How To Thrive With Chronic Pain?

Thank you for visiting my blog today today about how to thrive despite living with chronic pain.

You're likely here because you or some-one you love are living with pain, and have probably heard the words ‘there’s not much more we can do, you’ll have to learn to live with it’.

This talk is that missing link where you can actually take away some ideas of how to live and thrive, despite living with chronic pain.

My name is Jo and I am a Soft Tissue Therapist which sits somewhere between a ‘normal’ massage therapist and a physiotherapist (just to be super clear, I am NOT a physiotherapist and I cannot diagnose you with anything, BUT I do specialise in working with people with chronic pain, stress and fatigue).

I have been in practice for nearly 8 years and I have always been clear that I want to help people who are in pain, to feel good in the body they have .

And guess what, that’s because I too am a person with chronic pain and I want to feel good in the body I have – so my work is also my passion.

If you’re into sports and you injure yourself, there are plenty of professionals in Paignton/Torquay/Brixham ready to help you get back on your feet – physiotherapists, sports massage therapists, sports therapists to name a few.

But what if you are experiencing chronic pain?

Finding someone with the skills, knowledge and experience to deal with chronic pain, which is a completely different approach, can be more of a challenge.

Many therapists come from a good place, but lack the skills, up to date evidence based training and experience to effectively support people with chronic pain.

It's not the same as dealing with acute pain or injury. It’s complex, crosses many bio-psycho-social lines and affects multiple systems in the body.

So, my whole practice is centred around working with people living with Chronic Pain, Stress and Fatigue to thrive once again. To give people that support and understanding, encouragement and empathy, recognition and rest, from being a person in pain. And to give them the tools to move forward, putting one foot in front of the other with confidence.

The first step we take is understanding:

WHAT IS PAIN and WHY DOES PAIN HURT?

Why Does Pain Hurt?

Our current evidence based approach uses the BPS model of pain.

Very simply, this shows that Pain is always something that is created by the brain with the aim of keeping you safe when it thinks you’re in danger.

Just to be clear, this does NOT mean 'pain is all in your head'. Walk away from anyone who says that to you because we know that simply isn't the case - it's far more complex!

Pain is complicated, and is influenced by a wide range of things from inside and outside our bodies, brains and minds. Some of which we have control over and some we simply do not.

Because of this, there’s lots we can do to help ourselves influence our pain levels.

Pain doesn’t always happen purely because of damage to the body, it can happen without any damage at all.

Tissue damage can also happen without pain and can be a normal part of aging – did you know for example that osteoarthritis is now considered ‘normal age related change’ and it doesn’t necessarily equal pain? When scanned, 80% of 50 year olds showed some osteoarthritis in their back but half of these had no pain and no idea they had it, highlighting the current evidence that pain is complex and not always because we’ve hurt ourselves.

However, the longer you experience persistent pain, the better your brain becomes at alerting you earlier to what it thinks is danger.

It then takes less and less stimulus to trigger a pain response in you and this can make you feel like it’s getting worse even though it isn’t – think of a smoke alarm going off when you open the oven door, there is no fire and the house isn’t burning down, but it’s been triggered to sound the alarm in exactly the same way as if there really was a fire.

Another example is of two women, both age 55 and and out to walk their dogs. One day they each trip over exactly the same tree root, falling over and bashing their knee.

The first lady gets up, brushes herself off, laughs at herself and thinks ‘that’ll be a cracking bruise to show off’, safe in the knowledge that it’ll be gone and she’ll be completely fine in a few days. Her husband is at home with dinner on, so she knows when she gets in she can put her feet up and rest with an ice pack on while watching her favourite TV programme and if she can’t manage the dog walk tomorrow he’ll do it for her, plus she works part time and isn’t due back to work for another 3 days so has plenty of time for self-care.

