On pain and how to handle it

On the morning of Saturday, March 15, I woke up to shooting and stabbing pain down the right side of my neck, upper back and right arm. The pain encircled my ribs and was literally breathtaking.

I figured I must have slept with my neck in a funny position and a little massage would relieve it. But there was no part of my neck and back that my visiting friend could touch without eliciting a howl from yours truly. So I called my acupuncturist and bodywork specialist Steve, who was kind enough to accommodate me on short notice. Although the session gave me some relief, I realized that this was a different beast than a simple stiff neck.

Eventually, I found an experienced physical therapist/bodyworker based in San Rafael named Al Chan, whose deep knowledge of anatomy combined with his iron paws (I call his technique “Ow now, wow later”) helped put me on the mend.

This article is not about the clinical course of my ailment, though. This is about pain – where it comes from, how to deal with it, and the unexpected gifts it brings. Here’s what I’ve been learning.

1) Psychic pain and bodily pain are connected.

When the pain came on, there was no clear physical reason for it. I hadn’t been in an accident. I hadn’t twisted my neck or back in yoga class. I hadn’t fallen off a wall doing parkour tricks.

But I had been dropped on my head, metaphorically speaking. The girl I was dating, who I had felt was closer to me than my next breath, had stopped calling or returning calls for 9 days, and the uncertainty gnawed at me. Was she okay? Had I done something wrong? Were we breaking up? In the unsettling silence, there was no way of telling.

I recently read that uncertainty registers in the same part of the brain as somatic pain, so I wouldn’t be surprised if the heartache had precipitated the neckache. Or maybe by giving me real oh-my-god-can’t-move pain, the body had given me something to distract me from the potentially more debilitating psychic distress.

In any case, the combination of the two was a lot to handle. This brings us to…

2) Surrender to the pain.

When a nerve root is inflamed and muscles decide to spasm and pinch nerves, there’s not a whole lot to do besides accepting the situation. Sure, you can take some painkillers and muscle relaxants (more on that later). But if the pain ain’t going away, you only make it worse by trying to resist it. That’s how pain turns into suffering. Feeling sorry for yourself, “why me” and generalized whining directed at the injustice of the world does not help either.

The only solution: surrender to the pain completely. There you are, pain. I see you. I feel you. I’m awake at 4am again because of you, and I accept that. You’re making it difficult for me to focus on this book I’m trying to read, and that’s alright, too. We may not be friends, but we’re not enemies, either.

Most people don’t get to (or like to) practice surrender very often. We’re so accustomed to using our mind as a battering ram against the world’s problems that sometimes, we don’t realize that the mind is the problem. Pain can be a catalyst to letting the mind go for a moment and just practice being in the sacred state of now. And that’s a useful tool for your whole life, since there won’t be any time when it’s not now.

3) Use the pain as a means of increasing your empathy, compassion, and gratitude.

Except for a few rough patches, I’ve been blessed to live a pretty healthy, pain-free life so far. So when debilitating pain like this comes along, it whacks me upside the head like a cosmic mallet, as if to say, “Pay attention! There’s stuff to be learned here.”

For example, my parents are both in their 70s. I know my mom has all kinds of chronic pain that she doesn’t mention much, and my dad must have some aches of his own, too. And how about those people who are in chronic pain, for months or years on end? Back pain, lupus, cancer, parasites, migraines, arthritis, multiple sclerosis, diabetic neuropathy – the list is endless.

So now I have greater empathy for my parents. I call them more often, and ask about their ailments. If I can help through my doctorly ways, I do. If not, I listen. My pain gives me kinship with all others who are in pain, which widens my circle of compassion to include pretty much the entire planet – who hasn’t had pain?

Consequently, I’ve incorporated the Tibetan Buddhist practice of tonglen into my meditation routine. Basically, you imagine others in the world who are suffering, then draw their suffering into your body as a black cloud. Then you watch as you transmute the black into white in your body, then send it out back into the world as healing white light. It’s a powerful, heart-expanding practice that can make you a just plain better person. For more detailed instructions, I recommend Pema Chödrön’s tonglen description here.

