We’re around half way through the Inner Healng Mastery course and many are asking the question, “Doc, how do I fix or change this persistent physical or emotional pain or negative thought pattern that I keep experiencing?” We all experience this issue. And it always comes up in class at some point.
It’s a natural question to ask, “How do I fix this problem”.
But it’s the wrong question to ask.
Trying to “fix” inner pain and suffering usually makes it worse.
That doesn’t mean you’re going to suffer forever.
But we’re talking about inner transformation.
Fixing is the wrong outlook.
Inner Transformation is about healing.
Healing comes from a deeper place than the part of you that wants to fix it.
What’s Wrong with Trying to Fix Myself?
When I’m trying to fix something, I’m confronting it as if I’m going to make it change according to my will.
That “will to fix” is an agenda. There’s a part of all of us that doesn’t want to tolerate unpleasantness. We want to push away the pain. And usually when we try to push something away, we unknowingly pull it close to us.
My need to fix myself is usually coming from a place of fear, or anger, or sadness or other negative mind state. I have an issue with the issue that’s bothering me. I’m scared that I’m angry or I’m angry that I’m scared. When I take the desire to fix, which is rooted in a sense of brokenness and suffering, and push and pound on another aspect of my body-mind suffering, I create more noise, more tension, more pressure, more suffering.
It’s like two unhappy kids in the classroom. Bobby is convinced that Richie is doing something bad, so he starts to shoot spitballs at him or make fun of him or argue with him and maybe push him around. But Bobby is acting out his own aggression and unhappiness. So they create a bunch of noise and turmoil, and everyone in the room is affected by it.
It’s a simple metaphor. But there are actually good reasons why this is true, that are starting to be clarified by neuroscience. And it fits the map of our consciousness discussed by our sages, that they shared to help us transform our baser nature into something that is generous, kind, loving, and holy.
But lets keep this practical.
The main thing is I invite you to think differently.
To get out of ‘fixing’ mode and into healing mode.
Drop The Fixing Agenda and Rest Into Healing
I invite you to think and feel like a enlightened teacher in the classroom rather than two students pushing each other around. The enlightened teacher is not invested in the drama. The teacher is able to bring his caring and maturity. He understands the children and their needs. He intuits the root of their misbehavior. He creates boundaries for them, and nourishes them emotionally. So they become harmonious. He helps them grow up.
This fits well with the work of the Inner Healing Mastery course. We started by practicing being present to the flow of experience, including our unpleasant experiences. We are focussing on developing mindfulness, which lets us be with ourselves and start to see whats really happening.
There are three main steps that we are learning. 1. Naming the experience, 2. distinguishing the physical, emotional, and cognitive parts of the experience, and 3. acknowledging and agreeing to its existence in the moment.
The Power of Naming
First lets talk about naming or labeling the issue.
When we label the emotional tone of the thing, it’s often helpful to use one of three choices: pleasant, unpleasant, and neutral. If it’s pain or suffering, it can be helpful to name it as “unpleasant”. It’s a fairly uncharged word. It accurately describes pain, but it gives room for the pain to evolve. If I label something “horrible pain” or “intolerable” then I’m already activating circuits of suffering in my brain. We want to relate to it with acceptance and love like the enlightened teacher. So name it ‘unpleasant sensation’
The Power of Making Distinctions
Then I want to distinguish the physical sensation, from the emotions arising, and the thoughts and stories and judgments that are arising.
If there is physical pain I notice it’s qualities. Intense sensation. Unpleasant. Sharp, or dull or tingling or numb. It’s location. It’s shape. Noticing it and staying anchored in my breathing.
Sometimes there are emotions connected to the physical feeling. Perhaps I first just feel pain, but I ask ‘what emotion am I feeling?’ and I see that its fear (or anger, or whatever I am experiencing). Yes and there is also sadness. So I acknowledge and welcome the fear and sadness. I accept that this is what’s happening.
Sometimes there are all kinds of stories, judgements, rationalizations, explanations. “I’ll never get better. It’s all her fault. It’s all my fault. This is intolerable. I can’t live like this” These are judgements and stories that are often generated by my emotions. They are usually about the future and past. We want to relate to the reality of what’s happening in the present. So I acknowledge the thoughts, I name them ‘thinking’ or ‘judging’ or ‘catastrophizing’ and let them go. They may come back. But I don’t invest in them or hold on to them. And I don’t try to push them away. Like clouds on a sunny day I observe them while I stay anchored in my breathing or other pleasant present-moment experience.
When I make those distinctions, I’m getting more clear on what is really happening. What may have been a sense of overwhelming chaos and storm becomes a more clear understanding of the aspects of the suffering. I start to see cause and effect. I can see the stories and judgements that keep me from healing. it helps me see what is true and what is false. What is useful and what is counterproductive. It empowers me to let go of what is not serving me, and to bring compassion and forgiveness to the parts that need it. I’m giving myself options for how to work constructively with the situation.
