Chronic Pain

[DJLSFC]

I am new to this board so hello everyone.

I am relatively experienced I guess, have been meditating on and off for 3 years or so now but have really knuckled down since the turn of this year and practice at least an hour every day, often a lot more. I also practice mindful living which is just now starting to become second nature for me. It has been so helpful for me in getting over anxiety, insomnia and depression after a divorce so I don't need convincing about the relief it can bring to chronic pain. I broke my elbow pretty bad a while back and after a few ops, there is nothing else they can do apart from a full replacement, which apparently I'm way too young for (was nice to hear that at 43). I am stuck with the pain and the medication for a good while now. The guided meditations I have tried for pain obviously focus on the pain itself, but when I sit, stand or lie etc I dont have any pain, its only when I move and do certain things for with my left arm. I'm trying to find a way round this and I'm stuck for idea's so I was hoping for maybe some guidance to finding a solution around this problem. Is there anyone out there on this board who could give me any ideas ? or suffered similar issues ? I would greatly appreciate any help as I`m prescribed opiate pain medication and that is something I dont want long term. Thanks, Dave.

[JonW]

Hi Dave,
Welcome to the forum. Great to have you on board. I think you'll find us to be a friendly, helpful bunch.
Just a quick question for now. How did you go about learning mindfulness? Did you do an 8-week course with a teacher? Did you learn from a book? Other?
It would be useful to know this.
All good things,
Jon
mindfulpilgrim.com

[DJLSFC]

Thanks for the welcome Jon, so initially I worked, or tried to work my way through first Mark Williams book. Must have completed the first few weeks so many times , but finally managed to get through that and spent a few years on and off. Last Nov/Dec, I attended an 8 week guided course which was really helpful, and I have managed to carry on daily practice this year. I now put together a weekly unguided plan to try and cover most types of practice, based on how I know I'll feel at different times of the day or week ie times when I know things may get stressful, or I maybe relaxed, energetic, sleepy etc. I add in additional practices as and when I think they will be helpful and am working on mindful daily living.

I`m also working my way through Ron Siegel's book and downloads, which has freshened my enthusiasm, and opened my eyes a bit to longer periods of meditation.

Bit long winded reply sorry !! Thanks. Dave

[JonW]

Hi Dave.
That sounds like a solid grounding in the practice, quite similar to my own experience. I'm particularly intrigued by what you say about having difficulties 'working with' thoughts and feelings. How exactly are you working with thoughts and feelings in meditation?
Also, how often do you do body scans and practice mindful movement?
Don't worry about length of reply. Be as detailed as you like, squire.
All good things,
Jon

[DJLSFC]

Hi Jon, so I have two difficulties at the moment.

Trying to focus on the pain in my elbow is difficult as it only hurts when I move, so if I sit, the pain goes away and I have nothing to focus on.

I usually start the day with mindful movement as any other practice usually puts me back to sleep. I have to limit the type of movements, and the duration, with my left arm, not just because of the pain but I also need to watch wear and tear on the repairs they did. I dont need to hasten the inevitable elbow replacement. Very occasionally the pain does flare up even when still, so I guess I just need to work with those periods. With the body scan, which I usually do after exercise or shortly before bed, there isnt any pain in the elbow, in fact very few sensations in either elbow.

Another unrelated issue I have is working with difficulty or sadness etc, I can never conjure up any real emotion during this hence no body sensations, and no holding onto these feelings or growing them. So I'm a bit stuck on how I can progress with this practice. I was thinking of keeping these short and sweet for a while and maybe grow from there.

Loving Kindness and observation of thoughts I dont have any problems with. I just cant be sad !! I shouldn't complain.

Any advice welcome !! Thanks. Dave.

