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- Herausgeber: Dolman Scott Publishers
- Kategorie: Ratgeber
- Sprache: Englisch
- Veröffentlichungsjahr: 2021
This book is about holistic strategies and techniques I discovered to keep me active and alert by reducing pain. It encourages you to focus on the things you can do and enjoy, such as playing and learning instruments, rather than what you cannot do.
I developed a Continually Growing Big Plan which included: healthy living and healthy eating; home treatments; physical and mental exercises; complementary medicine and other alternative treatments such as yoga, tai-chi, meditation, Positive Mental Attitude (PMA), relaxation techniques, pacing, activating endorphins and many more.
Attitude and self-awareness impact on how we deal with obstacles and pain; it is a twofold battle: physical and mental. Included are pointers on:
- PMA - Is the practice of continually searching to improve the current situation.
- Optimism - A willingness to make an effort; readiness to do something.
- Acceptance - Acknowledging your current situation, which may change.
- Resilience - Bouncing back from adversity and never giving up.
- Gratitude - Appreciate the good things in life, focussing only on positives.
- Determination - Being purposeful, tenacious and resolute.
- Open mindedness – Being receptive to new ideas.
- Lateral thinking – Viewing problems from a new and unusual perspective.
- Creativity – Being imaginative to create or change your approach.
- Investigative mind – Be willing to learn more about every aspect of your condition and what can be done to improve it.
- Decisiveness – Developing the ability to make decisions with confidence.
- Organised/Discipline mind – Developing the ability to reflect and control feelings and impulses. This attitude refers to a person’s self-management skills.
- Tolerance – Developing the capacity to endure pain by focussing on the above attitudes.
- Self-confidence – Developing all of the above will boost self-confidence and regain trust on your own abilities, qualities, decision making and judgement.
It is my greatest wish that this book inspires and empower readers to seek their own personal positive outcomes. The key is: Never give up!
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Published by BookPublishingWorld in 2021
Copyright ©Alvaro Graña 2021
Cover Design by Scott Gaunt
Cover Photograph by Alvaro Graña
Alvaro Graña is hereby identified as author of this work in accordance with Section 77 of the copyright, Designs and Patents Act 1988. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopy, recording or otherwise, without prior written permission of the copyright owner. Nor can it be circulated in any form of binding or cover other than that in which it is published and without similar condition including this condition being imposed on a subsequent purchaser.
ISBN: 978-1-8384967-5-3
BookPublishingWorld is an imprint of Dolman Scott Ltd www.dolmanscott.co.usk
Acknowledgements
Most of all, I would like to thank my dear wife Ingrid for her incredible support, understanding and patience during the last 24 years, the most critical period of my life when my condition was deteriorating more and more, both physically and mentally.
I would also like to thank the many doctors, nurses, physiotherapists, and other health professionals, who have helped me over the last 52 years since my sports injury. I would particularly like to show my appreciation and gratitude to Mr. Robert Hatfield, my chiropractor, without whom my life for the last 30 years would have been very different and much more difficult.
I wish to express my love and gratitude to Ingrid, who has spent a lot of time proof-reading my book, and for her patience and understanding, while I have been engaged in writing this book.
I hope many people will find this book helpful, but if it helps just one person in similar circumstances, that would be my greatest wish fulfilled.
THIS BOOK IS DEDICATED TO MY FAMILY.
I dedicate this book to my wife Ingrid, who is my rock, who always supports me in whatever I do, and to the rest of my family, my chidren Natalia and Orlando as well as my grandchildren Maya, Alfie, Javie and River. I hope that one day they will read my book and learn that though there may be problems and suffering in life we each need to face them not as problems but as challenges. I love you all with all my heart and with all my strength.
Foreword
This is the story of one man’s experience and his way of coping with pain over a 52 year journey.
The book reads as if Alvaro Graña is talking to the individual reader, relating his ups and downs, revealing his strengths and weaknesses alike; admitting not taking specialist advice too seriously at times, not persevering or giving up, demonstrating he and the reader are likely to have much in common. It is only when things become really difficult that he realises that he needs to follow medical advice more rigidly, and in addition take charge of his situation by doing his own investigations to find ways of helping alleviate his situation.
The author could be described as ‘the man next door’, he has no medical qualifications, and no prior knowledge of alternative/complementary healing methods or medication.
