My Therapist Told Me to Write This Column

By Crystal Lindell, PNN Columnist

My therapist said I should write a column about how to travel while sick and I would love to do that, but I haven’t figure it out yet.

I get through work trips by drowning myself in dry shampoo, sleeping on conference tables between meetings, eating coffee for every meal, and using pain medication that wears off too fast — all while getting super behind on emails. 

My therapist said I should write a column about how to manage your health while maintaining a full-time job. Who the hell knows how to do this?

I work at home, which is a great gig if you can get it, but most people can’t.

Actually, I do have a life tip: If you have to work while sick, work at home. That’s it. That’s all I’ve got.

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I spend my work days in my pajamas under a soft red blanket on the couch. I take pain pills when I hit my 3 pm slump, and I tell my coworkers entirely too many details about my health, while also avoiding using scooters at conferences so that I can look cool. I call in sick too much and not enough. And I am always tired.

My therapist also said I should write a column about how to live with chronic pain. Yeah, okay. I’ll get right on that.

For now, my life tips include: Saying “yes” every single time your doctor offers you pain pills; throwing away every cute pair of heels you own because they just aren’t worth it; and using filters if you ever have to video chat someone.

Every day of my life is a struggle. Every flipping day. I tried working out recently and fractured my foot, and then I tore my rotator cuff by using crutches. Now my foot is still messed up, and I just limp around on it while rubbing my shoulder. Sexy.

I skip physical therapy appointments because they’re too expensive, I’m constantly crash dieting and then gaining the weight back, and I never wear my shoulder sling or my orthopedic boot.

I’m obviously great at this.

I spend all my money on co-pays, Taco Bell, and kratom. I have no long-term career plan that goes anything beyond, “Get disability — eventually.” And I literally go off my antidepressants every few weeks because I think I don’t need them because I’m feeling better. This is a lie. I need them.

I wish I was wise and cute and Pinterest worthy. I’m not. I’m barely Walmart trip worthy most days. I never get enough sleep, I cry entirely too much, and there is literally a dented space on the couch from where I spend all my time.

So if anyone has figured all this out, let me know. You should probably write a column about it.

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Crystal Lindell is a journalist who lives in Illinois. She eats too much Taco Bell, drinks too much espresso, and spends too much time looking for the perfect pink lipstick. She has hypermobile Ehlers-Danlos syndrome.  Crystal writes about it on her blog, “The Only Certainty is Bad Grammar.”

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represent the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.

Wear, Tear & Care: The Curable App

By Jennifer Kilgore, PNN Columnist

Nobody wants to be told that pain is in their head. If you’ve been in an accident like I have or suffer from a debilitating condition, that translates to: “This pain is your fault. You’re just lazy. If you tried harder, you wouldn’t be in pain.”

Pain is in your head. Pain is a signal that says your body is in danger, and for many people that switch never turns off. It becomes chronic, endless, crippling and traumatizing. This leads to a sort of fossilization in which we are scared to move, because movement hurts. Our lives become smaller, but the pain becomes larger until it consumes the entire world.

When my pain therapist suggested I try EMDR therapy (eye movement desensitization and reprocessing) for post-traumatic stress disorder, I resisted for two years. Why should I have to make a concerted effort to get rid of my pain and work through memories of crumpled metal and squealing tires? Why was it my responsibility to fix things when somebody else’s negligence was the cause of my injuries?

As always, it’s more complicated than that. My pain signals have coalesced over the past 15 years into a body-wide tangle of energy that never stops hurting. It spreads from my back up to my neck, down into my arms and legs, wrapping around my ribs. Pills are thrown into the void. Devices are worn. The pain remains.

I can’t even remember how I stumbled across the Curable app. I think it came up on a Facebook ad, though I do get many Google Alerts for this type of product. Either way, I now have it downloaded and pay for the annual subscription ($6.39 per month).

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The Curable app is like having a virtual therapist -- her name is Clara -- on my phone designed specifically for chronic pain. I can work through these memories in the comfort of my own home, on my own time.

As described in their FAQ: “Curable is an online pain psychology program. Modern research tells us that recurring pain is caused by multiple complex and interconnected factors. Treatments like drugs or chiropractic try to target some of the chemical or structural issues, but these issues are only part of the equation when it comes to recurring pain.”

Pain researchers have discovered that the way we act and think play a significant role in pain reduction. I’m not saying that people don’t have valid injuries -- I broke my back in four places and have two fusions in my neck -- but I know, deep down, that my level of pain does not make sense. There were structural abnormalities. Most of them were fixed.

What’s left?

The rest remains in my head, and I am quite curious to see what is actually pain and what part is catastrophizing, fear, anger and stress. Curable says that this cycle of pain can be “deprogrammed,” and the app trains patients to tease apart what is real pain and what is not.

