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These days, it is hard to remember what it was like to be in
pain day after day for over 2 years, yet I did experience
this. How much harder it must be for treating practitioners, co-workers,
employers, and loved ones to understand the experience
of chronic pain. I hope this brief account of my journey with chronic
pain will shed some light on the experience for those who have not
had chronic pain.
Surgery
It all began in 1984 when I developed severe
neck, shoulder and arm pain. For the preceding two months, I had
experienced
pins and needles down my left arm following certain movements of
the neck. Two weeks after the pain started, and treatment had been
unsuccessful, I was hospitalised because the pain
was so intense. A GP had manipulated my neck, a physio attempted
to use
traction, and I had several nights with morphine injections to
get some
sleep. When I was admitted to hospital, the neurologist
said that I would
need to have a test called a myelogram in which a
dye is injected into the cerebrospinal fluid. We were shocked to
hear that
the myelogram and CT scan were abnormal. The neurosurgeon's diagnosis
was a neurofibroma (a type of tumour), and the neurologist's
diagnosis, a prolapsed inter-vertebral disc or a
neurofibroma. It was a terrible
week as I tried to take in what I had been told and,
at the
same time, cope with a severe reaction to the myelogram. The surgery
was scheduled for a week later when I had recovered
from the myelogram. I had been told that the neurofibroma would make
me a quadriplegic
if it wasn't removed, and that the surgery itself
held some risk of paralysis. The morning that I was told this, I
lay in
bed
trying to comprehend the implications of this diagnosis.
I
had walked
these wards as a physiotherapist about 15 years before.
The roles were now reversed as I was the one in bed and I had been
told I might not be able to walk out of the hospital.
During the week prior to surgery I could not absorb
the full implications of what I'd been told, because
I was
so ill after
the myelogram.
Fortunately, it was a prolapsed disc, not a tumour,
and the surgeon was able to remove it. I recovered,
much
as expected,
over the
next few months. I had a lot of attention from friends
and relatives, and was very relieved to have had
the problem diagnosed
and cured.
The surgical procedure of Decompression alleviated
the intense pain, and the post-operative pain subsided
over
the weeks following
surgery. I returned to a completely normal lifestyle,
carrying heavy suitcases through Europe the following
year.
However, eighteen months after the surgery when I
returned from a conference in Europe, I had a car
accident.
I was hit from
the rear as I waited to do a right-hand turn. The
following day, I
was a bit stiff and sore but I thought that the damage
was minimal. It was only a week or ten days after
the accident,
that the neck
pain became strong. As the weeks passed, it became
worse and worse. I was often tearful and I seemed
to find it
more and
more difficult
to cope. Then, my understanding about injuries was
that they gradually improved but this turned out
to be the
opposite;
my condition deteriorated
as the weeks passed.
Beginning the journey into chronic pain
A month after the accident I returned to
the neurosurgeon as the pain had not subsided. He recommended that
I wear a
hard collar
to rest my neck. The prescribed 2 months in the collar
seemed like an eternity, but after 2 years of pain, this
became insignificant.
There was a further shock six weeks after the accident
when I was
hospitalised because I had difficulty walking and
my balance was disturbed. The cause of this remained
undiagnosed,
and I left the
hospital ten days later confused and frightened.
I had 2 myelograms in one week and because these
showed
no structural
problems
that could be causing the difficulties with my walking
and balance,
the condition was called “hysterical”.
It took some time for my normal walking pattern to
return, and
once I started
to get about and resume household chores, the pain
returned with renewed intensity.
The weeks, and then months, passed. There was more
bad news; my father had a brain tumour. It was serious
and
it could not
be fully
removed in the surgery. Daily visits to the hospital
over the next two and a half months brought back
memories of my surgery,
and
my hospitalization following the car accident. Dad
had radiotherapy but he did not recover and he died
just
two and a half months
after surgery. My pain was unrelenting and my life
gradually collapsed
around me. It is difficult to recall now just what
it was like but I started a book whilst I was recovering.
I wrote about
one day when I attempted to prune the fuchsias in
the hanging baskets
in my backyard. The garden was one pleasure left
in life,
the pleasure of watching plants growing and flowers
blooming. I
spent just ten
minutes pruning the branches of the fuchsias, and
had to lie down for 2 hours to recover.
Seeking solutions
I had suspended my PhD candidature
and I attempted to continue my part-time studies
in psychology to
keep my
mind occupied.
