Turning towards your pain

It’s been another week on the new eating plan, and my knee pain is still absent.  I am becoming increasingly convinced that the connection is inflammation (or, more accurately, lack thereof).  We will see how things develop as rowing season begins in ernest in the Seattle area.  (Lately, the weather has been too cold and miserable for fair weather rowers like me to venture onto the water.)

Diet is not a panacea for all types of pain, to be sure.  Today, I will offer some perspectives on how to live successfully with pain that does not remit so easily.

As discussed in the previous blog post, Pain, our BFF,  pain is an inevitable part of the human condition.  And for many of us, pain becomes chronic at various points in our lives.

When pain is chronic, we often create an inner dialogue about what we are experiencing.  “I am so out of shape, it’s no wonder I threw out my back.”  “Maybe something is really wrong that the doctors have missed.”  “I don’t know how much more of this pain I can take.”

Emotions also are often overlaid onto pain.  Sadness, fear, and my specialty, anger, are common responses.

So pain becomes more than pain.  It turns into the sensory experience plus the running inner dialogue plus the negative emotions.  No wonder we find it so exhausting!

What is the solution?  In the words of Jon Kabat-Zinn, founder of the Mindfulness Based Stress Reduction program, you need to “put out the welcome mat” for your pain.  Not because you’re masochistic, but because your pain is already there.  You might not like your pain, but learning to accept its presence (because it’s already there) is the first step in disentangling your sensory experience from all the negative thoughts and emotions.

Try this.  The next time you have pain, find a quiet place to sit or lie for a few minutes.  Take a few breaths to center yourself and quiet your mind.  Next, turn your attention to the area of your body where you are experiencing the pain.  As objectively as possible, observe the pain you are experiencing.  First, try to identify its precise location.  Where exactly in your body do you feel the pain?  Zoom your attention to its center.  Next, try to identify its borders.  Where does the boundary lie between pain and no pain?  Does this boundary change with time?

After you have located your pain, turn your attention to its qualities.  Is it dull or sharp?  Steady or throbbing?  Do its qualities change over time?  Go inside your pain.  Observe it moment by moment, staying non-judgemental all the while.  Think of yourself as a scientist or an explorer of the inner world of your pain.

Stay with your pain for a few minutes more, observing its location and qualities as they unfold over time.  You will probably find that your pain is not static, but rather dynamic, transforming in character and intensity even within the few minutes of this exercise.      

According to Jon Kabat-Zinn, if you move into pure awareness in the midst of pain, even for the tiniest moment, your relationship with your pain is going to shift right in that very moment.  By seeing the pain for what it really is, stripped of the negative thoughts and feelings that usually accompany it, it becomes immediately more manageable, more livable.  The sensory experience of pain might still be present, but the suffering is diminished.  Directing conscious attention towards softening and releasing the area of pain (even by the tiniest fraction) in these moments often brings additional benefits.

Some people resist trying this exercise. The notion of paying attention to the very thing that causes them so much suffering seems overwhelming at first.  This response is understandable: humans have a natural tendency to push away from their pain.  This exercise, in contrast, calls for the exact opposite response.  It invites people to get close to your pain, indeed, to inhabit their pain and recognize it for its true nature in that moment.

What does the evidence say?  A recent study found that participants in a single session of a mindfulness-based body scan reported less pain related distress and less interference of pain on social relations, compared with matched controls who did not participate.  A different systematic review of the effects of Mindfulness Based Stress Reduction interventions on chronic low back pain revealed similar and interesting results. Pain intensity did not decrease consistently as a result of the interventions, but pain acceptance did.  My reading of this evidence is that exercises similar to that described above do not necessarily reduce pain, but they do help people suffer less.  In the words of the Dalai Lama, "Pain is inevitable, suffering is optional."

Resources

Mindfulness Based Stress Reduction program website: http://www.umassmed.edu/cfm/stress/index.aspx

Audio clip and transcript from NPR entitled Meditation a Hit for Pain Management (2007): link

A book that changed my life: Jon Kabat-Zinn. Full catastrophe living: using the wisdom of your body and mind to face stress, pain, and illness. New York, Dell Publishing, 1990.  Amazon link

Research cited in this post:      

Ussher M, Spatz A, Copland C, Nicolaou A, Cargill A, Amini-Tabrizi N, McCracken LM. Immediate effects of a brief mindfulness-based body scan on patients with chronic pain. J Behav Med. 2012 Nov 6.

Cramer H, Haller H, Lauche R, Dobos G. Mindfulness-based stress reduction for low back pain. A systematic review. BMC Complement Altern Med. 2012 Sep 25;12:162.

Diet and chronic pain: fact or fiction?

