Podcast - Page 2 of 3 - Pain 2 Possibilities

Community For The Win

In this episode we talk with Tom Bowen about how serving his community helps to reduce his pain. We also discuss the power of community for those living with persistent pain…all in just 15 minutes!

For more information visit our site at www.pain2possibilities.com

The Chronic Pain Experience: Interview with Tom Bowen(001)

Welcome to Pain 2 Possibilities! In this episode we interview Tom Bowen, chronic pain champion and self care advocate about his journey of chronic pain and healing.

For more information visit our website at www.pain2possibilities.com

Understanding Pain – Part 1

Yes, chronic pain is a wildly complicated, complex process.

At Pain 2 Possibilities, we believe that managing your pain means truly understanding your pain.

So just like any good story we are going to take you back to the very beginning…

When you were born, you were equipped with some pretty amazing ‘built ins’. You acquired a body and a brain that combined is a machine that is intuitive, adaptable and responsive. It may not always feel like an amazing machine when you are living day in and day out with persistent pain. But I am here to remind  you just how amazing you and your systems really are! Each and every day your body and brain are going through some pretty complex processes to sustain you. Let’s take a moment to showcase some of those innate features.

When your body temperature rises due to environmental, exercise, hormonal factors and illness, your body instinctively knows what to do to protect your cells. Once your core reaches a certain temperature your body begins to sweat to start the cooling process.

When there is a stimuli (also known as a threat),  perceived or real,  the sympathetic nervous system stimulates the adrenal glands to trigger the release of neurotransmitters (adrenaline). This results in an increase in heart rate, blood pressure, and breathing rate to help get you into fight or flight mode (or sometimes the ‘deer in the headlights’ freeze). This all happens at lightening speed to prepare you for what ever decision you make…to defend, to protect.

Or how about the high speed withdrawal reflex when your hand senses extreme heat on a stove top of which includes a sensory input, central processing, and motor output. This all happens without us even having to think of it nor control it consciously. That’s a highly sophisticated process that happens in a very short period of time and it is meant to protect us from harm. Your limbic system is pretty incredible.

For our last example, I want you to take a moment and think about your favourite meal. Think about what it looks like, what it smells like and finally what it tastes like. Take your time and think of that meal in detail. Now notice what your mouth and salivary glands are doing.  This stimuli and response is incredibly powerful! And it is one of the best examples we have of how your thoughts affect or influence your physical self (which we will address in another post).

Why is this important? Because pain has purpose. Pain is our bodies natural defence mechanism against harm when exposed to a short term stimuli like an injury, damaged tissue, bruises, for real and perceived danger.

Acute Vs Chronic Pain

So our next step in understanding pain is deciphering between Acute and Chronic Pain and how one becomes the other.

Acute pain, as described by webmd.com ‘comes on suddenly and has a limited duration. It's frequently caused by damage to tissue such as bone, muscle, or organs, and it usually disappears when the underlying cause of pain has been treated or has healed.’
Whereas acute pain lasts for days up to 6 months, chronic pain lasts for much longer and is much more complex. It is the pain that stretches beyond the tissue healing.

So how does acute pain become chronic? There is still much to learn about this transition but what we do know is described best by ‘Medpage Today’. They state, ‘acute pain progresses to chronic pain when repeated or continuous nerve stimulation precipitates a series of altered pain pathways, resulting in central sensitization and impaired central nervous system mechanisms.’

Let’s unpack this a little bit. The key concepts in this description are ‘repeated or continuous nerve stimulation’, ‘altered pain pathways’ and ‘impaired central nervous system’.

Nerve stimulation can come from many different sources and can be both physical and emotional in nature. In the world of pain education we call it the Biopsychosocial model, where pain is an intertwining of biological, psychological and sociological factors (stay tuned for more on this). When our nervous system is constantly bombarded with stimulation of pain, worry, fear, stress, trauma, self doubt, and more our pain pathways become physically changed thereby impairing their function. This includes impaired sleep, immune function and overall healing. Just like our Wifi…our nervous system can become ‘glitchy’ (I hear this word A LOT when my son is complaining about our Wifi).

