![]() As an LMT and health educator and a long-time survivor of chronic pain, I have developed a unique combination of clinical skills and approaches that help me treat pain. My clients say, “Marian knows how (from the inside) to touch people who hurt”. The balanced and custom-tailored regimens we develop together help patients experience improvements, get involved and engaged in their own care, and maintain or improve functionality to vastly improve quality of life – doing the things that they love and bring meaning to them. Here are some suggestions for achievable goals that can make a big difference in pain levels:
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I will be presenting a free course introduction on September 2, 11 am PDT. Learn what I will present in my online Working with the Chronic Pain Patient 3-hour class for Embodied Health Learning tv. Link and sign up to introduction is here.
My very first You Tube is posted!!! Watch here to see Angela Sidlo interview me about Getting Shame out of Pain. Leave comments below and please be kind.
![]() “It is not only possible but natural for each of us to love our bodies to find ourselves beautiful – no matter how different, disabled, old or battle scarred we may be.” Harriet Goldhor Lerner “Reality is always kinder than the story we tell about it.” Byron Katie Shame is an emotion, like fear or grief. Shame is registered in the brain like strong physical pain. When combined with pain or stimulated by pain the hurt from each exponentially multiplies the other to create a Pain – Shame – Pain cycle. Ironically, the positive feedback loop spirals out of control and creates negative consequences for you. Shame is an emotion that affects all of us but physical Pain creates more situations that instigate or accelerate the Shame response. People with Chronic Pain have more worries about job security, how to sustain a relationship, or the effects of painful procedures or drugs on the body, and they feel like these situations are their fault. To compound the power of shame, withdrawing from what used to be fun activities in order to avoid Pain flares tips the balance further towards the negative. The lack of positive experiences and overabundance of adverse ones leads to a poor self-image that is ripe for cultivating Shame. Shame is also a social emotion, like shyness, guilt, or pride. You cannot have it without others being around, at least in your imagination. Shame may have once had a evolutionary purpose to keep an individual in good standing within a group by punishing brutally for the slightest imagined wrong doing. It is an ingrained habit, especially in our culture. After childhood, usually no one has to make us ashamed. We do it to ourselves. According to Brené Brown, a University of Houston researcher and lecturer who brought the study of Shame out into public awareness, shame is an “intensely painful feeling or experience of believing that we are flawed and therefore unworthy of love and belonging.” Brown interviewed thousands of people about difficult, sensitive experiences in their lives in order to uncover common themes around the experience of shame. She says, depending on how we deal with it, shame can either shut us down or lead to a new sense of bravery and authenticity. Often people have a visceral reaction to the word, “shame” and shrink when they hear the word. They try to dodge it, pretend they don’t have it or that it has nothing to do with them. That’s one reason it is so pervasive, because it is repressed. The truth is that everybody experiences Shame and the less we can talk about it, the more cruelly it can cut. Words help identify when shame is happening, what triggers it, and what is needed to move through it with authenticity, courage, and self-compassion. Identifying shame can also be tricky when we cannot distinguish between shame, guilt, humiliation, and embarrassment. We often use these words interchangeably in our culture. People who are better able to tell the difference between shame, guilt, embarrassment and humiliation can more easily bounce back from an episode that triggered shame. Shame vs. Humiliation The ingredient that separates shame from humiliation is whether you feel you “deserve” to feel bad. Both humiliation and shame call up the same immediate physical response - sweaty palms, racing heartbeat and the impetus to either fight back fiercely or run or shrink away. But the next internal reaction is key. If you spill milk and a stranger starts berating for being clumsy, you could react by thinking “that is the meanest, most nasty person ever, I didn’t deserve that!”. That is humiliation self -talk. In contrast, Shame self-talk would be, “She’s right, I’m so clumsy, why can’t I ever hold on to a glass?”. Shame vs. Embarrassment Embarrassment doesn’t leave you feeling utterly alone the same way shame does. If you tell me that I have some spinach in my teeth, I use my tongue to swipe it off and can laugh it off. I can move on because I know the situation isn’t really about me. The core of who I am and who I perceive myself to be can stay intact. I can take the next step out of embarrassment because I know that I’m not the only person in the world who has had food stuck on their teeth. Shame vs. Guilt Guilt is also milder than Shame. People who feel guilty feel that they have done something bad, but not that they are bad. Guilt is a focus on behavior while Shame is a focus on Self. An example would be after eating a whole pint of ice cream, thinking “I’m struggling and doing the best I can but eating that pint of ice cream was a bad decision.”