In previous posts, we looked at whether meditation works to relieve chronic pain as well as the science behind meditation’s efficacy as a pain treatment option. In this post, we’ll look at some simple ways to implement a meditation practice into your own pain treatment program.

Meditation: How New Age Do You Want to Go?

You may well be relieved to discover that when it comes to meditation, there’s absolutely no need to go the whole “crystals, rainbows, unicorns” New Age route. I mean, you can, if you want to, but you don’t have to.

Personally, I find a few well-placed props that help set the mood to be a welcome addition. Soy candles and the occasional incense stick or powder in a darkened room with a little spa-type music playing in the background help my way-too-active  consciousness let go of its death-like grip on controlling my life and embrace relaxation. (Do be careful about using incense, though, especially if your respiratory system is in any way compromised.)

But if that makes you uncomfortable, or merely roll your eyes mightily, then rest assured: no New Age props are required. Neither is chanting “Om” or anything else.

Meditation is simply the act of focusing your thoughts, or alternatively letting go of the need to obsess — the act of utter relaxation, tuning in to your body and mind, and allowing yourself simply to be in the moment. Sometimes props help with that, but if you find yourself uncomfortable at the thought of all the trappings, then don’t go that route. Just wear comfortable clothing, unplug the phone (and turn off the cell), get quiet and sit.

How to Meditate

Meditation is not some weird, scary thing. It’s something you already know how to do, but in a possibly new context.

You can meditate in any number of ways:

• Visualizing some desired outcome or a peaceful natural setting
• Counting your breaths
• Focusing mentally on one phrase or word
• Simply sitting and allowing your thoughts to float away like butterflies

There are also more advanced techniques you can pick up from traditions like yoga or Transcendental Meditation, or other practices. But for our purposes, we’re going to outline a simple breath-focused practice that I use to help manage my pain.

What You’ll Need to Get Started

• Comfortable clothing
• A comfy place to sit that supports your back (lying down isn’t advisable, at least at first, as it can signal the body it’s time to sleep — and since chronic pain patients are often sleep-deprived, this will be counterproductive to meditating; however, you can practice a form of this meditation lying down in bed before you sleep, and it should improve the quality of your rest)
• Silence — no interruptions of the human or electronic kind
• If you like, you can use New Age or spa background music. I advise against candles at first – you might find yourself worried about a fire starting, especially with your eyes closed

The Practice

Get comfortable – either cross-legged, perhaps with pillows supporting your knees, or with your feet on the floor. Cover yourself with a blanket if you’re the least bit cool. Place your hands in your lap, palms up, left hand on top of the right, so that your hands are basically right in front of your pelvis.

Close your eyes, and:

1. Phase One: Breathe. Just breathe. In and out, without trying to control the breath. Turn your awareness to your scalp, and check in with your body there. How does it feel? Don’t try to change it, just observe. Then slowly scan your body, moving from the scalp to the forehead, to the eyes, the chin, the neck, the shoulders, etc. – all the way down to your toes. This doesn’t have to take a long time — just check in briefly, observe, and move on.
2. Phase Two: Focus on the Hurting Parts. Find the part that hurts the most from your body scan in Phase One. Settle your awareness on this spot. Talk to it silently — not the way you usually do (“God, I hate you! Why do you HURT all the time?!”) but as if that body part were a small child in pain. What would you say to that child? You wouldn’t tell her you hate her! You’d comfort her. You’d tell her how much you love her. You’d say how sorry you are that she hurts. You’d tell her how proud of her you are. So say that to your in-pain body part. Offer it love and compassion.
3. Phase Three: Rinse, Repeat. Do the same for any other intensely pained parts of your body.
4. Phase Four: Envision Health. Now, bring your awareness back to the center of your self — somewhere around your solar plexus, usually, but wherever feels “right” to you. Allow an image of perfect health — your perfect health — to come to mind. See yourself doing the things you long to do, feeling great, moving easily. Try to bring as much sensory awareness into it as possible — not just sight but scents, the sensation of touch, sounds, tastes. Make it as real as you can. Stay with this image for as long as you can, up to ten minutes or so. When you’re ready, imagine that scene in your mind being enveloped in a glowing golden-pink bubble, and floating up to the universe where it will start to gather energy and begin to manifest. (Or if that’s too “whoo-whoo” for you, then just let it fade.)
5. Phase Five: Coming Out. Don’t rush the re-entry! Once you’ve let go of the vision of health, slowly bring your awareness to what’s going on around you — but don’t open your eyes just yet. Take a minute or two to become aware of your surroundings. Then slowly open your eyes. You might find it helpful to shake your hands vigorously for a few seconds to ground yourself again. Drink some water, get up and move around — basically, reconnect to your body.

That’s it.

This practice can take as little as ten minutes or as much as an hour – it’s totally up to you. Better to do it for a few minutes every day, than for an hour once a week, though. Set your schedule, ease into it if you must, but try to do it daily.

The Benefits

What can you expect from a regular meditation practice? It varies from person to person, of course, because we’re all different, but basically you can expect:

• Heightened sense of connection to your body
• Lessened pain
• More restorative sleep
• Lower blood pressure
• Reduced stress
• Increased ability to deal with flareups of pain and stress

That’s worth giving meditation a good trial run, isn’t it?

Read this and tell me you don’t want to go. Right. NOW:

The monsoon expends the last of its energy in the Indian state of Kerala, leaving plump raindrops on hibiscus flowers and puddles in the red mud roads. The air is thick but not oppressive, and I begin to understand the words of the local doctor, who says that monsoon season—nature’s own megacleanser—is the best time for treatment. Sipping sweet water from a tender coconut, I feel radiant from an hour-long herbal oil massage. The stiffness in my neck, which I once accepted as a necessary evil of urban living, has disappeared. Listening to the waves rolling up on the shore, I realize why this place, Kerala, is part of my treatment, too.

