In this third article of a series on the mind and body struggle against everyday stress, my wife Lillie talks about the various sources of chronic pain and how to break free from the pain cycle. Click here for the first article and here for the second.

This week I need to ride 450km in 3 days to complete a race called Dead Ends & Cake. As the race is in Switzerland, of course a total of around 8000 meters of climbing is also included. Oh, and I should mention that I only just started to ride my “unassisted” road bike again in April since my illness in August 2019 (see articles 1 and 2). 

So coming from a base fitness of ZERO, how am I actually going to be able to accomplish this? Without hurting myself that is. It’s actually quite simple. I’ve taken the immortal words of Fausto Coppi to heart…ride a bike, ride a bike, ride a bike!

So to get better, I simple ride. I’ve been riding a lot. As part of my training, I of course needed to test my ability to ride 150km. Inspired by another cycliste.ch contributor to discover some backroads up the Col du Mollendruz, I decided to test last month what I could physically accomplish in a day.

This 148km long, 2700m of elevation gain ride took me 10 hours. And something completely ordinary happened on that ride that I haven’t felt in a long time…I developed pain. 

You my fellow cyclists all know the pain:

• Sitting on that tiny little saddle made of who knows what becomes miserable, and I start shifting, standing, anything to find a non-painful spot to sit on. 
• I could barely turn my head to make turns and signal in Morges traffic as my shoulders and neck were so stiff from holding my head up all day. 
• And my hands, oh that was the worst…they were tingling with the occasional shooting nerve twinge that I was trying to avoid like COVID. Opening my little bag of gummy candies was almost torture but necessary to feed this hungry beast. 

But this “ordinary” pain was one of the most amazing happy experience I’ve had in my now almost 2-year recovery process. I was literally in tears of joy. Why? I had just spent 10 stinkin’ hours on a bike. All of these pains were totally normal…to be expected as it’s been years since I’ve ridden so long. Woohoo I’m fucking normal!!!

And like a normal human being, my body healed. After a nice meal, a beer, and a good night’s rest, I felt totally great the next day, ready to ride another day.

Life in chronic pain

Almost every single day since August 2019 I start my day in pain. On good days its mild burning in the muscles. On bad days the stabbing dagger pain is so intense I have to brace myself and resist fainting and vomiting from the overwhelming scale of it. Thankfully over the last few months my pain has been reduced to mostly annoyance, and even on bad days I know the pain is only temporary. 

Every day that I have this pain, I have to remind myself that this pain is based on nothing physical. Yes, my muscles are tight, my joints hurt, nerves are pinched and throbbing, and I feel the resulting pain.  But there is nothing physically wrong with me. There is no injury! But since August 2019, I’ve been struggling with restricted movement from fascia adhesions that can leave me in crippling pain nonetheless.

But how does muscle fascia get damaged if not from injury? Simple, our muscles also tighten under stress—it’s an auto-immune response. The more stress the body is under, the more the muscles deteriorate and the worse the pain becomes. As an example, think of knots in your neck and shoulders that build up after a long day in front of the computer. Imagine if those knots lasted days or even weeks? It would not be a pleasant experience.

By October 2019, 2-months after my illness started, I had so many adhesions throughout my body that my physiotherapists didn’t even know where to begin. I was crippled over most days like a 100-year-old woman (actually, my gma is 101 and in better shape than me!). I was under heavy pain killers just to do basic tasks, just to get out of bed most days. There was so much damage and so much pain pretty much everywhere that it was difficult to find the source. It took months of intense massage to clear and smooth most of the fascia. But even after almost all of the knots were completely removed, they would keep coming back. Why were my muscles constantly tensing up even after therapy? 

The e-bike was my savior. I was told by chronic pain specialists that movement was what I needed to escape the eternal pain cycle (see below). And they were mostly right. Every day that I ride my bike, no matter how terrible I feel when I start, the pain almost always disappears within the first hour of riding. But the pain would always come back after exercise. The same knots would come back in the same places no matter how much exercise or physical therapy I did. But why? 

To understand why, first we need to understand where pain comes from.

So, what is pain exactly?

We all know it. We all feel it. But where does it come from? Why do some people seem to have infinite tolerance for pain and others not? Some people are able to completely ignore pain to reach a goal. Others quit on the first tingle of discomfort. 

