Understanding Your Pain: April 2005 "This being human is a guest house. Every morning someone new shows up. This one's a joy, this is sadness, here comes a meanness and here some glimmering of awareness. The dark thought, the shame, the malice, meet them at the door laughing and invite them in. Be grateful for whoever comes because each has been sent as a guide from beyond." Rumi Dealing with pain can be the hardest part of having arthritis or a related condition, but you can learn to manage it and its impact on your life. The first step is knowing which type of arthritis or condition you have, because that will help determine your treatment. Before learning different management techniques, however, it's important to understand some concepts about pain. Not All Pain is Alike Just as there are different types of arthritis, there are also different types of pain. Even your own pain may vary from day to day. Each person needs a plan of action. What works for one person may not work for someone else. You may need to try several different treatments before you find the one that works for you. The Purpose of Pain Pain is your body's alarm system that tells you something is wrong. When your body is injured, nerves in the affected area release chemical signals. Other nerves send these signals to your brain, where they are recognized as pain. Pain often tells you that you need to act. For example, if you touch a hot stove, pain signals from your brain make you pull your hand away. This type of pain helps protect you. Long-lasting pain, like the kind that accompanies arthritis or fibromyalgia is different. While it tells you that something is wrong, it often isn't as easy to relieve. Managing this type of pain is essential to enhance your quality of life and sense of well.-being. Causes of Pain Arthritis pain is caused by several factors, such as: Inflammation, the process that causes the redness and swelling in your joints; Damage to joint tissues, which results from the disease process or from stress, injury or pressure on the joints; Fatigue that results from the disease process, which can make your pain seem worse and harder to handle; Depression or stress, which results from limited movement or no longer doing activities you enjoy. You can get caught in a cycle of pain, limited/lost abilities, stress and depression that makes managing pain and arthritis seem more difficult. Different Reactions to Pain People react differently to pain for several reasons. Physical factors include the sensitivity of your nervous system and the severity of your arthritis. Emotional and social factors include your fears and anxieties about pain, previous experiences with pain, energy level, attitude about your condition and the way people around you react to pain. Many people with arthritis have found that by learning and practicing pain management skills, they can reduce their pain. Pain Factors What can make your pain feel worse? Increased disease activity Stress Overdoing physical activity Focusing on pain Fatigue Anxiety Depression What can block pain signals? Positive attitude and pleasant thoughts Appropriate exercise Relaxation Medications Massage Distraction Topical pain relievers Humor Heat and cold treatments How the Body Controls Pain Pain signals travel through a system of nerves in your brain and spinal cord. At times, your body tries to stop these signals by creating chemicals that help block pain signals. These chemicals, called endorphins, are morphine-like painkilling substances that decrease the pain sensation. Different factors cause the body to produce endorphins. One example is your own thoughts and emotions. For example, a father who is driving his children is hurt in a car accident. He is so worried about his children that he doesn't feel the pain of his own broken arm. The concern for his children has caused the natural release of endorphins, which block the pain signal and prevent him from noticing the pain. The body also produces endorphins in response to external factors, such as medicine. Codeine is one example of a powerful pain-blocking medication. Other external pain control methods, such as heat and cold treatments, can stimulate the body to either release endorphins or block pain signals in other ways. THE BODY OF PAIN In my approach to healing the body I am cognizant of the imaginative representation of the body in my patient’s mind’s eye. Different people see their bodies differently. The patient with multiple tattoos has a different "reading" of his or her body in which the skin becomes a kind of parchment where inscriptions of the soul’s desire (usually romantic partners!) are inscribed. The patient who cannot bear to look at needles or blood has a different notion of body. Each patient has different needs when it comes to heeling the body in pain. The work of Susan Sontag and Elaine Scarry has helped me (see their works on Amazon) but most of all in my own spiritual development and evolution I have personally moved away from the psycho-somatic model of disease whereby pain is delimited and defined into categories mainly those with organic bases such as disc, neuropathy, tumor etc, and those with no organic basis. I'm my current thinking I believe that attention to the patient’s perception of their body goes a long way in understanding their perception of pain, and so my own inner work has played a large role in my understanding of the meaning of the body in pain. But first to the meaning of body! I define the body as that locus of meaning represented by the true body (or even phantom body as in patients suffering from the effects of amputation) as processed through the imagination and whatever cultural and religious symbols impose themselves consciously or unconsciously on the mind. In my imagined body all sorts of meanings come together to impact my perception. Body image in obesity is a well-know factor and the alteration of such images is the cornerstone to many therapies. Here too the imagined body of pain needs to undergo change before the real pain perception can be altered. Note that by using the word imagined the last thing I mean to suggest is that it is not real. Pain is real whether organic or imagined in the psychological sense. I am making the claim that even in the most organic situations of pain such as cancer pain or kidney stone pain, the perception of pain is mediated by the imagined body of pain within our minds. The mind negotiates and mediates all pain as well as perception of pain and it is this location that interests me. In my own upbringing the body was seen as an impediment to the world of the spirit, with its desires hungers and addictions. The power of hunger was told to me in Holocaust stories as to what extent men would go in degradation, to obtain a crusty piece of bread in the concentration camps. I lived in a world of survivors and a world of silence. I remember well the WWII wounded vets in England since they were given such prominent positions such as doormen to department stores and was horrified as a child staring as I did at their amputated limbs, the sleeves doubled back and pinned onto the shoulder without an arm. As a child then, the body was seen in Victorian terms and the discharges of the body were seen as pollutants. The spirit was seen as totally divorced from the world of eating and sexuality and the world of learning scholarship was disdainful of those who were seen to indulge the body and its pleasures. Of course all of this has been well documented in the literature of post-modern discourse, but for some curious reason the body in pain has been leftover in terms of old ideas and prejudices. Patients still come to me with feelings of guilt surrounding their symptoms. In my own crises the body has slowly replaced the imagined spirit as the center focus of my spirituality. The rituals I daily go through attend to the mind, of course, the studying and praying, the ritual objects etc. however the focus is now on the use of the body, the movement of the lips the cleansing of the body daily, the use of the rituals specifically designed for the limbs of the body, meditation cleansing the chattering monkey of my mind and the slow walks that pace my heart daily. No longer do I strive for some kind of dis-embodied spirit, rather I now focus on the body as the medium by which I reach through to the spirit within and without and in doing so the bodies desires have lessened allowing for a greater balance of needs. So too in my therapeutic work I find that focusing on body touch, body myofascial release techniques, body work I distract the mind that is constantly attempting to interpret and allow the "thinking heart" to slowly shift into gear. By shifting the focus from mind to body, by making the body in pain the locus of experience, the thinking heart opens itself to insights never before gained.