This, from “Taking the Cure in Kerala” from YogaJournal, makes me long for a round-trip ticket and a few weeks off. (Please note, after my frequent rants here and on Twitter against folks claiming to have the “cure” for fibromyalgia and other incurable chronic pain conditions, that I’m pretty sure they don’t mean “cure” in the Western medicine context but in the “damn, I feel nine kinds of better” sense.)

This made me think: is this what we’re all up against? Is THIS what we have to do to get better for real and for good?

Except – I already know the answer. The answer is “no.” Traveling to exotic locales and subjecting ourselves to round-the-clock spa treatments and yoga classes is not required to achieve health and wellbeing.

What is required, though, is just as out-of-reach, if you look at (A) what we as chronic pain patients know and measure that against (B) what we as chronic pain patients do.

Simply put: we know we need to change our lifestyles. But we don’t.

That’s the sad truth, folks. We all know we have to stop grinding ourselves down into a fine powdery version of our vital selves. We know we have to exercise – to move, often and every day. We know we have to cut out our bullshit and get real with ourselves and our current conditions. We know we have to meditate. We know we have to turn our backs on the sugary, chemical-laden crap in our diets and embrace organic and low-on-the-food-chain vegetables, fruits, and lean protein.

We know this stuff!

And we’re not DOING IT!

What’s the answer, then? If it isn’t a question of knowledge but of action — of actually making the changes we know we need to make — then how are we supposed to proceed here?

There’s something very romantic and enticing about “taking the cure in Kerala” — about making the grand gesture, fleeing our sad, sick lives and making wholesale change in a brand new, exotic locale.

But there’s just one problem with that (well, besides the pure impracticality for most of us and the exorbitant expense): it’s a lie. And it sets us up for failure when we inevitably return home.

It’s a lie because it suggests that the grand gesture is required — that nothing short of this kind of Eat, Pray, Love – style adventure will heal us. And that’s not true.

And it’s setting us up for failure because — well, damn, because it’s easy to put ourselves into low gear and embrace healthy living when we’re being massaged every day and don’t have to feed the kids every night.

What happens when we get back home? How successful will you be maintaining that glow of health and those new healthy habits when the pressures of daily life start clamoring for your stretched-thin attention?

Don’t wait for your ticket to Kerala to get better, is what I’m saying. Create Kerala where you are. Right now. Right this second.

Also? If you get a ticket to Kerala, can I come, too? I’m not crazy.

In order to understand the process by which meditation works to improve our experiences with chronic pain, we should examine the evidence supporting the premise itself. In short: how do we know that meditation works at all?

Studies Establish Meditation’s Effectiveness in Chronic Pain Management

Numerous studies have consistently found the same thing: meditation works on chronic pain — not just in our emotional reaction to it, but also the pain itself.

One study, published in the Journal of Neuroscience (Feb. 2008), found that chronic back pain patients demonstrated an always-active area in the frontal cortex associated with emotion, whereas healthy brains (in healthy non-pained patients) show those areas “go dark” from time to time. As columnist Jackie Gingrich Cushman notes in this article, meditation can help train the brain over time to “take a break,” as it were.

A Canadian physician found in one study that meditation of 10 to 20 minutes a day, over a period of ten weeks, significantly helped many patients to manage their pain. One participant, whose pain was so intense that she’d even considered suicide, noted she was “shocked” at how significant the impact on her pain was. (You can read more about the mindfulness method developed by Jon Kabat-Zinn which was used in the Canadian study here at NPR.)

In fact, Kabat-Zinn is somewhat of a pioneer in this area of study. His own studies served as the catalyst for many subsequent researchers. The abstract from one of those studies is here at his site, Wild Mind.

Another fibromyalgia study, this one conducted in Switzerland at the University of Basel Hospital, showed that a mindfulness meditation program yielded several key benefits in patients, including pain-induced suffering, anxiety, and depression. A follow-up three years showed continued benefits for those who stayed with the process.

Studies have also shown that a relaxed mind, one of the major benefits of meditation, is more capable of remembering and processing information, which might help alleviate that fibro fog we all hate so much.

The Mechanism Behind Mindfulness Meditation’s Impact on Chronic Pain

To get to the “whys” and “wherefores” we should review what happens in a normal pain response in a healthy individual:

1. A painful stimulus is applied — be it a hand on a hot stove or an injury in a car wreck;
2. The nervous system sends the “IM” as it were to command central: “Injury: Possible Pain Ahead”
3. The brain then acts like a relay station of sorts. It sends out the message, much like a PA system, to what’s been called “the pain matrix” — an association of brain areas responsible for different functions that, collectively, help us process and learn from the experience (more on this below)
4. Those areas jump into action, sending the signal to the rest of the body to either stop interacting with the painful stimulus (“take your hand off the stove, idiot!”) or prepare for biophysical stress (“this is gonna hurt”)
5. The brain’s various structures then learn from the experience thanks to a characteristic known as neuroplasticity.

To get to the heart of how meditation works, we need to focus on steps 3 and 4 — the sending of the signal to the pain matrix, and the various commands that then issue from the brain to the rest of the body in response.

The Functions of the Pain Matrix

In step 3, the PA message goes out to the pain matrix, which consists of those areas of the brain with the following functions:

• Turning the signal into a physical pain sensation — so you become aware of all this stuff (that’s happening at lightning speeds, of course — much too fast to discern separately)
• Keeping track of goals and conflict — so you can start to solve the problem of how to make this unpleasant experience better
• Processing emotions, thereby triggering fear and anger — so you become motivated to protect yourself

That last one, in particular, is important. It’s easy to look at this process and say “well, the emotional stuff, it should just go away. Who needs to feel such negative emotions all the time?” But in fact that’s a crucial part of the healthy pain response! Without it, you’d likely just keep doing the same thing over and over, because it wouldn’t have become something you desire to avoid.

