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My Pain Story Part 4

​This is the latest update on my chronic joint pain and on my efforts to lesson that pain.  In my last update I saw a delay in the local pain clinic services due to lockdown last spring.  They got back in touch with me last May with a letter informing me of an appointment with the pain clinic doctor I saw previously.  This was to be a phone appointment due to still being in lockdown.  I was not expecting to hear from her, but was pleased they still had me on their list.  The appointment was really just a check up to see how things were going and to make sure I still wanted to be on their list when services resumed again.  It was reassuring to be told that I could pick up where I left off after lockdown.  

The next communication from the pain clinic came in September.  I had a month to get back in touch and book an appointment with a pain specialist physiotherapist or they would assume I no longer wanted their services.  I got back in touch almost instantly.  Later that month I had my phone appointment with the physiotherapist.  She explained they were still unable to offer services in person, but were doing some things online.  She asked about my pain in detail and together we decided that the tai chi would still be something I could benefit from.  As suggested I had a go at some of the tai chi videos on the pain clinic website.  From the first try I felt it was something I would enjoy doing.  It seems to be about mindfulness with exercise which builds on things I have done previously both as a drama student and in laughter yoga classes that used mindfulness as a wind down at the end.  

Meanwhile as I was waiting for the first tai chi class, I started using Wii Fit.  I got a second hand Wii for my birthday with Wii Fit.  Having previously tried a Wii some years before and have seen Wii Fit I thought it might be a good way for me to motivate myself to get fitter.  Since mid September I have been trying to use Wii Fit for at least fifteen minutes most days, often longer.  I have found it extremely helpful to get me stronger and fitter.  It uses yoga, muscle exercises, aerobics and balance games.  It lets you work at your own pace and teaches the exercises one at a time, helping me to gain confidence in my abilities gradually.  Some exercise classes throw you in at the deep end and expect you to already be reasonable at things, with the Wii it lets you start at whatever level you are at even if that is absolute beginner.  I like how you score points and get feedback so you can see the progress you are making and what you need to work on more.  At the end of each training session you can take a body fit test and it will see how you are doing fitness wise overall.  My overall fitness scores have definitely been improving over the months. 

Then in October and November I had two video appointments online with the physiotherapist from the pain clinic.  She introduced me to tai chi with the basic stances and a few of the easier moves.  I practised between appointments and felt like I was getting the hang of it well.  Since I seemed to be enjoying it and benefiting from it, the physiotherapist put me forward for the group course.  Over eight weekly sessions it teaches tai chi adapted for pain management.

I had some technical issues at first trying to find a device that would work the application they use for the classes, since my tablet refuses to work with a rival companys video chat.  (They do assume you have the right technology and for some people this could be a serious issue.)  However I figured out a way to do it on my phone, although rather a small screen it did work well enough.  

The classes lasted about an hour each and gradually taught us the moves of tai chi building each week a longer routine of movements.  There are a few kinds of tai chi and the pain clinic use Shibashi Qigong which has eighteen moves in total.  Some of the moves combine with others making it easier to remember them all.  The classes also focused on body awareness and being present in the moment in a mindful way.  We shared at the end of each class together with how we were getting on with the tai chi during the week and how it was helping us.  There were about six of us in the class and we all agreed that tai chi was of some benefit to chronic joint pain.  

Tai chi is more of a work out than you may think.  Despite being fairly slow paced it stretches out muscles, helps posture, and improves breathing technique which eventually can improve lung capacity.  I find tai chi mentally beneficial as well.  The mindfulness is relaxing which is turn helps my muscles to relax; this is especially helpful for my tense shoulders.  

My shoulders are one of my most painful areas, especially the right one.  The physiotherapist says this comes from years of having had a limp that caused me to walk more on my right side.  Also previously having used walking aids such as crutches and a stick have probably not helped my shoulders.  Whilst doing tai chi I can actually feel my shoulders lowering and they feel as if they are less heavy.