I had followed instructions to rest my neck, but
there was no improvement,
and therefore I began to explore other avenues such
as meditation, acupuncture, physiotherapy, and a
pain clinic.
There was a
9-month waiting list for the pain clinic and even
if I didn't have chronic
pain when I applied, I certainly did by the time
I entered the program. There was a six-month wait
to
see Ainslie
Meares, a
psychiatrist (author of “Relief without Drugs”).
He had ceased his practice of psychiatry and hypnosis
and had become a meditation
teacher, assisting people with cancer, anxiety and
other disorders to develop peace of mind.
Physiotherapists attempted to mobilise
my neck week after week, and my arm pain increased. The waiting
period for
acupuncture treatment
was 6 weeks and this seemed like a long time. I went
along not
expecting pain with the needles (How could I possibly
experience more pain?) but after insertion of needles
across the back
of my head, down my neck, down both arms, and down
my back, I wondered
whether I would return for a second appointment.
I did, and I learned
to relax as the needles were inserted. I did not
experience dramatic relief, and I had not been promised
this.
There was some reduction
of pain in my arms, and at least I felt I was doing
something to deal with the problem.
I commenced a meditation course
at the Council of Adult Education, but had such difficulty
sitting
through
the class that I gained
little benefit, until the final session, when we
lay on the ground to meditate. I began to catch glimpses
of what meditation
could
bring. I am still meditating, and still discovering
more.
Fourteen months after the accident, I was accepted
into the program at the pain clinic.
By this time, I had experienced
severe depression;
anxiety about my future, the lack of diagnosis and
treatment, and my failure to recover; anger with
myself for failing
to
get better,
and with the doctors for their inability to help
me; and loss of self-esteem. I had begun to doubt
myself
- perhaps I was
imagining it, was I going crazy? Was I a malingerer?
But why should I malinger?
No-one had told me why I still had pain saying it
was just a soft-tissue
injury.
At the pain clinic, they seemed to understand what
I was experiencing and the assessment was extensive.
I
saw the doctor, physio,
OT, and psychologist. It was really important to
have the support of their understanding and experience
but
I still needed to
learn
the lesson about taking charge and managing the problem
myself.
More complications
In the second year of my chronic pain experience,
I had further complications. I commenced a swimming
program,
and swam a kilometre
several times a week. Over the subsequent weeks,
my right
shoulder gave me more and more trouble. Eventually,
I was diagnosed
as having a winging scapula, due to paralysis of
Serratus Anterior (a muscle
involved in stabilizing the shoulder girdle). Again,
the reason for this was never established and it
is only after my own
research
and experimentation that I now understand how this
happened. I have been able to put this understanding
to good use
in the courses
that I teach.
Taking charge of the problem
It was during this year that I began to take charge
of the problem; I realised that it was up to me.
An essential
part
of recovery
was developing a belief that I could heal myself.
This belief grew after I had attended a retreat with
Ian
Gawler who had
recovered from advanced cancer. He was an inspiration,
and I felt I must
be able to find a way to recover from chronic pain.
This was one of the major turning points. The feeling
began to grow stronger that I could find a way out
of this pain.
I refused
to contemplate a continuing life with pain. I wasn't
going to just “learn
to live with it”, a favourite expression amongst
some of the specialists.
My exploration led me to
discover the benefits of massage for
relaxation, and deep tissue work for
releasing
connective tissue
and stiffness,
and therefore pain in the long term. I began to use
the Feldenkrais method,
both “awareness through movement”, using tapes
and attending classes, and “functional integration” with
a physiotherapist who was training as a Feldenkrais
practitioner. This was one of the most helpful methods
I used, and I
still find it very beneficial. I also had some lessons
in the Alexander
technique which were helpful. TENS (Transcutaneous
Electrical Nerve Stimulation) provided great relief
in the short-term.
I
saw a psychologist who
helped me make sense of my experience and began to
put my fractured
life back together and I was able to release anger
and depression with a somatic therapy called Radix.
It was a slow and painful process as there was more
pain involved in getting beyond the pain. I realised
I had
to move my neck
and body, regardless of whether it hurt, to slowly
restore mobility and strength, and release patterns
of spasm
and tension. Even
though
it was slow, the conviction that I would make it,
seemed to grow.
Another significant turning point was my return
to work. I felt that I was
again going somewhere in life. It was
a new
career
as a rehabilitation consultant, and I had to let
go the disappointment of not finishing my PhD, particularly
since I was ready to
begin writing my thesis. The increase in pain on
returning
to work
was
offset by the feeling that I was doing something
for someone else; I was being useful again and I
had a
future.