Now, that’s a healthy response. But in chronic pain, the response gets all screwed up. Those hormones that flood our body in step 4, preparing us to “fight or flee”, don’t dissipate like they should. The emotional response continues longer than it would otherwise. In short, we get stuck in this cycle. Like the Energizer bunny — it all just keeps going and going and going …

What meditation does is akin to short-circuiting that cycle.  It breaks the emotional response (which only serves to amp up our suffering). It calms the biochemical stress response. It allows us to experience the pain without suffering through it.

My personal experience with this phenomenon tells me that the benefits are not only immediate but also cumulative. That is, you get an initial improvement in your well-being, sure — but over time, those benefits add up.

Now, when I go into a flare now (and of course, it still happens) my meditation practice has now retrained my brain to approach the experience with equanimity:

• I don’t get upset.
• I don’t feel nauseated afterwards (which is due to the overflow of adrenaline that’s produced in the pain response).
• I don’t feel that rage and debilitating fear that grips so many of us — and used to grip me tight, to be sure.

Want to Know More?

In a few days, I’ll share some solid tips and tools on how to implement a meditation practice, even if you’ve never meditated before.

If you want the full New Agey “whoo-whoo” experience, I’ll give you some suggestions to bliss out with the incense for the whole experience. If you’d rather keep it simple, I can help you there, too. No matter what your preferences, there is a meditation practice that’s right for you, and it will help you feel better. I promise.

Do you meditate? How has your experience with your chronic pain changed as a result of the meditation practice? Share your stories with us in the comments!

Over the rest of this month, I’ll be examining meditation in detail — what it is, how it helps, why it works, and how to do it. This won’t be a daily series – rather, I’ll fit in the posts into the already-established editorial calendar here. Each post will be tagged with “Meditation 101 for Chronic Pain Relief.”

No, It’s Not “All in Your Head” … But Quieting Your Mind Can Help

For a lot of us, any suggestion of remedy that even sniffs of “it’s all in your head” is automatically suspect. For some of us, meditation falls into that category.

Look, I’m as anti-head-caser as anyone (being a fibromite, it comes with the territory) but I’m here to tell you: this meditation stuff works.

Let me make this point clear, though: I’m no guru. I hate the word and think it’s overused both as an honorific and as a criticism.  What I am is someone who’s tried a lot of coping mechanisms and treatment options – someone with a pretty clear understanding of which of those options worked for me and which didn’t.

I’ve also done a fair bit of (OK, extensive) study on the subject, and while there’s absolutely no treatment for chronic pain that will work across the board — even for a particular illness — it seems that more and more evidence is piling up that meditation works. Specifically, it helps someone in pain cope with the pain by removing the suffering component. For me, it also goes beyond that and actually helps reduce the pain.

The Difference Between Pain and Suffering

First, we need to establish what we mean when we say “pain” and “suffering.” Interestingly tidbit: I used to be a lawyer, as most readers know. In preparing a complaint (the document that starts a lawsuit) for personal injury, lawyers will frequently use the phrase “pain and suffering.” Some of us in first-year torts class in law school wondered why use both? We chalked it up to typical lawyer-speak.

Fact is, though, they aren’t the same thing at all. The lawyers were right!

Pain is the unpleasant sensory perception we’re all too familiar with. It’s the biochemical response to certain stimuli — or, in our cases, the mere state of being alive with a chronic pain condition.

Suffering, however, is something very different. While pain is a physical phenomenon, suffering is entirely emotional and mental. It does, in fact, lie completely in your mind.  Suffering, put simply, is the emotional resistance to the pain that we throw up, consciously or subconsciously, and it’s usually based on fear or anger, or both.

Suffering is what makes us think:

• Why me?!
• This will NEVER go away.
• I’ll feel like this until the day I die.
• What the hell is WRONG with me?!
• OhGodohGodohGodohGod…

You get the drift.

There’s one more key difference: pain is a fact of life for the chronically pained. Suffering, however, is completely optional.

The Impact of Meditation on Suffering

Meditation works to relieve the suffering component of the chronic pain experience in several ways.

1. It quiets the mind.
2. It brings you out of the future-based fear you’re experiencing and grounds you back in the present.
3. It reduces the physical stress caused by the experience of pain.
4. It steadies and slows your breathing, which further reduces physical stress.
5. It fosters a stronger sense of well-being.
6. It moves you gently out of the “freak-out” mode into a more objective perspective.
7. It improves your mood.

Why There’s No Contradiction Between Meditation’s Effectiveness and the Biological Reality of Chronic Pain

So, this is the part of the post where I tell you why those jerks who insist that it’s all in your mind are still bone-crushingly wrong and meditation works, anyway, and these two things are not the contradiction that they might appear to be initially.

Let’s say it again, just to make it clear: it is not all in your head.  But meditation can help you reduce the suffering that accompanies your pain. And that can make it all just a little bit easier to bear.

This is true because — again — there’s a difference between pain and suffering. Pain is the biological response; suffering is the entirely emotional/mental response that accompanies the pain.

In future posts, we’ll look at how to start a meditating practice for chronic pain relief.

I love Twitter. This post is a good explanation of why.

As many know by now, I spent New Year’s weekend moving from North Myrtle Beach, South Carolina, to Salisbury, North Carolina, with my daughter and her kitten. As I expected, the physical and mental stress of this move triggered a fibromyalgia flare-up, and I thusly tweeted:

The Tweet That Started the Debate

As they do, my #fibro-tweeps sent me some virtual hugs and support, and this one in particular caught my eye:

@DebDrake's Response

Then @DebDrake kindly shared a link to a list of her recommendations for fibromites from her website.  (Deb’s bio on Twitter reads: “I’m a Naturopath, nutritionist & CNHP. I’ve had fibromyalgia for a decade and I am beating it with nutrition and lifestyle.”)

I don’t know what it was about the situation that prompted me to engage Deb but I did, and below, you’ll find what transpired over the next few days between us. Collectively, these tweets represent an interesting debate about alternative medicine versus pain medication for the treatment of fibromyalgia.

