Advice on some psychosomatic disorders?

[Cooper]

I talked with my doctor today, and here are the diagnoses I already knew I had:

Generalized anxiety, panic disorder
Clinical depression
Dyspraxia
psychosomatic/stress pain

Now, she's added:
hypersomnia, parasomnia (likely related. She says if I am not really sleeping when I'm asleep, it would explain why I sleep in excess)
ADD

I have the anxiety and depression under control after six months of therapy and meds, and for the fine motor dyspraxia, I'm taking ceramics, and calligraphy in college, and I've taken up knitting. The goal in these being if I work my hand muscles in new and complex ways, I'll force them to comply with simple things like writing legibly or buttons. XP

It's the others I'm not entirely sure how I deal with, so I was wondering if anybody here has experience with any of these disorders.

Note: To avoid fratching, I know these are a lot of diagnoses. I trust my doctor, even after getting screwed over as a kid by the psychiatric industry. She's always been careful to look at solutions instead of band-aids. All of these diagnoses make sense--the parasomnia, for example, is a list of things I always knew I did growing up, like sleepwalk, sleep-talk, toss and turn so violently I literally move my mattress, and the ADD kinda runs in my family.

So let's not discuss the validity of her approach to me, or whether or not I actually have these. Thank you.

[Der Cute]

I will say that I have at least 2 or 3 of those. Treatment for me includes counseling and medication, and lots of self-analysis. And a lot of acceptance issues! "self, do you really have depression? No, I'm so sad I can't think." (see the irony? :P )
This stuff isn't light at all, and it feels like a burden. Often. I also tell myself "you've been given what you can deal with". Cheesy but it helps.
There's been a small amount of stress going through my life within the last week. With my anxiety it could be going round round round wont shut up round round. But because I'm self-aware, AND I have skills to work with the anxiety, I'm not fussing in my head like that.
For me it's been a mix of 3 big things. Medication. 1:1 Counseling. Behavior Modification. Combining all those three help me function much better. I'm not fixed, not cured to say the least. And those three things (oh forgot, add time) took time to futz with them and figure stuff out.
But it's worked pretty damn well. Enough to the point I feel like I could hold a job down. Compare today to Jan 1 2011? Oh GOD it's so different.
Look at this like a project. You have a list of things to work on. Some of them are intertwined so two birds with one stone comes into play. You're already working on 2 of the issues, and I'll bet the efforts there will help other parts.
Hey. You are asking for help, figuring out what it is you've got - and since you're WILLING to work on that stuff, you're so far ahead of others it's not funny.
Hugs.

[Seshat]

Der Cute is absolutely correct: the fact that you're addressing these issues puts you way ahead of the majority.


I'm only going to discuss the psychosomatic pain issue: you say you're already handling the depression and anxiety, and the dyspraxia. And I don't know anything about sleep issues that you can't get from googling "sleep hygeine".


Now: My pain is not psychosomatic, but it is fake-pain in a strange way. Basically, my neurons misfire, signalling discomfort as pain, and mild pain as medium pain, and medium pain as strong pain, and so on.

One of the ways I deal with the pain is ... let me back up.

My goal is not so much to decrease pain as to decrease suffering. And I'm probably going to have to define the way I'm using those terms before it makes sense.

pain, in this context, is the neurological signal. It shows up on an MRI, it'd show up if you tested for electrical signals running up my nerves. It's the sensation, but not the interpretation of the sensation.

suffering, in this context, is my mental reaction to the pain. It's why childbirth is agonising (pain) but is also one of the most wonderful experiences women can have (lack of suffering); but if you had the same degree of pain from a really badly broken leg, you'd be hating it (suffering).

The childbirth analogy is imperfect, because the body throws huge amounts of endorphins (happy-chemicals) around at childbirth. But the goal of a lot of what I do to manage my 'pain' is actually managing suffering.


For instance: if you are both stressed and in pain, you suffer more than you do if you're only in pain. So I use meditation and creativity to reduce stress. And the creativity can be anything - some people find stress reduction in kneading bread dough, for instance.

One of my best techniques is simply telling myself 'yes, the arm hurts. But it's not an actual injury, it's just false reporting again'; and deliberately turning my attention away from it.

Distracting myself with something can help. Getting deeply into a sudoku, or a crossword puzzle, or playing with the dog.


This one relies on how pain signals are transmitted along the nerves. Heat, cold and pressure are all higher priority signals than aching-pain is; and because of the way signals are processed at nerve ganglions, if you have a fair bit of heat/cold/pressure being transmitted, many of the ache signals can end up being dropped and never making it to the brain.
Heat packs, cold packs, rubbing an aching joint (or a sting or an itch!), and the hot- or cold-feeling gels (eg tiger balm) all rely on this oddity of pain signal transmission. And as long as you use them sensibly, none of these have side effects like medication can.


I'm trying to think of other pain management techniques that are appropriate to psychosomatic pain.

