It’s a popular phrase in cutting-edge pain science. I would put an extra emphasis on the word “social.”⁠

In my work as a chronic pain recovery therapist and coach — and in my recovery journey — I see social dynamics as central to chronic pain patterns.

Codependency is one of the most common social dynamics I see in chronic pain clients (and I can totally relate!)

Codependency is about an unequal exchange of energy. When we relate to others codependently, our energy gets drained rather than replenished.

And when our energy is depleted, our nervous system may send out an “energy tank empty!” emergency signal in the form of a pain flare.

Chronic pain can indicate that we’ve got a “leaky energy tank”…

And that we need to patch the holes with energetic boundaries.

This is why learning to say “no” clearly and cleanly is so essential to chronic pain recovery!

Saying “no” may be challenging at first, especially if you’ve been conditioned to say “yes” by parents, teachers, bosses, leaders, culture, etc.

When I was growing up, I never heard about the concept of boundaries. It’s only recently that this word has started to enter the collective conversation in a big way. And in my opinion, boundaries are sooo important to healing — both personally and collectively.⁠

But new concepts take time and patience to acclimate ourselves to. We can catch onto them intellectually pretty quickly, but if the idea of boundaries is at odds with our early life social conditioning, it can take our nervous system time, patience, and practice to get used to this idea.⁠

So please be compassionate and patient with yourself as you recondition yourself to set healthy boundaries! It’s bound to be a messy process, but you — and your energy and wellbeing — are so worth it.

This isn’t just a personal journey, it’s one that we’re on together as an evolving society. I’m cheering for you and evolving right alongside you. 🙌

With love, warmth, and unconditional support,

Anna

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To varying degrees, everyone experiences stressors in life. Yet many people seem to be able to tolerate life’s stressors without showing symptoms of stress — symptoms like anxiety, depression, heightened emotions and/or chronic pain.

So, if you’re someone who seems to be highly sensitized to stress, you might get the impression that there’s something “wrong” with you. (Spoiler alert: there’s not.)

We live in a culture that pathologizes emotional sensitivity and normalizes emotional numbness.

But the truth is, numbness and heightened sensitivity are both symptoms of emotional repression. On the surface, they look different. But they’re two sides of the same coin.

Repressed emotions are compressed energy. And compressed energy can take on multiple forms:⁠

• Compressed energy can stay contained for a while, like a pot of boiling water with the lid jammed on.⁠ But eventually it explodes.
• In some people, the lid stays jammed on most of the time. You might not even be able to tell that there’s boiling water under the surface, and they appear to be “doing just fine,” meaning: they’re conforming to the standards of our societal norms.⁠
• In some people, the pot of water looks like it’s always on the verge of bursting … and from time to time it does.⁠
• In other people, the pot seems to be constantly bubbling over, with the lid nowhere to be found.⁠

All of these are symptoms of a culture that encourages us to reject our own emotions. “Under-expressed” emotions are simply more convenient to patriarchy than “over-expressed” emotions, so blunted sensitivity is considered normal while heightened sensitivity is pathologized.

All this to say, it may seem like others are “doing just fine” while you seem to be “overly sensitive” — physically and/or emotionally. And you may be asking yourself “why me?”

But the truth is that we are all impacted by living in a culture of emotional repression — even if that impact looks different from person to person. And we would all benefit from a shift in culture toward allowing, accepting and honoring emotions. (If you’re reading this, I have a feeling you’re already taking part in this collective culture shift.)

Instead of seeing your sensitivities as something “wrong,” what if you were to view them as your superpowers? Your finely attuned antennae letting you know that there’s actually a kinder, more wholesome, respectful and nurturing way of being that we could all be moving toward? What if your emotions are the guiding stars pointing us all in the direction of a healthier and more loving human culture?

What if you aren’t broken at all, just reacting to a world that’s aching for positive change?

With love and warmth,

💖 Anna

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Lower back pain is arguably the most burdensome public health problem on a global scale, COVID-19 aside. In terms of years lived with disability and prevalence among adult populations, lower back pain is a perennial top contender in almost any study of global burdens of disease.

Opioid use, abuse, and the damage done to individuals, families, and the societal ramifications of these medications are likewise well documented.

So it is welcome to see that chiropractic care, and other conservative treatments for lower back pain, are associated with less reliance on opioid medications, which do not have a particularly great track record in resolving spinal pain complaints and are not recommended as first-line interventions for acute or chronic lower back pain.