Accept, Agree, and Be
So after acknowledging and labeling, and distinguishing the physical, emotional, and cognitive parts, agree with the experience. You could also use the word “accept’.
That doesn’t mean agree that it’s going to be forever. Agree that its what is happening now. Because it is what’s happening now. And I have no idea what the future is going to bring. So staying with the now. “I agree that I am experiencing unpleasant sensation and emotion and mind states, now.”
When I agree, I’m dropping my agenda. I’m dropping the cruel pressure to make things different than they are, The pressure to fix things, that we almost reflexively add when we react to something that hurts. In the metaphor of the classroom, the agenda to fix is like Bobby, the other kid in the class, whose irritated by Richie’s pain. Bobby doesn’t have much skill, and he wants to come in and force Richie to shut up, and thus feeds the chaos and noise. When I agree with my experience, I disengage my resistance. I stop interpreting my experience. I let go the tendency to develop drama and other emotions about my experience. I’m dis-indentifying from the fighting children, and identifying with the role of enlightened teacher.
While doing these three steps, we sit and stay anchored in some pleasant experience like our breathing or sense of the body, and we give that unpleasant experience some but not all of our attention, and we wait.
To sum up, when I do these steps of acknowledging, distinguishing, and agreeing, I’m shining light into the experience of suffering. I’m unpacking it without emotional charge. When it is unconscious, the suffering is a vicious cycle of ripples in the integrated emotion/though/body system. When I shine the light of my consciousness into it, I’m uncoupling or disconnecting the reactive parts of the vicious cycle. I’m making space for something else to happen.
Watching the Flow of the River of Life
We shared a metaphor of the stream of life experience flowing along. And the practice of working with difficult experiences is to sit on the bank of the river, to be anchored on the bank of the river, while being aware of the river of unpleasant or pleasant experiences flowing past. So when an unpleasant emotion or physical sensation comes along, we note it, acknowledge it, but stay anchored on the bank of the river, by attaching to our breathing and present-moment awareness.
We try not to get sucked into the river. That means we don’t give the unpleasant experience too much of our attention. We don’t get emotionally activated by it. We notice that it’s happening. We care about the suffering with compassion, like caring for small child is crying. We agree to its existence, because here it is. But we don’t dive into it.
Sometimes we fall into the river. It happens. We get sucked in emotionally. Or we are staring at the pain our shoulder and wanting it to change, so we generate a bunch of muscle tension and the physical pain gets worse. So sometimes our old habits win and we fall in. And hopefully we forgive ourselves for being human and climb out maybe go for a walk and dry off. And then we sit back down on the bank of the river.
Activating The Power of the Heart and Soul
More recently in the course we’ve started generating positive mind-heart states. For instance, we started a practice where we find and generate a heart-full intention for the good of myself or another person. And I meditate on the intention and develop a heart-full energy of lovingkindness. It can be a very pleasant experience.
Soon we’ll also work with generating and developing a felt sense of connection to the Source of Life, or G!d if you are comfortable with that language.
Whether its a heart-full good intention, or a more spiritual sense of possibility, intention, and connection to G!d, what we are creating is a another kind of anchor. It’s another kind of ‘riverbank’ that we can attach ourselves to. We bring a positive, loving, energy of possibility and joy and sit in it, while we are also aware of that difficult emotional/physical/mental state.
So we take the three steps of labeling, distinguishing and agreeing while being present to them and turn on the high beams. When we connect to a higher state of heart-mind, it’s kind of like taking the 3rd step of “agreeing” and energizing it with sweetness and love.
Said differently, when I access a connected living mindbody state, I generate biochemistry of healing. I connect to an energetically charged integrated mind-body-emotion state, and also give some attention to the pain. I sweeten the pain and start to transform it.
The main thing is to practice.
To notice and label the experience as unpleasant
To distinguish it’s physical, emotional, and mental manifestations,
To agree to the reality of its existence in this moment
And to anchor ourselves gently and confidently in a state of heart/mind that is open, stable, receptive, loving, and sweet.
To give some attention to the existence of the difficult body-mind state, but not too much. Being aware that it’s there, while we rest into a place of of pleasantness.
What is The Most Powerful Tool Against Pain Inflammation and Fatigue? You Already Have it. - YouTube
If you’re suffering from fibromyalgia, chronic pain, or chronic illness, you might be curious about the importance of the mind body connection. If you’re not curious, you should be!
Simple Techniques That Can Help You Feel Better
Because the fact is that that simple easy techniques of mind-body healing have a good chance of helping you feel better and function more effectively. The can include less pain, better emotional state, and more energy. In some cases, the actual disease process can shift or improve when you activate deep relaxation, and transform stress and emotional pain.
