EXCERPT: Sunbreak: Understanding the Pain No One Can Explain
© Shana Johnson 2023
Available on Amazon Sept. 2023
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 12 EXCERPT
SunRISE Process: Start your path to healing
Healing starts with becoming aware of sensitization and stress effects on your body, the mind-body connection. When sensitization is present, the treatment approach is different. The direction shifts away from targeting a local injury and broadens to addressing the nervous system.
To manage symptoms from sensitization or stress, you must first be aware it is a factor. It is hard to improve a problem if you don’t know it exists. When I worked in the stroke recovery unit, we saw a common feature with “left” brain strokes versus “right” brain strokes. With a left brain stroke, the patient tends to have insight into their deficits from the stroke. They are aware they can’t swallow or walk safely. Because of this awareness, they tend to be more melancholy. They also tend to have more potential to improve with rehab because they know what they need to work on. Because of their awareness, even with impaired swallowing from their stroke, they are careful when they eat and there are few problems with choking.
Meanwhile, those with a right brain stroke have much less insight into their deficits from the stroke. They would choke more on food and fall more when trying to walk, even with milder deficits. Without awareness of a deficit, it is hard to compensate for it. Safety was a constant challenge since they didn’t realize their balance was off, so they would stand impulsively and fall repeatedly. The right brain strokes had a harder time in rehab since they had limited awareness of what they needed to work on.
RISE and shine
Before you can manage the symptoms of sensitization and the impact of stress, start with awareness. The SunRISE process helps you recognize sensitization in yourself, identify stress and the physical symptoms it causes (stress-body connection), and strengthens this connection with mindfulness practice. Along with exploring effective therapies to calm your over vigilant nervous system and decrease the pain level.
- Recognize nerve sensitization.
- Identify stress and make the stress-body connection.
- Strengthen the connection with mindfulness practice.
- Effective therapies to calm the nervous system
Let’s look at each step—what it is, why it matters, and how to get there.
Recognize nerve sensitization
Chronic lower back pain—like Melissa’s—is a common sensitization syndrome. In her case, sensitization was the predominant driver of her symptoms and included the non-pain symptoms of fatigue and brain fog. When Melissa’s back pain flared, her fatigue levels and brain fog also worsened. Her functional level decreased for days, and she needed time to rest and recover. With heightened awareness, Melissa now knows she is ok. She sees these symptoms as signals that she overdid it. Her body screams at her in a more “intense” way to lower demands because of the sensitization. She must prioritize her health. Melissa reduces demands that week and takes another look at the whole month. You need to analyze the triggers. Understand the body’s message. Then, listen to it without shame or judgment.
When it comes to building awareness of sensitization syndromes, a helpful starting point is the central sensitization inventory (CSI), which I’ve discussed previously. The CSI helps build awareness of sensitization symptoms and the factors that worsen it. The inventory reviews the pain symptoms and non-pain symptoms, as well as related factors like stress, mental health, and trauma. If you find yourself nodding “yes” as you scroll through the list, it is a sign that sensitization may be contributing.
Understanding recalibrates the “freak-out” meter.
As Melissa discovered, understanding that sensitization is present and contributing to symptoms made a difference. She received confirmation that the pain wasn’t something she imagined or exaggerated. Melissa found it reassuring that a symptom flare-up was related to sensitization rather than a new or worsening injury. When you know you are going to be “ok”, you’re in a better mindset to manage your symptoms.
With time, you see a pattern to your symptoms, which, in turn, builds confidence that you can work through it. A greater sense of control and less fear emerges. This, in and of itself, reduces suffering. Once you understand your pattern, management becomes easier. You can confidently resume activities you enjoy. And know to avoid some others! This is the first glimmer of light. The beginning of your own Sunbreak.
