Q and A with Sarah Anne Shockley, author of The Pain Companion
In the twenty-first century, one might wish that pain were an easily treatable nonissue. It is not. Millions of doctor and emergency room visits stem from pain, and addiction to pain medications, rampant in the United States, often takes root in an attempt to manage unremitting discomfort.
In the enclosed advance reading copy of The Pain Companion: Everyday Wisdom for Living With and Moving Beyond Chronic Pain (New World Library, June 12, 2018), author Sarah Anne Shockley, who has personally lived with chronic pain since 2007, offers fellow pain sufferers a compassionate and supportive guide for living with pain that can be used alongside their ongoing medical or therapeutic healing programs. We hope you’ll enjoy this Q and A with Sarah about the book.
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Tell us your story. How long have you been living with chronic pain?
In the fall of 2007, I contracted Thoracic Outlet Syndrome, a collapse of the area between the collarbone and first rib. This collapse squeezes the scalene muscle, nerve ganglia, artery and veins that have to fit through this narrow space, creating severe nerve pain in the neck, arms, and hands, which affects my ability to use my hands and arms. For quite a few years, I could barely function. My life basically stopped. I lost the ability to participate in just about everything I enjoyed. I was a single mom and struggled even to be able to cook a meal for my son. After about 5 years of being very stoic and putting up with the situation, I decided that I couldn’t live my life that way any more. That’s when I started developing the approaches I write about in The Pain Companion.
Readers in pain have tried everything. Why do you think your approach will work for them when other approaches haven’t?
Yes, people in chronic pain have usually seen a number of doctors and tried many treatments, therapies, and pain medications, none of which have completely healed their condition and some of which have made things worse. With the current scare about the opioid addiction crisis, many are being taken off their pain meds and left to fend for themselves in terribly difficult circumstances. While I don’t offer readers solutions from a medical standpoint and I don’t promise to make anyone pain free, what I do offer is a positive, constructive approach to living with chronic pain and relieving the incredible stress, fear, and emotional distress that comes with that. I know first hand what it’s like to live with long-term pain and it’s a stubborn and complex condition. Chronic pain affects the whole person, not just the physical body. I think it’s crucial that we understand how deeply long-term pain affects every aspect of a person’s life and begin to address it not just from a physical standpoint, but from emotional, mental, and spiritual levels as well.
What do you mean by the statement, “The first step in healing is to fully arrive in your pain?”
Usually, when we feel pain, the first response we have is to push away from it and to contract in the body. This is a natural response and there’s nothing wrong with that if we’re talking about short-term pain like a stubbed toe or a burnt finger. However, when this contraction response continues over time it is not helpful. In fact, it contributes to holding pain in place. So, one of the first steps in healing long-term pain, I believe, is to release the resistance to it and allow oneself to experience it. This is a very counterintuitive approach, I know, but I have found that it is very difficult to heal long term pain if we don’t allow ourselves to get in touch with it, connect with it, and work on healing it from the inside out, rather than the outside in. This doesn’t mean we can’t use pain medications, or that we have to allow ourselves to be swallowed whole by pain. Beginning the healing process with a positive approach to pain and allowing ourselves to be with the pain as it is, before we ask it to leave, paradoxically, seems to help pain move on faster. This can be a gentle exploration, a simple shift in awareness.
You talk about creating a relationship with pain in the body. What do you mean by that and what good will it do?
When we turn toward pain and regard it compassionately, it seems to relax and let go a bit. Instead of pushing against it, we pay attention to it with kindness and with understanding. When we turn toward the pain, we’re turning toward the hurting part of ourselves. When we listen to pain, communicate with it, ask questions, sit with it, dream with it, we are listening, communicating, and dreaming with a part of our body and our inner self that’s asking for attention through the pain. It might be difficult to imagine being kind toward pain, particularly when it’s acute and chronic. It seems like the last thing you want to do. But this isn’t about acquiescing to it or learning how to put up with it. This is a proactive approach that asks us to imagine that all pain has a positive purpose. Again all these things may feel counterintuitive, but they help pain fulfill its need to be seen, heard, and attended to in a positive way. This can allow pain to relax, release, and move on.
Most of us think of pain as an enemy. Why do you advocate making friends with it?
We think of pain as an invader, as something to eradicate and, yes, of course we want it to end because it’s extremely uncomfortable, but pain is a signal, a message that resides in our body. In that sense, it is not a foreign invader, it is part of our system trying to get our attention. In fighting pain, we tense up, we become stressed, we can’t relax and be a peace because there’s an enemy in the house. When we think of pain as a part of us that is trying to heal, then we can find ways to relax more around the pain. We can allow it to be where it already is. We can be with it rather than against it. There is a middle path here between the two extremes of 1) being in a constant battle with pain and 2) giving in and giving up. I have a number of exercises in my book that allow people to find a new relationship with pain.
Why do you think being in pain is shameful to many, and how can we change those feelings?
We have a cultural attitude that no one should ever be in pain. We don’t want to know about pain, we don’t want to see it, and we don’t want to feel it. We are advised to skate over grief, ignore trauma, and quickly get back to being happy. So people who live with chronic physical pain often feel bad about themselves, as if they are wrong for being in pain. Change happens when we begin to understand that pain is a part of life. Every human on this planet passes through places of physical or emotional pain at some point and usually at many points in their lives. Understanding that pain is a natural part of the healing process, not a mistake or a punishment, can help relieve feelings of shame. More conversations such as this one about the nature of pain will help, as will bringing the hidden, unacknowledged pain of our modern culture out into the open where we can acknowledge it, see it, feel it, and heal it.