So I asked Deb if she’d mind if I shared the conversation with my readers.  She graciously agreed, although she was concerned that I wouldn’t bash alternative medicine in general or specifically with respect to fibromyalgia. I promised I would (A) give equal time; (B) represent the conversation faithfully; and (C) share my opinion truthfully.

And that’s what I’m about to do.

The Twitter Conversation: @DebDrake and @SherrieSisk on Alternative Treatments vs. Pain Medication for Fibromyalgia

I replied:

@DebDrake Alt therapies didn’t work for me. I’m glad they work for someone but my open-mindedness turned to disbelief after my experience.:)

Deb responded:

@SherrieSisk I’m sorry to hear that. It is true that disease = constitution+environment & the remedy must treat both. No remedy works 4 all

@SherrieSisk Dont give up on nature tho. The body has the ability to heal if you give it the tools. minerals help the most -mostly magnesium

@SherrieSisk Many do just the opposite: give up on meds bc of side effects & not working.That was me-In pain 5yrs going to drs. never helped

I replied:

@debdrake Magnesium did absolutely nothing for me. Tramadol, however, works great. Side FX minimal if taken properly, uptitrated slowly

@debdrake Not anti-anything that works for the individual. Just sick and tired of #fibro patients talked out of trying medication b/c of…

@debdrake … baseless fears or bad doctor advice.

Deb next offered the following thoughts:

@SherrieSisk Magnesium by itself helped but not enough. It does pretty good when mixed w CoQ10 and malic acid.

@SherrieSisk But still, fighting fibromyalgia requires a combination of things to do. It was caused by any one thing. A change in lifestyle.

@SherrieSisk Natural remedies dont work the same way medications do. They help build the body up rather than undo a symptom. Symptoms=alarm.

@SherrieSisk So sometimes meds are good. They turn off the alarm & stop pain. but now something must change or damage is still being done.

@SherrieSisk I guess I just think that everything, even herbs, should only be temporary fixes. Herbs for example help the body rebuild.

@SherrieSisk There are a few things we need ongoing since food is deplete. A good multi, omega3, antioxidants, minerals, probiotics, enzymes

My response:

@debdrake It’d be great if that worked for everyone. You can read more abt my 10yr exprnc w/ #fibro at my site – but briefly …

@debdrake … I’ve tried many nutrtl supps – some made slight difference, most made none (incl CoQ10, malic acid and Mg). I just can’t …

@debdrake … agree that meds are not best treatment option, ever, for anyone. There is no one-size-fits all solution, until there’s a cure

@debdrake Basically: I’m a big believer in better living thru chemistry, until they come up with a cure, and strongly believe#fibro ptnts..

@debdrake … shouldn’t feel guilty for trying/relying on them, if they work. Yet that’s the msg we’re constantly bombarded with.

Deb’s response:

@SherrieSisk I hope I dont come across as anti meds. I dont talk about meds. Im not an MD. I’m an ND so only talk about natural alternatives

@SherrieSisk Im def not trying 2 make any1 feel guilty about anything. U have to feel good about what u are doing 4 it to help & not harm u.

@SherrieSisk Fibromyalgia is very much tied in to our emotions and feelings. Choosing a treatment should not be based on fear.

@SherrieSisk I know that many don’t want to use chemicals and so are looking for how to reduce symptoms without meds. I am here for them.

@SherrieSisk Ur right about just trying to use one answer for fibro. It wont work. Like I mentioned bf, must be an individualized program.

@SherrieSisk If a person comes to me and says they live a hi stress life, eat fast food everyday, wont sleep at night, etc, & then say that…

@SherrieSisk They want rid of symptoms but don’t want to make any changes. just a supplement 2 fix it. It’s not possible. I can’t help them.

@SherrieSisk If you are happy with your treatment plan and have no side effects or fear of long term issues, then don’t change it.

Then she said something nice about my writing.  I thanked her, and said:

@debdrake I understand completely. I’m not “PRO”-meds – except when they work and are taken properly. I’m PRO-anything that helps.

@debdrake It’s just that for me, I don’t see the proof that alt remedies really work as well as meds, & there’s a TON of bias against meds

@debdrake … that ticks me off, frankly. No #fibro ptnt should B scared away from ANYTHING that works. Alt remedies, meds, yoga, ANYTHING.

My Position on Alternative Remedies and Prescription Pain Medication for Fibromyalgia

Let’s clarify what we’re talking about when we talk about “alternative remedies” for fibromyalgia.

As I use the phrase, I’m referring to nutritional supplements, acupuncture, acupressure, Chinese medicine, massage therapy, Ayurveda … pretty much the world of treatment outside prescription pain medication, surgery, and exercise/physical therapy-based treatments.

I realize some might disagree with me that yoga isn’t really an alternative therapy, but I consider any movement-based program to be in the same ballpark as any kind of exercise, including walking.

I wrote about nutritional supplements, and described my experience with them, on this blog previously. I realize now that I sort of shied away from my true feelings about natural or alternative remedies in that post, and I apologize for that. But there was a reason for my reserved approach, and it’s echoed in my statements to Deb above: I don’t want anyone with fibromyalgia to be persuaded not to try something that might help them.

See, I agree with Deb in a few respects here. Until we have a cure, there will never be one single treatment that works for everyone and every symptom.

One place where I part company with her is in the why: Deb thinks no one thing causes fibromyalgia and that’s why no one treatment will work. I think it’s entirely possible that one thing does cause fibro, although it possibly depends on a more complex mechanism or series of events to really get going.

The point: We don’t know what causes fibro. We don’t know what the cure is yet.

And with respect to alternative remedies, by and large, we don’t know whether they “work” to either cure, lessen, remedy, heal, or alleviate fibro. We have some evidence, mostly anecdotal, that certain treatments have a beneficial effect more often than others. We have very little empirical evidence, though, especially with respect to nutritional supplements.