Identify stress and make the stress-body connection
Bryan’s experience with chronic headaches represents another common sensitization syndrome. Within a CSS, sensitization can increase symptoms anywhere from a mild to a severe amount. A CSI score greater than 40 suggests significant sensitization symptoms are present. Melissa’s CSI score was 59. Sensitization was a significant contributor to her pain level. In contrast, Bryan’s main issue was that high stress levels triggered headaches so his CSI score was 17. He had minimal sensitization affecting his pain level.
Sensitization syndromes have predictable triggers that worsen symptoms. High stress is a common one. Work stress is a big one, especially when the demands are high and the control of the situation is low. When you’re working against continuous tight deadlines or high stakes with no control over work volume or resources, you feel the strong push and have no control to change it. Think about those situations when perfection is required but the time or resources for it are not available. For Bryan, perfection was a must; each project had to be perfect and completed on a tight timeline. But, the work volume overwhelmed his company’s resources. The work demands were unrealistic and unsustainable.
Bryan needed to grasp the stress-body connection. When his headaches flared, he had to reduce work demands to bring his headaches under control. When he keeps his stress levels manageable, he keeps his headaches manageable. Understanding the stress-body connection was key to managing his CSS.
To build your stress-body connection, start by exploring how stress presents physically in you. Here is a hint: Stress likes to exploit our weak links. Bad back? Feel it there. Bad shoulder? The pain hits there. Sensitive stomach? That’s where it goes. Prone to headaches? You’ll probably feel the stress in your head. Similar to how stress expressed itself in the people we have met, Melissa’s back hurt, Bryan had piercing eye pain, and Olivia had miserable bladder pain.
Starting an Awareness Journal helps you see how your stress shows physically. It helps build the stress-body connection. When symptoms flare, write down what you are feeling physically and emotionally. Write down where you feel the symptoms, what you are doing, and how you are feeling. Write the emotions—like sad, frustrated, disappointed, worried, confused, or angry. Get in the habit of labeling the emotions you are feeling. And, let yourself feel them. Over time, this process reveals patterns and symptom triggers.
After keeping an awareness journal for two weeks, check for patterns. Are there certain activities that consistently result in increased symptoms? Do certain emotions consistently intensify symptoms?
The Awareness Journal shows patterns that are easily overlooked otherwise. In the beginning, you may not realize your triggers or the degree of stress you’re bearing. Your awareness may start slowly, but it will grow with time. With each journal entry, the picture becomes clearer. It is a process that shows itself with consistent practice.
Strengthen the mind-body connection with mindfulness.
Mindfulness refers to living in the present moment as opposed to being lost in thought. For example, standing in the kitchen first thing in the morning and feeling the sunshine on your skin rather than thinking about your work meeting with your difficult colleague Karen. Meditation and mindful exercise (e.g. yoga) are other ways to practice mindfulness. The practice elevates awareness of yourself, your body, and the connection between them.
Mindfulness practice changes how your brain processes information. You are able to separate from your thoughts and emotions, allowing the real you to emerge. You are in control of your thoughts and emotions, rather than them controlling you. You are able to enjoy the life you are living now, in the present moment, rather than existing in the worries of your mind.
Effective therapies to calm the nervous system
If sensitization pain is filling your day with suffering, there are medication and non-medication therapies that help calm over-reactive nerves and lower the pain level—medications that are specific to nerve and sensitization pain. Acupuncture has also shown benefits. In addition, complementary treatments with physical therapy, chiropractic care, and massage therapy can play a role in your sensitization treatment, depending on the type of CSS.
In the next sections, I will go into more detail about key stress management tips, then dive into how to strengthen the mind-body connection (S) and effective medical therapies (E).
Healing starts with becoming aware of sensitization and stress effects on your body. The SunRISE process guides you through how to recognize nerve sensitization, identify stressors and make the stress-body connection. Tracking your CSI score, keeping an awareness journal, and following your PSS score all help build this connection. Mindfulness practice strengthens the stress-body connection. The practice has been around for thousands of years, and now science reveals why they are beneficial.
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.