PEACE TALKS RADIO
A PATH TO PEACE WITH CHRONIC PAIN TRANSCRIPT
HOST: Today on Peace Talks Radio, a real threat to inner peace that can also create conflict in all our relationships is chronic pain, moderate to severe. It's a daily challenge for one in six Americans,
(Tom Bowen clip)
But it's not so much the pain that really wears you down. It's the struggle with the pain. It's how am I gonna get through the day? How am I gonna function at work doing this? How am I gonna function at home? With this. So it's the struggle with pain that's often worse than the pain itself.
HOST: Today we meet clinicians treating chronic pain and survivors who've learned some keys to pain management and conflict management that have broader application to life and our role in the world.
(Quana Madison clip)
Any of us at any given point can be suffering, and in the same ways of how I felt shame or stigma about my pain, I think people can feel that too about their own suffering. And feel alone and isolated when wanting to seek peace, let it be. It's in themselves, in other relationships, in their community, the world.
HOST: What can people who have it do to seek peace with chronic pain? How does someone come to terms with disability in general? What does dealing with this condition teach us about approaching other challenges in life? All ahead on Peace Talks Radio.
This is Peace Talks Radio, the radio series and podcast on peacemaking and nonviolent conflict resolution. Whether it's the search for Inner Peace or how we resolve conflicts with each other in our relationships, families, workplaces, neighborhoods, or nations, we consider it here on Peace Talks Radio. I'm series producer Paul Ingles today with Correspondent Anna Van Dine.
We'll be exploring chronic pain, what it is, how it affects people's pursuit of inner peace in their lives, and how it can lead to conflicts with others in families at work and elsewhere, and how a variety of treatments are offering hope and in some cases, guidance for life in general as a result of the struggle.
First, we'll hear Anna's conversation with Tom Bowen. Tom's a 66-year-old Iowa resident who's an advocate for those living with chronic pain, which he's experienced himself for many years. Anna began by asking him to talk about his journey with pain.
TOM BOWEN:
My pain journey started after emergency surgery, left me with nerve damage in my groin, and I, it was like someone had just taken a sharp knife stabbing it in me.
That's what it felt like, and it was just a constant turning of that knife. Over and over and over again, and I would wake up every morning crying. The pain experience for me worsened four years, eh, three or four years into my journey. I fell and hit my head, and then I had a constant headache that was, if you rate it on a pain scale, I would say nine, and it was 24 hours a day.
Constant headache, but it's not so much the pain. It really wears you down. It's a struggle with the pain. It's how am I gonna get through the day? How am I gonna function at work doing this? How am I gonna function at home with this? So it's the struggle with pain that's often worse than the pain itself.
It's, it's not much like anyone else feels. When you have acute pain, you're, you're worried, you're fearful. You're stressed by it. You're, you're wondering what's wrong. There's something wrong and it steals. Chronic pain steals so much from you. It steals not only your time, your energy, your money, your emotions, your livelihood.
I, I had to go on disability, lost my job. It steals so much from you 'cause you're totally focused on that pain. You think back to what your life was before pain. And you try to get back to that normal and, uh, what I've come to learn now, my new normal is different than my old normal, but it's natural.
Early in that journey, what I was doing was fighting it and fighting the pain. No one wants pain. But it's a lot easier when you accept it.
ANNA VAN DINE: Could you talk me through the different strategies you use to try to manage that pain at the beginning?
TOM BOWEN: Yeah. The doctors prescribed rest. They prescribed eyes, they prescribed heat, they prescribed medicines, all those kind of things.
And that's, that's what I was trying at the very beginning. There used to be a time actually, I, I would take, and I would, each day I would write down what my worst pain was that day, what my average pain was that day, what I was feeling that day. And what I was doing that day in terms of any pain treatments, because I was trying to find, you know, the, the cause and, and a cure for it.
And it just, what that ended up doing is just adding more focus to the pain by doing that, uh, in retrospect that it, you'll do anything. To try to resolve the pain. Multiple doctors saw multiple doctors locally. I got to a point where I couldn't find a local doctor. I traveled a couple hours outta town to see a, a doctor.
That didn't help. I traveled six hours outta state to talk to a doctor and had surgery done to remove nerves from my body. In an attempt to remove the pain thinking, you know, if you're gonna remove the nerve, then you're not gonna have pain, you're not gonna feel it didn't work. I flew to Washington, DC out of Iowa to talk to a doctor about doing the same kind of surgery, thinking a different physician, but have a different effect or a different result.
And I end up not doing that, but it's, it is amazing what you'll do. To try to resolve the pain. Every pill, every supplement I could possibly take I was taking.
ANNA VAN DINE: So at that point, when you're feeling kind of desperate, what changes?