From Reuters Health in 2019:

Patients with spinal pain who visit a chiropractor may receive treatments such as spinal manipulation, massage, acupuncture, exercises and education as appropriate,” said lead author Kelsey Corcoran of Yale School of Medicine in New Haven, Connecticut. These therapies may lead to decreased pain, improved range of motion and increased function, Corcoran said by email. If a patient’s pain is well controlled by the treatment they received from a chiropractor, they may subsequently need less pain medications or even none at all.

Addressing Biases

Of course, you might say, “You’re a chiropractor so obviously you’re going to tout these studies” and you’d be correct. Also, there is selection bias involved, people who self-select conservative care like chiropractic or physical therapy over medical care may be doing so with the explicit intention of avoiding the use of medications.

However, these studies were not just done by chiropractors, and they haven’t only been published in niche journals catering to the chiropractic or manual therapy professions. It is true that these types of studies tend to be retrospective and observational, and cannot imply causation, but evidence will continue to accumulate and it will be interesting to see what future work on this topic elucidates.

Final Thoughts

I’ve written on this subject several times before, but when it comes to addressing your pain, you have options. One of those options is to see a chiropractor. Unfortunately, chiropractic care is a mixed bag ranging from evidence-based multimodal care to, ugh, pretty much any of the trash you will see if you type chiropractic into YouTube.

In my personal opinion, and knowing the majority of lower back pain has a favorable natural history, I’m inclined to recommend conservative treatments such as yoga, walking, chiropractic care, PT, or a general exercise program over medical care and definitely before considering opioids, advanced imaging, injections, or surgery.

Thank you for reading and let me know what you think or share your experiences in the comments.

Works Consulted:

Wu A, March L, Zheng X, et al. Global low back pain prevalence and years lived with disability from 1990 to 2017: estimates from the Global Burden of Disease Study 2017. Ann Transl Med. 2020;8(6):299. doi:10.21037/atm.2020.02.175

Whedon, James M et al. “Impact of Chiropractic Care on Use of Prescription Opioids in Patients with Spinal Pain.” Pain medicine (Malden, Mass.) vol. 21,12 (2020): 3567–3573. doi:10.1093/pm/pnaa014

Whedon, James M et al. “Association Between Utilization of Chiropractic Services for Treatment of Low-Back Pain and Use of Prescription Opioids.” Journal of alternative and complementary medicine (New York, N.Y.) vol. 24,6 (2018): 552–556. doi:10.1089/acm.2017.0131

Kazis, Lewis E et al. “Observational retrospective study of the association of initial healthcare provider for new-onset low back pain with early and long-term opioid use.” BMJ open vol. 9,9 e028633. 20 Sep. 2019, doi:10.1136/bmjopen-2018–028633

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Many of those people first received an opioid drug, not from a drug dealer, but from a doctor, prescribing it in good faith to treat pain. The question is: are opiates good for treating pain that is not from cancer. The latest research says, “No.” 

Researchers from Australia randomized two groups of patients who had 1 or more bone fractures that required surgery to receive either oxycodone — what they called a “strong” opioid — or acetaminophen and codeine (aka “Tylenol #3) to treat pain after they were discharged to the hospital. 

They found no significant difference in pain between each group, despite the fact that the oxycodone group had a 6-fold higher opioid dose. The study authors concluded, “These findings suggest that ongoing first-line strong opioid use after discharge from the hospital should not be supported” in those patients who had a surgically managed bone fracture. 

This is an important study. It further strengthens the recommendation that strong opioids such as oxycodone should not be used for noncancer-related pain. In fact, when thinking about a bone fracture, the mechanism of the pain after surgery has nothing to do with the opioid receptors in the body, and they are more likely due to the inflammation after the fracture and the surgery to fix it. 

In fact, the absolute best pain medicine I’ve used to treat the surgical pain of patients recovering from heart surgery — and this was confirmed to me by a physician colleague who had the surgery himself — has been ketorolac, which is an NSAID like ibuprofen. The only thing is, NSAIDs such as ketorolac can cause serious complications like bleeding and kidney failure (which I’ve seen in my practice). 

Still, even though opioids are ubiquitously used for post surgery pain, they really are not good drugs for the pain. This also goes for pain after dental surgery and procedures. As clinicians, we need to use less of them. 

Of course, it is not our fault if we prescribe an opioid for pain in good faith and our patients abuse the medication. At the same time, we need to heed the science about opioids for noncancer pain. The literature increasingly suggests that opioids are not effective and can lead to abuse and complications. Thus, we should prescribe less of these medications as much as possible. 

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