Therefore, this book is an invitation to fellow chronic pain sufferers to accompany him on his journey, a voyage of discovery, as he finds ways of confronting what would otherwise limit his horizons.
Alvaro talks about failures as well as successes, however it is important to remember that some process or method that was not helpful to the author, has indeed helped others, and viceversa.
The aim of this book is to encourage the readers to take charge of their own individual situation, and to find what works best for them, by pointing out shortcuts, describing what is available and what he has found helpful.
You will note that the reader is repeatedly encouraged to seek medical guidance before trying anything new, rather than ‘going it alone’.
On a personal note, I find this book very readable while crammed full of helpful tips and information, as well as some interesting anecdotes.
Ingrid Graña
Editor
Table of Contents
Acknowledgements
Foreword
Introduction Me and My Back Pain
Joint and Back Pain
• How can we define pain?
• Types of pain
• Words to do with pain
• How we respond to pain
Chronic Pain – The Gate Control Theory of Pain
• Vicious Spiral of Chronic Pain
• Types of medicine to manage chronic pain
The two types of sufferers
Pain Management
Things that you can do yourself
Things to avoid
Pain suffering scenarios
Causes of joint pain
Back Pain:
• The anatomy of the back
• Causes of back pain
• Persistent and chronic back pain
• Stress
The Way Forward – Treatments and Recommendations
Possible Solutions
1. Movement vs Inactivity
a. Movement and being active
b. The benefits of movement
c. Movement and blood circulation
d. Physical exercise
e. Other ‘structured activities’
2. Medication
a. Traditional Western Medicine
b. Complementary/Alternative Medicine
3. Mind and Body
a. Psycological Issues
b. Cognitive Behavioural Therapy
c. Mind Set – Positive Mental Attitude (PMA)
d. Acceptance of living with chronic pain
e. How to be more in control of your pain
– Controlled breathing
– Relaxation
– Meditation
– Pacing
– Resting
– Posture
– The Alexander Technique
4. General Health Recommendations
a. What your body needs
b. Stress Reduction Strategies
c. Stress may lead to Depression
d. My Continually Growing Big Plan
– Healthy Living
– Healthy Eating
– Home Treatments
Heat Treatment
Cold Treatment
– Activating Endorphins
What are endorphins?
What is the effect of endorphins?
How to boost endorphin release – Triggers
– Other creative/alternative solutions
5. Other Therapists and Health Professionals
– Chiropractic
– Osteopathy
– Acupuncture
– Other Cognotive Strategies
6. Summary of my Story
Appendices
General References
Websites
Useful Organisations
INTRODUCTION -ME AND MY BACK PAIN
I am writing this book in the hope that I will be helping people out there in the wide world, with similar problems to mine. I have been suffering with chronic back pain since my sports injury in 1961, later aggravated by arthritis in my joints in 2002.
There are many things I have learnt over the years, which I would like to share with you. Things I wish I had known earlier. But this happens in any scenario. In any case it is important to be positive and look forward.
There are many joint pain and back pain sufferers all over the world. I am one of them. It has been a long journey for me with my Chronic Back Pain caused by an injury to my lower back whilst playing basketball at the age of 16 (year 1961). This sport’s injury happened in Lima, Peru, where I was born. After my injury and for quite a while – I will call this period my first phase – I was seen by 2 orthopaedic surgeons from the Mayo Clinic, USA who were visiting Lima at the time. Their diagnosis was that I had broken two vertebrae in my lower back. Their prognosis was not good, medical science was not yet advanced enough for them to offer any treatment beyond a referral to a physiotherapist. They said that in the future surgery might be possible. They also warned me that my condition would deteriorate slowly and that in the worse case scenario I might end up in a wheelchair.
My sport’s injury happened whilst playing basketball. I was jumping to get the ball at the same time as a player from the opposing team also jumped causing a mid-air collision. I landed awkwardly on my hands and knees, and my opponent landed on my back. A number of people, including my coach, said they heard the sound of my bones cracking, which resulted in a long-lasting injury. During this phase just after the injury and right through the 1960s I was in constant pain. I was prescribed valium, anti-inflammatories and pain killers. The side effects were horrendous. I even became addicted to valium and it took me a long time and great determination to beat the addiction. I was on strong prescribed medication for forty years until I decided to try alternative solutions, which I will cover later.
In 1973 I came to England (London) to pursue post-graduate studies, I was living with chronic pain all down my spine and my right leg in spite of the strong medication. I will expand on this later.
