I’m blaming global warming for my back pain. It’s not doing me much good, but I’m blaming it anyway. A couple of years after Katrina decimated New Orleans I led a church group to that ill fated city to rebuild houses. I’m not sure how much good we were doing, but we sure worked hard. I worked very hard. There was a young woman “supervising” us on site. She was an AmeriCorps volunteer – you’ve got to admire that. At the end of the week I said to her, “There comes a moment in every man’s life when he realizes he’s not 23 any more . . . this is it.” I was 54 at the time. (OK, so maybe global warming isn’t completely to blame for my plight. My doctor says I have the wrong genes. Blame my Dad? Yeah, I’m comfortable with that too.)
Man did my back hurt, and it kept hurting and kept hurting for a long, long time. Eventually, you know, after my doctor waited for a month or two to see whether it would heal on its own, I had an MRI. Over the last several years I had some relatively minor back episodes in my cervical spine, so I was actually hoping this episode would push things forward a bit so that now I’d finally be able to take care of it – kind of like we’re all hoping that Donald Trump will finally be the destruction of the GOP. Well, sure enough, I have a collapsed disk at L5-S1 and another one at C6-C7, along with all the requisite pain for such a condition. There was the shooting pain, and the deep, relentless, aching pain, and that burning pain that wakes you up at 3 AM, and then my personal favorite, the stabbing pain. Sometimes it comes out of nowhere.
Over the next several years I “tried everything,” as they say. First, there were three surgeries – two on the cervical spine, one on the lumber spine. Miracle of miracles, they worked! No more shooting pain. Sadly there was still the deep, relentless, aching pain, and that burning pain that wakes you up at 3 AM, and of course my personal favorite, the stabbing pain that comes out of nowhere. All of those were still with me. I had a good surgeon. He said, “If you look around you’ll find someone who will operate again, but I’m not going to do it. I just don’t see what else I would do.” It didn’t make any sense to me to go looking for someone to operate, so surgery as an option was over, and at that moment, hope died. I asked the surgeon what I should do. He told me that sometimes the best course of treatment is to go ahead and take medication for the pain. “There’s no shame in it,” he said. Really? There was for me.
As many of us do, I moved on to nerve blocks. Again, I found a great doctor – sensible. Over the years, I think we did nine blocks, maybe it was just seven, but enough so I was on first name basis with the surgical nurses. One of those blocks even seemed to work for a day or two. That’s what kept me coming back, kind of like that rare moment when you hit a long drive right down the middle of the fairway. It keeps you coming back. (Not that I can do that anymore.)
Then we decided to try something fancy. I think most persistent pain patients do something like this – something vaguely drastic that qualifies us as exceptional, rather than run of the mill pain patients. My doctor implanted two wires in the epidural space of my lower spine. The wires came out my back – literally out my back – and into an electronic battery pack on my belt. When I felt pain, which in spite of the medicine, I was feeling most of the time, I could turn on the battery pack, stimulate the spine, and block the pain. At least that’s how it was supposed to work. I walked around with wires coming out of my back for a week. If it worked, we would then implant a smaller device under my skin, one I could program from outside my body. Cool.
The salesmen who sold the device was in the procedure room when the wires were implanted. He was in the exam room at the end of the test period too. “Did you get good stimulation,” he asked? “Absolutely,” I said, “It definitely worked, except that it didn’t take my pain away.” It was a discouraging moment. My doctor actually had to explain to this guy that dramatic relief from my pain was the point of this little exercise. Then once the wires were out of my back, he told me there really wasn’t much else he could do, except refer me to a friend, a psychiatrist who lived a little closer to me and had some novel ideas about treating pain. Well at least I wouldn’t have to drive across the Golden Gate Bridge just to pick up a prescription. Still, more hope had died.
You understand of course that I wasn’t just sitting around waiting for western medicine to work its miracles this whole time, right? I was doing acupuncture, and Pilates, chiropractic care, and cranial sacral therapy. I suffered through a process that was supposed to stretch out the “tubes holding the nerves,” (I still don’t know what that means). I did a session of Rolfing, and sat on an exercise ball two hours a day, (part of the dreaded core strengthening exercises). Before you ask, yes, I too bought an inversion table, along with another traction device and I tried medical marijuana which was great except I get really, really paranoid when I smoke it. That’s not an option. The thing I liked best was Watsu, which is basically a Shiatsu massage given by a naked woman in a pool full of warm water under the stars. (I’m thinking insurance really should pay for this.) But the reality is, nothing “worked,” and each time I tried, more hope died.
If you have persistent pain for any length of time you know what this is like. When you’re at a party and make the mistake of talking to someone about your epic struggle with pain, people always have a new idea for you to try. “You should try Praying Mantis wings roasted in sesame oil.” (No one has actually said that to me, but it wouldn’t surprise me if they did.) You come to the point where you dread those moments because you know full well you’re not going to try anything else, and they can tell too. So you wonder if they’re thinking your pain is your fault, that you’re not trying hard enough, that you’re just one of those people the New York Times writes about who only wants to take those diabolical opiate medications. Hell, sometimes you even wonder that yourself. (Which is the point, because they’ve probably moved on to the blond in the scoop neck top and aren’t thinking about you at all.) Sound familiar? Hope isn’t just dying; it is dead and gone.
