Starting from scratch

A few weeks ago I wrote about a family member having had Covid-19. She is young, fit and healthy, and expected to have a mild case of the disease, but ended up in bed for two weeks. I wrote about how difficult it was to persuade her to rest while she was ill, but the virus has since delivered another challenge.

She was very fit before she caught the virus, exercising almost every day. She went running in the mornings, and went to strength and conditioning classes in the evenings. For her, exercise was a way to feel good about herself, stay physically healthy, and manage stress. It was also a big part of her social life, and one of her main “hobbies” which she told people about when they asked what she did in her spare time.

But Covid-19 changed all this. For two weeks she was unable to spend more than a few minutes at a time out of bed, and then as she gradually recovered, she still felt too weak for strenuous exercise. This long recovery period meant she lost her level of fitness, and several months after her illness she has still not returned to her routine.

Now she is working to bring back her fitness, but spoke to me about feeling frustrated that she had to “start again”, trying to rebuild her ability. It was a familiar story to me, as many people with chronic pain feel as though they lose part of their identity when they can no longer exercise like they used to.

It is often very difficult to “start again” from scratch, for example working hard to walk a few extra steps each day, when in the past a few extra kilometres would have seemed like no challenge. But in my experience the sense of achievement at finally winning some small progress can be very special indeed.

Dear former self

I sometimes ask people to write a letter to their former selves, at a time when they were in a different place and often in pain. It can help show people just how far they have come, and allow them to reflect on their progress.

One client, I’ll call him Sean, gave me permission to share his letter. He had just returned from seeing a concert in Dublin, and chose to write to himself in the past at a time when he had also just returned from a concert, Oxygen festival. The difference was that at Oxygen Sean was in pain “the entire time”.

“You felt it in your left hip all the time and you drank to make yourself feel better,” he wrote.

“You have been going to physio and doing copious amounts of stretching and strengthening work, but nothing is working.”

Sean'’s life has changed since that time.
“I’m here to tell you that you have finally broken free,” he wrote.

“You are living in a way that was unimaginable to you back then. It turns out the pain you have been a victim of is your body’s last ditch attempt to get your attention. You haven’t felt safe in a long time. You knew something was off; that life was hard; that being around people was difficult. I can tell you that all those feelings, sensations, and pain are related.

“You have met the love of your life and you have two beautiful, healthy, happy children. In the years after that concert, you put up an enormous fight: training; persevering; battling; and ultimately learning to live with pain, anxiety, bitterness, regret, and resentment. You tried so hard to keep it all in. You fought tooth and nail to live your life the way you wanted to live it.”

Now Sean has just taken his two children on their first holiday, and he describes having “so much fun”. He has stood up for himself at work, and driven to Dublin for a concert, heavy metal this time.
” You are still on a journey but it’s a good one,” he wrote.

“You are blazing a trail with Mags’ help. That painful chapter of your life is over, this new one is just beginning.”

Read the letter Sean wrote to his former self here.

Taking a rest

One of my family members recently had Covid-19. She had managed to avoid it through the whole pandemic, but the virus finally caught up with her. Many of her friends had already had it, and as someone fully vaccinated, in her twenties, fit and healthy, she expected a similar experience: mild, cold-like symptoms for perhaps a day or two. Instead, she ended up spending two weeks in bed, completely floored by fatigue and feeling a heavy weight on her chest.

What stuck me during this time was how difficult it was to get her to stay in bed. Every day she would get up and struggle to her desk, insisting that she must go back to work. I don’t know if the reason was partly her early career stage, and the fact that she had never taken any sick leave before so wasn’t used to the idea. Or if it was because she works from home: she certainly wouldn’t have had any ideas about travelling into an office in that state. Inevitably she would find herself unable to work, and end up giving up and crawling back into bed halfway through the morning. I couldn’t help thinking the whole thing would be easier for everyone involved if she had just stayed there.

The theme is a familiar one, as many of us struggle to take time to rest, or to do so without feeling guilty. It is so easy to think that resting is a waste of time, when in reality it is vital to living the rest of your life as best you can. I remember reading the autobiography of Chrissie Wellington, a world champion triathlete at the absolute top of her game. She wrote about learning that resting was part of her training – part of her job, even – as she couldn’t perform without it. The rest of us may not be putting our bodies through such brutal training as she was, but it would do us good to also think of resting as a crucial part of our lives.