TOM BOWEN: I was following up with that surgeon and my family doctor had recommended that I go to a pain rehabilitation program at the Mayo Clinic.
The Mayo Clinic, pain Rehabilitation Center is the name of it. I was contemplating this surgery and actually flew back, like I mentioned, to Washington, DC to talk to a surgeon. And my wife wanted me to go to the Mayo program and I wanted to have the surgery and I thought, okay, this is gonna be real easy.
I'll talk to the surgeon with my wife there, and he'll recommend the surgery. 'cause he's a surgeon, right? So I asked the surgeon, I said, I got these choice. Be the two, two options. What would you do? He said, Tom, what caused your pain in the first place? I said surgery. I said, then why would you have surgery?
I went to the Mayo Clinic program, that was three years into my pain journey.
ANNA VAN DINE: What did you learn at the Mayo Clinic Program?
TOM BOWEN: I learned that all, pain isn't bad. Pain isn't something you have to fear once it comes from acute to chronic. It's more about an overs sensitized nervous system, and it's not about damage to your body.
And, uh, pain is actually created in the brain. I. All I ever thought was pain was if I got pain in my knee, I have damage in my knee. Right? Well, that's not it. The the brain is telling the knee it hurts because there's something wrong. But with chronic pain, there's nothing wrong. There's, there's just nothing wrong.
So it's like, it's, it's just a shift in thinking and it's a shift from. Relying on like doctors to fix me to me, fixing me and taking personal responsibility to self-manage the pain.
ANNA VAN DINE: Did that change your experience of your pain?
TOM BOWEN: Yes, yes, until I fell and hit my head. And then it's just kind of like everything I learned at Mayo Clinic kinda like went away and I was focused back again on getting fixed, and I went through a downward spiral from there.
It was. It was what, four years, five years later, after new diagnosis of viral myalgia, tinnitus, SI joint dysfunction, si joint dysfunction, depression, anxiety, uh, all these new diagnosis that I had as a result of that fall. All these diagnosis. That I, that I said, I need to go back to Mayo Clinic again. So I went back to the Mayo Clinic.
Soon as I stepped in the building and started taking classes, it just shifted. It kicked in a little spark in my mind. Went. The light bulb came off and it's like, that's what you need to do. And so that was the, the beginning to my final recovery.
ANNA VAN DINE: This is Peace Talks Radio. We're exploring how chronic pain can stand in the way of inner peace and how people reconcile with that.
We're hearing Tom Bowen talk about his experience finding peace with chronic pain. He told me what changed for him wasn't the pain itself, but how he thinks about it.
TOM BOWEN: I thought a pain as something that was bad. It's a danger warning signal. And I'm, I'm gonna give you an analogy. This is an interesting analogy that I love and that's, imagine you have a house and someone kicks in the door to your house, right?
Your alarm system's gonna go off, but you repair the door. The alarm system is not going off anymore, right? That's acute pain. The door is fixed. Chronic pain happens. When the doors kick down, you fix the door up again, so the door's fixed, but the alarm's still going off. So the problem isn't with the door.
You don't have to call the door company. You have to call the alarm company. The problem is with the brain and the false alarm that we're giving to ourself that says there's danger and there really isn't Danger. Pain doesn't mean me harm. Pain means me no harm. Hurt doesn't mean harm. I don't worry about it.
I don't focus on it. I don't fear it. It's just pain. And as a result, I've no longer take any medications for the pain. It's not noticeable. And when it is noticeable, it's just there. It's like an uncomfortable noise. It really doesn't bother me. I. Not to say I don't have those twinges that are really sharp and they might grab my attention, but I don't dwell on them.
I just let 'em go.
ANNA VAN DINE: That sounds easier said than done,
TOM BOWEN: And that is exactly true. It's easier said than done, and many find it hard to do, and. I did too. It's a learning curve. It's a journey. It's a process from the shock of the pain to denial of the pain, to the anger and emotions of the pain, the fear of the pain to learning to accept the pain.
That's a big one. Learning to accept the pain and then to finally adapting to it and just making it part of your life. Speaking of life, I was gonna share with you one of the things I share a lot. It's, it's a physiotherapist, Ben Cormack in, in England. He talks about making life bigger than the pain. And so imagine a, a circle with a ball in it and that ball is pain.
So pain is taken a big amount space in that circle. Well, how do you reduce the pain if you can't make that ball any smaller on the pain? It's not getting any smaller, no matter what the treatments you're doing, what do you do? Make your life bigger, then the pain gets smaller as part of your life, and I love that analogy.
ANNA VAN DINE: What does that look like for you?