The second lady got up, brushed herself off and hobbled back to her car. She was rushing to walk her dog inbetween jobs and scalded herself for being so clumsy and knew this would make her late. She was over tired, as always, as she struggles to sleep and she hadn’t had chance to eat anything properly yet today, let alone drink enough water, she had just about managed to chuck back a coffee for some energy before rushing out to work. Having to work two jobs she didn’t get much time for seeing her friends or doing the things she loved and she always felt guilty about missing out so much with her daughter and grand-kids. She doesn’t have time to rest and recover, she always feels like she’s running behind and she cant afford to stop, but the fall kicks off her chronic pain and she really struggles and has to push through for the next week, which makes her feel depressed and she really struggles.

Both women have had the same accident, however their experiences are very different because of all of the factors of their lives affecting essentially how stressed their bodies are. The second lady who has chronic pain is sensitised to pain, so this relatively small incident causes her to struggle for a week and feel immense amounts of pain.

I’m using this example to highlight that your brain in essence learns to lower the threshold that triggers pain, and this is why for someone with chronic pain it can feel like whatever is causing their pain is getting worse over time.

Pain is therefore quite unreliable at telling us if there’s tissue damage or how bad it is.

In addition to this, we know that pain isn’t always due to damage to our bodies, we have all heard of phantom limb syndrome where someone experiences pain in the missing limb.

Or have you heard of the case where a nailgun shot a nail through a workers boot - as you can imagine causing incredible pain - only to take the boot off and discover it had gone between his toes, not so much as a scratch, but he had experienced intense pain because he believed it had gone through his foot.

The science behind pain:

I’m adding in the science bit here because it’s really important in understanding how our brain and body works when it comes to understanding chronic pain, and how we can help ourselves to feel better.

We have special receptors in our bodies which respond to different stimulus:

• Nociceptive receptors respond to inflammation / injury of tissues

  
  

• Neuropathic receptors respond to inflammation / injury of a nerve

  
  

• Nociplastic receptors respond to pain when there is no tissue / nerve damage OR where pain persists even once damage has healed

Information from these receptors in the body is constantly being sent to the brain, and the brain is what makes sense of all that information, taking into account everything it has learnt throughout your life – for example:

‘have we experienced this before, oh yes I remember last time we did xyz’ which can also explain why we often have recurring areas of pain even after an injury has healed – your brain remembers!

Your brain is the computer controlling the body, it weighs up all the information coming from the thousands of receptors in your body to determine if you are in 1 of 2 states: ‘safety’ or ‘danger’.

When our brains have determined ‘safety’ our nervous system is in a parasympathetic state of ‘rest and repair’.

Think of how you’ve felt if you’ve ever done meditation, yoga, floated in the sea on a hot day, or when doing something you really really love – it’s that super relaxed feel good state, life feels amazing and everything just feels good.

When our brain thinks there’s danger, our nervous system is in a sympathetic state of ‘fight, flight or freeze’, cortisol and adrenaline levels rise and this is what sets our warning alarms off – and in the case of chronic pain it affects how much our pain hurts.

The more this happens the worse our pain feels.

So a chronically overstressed system can exhibit pain that is getting worse, even though the Drs can’t really find a physical reason for your pain (have you ever been told ‘all your bloods are normal’?!) – which you’d think would be reassuring but can actually feel really frustrating which in turn can make your pain worse – ironic hey?!

As people experiencing chronic or persistent pain, anything which can be interpreted by our brains as a stressor on our body can affect our pain levels.

Have you ever noticed how your pain feels much worse when you’ve had a really bad nights sleep?

Or you just know your weekend is going to be spent pretty much in bed because you’ve got a crazy stressful work week ahead of you?

Or how this evening will be a complete write off because today you’ve managed to get yourself out of the house to do something you really wanted to do and although you’ve been looking forwards to it for weeks, you know the pay off will be exhaustion and pain, wiping out the next few days…

In the same way, things which make us feel good help lower the stress burden on our bodies and we feel good!

Have you ever noticed how amazing you feel when you go out with your friends, chat and laugh and put the world to rights? Your friends might not even realise you have chronic pain because when they see you, they fill your cup so much that for a few hours you don’t notice your pain.