These aren’t just my words. They’re supported by substantial body of research showing the importance of mindbody variables in chronic pain and chronic illness, and showing that mindbody techniques often help many people improve and feel better. For example, research tells us that we can use our mind to generate the relaxation response. The relaxation response is a well-documented restful state of mind and body, that helps with all kinds of things like better sleep, less suffering from pain, better learning and memory, lower blood pressure, decreased heart attacks, and so on.
Where Modern Science and Ancient Spiritual Wisdom Meet
This is an area where modern science and ancient spiritual wisdom agree.
Modern science is showing us about how we can activate physiologic healing responses and transform negative emotions and trauma.
And the worlds spiritual traditions speak about the same principles. We have a body, and an aspect of ourselves that is “above” the body. Lets call that the soul. The soul shares vitality, creativity, purpose, and meaning with the body. In the Torah tradition the soul is constantly irrigating the body with energy and life. It contains the “blueprint” of who you are an why you came to the world. So it has the capacity to help your body and emotions heal, and to realign itself with life, meaning, and purpose. These are incredibly valuable in your healing process.
If you don’t believe in the soul, you can call it, “the powers of the mind”. The process of healing is the same, regardless of your belief system.
Rebbe Nachman of Breslov (luketei Mohoran 22:5) shares an interesting understanding of the process. He points out that the mind and soul are dynamic and flexible, and have access to insight, wisdom and understanding, regardless of the state of the body. He suggests using the powers of the mind and soul to have compassion on the body, and thus purify and elevate the body. And then the body will be elevated to the place of new insight. When we condition the body with insights and wisdom of the soul, the body is purified.
He’s talking about a healing process. About returning to ourselves and revitalizing our sense of purpose and connection in the world. The language he uses is exquisite. He says,
“Using the insights and awareness of the mind to have compassion on the body”. It’s a beautiful phrase!
Why Do We Need to Have Compassion on the Body?
It’s so easy to develop an antagonistic relationship with the suffering of the body.
In my practice caring for thousands of people with chronic pain and illness, there is a recurrent theme. For many people, pain, trauma, fatigue, paralysis, and disabilty generate toxic beliefs and emotions. Frustration, anger, blame, shame, hopelessness, overwhelm.
Suppose you’re dealing with chronic pain or illness. You’re exhausted all the time. It’s hard to get out of bed. Maybe there has been a neurological injury and you can’t use your arm or leg or both. You can’t function. It’s so natural and easy that those physical feelings generate frustration, anger, helplessness, fear, overwhelm. And it’s not your fault.
And all of those painful mental/emotional states generate biochemistry that can worsen the pain, fatigue, weakness, inflammation, insomnia, etc. That is well-established scientific fact.
It’s a vicious cycle. Physical pain and dysfunction that generate mental/emotional distress; that feeds physical pain and dysfunction. And so on….
The Rabbi Nachman suggests, “Using the insights and awareness of the mind to have compassion on the body”.
The Power of Compassion
Compassion is a deep principle. Compassion is when I see what’s wrong, and I choose to care and love anyhow. Compassion is a powerful opening of the heart to suffering, loss, and pain. Compassion means developing a degree of acceptance. It doesn’t mean I agree to suffer forever. It means I agree that indeed this is the reality right now and I make a powerful choice to transform it.
Have compassion on the suffering of the body. Activate the higher intelligence of your mind, and your heart to create a wave of compassion and relaxation on your body. That’s a powerful step in healing.
That’s how you empower your mindbody system to heal yourself. You choose it.
Do It Now. Over and Over Again.
You could start to do it right now.
Stop what you’re doing. Do this on your own or follow the instructions in the video.
Clear distractions for 5-10 minutes. Put your phone on ‘airplane mode’ and set a timer if you want.
Sit down and contact your breathing. Notice the feelings of inspiration and expiration. Don’t try to do anything except be aware of your own breathing.
Decide to let go of what you were doing before and what you will do later. Just let your mind float in and out of your body on the waves of your own breathing. Like gentle waves on the beach, on a warm sunny calm day.
Let yourself dwell in that space for 10 minutes. Your soul is speaking to the body with compassion. Your brain is generating biochemistry of healing. And your body receives it, and appreciates it.
That is an initial step.
Commit to the Process to See Results
There are many techniques for evoking a calm, present, happy, resourceful state of mind, and of sharing it with the body.
And there are other techniques for intentionally generating the emotional energy of compassion, forgiveness, and love. Those energies can transform the judgement, shame, frustration, anger, and other forms of pain that often accompany us, especially if our body is suffering.
It is an art to find what works for you and learn to apply it in your life.
“Apply it in your life” means to do it regularly. The mind is flexible and powerful. But it is gentle and soft, when compared to the body. Mindbody techniques can help you feel better right away. But long term lasting results come from substantially shifting your physiology.
Your body learned the habits of pain, fatigue, insomnia, distress. Your body can learn the habits of comfort, energy, good sleep, joy, purpose. But remember it means shifting something heavy (your biochemistry) with something light (your mind). But water dripping on a rock can dig a hole over time. Your body isn’t as hard as a rock. It “wants” your mind to heal it. But success comes from regular practice over time.