[BarryL]

Hi DJLSFC
It sounds like you are motivated in your practice, well done and keep it up.
I tend to use a medical or neurobiological stance when deciding what and how to practice mindfulness. I ask myself what traits I feel need to be improved, such as kindness, patience, happiness, etc. and what traits I would like to soften such as been judgemental [of others and myself], perfectionism, etc. From there I look for a practice that would produce the physiological response to promote the neuroplastic brain change to strengthen or weaken that trait.
From what you write I don’t thing sadness is something you struggle with and hence working with sadness is not really required in your case. Further, practicing feeling sad may even have the unwanted effect of neuroplasticaly enhancing your ability to feel sad!! It would be interested to know how you define “sad” as you mention you have suffered depression. Is low mood [or depression] different from sadness?
Chronic pain is a fascinating subject and quite the buzzword in modern medicine. May I suggest you look at the work done by David Butler and Lorimer Moseley. They are world renowned chronic pain researchers. What makes them really special is that they can take very difficult neurobiological processes and explain it in a way that is interesting and helpful to the pain sufferer. There are also several YouTube videos of theirs you can watch.
One interesting thing you will learn from them is that pain is imaginary [That should get a few replies to this post…LOL]. Yip, all pain is not real and is made up by the brain! If you investigate my statement and get a good understanding of the how the brain does this I believe it will give you a very good idea on how to direct your practice for your painful elbow. Here is their site URL:

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www.noigroup.com

That said, I don’t think you have chronic pain so be careful when doing a google search on “chronic pain”, the results would scare you! In medical terms chronic pain is referring to unrelenting pain that nothing makes better, not even medication [including opiates]. So although you have felt pain in the elbow with movement for years [hence chronic], when you don’t “provoke” the elbow you have no pain. Chronic pain suffers always have pain and nothing they can do eases it.
From a medical point it would be useful to know:
How much exertion is needed to produce the pain? E.g. lifting a heavy object or simply bending and straightening the elbow.
Does your elbow swell or get warm after movement/exercise.
How long does the pain take to disappear after movement?

Would you mind sharing your expectations in terms of mindfulness in controlling your pain?

[DJLSFC]

Thanks for the great reply Barry.

I did write quite a long reply and went to submit and I got logged out so I may summarise in this email .

I have started to tailor my routine very much in the way you describe so its good that your reply backs that up.

You are right in that I don't struggle with sadness right now. I was prescribed a powerful class of antidepressants (MAOI's) which are very rarely used these days as they have numerous food and drug interactions, and I have this to thank for pulling me out of deep hole of depression. This gave me the energy and motivation to make some changes to my lifestyle including practicing mindfulness on a daily basis (rather than intermittently the previous few years). These lifestyle changes and antidepressant have helped me live a very happy and contented period of my life. Despite this I am aware, through experience, that once you have suffered depression, it can come back quite easily if you are not careful. The tiniest bit of sadness can set this off, which is why I guess i have felt the need to practice this kind of meditation.

As for sadness v depression, i guess sadness is an emotion we all feel at times, either for a day or so or more prolonged but with sadness, you tend to carry on functioning, you still laugh at times, socialise etc. Where as depression can manifest itself in all kinds physical and mental difficulties, can leave you feeling hopeless and unable to relax or enjoy life in anyway.

I will check out the 2 guys you mention below regarding chronic pain, and imaginary pain ? sounds very interesting so thanks for the heads up on that.

You are right, chronic pain is the wrong term, its just something the pain specialist mentioned, although neuropathic pain was the main term he used.

Pain in my elbow is strange I can lift a heavy suitcase up with no pain or I can reach over to grap an apple and its agony. There tends be certain movements, for example, when I twist my hands facing upwards or grabbing things in a certain way, that always cause pain. Other movements are sometimes painful and other times fine, so overall its quite hard to pin down the exact pain that I get.

My expectations were kind of along similar lines to how mindfulness has helped my anxiety and depression. How its changed my thought process, and stopped me from continued worrying or catastrophizing even small events. I was hoping by being open and accepting the pain I could somehow live with it easier and not have to rely on painkillers so much.

Thanks, Dave.

[Mindbodymovement]

Hi Dave
I hope you don't mind an answer from a mindful movement specialist rather than a mindfulness specialist.

This is my first post in this forum so hello everyone. My area of interest is pain management and rehabilitation through movement, using in particular Clinical Hanna Somatics (a sensory motor movement modality and education process which has its heritage in the Feldenkrais Method) and pain education from Noi Group,( Butler and Moseley), which Barry has mentioned. I am also a yoga teacher, with a background in pilates and back pain exercise referral. I'm in clinical training with Martha Peterson of http://www.essentialsomatics.com so I'm by no means an expert, but in my own pain journey I've done a lot of courses and have developed a clearer picture of what works and doesn't work with regard to pain.