Now that I have completed the tai chi course I need to keep up the practise of it so that I continue to benefit from it.  I use the videos on the pain clinic website fairly regularly and try to practise some of the stances and moves at home when I can.  Music can be helpful to a practise, especially calm classical music.  I am still using Wii Fit regularly and plan to buy the extension pack to this soon once I have reached a point I need to advance my workouts.  I feel fitter now than I probably have been for most of my life.  I can walk faster and further than I used to and feel less out of breath walking up hill than I once did.  I still get frequent joint pain, but less debilitating levels than it was most of the time.  I have managed to reduce the number of pain killers I take a fair amount, although I still take more than some people do.  Cold weather and having a period can cause my joint pain to flare up again sometimes and I still have to be careful not to over do the exercise and walking or I can suffer for it the next day.  

I will write another post on this one day if and when something interesting occurs with my pain.  I welcome questions and comments on my posts. 

Tai chi pain clinic videos:

https://www.torbayandsouthdevon.nhs.uk/services/pain-service/reconnect2life/improving-health-and-fitness/tai-chi/tai-chi-for-health/ 

You can find more relevant posts about my usual blog topics on my Facebook page Artificallyhip.

 

My experiences of therapy

I have tried various kinds of therapy for my mental health over many years, some though the NHS and some I have found for myself.  These are my experiences of the therapies I have tried.

Cogitative Behavioural Therapy (CBT)

‘CBT is based on the concept that your thoughts, feelings, physical sensations and actions are interconnected, and that negative thoughts and feelings can trap you in a vicious cycle’, (www.nhs.uk/conditions/cognitive-behavioural-therapy-cbt/). 

It aims to break down problems into smaller more manageable parts.  You are shown how to change negative patterns to improve the way you feel.  Unlike other talking therapies it focuses on current problems rather than issues from your past.  It is most commonly used to treat anxiety and depression; hence I have had it for my OCD, which is a type of anxiety disorder.  

However it was not that well explained to me when I had it and seemed based on the idea that I could just stop and walk away from my OCD rituals, which if I could do that I would not be needing therapy in the first place.  The NHS website says each session should last thirty to sixty minuets, but after my initial session most of them did not last that long.  I was encouraged to take a lot of my therapy sessions by phone, which seemed to not be a very effective form of therapy for me. 

CBT does not address winder problems such as other mental health issues that could be impacting on your anxiety or depression.  I have since found out that CBT is often ineffective for people with autism, such as me, as it does not address the autistic side of things.  All CBT seemed to do for me was to get rid of one OCD ritual for it to be replaced with another.  I can see how this might help if you have a dangerous ritual, but otherwise seems a bit unhelpful.  I can see CBT might work for some who have not got more complex issues, but it was not for me.  However this seems to be the only therapy a lot of people can ever access on the NHS as if it is a panacea that will cure all mental health issues. 

Mindfulness

Mindfulness is a type of meditation that focuses on being present in the moment without judging anything. ‘A typical meditation consists of focusing your full attention on your breath as it flows in and out of your body. Focusing on each breath in this way allows you to observe your thoughts as they arise in your mind and, little by little, to let go of struggling with them. You come to realise that thoughts come and go of their own accord; that you are not your thoughts. You can watch as they appear in your mind, seemingly from thin air, and watch again as they disappear’, (http://franticworld.com/what-is-mindfulness/)

Mindfulness is about noticing what your body and mind are telling you, and then being able to react more calmly to things.  One exercise is a mindful body scan where you focus your attention slowly through the body one part at a time.  Tensing up and relaxing muscles as you go so you notice the difference between the two states.

Mindfulness can help problems such as anxiety, depression and stress.  Some mindfulness exercises are often used as part of other therapies and workshops.  I have found some of the exercises helpful as part of laughter yoga and drama therapy.  I find focusing on my breathing sometimes helps me to clear my mind and relax.  However I feel that the word mindfulness has been corrupted as a marketing term to sell stuff from colouring books to health food snacks, and I refuse to buy anything labelled as such.  

Counseling

Counseling encourages you to talk about your feelings and emotions with a trained therapist.  They can help you clarify issues, explore your options, develop strategies and increase self-awareness.  I had counseling at university and later through my GP surgery.  I found it slightly helpful at university as she gave me some strategies I could use, but the other counseling I had achieved nothing other than me talking about my issues and going round in circles.    

