EXCERPT: Sunbreak: Understanding the Pain No One Can Explain
© Shana Johnson 2023. Available on Amazon
Take a look inside Sunbreak. The book you didn’t know you needed!
TABLE OF CONTENTS
Chapter 1 When the sun breaks through
Chapter 2 My story: I feel your pain
Chapter 3 Stress-related disorders that are not obviously related to stress
Chapter 4 Melissa’s story: Stress strikes in the back
Chapter 5 Nerves gone rogue: Sensitization syndromes
Chapter 6 Why living in the stress response makes you sick
Chapter 7 Bryan’s story: Stress can make your head explode
Chapter 8 How sensitization turns up the pain
Chapter 9 Olivia’s story: Abuse has lifelong impacts
Chapter 10 The big “mis”: Misunderstood and misdiagnosed
Chapter 11 Is everything really ok? Learn the symptoms
Chapter 12 SunRISE Process: Start your path to healing
Chapter 13 Small things make a big difference: Stress management strategies
Chapter 14 How mindfulness practice shapes brain health
Chapter 15 Darren’s story: When stress becomes a gut punch
Chapter 16 Sometimes, you need some help: Medical therapy for nerve and sensitization pain
Chapter 17 Stress Rx on the treatment note
Chapter 18 Kristina’s story: The slow creep of clinical depression
Chapter 19 Depression doesn’t look depressed
Chapter 20 Voula’s story: The grown-up pain of childhood trauma
Chapter 21 Stress, anxiety and panic attacks
Chapter 22 Correcting cognitive distortions…stay with me, this is interesting
Chapter 23 Jenna’s story: Hard-working mom goes numb from stress
Chapter 24 Burnout: Stress rewires the brain…and not in a good way
Chapter 25 The troublemakers: Stirring up chronic inflammation
Chapter 26 Tying it all together
Chapter 27 Find the right provider for you
CHAPTER 1 EXCERPT
When the sun breaks through
When I lived in Seattle, the sky was gray for nine long months, from October through June. During this gloom, short bursts of sun appeared, lasting only a few hours. We called them “sunbreaks”—so rare that they were considered events. These exciting moments delivered a rejuvenating break from the gray and gloom, as the sun reflected off the ocean and lit up the mountain ranges. No place is more beautiful than Seattle when the sun breaks free.
I remember the welcome sight of a sunbreak during the years I worked as a physical medicine and rehabilitation physician in the Seattle area. I focused mostly in the neurology world, treating people with conditions affecting the brain, spine, and nerves. Multiple sclerosis was a particular specialty of mine. I also cared for patients who had suffered severe brain injuries, spinal cord injuries, and strokes. And pain of all different types—back pain, headaches, and whole-body pain. I treated the vast spectrum of injury and recovery.
Throughout the years, I frequently encountered a condition that my medical training hadn’t prepared me for: people who developed medical disorders while under long-standing overwhelming stress.
And, then, I developed one too. My stress-related disorder (SRD) turned my life upside down. While devastating at the time, I can now feel the pain of 30 million Americans suffering from similar disorders.
The sun breaking free reminds me of finding hope and starting on a path toward healing. Finding light in the gloom. Realizing that dark days are temporary. These momentary flashes of sunlight inspired me to write this book on a subject close to my heart. Sunbreak offers insight and guidance for healing from medical conditions that are triggered and worsened by stress. Conditions like chronic headaches, back pain, bladder pain, and digestive issues, as well as depression and anxiety disorders triggered by trauma and overwhelming stress. As a doctor, I’ve seen too many patients with real and serious pain who were ignored, dismissed or misdiagnosed. I’ve also been one of those patients.
Follow me down the path from pain to wellness for several individuals—each on a different life path—who developed different medical conditions while under high stress. Each person faced significant losses because of their medical issues. Despite their individual life paths and conditions, their journeys to healing all contained the same key elements. And I want to share them with you so that you understand that there is hope for healing and you know where to find it.
I titled the book Sunbreak because this “enlightening” represents the first element of healing; the illumination that comes with awareness. Becoming aware of your mind, body, and self. And, more importantly, becoming aware of how they are connected.
At the time I developed my stress-related disorder, I was working as a physician at a multiple sclerosis center. The position had been my career goal, my dream job, and my definition of success. The future looked bright then. But it did not go as I had dreamed.
I started on my path toward healing there, in the Pacific Northwest, where my greatest success met my greatest failure.
CHAPTER 3 EXCERPT
Stress-related disorders that are not obviously related to stress
Central sensitization syndromes (CSS) are stress-related disorders and affect upwards of 30 million adults in the United States. They are a common reason for chronic pain. And a common reason people seek out opioids. Yet, in my experience, the root cause or driver of these disorders is rarely addressed in mainstream medical clinics. To bridge this gap in the healthcare system, I will talk about them here.
