There is nothing as practical as a good theory….

Since I’m a used to be academic and a theory nerd I have taken time to really dig into the subject of pain research. I would like to provide you the basic theoretical insights I have gathered about the topic, if you’re not into theory you can just skip this section and wait for the next post.

What is pain? For a long time, pain was seen as a sensation produced by injury, inflammation or other tissue damage. This is the ’old’ – the Cartesian – understanding of how pain occur. Nociceptors – pain receptors in the tissue send information about damage to the brain and thus we feel pain. In this sense pain is a sound reaction preventing us from causing more damage by not moving or touching the place that hurts. This view, however, has come to be altered with progressions in pain research. We know now that pain is utterly complex and there is more to it then just the physical, structural aspects.

”While sensory input may initiate pain or other bodily awareness, it is not the sole, or even the dominant, causal mechanism” (Chapman 1996).

Physical pain is tackled from many different academic fields, such as neuroscience, psychology and physiotherapy. I also look into non research-based knowledge in the area of back pain; the topic has been adressed by alternative practitioners of therapeutic body techniques, such as yoga. Neuroscience, the science of the nervous system, focuses on nerves and nerve impulses, hence it concerns a rather high level of abstraction of the body. Physiotherapy, on the other hand, is more practice-based in its approach and concerns a lower abstraction level of the body. While the two fields produce different knowledge output, one is not more right than the other, they complement each other in a nice way.

There are two theories that really pushed forward our understanding of the causes of pain. The first one is the gate control theory from 1965. The neurologists Ronald Melzack and Patrick Wall showed, through a number of experiments, that non painful input closes the ’gates’ to painful input, thereby preventing pain sensations from travelling to the central nervous system (the brain and the spinal cord). So by creating other sensations in the body we may prevent the nervous reaction causing pain. It is generally believed that the gate control theory provides evidence of the psychological aspects of pain perception.

Ronald Walzack continued to work on the gate control theory, however, and later developed the neuromatrix theory of pain. Basically Walzacks insights came from studying phantom limb pain, reflecting on the fact that patients experience pain in a body part even though there is no body part there to feel. The neuromatrix theory of pain states that pain is produced by the central nervous system instead of the peripheral nervous system. Nociception, pain signals, travel from damaged tissue, via the peripheral nervous system, into the central nervous system. These are one part of what causes us to experience pain. The matrix, however, is made up of a network of neurons that consists of loops between the thalamus and the cortex, as well as between the cortex and the limbic system. Hence, pain is caused by this network, and by a characteristic pattern, the neurosignature, defining all the nerve impulses within the neuromatrix.

Does it seem a bit too complicated to grasp? In short it means that pain is in the brain more than in the body. Internal nerve impulses may be nociception – nerves sending signals about tissue damage. Nociception is an internal stimuli, it comes from within the body, just like an inflammation, a slightly irritable bowel, or stress. But nerve impulses in the neuromatrix comes from internal as well as external stimuli, that is, from changes taking place outside of our bodies as well as changes inside of our bodies. External stimuli could be we hear someone tell us we are strong, or weak, or maybe we read about someone having a strange and paralyzing disease that started out with a sore lower back. It could also be that we engage in some activity that we love to do and that makes us forget about the pain. Each part of the neuromatrix contributes to various aspects of the pain experience, the sensory, the emotional, the cognitive, motoric, behavioural, and conscious aspects of pain.

In short, pain is a nervous system condition rather than a structural, physical, condition. In the next post, I will look deeper into the causes of pain from a yogic perspective, how can we make sense of the complexity of pain and its connections to our general state of mind and all other things that provide inputs into the neuromatrix?

Hello back pain, my old friend!

Being a somewhat fit and healthy yoga teacher with a bendable body does not exactly add credibility in the field of back pain. Have I ever had a sore back? The answer is a clear and loud -yes! I have, and its been bad. But I’ve moved my way out of it (literally and figuratively) and I’d like to share what insights I’ve learned from the journey to becoming completely pain free (knock on wood!). Firstly, recognise that pain can be a great teacher. It’s not meaningless and completely bad to experience pain, at least seeing it as meaningless and bad might be an obstacle to becoming pain free. I’d like to think of the relationship between me and my back pain as the relationship between me and an old, slightly too traditional, a bit stubborn and hard-necked professor in a tweed suit whose standards are too high and who forces you to tie yourself in knots in order to prove yourself, but who you still hold on to because you know deep inside that he has a lot to teach you, even thought he can be a real idiot sometimes.