Making the dream work

I love the sound of geese flying overhead. I look out for them every autumn and spring, and love seeing their beautiful formations and hearing their honking – which I always assumed was them sharing titbits of gossip and chat to pass the time on a long journey.

If I’m honest I never gave the migration habits of geese much more thought than this, until I happened to be sitting in the garden with a family member, who is a teacher, when a flock of geese passed overhead. She remarked that she had given a lesson about geese to her class, and asked if I knew why they fly and honk as they do.

It turns out that the v shape flying formation, like so much else in nature, is a lot more clever than it seems. The front bird breaks up the air and makes flying much easier for the two behind it, and so on through the group. Usually the bird in front is one of the more experienced fliers, and when it gets tired it swaps with another member of the group. According to the RSPB, birds flying in a v formation can travel 70 per cent further than one bird flying alone.

 The honking also has a purpose: to help geese stay together in the group. White markings on many breeds also help with this. If one goose is sick or injured, it will not be left to fend for itself. A few others from the group will break off with it, and stay with it until it recovers, when they join another flock.

The relative who told me this uses the example of geese to teach the principles of teamwork to her class. It’s a nice illustration, and it reminded me how rewarding it is to be part of a team. In my case this is usually to work on research projects, and it’s always brilliant to see the different perspectives and ideas that come through teamwork, as well as the feeling of being supported by colleagues.

Not everyone can rely on good teams at work, either because of difficult environments or more independent jobs. But there are plenty of opportunities to find a team elsewhere, whether through sport, volunteering or another hobby, and this can often bring great rewards.

Encore!

I recently heard that a friend of a friend had decided to retrain as an architect at the age of 40, having worked sales until that point. The friend who told me was initially shocked (what on earth is he thinking?!) but then admitted she was also in awe of this man’s courage to begin a new career and leap into the unknown.

The “rules” around working life have changed hugely in the last few decades, and this friend’s story is becoming more and more common. There’s no rule saying you have to change careers, and many people won’t, but there are now fewer barriers to making a change if you realise your current career path is not making you happy.

One of my favourite of these stories is that of a 56 year old British woman who felt exhausted and burned out after decades of working as a journalist and decided to retrain as a teacher. She then founded an organisation to help other people in their 40s and 50s do the same, aiming to allow people to change their lives mid-career, and also combat a shortage of teachers.

An article in the Irish Times about other people making similar changes recently caught my eye, making the point again that such “encore careers” are becoming more and more common. One of the people featured was a 47-year-old man from Dublin who left a 20-year career in insurance, trained as a chef, appeared on Masterchef Ireland and then worked in a few restaurants before deciding it wasn’t for him and training as a pilot, with the goal of working for commercial airlines.

He makes the point that “switching lanes” in your 40s is difficult, especially financially. You also find yourself being managed by people younger than you, and have to start again from the beginning despite your depth of experience in another field. But a quote from this man stood out: “The way I see it, I still have 20 years of work still left in me. There are other currencies in life other than money.”

It is still true that many people need to stay in certain jobs or certain careers for financial reasons, or in order to support families, regardless of how much satisfaction this job brings. But for some the biggest barrier to making a change might simply be fear of leaping into the unknown – often a well-founded fear, but not always one worth listening to.

To my former self

I sometimes ask clients to write a letter to themselves in the past. It’s a useful tool, as it allows people to take a moment to reflect on just how far they have come, as well as often giving their former selves words of kindness or encouragement. One client – I’ll call him Aaron – gave me permission to share excerpts of his letter in the hope it may help other people.

Aaron wrote a letter to himself at a time in the past when he was in “unimaginable” pain, on a particular trip for work. He found himself in a hotel room, curled up into a ball on the floor for three days. At this point he had not met me, but was beginning to realise that he would have to do something about confronting the causes of his pain.  

“It's a difficult step to take because you feel like you could be fuelling the issue by giving it more attention, but you also can't go in living in this fear which is crippling you,” he later wrote.

