Blog# 27 June 30th

Dark threads are part of the tapestry

Pain as guide and teacher. (part 2/3)

An ongoing part of my sabbatical has been my relationship with pain in my spine, especially neck and shoulders. This has been part of my life since 2005 or earlier, but gradually worsened. In fact my pain is not an insignificant part of the reason for leaving my practice and embarking on this pilgrimage/sabbatical. I have undergone extensive evaluations by primary care docs, orthopedists, spine specialists, with two MRIs over the past 5 years. Initially, an anterior herniated disc at C5-6 was discovered, but was not compressing any nerve root. It was more like a large pebble in my shoe, causing me to shift position and angle of my neck above and below the herniation, in order to relieve this small “pebble” protruding in my neck. Gradually cervical ligaments and small and large muscles adjusted and tried to compensate for this injury. I developed hyper- mobility in the ligaments of my upper cervical vertebra to compensate for the decreased mobility, locked vertebra above and below the injury. This led to slippage and instability of my upper cervical vertebra in and out of alignment? The muscles of the vertebra in my lower cervical spine contracted to try to maintain my neck in a stable position. In addition, my default holding pattern, the way I unconsciously hold myself, head position and neck and shoulder patterning adapted to the injury and in a sense locked it in.

I have had extensive physical therapy, massage, acupuncture, topical salves, chiropracty, and osteopathy. I have had myofascial release, worked with craniosacral practices, and Heller workers. I do a varied set of exercises and walk every day. I have had ergonomic evaluation and purchased a sophisticated new chair, use a specifically shaped cervical pillow, and obtained special computer focal distance eye glasses, since craning my neck to look through the bottom of my bifocals clearly was making it worse. I have, and carry with me when I travel, a cervical traction device that I place over a door and stretch my neck in small increments 25 times, sometimes twice in a day. This is only a partial list of the many treatments I have tried with sometimes partial or temporary relief. I have not considered surgery, since the problem extends up and down my neck into shoulders and back and is quite variable. I am able to cope with the pain and misalignment with only Tylenol and Ibuprofen, as long as I stay active and do my exercises. My Chiropracter is able to provide substantial temporary relief and correct the misalignment. But my neck returns to its default position in my sleep or through returning to my default holding pattern.

I describe these various treatment attempts because whenever I mention my chronic pain problem, almost inevitably the person asks me if I have tried such and such treatment that cured their grandmother, uncle’s cousin’s best friend etc. The effect of such “helpful” diagnostic or treatment recommendations implies that I have not done what I should to help myself. The listener, without knowing any details of a complex and atypical problem, is quick to point out what I should have done or should now do. The response to mentioning pain is usually a “fixing” response and not a listening and compassionate one.

In our society, pain, especially chronic pain, is often viewed with suspicion. It is a weakness or vulnerability that is mild to moderately shameful. It implies there is something wrong with the person who has the pain (hence shame) rather than a physical problem. Are they faking it? Too sensitive? Trying to get out of something? In any case, every person is hard wired to pain avoidance. Hearing about and empathizing with someone’s pain requires them to draw near to and to some extent feel the pain with the person, which is what happens when we empathize and “suffer with” (the meaning of compassion) the person in pain.
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A “fixing” response absolves the listener of having to empathize or imagine the person in pain’s experience. There is a whole cultural and family of origin aspect to the experience of pain. Many of us, especially men, are taught to be tough, grin and bear it, stiff upper lip, don’t let other see you sweat, gut it out, no pain, no gain. Think of all the people who suffered terribly in concentration camps, compared to which my pain is negligible. Well, “I’ve had such and such pain and it never stopped me”. Or “I know someone who had it much worse and they had treatment x,y,z”.

Then there is the very real psychosomatic aspect of chronic pain. Most people understand psychosomatic as “it’s all in your head”, somehow imaginary, or the person’s own fault. If its in my head then I should be able to think differently and it will disappear. Everyone has experienced pain and for most people, at least in the first half of life, it always goes away as the problem heals. But chronic pain is poorly understood, even by most doctors. Psychosomatic pain most assuredly is in my head And my body. The black and white, either/or thinking about pain or other psychosomatic ailments is incorrect. All pain perception is in the brain. All kinds of involuntary reflex responses originate in the brain, some of which malfunction and reinforce the pain problem. Muscular guarding is a simple example. When we hurt ourselves, muscles and tissues around the injury contract in reflex effort to immobilize the injured area to assist in healing. The problem is sometimes, the signal to muscles to contract or alter position continues long after the injury is healed. Similarly sometimes the pain center in the brain continues to fire, it does not “turn off”, after the original trigger is long over. These are only some of the mechanisms of chronic pain, much is unknown.

Chronic pain is a common problem in our society that causes significant disability and unfortunately can result in opiate dependence which in some people leads to addiction. Opiate pain relievers, the strongest medications that doctors have available are excellent for treating acute pain from acute injury, after surgery, etc. It is almost always a mistake to prescribe opiates for long term, chronic pain, unless it is truly unbearable.

After all of the feasible medical, surgical, manual, and psychological therapies have been tried, the person (me, in this case)must learn to live with and adapt to the problem. They (I) have to accept that not all pain can be cured, nor does it necessarily signify that something else is wrong. In acute injury, pain is a warning sign, an alarm that forces the individual to get help and treatment. But if the alarm signal and it’s reflex muscular contractions fails to turn off, a whole different problem is occurring.

