I recently decided to go all in on addressing chronic pain - a condition which affects an estimated 1/5 adults in the US[1] and nearly the same proportion in my country of Australia.
This is the first of several blog posts exploring this invisible condition.
If you're passionate about this space feel free to reach out, thanks!
I asked chatgpt to explain this to me and it did a poor job.
Generally speaking in my friend group. Chronic pain used to be opiods; though long ago medical cannabis came along. I couldnt tell you how many people i know who arent stoners who got into the cbd thing and fully got off opiods. 1 addiction for another, but at least cannabis has far less negatives.
>If you don’t have chronic pain and you’re just here for vibes and to see some cute brains, I really appreciate you .
The problem, CBD never fixes the pain. ~8 hours later you need more.
There's no business case for solving chronic pain. Here's my take.
1. There can be cases where there's something legitimately physically wrong causing chronic pain. In detroit I had a friend who got shot with birdshot, a tiny pellet was in his spine that surgeons didnt want to go after but there's no getting away from that pain. If this is the case, you're not seeking explanation.
2. There's stress/emotional pain. "The body keeps the score" by Bessel van der Kolk. He's big on EMDR and yoga. Your achilles pain and such absolutely could be, Probably something like 'change or abandonment' one of my favourites for yoga: https://www.youtube.com/watch?v=2XhJ63OQ7Ww
Do that 23 minute video and see if it helps.
3. Mindfulness meditation. Get into the most comfortable position possible. Dont move; and far more difficult dont think. Your mind will wander. If the pain is in your achilles. The only thing you're doing is monitoring the pain. What's the exact shape of the pain? Is it 4 inches long or is it only 2 inches? Is it sharp like a knife, or is it round in shape? Do you have any taste, smell, or sound from it? You need to wait as long as you have to, maybe it only makes a sound every 2 minutes, you have to wait and your focus is only on waiting for the sound and nothing else.
4. Yoga nidra or progressive muscle relaxation. Start at your toes, you try to flex the muscles to the maximum and hold for 5 seconds, release. then do your feet, ankles, legs, every muscle has to have been flexed and held for 5 seconds. Then when you're done, you simply do nothing at all. dont even focus on anything; maybe your breath at most.
> Before moving forward - I’m not a doctor. Just a bit of a nerd with a blog. Please do not sue me or use these posts as a replacement for medical care.
unnecessary disclaimer here. when it comes to chronic pain treatment doctors are mostly useless or even harmful, proposing surgeries or drugs that will do more bad than anything else because they have no interest in learning how to customize their approach and will parrot and prescribe what they heard from medical representatives. Remember, the opoids crisis was enabled by doctors in the first place.
I think he has to put that to prevent any crazy things from the law side. You have a great point on doctors there, no wonder why people lose trust in them after so many wrongs.
As someone who had years of undiagnosable pain and after many years (and more than one doctor trying to suggest it was all in my head) I just want to say to anyone reading who has it -
Don’t let yourself be gaslit that it’s all mental. It seems some do have that, but there are also many hard to diagnose and completely valid physical health conditions that cause terrible chronic pain. And don’t give up on trying to find out what they are. Once I did, I was able to largely manage mine, and more importantly, to stop constantly questioning my own sanity.
> Don’t let yourself be gaslit that it’s all mental.
This is a big problem women have around menstrual cycle pain. "It's normal" is what many doctors say - particularly men. A woman I know was basically bed ridden for a couple days/month until she found a doctor who believed her and addressed the problem.
I make an app called Reflect [0] that’s designed to track things like chronic pain and help you get to the root cause with self guided experiments. I’ve used it for my own pain symptoms, especially joint pain. Happy to answer any questions. Wish you the best on your journey.
I’ve been dealing with chronic reflux for about 8 mos now. On PPIs and they don’t seem to do much. But once I get away from my typical routine of work/dadding then all the symptoms vanish, even to the point of being able to eat foods that are not good for reflux: spicy things, tomatoes, a bit of coffee. In my case, this is absolutely a downstream symptom of something mind-body. Already been scoped and got a diagnosis of visceral hypersensitivity, which is medical speak for “nerves in esophagus are too sensitive.”
The question of why is out of scope.
In this case, docs just don’t know why. (I think it kinda pisses them off not know, tbh). And finding out is not really in their wheelhouse.