(Guilt) versus “I’m stupid” (Shame) Guilt does not have the sense of finality that Shame carries. There is no potential for change if you are just bad or stupid or wrong or cursed. There is no hope that you can fix the problem or hope to be forgiven. Secrecy, silence, and judgment serve to propagate Shame. Unfortunately, the Pain experience fosters all three factors. Secrecy and silence are a normal response to the message that no one really wants to hear about your troubles with ongoing Pain. Even friends and loved ones get tired of hearing about struggles with medications, side effects, painful procedures, and worries about your health or job (if you are lucky enough to still have a job). During my toughest bouts with doctors, CAT scans and MRIs , one of the questions I was most commonly was greeted with was “Are you better?” People don’t want to hear a “NO” answer. So the standard response becomes, “I’m fine.” You start to feel like it’s all your fault that you’re not getting better according to plan, and that’s where self- judgment comes in. You also may judge the lack of compassion you are finding in the outside world as well. All of these harden your heart and leave you cloistered off all on your own. In my darkest hours, a cluster of fears about the future arises, “that I will be alone, homeless and in Pain.” You have encountered Shame if:
Linda Hartling and Jean Baker Miller, researchers at Wellesley College, found three typical responses to shame: moving away, moving toward, and moving against it. Moving away is keeping secrets, not talking about it and just wanting to disappear into the earth. Moving toward shame is people-pleasing to the point of denying self. Moving against means striking back against the person who sparked your Shame feelings with something equally hurtful, painful, or shaming. All three strategies keep you feeling isolated and alone. The antidote is meeting the Shame and bringing it into the light so it’s not such a scary unknown. Why should we engage with shame when it’s so painful? What’s the benefit to that? Looking at Shame is like shining a light in our darkest corners and normalizing universal experiences that make us feel very alone. One of the byproducts of being able to move through shame constructively is that people who come out the other side feel braver, more connected and compassionate. You need to be mindful when you look at Shame, to maintain some distance so that it doesn’t swallow you up and reinforce its Identity. More important than that is cultivating emotional curiosity. Most of us were not raised in families where we were encouraged to get curious about our emotions, ask a lot of questions, dig in, name things. Wanting to name and do more about shame that comes up is a good first step. Starting small conversations with people we trust and care about, acknowledging the Shame that can be brought on by Pain, can be healing. Expressing the Shame we feel around our Pain can be transformative. It’s all about being curious and in connection while learning. But how can we express that curiosity when people around us just want us to shut up and get well? Finding a trusted counselor is one way. They are paid to listen. Another way is finding your tribe. People who understand what it’s like to confront Pain on a daily basis (their pain doesn’t have to be exactly the same as yours, it doesn’t even have to be physical pain). People who are honestly wanting to meet and get more understanding about the Shame and isolation they experience and how it both creates and is fostered by their Pain. Sometimes you can find these like-minded people by searching online – there are for example, Facebook groups for everything under the sun. Just googling the subject or posing a question on Quora can lead to others who are interested in reframing the Shame they feel around Pain. You don’t even need to work with other people who are focused on Pain. As long as people are honestly trying to examine any behavior or situation that stimulates Shame, you are in good company. SMART (an anachronym for Self-Management And Recovery Training) recovery groups are a low-cost alternative for processing in a group. They are getting to be very popular, and can be found online and in most large cities and maybe even small towns. I would say that SMART group are like AA or Al Anon groups sans the religion and identification with alcohol. You don’t even need a group per se. The satisfaction you feel from a “tribe” who understands you can be found with just one person who is willing to listen. And if all else fails that one person can be you. Writing about your experiences is a way to “talk to the shame.” You can also use the Inquiry process of questioning stressful thoughts by specifically focusing on stressful thoughts of Shame. Being willing to share is part of dissolving shame. Owning up to what I’m ashamed of not only helps me, it also helps the person I am sharing with. Speaking shame is actually a service. It helps other people feel less alone. When one person has the courage to get real about where she’s struggling, it allows everyone else to exhale an “Oh My God me too.” Owning shame also helps increase resilience to being derailed by it in the future. Which means the sharer not only gets to stop feeling the yuckyness of shame, but also it prevents engaging in the negative kinds of behaviors (e.g., hiding in the house, overeating, smoking) that Shame inspires. Compassion overflows for the person who’s struggling – that person receives the