Programming With Chronic Pain

If you know me personally you’ll know that I’ve dealt with chronic pain for years. Mainly, I’ve had issues with my shoulders, arms and wrists/hands. Despite a myriad of medical appointments, physios, scans, etc. it persists. Unlike many, I’ve been lucky to at least get what appears to be an accurate diagnosis in my case (multi-lateral shoulder instability, bursitis and a history of tennis elbow), but the road to recovery is a slow one. Over the years I’ve tried the whole range of solutions to alleviate the pain with most having minimal impact, but a few things have made a notable impact that I’d like to share with you.

What hasn’t worked?

First I think it’s worth quickly saying what hasn’t worked. I’m guessing that most of you reading this article have already tried these and been frustrated with the lack of progress.

Better equipment and ergonomics

I should start this section by saying that proper ergonomics when working is still very important. The changes that I made to my workstation (especially seating height and keyboard & monitor position) made a huge difference in how I generally feel when I work. However, when it came to the pain I experience they did little. I noticed less impact from equipment (e.g. new ergonomic keyboards) but that’s probably because I didn’t really use it for as long as you need to before falling back to old habits.

One million stretching breaks

Obviously it’s important not to sit still in one position too long. Despite this, no matter how many times I stopped to stand up, move around and stretch out the arms, I can’t say that it made any huge improvements. I think the research on stretching (especially static stretching) is mixed and you’ll get a million different opinions from a million different people. In my case though, it just served to slightly annoy my shoulders and wrists, leaving them more sore and tired than before I started.

Strange exercises

I tried all the various exercises for wrists and forearms especially with minimal impact. Wrist extensions and flexions, hand pronations and supinations, grip training, therabands, etc. Ironically, when I did get some scans done, both the reports and the doctors themselves remarked that the structures being scanned were in remarkably good condition, which is not really what you want to hear when you’re trying to diagnose pain. As you’ll read further down, this should probably have been a sign to change approach.

What made a difference

Okay so the above didn’t help much, but there have been notable improvements. What worked?

Handling environmental factors

Months after I started having issues, I noticed something one day after a few hours of work: my pain was much less? What’s happened? I haven’t felt like this in months! That’s weird… I felt thankful but I couldn’t figure out what was different. Later when it got warmer I finally turned on the air conditioning that I had left off unusually long. Within an hour, the pain was back as normal.

That’s when I realised, my desk both in my home and at the office was directly under the air conditioning unit! Since I realised this, I’ve made a conscious effort to wear long sleeves when sitting and working in the air conditioning. I won’t lie and tell you that the issues are completely gone, but it’s definitely made a huge difference. Itamar Turner-Trauring had the same realisation long before me and wrote about it on his blog, so there seems to be something to it. He suggests it might be related to blood flow, which seems plausible.

Understanding referred pain

In the case of my wrists specifically, I was barking up the wrong tree for a long time. I would get very regular pain, concentrated mainly in the base of my thumb and in the wrist itself. None of the approaches above had any real impact at all, yet the pain felt very real.

It took me a long time to make the connection that the pain that I felt in my wrists seemed to flare up at exactly when my shoulders flared up! What I know now is that when my wrists start aching, my focus should be on my shoulders. Usually, a good massage into my shoulders (and maybe a warm blanket thrown over them as above) sorts out my wrist pain when it shows up.

This is a phenomenon known as referred pain. The body is extremely complex, and injury or nerve problems in one part of your body can have big cascading effects on other structures. In my case, it’s common for my shoulders to flare up and give me issues in my wrists without any pain or discomfort along the arm between the two. This is one of the reasons why many people with chronic pain experience improvements when they focus more on their general health, it’s not always clear where the actual culprit lies!

Acceptance

Ok this last one is getting a little outside the realm of the concrete so feel free to end here, but honestly it’s worth considering. There’s a lot of quality evidence that your mental state has a notable impact on how you perceive pain. While I may not take this as far as someone like Dr. John Sarno, I have noticed that how I perceive the pain that I experience has a huge impact on how much I feel it.

Those of you with chronic pain would be very familiar with those first few months: You start feeling this pain or injury and you do the usual rest, medication and maybe a Dr’s visit. But it doesn’t work. The pain stays. Months go by and you dive deeper and deeper in the rabbit hole. Scans, treatments, exercises, lifestyle changes. It slowly consumes you. However, research suggests that catastrophizing can lead to acute pain becoming chronic and that it increases activity in the brain related to anticipation of and attention to pain. There is also some evidence that Cognitive Behavioural Therapy that focuses on rumination as the key element of pain catastrophizing offers moderate benefit for patients with lower back pain.

This is all a lot of words to basically say “try not to stress/focus on it”. I know that’s hard, but trust me it has a notable impact. Your brain is looking for you to give it signals on what is worth focusing on and what isn’t. Don’t give it a reason to highlight that pain.

Conclusion

Honestly I don’t really have much to add to the above. Pain is highly personal and what works for me might not work for you. What I will say, is that you will come out on the other side of this. Until you do, try and keep your head up! If you’re interested in more information on any of the above, leave a comment or email me at [email protected]

Small note on back pain

Years ago I experienced chronic back pain for several years but I decided to exclude that from the scope of this article. What worked there was far different and probably needs an article of its own. If you’re experiencing this and want to ask me some questions feel free to reach out at the details above.