The start of my second phase was when I decided to look into my condition in greater detail, though I still did not grasp the seriousness of my injury.
My advice would be not to leave it all to your doctor, take action, be pro-active and find out as much about your condition as possible. Speak to other health professionals, search books and the internet, and listen to other people who have experienced pain themselves and have discovered coping mechanisms.
From now on my personal experiences will be in bold and in a different font.
JOINT AND BACK PAIN
Joint and back pain account for a very high percentage of the pain experienced in the world. Joint and back pain can be under the umbrella heading of Musculoskeletal Pain. Symptoms can range from muscular spasms to inflammed joints. Nerve pain can also be experienced and it is characterised by aching – felt sometimes like an electric sensation (an electric current) running up your nerve, and a tingling sensation (a feeling of edginess). You may feel a stabbing or burning pain as well.
We are talking about pain, so let us address these questions:
– Can we accurately measure the various levels of pain people experience?
– Do we know how the brain works and responds to pain?
– Why is pain tolerated at different intensities by each individual?
– Does gender or age make any difference to how we feel and react to pain?
– What is a pain threshold?
– Can endorphins produced by our bodies be as efficient as a painkiller?
Let’s start with what pain is.
How can we define PAIN?
The International Association for Study of Pain (IASP) define pain as:
‘An unpleasant sensory and emotional experience which is due to actual or potential tissue damage or which is expressed in terms of such damage’.
Pain works as the natural warning system. It is a message sent from any part of the body to the brain (the mind) through our nervous system, to tell us that something is wrong.
Pain can be broken down into the following categories.
Types of pain
Acute Pain: The term ‘acute’ indicates a relatively abrupt onset with evident symptoms and limited duration. This can be caused by a physical event such as a fall, a sprain or break, as well as an inflammation or infection. Acute pain normally resolves itself as healing occurs.
Chronic Pain: This is long-term pain, unlike acute pain, which is normally temporary and disappears with time and treatment. Chronic pain persists after healing has occurred. Chronic pain is constant and nagging. There are many conditions which produce chronic pain including arthritis, gout, joint pain, and back ache, among others. This type of pain may be either constant or sporadic. It may be difficult to identify its cause.
Referred Pain: Referred pain is felt some distance away from its origin. Osteoarthritis of the hip, for instance, causes pain in the knee.
It is extremely important to seek professional medical advice if your pain persists or has no obvious cause.
Emotional pain: Pain is usually thought as physical, though emotional pain or mental distress can manifest itself in the body. This type of pain can be caused by being rejected, from bereavement, from problems with relationships, etc. One acute form of emotional or psychological distress is depression, a term that covers anything from feeling down and sad to extreme mental and emotional agony. Emotional or mental pain can manifest physically as a headache/migraine, stomach upset, ulcers or even muscle pain (through tension and stress) for example. The causes of these pains can include nightmares, fears, phobias, obsessions, and addictions to food, drink, drugs, etc.
It is important to recognise that long-term emotional pain can lead to physical symptoms as well as the other way around.
Words to do with pain
Describing pain can be very difficult. Here is a list of words that might be associated with pain:
Ache – Anguish – Misery – Suffering – Torture – Affliction – Agony – Discomfort – Pangs – Twinge – Distress – Torment – Wretchedness How would you describe your pain? These are some symptoms:
You might feel:
– a sharp pain
– a nagging pain
– a persistent/constant pain
– edgy (ie.: nerve pain)
– a stabbing pain
– a niggling pain
– a tight (stiffnes) pain
Pain can result in the following side effects:
– stomach ache
– constipation
– insomnia (difficulties in sleep)
– nausea
– dizziness
– lethargic/spaced out
– very low in energy/tired/exhausted
Describing your mood while carrying pain can also be difficult. These are some descriptions:
– Fed up
– Worried
– Anxious
– Confused
– Depressed
– Angry
– Embarrassed
– Very sad from feeling sorry for yourself
– Frustrated
– Introverted
– Aggressive
– Moody
– Impatient
Other nagging thoughts can be:
– Will the pain stop?
– Financial worries
– Will I lose my job?
– Sexual problems
– I am always loosing my temper
– Why me…?
– I used to be very strong and independent, now look…?
– What will other people think of me? Look at me…
– Will I end up… severely damaged?
in a wheel chair?
being rejected?