What are some of the difficult emotions that people in pain experience and how can they alleviate them?
Pain affects every aspect of life and limits our participation in the world around us which leads to feelings of isolation and loneliness. When this goes on for years it’s very difficult not to be depressed and sad about losing our lives to pain. We often feel blamed for not healing, or for not doing enough or for exaggerating our pain, when, in fact, most of us have learned to minimize it around others. These feelings can lead to a sense of being invisible, misunderstood, cast out, and ashamed.
There are many ways to alleviate these difficult feelings but most importantly, I feel, is that we need to understand that no one is wrong for being in pain. No one has made a mistake. Pain occurs along the road of life, like a landscape we’re passing through. It is not who we are. We are much more than our pain. Those of us living in pain for long periods of time must learn to give themselves, rather than pain, primacy in life. That means reconnecting with things we love to do, even if pain has to come along for the ride. That means not isolating ourselves, but finding ways to participate in the greater world, even if it must be in small doses. That means not staying silent and invisible but finding healthy ways to express what we’re going through, both in physical and emotional terms. And it means finding ways to honor who we are deep within and who we are becoming, not only despite our pain, but also as a result of this incredibly difficult healing journey we are on.
Some people need pain medications to get through the day. Why don’t you use them? Are you against them?
I don’t use pain medications because I found that they didn’t help my nerve pain and caused pretty distressing side effects. I also am someone who will first look for natural or holistic treatments before using pharmaceuticals anyway. With that said, I am not opposed to the use of pain medication, including opioids when necessary. There are many, many people in severe pain who cannot function even minimally without the help of pain meds and I don’t support the new policy of withholding medication from people who need it. At the same time, I am also in favor of finding holistic ways to work with pain while using medications judiciously. I believe that we need a multi-level approach to chronic pain which can include pain medication in conjunction with alternative approaches that address emotional and physical pain relief. Allopathic and alternative approaches need not be mutually exclusive.
Why do you advocate people telling their pain story? Who should they tell it to and how? What good does that do?
We live in a pain-avoidant culture. We’re taught not to talk about our pain, that showing pain is bad or weak or somehow inflicting it on others We try to avoid pain, not feel it, look away from it. I believe, however, that not talking about pain, not looking at it, not acknowledging it, is not a healthy approach in the long run and actually increases pain’s longevity.
I tried ignoring my pain for a number of years, and what I found was that it didn’t go away and it didn’t get any better. I ended up feeling very isolated and alone in my pain. I think many pain sufferers feel this way right now - that there is no one in their pain with them, that they are alone in their suffering and that no one understands. Once I started expressing how I felt about living with pain, what it meant to me, how difficult it was, I felt better emotionally and I also felt some of my physical pain release.
Telling your pain story means finding someone you can trust to listen without interrupting and without giving advice. It means talking about how hard it’s been, what pain makes you feel like, how it has taken over your life, how it makes you feel about yourself. You are asking someone to witness you, to see your pain and acknowledge it as it is. Seeing the pain, acknowledging it, giving it a voice is, in my experience, an extremely important step in creating true healing. It helps pain move on. It does something to release it from its holding pattern.
What do you think is most important for doctors and caregivers to understand about people in pain?
People in pain are living inside a bubble of pain that extends several feet around the body. We are sleep deprived, and our brains don’t function very well. We overwhelm easily and are under a great deal of physical, emotional, financial, and relationship stress because of our compromised ability to function. It can be difficult for us to remember things you want us to remember, or to articulate our symptoms because they may change from hour to hour. We may not be able to describe to you exactly how pain affects us because it affects our entire selves and we are living immersed in it and may no longer have a reference point for life-without-pain. We know that you get impatient with us for being in pain for so long. We know you wish you could help us and that you find it frustrating that we aren’t healing. But because our medical system does not understand chronic pain or have the capability to eradicate it does not mean it doesn’t exist or that we aren’t trying to heal. All of us, every day, all of the time, are challenged by the simplest, most minimal, demands of life that almost everyone around us does without even thinking about them. We are always trying to heal – it can’t help but be our primary focus. We want you to respect us and to respect our limited capacities at this time, not as an indication of a failure to heal ourselves, but as a reflection of how intense and demanding our pain really is and how remarkable it is that we’re functioning at all.
What do you most hope readers will take away from your book The Pain Companion?
That they are not alone, that they are not wrong for being in pain, that their life is not a mistake. Sometimes we meet pain on the path of life and sometimes, in a way, pain becomes the path, but it is never the totality of who we are. It does not define us. And it is worth paying a different kind of attention to pain, being with it more positively and treating it less as an adversary, which can be the first step in healing it and helping it move on.
Sarah Anne Shockley is the author of The Pain Companion. In the Fall of 2007, she contracted Thoracic Outlet Syndrome (TOS), which is a collapse of the area between the clavicles and first ribs, and has lived with debilitating nerve pain ever since. She has been a regular columnist for the Pain News Network and is a regular contributor to The Mighty, a 1.5 million–member online community for those living with chronic illness and pain. Visit her online at www.ThePainCompanion.com.
YouTube interview with Sarah Anne Shockley: https://youtu.be/ncr7WUVzEpc
Excerpted from the book The Pain Companion. Copyright ©2018 by Sarah Anne Shockley. Printed with permission from New World Library.