That’s what we do in the Inner Healing Mastery program. We teach the mind to access new insights and possibilities. We learn techniques to empower the transformational loving energy in our own hearts. And we bring the mind and body together so that the mind can have compassion on the body.
People who learn and practice these techniques often are able to reduce pain, anxiety, confusion, frustration. They often develop the capacity to generate positive thoughts and emotions, and bring those to their body pain, illness, an so on.
You can too.
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Next post in this series: many of my patients have a very hard time evoking the relaxation response. Their body is so uncomfortable, or their mind is so busy and tense, that when they try to meditate they get more tense. What to do then?
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Here is a thought about how you can live better, despite chronic illness or pain. It starts with the well-known fact that your inner reality has a huge impact on your outer reality. The question is, “how do you see yourself in relation to your illness?” Your self-image falls on a spectrum between sick and well, between broken and whole. Your self-image is part of what determines your success in coping, living, healing despite your diagnosis.
Do you you see yourself as sick and broken? Or do you see yourself as someone who is well (despite the disease), as someone who is whole?
Do you identify with your illness? Or are you a well person who has a diagnosis?
Lets unpack this because its really important.
Living in The World of Brokenness
For many people, the experience of illness is an experience of brokenness. It can triggered by the pain, the fearful diagnosis, difficulty functioning, or uncertainty about the future. The constant feeling of “there’s something wrong with me” can create a tremendous sense of distress. And if you are unable to function as you used to, then there’s another source of distress and suffering. It’s not a good feeling. It can automatically create a sense of vulnerability. A sense of “I need someone to fix me”.
A sense of vulnerability and need could be realistic and a good thing. So if you have a fever and are coughing up green junk and feel exhausted, you get evaluated and a diagnosis of pneumonia and an antibiotic and hopefully you’ll be feeling better soon. And it would be unwise and perhaps dangerous to tell yourself you’re not sick, that you should tough it out and not get professional help.
But there’s a way that “the diagnosis” or focus on the symptom can be a problem. Because sometimes the search for the diagnosis, or the diagnosis itself, takes away your power, and you don’t get anything in return.
Yeah, sometimes the diagnosis hurts you more than it helps you.
Some diagnoses or symptoms cannot be fixed medically.
Chronic widespread pain (like fibromyalgia) is often an example of that. The problem is a hypersensitivity of the pain pathways. And if you keep trying to find “the diagnosis” or go to another doctor for every symptom of pain, it doesn’t necessarily bring you healing or a cure. Sometimes it is very disempowering. You’re looking for someone to fix you, rather than learning if there is something you can do to help yourself. I can’t count the number of patients who have unsuccessfully gone to specialist after specialist looking to be cured. Each time they get their hopes up, and then they are disappointed.
It can stimulate a spiral of negative thinking.
One big problem with “negative thinking” is that your thoughts can make you sick. Research is now showing how a persons state of mind can have a huge impact on the outcome of chronic illness. Research supports the common sense that there are often better outcomes when the patient is able to connect with their purpose, goals, relationships, and inner resources for healing.
I always share this caveat when I share that idea: If this article is triggering a sense of blaming yourself because you’re stuck in the “sickness cycle”, please stop right now. Beating yourself up about it feeds the problem. It’s not your fault. Most people don’t learn about this until their backs are to the wall. So start to learn. You can do it.
Here’s why its not your fault.
Our medical system is focussed on sickness and finding the expert to fix the sickness.
In medical school we learned to identify people by their problems. We worked hard to efficiently deliver the “problem list” in the context of a case presentation. We’ve got dozens and dozens of 3-4 letter abbreviations for diseases. Sometimes we identify a person by many of them at once. “This is a 63 year old man with COPD, CAD s/p MI, DMII, DVT, Afib with complaints of fatigue.”. When I was in training they didn’t encourage us to refer to people as their illness. We weren’t rewarded for saying things like, “the leukemia in room 214 is complaining of chest pain”, but sadly it was known to happen anyhow.
Maybe you’ve seen more than one medical provider who mainly focussed on your illness. Maybe you got a diagnosis and now you ‘have a herniated disc’ or ‘have fibromyalgia’ or ‘have psoriatic arthritis’. The medical provider probably did very little to connect you with your own resources for healing. It doesn’t surprise me how many of my patients think of themselves as sick. It’s not your fault. You trusted the expert.
They may have done the best that modern medicine has to offer, but they didn’t have the whole picture.
Mainstream media and society often support the same unproductive mindset.
The power and miracles of modern medicine have led us to believe that technology will cure everything. And the media love to make us worry, so we tune in and spend money.
Without great wisdom and support, it’s very easy to stay stuck in a sense frustration and grief about what has been lost. And to live in fear about the uncertain future. Life can feel very broken. And that’s a toxic way to live that often feeds into processes that brought us to the illness and pain. And so the cycle continues.
