=gwd-wLdIHjs

An entertaining exploration of the physiology of pain.

5) Chronic Pain Australia

www.chronicpainaustralia.org.au

“What does this nausea in my stomach and tightness in my chest mean? ”

What does this nausea in my stomach and tightness in my chest mean

 

 

 

 

 

 

Chest tightness can stop a person from breathing deeply

Michelle* was in her late 40’s when she first came to the Wholistic Medical Centre. For the previous five years she had an upset stomach, felt nauseous every day, had some bloating after meals with bouts of diarrhoea alternating with constipation. She had been advised to reduce grains, dairy products, sugar and caffeine. She followed that advice and lost 11.5 kilos. The abdominal discomfort reduced a little but did not disappear.
In the previous few months Michelle also noticed a discomfort in her chest. It was so tight that it stopped her from breathing deeply and even prevented her singing. Given that she was a singer, this had become quite a serious limitation. Further medical investigations revealed no abnormalities in her digestive or respiratory systems.

Michelle felt that she couldn’t do anymore with her diet or medication and she suspected that there might be an underlying emotional problem that was behind all her symptoms. She chose to work with a mindfulness based psychotherapy approach.

During her first session, she was guided to study her experience of tightness in the chest/throat and tightness in her abdomen. As she did this, in mindfulness, it became apparent that she had felt exactly the same feeling many times before. It felt like a strong fear. When asked to trace her earliest memory of that, she vividly remembered that at 13 she was made to sing at family functions and experienced ridicule from her cousins. In order to cope, she remembers tightening up her diaphragm and ignoring her feelings of shame and fear.
She was directed to imagine going to help her 13 year-old self: to appear in the family room and to go to her 13 year-old self in a kind and comforting way; to let her know she doesn’t have to sing if she doesn’t want to and to tell her cousins to sing themselves or to be quiet. Staying with that imagined new scene gradually produced a relaxation of the throat and abdominal contractions.

Those muscles relaxed all by themselves, as a new possibility was introduced: ‘I don’t have to go along with my family’.
Subsequent sessions revealed that feelings of fear were constant during her early home life. Sometimes after school, she would stay in the driveway outside her house, too afraid to go inside, because she did not know what she would walk into. Her father could be drunk and yelling abuse. Her mother could be either withdrawn or panic stricken.
Since her childhood she had learnt to ignore her fear and tighten her body in order not to feel it and keep going.

Over the next 5 sessions Michelle was able to go towards her ‘exiled’ feelings – they were allowed to come into her awareness and she was able to take care of them in a soothing way.
An important realisation was that she was so used to being fearful that she had concluded an existential belief of ‘I fear therefore I am’. In fact not feeling full of fear felt strange and empty, even though feeling free of fear was what she was seeking.
Once Michelle began noticing that belief in action she slowly began ‘digesting’ a new possibility of ‘I can live without fear’. This did feel strange and took some getting used to, especially as the fear would bounce back by itself. She would have to feel it and let it pass over and over again. Over 3-4 weeks the previous habitual states of fear and physical contractions gradually lessened, the abdominal tension stopped and her singing voice gradually found an open channel.
A new way of being in the world was now becoming a real possibility!

Discussion
The notion that feelings are ‘exiled’ from day-to-day awareness is fascinating. Our nervous system learns to actually shut out the unpleasant experiences from our consciousness for the purpose of getting through it. When there are no other choices and no support this is a useful ability to have had at the time.
However the underlying feelings persist in the body and the conclusions that were made based on those past events continue to influence current life. Conclusions like: ‘life is scary’; ‘I’m not quite good enough’; ‘nobody is interested in what I feel’; ‘having emotions means I have a mental health problem’ and so on, place profound limitations on our lives.
The use of mindfulness in psychotherapy allows an exploration into the emotional memories without re-traumatizing and without intellectualizing. The original pain is accessed and new more soothing experiences can be introduced. These new experiences allow new conclusions which are far less limiting than the previous ones.
In this precise and gradual way Michelle released her pattern of holding tension in her abdomen, chest and throat. She felt more at ease and confident within herself and as a bonus she became less angry with her children and more loving to her partner.

 

*Name and details have been changed. Results obtained by one person does not mean the same  can be expected by another. Each person has different life experiences and circumstances which will influence responses.

Dr Nick BassalGeneral Medical Practice, Mindfulness-Based Psychotherapy – Wholistic Medical Centre