Traditionally the sources of pain were broken into 3 categories:

1. Pain from some sort of physical injury (e.g. broken limb, bee sting)
2. Pain from the inflammatory response to the injury
3. Pain as a result of damage to the nervous system from the injury (e.g. pinched nerve)

Pain should go away with time as the body heals, especially with the first two types. The third type is more complicated as nerves don’t heal as well as other parts of the body, and therefore damage to the nervous system can certainly lead to chronic pain that lasts a lifetime. Things like paralysis and phantom limb fall into this category.

However, sometimes the source of chronic pain can be extremely obscure. Millions of people across the world suffer from chronic pain with no recognizable physical origin. It is a problem on epidemic proportions.

Stress hormones and the auto-immune response

Thankfully, lots of research is now focused on how the endocrine (hormonal) and immune systems play a key role in how pain is perceived by the individual. Pain is an auto-immune response to tell us when something is wrong. This “pain perception mechanism” is developed from early life experience and determines how our bodies will process pain for the rest of our lives. 

But our bodies pain perception can also be shifted by trauma, both physical and emotional. My pain perception was shifted by emotional trauma, which may be the case for millions of chronic pain sufferers. The source of pain, many researchers theorize, is trapped in the unconscious mind. And unfortunately, the endocrine-immune response effects the mind and body in such a way that chronic pain sufferers become literally trapped in an eternal pain cycle.

Our bodies are incredible at doing whatever it takes to keep us alive. A key mechanism is the endocrine system. If you have ever overcome a truly dangerous situation, you understand exactly how the system works. Your heart rate jumps. Hormones like adrenaline and cortisol kick in. You feel a burst of energy throughout the body. Your head is clear and all the sudden time seems to slow down. You can take action to do exactly what you need to do to survive. It is an automatic response to an external danger. It can be triggered in an instant and give you superpowers to overcome enormous pain or physical obstacles. It is an incredible part of our auto-immune system that has allowed us to survive as a species to this day. This system is likely responsible for helping you survive some of those “Type 3 fun” errors in judgment.

In the past I followed the HTFU mantra: suck it up, ignore the pain and push on. I am extremely strong willed…I don’t quit! As I describe in article 2, I’m not afraid of suffering. Perhaps I even embrace it. My pain threshold was very high.

This attitude has allowed me great success in life. But it also caused my illness—because I no longer listened to the pain signals my body was sending. I shoved aside and ignored what my sensory brain was telling me in order to accomplish my conscious goal. Until one day my own unconscious mind fought back with vengeance due to a perceived danger. I didn’t know the monster I was suppressing, the overwhelming scale of my unconscious rage. The conscience mind doesn’t stand a chance to win against the unconscious.

My burn-out was an auto-immune response to an external stress. I had buried years of emotional manipulation and abuse at my workplace deep into my unconscious mind. And one day my consciousness woke up and saw it, and I had an overwhelming endocrine response. Just like if I was about to be attacked by a bear. As a result, my body’s alert system associated my work as a place of danger. Because I continued to go to work after the shock, my unconscious mind triggered the nervous system to generate pain as a deflection from the true emotional burden I was living. Only once I was able to cope with the emotional source of trauma, thanks to various forms of re-education and psychological therapy, in combination with physical therapy (chiropractic, osteopathic, massage, acupuncture and specific muscle rehab exercises), did the physical pain finally start to subside.

To better understand how the auto-immune system works to induce pain, I highly recommend reading The Mindbody Prescription by Dr. John Sarno. An excellent summary of the book can be found in the video below.

So this is my journey…overcoming the trauma that triggered my pain perception system to process stress as pain. Much of my journey is learning how to manage stress through mental exercises and mindfulness, and slowly discovering the multiple sources of trauma which continue to trigger my pain. 

But the key component to my healing has been through exercise and physical stress—I have to reteach my body and mind what is “normal” pain versus what pain can be ignored. Saddle sores cause physical pain. Repressed shame, regret, and anger should not. In essence, I need to rebuild my pain threshold. It is indeed a long journey with lots of ups and downs but it is the adventure of a lifetime that, in the end, will only make me stronger. It really is just as simple as Fausto Coppi said, to get better, ride a bike, ride a bike, ride a bike!