I’ve made some life changes (new job) to see what happens here. But I also have to be prepared for the possibility that it doesn’t fix it. Been working through The Body Keeps The Score as well.
Looking forward to seeing what the author discusses here.
I had the same diagnosis, and treatment was getting on serious antidepressants for their nerve dulling properties.
After getting that diagnosis. I eat everything within reason. I decided not to take medication, knowing whats up with my body is sufficient. I mainly try to do all eating 4 hrs before bed.
What i have read is that covid may be responsible for micro lesions in the esophagus...acidic foods are essentially rubbing salt in the wounds.
Just a note about VH - it is more so over sensitivity to regular digestive function. Which is why feeling super full after eating/dispepsia is common as well. Im sure you did a 24 hr acid monitoring test - i pressed the reflux button during all my trigger foods and was surprised to see ph levels as neutral.
> For the next 4 years, I continued to accumulate weird and persistent pains in different parts of my body.
Anyone who is accumulating weird pains in random, different locations should definitely pursue some of these alternative explanations. Another sign that these techniques are appropriate is if the pains come and go depending on your mood or situation (worse when working, disappear when doing something fun) or are prone to suggestion (someone talks about their back pain and then you have back pain for the following days or weeks).
However, I’m also getting tired of the people who benefit from this techniques deciding that their explanation for chronic pain covers everyone. It’s a huge trend in parts of tech Twitter right now to apply these theories to all chronic pain. A small number of people who had unexplainable pain and addressed it through meditation, therapy, and similar techniques are now pushing it as a far more universal explanation. It really needs to be applied to the appropriate situation, not used as a universal treatment for chronic pains.
This parallels similar trends with topics like PTSD, where a smaller group of people have benefited from therapy that addresses past trauma and now they’re trying to export the theory that past trauma and PTSD is the explanation for all psychological ills. Again, matching the right treatment to the condition is critical and being open-minded is important, but beware of people who are preaching that doctors are misinformed and you should subscribe to their app, blog, newsletter, or course instead.
I felt like I was dying at 35 years old, my body was completely betraying me, exhausted, constant pain, no life as absolutely no energy on days off and still exhausted starting the next week. Even years in the Army never left me feeling like that
I had no idea it was the misery of the IT job that was causing most of my pain and suffering, and it had nothing to do with the job itself, it was the endless insanity of everyone else around me doing exactly what they were informed would cause problems instead of having discussions with people that actually knew how shit worked. I was endlessly picking up everyone elses mess and treated worse than a pile of shit all because people were incapable of having a speck of respect for other people since all their hatred for computers fell on me
I GTFO of the career of misery and took half a decade to finally start feeling better
I have now spent years and countless hours working on software and I greatly enjoy doing this work again and find I get even more done than I used to simply by doing life the way I need to instead of how some backwards/abusive control freak "needs it done"
I've dealt with chronic illnesses for the past 10+ years now. It's such a hard path.
I recently found out after a violent burn-out that a significant cause was chronic stress and its psychosomatic symptoms. It made me have a hard look at the topic, and I'm gradually adjusting to solve the issue.
If I get better, I'm tempted to do as OP and spend more time working on this issue for others. It seems so much more impactful than grinding the tech / startup life.
I was just talking to a friend of mine, yesterday, about what happened to me.
In 2017, I was laid off of my job (of almost 27 years). I immediately started looking for work. Since the company I worked for, was a marquee-name company, I assumed that it wouldn't be hard.
Boy, was I in for a shock.
I almost immediately learned that no one in tech, is interested in hiring a 55-year-old, regardless of their pedigree. I could have gotten a job, but those companies made it clear that I would be treated quite badly.
So I made the decision to just throw in the towel and retire. I had the means, but I would have liked to have at least another ten years of salary. I have never had any intentions of stopping working, though. I love developing software. It's a hobby and a personal passion; not just a job.
I was really pissed off at the treatment. I suffered great butthurt.
But in the long run, it's the best thing that ever happened to me. I never realized how much stress I was under, while working. I sincerely believe that, if I had kept working, it would have killed me. I have no intentions of returning to the rodent rally; even though I'm quite good at what I do, thanks to all the learning that I've done, in the last eight years.
I now work every day (my GH Activity Graph is quite green), and do a fairly good job on my chosen projects, but I no longer feel that awful weight on my soul.