Let’s review the role of stress on performance. I promise to be brief.
The Yerkes-Dodson curve shows the relationship between stress and performance. Mild or even moderate levels of stress actually enhance performance. It’s a good stress—yes, there is such a thing! That’s when you are motivated and focused.
When the stress level keeps escalating, you hit unmanageable levels that lead to overload and burnout, the dreaded red zone. Here is where you reach distress, exhaustion, anxiety, anger, or a combination of these stress-related states. When you are living in the red zone, the body’s weakest link is bound to break.
During my clinical practice, I observed that people who were living in the red zone developed one or more of a variety of stress-related disorders (SRD):
- Disabling headaches
- Miserable back pain
- Embarrassing digestive issues
- Crippling anxiety
- Debilitating panic attacks
- Life-threatening depression
Having experienced my own red zone condition that either puzzled providers or was not worth their time, I decided to take a deeper look at the underlying cause of these disorders.
The link between stress and health problems
Between my research and observations, I found long-term, overwhelming stress provokes dysfunction in the nervous system which results in a variety of medical disorders. I witnessed numerous people develop one or more of these disorders while under high stress. Their bodies snapped and broke under unmanageable demands. Like a bridge carrying too much weight for too long. At first, cracks develop. If the weight continues, the structure buckles under the pressure.
Headaches, back pain, and digestive issues may not appear to be stress-related. In fact, stress instigates changes in your physiology, like revving an engine and pushing it to the limits. Then, it feeds more intensely and deeply, creating disorders. You may feel the symptoms in your stomach or back, but the problem may reside in the nervous system. An issue with how the nervous system is relaying pain signals. If the stress and nervous system dysfunction are not addressed, you won’t get better. It is like sweeping the garage while intending to clean the kitchen. You have to do the work in the correct room.
To better understand how things go wrong in the nervous system, let’s review its parts. The nervous system is comprised of the brain, spinal cord, and nerves that control the functions of our body from our thoughts to our movement. When there is dysfunction in the nervous system, it affects the whole body. From your head to your toes. How you feel pain to how energized you are. Left untreated and unmanaged, stress spurs dysfunction in this system.
The onslaught of referrals
As a physical medicine and rehabilitation doctor, my clinic was a funnel for stress-related disorders. Once the traditional medications or procedures failed to help, people were referred to me for symptom management, which meant caring for pain and problems for which their doctors had no course of treatment. These people often shared the same patterns:
- They had disabling symptoms with medical tests that were mostly normal. A mismatch with severe symptoms but normal or only mildly abnormal diagnostic tests.
- These patients were desperate for help and felt their providers thought their symptoms were all in their head.
- They had seen multiple providers with no answers and had undergone multiple procedures that did not help or worsened their symptoms.
The most common referral during my general practice was people with chronic severe back pain without a clear explanation for the intensity of their symptoms. These patients had severe pain, even though their tests showed only mild abnormalities. For example, they had mild arthritis in their lower back, but they were unable to work due to the pain level. Standard care—such as physical therapy, anti-inflammatory medications, and injections—had resulted in minimal benefit. Procedures or surgeries worsened symptoms. Their providers were puzzled at best and dismissive at worst.
These patients feared a serious medical issue had been overlooked or that they imagined their distress. It felt horribly real to them, but when tests showed no reason for their misery, they questioned themselves. “Is it possible what I’m feeling isn’t real?” How could something hurt so much and nothing be wrong? I could relate to their painful dilemma.
Many factors contribute to the development of neurologic conditions, sensitization syndromes, and mental health conditions. Not every case is stress-induced. Not every case has sensitization features. That said, I witnessed how long-term, high stress triggered and worsened these disorders. And how these disorders improved with reduced stress. I not only saw this in the clinic but in family members, friends, work colleagues, and myself. If you’re living a high-stress life and experiencing chronic pain, look closely for nerve sensitization.
Sunbreak: Understanding the Pain No One Can Explain
By Dr. Shana Johnson
© Shana Johnson 2023
No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the publisher, except in the case of brief quotations embodied in critical reviews and certain other non-commercial uses permitted by copyright law.
While all the patient stories described in this book are based on true experiences, names and personal details have been changed to protect their privacy.
The information included in this book is for educational purposes only. It is not intended or implied to be a substitute for professional medical advice. The reader should always consult with a qualified healthcare provider to determine the appropriateness of the information for their own situation or for information regarding a medical condition or treatment plan. Reading the information in this book does not constitute a physician-patient relationship. The statements in this book are not intended to diagnose, treat, cure, or prevent any disease. The author expressly disclaims responsibility for any adverse effects that may result from the use or application of the information contained in this book.