Unfortunately,
it
was many months before the pain subsided significantly,
but I felt very different as my confidence returned
and my life
became
normal
again.
Recovery from chronic pain was about reconstructing
my life, believing in myself and my capacity to heal.
I
discovered that
no-one could
remove my pain and put my life back together for
me.
I had also discovered that traditional medicine had
little to offer me. I had to break free from the
idea that there
was a
specific
diagnosis and cure. My faith in medicine was shaken,
and I had to find another way of approaching healing.
This involved
working
with the various therapists and doctors in partnership.
They could not hand out simple solutions, instead,
I had to develop
new skills
and new ways of approaching life and health.
From my experience of pain, and working with many
clients since, I have learnt a great deal about healing.
In
this approach,
there are no simple prescriptions and the solutions
can only evolve
over time as the practitioner/s, and person in pain
work together. However,
the person in pain is the most important one in the
partnership, as he/she needs to take charge and actively
search for
a path out of pain.
I also learnt that rest
does not cure chronic pain.
Pain should not be the guide as to when to stop activity
and
movement,
something that many physiotherapists and doctors
often recommend. I found
that pacing activities was important and that rest
alone was disastrous. In subsequent years I have
seen extreme
cases of
the damage that
prolonged rest can do. One client was told to rest
his arms to recover from RSI and he took this literally,
sitting in
a chair
all day, using his arms for less and less as the
months went by. When I saw him, he could not dress
himself,
pull up the
bedcovers, or feed himself. He was having great difficulty
walking and standing.
Several days later he was diagnosed as having a deep
vein thrombosis. When he was admitted to hospital,
he
could not press the buzzer
by his bed.
Many years after this experience
I can look back and see that it was an opportunity
to change myself
and
my life
in profound
ways.
It changed the direction of my life and set me on
a path which has led to much satisfaction. It allowed
me to
bring together
the different threads of my professional training
and
put them to good
use in my work. It has not only changed my career,
but my outlook on life as well. I keep myself pain
free by
doing the self-management
program that I teach. I have been delighted to find
that, in spite of significant degeneration in the
neck and
low back,
I have good
mobility, probably better than average for my age,
and can work long hours at my computer and lift quite
heavy
things.
This has
been possible through the combination of activating
and strengthening my low back and shoulder girdle
stabilizing muscles, and learning
how to release holding patterns and muscle tension.
The
secret is to enjoy the relaxation and exercise, both
the aerobic component
and the floor routine. I don’t need lots of
equipment, just an exercise ball and my walking shoes.
It is a simple
but successful
approach to long-term management.
Click here to
read more in the article “Rosemary’s
Reflections on Working with people experiencing Chronic Pain”. Top
of page
When I left school I trained as a physiotherapist
and practiced physiotherapy for 3 years. It was then
that
my interests turned
to teaching, and, after completing a teaching diploma,
I taught in secondary schools for several years.
My interest in teaching
took me back to study Science and later to pursue
post-graduate studies in Zoology. While I was doing
my PhD in Zoology,
I studied Psychology. It was during my second and
third year
of the PhD
that I had the surgery and then the car accident.
I was unable to complete
the PhD as the break from my studies was too long,
and I was drawn back to working in health care but
this time
as a psychologist
and rehabilitation consultant. Not surprisingly,
I became very interested in working with people experiencing
chronic
pain
as my car accident had set off a chronic pain cycle.
This experience of chronic pain became a turning
point
in my life, drawing
me
towards
Complementary Medicine and various therapies such
as the Feldenkrais Method, the Alexander Technique,
a
Neo-Reichian therapy called
Radix, and the practice of meditation. In my development
as a Psychologist I was drawn to hypnosis and later
to a body-centred
psychotherapy
called Hakomi.
Psychology And Psychotherapy
My own healing journey has strongly influenced my
work. Whilst practising in general areas of psychology
such
as Anxiety,
Depression, Relationships, Grief, and Stress Management,
I also specialize
in Self-Management of Chronic Pain and Trauma Resolution.
However, my greatest interest, now, is a depth psychotherapy,
called Hakomi, which can
be most helpful in working with physical symptoms
such
as chronic pain but provides a method for long-term
therapy with clients interested in self-study for
personal growth
and life-enhancement.