Sometimes, the only way that we learn how much pain we are in, is to stop suffering it for a while.
I’ve been struggling with chronic pain for almost eight months. It started when my orthodontic treatment caused the root of one of my teeth to break—it had already been weakened from a previous injury. The extraction was straightforward and only took 10 minutes, and I had an implant placed (with a temporary crown attached to my braces). Healing went smoothly, and the CT scans looked fine.
But soon after, I developed constant headaches that never went away. At first, I assumed they were related to the procedure, but everything had healed well, and multiple check-ups didn’t reveal anything. Since then, my braces have been removed, but the daily headaches persist. Occasionally, I also feel a strange “foreign object” sensation around the implant site.
A follow-up CT scan of the implant showed perfect integration with the bone. I’ve also had other tests done, including a head MRI. Medically, everything appears normal.
It’s getting really hard to manage—painkillers don’t help at all. Has anyone experienced something similar or have any idea what to try next? I’m even considering having the implant removed, despite there being no medical reason for it.
Dental procedures can setup trigger points in the masseter and pterygoid, as well as in your neck, all of which can cause headaches until they're resolved. Massage and trigger point needling by a physical therapist can help resolve these.
“As pain becomes chronic, it is increasingly associated with activity in the affective and motivational systems tied to avoidance and less closely tied to systems encoding nociceptive input” [1]
I’ve been on the slippery slope of chronic pain. Minor post surgery issues caused me to change my routine and avoid certain activities which only exacerbated the issues, which led to more avoidance. Eventually I couldn’t walk.
The American medical system is very focused on avoiding health issues that show up on mri, rather than quality of life health. But quality of life issues quickly become serious.
I think the middle ground of activity: not all out intense as if you are healthy, but also not avoiding movement is so challenging to find for many people but also so crucial. A lot of chronic pain for myself and I suspect for many others could be avoided with short and quick combination of therapy and daily movement. So simple but so challenging to effectively identify and allocate resources.
Not suggesting this is the total solution but it’s the pathway that I took to return to activity and I’ve seen it help a number of my friends as well.
Your method is how I treated pain and it served me well for many years (including broken ankle, countless elbow/wrist/finger injuries), as soon as I could I started movement again, and for tendon injuries even decent intensity seemed to help trigger healing.
That all changed when I tore my achilles, the pain/recovery/etc. process had me doubting everything I knew about recovery and now 14 months later I still question if it needs more rest or more activity or the whole thing is in my head. Ankle/foot injuries seem to have an entirely different approach because standing and walking are so fundamental that you might overdo it just by deciding to make eggs or something.
not a cure and barely a treatment but it's one of the only tools in the toolbox
Modulates endorphin receptors (by blocking them for a little while)
Not only causes the body to produce more endorphins to reduce pain but is actually proven in studies to make the ion channels work better if dysfunctional
It's crazy how much your physical health is tied to mental happiness/lack of stress. I had a friend that during his most stressful period as a 24 year old in Investment Banking had strep throat 4 times in 2 months.
Several doctor visits concluded that it was the long hours and insane amount of stress that was severely crushing his immune system.
Moral of the story is love what you do and take care of yourself: nothing is as important as your own health and happiness
69 comments
[ 2.7 ms ] story [ 76.9 ms ] threadThis is the first of several blog posts exploring this invisible condition.
If you're passionate about this space feel free to reach out, thanks!
[1] https://www.cdc.gov/mmwr/volumes/72/wr/mm7215a1.htm [data from 2021]
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[Edit] Thanks so much everyone! Excited to get the next article out soon!
I asked chatgpt to explain this to me and it did a poor job.
Generally speaking in my friend group. Chronic pain used to be opiods; though long ago medical cannabis came along. I couldnt tell you how many people i know who arent stoners who got into the cbd thing and fully got off opiods. 1 addiction for another, but at least cannabis has far less negatives.
>If you don’t have chronic pain and you’re just here for vibes and to see some cute brains, I really appreciate you .
The problem, CBD never fixes the pain. ~8 hours later you need more.
There's no business case for solving chronic pain. Here's my take.
1. There can be cases where there's something legitimately physically wrong causing chronic pain. In detroit I had a friend who got shot with birdshot, a tiny pellet was in his spine that surgeons didnt want to go after but there's no getting away from that pain. If this is the case, you're not seeking explanation.