TOM BOWEN: For me, what I've done is I've turned my life from being a pain patient to a pain champion and a pain advocate. I, I have a website. Chronic Pain champions.com with all sorts of free information and resources, links to all these tools that people can use to manage pain. To learn about pain. I manage a Facebook group with about 3,500 people in it worldwide. I am active in social media, so what I'm doing, what I've done is changed my whole perspective about pain from being a victim of pain. To a person who's now helping others with pain. So that's been very instrumental in my own recovery.
ANN VAN DINE: This experience from fighting with pain to learning to live with pain, has that, has that taught you things that go beyond pain?
TOM BOWEN: What I've learned is control what you can control and don't worry about the things you can't control. Don't worry about the news, don't worry about all the political stuff that's going on. Don't, don't worry about, you know, everything else that you can't control the weather. Control what you can control. I've learned that I have more control over my life than I thought I did. I was always constantly relying on other people first. My life, the doctors to fix me for people, for joy. I don't, I don't need that anymore.
I have that control. So I've learned that. It's funny, a lot of the self-management tools that I share aren't tools for pain. They're tools for life. Things like being grateful, being kind, uh, happiness, laughter, smiling. I. All these things, really, not just for pain, they're for life.
ANNA VAN DINE: Do you feel like this experience has changed who you are as a person?
TOM BOWEN: I'm a better person because of pain. My life has improved, even though I lost my job. I went through all those hard times. I've learned from this and I've come back stronger than ever before.
ANNA VAN DINE: That was Tom Bowen, who's been living with chronic pain since 2009. In this episode of Peace Talks Radio, we're considering chronic pain as a threat to inner peace and to living peacefully in the world. We're next going to hear from Dr. Robert Shapiro. He's a professor emeritus of Neurological Sciences at the University of Vermont and an attending neurologist at the University of Vermont Medical Center.
He's also a research scientist and an advocate for people living with disabling headache disorders. I started by asking Dr. Shapiro to define what exactly pain is.
DR. ROBERT SHAPIRO: So it's kind of ineffable. It's a little bit difficult to pin down for most people because it's essentially a private experience. It's one that is difficult for people to express in words exactly what it is there.
Experiencing, but it's a shared experience in, in that pain is almost a universal thing that people may experience during their lives and typically do. So there are some formal definitions for it, and the International Society for for Pain has, uh, defined it as an unpleasant sense sensory and emotional experience associated with actual or potential tissue damage.
So what does all that mean? That means that. Pain is a warning signal. It permits us to respond to potentially threatening events which could harm us. So if you place your hand too close to a fire, you experience pain before you end up having damage to your hand. And in the future you may be more prone to recognize.
The cues that that is not a good thing to do. Like you notice that there's a fire there, so don't move your hand close to it.
ANNA VAN DINE: So it it's like a survival mechanism.
DR. ROBERT SHAPIRO: Yes. Pain is, is essential. It's a necessary reserving adaptive response that we all depend upon.
ANNA VAN DINE: Could you talk us through the mechanics of what we know goes on in the body and in the brain?
DR. ROBERT SHAPIRO: When we experience pain, typically there is detection of some problem, some threat or injury. This is the burn on the stove. Yeah, it's the burn on the stove or, or something similar. And that's detected by the, the ends of nerves which have come off the spinal cord, typically some off the, the, uh, the, the what's called the brainstem at the lowest part of the brain.
And they provide really sensation, mostly in the skin, but sometimes in some in the organs as well. And that information gets transported electrically. Up to the spinal cord and to the brainstem, and then in relays up to further areas such as the, the cortex where awareness of this sensation is processed.
And that awareness can be both a direct, um, cognitive sense that this is going on, but it also has a very important emotional impact to it. And that emotional impact is crucial to ensure that we. Have respect for those, uh, circumstances, which could be injurious.
ANNA VAN DINE: It's what makes us learn to not touch the thing that could hurt us.
DR.ROBERT SHAPIRO: Exactly, exactly.
ANNA VAN DINE: What do we know goes on when someone experiences chronic pain?
DR. ROBERT SHAPIRO: So chronic pain we're growing to understand is something different, qualitatively different and quantitatively different. So operationally it's defined as pain that persists. For more than three months or more generally persist beyond the time that you would expect healing to have occurred for whatever the injury or threat had been.
And chronic pain, uh, carries the greatest burden when you think about all of the ways that pain can, can be appreciated or experienced. And this burden is not one that is rare. So the, the estimate is. That approximately a hundred million Americans will experience pain on a regular basis for at least three months or more, and about half of 'em, 50 million Americans.
We'll experience pain on a near daily basis or daily basis at this point, and this has enormous impacts, both personally and in terms of functionality and relationships and big, big societal impacts as well.
ANNA VAN DINE: You're listening to Peace Talks Radio. We're speaking with neurologist Dr. Robert Shapiro about chronic pain.Dr. Shapiro is a headache specialist, and I asked him to explain how someone who experiences chronic pain like the headache patients he's worked with, might see their lives disrupted.