– Self-pity
Personal experince - I reacted to pain very badly with a negative response. I got very angry, had mood swings sometimes feeling sorry for myself allowing the pain to get me down. Right through my first phase I suffered from regular migrains, which were sometimes severe. I was not in control. In the second phase I began to realise how my mental state affected me physically. Talking about nagging thoughts, I experienced most of those mentioned above, including the thought of ending up in a wheelchair in the future, as mentioned by the doctor I first saw right after my injury. This could be described as the poor me syndrome. To summarise, right through my first phase (40 years, from 1961 till 2001) I suffered from regular lower back pain, pain to my sciatic nerve down my right leg, pain to my upper back and migrains. By 2001, I realised that I needed to be more self-aware and to devise a method of how to respond to pain, in order to feel in control of my situation.
How we respond to pain
It is difficult to establish why one person appears to feel less pain than another in similar circumstances. Pain perception is more likely to stem from a combination of factors which may include:
– the state of the individual person’s nervous system: This could be due to genetic make-up and/or degenerative consequences. Some people’s nervous system is naturally more efficient.
– the consequences of reducing health: Younger people are usually better able to deal with trivial injuries than the majority of older people. In addition to the general effects of ageing, some people become weakened further by chronic disabling illnesses or injuries.
– personality: Where people are of similar age and comparable health, inherent personality may be a motivating factor. People with strong will power, often try harder to conceal what they perceive as deficiencies, whereas other people tend to be more sensitive and less likely to disguise their feelings.
– circumstances: In extreme conditions a person with a focussed mind is often capable of blocking out unpleasant stimuli. An example of this is when soldiers in battle continue to fulfill their mission despite severe injuries, because of their overriding struggle to win and their survival instinct masks everything else.
Physical pain and psychological pain are very much linked together. One can affect the other. Many medical practitioners, both alternative and conventional are considering a wholistic approach as a more effective form of healing. This means mind and body being treated as a whole rather than as separate entities: the mind can heal the body and the body can heal the mind. For instance using a treatment of diet and exercise, and in addition adopting a positive mental attitude towards his/her living and working conditions, may diminish the symptoms of mental or emotional pain.
Our attitude to pain is absolutely crucial. A negative attitude may lead to extra tension, stress and unhelpful messages being sent from the mind to the body, which consequently aggravate the on-going pain situation. We need to accept pain and work with it, especially those who suffer from chronic pain. The ability to control our reactions, the response of those around us and the situation causing the pain will affect our tolerance to it. Knowledge and understanding could help towards our ability to implement Pain Management.
Personal experience - During my second phase I was not mentally strong enough to deal with chronic pain. My negative attitude did not help. I was not in complete control of my stressful life either. I began to realise that I had to juggle lots of things at the same time. Lets go back a bit, between 1973 and 1975, while I was a post-graduate student in London, I started to try different alternative solutions.
My GP referred me to St. Thomas’ Hospital. At first they tried Traction Treatment, which included some traction exercises for me to do at home. This was not successful. The doctors then tried epidural injections which were also ineffective. After these unsuccesful treatments they recommnded acupuncture which unfortunately did not help either.
Later I went to see a back specialist at East London Hospital. After a thorough examination and looking at my past history, he recommended specific physio exercises in order to strengthen my back muscles, rather than surgical intervention. At this point I was still hoping for a magical medical cure. Exercise did not seem to me to be a proper medical solution.
During these two years in London, I was not often in control of my pains and mental state. When I practiced pain management I was more in control of my life in general, while at other times, when I allowed pain to take over, the pain was more intense. It is possible to endure chronic pain without being controlled by it. It is a matter of knowing how to minimise the pain, knowing that “pain can be let in the gate”, as the scientists Melzack and Wall found out.
CHRONIC PAIN - THE GATE CONTROL THEORY OF PAIN
In 1965 two scientists, Ronald Melzack and Patrick Wall, carried out research into pain systems. They proposed that the Gate Control Theory of Pain offers a physiological explanation for the previously observed psychological effects of pain perception.
According to this theory there are ‘gates’ in the neuromuscular junctions, the spinal chord and the pain centres in the brain. When these gates open and let the message through the system, we feel pain. The gates can also stop messages entering the system, so that the pain is reduced or not felt.
