Chronic Pain and Injury Management

Mindfulness can be defined as "moment-to-moment awareness of present experience." When you are in pain, the only thing you can think about is your pain. You become your pain and it encompasses the entirety of your perceptual experience.  Even when pain is low or not present, your mind may still be dwelling on it, wondering if tomorrow is going to be a bad day or if you will be able to attend that family event later in the week. Mindfulness training teaches you to control your mind, not let it control you. Sometimes we might shift the focus of the mind like a spotlight, focusing on other parts of the body or your perceptual world (i.e., sights, sounds, smells, tastes). Other times we might widen the lens to allow your mind to become saturated with the vast and expansive reality you are immersed in rather than focusing on your injury. Mindfulness training lays the foundation for the other parts of the pain management protocol to work more effectively and is generally where we will start unless you already have these skills at your disposal. 

I have had very good success with this in my practice and in managing my own pain. It is a modification of the trauma protocol that helps change the relationship you have with your pain. Once you are trained in the protocol you can actually use it as needed self-administered on high discomfort days/nights. On average, my clients report a reduction of 3-4 points on the pain scale as a result of using the protocol. The protocol is evidence-based and was developed by Mark Grant (1999) as a modification to Shapiro's (1995) original EMDR trauma protocol. 

Sleep, diet, and exercise all need to be optimized for pain to be reduced as much as possible, and I find that often 1-3 of these areas are in the impaired range when dealing with chronic pain. This includes collaboration with other specialists such as PT/OT, sleep specialists, etc. when necessary.

• Sleep - Trying to sleep when you are in pain is one of the hardest things a person can do, and also probably the most necessary when it comes to helping your body do what it can to manage pain. Deep sleep is when our body produces Human Growth Hormone (HGH) to repair damaged tissue and REM sleep is when our mind can repair itself from the toils of the day, If either or both of those cycles are being hindered, pain will almost assuredly increase and recovery time will be slowed. 

• Diet/Nutrition - When we are in chronic pain the body produces an inflammatory response that not only makes us cave comfort foods high in sugar and fat which can lead to weight gain, which in turn leads to more oxidative stress on the body and more inflammation and . . . you guessed it - More pain! Several micronutrients such as Glutotione, Vitman's E, C, and Omega 3 are often missing in our diet and can help reduce oxidative stress. Thus, even if you aren't overeating, you may be lacking in vital nutrients that can help reduce pain at the margins. I am not a dietician and do not make recommendations on what you should or shouldn't eat, but when it comes to the psychology of getting yourself to adhere to a diet plan designed to either lose fat or reduce inflammation and oxidative stress, I am your guy! 

• Exercise - If you, like once did, have a daily step count of 500 and the very thought of exercise sends you reeling, then exercise might be a four-letter word. The thing is, your body needs to move for your lymphatic system (think: the sanitation department of the human body) to work. Pain makes us stop moving which prevents the lymphatic system from doing its job, which is to clear out cortisol, adrenaline, and other hormones/toxins from the body that lead to inflammation and. .. more pain! This is the tragic paradox of the pain cycle. I will work with you starting where you are at to slowly get more and more movement each day in order to help your body help itself the best it can to manage your pain and/or injury. 

This is the part that may be a bit atypical in terms of what you might normally receive from a therapist for pain management, but I find it to be the most important. Chronic pain and injury take something away from us and cut down to the core of our very sense of self and who we are in the world. I find the depth-oriented approach of Sandplay to be incredibly valuable in helping to process the grief associated with what is lost to chronic pain and the formation of a new sense of self as a person living with pain and injury.