DR. ROBERT SHAPIRO: It can be devastating. First of all, it's extremely isolating. It's, I, it isolates people from the normal functioning that they ad lived before they had experienced it, and which most people expect that they should be able to experience and lead a fulfilling and productive life.
And it also isolates people from all of their relationships, their personal relationships, family and coworkers, associates and the like. And because pain is private, because you experience it and. It's something which you can't know for sure what others, others are experiencing. It's been been said that uh, people with migraine, particularly chronic migraine, that they quote, struggle to avoid being doubted.
End quote. So consequently, people who have migraine. Are stigmatized. So people who are in the workplace who have these attacks, which occur unpredictably and may or may not impact their their productivity, they can either report that they're having this experience and potentially risk losing their job because their employer doesn't believe that this is either real or important or they can silently, uh.
Suppress whatever signs or evidence that they have of pain, for example, and go on with their work, but work less productively at times. And this is, this type of choice is is not really a choice at all. So this puts an extra burden on people who have migraine to kind of multitask, having their disease and their job, and it requires them to work even more.
In order to ensure that their productivity is, is high enough to overcome the fact that they're gonna have these intermittent attacks.
ANNA VAN DINE: So, so you're describing a situation where a person is in pain, they're working really hard, probably exhausted, where they are facing stigma from those around them who can't quite understand or see what they're experiencing.
There's this physical, psychological, and social situation that you're describing. What, what kind of effect does that have on a person?
DR. ROBERT SHAPIRO: Well, disability is the, is the distilled word for it. So these impairments, individual impairments collectively can lead to people being unable to fully function the way they need to, and chronic pain.
Is the number one cause of disability, period.
ANNA VAN DINE: You talked earlier about what happens inside our bodies and in our brains, and with our nervous system responding to these generally external or internal stimuli. There's a reason why we feel pain, but why? Why do people experience chronic pain? Do we know?
DR. ROBERT SHAPIRO: We don't know. And the kind of the, the general held opinion about this is that it is actually a disease. A disease unto itself. It's not an adaptive process, it's a maladaptive process. But by adaptive, you mean could be seen to have some sort of evolutionary benefit in some way. Exactly, exactly. And maladaptive is just like inconvenient, detrimental.
We don't see the benefit. Shows no, um, obvious help in allowing us to live, uh, long and, and productive lives. Right? Why it has become as prevalent as it has is a different question. Typically, when diseases become very prevalent and there are mysterious. We search for why there's an un uh, detected or unappreciated reason or basis for why this might actually be adaptive.
And there's a lot of speculation about that, but at this point, I. We, we see it as, as a disease, even though we don't know what exactly is going on for people who are experiencing different kinds of chronic pain.
ANNA VAN DINE: For you as a physician and your colleagues, what do you have in your toolbox when it comes to helping people deal with this?
DR. ROBERT SHAPIRO: So the therapy for chronic pain. Almost universally at this point is appreciated as being something which is not a single way of approaching it. It's sometimes called multimodal or multidisciplinary, and yes, it includes pharmaceuticals or medications or drugs, but in addition, there are other ways of addressing it, which are, uh, equally important.
So behavioral therapies are important, and then there are restorative therapies such as physical therapy or massage. There are interventional therapies, which in some cases are important, such as nerve blocks and things like that. And then of course there are alternative, you know, and other type, other types of therapies, which are very broad in terms of the types of therapies and how they work and how they're understood.
All these things together often are important in order to allow people to move in the direction of, of healing. I,
ANNA VAN DINE: I wanna turn back to the experience, uh, and sort of the journey of patients. I'm wondering, you know, you in your role have gotten to observe a lot of people over. I imagine for long periods of time as they went through the experience of having chronic pain, learning to manage it, and for some eventually successfully living with it. Could you talk a bit about what that is like for people, you know, what does it look like? What can it look like With the resources we have available to, to live with a condition like chronic pain?
DR.ROBERT SHAPIRO: It's been a privilege to be a doctor. And, uh, I am deeply grateful for the relationships I've had over the many decades that I've been doing this.
And any doctor who says they haven't learned from their patients has been sleeping through their career. Most people by the time they came to see me, 'cause I'm a, it's called a tertiary referral specialist. The people who get referred to see me, uh, are people who have these, um. Headache disorders in particular, headache disorders, which have typically failed other doctors.
Um, I don't mean that failure of the doctor or the failure of the patient, but there has not, you know, been a reasonable, uh, way to bring this to, to an acceptable level. So most people who come have been living with this for quite some time, and they've developed their own. Strategies for living with it.