Here’s my beef with the whole alternative field: I’ve read a lot of those books detailing the supplementation regimens recommended for fibro, and the regiments simply aren’t practical. I’ve tried a lot of those regimens — the expense coupled with the not-insignificant hassle of taking handfuls of pills every day at different times means, for me, that in order to be worth that hassle, that regimen better produce some impressive results pretty darn quickly.

They never have. For me. Others say that their mileage varied — they believe the regimens worked and they feel a lot better. And that’s great for them.

Let me make this clear, once more: I support wholeheartedly any fibromite’s treatment regimen if it works for you and is safe. Heck: even if it isn’t safe, if you’re fully informed and make a deliberate decision to try it anyway, knowing the risks, then I support that, too, as long as it poses no risk to anyone else.

Where I get irritated is when folks make claims that fibro can be cured by natural means — or frankly, by any means. It can’t. Not yet. I also get irritated when medication is presented as something unnatural — in the sense that it’s bad, or wrong. It sends the message that anyone who chooses medication is somehow weak, or doing the wrong thing, or harming herself.

It’s just not true. I resent it, it gets my hackles up, and it’s dangerous, to boot.

Medication wasn’t something I chose lightly. I looked for more conservative measures for four entire years before I finally agreed to give prescription pain medication a try.

But when I did — when I found what worked for me (tramadol plus acetaminophen) — the change in my quality of life was striking, immediate, and long-lasting. I’ve been on this cocktail for six years now, and have increased my dose only once (three years ago).

Far from being addicted to it, I’m indebted to it, but I take it in order to live my life, not to get high or to avoid withdrawal. I take it, in short, in order to function. It works for me, plus any side effects are minimal and can be managed completely by simply following the instructions for taking it.

Basically, what I’m saying is this: don’t be swayed away from any possible treatment — including nutritional supplements, and – yes – including prescription pain medication — by questionable value judgments placed on the treatment by others. Don’t reject prescription pain meds, when nothing else works, just because people tell you that they’re somehow wrong or objectionable, based on some faulty science or a personal agenda. By the same token, don’t go running to your doctor for tramadol just because I’m saying it worked for me.

And with respect to alternative remedies, I’d love to see some harder science on their efficacy. To my knowledge, only acupuncture has any studies supporting its usage in fibro treatment; it would be awesome to have more options for all of us. All I can do is tell you what worked — and what didn’t — for me:

• Tramadol, gentle yoga, minor diet adjustments: yes.
• Supplements, acupuncture, chiropractic, herbs, and just about everything else, including massage (damn it, ’cause I do love massages!): not really, or not in the least.

And, as always, your mileage may definitely vary.

* – (Twebate=Twitter debate. And I promise, that’s the last time I’ll ever coin a “tw”-starting word to describe something on Twitter.)

The Tramadol Diaries First Virtual Book Tour Proudly Presents Kelly McGonigal and Yoga for Pain Relief

From Sherrie: As I noted here earlier, Kelly McGonigal is a yoga instructor and Stanford University psychology instructor. Most importantly for our purposes, she’s just published a book titled Yoga for Pain Relief, and as a long-time Tramadol Diaries reader, she wanted to share some of the fruits of her labors with other TD readers in a virtual book tour.

Of course, I grabbed that opportunity! I’ve written about my experiences with yoga before, both here and in articles for other sites, but I really can’t say enough good things about yoga.

I joke that tramadol saved my life, and it did — but the truth is, so did yoga. Without my daily practice, I honestly doubt that I’d be here right now, joyfully writing this introduction in support of Kelly’s “labor of love.”  Chronic pain not only means we don’t move our bodies as we want to and should — it also means our psyches are burdened as well. It shouldn’t be a surprise to anyone that chronic pain patients have a high incidence of depression; as many of us say, “Let me stand on your chest for ten years and let’s see how long it takes YOU to get depressed.”

Yoga not only helps relieve the physical pain but it also gives me the tools I need to eliminate the suffering aspect of pain. That, in turn, greatly and positively enhances my quality of life and sense of wellbeing. Yes, I still hurt. The difference is, I’m not letting it define me, nor am I burdened with all those fearful, tense feelings that collectively comprise suffering.

So, without further ado, here’s Kelly with an excerpt from her new book, Yoga for Pain Relief: Simple Practices to Calm Your Mind & Heal Your Chronic Pain (Whole Body Healing) (disclosure: that’s an affiliate link to Amazon – costs you nothing extra, adds a few pennies to my bank account).  This excerpt includes instructions for a special practice sequence that might help anyone coping with chronic pain. Also be sure to check out the special bonus guided meditations at the end of the post!

CAUTION: As always, talk to your doctor before starting any new exercise regimen.

Lisa’s Story: Finding Hope Through Yoga

Lisa’s achey fatigue was both mysterious and maddening. When it first showed up during the winter holidays, she thought it was just the flu combined with exhaustion from overdoing things. But as the holidays passed and her fatigue didn’t, her family became alarmed and encouraged her to see a doctor. Her general physician couldn’t give her a definite diagnosis and referred her to a specialist.

The specialist gave her lots of tests but also couldn’t tell Lisa for sure what was causing her exhaustion. Eventually Lisa was diagnosed with chronic fatigue syndrome. By this time, she had taken an extended sick leave from work and was wondering if she would ever be able to return.

Lisa’s physician gave her two prescriptions: an anti-inflammatory drug and an antidepressant. What she wasn’t given was an explanation for her symptoms, or any answers about when or even whether she would recover.

To Lisa, the lack of medical understanding meant lack of hope. Her growing sense of hopelessness was accompanied by greater fatigue. Some days she was so tired, she crawled back into bed less than an hour after waking. The worst part was that even though she was almost always exhausted, she had trouble sleeping. This left her plenty of time alone with her worries and frustrations. She described it as a “wide-awake nightmare.”

Without a clear path for recovery, Lisa needed some way to feel like she was taking care of herself. She wanted to be able to do something every day that felt like an active step toward improving her energy and mood. Lisa didn’t have the strength for exercise, but she found great solace in restorative yoga. It was something she could do every day, knowing that it made her feel better both physically and emotionally.