So what is the good news? Just because those pain pathways in your nervous system have been altered does not mean that they cannot heal. They may never be ‘fixed’ but they can be improved which inevitably will change your experience with pain. Neuroplasticity, as defined by Oxford Languages is the ‘the ability of the brain to form and reorganize synaptic connections, especially in response to learning or experience or following injury.’ Yes, you read that correctly, your brain can regenerate and change, it just takes some know-how and lots of practice.

Stay tuned for our next instalment where we will discuss the Biopsychosocial model (it is such an important part of your pain experience that it deserves it’s own blog post!)

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Holding Our Breath

Breathing is the greatest pleasure in life"      Giovanni Papini

​Breathing before the pandemic?

It was an afterthought for the fortunate ones, simply an act of our autonomic nervous system doing it's job without our even having to think about it. For others with vulnerable lungs, a precious gift where life is breathed in with every thoughtful breath.

Breathing our way through a pandemic has refocused our attention on our beautiful often fragile lungs. From the thought of Covid-19 being spread into our lungs or to others, to the frontline workers finding breathing challenging in protective gear to our holding our collective breath globally bracing for the impact of this disease.

We are more conscious of our breath than ever before. ​And in my humble opinion, there is always some good that comes from this.

So let's dive in and show you how breathing is a powerful tool in your covid-19 toolbox with these five strategies.

​1) Bringing the breath back to 'front and centre':

As I mentioned earlier, the breath is controlled by your autonomic nervous system. When you are at rest, your body knows to slow the breathing without even thinking about it. Just as it does when you start to exercise, your heart rate increases, so too does the rate of your breath to keep up with the increase in demand for oxygen. Our bodies respond the same while under acute stress. When stress is prolonged (such as the times we find ourselves in now) our breathing lingers in this fight or flight mode with shallow, short breaths.

​​Bringing the breath back to front and centre simply means thinking about our breath and actively challenging that mindful breath. It means breathing through your nose, slowing your breath, breathing deeply and visualizing four corner breath.

​Paying attention to breathing through your nose engages the lungs' filtration system by activating the little hairs that line the inside of your nasal passages. These small warriors are our first line of defense against foreign invaders.

​In this time of uncertainty that we find ourselves in, our breathing becomes more shallow. Shallow breaths only stimulates the upper portion of your lungs so instead, place your hands on the sides of your rib cage and consciously breathe deeply into your hands. Visualize your lungs like a balloon that you are slowing filling up from top to bottom and side to side. These slow, deep breaths stimulate the nerves at the base of the lungs, activating the relaxation response.

​Four corner breathing is a simple technique that you can use to not only stimulate our 'rest and digest' mode but in the age of covid-19, can actively lengthen and strengthen our lungs.

Sitting or lying down comfortably, ​visualize  the outline of a book or a picture frame.

​As you follow your eyes along the top edge of the book take a slow, deep breath in and count. When your eyes turn the corner and follow the book's edge down, hold your breath and count. When your eyes turn the corner again to follow the bottom edge, breathe out slowly and completely. Hold you breath one last time while your eyes follow the outside of the book up to the start point. ​

As you expand your lungs and your breathing practice, increase the amount of time that you inhale and hold your breath for. Eventually, the goal is to exhale twice as long as you inhale and to extend the length of time holding your breath.

Another technique to try with healthy lungs is to inhale fully through the nose, hold on top briefly and then before exhaling, try to take in one more breath...filling up those lungs completely.

Breathing in, I calm my body. Breathing out, I smile.  Dwelling in the present, I know this is a wonderful moment."      Thich Nhat Hahn

2) Laughter:

Not only is laughter so therapeutic emotionally, it also serves the lungs beautifully. When you laugh​​​​, your lungs are rid of stale air and more oxygen can enter. This is because laughter helps to expand the alveoli in your lungs. ... Expanding these means that the area for oxygen exchange is bigger and more oxygen enters your lungs. In a time when we are trying to protect our lung output and functionality, laughter is a key component. This is why, now more then ever, we need to turn off the news and turn on a funny movie, to reconnect and laugh with friends (online), or get silly with the kids and grandkids.

3) Movement & Posture:

​Body position can influence respiratory function. Changes in body position can alter the length of the respiratory muscles (the diaphragm and the muscles in between the ribs), thereby influencing its ability to generate tension.