Or how when you finally get time to spend doing the thing you love, your favourite hobby in the world (for me it’s being on my own in a hot tub at a spa for three luxurious hours where no one needs a single thing from me!) you forget all about your pain while you’re doing it?

For one of my friends is the luxury of going to visit her horse. What is it for you?

There are lots of factors that influence pain:

Because there are lots of things which our brains interpret as a stressor on our bodies, there are lots of things we can do to help ourselves – hurrah!

Believe it or not we are designed to respond well to stress. Our fight/flight/freeze response is designed for exactly that – find yourself out in the wild being chased by a sabre tooth tiger?

Your body will gear you up to run away!

But, how often in our modern lives have we found ourselves being chased by a sabre tooth tiger?

It’s certainly never happened to me.

What we experience in modern times is lots of chronic stress. What I mean by this is stress that doesn’t really go away.

We’re constantly stressed by lots of different things, not just ‘stress’ in the traditional meaning, but things like our thoughts, feelings, emotions, overstimulation of our senses, junk food, dehydration, sedentary work, financial pressures, trying to keep up with the Joneses, not getting enough sleep, trying to perform 110% in our jobs 110% of the time whilst raising a happy healthy family where our kids come first 110% of the time too and we never ever forget that actually it’s a PE day so they need to go into school in completely different clothes today.

Our body responds in the same way to this kind of stress, but we aren’t able to run off the cortisol and adrenalin that our bodies produce when in fight/flight/freeze like we would if we had the temporary stress of being chased by the sabre tooth tiger.

Once the tiger has gone, the danger is over and our bodies self regulate again.

What do you think happens when the chronic stress doesn’t stop?

I’ve put together some examples of the different kind of stress we are under in our modern lives, this list is by no means exhaustive and you may recognise some of these challenges in your own life, or even have some of your own to add which I would love to hear.

These stresses are centred around the BPS model of pain, so I’m talking about things that stress us biologically, psychologically and sociologically; because all three of these areas need to be considered when we look holistically at how we can begin to understand, manage and improve our chronic pain.

Too often we’re looking for a physical cause of pain and totally miss all the other things we can work on to help ourselves too.

I’d like you to make 3 columns on some paper and write the following headings:

1. Things you have the power to change

2. Things you can’t change right now, but could in the future

3. Things you can’t change

Now take a moment to jot down any of those things which stand out to you which could be influencing your pain levels…

My examples are:

Your mind: negative past experiences or trauma, stuck in a cycle of negative thoughts or feelings, anxiety, depression, emotional stress, work stress, family stress, feeling unable to cope, feeling overwhelmed by life, feeling like you don’t have the time to de-stress, feeling like you’re bottom of the list of priorities. Listen in to the way you talk to yourself – does your mind fill you with positivity or are you negative self talking?

Unfortunately you can’t think away pain as it’s generated by the brain, not the mind. So to be crystal clear it’s not ‘all in your head’.

But understanding that looking after yourself and prioritising de-stressing is a huge step. This is where putting yourself first and carving out even 5 minutes of your day before you go to sleep to de-stress can be crucial – falling asleep to a meditation for example can be a great place to start in the immediate term, and booking in something you love doing could be a future term goal such as booking a monthly massage to help you physically and mentally reset!

Your lifestyle: smoking or vaping, high alcohol intake, dehydration, what you eat (please think ‘I am nourishing my body with nutritious food’ not that you need to be on a particular diet), not moving your body enough in a way you enjoy (I much prefer this view than ‘exercise’ as part of a generation who were told exercise is to keep skinny/lose weight, when in fact exercise can be fun, enjoyable and make you feel good – endorphins), does your job nourish the core of your soul or grind you down day by day, do you get time to socialise with the people in your life who make you feel good, do you have a social and family support network to rely on, do you get enough good quality undisturbed sleep, do you have time do the hobbies you really truly enjoy which make you feel good?

