Overexertion and anxiety/regret
 

Hello everyone,

I would like to ask for advice on two questions. My background is the following: I am having PCS since November 2016 after my second concussion, and I think I sustained a third concussion in my sleep three weeks ago.

My first question is the following. I tried to resume some moderate activities ten days ago after a period of complete rest. This went fine for a few days, and I was feeling optimistic again, but last Sunday I spent three or four hours doing the chores in my house. There was no violent effort, I was just walking around the house to clean up, but I have been feeling exhausted all the time since then, my eyes are red, and I am now experiencing some cognitive difficulties as well (slower processing, slight problems at finding words, difficulties to understand what I read), which was not the case before last week. Are these common symptoms of physical over-exertion? I am puzzled by the fact that this is a new set of symptoms. In contrast, the headaches, which were my major source of complaint, have almost disappeared these last days. I just don't get it.

My second question is: how do you guys deal with anxiety and regret? Since this third concussion, and especially since last weekend, I find myself in a very nervous state, crying often, and invaded by irrational thoughts. To add regret and blame to the anxiety, I keep blaming myself for these accidents and even more so for the mistakes I make during the recovery. For instance, I can't stop telling myself how stupid it was to overdo it last weekend. I know how ridiculous this is, and these thoughts are certainly not the result of a conscious assessment, but my inner voice tells me all the time that I ruined my own life and career (I am a mathematician in academia) by being careless.

I know that this reaction is irrational, and I now see these negative thoughts and emotions as the biggest obstacle to my recovery. I decided to start a psychotherapy soon to help me with these emotions, but given that this mindset is unfortunately common among PCS sufferers, I was wondering whether anyone had any other tip, advice or experience to share about it.

Thank you.

I think it is good that you are starting psychotherapy. I hope the therapist is good at teaching CBT so you can redirect your irrational thoughts.

Last night at my Brain Injury Support Group, we had an excellent speaker. He spoke about chronic pain but what he said also applies to chronic anxiety.

He spoke about PNE, Pain Neuroscience Education. This is a well research but new way of understanding how pain is triggered. Just like PCS, pain can be triggered by memories of past pain. The common struggle people have with pain is they connect it to an injury and add worry about a new injury. This worry about reinjury or a new injury magnifies the pain "FELT".

The worse situation is when worry about the original injury prevents the person from 'allowing' the original pain to resolve to a historical normal or no pain. Instead, of resolving to a 0 or 1 on a 10 scale, the pain resolves from a 8 to 10 on a 10 scale to just a 6 to 8. They see a parallel with this remembered pain and the pain experienced by an amputee when they experience phantom limb syndrome.

The same thought patterns impact PCS. The thought and worry about a new injury makes the symptoms of the original injury manifest. It is a PTSD like flashback. It has no basis in physiology but appears as real as the original concussion symptoms.

PNE is being promoted as a partial solution to the opiate overdose epidemic. Properly taught PNE has a high success rate of reducing pain and restoring function when compared to drugs (opiates, gabapentin, etc). 1 out of 3 will experience pain recovery with PNE versus only 1 out of 6 who take nerve pain blocking drugs.

I believe the same problem is plaguing the PCS community that struggles with prolonged symptoms. Most with prolonged symptoms struggle with the reinjury thought patterns even when the 'reinjury' is of such a minor impact force that is cannot cause a concussion. As the science shows, those who had a predisposition to anxiety prior to their concussion will statistically experience a must longer and troubled recovery. The doctors can predict who will have a long recovery.

Vania, I believe you need to start with trying to convince yourself that your bump was not a concussion. It may have been a subconcussive impact but that is doubtful. More likely, you just slept with your head jammed against your headboard and this caused an inflammation response at the point of contact. You may have even strained your neck with your head jammed against the headboard posture. You did not cause yourself to experience more brain damage. Once you convince yourself of this, your recovery will begin.

The symptoms you are experiencing are not common concussion symptoms. They are more likely sleep deprivation induced brain fog/fatigue with a big dose of anxiety. Anxiety prevents proper restorative sleep creating a vicious cycle of sleep deprivation brain fog and other symptoms that induces anxiety that prevents good sleep and starts the cycle all over again.

A sleep study might be worthwhile. You may have other issues adding to your lack of restorative sleep. They find that poor sleep also contributes to chronic pain.

I agree with Mark.

I have been seeing a professional shrink weekly for years....It has helped me greatly! Acceptance was very hard for me.

Im not crazy, I am injured.

Thanks a lot to both of you. Mark, what you wrote makes perfect sense. I'll look into PNE, that sounds interesting and highly relevant.

I indeed chose a therapist who specializes in CBT and PTSD. I'll report here if I have anything interesting to say about her approach.

Best wishes.