Persistent Pain: A Patient’s Perspective
This series of blogs are offered up by a patient of mine. Ellen found herself struggling with significant dystonia and disability with regards to walking and generalized activities of daily living. Although the majority of my practice centers around pelvic health and persistent pain specifically, Ellen’s journey inspired me to apply all that I know about pain to a different output of the brain, muscle spasms.
Ellen shares her journey in the first person, with a realistic look at her struggles and triumphs. I hope that her journey motivates you, if you are someone with your own physical struggles. I hope that her journey also motivates therapists and clinicians to take a whole-person perspective for every single output of the brain…. Pain, muscle spasm, muscle tightness, urgency, frequency, fatigue, etc. The brain is an amazing organ, and the brain is driven to establish homeostasis; that is ultimately the purpose of these output responses. The question is, “what is out of balance in your life, and how can you change that?”
Carolyn Vandyken, PT
Pelvic Health Solutions
Finding Hope: Thinking outside the Box
My journey to wellness is not over. I have made a lot of progress and that alone has given me hope for a better life. I am still not free to walk without support of a walker and I still have times when I freeze up, the severe muscle spasms return and mobility is a real challenge. In the desire to move beyond my current level of recovery, I have turned to thinking ‘outside the box’. That has lead me to do significant research about the brain. I was introduced to this idea because I know people who have been told by medical professionals that because of a stroke or back surgery they will never likely walk again. Yet these people did not listen to conventional wisdom and continued to push forward. Now they are walking. How can that happen?
Carolyn Vandyken gave me imagery exercises to do in the very beginning of my journey to recovery. She explained that by visualizing myself walking and “feeling” the muscles move with every step, I could achieve about 90% of the benefit of actually walking by doing these mental exercises. The mental exercise would not give the physical benefits to the heart and muscle strength that actual aerobic exercise does; however, the mental patterning was in fact creating new neural pathways in my brain, free of the constraints of learned protection my mind had created to protect me when things first got bad. She also gave me a number of audio files to listen to that calmed my overly sensitive nervous system – one is called Nervous System Restore and Relax. There were quite a few of these files that have supported my recovery by feeding mental imagery to calm my nervous system.
Since then I have read a number of books about the brain. I have learned that doctors used to believe that the brain was hardwired and that we had a set number of brain cells when we were born. They believed that only certain parts of the brain were designated to control certain behaviours like moving, seeing, hearing etc. They believed that once damaged, there was little hope that a person could recover.
New discoveries have changed that way of thinking. We now know that the brain is actually plastic. That means that there is growth and adaptability in the brain, making it possible to learn new pathways for recovery. In his book The Brain That Changes Itself, Norman Doidge, M.D. explains that while the brain is plastic, it also has a consistency born of genetic makeup and repetition. He quotes work done by Pascual-Leone and this metaphor:
“The plastic brain is like a snowy hill in winter. Aspects of that hill- the slope, the rocks, the consistency of the snow- are like our genes, a given. When we slide down on a sled, we can steer it and it will end up at the bottom of the hill by following a path determined both by how we steer and the characteristics of the hill. Where exactly we will end up is hard to predict because there are so many factors at play. But, what will definitely happen the second time you take the slope down is that you will more than likely find yourself somewhere or another that is related to the path you took the first time. ……And after you have spent an entire afternoon sledding…….there will be tracks you have created, and it will be very difficult now to get out of those tracks. And those tracks are not genetically determined anymore.”
We need to create a ‘roadblock’ to change the current over-used pathway and then practice novel activities to create new pathways. The ideas are too complex and lengthy for this blog but simply put, new pathways can be created. One way is through mental imagery. I did this in the beginning of my recovery.
Recently, Carolyn Vandyken advised me to spend 5 minutes, six times a day practicing ‘walking’ to create new pathways instead of following those old grooves cut by ‘sled on the hill’ that now only serve to take me down the path to immobility and spasm. I envision walking. It is an intense exercise where with every fibre of my being I try to make that imagined walking real by feeling the muscles, footsteps, see what is around, and engage all of my senses.
Confession time: I have failed at this because life gets in the way because we are out or with friends or whatever. I am now trying to do 3 x 10 minutes. I don’t know if I can accomplish the same results but I have a walking meditation file also supplied by Carolyn that helps me mentally focus. It last 10 minutes and so far seems to be working.
In the book by John J. Ratey, M.D. titled Spark, the author explores the ‘revolutionary new science of exercise and the brain’. He contends that not only is exercise good for the body, heart and overall health, but it also stimulates the brain and expands learning. He also talks about the plasticity of the brain. He purports that exercise actually stimulates new brain cell growth. He says, “Exercise spawns neurons, and the stimulation of environmental enrichment helps those cells survive.” There is a lot of research around exercise and education, raising learning scores of students who first exercise and then study the hard subjects such as math and science.
But for those recovering, he talks about the benefits of exercise and quotes many scientific studies that prove exercise benefits those suffering from depression, stress, anxiety, attention deficit, addiction, hormonal changes and even the effects of aging. The studies show the benefits not just in the ways we have heard before, like raising the good feeling hormones (endorphins) in our system, but actually creating neurogenesis and new pathways, healing damaged brains and creating healing that is as effective as medicine. The research is very promising. He claims that, “The elegance of exercise………sends information down a different pathway of the amygdala, paving a safe detour and wearing in a good groove.” In the section dealing with addiction the author says, “Exercise builds synaptic detours around the well-worn connections automatically looking for the next fix.”
In her book, Brain on Fire, Susannah Cahalan recounts the story of how a brain infection created havoc in her life. She calls it her ‘month of madness’ and but for the luck of being in the right place, under the care of the right doctors she may have been diagnosed with mental illness and never found recovery. It is a riveting story of a spiral into disability and loss, and then her journey back to recovery. There is a wealth of information about the chemistry and function of the brain as well.
Thinking outside of the box gives me hope that after all that I have done using traditional and alternative forms of medical help, I can also look to the new research into brain function to find hope in recovery. Much of that recovery comes in the form of:
- Imagery – ‘walking in my mind’ to create new pathways in my brain and
- Physical aerobic exercise to create new brain cells and stimulate brain cell regeneration