Lisa kept her yoga mat and props out so that there would be no barrier to practicing. She took great care in choosing inspirational music to play while she practiced, knowing that her favorite songs would lift her spirits. She took seriously the idea that focusing on gratitude, joy, connection, and courage could change the state of her body. She chose one meditation each day to practice in her final restorative pose, imagining the thoughts and sensations of each meditation restoring her strength and well-being.

Lisa thought of her restorative yoga practice as her third daily prescription. It became the one part of her self-care program that consistently made her feel optimistic about her future.

Many types of pain and illness are physically and emotionally overwhelming, especially when they pull you out of your normal life and put you into the role of patient. When pain or illness is this overwhelming, even a few minutes of focusing on health can restore hope and inspire courage in the journey of healing. Whenever you find yourself lowest in spirit, you can always turn to yoga to affirm the part of you that is healthy and whole, despite pain or illness.

A Simple Restorative Yoga Practice: Supported Inversion

Benefits: By gently bringing the legs above the heart, this pose improves circulation and has a healing effect on many systems of the body, including the nervous system, the lymphatic system, and cardiovascular system. It can be done no matter how little energy you have, and can help make “rest” more restful and less stressful.

Props needed:

• A wall, chair, or sofa.
• Optional: a small rolled towel or blanket to support your neck and head
• Optional: an eye pillow or cloth to drape over your eyes.

Instructions:  [Sherrie's Note: there are three parts to this practice -- the physical asana, breathing, and the meditation. Read through the entire description at least twice before attempting. You might also want to consider tape-recording these instructions and playing them back as you go, or having a friend or loved one read through them as you move through the asana, at least the first time you try it.]

1. Find yourself seated on the floor near the wall or your chair, with one side of your body facing the wall or chair.
2. If you are using extra support for your head and neck, place it about one arm’s length away from the wall or chair, where your head will rest.
3. Start to lean back on your arms as you raise your legs onto the support of the wall or chair.
4. Let your hips turn as you do so, until you find yourself lying comfortably on your back, with your legs resting on the wall or chair.
5. If you are at the wall, make sure that you do not feel a strain behind the knees, in the back of your legs and hips, or in your lower back. If you do, try the pose with hips further away from the wall, to reduce pressure on the legs and back. If you continue to feel any strain in the wall version, you may find the bent-leg version using a chair or sofa much more comfortable.
6. Let yourself relax into the support of the pose.

Breathing: Once you are settled in the pose, bring your hands to rest on your belly. Feel the belly rise and fall as you breathe.

Meditation: This pose is in invitation to drop your usual worries and burdens. As you inhale, say silently in your mind, “Let,” and as you exhale, “go.” Yoga is about feeling safe and supported, in both your body and in all areas of your life. You can also repeat silently in your mind, “I am safe” or “I am supported.” If there are other words, images, or memories that make you feel safe and supported — such as loved ones, a favorite place, or a prayer — bring them to mind.

Bonus For Tramadol Diaries Readers! Meditations Just For Chronic Pain Thrivers

In addition to the awesome meditation/yoga asana practice Kelly shares above, she’s offering something special just for Tramadol Diaries readers. At Kelly’s website, Yoga For Pain Relief, you can also download or stream a guided meditation that will guide you through practices of breath awareness, body gratitude, and listening to your body. There’s one for befriending your body, and another for listening to your body (both links are to MP3 files).

I’d like to thank Kelly both for writing such an amazing resource for those of us living with chronic pain, and for sharing her words of wisdom with Tramadol Diaries and its readers. I’ve learned a lot, and I hope you have, too. Kelly has an open invitation to stop back by anytime she likes!

Crocs are, without doubt, my favorite shoes when my feet ache. OK, pretty much anytime, really, but especially when my feet ache.

From now until December 18th, you can get 5% off your entire purchase. Here’s the affiliate link so you can help me keep my poor feet in Crocs, too: Exclusive 5% OFF Stackable coupon! This coupon can be used on ANY purchase between now and Dec. 18th. Simply enter N9DWZLKY3ISA.

Personally, I’m jonesing for a hot pink pair with a fur lining. You know, in case someone wants to buy me a Christmanukwanzyule gift a wee bit early.

Update – 12/5/09: the promo code for the Vitamin World site at the end of this post was good for December 2 only, but this one’s good today – Dec. 5th: One day only! $10 off $75 + FREE Shipping at Vitamin World. Use code TAVHOL5 at checkout. Valid 12.05.09

I’ll keep updating this post as long as the VW promotion is going on, so check back if you’re not ready to buy now. Again, that’s an affiliate link which might put a few cents back into the web-hosting account for this site! Gracias.

Many fibromyalgia experts  and texts recommend nutritional supplements as a way to offset or eliminate fibro symptoms. But do those supplements really work?

Following is a rundown of a few of the most-often recommended supplements, as well as my own personal experience with some of them.

CAUTION: Remember that, as with every potential treatment, you should always consult with your physician before trying any of these supplements out. Even so-called natural remedies can interact dangerously with other remedies and medications, so talk to your doctor first.

Malic Acid and Magnesium

Particularly when taken together, experts suggest, malic acid and magnesium can alleviate the more painful fibro symptoms. Malic acid is derived from tart apples, while magnesium is, of course, an essential mineral necessary for more than 300 bodily biochemcial functions.

Among the most important of these functions are muscular function and the creation/processing of ATP in the body. (ATP, briefly, is adenosine triphosphate, and results from the enzyme-catalyzed processing of sugar and fat.) Magnesium activates the process, and malic acid helps the body make ATP more efficiently.

Past research also suggests that magnesium may work to dampen the processing of some types of pain signals in fibromyalgia sufferers.

You can view more information on magnesium at the NIH fact sheet here, and an abstract of one study’s results looking at the combination of malic acid and magnesium can be found here (results: “significant reduction” in pain symptoms in increased dosages in open trial). However, it should be noted that an earlier double-blind phase of that same study showed no appreciable effect on FM patients who took magnesium/malic acid supplements.