Adapting work position, work load, work/life balance, and decentering the pain from the center of my life by focusing on things that I love and am interested in can make the pain fall into the background and become much less troubling. In addition, chronic pain can lead to inactivity, occupational loss, and social isolation. I realize that inactivity can cause deconditioning and loss of function, leading to true disability. I have learned that being active mentally, socially, and physically can prevent a painful impairment from turning into disability.

I am convinced that the psycho part of the psychosomatic problem can be changed to some extent. Psychotherapy, meditation, visualization, hypnosis, CBT, and other psychological methods may provide significant relief or at least give the person some control over their pain, thus alleviating a depressogenic feeling of helplessness. Pain and depression have a common and complex relationship to each other. Many times, major depression is associated with chronic pain. When depression is effectively treated, the pain often becomes less severe, more manageable, or goes away. Of course, chronic pain itself contributes to someone becoming depressed. Thus their relationship is bidirectional, again causation is not black or white. If a person has chronic pain, becoming depressed will lower his/her pain threshold, making the experience of that same pain much worse.

For me, I have chosen to believe that my pain and misalignment is a metaphor for something “too tight, contracted, misaligned in my life. Perhaps it is not only a response to a physical problem, but an alarm signal telling me, in the language of the body that something is amiss. And the specific type and location of pain can often provide clues to the type of life problem.

I choose to view my pain as a guide and teacher, to develop my own awareness of what my body is trying to communicate to me. I am supposed to be doing my life less compulsively, hyperresponsibly, with less effort-fullness. I must retrain my self to listen to my emotions, my body, move more slowly, with intentional alignment with who I am, below the level of personae, roles, and surface identity. I must change from being a “people pleaser” to acting honestly from my true self. I must overcome my aversion to conflict and effort to satisfy internal and external expectations, stand up straight for myself, not twisting myself into knots. I must trust that I can expand, reach out into new places, even if I disappoint someone, as opposed to contracting, hunkering down to fulfill my roles and conventional expectations. This would be giving in to the “death instinct, letting the pain pull me further into contracting and holding on to the familiar, the “safe” path. Although it has been a battle, including a journey through depression, and the urge to give in, let myself go. I had thoughts of “I have fulfilled my duty”. I have had a good career, wonderful marriage, and great kids. I have had many interesting experiences, a full life without regrets. It is enough. Maybe keeping on keeping on is ok and death would not be such a bad thing. With constant pain all of the time, it might be welcome….. Such are the beguiling thoughts and attitudes that beset me.

Slowly, over several years time, and with confusion of not knowing if there was something else I was here for, something else I needed to learn, I began to risk thinking that perhaps I am not done. Maybe there is another gift that I have been given that I have not allowed myself to develop. The old saw, “don’t die with your song still in ya”, wrenched a sob and burning tears in me. What song is yet unsung? What can I offer the world, what can I become as I become an elder in our society? I still don’t know, but this sabbatical is a pilgrimage to find out, to make time and space away from all of the lifelong patterns and rewards for conventional behavior. Fruit basket turnover, break the rules, spoken and unspoken, where they harness or contract and block my real self. Take the risk that there is something new for me, something that I will be an inept beginner in, something that has been in me all along. If God has anything to do with new creations, continually emerging, then I want to learn to be more deeply mindful of my soul’s call and aware of the still small voice of the enlivening spirit within me. I want to get out of my own way and seek renewal, thus aligned with life and new creation, the invisible movement and flow of spirit. I don’t know how to do it, but I can no longer trust my own mind, what I think “I know”. I am at a new place where I must and I will choose to listen and heed subtle, non-rational signals, signs, synchronies, dreams, coincidence, images, inclinations. As a song by Cat Stephens that I have always loved, “I am on the road to find out”.

The Pleading John O’Donahue

All night long, and all through the
white day,
The beat of the wind’s bulk against
the house,
Pausing only for a breath, and then
again,
The rise and wail of its keening, as if
I
Could come out of it, and answer
Its unbearable grief with some sweet
name,
From which it could make an
antiphon
To calm down its demented legion
Of breezes, or failing that, could I
find
And release a granite rock, to open
A duct in the mountain, for it to
enter
And search the underworld for itself.

The Circle. Rumi

Is there anything better than selling
figs
to the fig seller?
That’s how this is
Making a profit is not why we’re
here,
nor pleasure, nor even joy.
When someone
is a goldsmith, wherever he goes, he
asks
for the goldsmith.
The clouds build with
what we share.
Wheat stays wheat right
through the threshing.
How just do you
feel when you load a lame donkey?
The world has some share in this
cup.
That’s how it turns green.
Let the lean
And the wounded be revived in your
garden.
How would the soul feel in the
beloved’s river?
Fish washed free and clean of fear.
You drive us away, but we return
like pet pigeons.
The nights becoming dawn flow
in us as a new kind of waking.
Shahabuddin
Osmond joins the circle! We will say
the poem again so he can play.
There is
no end of anything round.

Inner Circle. John O’Donahue

Stranger sometimes than the yellow
crochet
Of glimpses that civilize the dark or
the
Shelter of voices who stall the dead
Silence that longs to return to stone,
Stranger is the heart, a different
scripture,
Weighed down by thoughts of gods
Who will never emerge to
recommend
One way above another to anywhere,
Lest they distract from the festival
Of vivid presence, where journeys
are not
Stretched over distance, and time
Is beyond the fatality of before and
After, and elsewhere and otherwise
Do not intrude on day and night.