Your biology: you may have genetic factors you can’t change or have to manage, you may Have a physical injury or disability that require adjustment or use up more of your energy, you may have reduced immune function, you may need to take medications which can have side effects you have to deal with, you could have health conditions which you need to manage, you could have vitamin deficiencies you have to keep on top of (not going out enough because of your chronic pain? Are you getting enough vitamin D?)

Your environment: your home space, work space, car – anywhere you regularly spend time. Your environment can stress or relax you – what does yours do? Things that can impact you include mess, clutter, lack of natural light, lack of fresh air, noise, colours. Which of these things can you change, which could you change in the future and which can you be at peace with?

The idea here is to look at every aspect of your life and noticing the things which deplete you and the things which fill your cup.

Now look at your list.

The idea of this list is to create your unique pathway to thriving despite living with chronic pain, prioritising time to do more of the things that bring you joy and make you feel good, improve the things which are in your power to control and accept the things which you cant change – the aim being to return the balance in your favour for as much of the time as possible.

We begin by tackling the things you have the power to change right now. Which will be different for everyone. The things you have written down in the different columns will be unique to you because we’re all individual with our own challenges and life experiences.

No competition. No comparison. No judgement.

It’s just you working on you, be honest about where you’re at now, and where you’d like to be.

For you it might be making sure you drink enough water every single day by buying a new 2 litre water bottle so you can visually see you’ve done it every day. But getting enough sleep at this point may feel near impossible for example if you have a baby you’re on their schedule until they begin to sleep through – so that’s something which could change in the future.

Tackling 1 thing from your list at a time allows you to have time to adjust and allow it to establish itself as a habit before adding in the next thing, which helps prevent it feeling overwhelming and causing further stress!

My top tip is to allow yourself at least 2 weeks or more if you need to before tackling the next thing on your list.

Once each one of the things on your list have become habits, you can then look at the things on your list that you thought you might be able to do in the future and see if any of those have become possible.

Deal with this list in the same way – 1 new habit allowing at least 2 weeks before tackling the next one.

At this point you might think gosh, there’s a lot on my list and that’s going to take me a long time if I take two weeks for each of them. Well, your body didn’t get to this point of chronic pain overnight, so it will also take time to rebuild the life you want to live in – there’s nothing more important than investing in yourself – and it will be worth it!

You can’t pour from an empty cup. It’s essential that YOU become the priority in your own life.

That’s a really hard concept to get your head around isn’t it? Your immediate reaction might be that it sounds really selfish always putting yourself first.

BUT if your cup is already empty, how can you be giving your best to the important people in your life? If you have a crash or flare up how can you help them?

By caring for yourself first you are in fact being SELFLESS. Read that again.

Because the more well you feel, for more of the time, the more capacity you have to give your best self to others.

And when you look back in a years time, you’ll be able to see all the things you’ve managed to achieve from your list, that now feel like just normal parts of your day that you don’t even have to remember to do, and think how far you’ve come.

So, I hope that I have convinced you of how important you are in your own life and how you must be the priority in your own life because you deserve to thrive!

Jo’s Jenga Theory:

So, with everything I’ve talked about today, I want to leave you with the representation of chronic pain through Jenga!

Think of each stressor we have in our modern lives as a Jenga building block.

When we invest the time to stack the blocks properly they form a strong stable tower.

Take one block out and put it on top, no problem at all, it’s still stable and unlikely to topple. It can cope.

But as you take each block out and restack it, the risk of the tower toppling over increases, until eventually it falls.

We could handle one, two, three stresses on us. But when too many build up and we don’t take the time to really care for ourselves first, our system can become overwhelmed and that’s when the pain signals start getting louder and louder until we crash.

So it’s not one specific thing that ‘causes’ our chronic pain.

And it doesn’t mean that when it hurts more it’s because we’ve caused more damage.

But instead it’s a build up of lots of things over time sending messages to your brain, which creates the sensation of pain and affects how much we feel it.

The good news is, as in Jenga, we can re-stack your tower. With each block brought back into balance we’re re-training your brain to know that everything is ok, there’s no need to sound the alarm anymore, your pain can settle down again.

We call this ‘de-sensitising your nervous system’.