Possible side effects:

• Diarrhea
• Nausea or diminished appetite
• Respiratory difficulties
• Hypotension
• Adverse interactions with some medications (including osteoporosis drugs, certain hypertension medications, antibiotics, and muscle relaxers)

S-adenosylmethionine (SAMe)

A naturally-occuring chemical compound found in the human body, SAMe plays an important role in several critical functions, including the immune system response and the creation and processing of chemical neurotransmitters such as serotonin and dopamine.

Some research indicates that SAMe might be beneficial for FM patients.  In one double-blind study looking at SAMe’s effects on 17 fibromites (more than half of whom also had been diagnosed with depression), both the number of painful tender points and assessed depression decreased appreciably with SAMe as compared to the placebo group. While intriguing, the relatively small number of subjects in this study warrants caution in evaluating its results.

Other study results conflict with each other. In one slightly larger study (44 subjects), there was appreciable decrease in some symptoms (pain, tiredness) but not others (tender points, mood). Another study delivered SAMe via IV, but found no measurable decrease in tender points.

Possible side effects:

• Indigestion and other digestive disorders
• Insomnia
• More rarely: diarrhea, acid reflux
• Caution: FM patients who are diagnosed with bipolar disorder should not take SAMe; it may increase the occurrence and severity of manic episodes. SAMe may be contraindicated for those taking antidepressants; consult your doctor first (as you should before taking any new supplement or medication).

5-HTP (5-hydroxytryptophan)

There is some promising research on 5-HTP and fibromyalgia, showing that it can reduce tender points and increase serotonin, the “feel good” neurotransmitter.

There is no fact sheet for 5-HTP at NIH, but you can find good information on it at this site. While it’s found in low levels in some foods (turkey, for one), most will want to choose a supplement form.

Possible Side Effects:

• Loss of appetite, nausea, and vomiting
• Diarrhea
• Pupil dilation
• Muscular coordination problems
• Blurred vision
• Irregular cardiac rhythms
• Caution: Do not take 5-HTP if you’re currently taking any antidepressant.

Vitamin B12

A few studies with relatively small subject numbers indicate that FM patients may have lower levels of vitamin B12. As B12 is an essential vitamin, it’s certainly worth looking into your intake.

Good dietary sources of B12 are animal products — meats, fish, eggs — and fortified cereals. It’s not usually found in fruits and vegetables. The current RDA for mature men and women ranges from 2.4 to 2.8 micrograms.

You can also take a multivitamin that has B12 in it, or an individual supplement pill for B12 or B Complex (includes B12 as well as B1, B2, B3, and B6).

You can read more information on Vitamin B12 at the NIH website’s fact sheet.

Possible side effects:

• B12 has a very low risk of toxicity but it can be contraindicated with certain medications. As always, talk to your doctor.

Vitamin D

Some researchers have found a connection between vitamin D deficiency and general musculoskeletal pain. Certainly, vitamin D is generally recommended for overall nutritional health and wellbeing.

The current recommended intake level for vitamin D in the US is 200 I.U. for men and women up to age 50, rising up to 600 I.U. for older patients.  Toxicity has been established at 50,000 I.U.

It’s difficult to get all the Vitamin D you need from foods, but it is present in fortified milk products and certain fatty fish (particularly the skins). You can also increase your body’s own production of the vitamin with sunlight exposure without sunscreen (just a few minutes a day are all that’s required).

Get more info from the NIH Fact Sheet on Vitamin D.

Possible Side Effects:

With too-high intakes of Vitamin D, certain side effects are known:

• Nausea
• Vomiting
• Decreased appetite
• Constipation
• High blood levels of calcium may also lead to confusion and irregular heart rhythms

Personal Experience With Supplements for Fibromyalgia

Of these commonly-recommended supplements, I’ve given two-month trials to malic acid and magnesium (taken together); vitamin B12; SAMe; and 5-HTP. I’m currently experimenting with vitamin D.

I experienced no measurable relief with malic acid and magnesium. While on increased levels of B12 (a multivitamin plus an additional supplement, providing a total of 580 mcg, I did notice a slight increase in my energy level, but no decrease in pain symptoms.

SAMe and 5-HTP both produced some interesting results. I believe my pain symptoms leveled off — I had fewer flare-ups, and when I did experience increased pain days, it seemed that my “lows” weren’t quite as low as previously. Also with 5-HTP (but not SAMe), I felt my neck/shoulder tender points were a little diminished in terms of sensitivity.

Of course, in each of these try-outs, I knew what I was taking. My results could be attributable to a placebo effect (although that doesn’t explain why I didn’t experience any benefit with malic acid and magnesium; 10 years ago, when I was first diagnosed, it was the first- and most-often-recommended supplement).

You should never take any one person’s recommendation for a treatment option. Do your own research, talk to your doctor, and if you do want to try one of these supplements, try going in without any expectations.

Special Promo Code for Tramadol Diaries Readers from Vitamin World

If you’re interested in trying out some of these supplements, Vitamin World is offering a series of specials for the next few days. Today’s special, good for December 2, 2009 only: One Day Only! $1 Shipping on ANY order at Vitamin World! Use code TAVHOL2 at checkout. Valid 12.02.09 Today (12/5/09)’s code: Dec. 5th: One day only! $10 off $75 + FREE Shipping at Vitamin World. Use code TAVHOL5 at checkout. Valid 12.05.09 Yes, that’s an affiliate link and might just net me enough to help offset the hosting for this site … maybe.

Here’s a simple little meditation that’s incredibly powerful at helping your body release chronic pain and heal itself. It draws on the power of two of summer’s most iconic elements: the sun’s rays and the ocean’s waves.

Why Meditation Coupled With Visualization Works To Relieve Chronic Pain

Many of us resist the advice to meditate when it comes to managing our chronic pain. Yet meditation can have profoundly beneficial physical effects when it comes to our body’s ability to heal itself. When you couple meditation with visualization — the practice of envisioning certain scenes or images — you can ramp up the healing power of meditation.

