Pain We Obey!

Pain We Obey!

             “Intense physical pain had forced a regime on him. Illness is the most heeded of doctors: to kindness and wisdom we make promises only; pain we obey.”   -Marcel Proust

Three Stages Of Healing

     As a very distracted culture, it can seem impossible to get one's attention without being extreme or over the top. But on a personal level, perhaps nothing gets our attention like pain. Immediate, visceral and "real" to us right away, pain gets us to drop other priorities", and take note, or even pay tribute!

    Pain has our attention, and then what? We clean a wound, get out band-aids or pop an Ibuprofen. Emergency over, and we can get on with our lives. Or can we? 

     Putting aside for the moment the impact of chronic illness or severe disease, we may easily miss the point of pain. When I see patients as a chiropractic physician and bodyworker, most of my patients come in because of pain. Their goal in treatment is to get rid of the pain. Most patients do "get rid" of their pain, and promptly drop out of care, only to return six months later with the same pain syndrome which brought them into my office in the first place. Why?

    Patients return because they did not "get it" the first time around in my office, when I try to educate patients as to the nature, cause and treatment of pain. This is not as easy at it may sound, because people are taught from very early on that pain is a problem, not an indicator. That is, the pain is the end point issue to take care of, after which all will be right with the world. 

    The fact is, pain is an indicator, not just a symptom. Pain is the very last thing to show up, and the very first thing to go away again. If you understand this, then your relationship to pain changes drastically.  You look at pain as a sign that there is an underlying problem at hand to work on. As a rule, treatment of pain, at least as far as musculoskeletal pain goes, occurs in three stages: Pain relief, Rehabilitation and Preventive maintenance.

    Stage one: Pain relief is what it sounds like. In my office, that usually means a combination of chiropractic manipulation, varied forms of bodywork, physical therapies like ultrasound or laser therapy, and a home program of exercise, stretching, nutrition, and the use of ice, heat and rest. Everything is oriented around simply making the pain more manageable for the patient, and allowing them to work or do routine chores as easily as possible.

    If pain relief is working, many patients are gone for a good six months, until their pain returns. I again try to educate the patient about the three stages of care, and usually get a more interested listener the second time around. Maybe this Dr. Drier knows something I don't! I explain pain as an indicator that there are more systemic problems, that it shows up late in the game, and leaves early. The fact is, not having pain does not mean you are fine. We all have heard about someone who saw their doctor, and was given a clean bill of health, only to keel over from a massive heart attack later that same day. What about brain tumors, one of the scarier forms of cancer for many of us? These tend to be very slow growing lesions in the brain. So you could go years with no pain or symptoms at all, and not look into the problem until your behavior changes enough so that a loved one forces the issue. Does that mean there was no problem while you were pain free? Obviously not. Pain is not the only or best indicator in many cases. 

    Looking at this same point just in musculoskeletal terms, you can have degeneration of your low back or knees for years with no symptoms or pain. Sooner or later, pain will show up, but it may be a long time in coming, or follow an acute injury. The problem was there all along, with or without pain. In fact, it is often discovered only after an acute injury, such as a car accident, when x-rays or an MRI are performed, and the more chronic problems are identified, along with the damage from the accident itself. That said, if two people have the exact same car accident, and they are the same age and gender, then the person with the unknown pre-existing degenerative changes will usually have more pain, and take longer to heal.

    Stage two: Rehabilitation is actually where the real healing begins, as the pain is going away again. In this stage of healing, it is possible to move beyond pain relief measures, to begin rehabilitating the musculoskeletal systems which were the underlying cause of the problem and pain. Treatment will move further into bodywork which is body-wide, working out larger patterns of poor movement, weak musculature, fascial adhesions in the soft tissues and long-term postures which have weakened the body. Treatment will now be more focused on kinetic chains, the muscles and soft tissues which are all linked in movement. An example would be the elbow. If the left elbow has pain, then it will not be fully treated with treating the elbow, but also the hand, the shoulder and the neck on that side, which form a kinetc chain of action. This is where I can "chase out" a pattern that does not work for the patient, so that pain is not going to come back in six months. 

             In this stage of healing, deep myofascial release is used extensively to break up fibrous tissue adhesions, often chronic in nature. Manual lymph therapy will be used less for pain relief than for bringing a deeper relaxation to the muscles. A home program of exercise will move from simply stretching to adding strengthening work, to offset muscle imbalances and areas of postural faults. Feldenkrais and proprioceptive exercise may be added, to increase body awareness and create more effective movement patterns. At this point, emotional work- Body-Centered Psych/Therapy- is often used to look at not only the effects of pain and chronicity on the patient, but the "emotional posture" and psychological antecedents to the pain syndrome the patient is suffering from. This work is supplemented by teaching patients mindfulness practices and meditation, to better contain pain states, and modulate them, and to better contain emotional states, and develop a state of curiosity about oneself, one's inner state of awareness and the ways in which life events past and present "show up" in the body. 

    Rehabilitation is the point of treatment where the cause of pain is most often encountered and worked with, so that there is no need to comewith back in six months, in pain, back at square one. 

    Stage three: Preventive maintenance is what we were all meant to be doing all along, to avoid the majority of health problems, such as heart disease, lung disease, high blood pressure and degenerative changes. In my office, that means treating the whole system with chiropractic, deep myofascial release work, possibly emotional work, and ongoing nutritional work, with a focus on an alkaline diet, to reduce inflammation in the body, and selected supplements for the problem which brought someone into my office at the start of treatment. This work is not based on pain, but on maintenance, like giving the body an oil and lube, for avoiding future problems. If only people treated their bodies as well as their cars! Our bodies are designed for, and need, regular daily cardiovascular exercise, stretching, mindfulness time (usually as meditation), good diet and nutrition and rest. Without those, one should expect problems. These are not problems of "just getting old, doc", but of not maintaining the body properly or with respect. Who wants to reach an old age of trading hospital and surgery stories, anyway?

     Ultimately, pain as an indicator, not only of systemic issues that need to be addressed, but of one's general health, as well, including one's emotional health, which is always reflected in the body. For this reason, it is always helpful to look, not only at how you manage pain, and how it is effecting you, but to ask the pain itself what it is here to teach you. I have had many cancer patients and car accident victims tell me that the pain was a way to get attention, less for a part of the body, than for the whole bodymind. They expressed thanks in many cases, because the pain caused them to really stop, and listen to their inner voice, the still place inside, and to make changes in their life. Pain can be a way of being told to stop, look and listen. To change one's life. The patients who get the most out of pain not only get out of pain, but avoid a good deal of future pain, and use the opportunity to educate themselves, to take charge of their health and lives, and to create new habits of diet, exercise and mind to truly achieve well-being. At that point, you can say you really did hear and obey the pain's message.