The pain has also made me aware of the trillions of other blessings I do have – for example, the remaining 99.9999% of my body that’s working flawlessly. Lungs breathing through the night even though I’m unconscious? Check. Heart beating around the clock with no coffee breaks? Check. Immune system fighting off billions of pathogens every minute without sending me a 100,000-page progress report? On board. Digestive tract and mitochondria turning the pizza I had last night into life-sustaining energy? We’re on it, boss. Also: absence of every disease I learned about in med school; clean, drinkable water pre-heated for me to take baths in; pharmacies everywhere with drugs someone else has made for me; vast telecommunications networks that allow me to contact other human beings and ask for help if needed.

Gratitude is good.

4) Use pain as a catalyst for reordering priorities and getting stuff done – like, NOW.

When some people encounter trauma, they buckle, identify as victims and never recover. Others experience post-traumatic growth: over time, they end up in a much better spot than they started.

I’m starting to appreciate how this works: you’re hit by a cancer scare, a near-death experience or a bulldozer of a depression, and then you say, “Holy cow – life really is short! Better get my stuff in order. Like, IMMEDIATELY.”

I’ve realized that the convergence of body and mind both being pain-free and in perfect working order is a golden minute that needs to be celebrated – and put to good use. I haven’t written a real new book since 2009, and perhaps it’s time, world. Thanks for the wake-up call.

5) Treat the symptoms (without getting too crazy with the drugs).

I used to think that pain builds character (which is partially the topic of this article). Well, it does – up to a point. Then it just hurts. Treat the hurt.

There are excellent drugs to this end. Use them without abusing them. It’s true that pain is often communicating where the damage is. But once you know, the information isn’t as useful. Your writhing and moaning is not making the world a better place, so just take the damn Vicodin already.

6) Reach out to people and be as social as possible.

Innumerable studies show that people heal faster in the context of a caring community (and when they have a nice view of nature through their window). In fact, being in community all by itself is curative of countless ailments – read the New York Times article about The Island Where People Forget to Die if you haven’t already.

So if at all possible, be amongst people. Invite them over. Bribe them with chocolate. Let them ransack your wine rack. Yes, this will require that you suspend your invincible self-sufficiency, make yourself vulnerable, admit your need and ask people for their company. Do it anyway. I emphasize this because as a gregarious person myself, I only reached out to three people and had just one visitor. This is what Facebook’s for, kids – put out the flare and let people care. When their turn comes, you’ll be there for them, so why not let them return the favor in advance?

To sum it all up, I present to you this passage from Mark Nepo’s extraordinary Book of Awakening:

Seldom seen, growing along the ocean floor, the white-plumed anemone is a watery blossom. It is a white lace opening under tons of black, opening as if bathed in the sun, while so far from the sun. This is the trick to staying well, isn’t it: to feel the sun even in the dark. To not lose the truth of things when they go out of view. To grow just the same. To know there is still water, even when we are thirsty. To know there is still love, even when we are lonely. To know there is still peace, even when we are suffering. None of this invalidates our pain, but only strengthens our way back into the light.

That’s most of it. Thanks to Eckhart Tolle’s The Power of Now audiobook and Dr Rachel Naomi Remen’s Kitchen Table Wisdom for their uplifting companionship. I’m feeling much better now than I did 2 weeks ago. I’m not going to yoga class quite yet, but I’m sleeping full nights, getting out of the house, and my right hand is now functional enough to write this article for you. In the meantime, remember that you don’t need to be in pain to engage in empathy, compassion, gratitude and service. Now is good enough.

4 Comments on “On pain and how to handle it”

  1. Violet

    Dr. A! Glad to hear you are feeling much better, and wishing you continued recovery. Thank you for a very thoughtful and important piece. And hey – you didn’t say what happened with the girl who’d gone incommunicado for 9 days. Having been through that kind of experience a few times, i would really like to know how you handled that, what ended up happening, and if/when you’re up for it i’d be really interested in a blog post on what you learned from it all, how this experience might shape or change your advice to others on either side of that kind of dynamic…. Thanks for all you do, and be well!

  2. Ken

    Thank you for this article, and what a coincidence! I’m a healthcare provider who specializes in pain management. Just today I interviewed for a position at a cancer hospital that specializes in holistic, integrative medicine. I brought up some of these very same points. Glad you’re feeling somewhat better. Watch those Urdhva Dhanurasana if you’ve got neck issues!

  3. Dr. Liou

    What an insightful blog post! You might be someone who appreciates my free neck pain guide .pdf (downloadable on my website) in case this happens again. It’s not the typical cook-book advice.
    You seem to have the important energetic components covered – kudos! I also write a bit about all of this from a whole systems perspective here: http://www.stopeverydaypain.com