Despite all this, there is another way. We can cultivate and learn to find wholeness despite pain, illness, and suffering. And then we shift the process from a vicious cycle of suffering and sickness, to a process of transformation and healing.
Living in the World of Wholeness.
Even if you have significant illness, you also have abundant health.
You might not be paying attention to it. But it’s there.
Your ability to read and understand this means that you have significant health. Do you have any idea how much neurological complexity and health goes into reading this article?
Its awe-inspiring if you think about the three trillion cells that make up your body, and the innumerable chemical reactions and physiologic processes that are constantly working so you can think, speak, move, eat, digest, breathe, etc. The very fact that you’re alive means that you have abundant health moving through you. And every bit of the health is worth paying attention to.
Because your attention is a key to connecting to your health.
If you take it a step further, and find ways to reconnect to purpose, goals, meaningful relationships, and inner sources of strength, then you’re doing something quite heroic.
You’re beginning to live in wholeness despite your illness or pain.
When you are connected to your health, your sense of wellbeing, you have a sense of wholeness, even if you have an illness or pain. You know there is a part of your being that is unaffected by the illness. Maybe you can even tap into a state of mind where you feel good, confident, clear. You are bigger than the illness. You have purpose and meaning in life. you have tools and inner resources for dealing with the pain, the disability, the infirmity. You have a sense of power, a sense of coherence. You’re resilient. You are whole, despite the parts that are not yet back to 100% function.
It’s a process. And no matter where you are right now, you can start moving toward healing and wholeness.
When you contact your inner resources for healing, the pain and illness becomes a catalyst for growth. Loss, grief, and fear become focal points for transformation. When we crack the shell of darkness, then we find the light that hides inside of it.
And living with a sense of wholeness is not a contradiction to having a diagnosis and getting medical care. This isn’t “either/or”. You can keep going to your doctor and doing the sensible effective biomedical things that support you. This is about addressing the whole picture.
A sense of wholeness can be cultivated.
How can we be whole while we are sick and sometimes feel broken?
It starts with awareness. You can choose to give your attention to your vitality, to your connection with life.
You can intentionally reconnect with purposeful activities, even if they aren’t the same as the things that used to be meaningful to you.
You can learn to let go of the past. To forgive the people who hurt you. To forgive yourself. To forgive the Source of your life.
You can find opportunities to be in meaningful relationships. Sometimes that means letting go of toxic relationships, and finding healthy ones.
You can learn to bring your awareness to your sensory experience in each moment. To see the flow of thoughts, emotions, and bodily sensation. You can activate your sense of wonder, creativity, and spirituality. Your own inner sense will begin to unravel the knots of suffering and reveal your new connection to life.
You’re developing the power of your mind to access a healing state of mind and body. The research is beginning to show that has a positive impact on the illness itself.
The Timeless Need for Wholeness
There’s a remarkable illustrative episode in the Torah portion of Va’era. (You don’t need to be Jewish, Religious, Spiritual, or anything else in order to appreciate the power of this metaphor).
The Patriarch Abraham is sitting at the opening of his tent. G-d appears to him. The oral tradition tells us that it is the third day after Abraham circumcised himself in his old age. He is suffering very much. And G-d comes to visit him. We learn about visiting the sick from this episode. But it’s a different kind of visiting the sick that many of us are used to. Usually when we go to the hospital to visit someone who is sick, we ask about their pain, about their diagnosis, about when they can go home. But there is something striking here. The commentator Rashi notes that when G-d went to visit Abraham, he went to “inquire about Avraham’s Shalom”.
Shalom is an interesting word.
Most people know it means “peace” and “hello”. But at its root, it means “wholeness”.
Shalom is a coherent state of being where everything makes sense.
Shalom is the kind of peace that can contain conflict. It’s the wholeness that can contain brokenness. It’s the comfort that can contain the pain of a 80 year old man who just gave himself a painful operation without anesthesia. Shalom comes from being connected to truth, to purpose, to love. It is a sense of coherence.
The Torah is giving us a hint. When we are visiting the sick it’s vitally important to bring their attention to their wholeness. If you are sick yourself, it’s vitally important to pay attention to your wholeness. To find a place of ease and stillness in your spirit, mind, heart, body. To connect to your inner sense of what matters. To remember that you are more than just your illness.
How do You Cultivate Wholeness?
There are many ways to cultivate a sense of wholeness. Perhaps you are already familiar with one or more.
Are you practicing it?
Life is so complex and distracting. Living without a chronic illness or pain is challenging enough in these days. If you have chronic illness or pain, even more-so.
I invite you to recommit to your practice. It could be meditation, time in nature, playing music, prayer, song, journaling, or a combination of these.
Do it regularly. Consistency in key.
If you don’t have a practice, I encourage you to find one.
Even 5 minutes a day is a good start.