And some of them are adaptive and successful and some of them are maladaptive and kind of make things worse. But in general, living with these conditions and in particular living with it where it's not widely disclosed, uh, it means that people develop resiliency. I would wish nobody to experience chronic migraine, but People who I've cared for, uh, by and large, can tell me a lot about how to encounter problems and work through them, and those that have been really remarkably successful. They're some of the most remarkable people who I've been able to meet in my life.
HOST: That was Dr. Robert Shapiro speaking with Correspondent Anna VanDyne.You can learn more about his work with chronic pain as well as Tom Bowen's experience with chronic pain and sharing his coping techniques with others that we heard about earlier. all@peacetalksradio.com. Lots of extras at our website. Peace Talks radio.com. In part two of our program. Coming up shortly, we'll hear from a psychotherapist who specializes in working with people who have chronic pain.
We'll also talk to an artist and advocate who's found a way to fit her experience of pain into her understanding of peacemaking. For correspondent Anna Van Dyne, I'm Sirius producer Paul Ingles. Thanks for listening to and for supporting Peace Talks Radio. Stay tuned for part two shortly after this break.
MUSIC BREAK
You are listening to Peace Talks Radio, the radio series and podcast on peacemaking and nonviolent conflict resolution. I'm series producer Paul Ingles. Today with Correspondent Anna Van Dine. We continue with our consideration of chronic pain, one of the most common afflictions in America and throughout the world.
It can be extremely debilitating, completely disruptive of one's inner peace and compromising of one's ability to make peace with others in their lives and their families at work, at school elsewhere. Before the break, we heard neurologist Dr. Robert Shapiro. And advocate Tom Bowen talking about what chronic pain is and what it feels like to live with it.
We're gonna pick up on the topic now by hearing Anna's conversation with Dr. Deb Nelson. Now she's a licensed clinical psychologist based in California who specializes in working with people who are experiencing chronic pain. She told Anna that when patients first come to her, they're often in a very difficult place.
DR. DEB NELSON: Usually it's a feeling of despair. It's a feeling of anxiety, depression, the experience of pain has a huge emotional component. You know, certainly living with pain can cause feelings of anxiety and depression, feelings of anxiety and depression, exacerbate chronic pain. It's very bidirectional and. Often folks are saying things like, I can no longer engage in the activities that are important to me.
So I've worked with professional athletes and it's really difficult, you know, their identity of who they are and how they earn a living is tied up in their ability to move to somebody who can no longer play golf on the weekends with friends. And those relationships are becoming distant to a grandmother who wants to help out with a new baby.
But it. It's difficult for her to hold the baby. So that's where the despair comes in. I mean, certainly the experience of the brain sensing this signal is distressing, but then the impact on the quality of life is, can be really profound.
Well, it sounds like the physical and the emotional are kind of inseparable and And they compound each other.
DR. DEB NELSON: Completely. Yeah. People can really spiral down. That's a big piece of my work is trying to uncouple that the experience between the physical sensation and the pain and the emotional, even though they're linked and there's good reasons for that, but when people are able to identify, one is the physical sensation and recognizing the other piece is the emotional response, then we can start to get a little bit of freedom from feeling trapped by the sensation.
ANNA VAN DINE: How do you start that process? Like when a patient first comes to you, where do you begin?
DR. DEB NELSON: It's twofold. We know that education about how the body responds to pain is really key because that gives people a foundation for how to navigate their own experience. So what we do is we explain in detail. Our brains are designed to respond to pain with fear and a sense of urgency.
And that's how pain acts as a protector. But when we move into the chronic pain part of the experience, we can't keep having the person respond to the signal with fear and a sense of urgency. The work that I do and many others do is, okay, there's that signal. Let's redirect your attention.
ANNA VAN DINE: How do you do that?
DR. DEB NELSON: So those could be pretty traditional psychological tools, cognitive behavioral therapy, dialectical behavioral therapy, acceptance and commitment therapy, which are essentially different interventions you can do. Yes. And then also we know that antidepressants can really help with pain. Often folks with fibromyalgia prescribed Cymbalta, which is an antidepressant, and that seems to be really effective tool for pain management.
It's also just important to have people feel like they are being paid attention to, that they are heard. I often hear my spouse is tired of hearing me complain about this. My friends don't wanna hear about it anymore, and everybody's experience of pain is unique. So it further complicates if I, you know, maybe you had a friend who had back surgery and they were back playing basketball after a few months and you're still struggling to walk.
So it's really important to address the emotional piece.
ANNA VAN DINE: It sounds like you're talking about like a recalibration, like people at one time were living life without pain, and then they have to face this whole new reality where they'll always have pain to adjust to. That seems like a huge project, right?
DR. DEB NELSON: I mean, yeah, certainly, and honestly, a piece of it for a lot of people can be working with them through the grieving process.