The program is easy enough to use. It can be done entirely on a computer, tablet or phone, and it’s compatible with almost every device.

Clara, the virtual pain coach, interacts with you by a stream of text messages, and it honestly feels like I’m talking to a friend who just gets me. She sends information and leads you from one activity to another, offering resources, exercises and funny gifs to help you “reverse the cycle of pain going on in your brain.”

Each session is between five and 20 minutes, and lectures run about the same length. Some of them are difficult -- for instance, I’m resisting the “Identifying Your Stressors” exercise in which I have to free-write, simply because I don’t want to face that part of my brain. It’s hard. I don’t particularly like waging battle against a part of myself, no matter how unwelcome that part is.

Clara even noted that many users find the writing exercises difficult and avoid them in favor of the other activities, because who wants to commit to such a level of self-reflection?

The makers of the app know this, and they get how hard it is because all three of the founders suffered from chronic pain. That level of understanding makes all the difference.

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Curable is designed for three weekly sessions, though any pace can be set. A survey of users showed that some reported a reduction to zero pain within three weeks of trying the app. Everyone’s pain experience is unique, however, and they acknowledge that “there is no correlation between the total number of exercises you complete… and when you will begin to experience relief.”

As they also note, “Racing through the program ‘to feel better faster’ will not work.” I’ve found that racing through is pretty much impossible, because facing all of these thoughts and memories is exhausting.

I’m very excited about this app. I think it will be a great complement to my EMDR therapy and can keep me on track when my therapist can’t. Clara even speaks to me in a way that only other pain patients do. She understands our language, and the relief from that is staggering.

You can try the Curable app for free here.

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Jennifer Kain Kilgore is an attorney editor for both Enjuris.com and the Association of International Law Firm Networks. She has chronic back and neck pain after two car accidents.

You can read more about Jennifer on her blog, Wear, Tear, & Care.  

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.

The Difference Between Pain and Suffering 

By Ann Marie Gaudon, Columnist

It’s very easy to increase your pain and suffering. That’s not a typo. Believe me, we do it all the time. 

In my field, we use the term “clean pain” to describe something that we don’t have any choice over. Clean pain is the biological pain that science just can’t seem to fix. My clean pain is a result of disease. Your clean pain may be a result of disease or injury, or perhaps a combination. In the context of chronic pain, clean pain is unavoidable.

Clean pain is influenced by many factors and culture is one of them. For example, some African women deliver their babies in total silence due to learned beliefs. Clean pain can also be influenced by context, such as athletes who feel no pain as they push through their training and competition. Only when it is over do they feel pain and get care.

Clean pain is influenced by anticipation and previous experience. For example, you tell yourself that it’s happened this way in the past, so it’s absolutely going to happen this way again. We catastrophize (“It’s going to be awful and I won’t be able to cope!”) or we ruminate and obsess over our pain thoughts.

Grieving over the past or imagining a catastrophic future are two long highways to hell for chronic pain patients. I’ve driven on both of them. It’s not a fun ride.

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Clean pain is also influenced by emotional and cognitive factors such as fear, anxiety, anger, depression and distorted thinking (“I will die from this pain!”). 

Dirty Pain

Clean pain is unavoidable within the context of chronic pain. However, what psychotherapy sees as avoidable, and completely within our control, is a second layer of struggling that we add to our pain. This second layer is called “dirty pain.” 

This dirty pain accumulates when we focus our attention on the negative thoughts and feelings about the pain, as well as the stories we tell ourselves (“I cannot live my life until I am pain free!”), and the rules we make up about the pain (“I cannot exercise in any capacity at any time with this pain”).

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Some of these beliefs have a bit of truth to them, while some are arbitrary with no evidence to support them. Yet we can come to buy into them hook, line and sinker. Let the suffering begin.

Just to be clear, we absolutely must try to help ourselves with medical treatment in an attempt to alleviate our clean pain. However, there comes a time when the pain will budge no more. When we’ve reached that limit, yet continually strive to control pain that is not controllable, our efforts then become maladaptive and we suffer even more.

This metaphorical “chasing your tail” is also added to the layers of dirty pain.

We are all allotted only so much time and energy. We have a choice: Spend this time and energy trying to change the unchangeable, or engage in activities and relationships that help give you a sense of purpose and well-being.  

The goal of therapy is to help pain patients increase their repertoire of behaviours, guided by what they see as important, their own goals, and what they value in their life. This is in direct opposition to a restricted, limited and socially isolated life where pain is lord and master. By helping people to change the way they experience their thoughts, feelings and pain sensations, there is an opportunity to drop the struggle with your pain and to connect to what really matters to you.

