Hi there, new members akgh, hannah, Azailia and Corinne -

You have all touched on an important question. First of all, living in chronic pain wears us raw. The first so-called "pain psychologist" I saw (a psychologist who happened to get a job at a pain clinic, more like it) told me, when I brought it up maybe 8 -10 months into this, that it, just "went with the territory" and there was nothing I could do about my occasional rudeness to random sales clerks, etc. That was only a small part of the reason I left that pain clinic.

A couple of months later, a new neurologist with many years of experience wanted be evaluated by his pain psychologist, who was also an analyst by training. We had only one two hour session but it changed my life, fundamentally. When I got to the part of being told that anger "went with the territory," she basically uttered that two letter acronym and handed me the card of a woman who taught the Mindfulness Based Stress Reduction course, developed 30 years ago by Jon Kabot-Zinn at the Univ. of Mass. Medical School, which still administers the program nationwide. http://www.umassmed.edu/Content.aspx?id=41252 If you're interested you can go on their site to find some 543 currently accredited teachers around the world, 60 in California, and three of those I can personally vouch for!

Eight years later my MBSR teacher is still one of my closest friends, and through the eight week class, which met for two and a half hours once a week with daily guided meditations and yoga exercises - probably the most efficient way to understand the literal position of our body in space (proprioception) ever devised - I started to see that there was no reason why, for instance, we couldn't just note searing pain as sensation, map it, explore it is detail in parts of the body where it wasn't so intense, and not most importantly, not spend my energy trying to push away something that was unavoidable.

The flip side of course is giving up attachments, specifically in our cases, to the lives we lead before this all started. For example, check out a post I put up a couple of years ago about a talk given in San Francisco, post-stroke and from his wheelchair, by famed Guru Ram Das, fka Richard Alpert, PhD, and the son of the president of the New York, New Haven and Hartford Railroad. (Talk about a lot of past lives all rolled up into one.) http://neurotalk.psychcentral.com/sh...d.php?p=252371 [post no. 2] In my case, it was "walking" away from being a business bankruptcy lawyer, where I was well past the point - due to illness - of being able to make a profit doing it, but I had so much attachment to a career I spent 20 years developing and going to endless professional programs, etc., and then, after 18 months, one day I finally had to freedom to just let go and start the wind down process.

Anyhow, there have been lots of posts on this one before. But for new members, MBSR, which was developed in large part with the need of the chronic pain patient in mind, is something to be checked out. And for those how aren't up for a whole class, it's definitely worthwhile checking out Shinzen Youn's little 80 page book and CD of guided meditations. BREAK THROUGH PAIN: A Step-by-Step Mindfulness Meditation Program for Transforming Chronic and Acute Pain (2005). No one claims you can make pain go away, but dealing with it directly is a whole lot better than having it deal with you.

In fact, doing it right, pain can actually be the vehicle through which we learn to pass through suffering altogether.

Then there is what Corinne refers to, how intense stress, especially that which perfectly pushes our buttons (my spouse in full tirade for some screw up on my part) translates immediately into the sharpest possible pain. Personally, I've assumed for years that this was mediated through the release of adrenals which in turn produced an immediate ischemic response, but I'm open to the suggestion that there is a more direct relationship.

Finally, there is a dark side to all of this in the case of chronic RSD/CRPS.

A couple of posts in recent days have mentioned research linking CRPS to the "limbic system" without saying more about it. Yet, based solely upon the fact that a PubMed search of "CRPS limbic" generates only a single article, the suggestion is there that the definitive and in fact only published work to date is that based on functional MRI studies coming out of the "Pain and Passions Lab" http://www.apkarianlab.northwestern.edu/ of A. Vania Apkarian, PhD at Northwestern possibly the leading neuroscientist in the county specializing in research on chronic pain. See, Geha PY, Baliki MN, Harden RN, Bauer WR, Parrish TB, Apkarian AV, "The brain in chronic CRPS pain: abnormal gray-white matter interactions in emotional and autonomic regions," Neuron 2008 Nov 26;60(4):570-81, FREE FULL TEXT AT APKARIANLAB SITE http://www.apkarianlab.northwestern....00811_Geha.pdf

Abstract
Chronic complex regional pain syndrome (CRPS) is a debilitating pain condition accompanied by autonomic abnormalities. We investigated gray matter morphometry and white matter anisotropy in CRPS patients and matched controls. Patients exhibited a disrupted relationship between white matter anisotropy and whole-brain gray matter volume; gray matter atrophy in a single cluster encompassing right insula, right ventromedial prefrontal cortex (VMPFC), and right nucleus accumbens; and a decrease in fractional anisotropy in the left cingulum-callosal bundle. Reorganization of white matter connectivity in these regions was characterized by branching pattern alterations, as well as increased (VMPFC to insula) and decreased (VMPFC to basal ganglion) connectivity. While regional atrophy differentially related to pain intensity and duration, the strength of connectivity between specific atrophied regions related to anxiety. These abnormalities encompass emotional, autonomic, and pain perception regions, implying that they likely play a critical role in the global clinical picture of CRPS.

PMID: 19038215 [PubMed - indexed for MEDLINE]

This is an article that has been discussed before in this forum but is deserving of another thread in it's own right, along with whatever I can come up with on other sources. The apparent consequences of the research are staggering, first at to the direct relationship between CRPS and an organic loss of skill in "emotional decision making," which had been previously noted in psychological studies with matched control groups, only to have the mechanism of action verified through fMRI studies showing a significant loss of gray matter cortical thickness in the brain's "anterior insula" which is believed to play a direct role in emotional regulation. I'll try to get that up tomorrow.

Moral of the story: we will probably need all of the "mindfulness" skills we can get.

Mike