Be careful not to allow the pain to tempt you into muscle atrophy. It sounds like you get along well with your doctor, so discuss the 'pain spiral' with her and how to avoid it.
Pain spiral: you hurt -> you do less -> your muscles atrophy a bit -> your normal activities are harder and hurt more -> you do even less -> more muscle atrophy -> yet more pain for normal activities ->....
Fortunately, this spiral works in reverse, as well: If you train the muscle -> your normal activities hurt less -> you are in less pain -> you can train more -> you hurt less -> ....

Basically, you probably want to organise some way you and your doc can measure your muscle strength and general physical wellbeing periodically, so you can make sure you're not spiralling down. The obvious-to-me method is figuring out a current and a goal activity; perhaps a weights routine, perhaps a 'walk the dog along this particular path in times X (current) and Y (goal)', perhaps the ability to play a vigorous game of tennis or squash. Whatever works for you.
And remember: the only reason for it to be timed or otherwise measured is so you and your doc can keep track and prevent the pain spiral. If you're doing fine, you only need to actually measure it once every couple of months, or even less.


That's all that's come to mind right now. There may be more later.

[KiaKat]

I'm working to get out of the pain spiral myself - physical therapy is a godsend, and my insurance paying for it is even more so. I actually got back out on the mountain today with no knee pain, and minimal shoulder pain!

Something that might help the ADD/anxiety/depression is to keep lists and calendars. I LIVE by my iPhone, because I keep all my lists there, and it goes ding when there's stuff. Even normal things like "take pills" and "take shower" are scheduled, just so I don't forget them and end up more stressed. Gym, work, skiing, meals, everything has a time assigned to it. This reduces my anxiety by about a third, and solves a lot of the inattention, because there's always something reminding me to get back on track.

Exercise is another good one. Even just getting out and going walking for a half hour is enough to shut my brain up for a little while. Sunlight (hiss boo evil daystar) is a good thing, and the happy chemicals produced by sunlight will help.

[scruff]

As a depression sufferer I recommend the calenders, it's great to look at the calendar and say, yes, I know I feel bad, but, this week is an expected dip in emotion, I had the same dip this time last month, it will pass.

For ADD, there was a chap in our scouts group with that and related issues, we all knew he had an issue with attention span and temper, and so were prepared to distract him with safer options when he had a fit (read "I'm bored and so going to throw rocks at people" (no, I'm not exaggerating, he really did that)). If friends know someone is likely to need a distraction on a bad day, it makes life easier for everyone. :-)

[Seshat]

Yes - a physiotherapist is the perfect person to track and prevent a pain spiral; especially one who understands the sub-specialty of physiotherapy that focuses on pain management. But any good physiotherapist is more than capable of preventing muscle atrophy and keeping you at no less than your current level of fitness; and helping you improve to a greater level.

For that matter, if you have no physical problems that require special management, any properly trained fitness instructor can do that too.

[Cooper]

My psychosomatic pains are: Stress headaches, and pain in my leg. The leg pain is linked to a car accident I had when I was a kid, which also dislocated one of my lungs. So physical activity is harder for me than most, as I get winded so easily. I have nerve pain in my face from jaw surgery that I had. I also have a limp, related to the leg, but I think that's psychosomatic, because I've noticed the limp switches legs.

I've been rolling yarn all day. My hands ache. I also had to get bigger knitting needles. My first set came from a garage sale. They're like, size 8. I got size 10, size 17, and 20 needles on the way, so one of them should be big enough.

I did finally manage to get beyond the second layer today though, so I'm proud of myself for that. (First layer being casting, second layer being the first stitch.) There I ran into problems where the work was literally too small for me to work with, hence the upgraded size of needles.

[Seshat]

The limp is not necessarily psychosomatic just because it switches legs: you limp, which causes uneven stress on your legs. The non-favoured leg gets sore and tired from excessive stress, and once it becomes the sorer leg, the limp switches.

Now, that is only one possible scenario, but it's enough that I recommend taking the limp to your doctor to have her check it. Especially since you do have the history of injury to the leg.

With the note that you get winded more than most due to injury; I would strongly suggest asking your doctor for a referral to a physiotherapist. Not necessarily for long term physiotherapy, but so you can discuss appropriate activities to strengthen your lungs. Also, to discuss appropriate activities to heal and strengthen your legs (if your doctor finds lingering injury, or lingering weakness).

Regarding the headaches: stop for a moment and think about your shoulders. Are they high? Are you holding them tense? If you consciously try to relax them, do they lower?
If the answer is yes; I can tell you how your headaches happen.
You get stressed. Your back and shoulder muscles tighten in response to the stress. This signals your neck muscles - especially the ones at the back of the neck - to tighten as well. And that pulls on some of the scalp muscles, which start to hurt, which makes a headache.
This is why a shoulder massage can often help reduce a headache. I can also recommend conscious relaxation, and heat packs on the shoulders and the back of the neck: heat tends to encourage muscles to relax.
You can test this theory easily enough: visit your doctor while you have a stress headache, and ask her to feel your neck and upper back for tension. If they're tense; that's got a high probability to be the cause of the headache.
If a massage, conscious relaxation, a heat pack, or a combination of the three, eases the headache - then whether or not it's tension or psychosomatic, WIN!