In my individual therapy I continue to use my basic
training in Cognitive Behaviour Therapy, when it
is appropriate,
and Solution-Oriented Therapy for specific problems.
Hakomi
Hakomi is a Hopi Indian word which
means
“How do you stand in relation to these many realms?
A more modern translation is “Who are You?”
Hakomi is a depth psychology which assists with self-exploration.
It was developed by Ron Kurtz in the mid 1970’s as the culmination of his previous study
in psychology, science and philosophy. The method is now referred to as Hakomi
Integrative Psychology indicating the integrative nature of the work. Unlike
many other branches of psychology which focus on the mind, Hakomi works with
the body, emotions, movement, postures, and gestures as well as thoughts, images,
memories, and dreams. It was previously called “Body-centred psychotherapy” to
indicate the focus on the body. The method does not involve bodywork
or any attempt to manipulate or change the body; it uses the body
as a way of accessing
aspects
of us which are outside our awareness or conscious mind. This is
one of its greatest strengths because the body can be a source
of information
that is
normally unavailable
to us. Work that may take months or even years in more traditional
talking therapies can frequently be done in less time. Depth psychological
approaches
do take time
because patterns developed in childhood are not changed easily.
Hakomi can be used for Brief therapy from one to ten sessions or
more, but is
generally
a psychotherapy
designed for deeper exploration of who we are.
Ron has been influenced by modern theories
and therapies as well as the traditional practices of Buddhism
and Taoism. The Taoist
concept of “going with the
grain” and the gentleness, compassion and mindfulness of
Buddhism are integral to the practice of Hakomi. Being a scientist,
Ron has incorporated
aspects of
systems theory and information theory. He has also drawn on Reichian
work,
Bioenergetics, Gestalt, Psychomotor, Feldenkrais, Structural Bodywork,
Eriksonian Hypnosis,
Focussing, and Neurolinguistic Programming. Click here to
find out more about Hakomi.
Trauma Resolution
Rosemary has also studied with the Hakomi Somatics Institute (now
the Sensorimotor Psychotherapy Institute) which has a greater focus
on
the body, and has developed
an approach to working with resolving trauma in the body called
sensorimotor processing. This approach to sequencing truncated
emergency responses
is very effective in working with chronic musculo-skeletal pain.
Whilst Cognitive-Behavioural
Therapy can be helpful in changing self-defeating beliefs related
to recovery, this work addresses the primitive responses to pain
that
are found in the
body.
With chronic pain these can relate to car accidents, injuries,
surgery, and childhood sexual abuse. This work can be valuable
for reducing
activation
(hyper-arousal/vigilance) and the opposite, a freezing response.
It allows completion of the truncated
emergency response by completing the unfinished sensorimotor sequences.
This hierarchical approach to resolving trauma works from the bottom-up,
completing
the physiological sequences before the emotional and cognitive
sequences. The higher level processing becomes much easier when
the physiological
sequence is
processed first or simultaneously. It seems to be a missing piece
in the chronic
pain work, explaining the difficulties people seem to have in learning
approaches to self-management and being able to move on in their
lives. Click here to
learn more about Sensorimotor Psychotherapy.
Hypnosis
I have completed the Australian Society of Hypnosis training and
the Diploma of Solution Oriented Hypnosis in Ericksonian or Indirect
Methods
of Hypnosis.
The Ericksonian methods, particularly, have had a strong influence
on my practice.
Meditation
My background in meditation has included
a one year meditation leaders training program led by Dr Ian Gawler
(author of “You Can Conquer Cancer” and “Peace
of Mind”). I taught meditation at the Melbourne Living Centre
for 5 years, and in my own practice for a further 5 years. My main
focus
now is Buddhist
approaches to meditation and I am particularly interested in the
ways that Buddhism is being
brought into Psychotherapy.
Physiotherapy
Although I no longer practice physiotherapy, I remain interested
in body mechanics, movement, and neurophysiology as it relates
to my work
with chronic
pain, trauma,
and body-centred psychotherapy.
Self-Management Of Chronic Pain
The self-management of pain program has evolved over the last fifteen
years and represents a synthesis of my training and personal experience.
The potential
for self-healing is often forgotten in this increasingly sophisticated
technological world. These courses help participants awaken their
own healing potential,
providing
them with skills for self-help and self-healing. During the course
participants learn to take responsibility for designing and practicing
their own programs
of relaxation and gentle exercise. They also learn how important
attitude is in maintaining their practices and healing themselves.
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