2. There's stress/emotional pain. "The body keeps the score" by Bessel van der Kolk. He's big on EMDR and yoga. Your achilles pain and such absolutely could be, Probably something like 'change or abandonment' one of my favourites for yoga: https://www.youtube.com/watch?v=2XhJ63OQ7Ww
Do that 23 minute video and see if it helps.
3. Mindfulness meditation. Get into the most comfortable position possible. Dont move; and far more difficult dont think. Your mind will wander. If the pain is in your achilles. The only thing you're doing is monitoring the pain. What's the exact shape of the pain? Is it 4 inches long or is it only 2 inches? Is it sharp like a knife, or is it round in shape? Do you have any taste, smell, or sound from it? You need to wait as long as you have to, maybe it only makes a sound every 2 minutes, you have to wait and your focus is only on waiting for the sound and nothing else.
4. Yoga nidra or progressive muscle relaxation. Start at your toes, you try to flex the muscles to the maximum and hold for 5 seconds, release. then do your feet, ankles, legs, every muscle has to have been flexed and held for 5 seconds. Then when you're done, you simply do nothing at all. dont even focus on anything; maybe your breath at most.
unnecessary disclaimer here. when it comes to chronic pain treatment doctors are mostly useless or even harmful, proposing surgeries or drugs that will do more bad than anything else because they have no interest in learning how to customize their approach and will parrot and prescribe what they heard from medical representatives. Remember, the opoids crisis was enabled by doctors in the first place.
Don’t let yourself be gaslit that it’s all mental. It seems some do have that, but there are also many hard to diagnose and completely valid physical health conditions that cause terrible chronic pain. And don’t give up on trying to find out what they are. Once I did, I was able to largely manage mine, and more importantly, to stop constantly questioning my own sanity.
This is a big problem women have around menstrual cycle pain. "It's normal" is what many doctors say - particularly men. A woman I know was basically bed ridden for a couple days/month until she found a doctor who believed her and addressed the problem.
[0] https://apps.apple.com/us/app/reflect-track-anything/id64638...
The question of why is out of scope.
In this case, docs just don’t know why. (I think it kinda pisses them off not know, tbh). And finding out is not really in their wheelhouse.
I’ve made some life changes (new job) to see what happens here. But I also have to be prepared for the possibility that it doesn’t fix it. Been working through The Body Keeps The Score as well.
Looking forward to seeing what the author discusses here.
After getting that diagnosis. I eat everything within reason. I decided not to take medication, knowing whats up with my body is sufficient. I mainly try to do all eating 4 hrs before bed.
What i have read is that covid may be responsible for micro lesions in the esophagus...acidic foods are essentially rubbing salt in the wounds.
Just a note about VH - it is more so over sensitivity to regular digestive function. Which is why feeling super full after eating/dispepsia is common as well. Im sure you did a 24 hr acid monitoring test - i pressed the reflux button during all my trigger foods and was surprised to see ph levels as neutral.
Anyone who is accumulating weird pains in random, different locations should definitely pursue some of these alternative explanations. Another sign that these techniques are appropriate is if the pains come and go depending on your mood or situation (worse when working, disappear when doing something fun) or are prone to suggestion (someone talks about their back pain and then you have back pain for the following days or weeks).
However, I’m also getting tired of the people who benefit from this techniques deciding that their explanation for chronic pain covers everyone. It’s a huge trend in parts of tech Twitter right now to apply these theories to all chronic pain. A small number of people who had unexplainable pain and addressed it through meditation, therapy, and similar techniques are now pushing it as a far more universal explanation. It really needs to be applied to the appropriate situation, not used as a universal treatment for chronic pains.
This parallels similar trends with topics like PTSD, where a smaller group of people have benefited from therapy that addresses past trauma and now they’re trying to export the theory that past trauma and PTSD is the explanation for all psychological ills. Again, matching the right treatment to the condition is critical and being open-minded is important, but beware of people who are preaching that doctors are misinformed and you should subscribe to their app, blog, newsletter, or course instead.