Several studies have reported that a slumped posture or prolonged sitting significantly reduces lung capacity and expiratory flow, ​ compared with a normal upright posture. We are living in a time where social isolation has seriously increased our cellphone and laptop use which ultimately increases our rounded forward posture even more.

So what's the moral of the story?

We've got to keep moving! Even patients with Covid-19 are being told to move their limbs, practice their breathing to help elongate those respiratory muscles. Roll your shoulders, open up your ribcage, lift your arms above your head, be mindful of your posture...all these movements count and have massive impact.

4) Singing:

Singing in the car or in the shower is essentially a mindful way to breathe...without even having to think about it. The rhythmic breathing required in singing somewhat mimics the breath control practiced in mindfulness meditation. So let go of any inhibition and belt it out!

5) Getting outside for fresh air:

This is an obvious one but a simple walk outside can raise your immune system and your spirits. "Exercise leads to an increase in natural killer cells, neutrophils and monocytes, which ultimately increases immune function," Ather Ali, ND, MPH. If it is warm enough to do so where you live, take your shoes off and put your feet on the earth and reconnect. 

As we metaphorically and physically hold our breath waiting for this pandemic to come to an end (and it will), take a deep breath and let that go. Soon enough our global community will exhale with a collective sigh of relief. ​

When Emotional Intelligence Meets Pain Management

​Emotional intelligence (otherwise known as emotional quotient or EQ) is the ability to understand, use, and manage your own emotions in positive ways to relieve stress, manage pain, communicate effectively, empathize with others, overcome challenges and defuse conflict. EI can be thought of simply as the power house three's...our attention to emotions, clarity in understanding emotions, and emotion regulation.

When dealing with pain and all of it's 'ripple effects' our mindset and our emotions affect our perception of pain, how we ​deal with anxiety related to pain (or life stressors) and how we communicate with others about our pain. And the truth of the matter is, most of us aren’t taught how to identify or deal with our own emotions, or the emotions of others let alone how to deal with those emotions while living with chronic pain.

​So why is understanding your EQ an important part of your pain management strategy?

According the article, 'Emotional Intelligence Moderates Anxiety Reactions in Chronic Health Conditions' as cited in the American Journal of Applied Psychology,  Emotional Intelligence plays a major role in determining not only the experience of anxiety but it also helps to moderate the amount of anxiety experienced.​ In other words it represents an individuals ability and tendency to ‘work well with emotions’ and to regulate emotional responses in a way that allows for more effective coping

There is a lot to unpack here so let's start by understanding a little bit more about Emotional Intelligence and it's protective effect through mechanisms related to stress processing and regulation.

In one well known model of EI, as written by psychologist Daniel Goleman, 'The Mixed Model' has 5 key areas:

  • Self Awareness: Self-awareness involves knowing your own feelings. This includes having an accurate assessment of what you’re capable of, when you need help, and what your emotional triggers are.

  • Self Management: This involves being able to keep your emotions in check when they become disruptive. Self-management involves being able to control outbursts, calmly discussing disagreements, and avoiding activities that undermine you like extended self-pity or panic.

  • Motivation: Everyone is motivated to action by rewards like money or status. Goleman’s model, however, refers to motivation for the sake of personal joy, curiosity, or the satisfaction of being productive.

  • Empathy: While the three previous categories refer to a person’s internal emotions, this one deals with the emotions of others. Empathy is the skill and practice of reading the emotions of others and responding appropriately.

  • Social Skills: This category involves the application of empathy as well as negotiating the needs of others with your own.

I have always said that those who live with chronic pain are acutely aware of their bodies. More aware of where they carry their tension, how they carry themselves, where they feel the pain. It's a matter of necessity when trying to describe their experience to their health care team and loved ones (if they are listening). ​

This is where we get to take the self awareness piece one step further. Improving your self-awareness is the first step to identifying any problem area you’re facing. Here are some ways to improve your self-awareness:

  • Keep a journal of your emotions: at the end of each day, write down what you experienced, how you felt and how you dealt with it (you can address both the physical and emotional here). This not only helps you to articulate what you are feeling for yourself (a healthy outlet) but also it can offer real clarity to your physician and your loved ones when the time comes to communicate with them.