Aaron worked with me for some months, and discovered he is a sensitive person. He spent a lot of time thinking about his beliefs, and the beliefs he had as a child. He had been through some very difficult experiences and taken on a huge weight of responsibility while very young, and this had major repercussions into his adult life.

When writing the letter, Aaron had not yet resolved his pain, but had made enormous progress towards doing so.

“It's difficult to know how far along the road we are - I suspect it's not even half way yet,” he wrote.

“But I am now far enough through that I can begin to believe that I can free myself from TMS/PPD and go on to live to my full potential for myself, and for those around me.”

When people begin the process with Resolving Chronic Pain, they fill out a questionnaire called the Roland Morris Pain questionnaire. This gauges the level of their pain, and can be used as a starting point from which to help recognise progress later on. In his first session Aaron scored 14 out of 24. When we repeated the process this week, his score was zero, or no pain at all.

Some good news

I had some good news recently, with two clients getting promotions at work. Both these people were debilitated by pain just a few months ago, and the last thing they were concerned about was work, let alone promotion. One of them, Charlie, found himself in a position where the idea of chasing a promotion was “very unappealing”.

“I thought I would never get the recognition I deserved,” he said.

“Any time I saw someone else getting promoted or getting praise for their efforts I was resentful and bitter. I knew I was doing good work but I had concluded - after years of frustration - that I just wasn’t a people person and unfortunately that’s just the way it was going to be forever.”

He felt he would have to ‘pretend’ to be a team player in order to get promoted, betraying his true self.

“I decided that wasn’t what I was prepared to do, so I did nothing and tried to manage the frustration instead. I was miserable. I was also in pain and fighting what at times felt like unmanageable anxiety.”

As the all-consuming pain began to subside, Charlie became aware of the relationship between his work frustrations and unresolved pain or anxiety episodes. He began to consider what a sense of fulfilment and potential at work might feel like.

About six months ago Charlie began trying a combination of strategies that has sky-rocketed his happiness at work: Leading by example; detachment from outcome and leaning back. This has ‘completely changed’ how he views his role at work.

 He said: “I don’t need to chase approval all the time. I don’t need to care how something gets built. I don’t need to continuously speak in meetings and try to influence every decision. My role now has a boundary that I understand.”

He now leads by example, and loves the feeling of diving into things that colleagues find scary.
On detachment from outcome, he said: “It doesn’t matter if I’m wrong or someone else is wrong. Perfection is the enemy of good. Ultimately it’s only work so who cares! Let’s try to take a step in the right direction.”

Leaning back was the ‘biggest and most satisfying’ adjustment he has made. It’s the most difficult challenge for many people learning to resolve chronic pain: embracing and appreciating all their skills, expertise and experience. This change reduces the pressure to continuously demonstrate your worth to colleagues.

 “When in a meeting I don’t need to “fix” it if it is not going smoothly,” he said.

“I am confident and competent so I can lean back and participate when I am needed. I can draw people in with simple sound bites like “I have some ideas around this” and then return to leaning back. Leaning back is my true nature. Leaning forward is the opposite. I had been leaning forward for far too long.”

Charlie is one of two clients who have recently been promoted at work after being able to focus on more than their pain. I hope there will be more stories like his - whether good news from work, or any other area of life.

My talk with Chronic Pain Ireland is now available to view here. Tuesday 29th March 2022 CPI published my article 'Pain Science, Chronic Pain and Movement', to complement the above video, click here to read the full screen version.

Chronic and acute pain

A ground-breaking study published in 2021 provided evidence that a psychological approach can cure chronic pain. In the Boulder Back Pain Study, published in the journal JAMA Psychiatry by researchers at Colorado University, 150 people with chronic back pain were treated either with psychological therapy around their beliefs, or a placebo. After four weeks, 66% of those who had received the treatment were nearly or fully pain-free, compared to 10% of the control group. These outcomes were mostly maintained a year later.

This new research validates the emerging view that a large proportion of chronic pain is not structural, but a brain response. The pain is persistent and certainly not imagined or ‘all in the head’: it’s a brain response with physical impact. It is a similar concept to blushing, crying, or an elevated heart rate, all of which can be bodily reactions to what the brain perceives.