If conscious relaxation, heat, and massage aren't enough to relax your muscles, discuss options with your doctor. There are medications which can help; but IANADoctor!


One final option: regardless of whether or not the pain is psychosomatic, sometimes a placebo can help.

A placebo is, quite literally, your doctor lying to you. Also, your pharmacist. She prescribes a harmless pill which is entirely filler - often a tiny sugar pill - and the pharmacist fills the script as if it were a normal pill. It works by fooling your mind; you believe you're taking something to reduce your pain, and so your mind accepts or perceives fewer pain signals.
It doesn't work in all cases; but for some people and with some problems, it works wonders!

To actually achieve it, you would have to discuss the legal/ethical implications with your doctor, and let enough time pass for you to forget you've done it. For very, very good reasons, doctors and pharmacists are not permitted to lie to their patients.


I accidentally tested the placebo effect on my own illness, a while back. I was filling my pill tray, and discovered that I'd run out of my major pain medication. So I told my husband, and filled the med for the first half of the week.
By the time I was up to the days without my main pain med, I'd totally forgotten. Took the meds in my tray without paying attention or thinking about it. Did the same the second day.

(For me, the placebo effect failed. But it can work, and work well.)



Editted because I got too advice-y and not 'this is what works for me, a fellow patient'-y. Also, removed a fratching-worthy sentence.

[Cooper]

"Regarding the headaches: stop for a moment and think about your shoulders. Are they high? Are you holding them tense? If you consciously try to relax them, do they lower?"

This is part of why I came to ask about this. Because seriously, that makes so much sense it isn't even funny. I'd been focusing on another habit I did when I was stressed, chewing on my cheeks, but that feels like the missing link. Maybe I can get off my muscle relaxant if I learn to do it on my own.

Also, my doctor did check my leg, and said that there was no physical damage to it. The pain I was feeling seemed to literally only be skin-deep.

[Der Cute]

De-stressing is hard - because you have to be self-aware enough to realize "oh I'm stressy". You will feel "man my shoulders/head hurts ow." Learn to think "wait. My shoulders/head/jaw? Ah ha, we're going to do the stretch now." It's a habit to change, instead of "waa I hurt aaarrgh it hurts"

The 4 second trick: Sit upright, good posture as well as you can. Inhale to the count of four. And that's a deep inhale, try to get the air to your belly button. HOLD it for four. Exhale to the count of four. Do this a few times. As you go along, gradually as you practice, your brain will stfu. (mostly). Try a ping/listen to your body. As you exhale, slowly, run a ping down your muscles, body, arms. Anyone stiff? Any backups? That's a spot to work on!

KiaKat has a great system: schedule yourself. It is a PITA to change your routine, so, why don't you set your clock/phone/alarm to do the 4 second trick once an hour, every two hours? This will have you practice it, you will be better self-aware with your BODY, and better relaxation. Right after the breathing, do a quick upper body stretch. And yes, you might be in the middle of a project or something you can't stop. Find a stop point after that, soon.

Does physiotherapy help you with psych based pain? Would it be possible to say "yo, leg, stop. Leg. leg!!! Hush" and run another ping down your leg, attempt to relax any kinks. Would this be feasible? (I have no idea about physiotherapy.) Hell, sometimes I tell my body "thanks, muscle part".

Go here, I've saved and copied a lot of my DBT (dialectic behavior therapy), and go to the mindfulness folder. http://bit.ly/Z3n0ud These skills kick ass, and they're now so ingrained I pull one up when I need it, without stopping "oh, yes, pull X up". You will too, if you practice.

Please try the 4 second rule, and let me know how that works (today.)

[Cooper]

It won't let me see the link. I've tried the 4 second rule the past few days, along with the 3,3,3 rule from meditation class, (3 seconds, 3 breaths, 3 times a day), and I'm not seeing much of a difference. I'm still doing it.

[Der Cute]

It won't let me see the link. I've tried the 4 second rule the past few days, along with the 3,3,3 rule from meditation class, (3 seconds, 3 breaths, 3 times a day), and I'm not seeing much of a difference. I'm still doing it.

Hm. Try this? I've logged out of my own google account, and this is what I get.

https://docs.google.com/folder/d/0B5...HN4eVJXRDRYb0k
Can anyone else try that link?

Oh and I need to upload more stuff to those folders.

[Cooper]

There we go. That one worked. ^^ Good news is that today I got approved for Medicaid, so my options just opened way up. Like a sleep clinic is actually plausible now. I looked at how much some things that had been stressing me out, like my meds were going to cost, and I about cried in relief.

I did have insurance before that, technically, but my mother has one of those 'pre-existing conditions' so it basically existed so the hospital would have to give us discounts.