For loss of the life they had for loss of the life they imagined they would have. I mean, those are very real experiences and, and we need to honor that. I mean, it would be cruel to tell people like, oh, look at all the things you still can do, which is a piece of it, but we can't ignore the loss. And I find that that's actually, for some people, a pretty important piece of the work is to give them the space to process that.
Once they're able to kind of be open and talk about it, they're able to, to move on to move towards recovery. But if they. Don't have a sort of a safe place in another important relationship or with a therapist to really explore that people can get very stuck.
ANNA VAN DINE: This is Peace Talks Radio. We're speaking with psychotherapists Deb Nelson, about managing chronic pain, which disrupts individual peace for millions of people. Dr. Nelson explained what she works to shift with her patients to help them find more inner peace.
DR. DEB NELSON: Well, I'll give a really simple, broad example is folks who tend to run pretty anxious, often catastrophize, so everything's going to be the worst thing possible. People will get an unexpected bill and all of a sudden they're, they're going to be become broke and then homeless.
The mind will go to extremes if your mind is going to extremes. It's releasing the neurotransmitters of adrenaline cortisol, which will cause your muscles to tighten, which will cause your heart to beat faster. Cause your GI tract to shut down all of those will exacerbate the pain experience. So again, what we do is try to move people towards feelings of safety. Towards feelings of calm. For people with a lot of anxiety, control is a big issue, and so we try to get them to engage in behaviors that can remind them that they are actually in control. They can live their lives.
ANNA VAN DINE: It sounds like from what you said, just the experience of having pain is sending signals to the brain that trigger anxiety and stress and over a long period of time, maybe depression, and that's gotta make things so much harder.
DR. DEB NELSON: It does, and you know it. People experience brain fog from long term experiencing brain signals. Adding to the complexity of it, we know that for most of us who aren't living with chronic pain, the dopamine receptors allow us to be motivated towards things. But unfortunately, sometimes with chronic pain, those reward systems get damaged.
So the work is really multifactorial and the people that do the best, um, have a combination of they're working with a pain doctor, they're doing physical therapy, movement is really important, and they're working with the pain psychologist. We kind of can approach it sort of in a linear fashion. An example I often use is people will come to me for individual work, for pain therapy and we'll be pretty focused on discussion about treatment and how they're working with their pain doctor, how they're doing with movement, very pain specific sort of conversations.
Then about the fourth or fifth session, we're talking about a difficult relationship in their lives. The emotional piece is so big, and again, it heavily influences the pain experience. So from then on, the work becomes sort of this back and forth. And again, part of the treatment is recognizing, oh, okay, this is the body's physiological signal and this is my emotional reaction to it.
ANNA VAN DINE: Which it sounds like for many people can be difficult at the beginning to identify, but can be become easier with practice.
DR. DEB NELSON: Exactly. Exactly. People, when they talk about chronic pain, they often talk about pain management. This word seems important. It sort of acknowledges that it's something that is not going away and that you are dealing with.
ANNA VAN DINE: Is pain management a term you think is important?
DR.DEB NELSON: I do. A big piece of the work that I do, many other people do is around acceptance. And that is really hard for people, understandably. Um, and when we talk about acceptance, the way that. I talk about it certainly not about giving up. It's certainly not about resignation or apathy.
You keep taking your medications, you keep going to the doctor, and you can hold out hope for a cure or a new medication or something to change. But we're accepting what we've got for today. We've got it for the near term. Maybe forever, maybe not, and then. We start to look at, okay, now what do I do with this?
How do I take that energy I was spending, hating it and use it towards rebuilding my life? And this is kind of the, the core of pain management. We're not telling people it's gonna go away. Sometimes it does, but I believe strongly it'd be really unethical to promise people that it'll go away.
ANNA VAN DINE: What does it look like when a patient who you've been working with is successful?
DR. DEB NELSON: Oh my gosh, I really might cry. Seriously. I'm getting choked up. It is so rewarding and it's absolutely what keeps me in this work, and unfortunate that I see it enough that it's like I can keep doing it because it is hard work. It's far reaching. In terms of that person's experience, because not only are they, again, going back to the idea management, they're not necessarily freed from the sensation, but they're freed from the struggle with it.
They're freed from the feelings of depression and anxiety around it, and that's helped them engage in important relationships and behaviors. And then sort of the cherry on top is this incredible sense of self-efficacy and agency. And when you believe in yourself and you have that confidence, then that gets translated into a lot of other endeavors or arenas of life.
So it's really exciting.
ANNA VAN DINE: How have you seen people's lives change when they learn how to find peace with their pain?
DR. DEB NELSON: Yeah, so I mean, it really depends on the individual. But I hear stories about people who'd wanted to go to Italy with their spouse for years, and they're finally able to take that trip. Or, um, somebody's able to kinda play 18 holes, but they played nine and they had a great time with their friends.