I had no idea it was the misery of the IT job that was causing most of my pain and suffering, and it had nothing to do with the job itself, it was the endless insanity of everyone else around me doing exactly what they were informed would cause problems instead of having discussions with people that actually knew how shit worked. I was endlessly picking up everyone elses mess and treated worse than a pile of shit all because people were incapable of having a speck of respect for other people since all their hatred for computers fell on me
I GTFO of the career of misery and took half a decade to finally start feeling better
I have now spent years and countless hours working on software and I greatly enjoy doing this work again and find I get even more done than I used to simply by doing life the way I need to instead of how some backwards/abusive control freak "needs it done"
- taking sport seriously
- regaining control over my life (which I did by creating a startup)
- moving to a city that cares about walking pedestrians and social life (moved from SF to New York!)
I recently found out after a violent burn-out that a significant cause was chronic stress and its psychosomatic symptoms. It made me have a hard look at the topic, and I'm gradually adjusting to solve the issue.
If I get better, I'm tempted to do as OP and spend more time working on this issue for others. It seems so much more impactful than grinding the tech / startup life.
In 2017, I was laid off of my job (of almost 27 years). I immediately started looking for work. Since the company I worked for, was a marquee-name company, I assumed that it wouldn't be hard.
Boy, was I in for a shock.
I almost immediately learned that no one in tech, is interested in hiring a 55-year-old, regardless of their pedigree. I could have gotten a job, but those companies made it clear that I would be treated quite badly.
So I made the decision to just throw in the towel and retire. I had the means, but I would have liked to have at least another ten years of salary. I have never had any intentions of stopping working, though. I love developing software. It's a hobby and a personal passion; not just a job.
I was really pissed off at the treatment. I suffered great butthurt.
But in the long run, it's the best thing that ever happened to me. I never realized how much stress I was under, while working. I sincerely believe that, if I had kept working, it would have killed me. I have no intentions of returning to the rodent rally; even though I'm quite good at what I do, thanks to all the learning that I've done, in the last eight years.
I now work every day (my GH Activity Graph is quite green), and do a fairly good job on my chosen projects, but I no longer feel that awful weight on my soul.
Sometimes, the only way that we learn how much pain we are in, is to stop suffering it for a while.
But soon after, I developed constant headaches that never went away. At first, I assumed they were related to the procedure, but everything had healed well, and multiple check-ups didn’t reveal anything. Since then, my braces have been removed, but the daily headaches persist. Occasionally, I also feel a strange “foreign object” sensation around the implant site.
A follow-up CT scan of the implant showed perfect integration with the bone. I’ve also had other tests done, including a head MRI. Medically, everything appears normal.
It’s getting really hard to manage—painkillers don’t help at all. Has anyone experienced something similar or have any idea what to try next? I’m even considering having the implant removed, despite there being no medical reason for it.
I’ve been on the slippery slope of chronic pain. Minor post surgery issues caused me to change my routine and avoid certain activities which only exacerbated the issues, which led to more avoidance. Eventually I couldn’t walk.
The American medical system is very focused on avoiding health issues that show up on mri, rather than quality of life health. But quality of life issues quickly become serious.
I think the middle ground of activity: not all out intense as if you are healthy, but also not avoiding movement is so challenging to find for many people but also so crucial. A lot of chronic pain for myself and I suspect for many others could be avoided with short and quick combination of therapy and daily movement. So simple but so challenging to effectively identify and allocate resources.
Not suggesting this is the total solution but it’s the pathway that I took to return to activity and I’ve seen it help a number of my friends as well.
[1] https://pmc.ncbi.nlm.nih.gov/articles/PMC8482298/
That all changed when I tore my achilles, the pain/recovery/etc. process had me doubting everything I knew about recovery and now 14 months later I still question if it needs more rest or more activity or the whole thing is in my head. Ankle/foot injuries seem to have an entirely different approach because standing and walking are so fundamental that you might overdo it just by deciding to make eggs or something.
It seems to be relatively common and under diagnosed. Also somehow controversial and not fully understood
However, looking into it might shed some light on some issues of chronic pain and potential ways to address it
not a cure and barely a treatment but it's one of the only tools in the toolbox
Modulates endorphin receptors (by blocking them for a little while)
Not only causes the body to produce more endorphins to reduce pain but is actually proven in studies to make the ion channels work better if dysfunctional
https://scholar.google.com/scholar?q=Low-Dose+Naltrexone
https://reddit.com/r/LowDoseNaltrexone
Several doctor visits concluded that it was the long hours and insane amount of stress that was severely crushing his immune system.
Moral of the story is love what you do and take care of yourself: nothing is as important as your own health and happiness