“We interrupt this previously-planned blog post to bring you this breaking news. Recent anecdotal evidence supports the notion that diet might have a big impact on chronic pain.”

That’s the 1960s-style news spot that is running through my head as I begin to write this post.  I was planning a different topic altogether, but a sudden aha! moment in the shower today compelled me to change my mind.

Specifically, as I was hurrying to get ready this morning, I gazed down through the lather to take note of my pesky right knee.  Normally, it makes its presence known on an ongoing basis. In recent days, however, it hasn’t been talking to me.  At all.  Strange.  Very strange.

As I ran through a mental list of what might account for this sudden change, I struck upon a distinct possibility.  In recent weeks, I’ve changed my diet.  Specifically, I’ve stopped eating food that contains added sugars, fruit, processed grains (wheat, flour, rice, etc.), or root vegetables (potatoes, carrots, etc).  My new diet consists mainly of lean meats, dairy, vegetables, nuts and legumes.  

I made this change because I’ve added a few pounds during 2012 that I want to shed.  (Never mind that so far I’ve lost almost nothing, while my husband, who isn’t even on the diet, has lost three pounds!) Pain was the last thing on my mind when I decided to change what I eat.

So what does science have to say about the food-pain connection? Most of the evidence comes from small studies.  Large-scale randomized trials (the gold standard of clinical evidence) haven’t been conducted.  Some experts speculate that certain diets – such as the one I am following – reduce inflammation in the body, which in turn lessens chronic pain.

The strongest known connection between food and chronic pain is through obesity.  Carrying extra weight puts tremendous strain on joints, especially in the spine, hips, and knees.  New evidence also suggests that obesity might fuel pain through the impact of fat cells on inflammation throughout the body.

Obesity is not a factor in my situation.  Honestly, I don’t know what to make of my lack of knee pain.  I would be the first to acknowledge that its connection to my dietary change might be ‘spurious’ (a favorite term of scientists – basically meaning not really true).  Stay tuned.

In the meantime, I’ve listed a couple of articles (below) that discuss the potential pain-relieving properties of certain foods.

AARP magazine, May/June 2011 issue, Pain-fighting foods: http://www.aarp.org/food/diet-nutrition/info-03-2011/pain-fighting-foods

Psychology Today, April 2011, Nutrition and chronic pain by Mark Borigini, MD:

http://www.psychologytoday.com/blog/overcoming-pain/201104/nutrition-and-chronic-pain

Yoga: what's behind the craze?

These days, it seems like everyone is doing yoga.  In my home city, Seattle, yoga classes can be found just about everywhere: gyms, workplaces, neighborhood community centers, and nursing homes.  Anyone with an Internet connection can access hundreds of free, full-length yoga classes via YouTube or iTunes.

What is behind this craze?  In reality, yoga is far from a trend: yoga originated in India and has been practiced in different forms for thousands of years.  That being said, it is true that yoga has has gained tremendous popularity in the USA and other Western countries over the past 10 to 20 years.

In the United States today, 'yoga' typically refers to some form of hatha yoga, which uses physical poses, or asanas, combined with breathing techniques meditation to achieve better health. Subtypes of hatha yoga that you might see advertised include Bikram, Baptiste, and Vinyasa yoga, to name but a few.  All are variations of the hatha approach.

Perhaps the best way to understand yoga’s popularity is to go right to someone who practices it. Full disclosure: I started practicing yoga about seven years ago. At the time, I chose to enroll in a worksite yoga class because it was the only fitness class that fit my schedule.   When I started, I couldn't touch my toes and I didn't know the difference between a downward facing dog and an upward facing dog.  It took me awhile to touch my toes (and I am still learning the names of all the poses), but I quickly found that yoga made me feel great.  I kept coming back for more.  And the more I practiced, the greater the benefits I experienced.  

Anyone who has regularly practiced yoga can attest to its positive impact on muscle strength, flexibility and balance.  According to the National Institutes for Health, current research also suggests that yoga reduces certain types of pain, improves quality of life; reduces stress; lowers heart rate and blood pressure; and helps relieve anxiety, depression, and insomnia.

Ready to get started? If you a beginner, try to find an instructor (as opposed to watching a video or reading a book).  A qualified yoga teacher will teach you proper alignment and correct your positioning as needed.  He or she also will teach you modifications for different poses if you have physical limitations or if you are at risk for an injury.  Once you learn the basics, you can practice on your own (although many elect to continue with a teacher for at least some of their practices).

Anyone can practice yoga - regardless of age or level of physical disability.  But pay attention to how you feel during your practices and never push beyond your edge.  A key principle of yoga is to notice and respect your limitations.  If you follow these suggestions, you will most likely find that you want to continue yoga because you it helps you feel so great.