Unfamiliar pain, fear and pain spirals

I think I’ve got a pretty good handle on coping with fibromyalgia-induced pain. My bipolar meds are fine-tuned enough that it’s usually under control, and I know all the warning signs and have my list of coping mechanisms ready. I do what I can to prevent migraines (wearing sunglasses, avoiding too much dark chocolate, avoiding other triggers), and have medications that usually work.

I like to think that I kind of have things “under control,” or at least well managed.

Recently I got hit with a new kind of pain. I’ve had occasional foot pain this fall, which got better when I switched shoes and insoles. On Thursday, though, I found that the occasional pang in my right foot was interfering with my ability to walk…causing me to limp…causing me to throw my body out of alignment…causing everything to hurt (an 8/10 on the “pain scale”)…causing my mood to just come crashing down. I worried about when it would end, how I would cope, and just wanted to scream. I tried doing mindfulness meditation. It helped a little bit with my mood, but I really became aware of just how much I hurt. My pain started feeling like a Jackson Pollock painting. (You know, the ones with all the paint drips everywhere?) It was a discordant symphony of pain – stabbing, burning, crawling, icy, hot, and on and on. I have a lot of experience with pain, but I had never felt anything quite like this.

There is something about unfamiliar pain that is much scarier than pain you know. There is all this emotion tied up with the pain. “When will it end? Is this something acute or chronic? How much will treatment cost? How will it affect my daily life? Am I going to be able to exercise? Am I about to go into a bout of a bipolar flare-up too? I don’t think I can take much more of this…” With fibromyalgia, it’s mostly, “Oh, this again. I know how to deal with you. If you get really bad, I’ll call my doctor.”

I woke up with pain yesterday morning, and managed to get an appointment with my physical therapist right away. She helped a lot, put tape on my knees, etc. I was pain-free all day (always a plus). Later in the evening, though, I found myself with stabbing pain in my foot when I was sitting at the computer. I quickly found the pain spreading throughout my body, and consequently spreading through my consciousness.

I ended up in bed, sobbing and having a panic attack. It was not a fun night. I’m worried about the potential cause, how long it will take to treat it, etc. I really enjoying walking as exercise, and I’m afraid my body will suffer from not being able to get out. I have to climb stairs to get to my bedroom and my office. My brain went on and on into worst case scenarios and pain, and everything started to spiral out of control.

I tried Tylenol, with no luck. I tried my usual dose of Tramadol (25 mg). I tried the higher prescribed dose of Tramadol (a total of 50 mg), and that eventually started to dull the pain. It also knocked me out, which meant I didn’t have to think about the pain for about eight hours. Sleep helped, too. This morning, I’m achy and the only real pain is in my foot.

I managed to get an appointment with a podiatrist my friend recommended. The appointment is in 13 days. I’m going to try not to catastrophize about what might happen, and try to be in the moment.

Here’s hoping for inner strength and compassion towards myself.

Early post (Tuesday instead of Wednesday) because I feel like sharing now instead of later.

Body as a processing tool

If I ever needed a reminder that the mind-body connection is a real and vital part of life, I’ve gotten it recently. There have been a lot of new changes and new beginnings (no need to go into it here).

The thing with change – it’s hard, it’s difficult, and it’s absolutely essential to growth and development. (Just google “death and rebirth” if you want more examples.) That’s really a topic for another post, which will come at some point. But back to mind-body connection.

I went through a whole wealth of emotions recently – fear, anger, compassion, elation, frustration, and so on. I ended on a high note, and was really feeling proud of what I’ve accomplished.

As for my body – there was a delay of about 2-3 days, and then it started processing all that change physically. I’ve been dealing with a fibro flare – pain, fatigue, and fibro fog. This morning my stomach started acting up at about 6 am.

The thing is – it’s not a bad thing that my body is going through all these changes so rapidly. It’s only natural that with so much change going on, my body needs to process it too. When I go through emotional changes, I expect to cry. Why shouldn’t my body cry, too?

I know it’s going to get better. I just have to be with it for awhile, and let the changes happen. I don’t think burning up is a particularly pleasant experience for a metaphorical pheonix. But being reborn – that must be something.

Weekend extra: Blog post on values and balancing mind-body wellness

Bronnie Thompson has written a wonderful blog post about Balance, control & passion. It echoes a lot of what I’ve been pondering (to myself and friends) lately about the meaning of work and values when one has a chronic medical condition/disability.

“Yesterday a couple of colleagues were talking about balance in life, and making it plain that they think people who spend a lot of time and energy on their work are sad.  Their opinion? Work is the means to pay for your ‘real’ life, to spend more on working means less on what is really important to them…

One way of looking at the distress and disability associated with chronic pain might be to think of it as a result of conflict between what can be done (resources) and both values (what is important) and goals (how I want to express my values). An ongoing problem with life itself is the limited resource we have to do what we want!  The whole of life is really about this balancing act.  And I suspect that one of the major sources of distress for people with chronic pain is that they carry on using the same strategies to express values but with limited resources to achieve it.

I’m not the only one to think of it this way – several authors have talked about the concept of ‘psychological flexibility’ (McCracken & Vowles, 2007).  Psychological flexibility involves several processes such as acceptance, mindfulness, values, and cognitive defusion.  This is a bit of jargon from ACT (Acceptance & Commitment Therapy) and basically means being able to allow oneself to experience all that life brings, while at the same time choosing to act according to what is important and valuable to you – and being prepared to alter the way in which this is achieved, depending on the situation.