Start by addressing things that are in your control, such as cutting down on drinking / smoking, keeping hydrated, adding more nutritious food into your day, getting enough sleep, moving your body more in a way that feels good, doing things you enjoy and help you de-stress (massage, anyone?) or anything else you can think of.

So, how can I help you with Soft Tissue Therapy?

Soft Tissue Therapy is more than ‘just’ massage.

Yes it’s a brilliant massage that leaves you feeling so much better than when you walked in, able to help with stress, pain and injury; working on muscles, joints, tendons ligaments, fascia and range of movement; but it is also so much more.

My consultation not only goes through the normal health conditions and medications, it also looks for red flags which could be more than Musculo-skeletal pain which needs referring back to your GP (I’ve had lots of success recently in helping people get Rheumatology referrals via their GP, and raising discussions about the onset of perimenopause for example).

It also gets to the heart of your pain experience, how it affects you, what a normal day and week feels like to you, your stress points and the things that make you feel good.

All of this information helps me to tailor a massage treatment that will give you exactly what you need – super stressed? Great lets get you so deeply relaxed your entire body feels weightless. Shoulder pain? Ok lets assess what’s going on, what movement you haven in your neck and shoulder, is it restricted in any direction, what makes it hurt and what makes it feel better, then using some incredible techniques to reduce pain and improve range of movement.

I also give homework – which isn’t nearly as bad as it sounds!

Your homework is always tailored to you and it might surprise you some of the things I advise, often it’s just about giving you accountability to do the things you already know you need to do. You’ll do them simply because you know I’m doing to ask you next time I see you!

I recently saw a client who had had breast cancer many years ago. She had noticed some pain begin in the same area and it had been worrying her for a few months but the fear of contacting the breast clinic, who were only too happy to help put her at ease, meant she had been too scared to make the phone call and she confided in me that it had been worrying her for months. So I supported her to make that phonecall as soon as she got home after her massage. And I told her I’d be ringing her tomorrow to check in on her and see what they said. Guess what, I had a text that evening to say she’d made the call and was going to see them the next day. When she went to her appointment she was reassured everything was ok, and guess what, her pain miraculously cleared up. All she needed was the accountability and support to make that call.

Homework can also be things like lifestyle tweaks – and I emphasise the word ‘tweak’ because small tweaks add up to big improvements over time. But if I try to get you to run before you can walk you’ll be set up to fail! And that will only re-inforce to your brain that you’re doomed to feel this way forever.

Whereas if we set you up for success, recognising the little wins along the way, you’ll be re-enforcing to your brain that you are smashing this and are capable of more than you knew!

A common place I start with people is if they don’t drink enough water, get a water bottle and make sure you are drinking enough day in day out, write it down in book every time you’ve drunk that bottle of water so you know exactly what you’ve had every day for a couple of weeks and before you know it it will become habit to reach for the water.

Do you HATE water? What would you drink? Squash? Herbal tea? Do what you need to keep hydrated.

It might also be that you need some stretching or exercises to do at home so that we can keep improving inbetween massage sessions. These will always be tailored to you and I’ll check you can do them pain free before you leave.

Often advice is simply to do some form of exercise you ENJOY because if you enjoy it you’ll relish the thought of going out and doing it – my favourite thing to do is walk on the beach through the water on a sunny day, so I’m doing as much of that as possible because I feel amazing for doing it. Some people love yoga, walking their dog, paddleboarding, dancing, lifting weights, taking their grandkids to the park – the key is find something you enjoy and carve out the time to do it regularly.

For other people, such as in the shoulder pain example, targeted exercises to help improve range of movement, reduce pain and improve strength are given so they have the tools they need to help themselves inbetween massages.

Most importantly I am here to listen and to help by tailoring your appointment to suit you.

Thank you for reading this far! I hope you’ve at the very least taken one thing away from it that helps you.

If you’d like to see me in person to support you with massage and soft tissue therapy, please do get in touch, or you can book online here: https://bit.ly/3TR7QPd

-Jo