My last article about the dangers of opioids for chronic pain was full of sad news. But here I will bring you good news: the vast majority of people living with chronic pain do not need to turn to these medications at all. Through integrative approaches (meaning healing-oriented medical care that utilizes all appropriate therapies, both conventional and complementary) it is possible to improve pain levels and function, and even often be rid of pain for good. This approach works in part because it actually empowers patients to take charge of their own health, partnering with their doctors and sharing in medical decision-making.
Research on many types of chronic illnesses shows that when patients understand that they possess the skills to recover their health, their outcomes are improved, and stress and depression are decreased. Growing this confidence and self-responsibility decreases chronic pain severity and its impact on activities of daily living, and enhances overall quality of life.
A recent study evaluated 80 people living with chronic pain with in-depth interviews.1
Fifty-nine were found to be “wisdom exemplars” who could be role models for others with pain. They displayed positive attitudes, wisdom, gratitude, forgiveness, post-traumatic growth, and more use of integrative therapies compared to the non-exemplars. These findings give evidence to the need for a much broader view of chronic pain than just the medical side. Other beneficial themes also emerged, such as self-care, spirituality, social support, and healthy lifestyle.
I discussed in my second blog article
how therapies promoting our mind-body connection, such as those of Body & Brain Yoga, are key aspects of integrative care for chronic pain.
From experiencing our mind existing in our body, not in a separate place or time, comes sensitivity to the “voice” of the body, the sensations reflecting our internal physical state, called interoception. Examples are blood vessel dilation and constriction, intestinal activity, heartbeat, air hunger, temperature, blood & energy circulation, vibration, and pain
Enhanced self-awareness allows us to observe and acknowledge pain without judgment or emotional reaction, and appreciate that its intensity depends on our level of awareness, focus, fear, and preconceptions and misconceptions about what this physical phenomenon means. With a mind-body perspective, we are able to retrain our brain and decrease our suffering from physical pain.
Another key aspect of integrative medicine is appreciation of the importance of strengthening the physical body. Most of my patients with chronic pelvic pain were deconditioned from months or years of sedentary living. Many limit activity and unconsciously splint their painful areas, fearing that movement will increase pain. They need support to overcome this fear, and then encouragement to engage regularly in low to moderate intensity exercises, exemplified by those of Body & Brain Yoga, to recondition their bodies.
Becoming physically strong eases the sense of disempowerment so common in chronic pain patients. Exercise also circulates blood, lymph fluid, nutrients, and energy to nerves and other tissues that are often “starving” in the pain focus. When I scrubbed in to watch surgeries to release entrapped nerves in my patients, I was amazed to observe how the tissues in the area of pain were dry, thin, inelastic, and pale from lack of circulation.
Exercise-enhanced circulation also removes toxins and by-products of inflammation from our tissues. But we need to avoid toxins getting into our bodies through food, water, and air as well; many pesticides, food additives, and inhaled toxins increase inflammation and autoimmunity, which may intensify pain. Vitamins and nutrients work best when obtained in food, but even the best of diets may lack enough vitamin D and B12; both are important supplements for chronic pain. Nutrients for injured nerves and other tissues include omega 3 fatty acids, found in fish oils. Curcumin, from turmeric, has anti-inflammatory action and is a helpful supplement for pain conditions.
Our external environment may also be harmful; we need a safe home, free from tension and toxins, and soothing to our senses, for best healing. Creating a small personal space for peaceful mini-retreats is of great practical and symbolic value, as is putting ourselves in nature as often as possible. Our internal environment can promote healing too, if we regularly make our thoughts soothing with positive visualizations and memories of peaceful scenes. This is especially needed if our outer environment is stressful.
A majority of Americans are sleep-deprived, but for people with persistent pain, adequate sleep is essential. Pain medications often interfere with sleep quality, making restorative rest more difficult. Good sleep habits do help: wind down an hour before bedtime with breathing disciplines, meditation, and relaxation, as opposed to watching screens on computers and TV. Avoid alcohol, caffeine, heavy meals, and exercise in the evening, and keep a regular sleep schedule even on weekends. Toe-tapping for 5 minutes once in bed also does wonders.
I walked past a church in Manhattan one day, while stressfully trying to figure out in my tired mind how I would accomplish all I had to do for my patients and family. A simple sign in front caught my eye and enlightened my mind: "Self-care is not selfish: an empty vessel cannot serve." I started using that line as a mantra for myself, and told it to many patients who shared feelings of guilt about spending time caring for themselves, instead of for their loved ones. The importance of self-care is now being researched as an integral component of treatment in all kinds of chronic illness. Active self-care therapies are individualized and patient-centered, excellent for complex symptoms, safe, cost-effective, and decrease over-utilization of health care services and medications.2
I would like to report my personal pain follow-up.
Practicing good self-care has brought my chemotherapy-induced peripheral neuropathy in my feet down to such a low level that I am relieved of pain, and can even massage my toes! I researched and bought shoes with a wide comfortable toe box, and kept this self-care promise to myself: to walk 1.5 to 2 hours each day, no matter what. Along with daily Body & Brain classes, simply moving by walking healed my pain. Our precious bodies deserve to be loved and cared for, and we can do that best for our own selves. With a mind-body practice, exercise, wholesome nutrition, quality sleep, and a healthy lifestyle, our bodies can amazingly self-heal!
In my next article, I will discuss common psychological ramifications of chronic pain, and strategies for healing.
Alliance for Pelvic Pain Retreat (May 20-22, 2016)
Are you living with chronic pelvic pain? Join Dr. Deborah Coady and 5 other Chronic Pelvic Pain Specialists for a 3-day wellness retreat for managing chronic pelvic, genital and sexual pain disorders. It will take place May 20-22 at Honor’s Haven Resort and Spa in the Catskill Mountains.
This all-inclusive weekend will include educational seminars, interactive workshops, one-on-one attention, 3 healthy meals a day, and connecting with a supportive community in a beautiful, healing natural surrounding.
Download the information here and reserve your spot today.
Owens JE, Menard M, Plews-Ogan M, et al. Stories of Growth and Wisdom: A Mixed-Methods Study of People Living Well With Pain. Global Advances in Health and Medicine, January 2016, Vol. 5, No.1: pp. 16-28.
Pain Medicine: Volume 15, Supplement on Self-Care. April 2014.