In the 1970s, it was discovered that the body can make its own opioid-like substances called endorphins (we shall expand on this later on), which can reduce pain by acting as a pain-killer. Codeine and morphine for instance contain pain relief substances found in opium poppy seeds. Morphine attaches to the same receptors in the brain as endorphins. Endorphins can help close the gate. Researches believe that the body releases increased levels of endorphins into the blood stream during and immediately after exercise. These endorphins became the popular answer to anything that gave pleasure, such as regular sex, masturbation and orgasms (more on this later on).
As most chronic pain sufferers know, there are no treatments that can eliminate pain completely. However, according to the Gate Control Theory there are other ways to close the gate, for example:
– Pain relief medication
– Physical activity – walking, playing a garden game, swimming, etc
– Pacing activities – doing ‘something’ in stages
– Relaxation – meditation, slow deep breathing, relax tense muscles, etc
– Distraction – playing a board game (ie,: chess, cards, etc.), engaging in a hobby (painting, drawing, etc), watching a good film, etc
– Addressing stress and worries
– Sitting in a jaccuzi
– Having a warm shower
– Talking to a friend
– Reading a good book
– Interacting with other people – socialising
– Being positive and optimistic
More on these later on.
What opens the gate?
– Worry and stress
– Being moody and bad tempered
– Feeling fed-up
– Feeling down
– Moaning and getting angry
– Not enough sleep
– Staying in one position too long
– Getting frustrated
– Being bored and not enjoying life
– Focusing on the pain - Going round in circles thinking about the pain
– Thinking ‘why me’ and feeling sorry for yourself
– Being negative
Personal experience - In the late seventies and all through the eighties my constant chronic pain continued to increase. My condition was going from bad to worse as I wasn’t doing anything about it. I had not taken on board anything I had learnt and I started having severe pains down my legs (especially my right leg). In 1988, by which time I had moved to Coventry, my condition was so bad that I went to see an orthopaedic Surgeon who recommended an operation to my lower back, to which I agreed because I could hardly walk 100 yards without having to stop for a rest. The consultant warned me about the odds: there was a 65% chance that I might end up the same or worse vs a 35% chance that I might find some unquantifiable benefit. I felt I had nothing to lose, so agreed to have the operation. The procedure was a fusion of two vertebrae (L5 and S1).
I was doing voluntary work at the time alongside looking after my 8 year-old daughter and my 4 year-old son. By then I was aware that stress affected my physical condition and aggravated my pain. I felt I was on a vicious downward spiral.
Vicious Spiral of Chronic Pain
As physical and psychological pain are very much linked together, here is a sequence of a possible downward spiral of chronic pain.
In this scenario the situation goes from bad to worse to completely out of control. It is a spiral rather than a circle. The aim must be to avoid getting into this downward spiral of pain.
Peronal experience – After my operation I had to spend 6 months convalescing at home with some physiotherapy and rest, gradually returning to a level of normality.
A year after my operation, I did a teacher training - PGCE course at Warwick University, which I completed in spite of my intense physical discomfort. The operation put me back to work, I got a job as a primary school teacher almost straight away so this might be perceived as a success story.
When I started teaching (1989-90) at Hearsall Community Primary School I did not take any medication other than paracetamol when required, but I found it very tough going. The work was both physically and mentally very demanding which resulted in constant lower back pains, and migraines and neck aches at times.
After my probationary year as a teacher I realised I needed further help with my condition. A friend recommended a chiropractor, whom I went to see (1991). After a few visits I began to notice my condition improving thanks to the treatment. I was going to my chiropractor every week to begin with, then booking appointments as and when necessary and was able to keep the pain under control for the rest of that year.
After a few years my marriage began to crumble adding another level of stress in my life, in addition to the stress from work. It eventually started to affect me physically and mentally and pain once again became more frequent and severe. My marriage ended in divorce, a very painful process. I continued in my determination not to take strong medication for a few more years until one day in 1999 while I was at work teaching 6-7 year-olds, sitting along side my pupils on a very small chair at an equally small table. At the end of the lesson I could not stand up, on a second attempt I felt a horrendous pain on my back and right leg and was unable to move. I was taken to the staff room by some of my colleagues but as I did not recover I was sent home. This was my darkest hour. Not even my chiro-practor could put me right this time, as he had done previously. I was unable to go back to work for the rest of that year and was on sick pay until it eventually became clear I had to retire on medical grounds in the year 2000.