Therapy for chronic pain management is a tool, and a good one at that, especially within a multi-disciplinary setting where you also have access to a team of other professionals. Some people with mild pain do very well using just one or two tools. However, if you are moving toward severe pain, you will need to have a larger toolkit.

My own toolkit -- in alphabetical order -- contains diet, exercise, ice packs, lifestyle modifications (e.g. strategic scheduling of work), medications, psychotherapy, rest, and a support system of family members, friends, and colleagues.

Some tools help with my clean pain while others help with my dirty pain. They all work together so that I can disconnect from struggling and connect to what matters to me. It isn’t an easy thing to do – especially at first -- but it is doable, as countless others are doing it as well.

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Ann Marie Gaudon is a registered social worker and psychotherapist in the Waterloo region of Ontario, Canada with a specialty in chronic pain management.  She has been a chronic pain patient for 33 years and works part-time as her health allows. For more information about Ann Marie's counseling services, visit her website.

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.

The Link Between Trauma and Chronic Pain

Ann Marie Gaudon, Columnist

It has long been accepted in my field that chronic pain is a frequent outcome of trauma. There is extensive evidence to suggest that people suffering from post-traumatic stress disorder (PTSD) report chronic pain with striking frequency regardless of the nature of the traumatic experience. You don’t need to have been diagnosed with PTSD to be negatively and chronically affected by trauma.

One strong and commonly referred to theoretical model explaining the connection between trauma and chronic pain is known as the Mutual Maintenance Model. A person may respond to reminders of trauma through stress response, which may include avoidant coping (trying to avoid your distress by zoning out with video games or drinking to numb yourself), fatigue and lethargy associated with depression, pain perception elevated by anxiety, and intrusive memories of the trauma itself.

These considerable mental demands limit one’s capacity to control or decrease their physical pain and have the opposite effect of exacerbating and maintaining pain. To put it simply, experiencing pain prompts memories of the trauma, and memories of the trauma prompt experiences of pain.

The end result is that a person is trapped in a vicious cycle whereby the symptoms of trauma and chronic pain interact to produce self-perpetuating psychological distress and physical pain.

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A second model, called the Shared Vulnerability Model, suggests that the interaction of trauma, psychological vulnerability (anxiety, loss of control over thoughts and feelings), and a lowered physiological threshold for alarm reactions all influence negative emotional responses, resulting in the development of PTSD and the co-occurrence of chronic pain.

This chronic arousal of the nervous system may be responsible for the symptoms of both PTSD and chronic pain. There is research which suggests that chronic pain and PTSD are not necessarily distinct from each other, but rather connected and overlapping. The fact that sympathetic activity (the gas pedal to your distress) is increased, and parasympathetic activity (the brake pedal to your distress) is decreased, both in general and in response to trauma-related stimuli, is one of the most robust findings within the PTSD literature.

Disastrous events can strike any of us, at any time in life, and no one is immune. Some events are relational such as a school shooting or a rape, while others are natural disasters like earthquakes or floods. After any distressing or life-threatening event, psychological trauma may set in. One may go on to develop extreme anxiety, depression, anger, or PTSD and may have ongoing problems with sleep, physical pain and even relationships.

Healthy ways of coping include getting support, avoiding alcohol and drugs, seeing loved ones, exercising, enhancing sleep habits, and other methods of self-care. Certainly not everyone with chronic pain has experienced trauma and vice versa. However, there is extensive research to show that PTSD and chronic pain are intimately connected.

Seek an experienced trauma therapist if you feel you are not coping well. Trauma therapy is highly specialized, takes place in healing stages at your pace, and works to re-wire what’s become maladaptive in your brain by laying down new and healthier neural pathways. Click here to see a YouTube video that explains that process.

The work will be hard and challenging, but the good news is that many people heal from trauma and go on to live rich and rewarding lives. Some offer inspiration to others who have also endured life-altering negative experiences.

People become sick and pained, and people also heal. Suffering can skyrocket, and suffering can also take a nosedive. You do the work as if your life depended on it, because experience tells us it often does.

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Ann Marie Gaudon is a registered social worker and psychotherapist in the Waterloo region of Ontario, Canada with a specialty in chronic pain management.  She has been a chronic pain patient for 33 years and works part-time as her health allows. For more information about Ann Marie's counseling services, visit her website.

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.

Wear, Tear & Care: Emotional Insight App

By J.W. Kain, Columnist

Biofeedback is probably the closest thing to having actual superpowers. To quote the Mayo Clinic, it’s “a technique you can use to learn to control your body’s functions, such as your heart rate” by using electrical sensors to "receive information (feedback) about your body (bio).”