So one way of looking at people with disability from their chronic pain is that they are stuck.  Stuck using old and unhelpful ways to achieve what is important to them.” [emphasis mine]

What wonderful insight. In my introduction, I talk a lot about my pre-bipolar-and-fibromyalgia self and preconceptions about what it means to be successful.

A lot of people talk about finding a balance, often finding a balance between mind, body, and spirit. How does having fewer resources to do so affect this balance? What happens when you don’t have as much energy, or you’re dealing with chronic pain? Bronnie discusses some different treatment modalities, such as Cognitive Behavioral Therapy (CBT) and ACT (Acceptance & Commitment Therapy).

“One problem I have with CBT is that when my own resources are low (I’m really tired, maybe I’m a bit depressed) the energy it takes to process and evaluate my automatic thoughts can be really hard to find.  It takes a lot less energy to simply allow the thoughts to be there but not act on them and remain focused on achieving things that are important to me.”

I actually hadn’t heard of ACT before, so that’s something for me to look into. I have to echo thoughts on the energy it takes to use CBT. If you’re already in the midst of some emotional or physical pain/fatigue/distress, it’s very hard to kick-start yourself into using those CBT coping skills. When I’ve dealt with some negative thought patterns due to mental illness, I found that it was very important to use my coping skills as soon as I noticed a problem. If I waited until it was a bigger problem, it snowballed out of control. Physical pain can sometimes come on very suddenly. You don’t always get some head notice that you’re going to have a flare-up. That’s why I prefer mindfulness meditation to CBT when I’m having a fibro flare.

“What we are trying to achieve in pain management is living according to what is important (valued) and being flexible enough to find ways to achieve this despite pain…

What this means is that there are times when I choose to act according to what is important to me, despite my own thoughts (which might be automatic, and wanting affirmation from people that I’m OK and not ’sad’), and despite my own energy levels.  To be able to choose whether I persist with some things and drop others, knowing that I’m living out my important values gives me that freedom that we call ‘being in control of my own life’.”

Well said.

Reactions to a snow-induced pain flare

We had the mother of all snowstorms this weekend, with 29″ dumped on every surface. It’s beautiful, and it also presents many practical challenges. (These include power outages, being housebound, snow-weighted trees, and making a space for the terrier to go outside and use the bathroom.)

Saturday night I was keeping my friend company while she started clearing off one of our cars. The power was out all around the neighborhood. The storm clouds had passed. The sky was a deep purple, reflecting the light of the snow and city lights in the distance. All of our street lights were out, giving a much better view of constellations punctuated by the occasional whispy cirrus clouds. Partway through shoveling, the power came back on. Some of the constellations disappeared, but my disappointment was tempered by the promise of having heat for the night.

That was the wonder of the snowstorm.

We also probably lost at least two trees, which succumbed to the weight of the snow and ended up almost touching the ground. I spent a good bit of the day of the storm wading through the ever-accumulating snow (it ended up reaching almost to my hips) and shaking trees off to prevent further tree death. My friends did a lot of the work, but just “walking” through the snow proved difficult.

Then came my body’s reaction to the experience.

I won’t bore you with an entire catalog of the pain. Suffice it to say that every joint in my legs was sore and burning. Other parts of my body would periodically pipe up, as though saying, “Me too! Pay attention to me too! I hurt too!”

I knew what would help: very light exercise (stretching or walking), meditation, medication, a hot shower, taking it easy by staying out of the snow…

Knowing is easier than doing. It was as though the pain had taken over my brain, and all I could focus on was how much I hurt. Add to it the increasing dismay at being housebound AND in pain, and I was not a happy camper.

I recruited my friends to help me out. Sometimes I just need encouragement to take steps in the right direction. I unhesitatingly took my pain medication, and got to verbally express some of the pain I was feeling. My friend helped me pick out some nice shampoo, and I took full advantage of my shower chair and hot water. I just let it wash over me.

Then I took my big step. I decided I would get situated for a meditation. I got out my mp3 player (which has several guided meditations on it). I decided I would see how meditation went – I wouldn’t force myself to do it for a certain period of time. I just let my meditation be what it was – a way to get in touch with what was going on in my body.

It was painful, at first. But because I have some experience with doing mindfulness meditation while I’m in pain, it was not unexpected.

There was this remarkable feeling of openness that happened during my meditation. I realized how much of my body actually feels pretty good.

This next part may sound crazy, but bear with me. (Having a familiarity with the Buddhist idea of equanimity might help.) I realized that when I found a part of my body that was not in pain, I thought, “Oh good, it feels great!” When I found a part of my body that was in pain, I thought, “Drat, that hurts. Maybe if I focus on it, it’ll stop hurting.”

Then I tried something different – letting go of the idea that pain is good or bad. However terrible the experience of pain is, it is a million times worse if I dedicate my conscious mind to thinking about how terrible it is. I also have a tendency to dedicating my conscious mind to how I want to feel good all the time when I’m enjoying myself. If I do that, I’m not actually enjoying myself anymore – I’m just dwelling in the desire to feel good more often.

So I just let go. I allowed myself to be in pain without judgement. The pain was still there. It still hurt. But it wasn’t in control of my consciousness anymore.

Now I can just be.