A growing body of research shows extraordinary benefits to regular meditation and other mindbody practices. When you regularly access a state of calm, peaceful clarity, it has beneficial effects on inflammation, pain, emotional distress, and even expression of genes that help you cope with and heal from stress, pain, and illness.
An even deeper process happens that may be beyond measurement. When we gently and lovingly turn our own consciousness back in on itself, we naturally heal the roots of our unproductive habits of thinking, feeling, and acting. We gain energy and access to our deeper capacity for beauty, order, generosity, forgiveness, calm, love.
Life becomes a process of living and our external circumstances become less hard and difficult. It can take work, especially if you are suffering. But the rewards are invaluable.
Believe in yourself. Believe in your life. The possibilities are always greater than we imagine.
You might find beautiful red flowers blooming where you once only saw thorns.
And please leave feedback to this article and share it if you see fit.
Why should everyone with chronic pain or autoimmune disease know about LDN (low dose naltrexone)?
Because for many people it helps them, even if they’ve “tried everything”.
That doesn’t mean it’s for everyone. What I say doesn’t mean diddly if it doesn’t help you. But LDN is something that most people don’t know about. And it’s something that helps many many people.
Some patients have told me it’s like a miracle. But to me it’s applied physiology and common sense. It’s not a miracle. But it is a very safe choice that might help.
If you’re facing chronic disease or chronic pain, it’s very important to be open-minded. Conventional medicine doesn’t have all the answers.
Knowing that truth, is part of What Heals.
Yes, part of your healing is an attitude of “What?”
What next? What now? What works for me? What heals?
Stay open-minded, but not so open that your brain falls out.
Here’s a recent interview from the LDN radio show, that talks a bit about what is LDN and why it helps some people with chronic pain or autoimmune problems.
Barbara was 57 and had severe burning pain in her legs and feet.
Her pain began after chemotherapy treatment for ovarian cancer which took place 4 years ago.
Thank God the cancer was caught early, and since treatment she has no evidence of cancer. But she does have burning in her feet. Her joints hurt. She also has fatigue and aching in her muscles that was diagnosed as fibromyalgia. She is not able to sleep. She feels exhausted all the time. Getting less and less functional as the months go by. She’s scared and anxious about what’s going to happen.
She saw a doctor who did an EMG, which is a nerve test, and he told her she had neuropathy. They tried various medications like Lyrica and amitryptilline. But they gave her side effects like dizziness and fuzzy-headedness and inability to think and remember.
She continues to take the Lyrica because nothing else helps the severe pain. But she’s fuzzy all day, even when she only takes it at night. And she can’t take it during the day so there is more pain by day.
What Should We Learn From This?
We’re going to jump off from here and learn a few main points:
What is neuropathy and how is it related to chemotherapy?
Why does conventional medicine have such a hard time helping it?
What did we do with Barbara that helped her?
What is the role of functional medicine in helping neuropathy?
What is neuropathy?
Neuropathy is when the nerves get sick. Nerves are not like electrical wires. They are living cells that have a cell body that is usually in or near the spinal cord. Nerve cells have projections called axons that are living dynamic tubes that nerves use to communicate with other nerves. For instance, the nerves that provide sensation and activate muscles in our lower legs and feet have their cell bodies in or near the spine So they are quite long. Other nerves are shorter, like the ones that provide sensation to the skin near the spine.
In order to function, nerves are constantly building and repairing themselves. They cell body has these awesome manufacturing plants that make proteins, enzymes, ion channels, and produce energy. All of these things are necessary for nerve function. In neuropathy, the nerve gets sick, so it doesn’t do all the things it needs to and the nerve stops functioning. That’s why a person with neuropathy can have numbness, pain, loss of coordination, muscle weakness, muscle spasms, and so on.
What Causes Neuropathy?
Many things can cause neuropathy. Diabetes may be the most common cause. There are the toxic effects of chemotherapy, like in this case of Barbara. Neuropathy can be caused by metabolic diseases like thyroid abnormalities, and autoimmune disorders. Other causes include nutritional deficiencies like B12 or folate, heavy metal toxicity, and other environmental toxicities.
Studies have shown that something like 65% of people getting chemotherapy get peripheral neuropathy. For some of them, it resolves over time after chemo ends. But something like 30% of people still have neuropathy 6 months later. It’s a severe problem that causes much suffering and disability.
What Can We Do About Neuropathy?
Conventional medicine—doesn’t do much.
A good neurologist will look for underlying diseases or nutritional deficiencies. But still, many people never have an identified cause.
Drugs can sometimes control the pain. But they’re like a band-aid. they don’t address the underlying cause, so the neuropathy can get worse. And the medications often cause side effects.
What About Supplements and Nutrients For Neuropathy?