Important note: I don’t identify myself with my pain. I’m essentially pain free, the pain is just a visitor.

However, the first round of back pain happened when I was a teenager. I remember seeing a physiotherapist and being diagnosed with sciatica. That just made feel like an old lady so I didn’t make much of a fuzz about it. The second round of back pain happened when I was 22 or 23. It was a nagging, dull pain and a feeling of stiffness, to such an extent I feared my back would actually brake if I forced it to flex. I could not bend over to wash my face, brushing my teeth was a challenge and to put on my shoes, I had to lie down on one side and slowly try to pull the shoes on without moving my back. The pain was so bad I literally cried. (And just a parenthesis about how some people don’t really have a tradition of seeking professional help when shit happens, so to speak, I’m one of those people. Most people would probably, and rightfully, have gone to the hospital when putting on their shoes had them crying of pain.) The pain came and went for some years. At this time I was a member of a large gym chain and they would have a campaign where a chiropractor visited the gym, giving brief examinations for free. I signed up for one and the first thing the chiropractor commented upon was my way of sitting in the chair, ”do you always lean forward like that?” he asked. This was the first time I came to reflect upon how my posture and my way of moving affected my body. He also recommended some treatments and that I worked on building strength in my back and in my abdominal muscles. I did and eventually got pain free.

The third round of back pain started when I was in my thirties. This time I had a regular yoga practice, I was doing weight lifting at a gym and I had developed a huge interest for anatomy and movement. During the second round of back pain I was really suffering from it, this time the suffering was not as bad, even though the pain was. Like someone wise once said: pain is inevitable – suffering is optional. I had learned so many things about my body during the years that had passed since the last time my back hurt and I believe that all that knowledge helped improve my experience of the pain. (It is scientifically proven that knowledge about pain helps aiding pain.) Also, I acted straight away in a desperate ”if I cannot move I’m gonna die!”-kind of fashion. I went to see a regular physician at the health centre, I went to a physiotherapist and a naprapat. The physician performed an x-ray and compiled a letter saying he did not recommend surgery in my case. The physiotherapist gave me some excercises to find stability in my core. She also taught me about the important difference between hyper mobile people and stiff people, more on that in a later post! The naprapat did some adjustments and suggested that I had a bulging disc that I could try to treat by bending my back backwards and slightly to the right. It all made sense, and I dare to say that all of it (except for the physician) helped in some way, yet nothing took the pain away completely.

In retrospect, and now that I know how to work it away every time I feel a little nag in my back, I can see that the most important features of my last round of getting well from back pain was my fearlessness and my wish to learn everything about pain. The second round I really thought my back was seriously hurt and that forcing it to move would most definitely be dangerous. The last round I was more into experiencing, I did quite intensive backbends and tried to bend and flex my back in every way possible, assured nothing was going to break, so to speak. I’d like to explore the theme of fear in relation to pain a bit more, but first we’re going scientific. The next post will be about what science has to say about pain, look for it tomorrow!

How to feel grateful when people mess with your life

Sometimes a person enters your life and arouses some kind of disapproval in you. A coworker, maybe your boss, a friends friend, an officer at some authority you have to deal with or someone else who comes into your life. Sometimes we’re all going to encounter people who raises unpleasant feelings of frustration, irritation, anger or something else in us. Now, here’s the thing, you can choose to try to avoid those people and the emotional response they spur in you, or you can treat your interaction with them as challenges that you need to find your way through in order to grow as a person.

Because people which we don’t approve, and who awaken negative emotions in us — are always here to teach us something.

It’s a perspective, to see every adversity, including exasperating people, of life as challenges that you have to solve in order to grow as a person. Its a perspective that I choose to adopt because it makes life more interesting, and easy to cope with. I gives a sense of meaning to the difficulties I face and I like that sense of meaningfulness.