compassion that she hasn’t been able to provide for herself. Compassion shows the person struggling that she’s not alone and that she’s not going to get kicked out of the tribe. It allows the nervous system to calm down enough to examine the source of shame objectively. There is space and time to get more strategic about charting a path through the difficult situation. Meanwhile, the listener gets fuel for their own next breakthrough. Identifying shame and making peace with it is part of how we heal shadow issues: the dark, murky, unconscious stuff from the past that undermines how we act in the present. Even if you process with others, it is also important to bring mindfulness to circumstances where shame arises. Processing on your own involves the following steps, not necessarily in this order. How to Escape the Pain-Shame-Pain Spiral
Chronic inflammation occurs when the natural inflammatory response of an acute injury does not fully resolve. Failure of a tissue to fully heal can happen with repeated small tears and overuse. Conditions such as an autoimmune disorder or the presence of a foreign material such as a suture or implant may also contribute to chronic inflammation. Pain in the chronic stage of inflammation may be hard to detect. It may only become evident with pressure or pull on the area. More commonly experienced symptoms are reduced range of motion and postural distortions, which if tested, invoke Pain.
It is important to note that chronic inflammation is not the same as chronic pain. Chronic Pain has been discussed in previous blogs and will be reviewed again in future posts as it is a major part of my practice and a personal concern, as I cope with medically unexplained chronic pain every day. But back to Chronic SOI - Chronic inflammation may not feel red, hot, swollen and painful at all. In fact, the area typically feels cold, hard, stiff and has a pale or bluish hue, due to lack of blood flow. The goal of Chronic inflammation is: to protect the formerly injured area. In order to do so, scars reorient and remodel in response to pulls and tensions placed on them during daily activities. Physiology - In order to protect the area, the following physiological processes happen:
The Symptom Picture is :
Treatment Plan (works to decrease symptoms). Therefore LMT's and other therapists work to:
Treatment follows directly from the Plan, So in addition to successful treatments from the Acute and Subacute SOI's,
Self Care Recommendations follow the Plan too, so good recommendations include
Hydrotherapy : Heat at rest, heat before and ice after activities or receiving bodywork, Contraindications include:
![]() Late Subacute Phase of SOI - Maturation /Remodeling Phase Pain in the sub-acute stages of inflammation is less widespread than acute pain. There are two stages of sub-acute inflammation;
During this phase, the scar begins to modify into its mature form with steady increases in tensile strength and a decrease in capillaries. Additional collagen fibers are laid down and realigned according to tensions placed on the tissues by normal pressure and movement At this stage, massage and joint mobilization can align scars to allow for optimal range of motion and functionality. Although scar tissue gradually approximates normal appearance and function, typically the tensile strength of a scar is less than 80% of a functional tissue. Besides vascularity, it lacks elastin, and appears stiff compared to normal, noninjured tissue. After approximately 3, weeks a firm, strong, nonvascular scar exists but the entire maturation phase can take several years to complete. The goals of Late Sub -acute inflammation are:
Physiology - In order to reinforce the damaged area with collagen, the following physiological processes happen:
The Symptom Picture is :
Treatment Plan works to decrease the symptoms. Therefore
Treatment follows directly from the Plan, So in addition to treatments for Acute and Early Subacute SOI, add in:
Self Care Recommendations follow the Plan too, so good recommendations include
Hydrotherapy : Mild contrast, beginning and ending with Heat Contraindications include:
Pain in the sub-acute stages of inflammation is less widespread than acute pain. There are two stages of sub-acute inflammation;
The goal of Early Sub -acute inflammation is:
Physiology - In order to fill in the damaged area with new tissue, the following physiological processes happen:
The Symptom Picture is :
Treatment Plan (works to decrease the symptoms. Therefore
Treatment follows directly from the Plan, So in addition to successful treatments from the Acute SOI, add in:
OI (origin/ insertion technique) for short tendons MA (muscle approximation technique) for the muscle bellies
Self Care Recommendations follow the Plan too, so good recommendations include
Hydrotherapy : Mild contrast, beginning and ending with Cool Contraindications include:
Addressing Pain is an essential part of my medical massage and qigong practice. On September 8, 2017, I attended a lecture on the Mystery of Pain by Douglas Nelson, at the Oregon School of Massage. Mr. Nelson is the current President of the Massage Therapy Foundation, and has been in clinical practice in the Midwest for over 22 years,
Here are my takeaways from the talk. The audience is LMT's who want to better treat Pain, but the information can also help patients seeding treatment to clarify how therapists can best help. My emphases are in bold and in italics are my understanding of how to translate the takeaways into more effective Pain treatment. 1. Pain is a global health problem.