Anger Management

Anger management aims to help you understand why you are angry and find a healthier way to express yourself.  CBT is often used in anger management to help deal with negative thought patterns.

I had some anger management as a teenager, whilst the relaxation part helped a little bit; I feel I was not mature enough yet to put the techniques into practise properly.  I was also depressed off and on at the time which may have not helped me to make the most of it. 

Group Therapy

Group therapy is a form of psychotherapy in which one or more therapists treat a group of clients at the same time.  Some uses CBT or mindfulness.  Group therapy tends to be focused on one particular issue such as addiction meetings, a shared illness or mental health condition or a traumatic experience you may have in common.  Some groups use skills training as therapy such as art, drama or music.  Group therapy has several advantages such as knowing you are not alone with the shared experiences and feelings, sharing ideas and information and hope when you see others recovering.

I had some group therapy in my early teens which used activities and discussions to help us.  Whilst I feel I did benefit slightly from it, I feel that it was hard to make the most of it due to some of the group not really wanting to be there.  I also feel that some of the group could have been a bad influence on me had I been more vulnerable, trying to persuade me during the breaks to take up smoking for example.

Laughter Yoga

Laughter yoga is a group therapy based on the idea that laughter is healthy, both for the mind and body.  Exercises are done to create laughter, starting with forced laughter; it usually turns into real laughter.  It uses chanting, clapping and games to encourage a sense of playfulness.  It often uses elements of drama therapy and visualisation techniques.  Yogic breathing is done in-between laughter exercises, relaxing the mind and body.  At the end of each session laughter meditation is done using some elements of mindfulness. 

I first encountered laughter yoga about three years ago and then last summer I started attending a new weekly session run by a friend of mine in the town where I live.  It helps me to relax and de-stress.  It is not hard work and I find it great fun.  I can understand it might not be for everyone, you need to be fairly comfortable with letting yourself go in front of others, (my drama background maybe helpful in this).  However I highly recommend giving it a try as it is my favourite form of therapy I have tried.

Drama Therapy

Theatre techniques are used to help personal growth and mental well-being.  Drama therapy is often used in schools, prisons, hospitals and in work places to promote team building and healthy working relationships.  It involves role play, voice work, movement and storytelling.  It can help people explore personal and social issues.  It helps some people learn to express themselves better.  As part of my drama studies over many years I have done a few workshops using drama as therapy to explore various topics. I think workshops have great potential to help a lot of people, but it has to not be forced on people as some could be very uncomfortable with it and not everyone is able to do things like this in front of a group.  

Self Help Books and Online

Often I have found that self-help is more effective.  I have read a few books on autism and mental health and used various online message boards and chat rooms.  Also I have watched some documentaries on TV about my issues.  I have often learnt more about how to help myself from these things than any professional therapy I have had because I can pick and choose what elements to read and watch and do it in my own time.  I also feel less pressure to recover or learn a technique in a set time period.  Plus the ideas are not restricted to the NHS guidelines which often appear very strict and limiting.

Hobbies can also be a kind of therapy, for me writing is like that.  Writing my thoughts down is helpful, so I keep a daily diary.  Writing this blog often feels as satisfying as therapy.  Sharing my issues, anxieties and feelings often helps me.  A lot of people seem to find art therapeutic.   

I have found therapy is a very personal experience and what works for one person, maybe less effective for another, even with same diagnosis.  It is worth trying different therapies or even retrying one at different stages of your life.  What may have not helped as a teenager, maybe more effective when you are more mature and not forced into it by your parents.  Do not just rely on what a doctor can refer you for, but do your own research into what is on offer in your local area outside of official medical channels.  There are other kinds of therapy that I know less about that maybe worth looking into.  Sometimes people need a combination of therapy and medication which is perfectly valid, it does not mean therapy has failed if you also need medication.  Therapy also requires will power and wanting to learn from it, being ready to get well, forcing it will not work.