At this point I did what lucky people do when they have tried everything else; they go see Dr. Moskowitz. He’s the psychiatrist I mentioned earlier. I sat in his office and the world of neuroplastic transformation opened before me. The moment he took over my care, I let myself hope just a little bit. It turns out, I discovered, that the pain I’d been feeling is wired into my brain. But the brain is changeable so as I counter-stimulate the areas of the brain that process pain, if I can keep them busy doing something else, the pain ultimately disintegrates. Damned if it doesn’t work. I shouldn’t be surprised – the science is undeniable, rock solid – but it works!
That doesn’t mean it is easy. It’s not. I repeat, it is not easy. It takes disciplined, dogged persistence. Trouble is, these are traits I don’t have in abundance. I’m not alone in that either. As it turns out lots of persistent pain patients aren’t very persistent. So it’s taken a while – longer than it would have if I’d stuck with it more consistently – but I’ve made enormous progress. My goal is never to have to take a dose of medicine because I’ll have withdraw symptoms if I don’t. I’m not there yet, but I can see it. I can taste it. This is within my grasp.
But why has it taken so long, or put another way, why haven’t I been persistent? That question gets to the heart of what Dr. Moskowitz has asked me to do in developing this coaching program. The reality is that when human beings try to make a change we put up internal resistance. Robert Kegan at Harvard describes this phenomena as a “competing commitment.” So we want to get rid of our pain, but there is another hidden goal that is working against it. (Just one example there are others: maybe we don’t want to lose the final ray of hope so we just go half way into neuroplastic treatment so that we always have that excuse for why we’re still in pain.) It’s as though we have one foot on the gas and one foot on the brake. Perhaps you know what I’m talking about? There are of course other ways to describe this phenomena, and other ways to deal with it, but Kegan has done a good job of addressing it in his book, Immunity to Change. He’s developed a series of exercises that move you to analyze your competing commitment and then move slowly to dismantle it – one step at a time. It is a neuroplastic process – one that I found very helpful and am apt to use in my pain coaching process.
But there is something about persistent pain, something resistant to Kegan’s straight forward process, and this is where the rubber really meets the road; . . . each of us carries a false image of the self, an image that leaves us separate and isolated. Alan Watts described this false identity as the mistaken assumption that each of us is a “skin encapsulated ego.” The false self is disconnected from what I’d call the source of creative power, some would call it the evolutionary impulse. Alfred North Whitehead called it the “gentle persuasion towards love.” What he means by “love” is not a the transient feeling we call “love,” but the power animating creation. Disconnected from that source, life has no defining sense of purpose or meaning. Connection to that source gives our life purpose and meaning.
I’ve had a lifetime of experience working on these issues, but as I’ve worked through this pain, as I’ve tried to understand what has been holding me back, I’ve had to wrestle them to the ground once again. In doing that, hope has come alive in me once more. That’s what I mean when I say that “all pain calls for transformation,” not just transformation of the “pain brain,” though certainly it must be transformed, but a deeper, life giving transformation as well.
I’ll come out and say it: what I’m talking about here are “spiritual issues.” Purpose and meaning, connection to source, have traditionally been the exclusive purview of the world’s religions, but no more. By “spiritual” I do not mean that moment of enlightenment you reach during your 116th straight hour of meditation and I certainly don’t mean a move back to whatever religious past you may have escaped. I mean something more like this: realizing your connection to the evolutionary impulse, the love intelligence of the universe, and opening to that creative impulse within. That will draw you forward in a way nothing else has. And here’s the interesting thing – we have every reason to believe that these spiritual dynamics are wired into our brains. In fact, it appears that they are wired into the very same circuits that carry pain signals throughout the brain. All pain calls for transformation.
This is not simple stuff you understand. I still have to be patient. It is going slower than I’d like, but I am so much better off today than I was the day that surgeon told me “sometimes taking medicine is the best course of treatment.” I’m so much better off today than I was the day those wires were pulled out of the epidural space in my spine. My brain has changed, it has healed, and me along with it.
I’ve had an incredible amount of support – from friends, from Dr. Moskowitz and from my wife, who has offered substantive spiritual support this whole time, all the while wrestling with her own lagging hope. (What the partner of a persistent pain patient goes through needs attention in coaching as well. Our pain impacts the people around us! My wife could write a book; in fact she may.) I don’t know how we could go through this without support. That’s why I’m doing this work. The first thing my wife said when she looked through the Neuroplastic Transformation Workbook was, “You really need a coach to sort through this and keep you on task.”
Dr. Moskowitz asked me to put together a coaching process for persistent pain patients that would address not only the neuroplastic transformation of pain, but also the transformation of people’s lives since, after all, that’s the point. “We’re not just healing pain; we want people to live a full and complete life,” he told me. (You gotta love that in a doctor.) I’d love to help you with this whether you’re focused solely on the neuroplastic transformation of pain or taking it one step deeper into pain’s call for transformation. If you are ready to work, I can help you engage the transformative process that comes in this journey, a journey that is changing me and allowing me to grow into a better version of myself, a version of myself that lives and loves with greater hope.