3. Therefore, treat Pain as a mystery rather than a puzzle.
4. Pain is different from nocioception
5. The Brain wants to provide a story for the Pain
7. The brain is neuroplastic
8. Massage is uniquely positioned to address Pain on many levels.
9. Patients in Pain want answers to questions
10. If you don't know, tell the truth, give options, and answer with authority
Addressing Pain is an essential part of my practice and I am always seeking to learn more. If you would like to schedule a consultation, please Contact Me Inflammation is how a body responds to injury, in the same way that your immune system fights off bacterial and viral infection in a sore throat. Both begin with an immediate local response designed to protect the body from further injury and tissue damage. Inflammation is an aggressive process that initially causes swelling, heat, a loss of function, redness and pain (SHARP symptoms). Unchecked, inflammation leads to additional tissue damage, which can lead to more Pain. This is why it is important to match massage treatments to your stage of inflammation: an incorrect assessment can interfere with or prolong the natural healing process. Describing symptoms, goals and treatment options for each stage of inflammation (SOI) is complicated. This post presents general information about inflammation and pain. Future posts will be devoted to elaborating on each stage of inflammation (SOI) and how massage can alleviate your symptoms. This series is designed to help those trying to rehabilitate from an injury or pain, so the goal of pursuing an active, fulfilling life is aligned with how the body is trying to heal. Here, I generally describe the process of inflammation, what purpose it serves in healing, and briefly outline the unique physiology of each stage. Why is inflammation so aggressive? Inflammation attacks potential invaders and walls off a hurt area so that a local injury doesn't become a systemic problem. Acute pain also slows you down so that you don't keep re-injuring yourself. Why slow down inflammation when it is a natural part of healing? Inflammation is a very aggressive process which can damage healthy collateral tissue as well. When used correctly, massage and other forms of bodywork can speed healing, while minimizing pain. This why it is important to match treatments, especially massage treatments, to the stage of inflammation (SOI) you are experiencing. This requires critical thinking by both treatment providers and treatment seekers about the symptom patterns involved with each stage. Addressing SOI is an essential part of my medical massage and qigong practice for people with medically complex conditions, located at Earthbody Wellness Center, 3810 SE Belmont St., Portland, Oregon, 97214. If you would like to schedule a consultation, click on Contact Me, I have been taught to recognize 5 stages of inflammation: Each stage has its own unique physiology and symptom picture. Treatment goals aim to reduce problematic symptoms related to each stage. Once goals are identified, optimum treatment techniques, hydrotherapy and self care become clear and follow critical thinking guidelines. A seasoned massage therapist should be able to understand your somatic pathology and stage of healing and together with your input, figure out what will be most helpful. Briefly described, the five stages of an inflammatory response are:
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Author![]() Marian Wolfe Dixon MA, LMT (OR #3902) NCTMB Approved Provider Continuing Education for Massage Therapists, CHt, TCMBB. Archives
June 2022
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