In theory, this can help you learn to control things like muscle relaxation, which often helps to lessen pain.

What if you want to go deeper than that, though?

In my own experience as a chronic pain patient, I’ve come to realize that much of pain -- or rather, the compounding of pain -- is emotionally derived. It can be stress from work, an argument with a spouse, dreading a rent payment, or anything else that thrills against your nerves. How does one separate the emotional aspect of pain from the physical? How do you know when you’re being your own worst enemy?

You look inward.

Somehow my father stumbled across the Emotional Insight app and sent it my way. I was very curious, as it seemed comparable to biofeedback. But how did it work without wires and electrical sensors? The price tag surprised me -- $49.95 for the app -- and so I reached out to the makers of the program, Possibility Wave, to ask if I could take it for a test drive.

Soon enough I found myself Skypeing with the delightful Garnet Dupuis, one of the founders of Possibility Wave and the creator of the app. He hails from Canada but now lives in Thailand with his wife, and I could hear the sounds of the jungle when we spoke. Suffice it to say he is a cool guy.

When processing experiences, Mr. Dupuis said, “It’s helpful to say it to somebody. A person begins a process of self-reflection even just by talking into a mirror.”

When asked how this relates to the app, Dupuis told me that it does exactly what it says on the tin: It provides emotional insight. “Something about declaration” helps people come to terms with things, he says.

In other words, just talk it out.

Clients have reported as much progress and growth in two to three app sessions as they would achieve in one to two years of actual therapy. As Dupuis says, “these are like quick spiritual experiences.” He calls Emotional Insight a form of “neurofeedback,” which made more sense to me; when I played with the app, I found it had nothing to do with the body and everything to do with the mind. Even so, “it’s a little bit like exercise,” Dupuis said -- as in, the more you work at it, the more you can discover about yourself.

This app is all about sharing information. Technically speaking, improvements could be made; there is so much data that at times the app freezes, and talking out loud can be impractical. That is when I realized this app was not made to be used on a train while traveling somewhere or while standing in line at the bank. This is literally a pocket therapist, but the therapist is the user.

It surprised me constantly, like a shrewd psychic, but in reality I was only talking with myself. Not only does it make you type out a problem, but it makes you repeat it aloud. This irritated me until I realized that I was resisting saying it out loud, because somehow, saying it out loud is harder.

When you open the app, you have three choices in terms of sessions. I chose “Spontaneous Insight.” You are prompted to speak aloud and identify the issue you want to explore.

This is when it becomes stranger. The voice analysis program does not pick up words you say; rather, it picks up the tones in which they were said and matches it to certain emotional responses. So if I say, “I regret the loss of the person I used to be,” it brings back three “clues” regarding the emotions behind my speech: longing, gladness, uneasiness.

The app brought up the fact that I am a workaholic. Considering I have a full-time job and still do things on the side, I would say that’s accurate. It told me to compose an “I” sentence with one of those clues. Somehow I came up with: “I’m glad my pain is getting worse because I’m a workaholic.” What? I am in no way glad about having pain, but I also know that I will run and run and run like the Energizer Bunny until I die, because I refuse to let my pain dictate my life.

By insisting that I don’t need help and that I can function like other people, I am making myself worse. It will take an outside force to make me stop. I have to admit to myself that I am not like other people anymore. I can’t do everything that I used to do. I have to mourn that loss and begin again.

Then the app essentially asks: “What are you going to do about it?”

I was squirming now, uncomfortable with what I was saying. “I need to stop working so hard in order to deal with my pain.”

The app then plays Sonic Signatures and the Crystalline Strategy, which I honestly do not understand. They are coded sound signatures that represent certain remedies, and you are supposed to listen to them a few times each day in order to reinforce what you have learned. It sounds like a whole store full of wind chimes and the signals of a lost radio station. There is a YouTube video that explains these “sound drops” (like herbal tinctures for your ears, if you will).

“The app never tells you what to do,” Mr. Dupuis said to me in our Skype chat. “It guides you, but you have to declare it to yourself.” That being said, the app is as enlightening an experience as you make it. For me, it brought up several things I have been avoiding; it was a strange experience, because I like to think that I face my problems directly. However, I learned that this is very far from the truth. 

Mr. Dupuis was intrigued that I am a columnist for a pain-related publication and that I wanted to use the app in this way. “Everybody hurts in one way or another,” he said.

Pain can compound for a variety of reasons. This app is a way for people to face what is haunting them, whatever that ghost might be.

J. W. Kain is an attorney in the Greater Boston area who also works as a writer and editor in her spare time.  She has chronic back and neck pain after two car accidents.

You can read more about J.W. on her blog, Wear, Tear, & Care.  

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.