  • Ask for input from others: when dealing with your self-perception, input from others can be invaluable. Try to ask multiple people who are in the same situation as yourself and who know you well, where your strengths and weaknesses lie, especially in how you deal with your persistent pain. Write down what they say, compare what they say to each other and, again, look for patterns. Most importantly, don’t argue with them. They don’t have to be correct. You’re just trying to gauge your perception from another's point of view. It is important to ask these questions to those who know what life is like with chronic pain as they will fully understand what you are going through.

  • Slow down or meditate: Emotions have a habit of getting the most out of control when we don’t have time to slow down or process them or when you live in a state of perpetual 'fight or flight' mode due to your pain. The next time you have an emotional reaction to something, try to pause before you react​. You can also try meditating to slow your brain down and give your emotional state room to breathe. Meditating also allows you to a) switch the fight or flight response into more of the rest and digest mode so you can cut through the 'noise' and reconnect with your thoughts and sensations and, b) become aware and more accepting of the emotions and sensations you feel by looking more inwards​, rather than focusing solely on external factors.

Emotional Intelligence is a highly effective tool when it comes to mitigating the pain through tough conversations. As you probably know all too well, communicating with loved ones and professionals can often be stressful and when tough conversations arise, the pain can become more intense. The more aware we are of our emotional state during these times the more able we are to respond accordingly so not to increase the physical pain.

Self Management: Once you know how your emotions work, you can start figuring out how to handle them. Proper self-management means controlling your outbursts to reduce stress, distinguishing between external triggers and internal over-reactions, acknowledging negative self talk and rewarding more self serving internal dialogue, and doing what’s best for your needs.

One key way to manage your emotions is to change your sensory input. If simply breathing through it is just not cutting it then try giving your physical body a shift to break the cycle. If you’re feeling lethargic, do some movement, get up out of the couch. If you’re stuck in an emotional loop, give yourself a metaphorical “snap out of it” slap. Anything that can give a slight 'shock' to your system or break the existing routine can help. Funneling emotional energy into something productive can also be very helpful. It’s alright to let overwhelming emotions stew inside you for a moment, if it’s not an appropriate time to let them out. However, when you do, rather than vent it on something futile, turn it into motivation instead by getting back to the things you enjoy such as crafting, hiking, reading, creating, or writing.

Motivation: When addressing motivation as it relates to emotional intelligence and ​chronic pain we’re talking about your inner drive to accomplish something. As Psychology today explains, there’s a section of your prefrontal cortex that lights up at the mere thought of achieving a meaningful goal. And yes, chronic pain warriors can have goals and aspirations as it is such a healthy and meaningful way to look ahead.

Empathy: Empathy is your most important skill for navigating your relationships​. Empathy is important because it helps us understand how others are feeling so we can respond appropriately to the situation. It is typically associated with social behaviour and there is lots of research showing that greater empathy leads to more helping behaviour. And helping behaviour leads to a broader sense of well-being and vitality.

If you are living in chronic pain you know all too well that empathy can be a bit of a tough subject. There is often a lack of empathy from professionals and loved ones when it comes to addressing or communicating your pain experience. This often comes from a place of not knowing what you live day in and day out. Where empathy becomes an important part of your pain management is in the a) understanding of where you partner is emotionally so it can be addressed together and b) in communicating with them how having empathy could help mitigate your pain. Emotional intelligence helps to bring the awareness, the acknowledgement and the resolution all ​ together.

So how can you practice empathy? In a word....listen!

You can’t experience everyone else’s lives to fully understand them, but you can listen. Listening involves letting someone else talk and then not countering what they say. It means putting aside your preconceptions or skepticism for a bit and allowing the person you’re talking to a chance to explain how they feel. Empathy is hard, but virtually every relationship you have can be improved at least marginally by waiting at least an extra ten seconds before you retake the conversation.

Seek to understand. Understanding is key to having empathy. When someone tells you about an experience that’s not your own, take some time to mull over how your life might be different if you experienced that on a daily basis. This especially rings true for loved ones who don't experience pain day in and day out.

By definition empathy means getting in the emotional dirt with someone else. Allowing their experiences to resonate with your own and responding appropriately. It’s okay to offer advice or optimism, but empathy also requires that you wait for the right space to do so. Be mindful of how they must feel and allow them space to feel it.

It is very important to understand that emotional intelligence is not the opposite of intelligence, it is not the triumph of heart over head - it is the unique intersection of both"    David Caruso