Why do we resist meditation? I think it’s because it “smells” like “it’s all in your head.” Yet the connection between the body and mind is just beginning to be understood in Western medicine. Studies have shown that our brains’ entrenched beliefs can and do have powerful impacts on our health; witness the many studies that show placebos often work, even if they’re nothing more than sugar pills.

Meditation works on so many levels. First, it relaxes your body physically. Especially with fibromyalgia, our muscles have “memories” that bring them back to a painfully tense state time and again. Meditation can retrain those muscles over time to relax, which can ease the pain levels tremendously. Secondly, it works to reduce overall physical stress levels, lowering the amounts of hormones that in large quantities wreak havoc with our body’s systems. Finally, it feels good — and we can all us as much of that as we can get.

Preparing to Meditate

You need no special training or equipment to meditate. Wherever you are, whatever you’re doing (except driving a car!), you can meditate. But for the best results, try this meditation when you’re alone. You can be outside or inside, although outside would be very helpful for this particular meditation.

If you are lucky enough to have access to a beach, that’s ideal. But even if you can’t get to the ocean, you can bring the water’s healing powers to you, wherever you are. Look for a pool, or failing that, use a bathtub or even an indoor fountain.

Wear comfortable clothes (unless you’re in the pool or beach, in which case a swimsuit is best, or in the tub, in which case no clothing is necessary). Make sure you won’t be disturbed for half an hour or so.

If you’re using a tub, fill it with warm but not hot water. Add some Epsom or sea salt to the water, to make it as close to the real thing as possible. If you’re in a pool, float on your back if possible, or simply sit comfortably on a step in the shallow end, letting the water cover your feet and ankles. At the beach? Anywhere will do, but if you can move your chair, or just sit on the sand, in the surf, that’s ideal.

Lastly, if you’re outside, make sure you put on sunblock! We’ll be working with the power of the sun to heal — but we all know the sun’s rays can be dangerous to unprotected skin, too. So, lather the white stuff on, and make sure you hit the areas that we always forget — the ears, the tops of feet and toes, the scalp.

Ready?

The Summer Sun-And-Waves Meditation

Begin by relaxing your body. Focus your awareness on each part of your body, starting with your toes, moving up to your feet, your ankles, your calves, and so on, until you reach the top of your head. At each point, pause and gently (silently) tell that part of your body to relax. Continue up your body until you reach the top of your head. Relax your eyes, your mouth, your forehead, your scalp.

When you’re thoroughly relaxed, focus on the sound of the waves coming in and going out. If you’re not actually at the beach, that’s OK — just call that sound to mind. (If you have a CD or sound machine that can recreate waves, great! If not, just use your imagination and memory.) Just focus on the waves for several minutes.

Now, turn your awareness to the warmth of the sun beating down on your body. Again, even if you’re not outside, it’s OK — just visualize the sun’s rays enveloping your body in warmth. See them in your mind’s eye as golden rays of pure healing energy.

Now, begin to direct those rays in your mind’s eye to the parts of your body that hurt. One at a time, “move” the rays of golden light to target a painful area. Let the rays do their job — visualize them sinking in (only the good parts, of course — the sunblock’s taking care of the bad stuff) and working magic on the tissue, the fascia, the very cells that make up your painful muscles. After awhile, you’ll feel a distinct tingle in each area. That’s your cue that you can move on to the next painful area.

When you’ve moved the sun’s rays over every painful area, and felt that little tingle in each one, now it’s time to move on to the water portion. Bring your attention gently back to the waves — listen to the sounds of the waves coming in and going out. Really listen — note every single nuance in sound between the coming and the going until you can hear each difference distinctly.

Now, imagine that the ocean’s waves are bringing in health and wellbeing, and then they’re picking up all the bad stuff in your body that causes pain as they take that bad stuff back out to sea. Way out there somewhere is a magic well where all the “bad stuff” is deposited and transformed into healthful energy. The waves pick up that energy and bring it back in to you, in a never-ending cycle of healing. Stay with this image for as long as you can, feeling the waves bring you health and vitality and take away your pain.

After ten or fifteen minutes or so (or however long you wish to perform the meditation, mindful always of the need to reapply sunblock if you’re outside), bring your attention slowly back to your body and your surroundings. Slowly stretch, blink a few times, and massage your hands and shoulders to bring yourself back to full waking consciousness. You might feel like you just dozed off for a bit — and if you did, that’s great! Sleep heals, too. (Just make sure you don’t fall asleep in the sun without someone to rouse you in case you sleep too long.)

I’d love to hear your reactions to this meditation. Did you try it? Do you use a meditation or visualization sequence that’s different? Share it in the comments!

I know Crocs aren’t exactly high fashion, but dang, those things make my feet feel good. I don’t know about you guys but when my scoliosis-triggered leg nerve pain extends down into my feet, I just don’t want to get on them at all. It’s couch time for me.

But Crocs — while they don’t fix every problem, they certainly make life on my feet easier by leaps and bounds.

So, I was super excited to see this cross my inbox today:

Buy Two or More Pairs at Crocs.com and Get 50% Off! Offer ends: 6.22.09

(Remember – that’s an affiliate link. Costs you nothing, but helps me feed my kid!)

Half off. Yep, you read that right. A full 50% off all Crocs purchases when you buy at least two pair. But hurry, because the sale ends June 22nd. Grab ‘em while you can! It’s not just one style either. You can buy Islanders, Ace Golf, Ace Boating, Athens, Kid’s Athens, Women’s Mary Janes and Girl’s Mary Janes, and any combination thereof — as long as you buy at least 2 pair, your purchase will be half-price.

These are great shoes for a walking program, by the way (and walking is one of the most recommended forms of exercise for chronic pain sufferers who are able to do some form of exercise).

Half off. Wow. Can’t beat that with a stick, even on my good days!