Well, it’s a no-brainer that if someone is deficient in B12 or folate, then supplementing those can be very helpful. Remember that when we talk about lab values, ‘normal’ doesn’t always mean normal. Many people have a B12 in the low normal range, but they still have neuropathy or other neurological dysfunction. That’s because different people have different needs for nutrients. If I have a patient with a neurological disorder or neuropathy, I like their B12 to be in the middle range. There’s also a special test called a methyl-malonic acid that looks at how the B12 functions. Its often helpful to see if a low normal B12 is actually normal for a given person.
Nutraceutical research in general has a problem, and that problem is true for neuropathy as well. The problem is that most research is done on single nutrients. Kind of like the nutrient is a medication. It’s a “Take this pill for this problem approach”. But that’s often not so realistic. In your body, there are multiple interacting biochemical pathways, and nutrients dance together as a group. In the world of functional medicine, we tend to supplement things together in the way they normally function in the body. So when we study a single nutrient, we are often missing the potential mechanisms, in which several nutrients are interacting with one another.
So, for instance, someone who has an MTHFR gene mutation that impairs their metabolism of folate, may have significant reduction in their body’s ability to eliminate toxic compounds, and they may also have impairments in their functioning of vitamin B12, B6, and other nutrients. That can lead to oxidative stress and inflammation, which can cause all kinds of problems, including neuropathy. So, someone with that mutation and neuropathy would get a number of nutrients that are aimed at a. enhancing the overall cycle of folate metabolism, and b. reducing oxidative stress, and c. stimulating the detoxification processes in the liver.
That’s a complex multifactorial process. It’s really hard to do good research on a complex multi-factorial process. It takes large groups of patients and costs a ton of money. And no-one stands to gain approval for a new blockbuster patented drug. So no-one wants to invest 50-100 million dollars in that research.
But that doesn’t mean research is bad.
For sure, if there is a randomized controlled trial that shows that a given nutrient is helpful, then of course, lets try it. But if there are not randomized controlled trials that give evidence of efficacy, don’t take that as evidence of inefficacy. That’s just dumb, but it’s the way many doctors seem to think. If we know the physiology of nerve dysfunction and know that certain biochemical processes are impaired in nerve dysfunction, then I’m very willing to give nutrients that support that biological function. Because we are not talking about doing surgery or something destructive. The risk-benefit analysis is still often in favor of supplementing, even when there is no evidence from trials. OK, so that’s a sensitive topic and we will talk about it more another time.
Regarding neuropathy though, we do have studies showing that alpha-lipoic acid, which is a nutrient and antioxidant that helps cellular energy production, helps with diabetic neuropathy. It may be useful in other kinds of neuropathy. So a reasonable number of mainstream docs will recommend it for neuropathy, especially in diabetes.
But overall, the therapeutic options offered by mainstream medicine are not so effective for many many people with neuropathy. So they continue to suffer, like the patient I discussed in the beginning.
If we are willing to think out of the box, then there are things to do that can be helpful. Let’s talk about that. Let’s start by talking about the cutting edge understanding of neuropathy. This is what is in the primary scientific literature, and it can take decades to get into mainstream medical practice.
What Are Some of The Root Causes of Neuropathy?
Modern science is showing us that many cases of neuropathy have their root in a vicious cycle of Inflammation, Oxidative Stress, and Mitochondrial dysfunction. What does that mean?
Inflammation means the immune system is over-active. We’re not talking about red hot warm tender knee joint, or the inflammation of sinusitis. we’re talking about low-grade activation of the immune system which is being shown to be the root of most chronic illnesses. Modern medical science is showing this, but mainstream medicine doesn’t yet know what to do with it.
One of the results and causes of inflammation is oxidative stress. Oxidative stress is kind of like the biochemical stress of living. And it gets higher when there is toxicity or inflammation. Oxidative stress is the biochemical metabolic load on the body’s ability to regulate itself.
And those two issues—inflammation and oxidative stress—are intimately connected with dysfunction of mitochondria.
Mitochondria are organs inside our cells that produce energy. When the mitochondria don’t function, the cells have an energy crisis. In the nerves, that means the nerves start to break down. And then the symptoms of neuropathy often happen.
This dance of vicious cycles of inflammation, oxidative stress, and mitochondrial dysfunction is implicated in many of our most difficult chronic illnesses. Fibromyalgia is a great example. You may remember that this patient also had a diagnosis of fibromyalgia.
Two ‘diseases’ one set of physiologic imbalances.
Please Understand This Crucial Point About Chronic Illness
This is a really important point. It’s relevant for most people with any chronic illness. Two diseases, and one set of physiologic imbalances. That’s not the way that doctors get trained to think. We get trained to think about one cause, one disease, and one treatment. That was the gift of the antibiotic era. Before penicillin was invented, a person would come to the doctor with pneumonia, and most likely they would die. After we isolated streptococcus and found that penicillin kills it, most people with pneumonia would be better in a few days. It was miraculous and changed the way doctors think about medicine. And the idea of one cause, one disease, and one treatment became a dominant way of thinking about illness. That helps in some situations. But not in chronic illness.