Um, being able to, um, go to music festivals. So, yeah, the, the biggest thing is people are engaging in activities that are important to them. And you know, as a technical aside, in the work that I do, you've retrained your nervous system. And so in a very titrated fashion, we encourage people to go out. You're just gonna walk, you're not gonna swing.
And slowly the nervous system starts to adapt and say, oh, oh, oh, okay. Protection isn't necessary. I'm okay. But that takes a lot of courage for people to do that. And belief in self belief that. If they do have a big emotional reaction that they'll be able to manage it.
ANNA VAN DINE: That was Dr. Deb Nelson, a psychotherapist who works with people experiencing chronic pain. Finally on Peace Talks Radio, we're going to hear from Quana Madison. Quana is a multidisciplinary artist, a healing arts facilitator, and a wellbeing advocate. Her pain started in childhood after an injury to her feet. Throughout her adolescence, she would experience occasional episodic pain. Then in her twenties, her episodic pain became chronic and the effect of pain on her life became more and more profound.
And a note, this story includes a mention of suicidal thinking.
QUANA MADISON: So when people experience episodic pain, it's short lived. When you have chronic pain. It does not stop. So every day, no matter what my activity level was, I wake up in pain in my feet, walking hurts. Any sort of exertion would cause post exertion pain.
ANNA VAN DINE: At that time. How was your pain affecting your quality of life?
QUANA MADISON: It limited what I could do socially and in my twenties, especially when I was in college, uh, due to a lot of the societal stigmas around pain and disability and some of the ableism that we experience in our society. I felt a lot of shame about having the pain.
And if I mentioned anything, there was, oh, you're too young to really experience pain. Um, so you're just exaggerating. And that was really upsetting and it led to me lying to friends about how much pain I was in, or just trying to push through it or just, you know, be tough and starting to try to find ways to numb my pain or disassociate from my pain.
And so that that was certainly not healthy and not helpful and impacted me in terms of my work. Where I was a public school teacher, and when I would experience pain, I'd be limping. And I remember having a lot of colleagues comment, not in a positive way about my limp, you know, um, teasing me sometimes about it.
And although I would try to like laugh on the outside, on the inside, my shame was steepening. It was very upsetting. I felt like not good enough or less worthy, and so it took a serious toll on my mental health where it was causing a lot of anxiety because then when I was out in public or doing things for my work, I was very concerned about how I was going to be perceived.
ANNA VAN DINE: Do you feel like being a woman affected that in any way and being a black woman? Do you wanna talk about that?
QUANA MADISON: So my experience of, um, living with and managing and getting support, uh, uh, as someone with chronic pain has, uh, been complicated by the fact that I am a woman because women are historically not believed, um, with pain and are often undertreated for pain.
But as a black woman, then there's all the unconscious bias around old, old beliefs that still are pervasive and problematic about black people's skin being tougher. Black people don't experience pain in the same way. That's led to being undertreated or just being dismissed outright. Um, if I ask about like pain medication for something I'm legitimately experiencing, I'm more likely to be assumed that I am drug seeking just by even talking about my pain.
So it definitely, being a woman, being a woman of color has affected me also. I identify as being queer, and I identify proudly as being a person who's living with disabilities and because of those disabilities, like that can complicate things, and I have definitely experienced insensitivity to that. And as a queer woman.
Uh, there have been times where it was really clear that I was working with a practitioner that was not comfortable with that, and that impacts your care. And one of the reasons I moved to Denver was because I knew it could be safer for me with getting medical care. And so I, I'm happy to say now I feel safe like that, but that's not the case in all places.
ANNA VAN DINE: As you're in your thirties and dealing with this more and more, how are you internally managing your experience of pain at this point?
QUANA MADISON: Honestly, I feel like I went a decade of not managing well internally, where there was times where I was experiencing substance misuse. Drinking a little heavier doing things to try to numb out those feelings of pain.
But also I didn't realize that I was experiencing major depression. And it wasn't until my depression started to lead to feelings of being suicidal multiple times that I eventually ended up seeing a, a mental health professional to basically had a much more holistic, integrative approach to pain, understanding pain and pain management.
And he brought up for me that you know, if you have chronic pain physiologically you are automatically going to have anxiety and depression. And this particular specialist was from Hong Kong, had trained in Hong Kong, India and in New York City, and was pulling from a lot of different cultural worldviews around integrative health, holistic health.
ANNA VAN DINE: What kind of work did you start to do at that time?
QUANA MADISON: At that time, a big change was understanding and learning more about how depression and anxiety from pain impact your body's chemistry and understanding why certain medications. Can be fitting for certain folks depending on what's going on. And in my case, antidepressants, anti-anxiety medication was like life changing for helping be one of the tools, not the cure all, but like one of the tools to rebalance me and help me better cope with.
The constant pain signals. And then this particular practitioner from Hong Kong, he had me read a book with him. So part of being a patient with him was reading a book about understanding how pain works in the body. And through that education, when we meet for sessions, we go over what we read. And I learned about how anxiety and like my thoughts around my pain can also have an impact on the physical pain signals, so that the, anything I can do to try to stay, um, calmer to reduce stress and change my stress responses can support me with managing my pain.
And so that led to lifestyle changes, and he really helped me understand the idea of stop chasing the cure. And ex practicing acceptance of what you're experiencing. Unfortunately, it cannot change. But by practicing acceptance, then we can focus on prioritizing what's most important to me in my life and deciding, all right, what things are you gonna have to cut or what things can you change?
That type of, uh, framework of thinking. Really continued to impact me as my pain conditions got more complicated through my thirties and into my forties, and so it led to decisions like changing my career or changing the type of jobs I can work and how I work. One reason I became an artist is because I, it was one of the only things that I could do that helped me not just experience joy, but it was something that did not hurt my body.
Um, because unfortunately like teaching and trying to do the labor involved with that was not conducive and would often cause more pain to make me more sick.
ANNA VAN DINE: This is Peace Talks Radio. We're hearing Quana Madison share her experience of finding peace while living with chronic pain. And this is something that's easier said than done.And after many years of living with chronic pain, Quana eventually began to not only start living with it within herself, but to do so publicly in the capacity of an advocate. I asked her how she managed to make such a monumental shift.
QUANA MADISON: It took near death to help me make that shift. After having hysterectomy and an ectomy for cancer previ treatments, I had a complication happen where I had something called a vaginal dehisce and evisceration happen where the surgical wounds internally spontaneously opened up like well over a month after the procedure, and I bled out nearly to death.
And I had a very powerful outof body experience when that happened and after that experience, it really hit home for me that if I wanna live, I'm gonna have to do, make sure everything I do is in alignment also with my body and trying to integrate my. Physical body, my mental body, my emotional body, my spiritual body, and my communal or environmental body to be all in alignment together.
And that. Really made me go, okay, I wanna live, so what am I gonna have to do? And so moving forward, I was going to have to find a way to be compassionate with myself to find inner peace. And that's when I really became dedicated to the practice of inner peace and exploring what that means for me in my life, and seeking out what ways or what practices can help me.
With that, and I feel really blessed that I have come out on the other side as someone who was suicidal before. With this, with living with my pain and feeling so depressed, I feel now like a bright light, like within my myself and in my ability to shine out and like I didn't know that I could experience that and that I could get to this space where.
Practicing peace, having self-acceptance, being able to manage and have the support can really allow me to experience a level of joy and happiness that is holistic.
ANNA VAN DINE: How does chronic pain fit into peace for you?
QUANA MADISON: I feel like my chronic pain fits into peace by reminding me. About this concept of suffering.
Oftentimes, any of us at any given point can be suffering, and in the same ways of how I felt shame or stigma about my pain, I think people can feel that too about their own suffering. And feel alone and isolated when wanting to seek peace, let it be. It's in themselves, in other relationships, in their community, the world.
And so I try to use my pain as that metaphor and to recognize I may not be able to cure the suffering. But there's things that I can do or that we as people or society can do to help people not be alone in their suffering and to seek to take actions or use tools to manage it. And if I can bring that peaceful presence that might help that person, um, experience that and be able to share that with others, um, I like the quote.
The Buddhist quote, one candle can light a thousand more candles, and the life of that candle will not be shortened. You know, happiness never decreases by sharing it. And so that was actually a poster and a message that I would stare at when I was bed bound, and sometimes in my worst pain fits. And just focusing on that and being like, you know, I've had other people be lights to me to light hope in me, to light peace in me when I could not hold that hope candle or peace candle.
And now that I can, I try to go, how can I light that? And others, like others, have lit for me when I felt like I could not hold peace for myself. And so that has, yeah, definitely has led to a very profound shift in my beingness and how I try to live my life every day.
HOST: That was Quana Madison, an artist and chronic pain advocate based in Colorado speaking with correspondent Anna Van Dine.
If you or someone you know is struggling or in crisis, there are people who can help call or text the National Suicide Prevention Lifeline at 9 8 8. You can find out more information about management of chronic pain, more about Quana and all of our guests from today's program@peacetalksradio.com, support for Peace Talks Radio comes mostly from listeners like you.
Also from the Albuquerque Community Foundation Ties Fund. I. Jessica Ticktin is our supervising producer, Nola Daves Moses, our executive director, Ali Adleman, composed and performs our theme music for correspondent Anna Van Dine series Co-founder Suzanne Kryder, and our whole team. I'm Paul Ingles. Thanks for listening to and for supporting Peace Talks Radio.