Acute Pain is sometimes described as a ‘useful’, because it alerts us to a need to act, to investigate the pain and find a suitable solution. The pain is recognised in terms of its site: a broken bone or sprained ankle, a deep cut or burn.

Chronic pain is different. It can be interpreted as the brain’s fallible perception of danger, generated by the brain to protect us from a perceived threat or fear. Therefore, changing our perceptions, acquiring knowledge, adjusting beliefs, thinking or feeling differently can dramatically reduce pain.  Almost everyone who has recovered from stress illness finds understanding the misconceptions of the brain illuminating. It is a physiological process, which can be enhanced by movement, developing body awareness and learning to trust the body again.

I was pleased to give a talk to Chronic Pain Ireland on this topic yesterday. There were lots of questions and positive feedback, and it strengthened my belief that most people experiencing chronic pain are eager to learn about the regulation of the autonomic nervous system. The role of beliefs and emotions in affecting that ANA regulation is a fascinating and illuminating area of research. I want to thank Chronic Pain Ireland for having me, and all the attendees for their attention and questions. You can watch a recording of the talk, it’s forty minutes, on the Chronic Pain Ireland website here it has just been uploaded on their home page, and in their online library. Tuesday 29th March 2022 CPI published my article 'Pain Science, Chronic Pain and Movement', to complement the above talk, click here to read the full screen version.

Amy’s story

Amy used to be very active, playing hockey, running, swimming, and always being “on the go”. But then in her early thirties she began to experience chronic lower back pain.

“It got to the point where I couldn’t do any of the things that I loved doing any more,” she said.

“I couldn’t run, and it hurt to walk.”

Amy felt as though she were “losing her identity” because of the pain, which is not an uncommon feeling.

Many people remark that it’s impossible to recognise yourself after a while as all your energy is focused on managing pain.

Each day becomes dominated by working out how to cope with the persistent pain, to the point that mundane tasks require enormous effort and planning.

Amy tried visiting physiotherapists, and did two lower back rehabilitation programmes, but nothing seemed to help.

Then she tried working with Mags, and began to move with much less pain.

Now she has returned to being active, and runs, swims and goes to the gym, as well as doing yoga and Pilates.

“I genuinely do not give my back a second thought,” she said.

“I have rediscovered a love of horse riding and gardening, so I get to do all the things that I love to do.”

Amy added that working with Mags has helped her to better understand her pain.

“I’m so grateful for this process, because firstly I am pain free, but secondly, I have a much greater understanding of pain, and that it may be a signal of something else that is going on,” she said.

“To be really able to delve into that and understand that has been the most rewarding part for me in this whole process.”

It has also helped her to reclaim her identity and her overall ability to cope with daily tasks.

With a new understanding of her highly sensitive nature, Amy has ensured she has regular quiet time at work to re-group.

This has allowed her to stay in her job and increase her responsibilities, and she recently accepted a rotation to a new role.

You can watch Amy telling some of her story previously here.

Into the unknown

Do you always go to the same supermarket? I do. The one nearest to me, where I know where absolutely everything is, and have begun to recognise some of the staff members. It makes the weekly shop much easier and faster, as I can find everything easily and know the products well.

But last week, my favourite supermarket was closed. There had been some fault in the building and repair work needed to be done, so I was left to turn elsewhere for my shopping. It sounds ridiculous, but in the humdrum of how much our worlds have shrunk in the past two years, venturing out to a different supermarket almost felt like an adventure. I ended up in a new place, and with a few new types of ingredients and treats to bring home.

It reminded me of the advice I often give to step out of your comfort zone every once in a while. I hadn’t been following it recently and had slipped into routine, in more areas than just which supermarket I was going to. I was finding myself with the same patterns week in week out, of who I was spending time with, what I was doing and where I was going. Breaking out of routine has been especially difficult during the pandemic, as there are limits to how much we can throw caution to the wind and jet off on an adventure.

But I have found it is always worth it if I can break those routines in some way, whether that be choosing a different recipe for dinner, heading off for a walk somewhere nearby that I haven’t been to before, or even taking a different route on a well-trodden walk or car journey. Or, as I discovered last week, switching up where I do my shopping.