What I glean from your posts is that you are focussing on the pain in your practice. In brief, what I understand about pain is that focussing on it can strengthen the messaging your brain is getting - even though there is no further tissue damage. So the nerves become more responsive and excitable. Expectation of pain, unconscious or subconscious, also plays a role. 'Pain' is the brain's interpretation of messages (nociception) from tissues. The brain responds to the message. If the brain perceives the messages as threat, it interprets the message as pain. Lorimer Moseley's snakebite story highlights this brilliantly: https://www.youtube.com/watch?v=gwd-wLdIHjs
Basically, when actually bitten by the snake, he thought it was a scratch and ignored it, resulting in him nearly dying. This left such an impression on his brain (a 'neurotag' http://humanantigravitysuit.blogspot.co.uk/2014/05/my-take-on-why-manual-therapy-works_10.html), that when he was later scratched, his brain interpreted it as incredible pain, based on the memory (neurotag) of the snakebite. The Noi Group books, Explain Pain and Painful Yarns are excellent. I would fully recommend getting them, even though they are expensive.

What could this mean for you? Is your brain interpreting messages from the nervous system as threat and therefore creating pain, when in reality there is not threat/danger? Is there a real threat (i.e. a lack of healing/tissue damage)? This article contains some useful info on healing times to help you mull this over: http://www.reyallen.com/pain-science/

Do you know Michael Chaskalon's work? He does a great 30 minute body scan (Chapter 12 ( I think!) of his audiobook, Mindfulness in 8 Weeks). Rather than focussing on sensations from the pain site, the guided mindfulness meditation gets you to go through the whole body, so you are focussing on sensations everywhere else. People in chronic pain can often, understandably, focus on the pain site. But this can lead to a distorted homuncular representation of that body part in the brain.https://www.youtube.com/watch?v=3QVAY5stO3U. Learning to take focus from the pain site, and taking stock of the pleasant or normal sensations in the body that exist side by side can help rebalance the bodily representations in the brain.

Most of the movements I teach are somatic movements, which are slow and mindful. We scan the body first, do the movements and then scan the body at the end of the session. Here is an example of a scan and some somatic movements to try:
https://youtu.be/RTuKBcwjYDM
https://youtu.be/E3cEqQM5cik
https://www.youtube.com/watch?v=CAcLHr_gk-0
https://www.youtube.com/watch?v=ZUn-3NLbwRo
https://www.youtube.com/watch?v=cxcJZkltaVo
https://www.youtube.com/watch?v=C5J2DXdub18
https://www.youtube.com/watch?v=QF-MSevUxyc
End the session with a soma scan. Alternatively my teacher has some great DVDs. As your area of pain seems to be the upper body, the pain free neck and shoulders (it doesn't just do the neck & shoulders!) or the general DVD would be good. Here's a link:http://essentialsomatics.com/hanna-somatics-education-store/ Here's more about our work in Somatics and how it uses the brain:
http://essentialsomatics.com/hanna-somatics-articles-case-studies/got-pain-maybe-its-sensory-motor-amnesia
http://essentialsomatics.com/hanna-somatics-articles-case-studies/somatics-science

Finally, physical exercise where your heart rate/circulation are increased are helpful in desensitizing the nervous system.

I'm by no means an expert and I've explained things in layman's terms as I understand them! These are just some of the things I have found useful in working with my own condition and in treating clients.

Hope it can be of use to you or others. Cheryl

[DJLSFC]

Wow, thank you Cheryl, a very interesting and useful post. A lot of new terms there for me so I will need to digest and investigate some of these and links etc, and then, I`m sure the questions will come

So a few brief things, the pain I have, I guess I`ve established now with Barry's help, is not chronic, although the condition is. Unfortunately there is wear and tear involved and I will require a complete elbow replacement at some point, so I guess you could say my brain does see an ongoing "threat" and that could contribute to the pain.

I also do regular body scans up to an hour sometimes and I never have pain whilst sitting or lying down.

Anyway, really appreciate your post and will be looking into further. I really like the sound of the somatic movements !!

Thanks. Dave