Common Underlying Causes with Variable Expression
Like I said, The physiologic imbalances that give rise to neuropathy, often also give rise to fibromyalgia. And they can give rise to autoimmunity or arthritis, or irritable bowel, or chronic tendinitis or bursitis and so on.
So often, people come to me with ‘everything is falling apart syndrome’. And that’s what it feels like because they have all these problems. And conventional medicine, which sees each disease as an isolated entity with one cause and one treatment, usually doesn’t look for root cause of everything. It gives each problem a name, and gives each problem a medication or two, and then the person has a long problem list with 8-10 medications, but nobody is addressing the underlying physiologic imbalances. So the person is getting sicker, and collecting more diagnoses and medications and more medication side effects.
Functional Medicine–Find The Root Cause of Illness
Functional medicine is different. We look for root cause. I looked at Barbara and saw neuropathy, fibromyalgia, sleep disturbance, and anxiety, and they’re all connected in a vicious cycle. And low grade sterile inflammation with oxidative stress and mitochondrial dysfunction are part of the cycle.
How Did We Help This Patient?
There is a powerful lifestyle approach to these kinds of problems that comes out of functional medicine. But she was getting ready to go on a long trip, and there wasn’t time or space to do all that.
So, we started with LDN (low dose naltrexone).
What’s is LDN, and why did I prescribe it for her?
LDN is a medication that is very unusual. It doesn’t work the way most drugs work.
It evokes the natural intelligence in the body.
Naltrexone blocks the opioid system of the body. In high dose, it can help a heroin addict stay clean, because they can’t get high.
In very low doses, (hence the name low dose naltrexone, or LDN), it tricks the body to produce
more of its own natural pain blocking chemicals called endorphins and enkephalins.
Some of these natural molecules modulate the immune system. LDN has been shown to reduce the level of inflammatory signaling molecules called cytokines.
That’s why research suggests that LDN is helpful in many chronic pain states, fibromyalgia, chronic fatigue, and other chronic illnesses.
So she started LDN. We do it at low low dose initially. She called me when she had been on the therapeutic dose for about 2 weeks. The burning pain was gone. She still had aching in her joints but it was tolerable.
So what does that mean? Did LDN work only partially?
This is very important
So pay close attention.
She hadn’t been on it long enough to know.
LDN, as I said, stimulates the body’s own pain blocking chemicals, and it reduces low grade inflammation that can cause oxidative stress and mitochondrial dysfunction.
This is not comparable to a drug that so to speak ‘takes time to build up in the blood’. LDN does not “build up” in the body. It does its job for a few hours and is inactivated. But THE BODY ITSELF does the work. LDN stimulates a healing process by which the body works on itself to block pain and reduce inflammation. So it takes time.
In other words, just like the disease process that causes fatigue, fibromyalgia, and neuropathy takes place gradually, so does the healing process with LDN or other means that help the body heal.
She she’s going to continue to take the LDN and lets see how it impacts her other symptoms and overall health.
Healing Chronic Illness Is a Complex Process
And just a note about the bigger picture.
To my eyes, LDN is part of a broader set of tools to heal chronic illness and chronic pain. As we discussed above there is a vicious cycle of of inflammation, oxidative stress, and impaired cellular energy production that drives problems like neuropathy, fibromyalgia, and chronic fatigue. That same process drives other chronic illnesses like Alzheimers, Parkinsons, diabetes, heart disease, and autoimmune diseases like arthritis, colitis, lupus, multiple sclerosis, and so on.
We have proven ways to address the underlying imbalances in physiology through diet, specific nutrients, enhancing digestion and detoxification, mindbody therapies, and so-on. The first step is to identify what issues are most relevant for a given patient. then we try to make the lifestyle changes that gradually bring the system back to health. That process is called functional medicine. It takes work and a willingness to make lifestyle changes, but the potential benefits are tremendous.
that’s it for today. Thanks for watching.
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Here’s Part of the Solution to Chronic Illness and Chronic Pain
If you continue to suffer from chronic pain, fibromyalgia, chronic fatigue syndrome, colitis, arthritis, chronic headache, or other chronic illnesses and pain, you know that conventional medicine rarely has the whole answer. And you may have discovered complementary therapies that offer benefit, but often give only temporary help. So what’s the answer?
I don’t pretend to have an easy answer.
Healing is a journey. You need to find what works for you. Often it involves a number of tools and lifestyle choices.
Low Dose Naltrexone (LDN) is often very helpful where conventional treatments fail. It is a great complement to the natural healing choices, like nutrition, exercise, and mindbody therapies, that often help with chronic pain and illness. It’s inexpensive, it’s very safe with few side effects, and many people find it to be life-changing for the better.
LDN stimulates the body-mind to boost its own natural healing chemistry. LDN has caused life-changing improvements for many people with conditions such as: