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Last year a disabled veteran came to see me for help with back pain. As we talked about his history, a familiar story arose. He got injured, experienced a lot of discomfort, was prescribed opioid painkillers, and became addicted to them. He described how his journey through his addiction treatment center and how, for several years, “I lost my personality and my life. I was barely a human.”
He lived in a numb haze, with no sense of humor or interest in anything, until a new doctor specializing in recovery treatment for all levels of addiction, finally recognized what was happening and began to wean him off these drugs. Much of the pain remained, but we were able to work on that. More importantly, he got his life back, and his friends and family got him back.
The familiar part of the story is the widespread long-term use of opioids and the unfortunate consequences. The uncommon part is that he got off of them. A 2017 study by the Centers for Disease Control called “Characteristics of Initial Prescription Episodes and Likelihood of Long-Term Opioid Use” looked at 1.3 million opioid users over 9 years.1 It found that the longer the initial prescription period, the higher the likelihood of long-term use. If someone used an opioid for 10 days, there was a 20% chance they’d still be using it a year later. At 35 days, the risk of yearlong use was about 45%. A 2014 study in the Clinical Journal of Pain came to a similar conclusion – the higher the initial dose and the longer the initial use of an opioid, the greater the chance of the patient developing a condition of abuse and dependence.2
It’s worth mentioning that both of these studies excluded patients with cancer pain (which is often expected to require ongoing medication, perhaps until death). That is, the great majority of those who were on opiates for several years were using it to manage back pain or joint pain (or to manage their dependency on opiates). Thus, we can assume that the prescribing doctors either didn’t know of an alternative method for pain relief or didn’t care. Do effective non-opioid alternatives exist? In the words of some ancient healer: Hell Yeah!
The first modality that comes to my mind, as you might guess from the story above, is acupuncture. Acupuncture is no longer a fringe therapy. Its effectiveness is well supported by clinical research (comparable to opioids in effectiveness3), it’s routinely offered by many hospitals in the U.S., recommended as a standard option for pain management by health systems around the world, and even adopted by the U.S. military (in a form called “battlefield acupuncture”) for severe pain.
If acupuncture has been unsuccessful at managing your pain, I advise that it isn’t always an instant miracle. Sometimes it takes several treatments to produce significant, lasting results. Also, practitioners vary in their specialties and level of skill. If you don’t experience any relief after a couple sessions, try someone else – and ask if they specialize in pain. Further, a licensed acupuncturist is almost always going to be more skilled and certainly has more training than a medical doctor or physical therapist who also does acupuncture.
While it’s great to receive acupuncture from a professional, it’s also useful to know how to utilize this system to manage pain on your own. Many acupuncture points can provide effective pain relief simply by pressing on them. Especially when traveling, or when needles weren’t available or practical, I’ve often utilized acupressure to successfully eliminate my own pain or that of friends and family. There are specific points for pain in different locations, though one of the most utilized for pain anywhere in the body is called Large Intestine 4, and it’s located in the muscular web between the thumb and index finger. If you press around in this area on the back of the hand, especially directing your pressure toward the hand bone that leads to the index finger (second metacarpal), you will find a tender spot. Pushing firmly on this spot while moving the painful area may alleviate your pain.
Mindfulness-based pain management techniques can also be very effective, and they have the added benefits of helping you live more in the present and experience more gratitude. These strategies were pioneered mainly by Jon Kabat-Zinn, and are based loosely on Buddhist meditation. There are numerous books and courses available in his Mindfulness Based Stress Reduction (MBSR) practice. The basis of these techniques is non-avoidance of discomfort – learning not to resist or mentally depart from the experience at hand, but to instead “turn toward” it and explore it willingly, whereupon it ceases to feel like suffering, and may even open us to a whole new dimension of experience.
Breathing is another vital practice for self-management of pain. How we breathe can profoundly affect both our mental state and the feelings in our body. I have witnessed people doing breathing exercises which, within a half hour, turned off pain that had persisted for decades. In a way, breathing through pain is similar to mindfulness techniques, in that we’re willingly bringing our attention to the experience. I feel that the power of the breath to reduce pain makes so much sense – it seems like an intelligent plan that we should all be equipped with the means to facilitate our own healing. In the most basic way, you can imagine that, with each inhale and exhale, you’re moving the breath – and energy along with it – through the painful area.
After years of teaching these and many other pain relief techniques to my patients, I decided to gather all my knowledge into an online course. In it, I teach a philosophy for understanding pain that will make sense and will illuminate your perspective of what’s happening. And I explain and demonstrate a huge array of methods for eliminating your own pain. As I was creating the course, in fact, the others who were involved in the project kept asking me, “How much more are you planning to include in this?!” But there are so many useful approaches, so many opportunities not just to overcome the pain, but to grow and evolve as a person, and that’s my real goal for participants in the course.
My greatest hope is to see fewer and fewer cases like that of my veteran friend – fewer cases of opioid dependence, fewer cases of pain relief at the expense of the joy of life. And more cases of people overcoming pain in ways that are empowering and even help them heal and awaken. If you’re in pain or know someone who is, check out the course. It’s called Live Pain Free. It’s affordable, and you’ll learn things you’ll use for the rest of your life.
Be well,
Peter
Let Me Teach You How to Erase Your Own Pain Without Drugs
Sources:
1: Shah A., Hayes C. J., Martin B.C. Characteristics of Initial Prescription Episodes and Likelihood of Long-Term Opioid Use — United States, 2006–2015. MMWR Morb Mortal Wkly Rep 2017;66:265–269. DOI: http://dx.doi.org/10.15585/mmwr.mm6610a1
2: Edlund, M. J., Martin, B. C., Russo, J. E., DeVries, A., Braden, J. B., & Sullivan, M. D. (2014). The role of opioid prescription in incident opioid abuse and dependence among individuals with chronic noncancer pain: the role of opioid prescription. The Clinical journal of pain, 30(7), 557-64.
3: Grissa, M. H., et al. Acupuncture vs intravenous morphine in the management of acute pain in the ED. The American Journal of Emergency Medicine, Volume 34 , Issue 11 , 2112 – 2116.
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We recently opened enrollment for this year’s life coach training program, which always feels exciting to me. There’s a buzz of activity as the new participants get oriented and we’re introduced to the next group of open-hearted individuals who are devoting themselves to helping others. First everyone goes through an eight-week program called Sacred Expansion which is kind of like “cleaning house” before we get into the details of how to help others.
Of the many topics we cover in the coaching curriculum, one that people often mention as being both incredibly basic and incredibly life changing is our relationship with agreements. Agreements can be seen as a primary tool of creation. Ideally, the process begins with getting in touch with the impulse to create – what is sometimes called “divine will” – and is informed by your life purpose. This way the effort comes with its own batteries, rather than draining us. Having a clear vision and setting a clear intention of what we want to create are also important.
When we then make an agreement (or agreements) in service to this intention – with ourselves, with others, with the universe – we initiate what my teacher Matt Garrigan called “a contract for fulfillment.” We engage the power of our word. And as we follow through on our agreements, momentum builds and opportunities arise. It never fails.
Except when it does.
The problem is, we often make agreements without any of the consciousness I described above, and then we consider it no big deal to break those agreements. While we might recognize, sadly, that what we intended never materialized, we often have a blind spot around the fact that we didn’t keep the agreements we made to support the intention. One of the things our coaches learn is how to bring clarity to this process for their clients (in a non-blamey way); it’s very gratifying for both the coach and the client. Not only does the client start achieving their goals, most importantly, they learn to trust themselves and their power.
Today I’m going to share with you a basic method for rebuilding the self-trust that’s diminished by broken agreements.
When we make agreements with others, most of us understand the consequences of breaking them. If you break agreements with your boss, you might lose your job. If you break agreements with your friends, you might lose your friends. If you break agreements with family, you might hurt their feelings and lose their trust. In all cases, a relationship will be damaged.
So, what happens when you don’t keep an agreement with yourself? It’s not so different, really. A relationship is damaged, it’s just harder to see. Let’s say you decide to work out every day for a month but you quit after five days. There doesn’t seem to be anyone getting screwed by breaking this agreement. Nobody is mad at you. Of course you’ll let yourself off the hook. But your self-trust is eroded.
If you forgot to pick up your child from school, you would probably make it a priority to regain their trust because you care so much about the relationship. But, chances are, you don’t do that when you break an agreement with yourself. You may be barely aware that an agreement was broken. This matters in many big and small ways.
If you serially break agreements with yourself – you don’t get things done when you say you’ll get them done, you don’t wake up when you say you’ll wake up, you don’t treat your body as healthily as you tell yourself you will – the material consequences are unfortunate, but small. The bigger consequences are things like not being able to count on yourself or giving up your big dreams for ones that are more “realistic” given your history. If you have a habit of breaking agreements with yourself, and now you want to do something big and important, your mind will have a lot of evidence to undermine you.
Here are four important steps for reestablishing self-trust.
1: Become clear about what constitutes an agreement and be conscious of the agreements you make. If you had a passing thought about washing the car and then it didn’t get done, is this a broken agreement? Well, you need to decide that (before it happens). I recommend choosing a format for making official agreements with yourself and sticking to it. If you want to make agreement with yourself to wash the car, you might think to yourself, “I agree to wash the car today,” or you might say it out loud, or you might write it down. Just come up with the terms for what constitutes an actual agreement.
2: Be forthright and clean with yourself. You know whether you meant something to be an agreement or not, and you can’t really hide from yourself. But we pretend to hide, keeping our agreements nebulous, by maintaining a cloudy mental environment. Did I say ONE more game of Candy Crush and then I’d walk the dog? I think I meant to say SIXTY games…Or, I know I planned to work out today, but what I meant was that I would work out unless something more important came up. Be honest. As you distractedly lift your two pound dumbbells while watching The Late Show, ask yourself, Is THIS what I intended when I agreed to work out every morning? Do your best. Think about the quality of participation a boss or client would expect of you, and deliver at that level to yourself.
3: Don’t make too many agreements, especially as you begin this process. If you wanted to get an estranged friend to trust you again after you missed five consecutive lunch dates, you wouldn’t start out by offering to edit their thesis, refinish their floors, and meet them to watch the sunrise every day for a year. You’d be setting yourself up for more damaged trust. Instead, you might ask them earnestly to give you one more chance at lunch, and you’d make sure to get there a half hour early.
The process of reestablishing self-trust starts with baby steps. For the first few days, you might want your only official agreements to be things you’d probably do anyway, like, Wake up by no later than 7 o’clock, and, Have dinner ready by 6:30. Do this so you can become more conscious of your agreements with yourself and the be sure to keep them. Over time, you can add a bit more to your list. But never make an agreement you think you’re likely to break.
4: Clean up broken agreements. Treat yourself like a friend. If you broke an agreement with a friend, you would acknowledge the damage that was done (“I feel terrible about missing your show. I’m really sorry. I cherish you as a friend and I want to be there for you.”). And you might do something special the next time you saw them (like bringing them flowers or helping them with a project) to demonstrate your interest in fixing the relationship.
Likewise, if you break an agreement with yourself, rather than beating yourself up, acknowledge and repair the damage. Believe it or not, there really is a hurt part of yourself – a part of you that takes these broken agreements to mean, I don’t need to keep my agreements with you, because you don’t matter. Affirm to yourself that you do matter and that you can be trusted. Then make a new agreement that goes beyond the one you broke, and be sure to keep it. Or, if you broke the agreement because it wasn’t a realistic agreement (which means you had no business making it in the first place), make a new agreement about something that supports you in another way (some act of self care, for instance), and keep it. Be a person of integrity.
Eventually, you’ll have an impressive mental dossier on your trustworthiness. In essence, you will have demonstrated to yourself hundreds or thousands of times that what you say is going to happen … happens. Then your word will be as good as law. When you say to yourself, I’m going to change the world, there will be a mountain of evidence to indicate that big things are coming. If anything is out of whack in your life, turn back to your agreements, start keeping them, and watch how things fall into place.
If you’re intrigued by the idea of teaching this to others, guiding them through the process of coming into their power and sharing their gifts with the world – then check out our coaching program. Enrollment will be open until April, but Early Bird Pricing ends Tuesday Feb 23rd at midnight!
Be well,
Peter
P.S. One more hint: when you’re in a state of trust, your heart will feel open. When you’re not trusting, your heart will feel tight, clenched, or closed. Tune in.
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A couple weeks ago, I introduced some concepts on the workings of pain that I think are useful for everyone to know. They’re derived from my explorations into Traditional Chinese Medicine. Here’s a synopsis:
- Virtually all pain is due to stagnation
- Resistance promotes and worsens stagnation
- All levels of our being are interconnected, so
- Stagnation can spread between levels
- Movement on one level can alleviate stagnation on multiple levels
- Relinquishing resistance restores the flow
When I speak of pain here, I don’t just mean physical pain, but also emotional pain and even “existential pain.” Understanding the workings of our pain can be tremendously useful in liberating ourselves from it. Working from this model, our main goal is to get back into a flow state, and there are lots of ways to do this.
First and foremost, when we feel uncomfortable on any level, we can cause an immediate shift by not resisting what we’re feeling. Ultimately this is simply a choice – a choice that’s always available (albeit a choice we usually have to make over and over). However, it’s a choice that sometimes eludes us, so we can employ some methods to facilitate it. Breathing is a good place to start.
When we are in a state of active resistance, this is usually reflected in the state of our breathing, which is restricted. Opening up the breath – breathing deeply and fully into the body and specifically into the area that’s restricted – can help us to feel willingly what’s up and to let go of resistance. Breathing promotes movement and helps to clear stagnation. I cover many different breathing methods in the Live Pain Free course, but the most basic approach is just to lengthen the exhale – that is, emphasizing the letting go phase of the breath. As we do this, we can visualize that the breath is opening and flowing through the body – or a particular region of the body – improving circulation, bringing in fresh blood, and encouraging the removal of waste.
Exercise and stretching are also great for facilitating movement and clearing stagnation for the alleviation of pain of any kind. We can get more out of mobilizing the body if we actively intend that our movement is shaking up, dismantling, and releasing stuck emotions, negative thoughts, and other painful patterns.
Using our voice is another way to promote movement. Whether through toning, singing, chanting, or speaking the truth, both the meaning and the sound vibration we express can have an opening effect on us.
These are just a few of the many ways to restore flow when there is stagnation and thereby alleviate pain. Acceptance, forgiveness of oneself or someone else, letting go, trusting in the process, laughter, loving connections, and spending time admiring beauty such as in nature – all of these tend to have an opening or expansive effect on us that can profoundly affect our experience of pain.
Now, let’s look at a progressive way to understand pain from a scientific lens. A good starting definition is: Pain is the brain or mind telling you it thinks something is wrong. Whether it’s physical pain, emotional pain, or existential pain, there’s an implicit interpretation that this is not how things should be. The pain of depression, for instance, involves an interpretation that, “I shouldn’t feel this way. I should be happy.” The pain of arthritis involves a brain interpretation that a joint shouldn’t be grinding and inflamed the way that it is. In both cases, pain could be seen as an alert that the situation is threatening and requires intervention.
This alert system is more often accurate and useful with acute pain than with chronic pain. For example, you feel burning pain in your fingertips, you move your hand without thinking, and you avoid skin damage from the hot iron you accidentally touched. Chronic pain, on the other hand, is almost always a mistake.
A broader, more technical definition of pain can help us understand why these mistakes occur. Pain is an output – the result of processing in your nervous system – that’s unique to the person that’s experiencing it, and it involves numerous elements – nerves, immune cells, chemical messengers, memory, and emotion – that interact and combine to form a pattern that the brain labels as PAIN. (Thanks to pain researcher Ronald Melzack at McGill University for developing this definition.) This pattern is known as a neurotag or neurosignature and it’s more complex than we tend to think. Pain is as dependent on our psychology as it is on our physiology.
For example, if you were once attacked by a dog and it was frightening and traumatic, something as minor as a dog swiping you with its paw in an attempt to get your attention could be experienced as severely painful because of the elements of memory, emotion, and interpretation. So it’s easy for inaccuracy to enter the pain equation. In this case, there is no danger, nothing wrong that needs to be addressed, but your brain sounds a loud alarm anyway.
Even looking strictly at the biological workings of pain, there is still room for error, though. Acute injuries are usually completely healed within a matter of three to six months at most. The body part can be used normally at that point, so there should be no need for pain after that. However, during the initial event and the healing process, a persistent neurosignature may develop. During all the yelling, crying, and wincing, the nervous system can become sensitized in such a way that the alarm won’t turn off and/or it’s easily retriggered by related images, scents, sounds, thoughts, feelings, and memories.
At this point – and this is true of virtually all chronic pain – it serves no useful purpose. So there’s little value in trying to track down a tissue pathology, and even less in utilizing an addictive mind-numbing pharmaceutical to make it go away. Instead (or in combination with pharmaceutical interventions, if necessary) we can utilize approaches that take advantage of the phenomenon of neuroplasticity – the ability to change our wiring.
We explore many, many such approaches in my online course, Live Pain Free, and I encourage you to check it out if you struggle with pain. The most useful thing, as I discussed in the last installment of this article, may be simply knowing how pain works. I sincerely hope these articles have given you a new way to understand pain that helps liberate you from its grasp.
Be well,
Dr. Peter Borten
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Last year a disabled veteran came to see me for help with back pain. As we talked about his history, a familiar story arose. He got injured, experienced a lot of discomfort, was prescribed opioid painkillers, and became addicted to them. He described how his journey through his addiction treatment center and how, for several years, “I lost my personality and my life. I was barely a human.”
He lived in a numb haze, with no sense of humor or interest in anything, until a new doctor specializing in recovery treatment for all levels of addiction, finally recognized what was happening and began to wean him off these drugs. Much of the pain remained, but we were able to work on that. More importantly, he got his life back, and his friends and family got him back.
The familiar part of the story is the widespread long-term use of opioids and the unfortunate consequences. The uncommon part is that he got off of them. A 2017 study by the Centers for Disease Control called “Characteristics of Initial Prescription Episodes and Likelihood of Long-Term Opioid Use” looked at 1.3 million opioid users over 9 years.1 It found that the longer the initial prescription period, the higher the likelihood of long-term use. If someone used an opioid for 10 days, there was a 20% chance they’d still be using it a year later. At 35 days, the risk of yearlong use was about 45%. A 2014 study in the Clinical Journal of Pain came to a similar conclusion – the higher the initial dose and the longer the initial use of an opioid, the greater the chance of the patient developing a condition of abuse and dependence.2
It’s worth mentioning that both of these studies excluded patients with cancer pain (which is often expected to require ongoing medication, perhaps until death). That is, the great majority of those who were on opiates for several years were using it to manage back pain or joint pain (or to manage their dependency on opiates). Thus, we can assume that the prescribing doctors either didn’t know of an alternative method for pain relief or didn’t care. Do effective non-opioid alternatives exist? In the words of some ancient healer: Hell Yeah!
The first modality that comes to my mind, as you might guess from the story above, is acupuncture. Acupuncture is no longer a fringe therapy. Its effectiveness is well supported by clinical research (comparable to opioids in effectiveness3), it’s routinely offered by many hospitals in the U.S., recommended as a standard option for pain management by health systems around the world, and even adopted by the U.S. military (in a form called “battlefield acupuncture”) for severe pain.
If acupuncture has been unsuccessful at managing your pain, I advise that it isn’t always an instant miracle. Sometimes it takes several treatments to produce significant, lasting results. Also, practitioners vary in their specialties and level of skill. If you don’t experience any relief after a couple sessions, try someone else – and ask if they specialize in pain. Further, a licensed acupuncturist is almost always going to be more skilled and certainly has more training than a medical doctor or physical therapist who also does acupuncture.
While it’s great to receive acupuncture from a professional, it’s also useful to know how to utilize this system to manage pain on your own. Many acupuncture points can provide effective pain relief simply by pressing on them. Especially when traveling, or when needles weren’t available or practical, I’ve often utilized acupressure to successfully eliminate my own pain or that of friends and family. There are specific points for pain in different locations, though one of the most utilized for pain anywhere in the body is called Large Intestine 4, and it’s located in the muscular web between the thumb and index finger. If you press around in this area on the back of the hand, especially directing your pressure toward the hand bone that leads to the index finger (second metacarpal), you will find a tender spot. Pushing firmly on this spot while moving the painful area may alleviate your pain.
Mindfulness-based pain management techniques can also be very effective, and they have the added benefits of helping you live more in the present and experience more gratitude. These strategies were pioneered mainly by Jon Kabat-Zinn, and are based loosely on Buddhist meditation. There are numerous books and courses available in his Mindfulness Based Stress Reduction (MBSR) practice. The basis of these techniques is non-avoidance of discomfort – learning not to resist or mentally depart from the experience at hand, but to instead “turn toward” it and explore it willingly, whereupon it ceases to feel like suffering, and may even open us to a whole new dimension of experience.
Breathing is another vital practice for self-management of pain. How we breathe can profoundly affect both our mental state and the feelings in our body. I have witnessed people doing breathing exercises which, within a half hour, turned off pain that had persisted for decades. In a way, breathing through pain is similar to mindfulness techniques, in that we’re willingly bringing our attention to the experience. I feel that the power of the breath to reduce pain makes so much sense – it seems like an intelligent plan that we should all be equipped with the means to facilitate our own healing. In the most basic way, you can imagine that, with each inhale and exhale, you’re moving the breath – and energy along with it – through the painful area.
After years of teaching these and many other pain relief techniques to my patients, I decided to gather all my knowledge into an online course. In it, I teach a philosophy for understanding pain that will make sense and will illuminate your perspective of what’s happening. And I explain and demonstrate a huge array of methods for eliminating your own pain. As I was creating the course, in fact, the others who were involved in the project kept asking me, “How much more are you planning to include in this?!” But there are so many useful approaches, so many opportunities not just to overcome the pain, but to grow and evolve as a person, and that’s my real goal for participants in the course.
My greatest hope is to see fewer and fewer cases like that of my veteran friend – fewer cases of opioid dependence, fewer cases of pain relief at the expense of the joy of life. And more cases of people overcoming pain in ways that are empowering and even help them heal and awaken. If you’re in pain or know someone who is, check out the course. It’s called Live Pain Free. It’s affordable, and you’ll learn things you’ll use for the rest of your life.
Be well,
Peter
Let Me Teach You How to Erase Your Own Pain Without Drugs
Sources:
1: Shah A., Hayes C. J., Martin B.C. Characteristics of Initial Prescription Episodes and Likelihood of Long-Term Opioid Use — United States, 2006–2015. MMWR Morb Mortal Wkly Rep 2017;66:265–269. DOI: http://dx.doi.org/10.15585/mmwr.mm6610a1
2: Edlund, M. J., Martin, B. C., Russo, J. E., DeVries, A., Braden, J. B., & Sullivan, M. D. (2014). The role of opioid prescription in incident opioid abuse and dependence among individuals with chronic noncancer pain: the role of opioid prescription. The Clinical journal of pain, 30(7), 557-64.
3: Grissa, M. H., et al. Acupuncture vs intravenous morphine in the management of acute pain in the ED. The American Journal of Emergency Medicine, Volume 34 , Issue 11 , 2112 – 2116.
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