When we run into someone and discover that we just can’t stand that person, there is often a logical explanation to it. Maybe it could be that she or he has some attribute that we also have, but that we are not so proud of. Or maybe something about her or him raises envy in us, envy that we hesitate to acknowledge in ourselves. (Have you ever disliked someone because he or she takes up too much space in social contexts, when it’s really about you wishing you had the courage to take up just as much space?) Maybe the person reminds us about something that we have neglected in ourselves for a long time and that we begin to long for or begin to realise that we need to pay attention to.

So this is what happened to me: a while ago I crossed path with this person who annoyed me so profoundly. She was horrible, although I couldn’t put my finger on why. Not knowing what she aroused in me, I tried to behave in a way so that our interaction would be nice and smooth. We met in a context where we more or less had to spend time together and stay really close. And, naturally, being a nice person I tried to make her feel good in my company. At the expense of my own wellbeing.

Outwardly she was a nice person, she was extremely enthusiastic to spend time with me, assuring me over and over how happy she was that we had met. She was also a bit of an over sharer, in contrast to my own general unwillingness to share personal stuff with people i don’t know well.  She told me about the hardships she had encountered in life, and somehow I felt that I also had to share such things. The first days I really went all in trying to be on her emotional level. I tried to make my voice sound as enthusiastic as hers when I assured her I was also glad that we had met and that yes, maybe, we would become really good friends.

After three days I had a constant gripe in my stomach. I began to avoid her. I went out without telling her where I went because I felt such a strong urge to spend time alone. My behaviour naturally made her a bit suspicious and I tried even harder to be on her level and create a nice relationship between us.  I also explained that I was an introvert person and that I just needed some time on my own, which she of course accepted. But still it didn’t feel right in my stomach. When the two of us reached the group of people we were going to spend some time with I was in a state where I couldn’t even look at her without feeling sick. The mere sound of her voice sparked shiverings of anxiety through my body. And I really tried to figure out why I didn’t like her when she had liked me so much and had really tried to befriend me.

Then, one day, a read something about boundaries. Slowly it became clear to me that I had spent time with this woman without a single boundary to protect my soul, my inner self. I had torn every boundary apart just to try to please her, and still I hadn’t manage to create a well-functioning relationship between us. Because she didn’t respect me. She didn’t respect that I didn’t want to share personal things with someone I just met, that I didn’t want to spend twentyfour hours a day together with someone whom I didn’t feel close to. And of course she didn’t, I never expressed how I wished our relationship would be. Instead I was completely boundary-less and deprived of all senses of integrity and self-worth. I never told her that I didn’t want to hear about her difficult childhood, that I didn’t want to talk about such things, that I wanted us to be the strangers that we were, until – maybe – we found that we could be friends. I didn’t tell her anything but tried to be nice and stay out of her way.

It had never occurred to me that I could be a person with boundary problems, and I really did not see myself as a person without integrity but it gradually became clear to me that this was precisely who I was. Starting to review my past relationships I realised that this was a pattern. I was often offended by the way people treated me and I never ever did anything about it. I just swallowed everything in some kind of misguided sense of mindfulness. I wanted people to feel good in my company to such an extent that I ignored my own wellbeing. And I had been completely unaware that it was like that. As time went on I came to feel grateful to this terrible woman who exposed me to her own emotional turns and obvious need for a close friend. She was like a torch who illuminated the relationship problems I needed to work on. I couldn’t have dreamed of a clearer lesson about how bad it is not to respect your own boundaries.

So, terrible woman, thankyou for entering my life to shine a light on my own relationship failings. Thankyou for making it utterly clear to me that I have to work on expressing my boundaries in relationships.

Recognising that you have something to learn from everyone who spurs negative feelings in you doesn’t mean you have to start liking them. It means you have the possibility to feel grateful to them, instead of feeling frustrated, irritated and angry, and that is the real beauty of the perspective of seeing every obstacle in life as a lesson. Because you deserve to feel good, you deserve to feel grateful, you deserve to develop your inner self and to protect your soul from the stress of feeling bad because someone treats you wrong.

And if you want to read more about setting boundaries in relationships, this article provided some insights to me: