Amanda Wilde (Host): Join us as we delve into the emotional, physical, and spiritual aspects of living with persistent discomfort. Our guest today is Rob Adrian, a Chaplain at Memorial Hermann Health System who specializes in physical rehab. He will offer invaluable insights into managing chronic pain. Whether you're living with chronic pain yourself or supporting someone who is, this podcast offers hope, encouragement and practical tools for navigating this challenging journey. Welcome to Every Day Well, a health and wellness podcast brought to you by Memorial Hermann Health System. Tune in for the latest tips and information about health care topics that matter most to you.

I'm your host, Amanda Wilde, and Rob, welcome to the podcast.

Rob Adrian: Oh, thank you. It's good to be here with you.

Host: Well, this is going to be a conversation on something that affects so many people and is so persistent. I guess that's why we call it chronic pain. What is the emotional toll of chronic pain and how does it affect our daily lives?

Rob Adrian: Well, you know, not knowing how long the pain will last, wondering when or if it'll go away and if it leaves, is it going to return? These are the kinds of worries for those dealing with chronic pain. And you know, we may become stressed that the pain will never stop. And when it stops, even though we may no longer be in pain, we can become anxious about it coming back, returning.

And at that point, our identity may begin to center moreand more around the pain and it taking over our life. And we develop radar for any sign that the discomfort or illness is returning. Any little pain or change can bring on anxiety, even a feeling of doom. And as a result, I think we can try to escape through unhealthy distractions.

We get lost in our devices. We stay busy. We drown our feelings with substances, perhaps. However, the body doesn't let us run away. I've discovered that running away from suffering has actually pushed me toward it. 

Host: Wow, that's our whole podcast right there. So anxiety plays a role in chronic pain. It's sort of like a feedback loop it sounds like.

Rob Adrian: Definitely.

Host: So how can we differentiate between physical pain and emotional distress and a follow up to that, how can we address both effectively?

Rob Adrian: Well, I'll give you my experience. My experience is that emotional stress can actually worsen physical pain. And for me, it's helpful to make a distinction between pain and suffering. There is the throbbing muscular ache drilling down to the bone. And then there are the strongly believed emotion based thoughts that go with that.

And these strongly believed thoughts can heighten the physical symptoms into the experience of suffering, which has its own painful quality. We can hold on to our suffering in place with fear based thoughts like, oh, this is never going to end. No, not again. I can't stand this. And these thoughts are further solidified by our resistance to just letting the pain be. In order to address this kind of suffering, I think we need to recognize these judgments as judgments, as a filter we add on.

And we also need to see how we normally accept them unquestioned as the truth. This recognition, you know, will allow us to see how the blind belief in our thoughts solidifies our physical experience of pain into the heaviness of suffering, as well as increasing the physical pain by causing the body to constrict.

One of the thoughts that anyone who experiences chronic pain will have to deal with is the thought that we want our old life back and we feel grief for the body that we no longer have. In addition, we can add catastrophic thought scenarios that magnify the threat and anticipate the worst.

So a good question, I think, for dealing with these kinds of plaguing thoughts is to ask the question, what am I adding? What am I adding? This question directs us, I think to thoughts like,

I can't do this, which is based on negative self-image of being incapable, and we also have to be careful about adding emotional judgment, such as this pain is my fault, I can't handle stress, or this pain proves that I'm bad, it's a kind of punishment.

In each of those examples, we're adding mental, emotional spin to what's happening. In fact, in many of these examples of our emotional stress, we're adding to the present moment something from either the past or an imagined future, and in each, it makes the situation a lot worse.

Host: So, we're talking about how to manage our pain and let go of suffering. What do you use to cope with chronic pain?

Rob Adrian: It's helpful to talk about and think about this. You know, instead of mindfulness, I've begun to use the word awareness to describe the state of being that helps me manage life more skillfully, because that word mindfulness is too focused on the mental to encompass what's truly helpful and the wholeness that can restore us.

Awareness involves all of the body. We have parts of ourselves like breathing, feeling, noticing, etc. that allows access to a richness of experience in our deeper self. So, certain awareness practices can help us with this. And, I can give you some of those. One is it's so important is to acknowledge your pain and suffering. Respect all of your feelings. We've got to treat anxiety, pain, and difficulty by not resisting it. There's that old adage, what you resist persists, so don't resist it. You know, when you resist, you must treat that with respect, too. And when we give all of our feelings our full attention without judging one feeling to be good and another bad, even if we think it is, then we have a chance to reach compassion for ourselves and for what we're going through. And a shift can then occur within us where we can experience some space and some breathing room.

I would say the second, would be around enriching your life by taking pleasure as seriously as I take my pain, living each moment of life to the extent that I can pay that much attention to it. Try to do each thing for its own sake, experience every motion, every contact for what it is. I'll play my guitar and I revel in the tone of the guitar as well as the touch that I feel in my finger picking. And even holding the laundry is an opportunity to smell the freshness and noticing those things helps me deal with difficulty and stay present.

And finally, finding a refuge, finding a place to retreat to when you can't cope. It means looking all over your body for at least one place that doesn't hurt. And to try to go there when you need to feel a measure of relief. Those are some things that have been helpful to me, at least. 

Host: Those sound like really powerful techniques. We're sort of getting into compassion and self-care for managing chronic pain as well. Are there other self-care practices that you would recommend? 

Rob Adrian: One of the things that I think has been helpful to me is breathing. And to say to myself when pain or any kind of adverse experience happens, where I feel some kind of anxiety. Saying to myself, yes, you're here. Anxiety, fear, you're here. Okay, I'm going to sit with you. Let's just hang out for a while and breathe into that. Have some tea with it or, if you prefer a glass of wine with it, if you can, to just kind of let it be there. And then it can sort of morph into something else. It can change, I think. I know it can when I'm able to respect it that way. So the breathing and the acknowledging are so important, because we're so conditioned to fight or flight.

And, that reaction isn't really helpful in terms of dealing with pain and adverse, you know, feelings like anxiety, so acceptance.

Host: So, acknowledging what is and not fighting that, but allowing it to be. Now we touched on this a little earlier, but can you talk a little bit more about how we can find joy and purpose in life as we live with chronic pain?

Rob Adrian: I can tell you how I found meaning as one who deals with some of this pain. I have some chronic shoulder pain and it's not a prescription for everyone. For me, there's a deep inward taste of meaning that comes to me from being present with whatever life is in the moment. It's helpful for me to kind of get out of my head. And enter fully into my lived experience. To directly experience my doubt, my pain, my confusion, and then ask the question, what is this? What's going on with me? And that grounds me kind of in a meaningful stance. Just observing the feeling, meeting, resting in the physical reality of simply being there.

And the response usually is just this. So in working with what is this? The practice is not to focus on getting an answer, but to live with the question as is, to stay with the question, with the inward experience, eventually the question resolves itself for me. It resolves itself through the sitting with the physicality of my present moment existence, and to stay with that awareness.

And it may take me many sessions of staying with the question, but as I truly reside in the physical experience, at some point, it's like popping a balloon, where the anxiety, pain, and confusion can become manageable. And the need to know the meaning disappears and what remains, it's kind of abstract in a way, but it's true. What remains is just being and being present, truly present, feels to me inherently meaningful in the midst of what's happening. I ask, what is this? And then breathe into exactly what I'm aware of in the moment.

Let me just say, lastly, it's been helpful to work with my identity. Because we are all of us only temporarily able, meaning that as human beings, we will be at some point in a fragile physical state. And knowing that reality, I become aware that my identity can evolve into being someone who can model how to navigate through difficult things. In other words, I may lose my familiar way of being as an active physical person, but I can now concentrate on being a teacher in some ways by navigating his way through uncertainty.

And resting in that role has helped me as I've lost old ways of identity. And this is something that's come up to me as I've observed patients. It's not something that I just magically one day thought, oh, this is how I'm going to deal with my identity. It's watching those patients who are dealing with really terrible, sometimes physical things that they're having to deal with. And they're able to go, you know, I have grandchildren, I have other people in my life, and they're watching me go through this, and, I want to sort of do it with as much grace as I can.

And so as they've been able to move into that identity as teacher, as mentor, about how to navigate through difficult things, they find a new way of thinking about themselves, and it gives them some comfort and some meaning.

Host: Yeah, it's much easier to be your best self when everything's fine and there's no pain, but to model your best self when you're challenged with living with pain is another matter entirely. And we're all challenged living with the questions and unknowns that you're talking about and the anxieties they create. So I think these techniques are good for anyone.

Rob Adrian: They've helped me, I know, tremendously.

Host: And you've seen it make a difference for your patients.

Rob Adrian: Yes, I have. It's really a magical thing in some ways, because I don't go into these patients rooms and say, well, here's what you need to do. Most often they know how to deal with these things. And they get to the point where they say to me, you know, Rob, it is what it is. When I hear them say that, I know that they've arrived at some kind of acceptance of what they're experiencing. And they're not resisting it, but they're paying attention to it and learning from it. And they sort of move into a new space of acceptance. And, like I said before, meaning.

Host: Rob, thank you so much for lending your personal perspective and valuable expertise to this conversation and for the awareness strategies you've mentioned for managing chronic pain.

Rob Adrian: You're welcome. It's been a joy for me to be able to do that and remind myself of these things.

Host: To get more Memorial Hermann health and wellness content, visit the Memorial Hermann website at mhhs.org/wellness. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thank you for listening to this episode.

Amanda Wilde (Host): Join us as we delve into the emotional, physical, and spiritual aspects of living with persistent discomfort. Our guest today is Rob Adrian, a Chaplain at Memorial Hermann Health System who specializes in physical rehab. He will offer invaluable insights into managing chronic pain. Whether you're living with chronic pain yourself or supporting someone who is, this podcast offers hope, encouragement and practical tools for navigating this challenging journey. Welcome to Every Day Well, a health and wellness podcast brought to you by Memorial Hermann Health System. Tune in for the latest tips and information about health care topics that matter most to you.

I'm your host, Amanda Wilde, and Rob, welcome to the podcast.

Rob Adrian: Oh, thank you. It's good to be here with you.

Host: Well, this is going to be a conversation on something that affects so many people and is so persistent. I guess that's why we call it chronic pain. What is the emotional toll of chronic pain and how does it affect our daily lives?

Rob Adrian: Well, you know, not knowing how long the pain will last, wondering when or if it'll go away and if it leaves, is it going to return? These are the kinds of worries for those dealing with chronic pain. And you know, we may become stressed that the pain will never stop. And when it stops, even though we may no longer be in pain, we can become anxious about it coming back, returning.

And at that point, our identity may begin to center moreand more around the pain and it taking over our life. And we develop radar for any sign that the discomfort or illness is returning. Any little pain or change can bring on anxiety, even a feeling of doom. And as a result, I think we can try to escape through unhealthy distractions.

We get lost in our devices. We stay busy. We drown our feelings with substances, perhaps. However, the body doesn't let us run away. I've discovered that running away from suffering has actually pushed me toward it. 

Host: Wow, that's our whole podcast right there. So anxiety plays a role in chronic pain. It's sort of like a feedback loop it sounds like.

Rob Adrian: Definitely.

Host: So how can we differentiate between physical pain and emotional distress and a follow up to that, how can we address both effectively?

Rob Adrian: Well, I'll give you my experience. My experience is that emotional stress can actually worsen physical pain. And for me, it's helpful to make a distinction between pain and suffering. There is the throbbing muscular ache drilling down to the bone. And then there are the strongly believed emotion based thoughts that go with that.

And these strongly believed thoughts can heighten the physical symptoms into the experience of suffering, which has its own painful quality. We can hold on to our suffering in place with fear based thoughts like, oh, this is never going to end. No, not again. I can't stand this. And these thoughts are further solidified by our resistance to just letting the pain be. In order to address this kind of suffering, I think we need to recognize these judgments as judgments, as a filter we add on.

And we also need to see how we normally accept them unquestioned as the truth. This recognition, you know, will allow us to see how the blind belief in our thoughts solidifies our physical experience of pain into the heaviness of suffering, as well as increasing the physical pain by causing the body to constrict.

One of the thoughts that anyone who experiences chronic pain will have to deal with is the thought that we want our old life back and we feel grief for the body that we no longer have. In addition, we can add catastrophic thought scenarios that magnify the threat and anticipate the worst.

So a good question, I think, for dealing with these kinds of plaguing thoughts is to ask the question, what am I adding? What am I adding? This question directs us, I think to thoughts like,

I can't do this, which is based on negative self-image of being incapable, and we also have to be careful about adding emotional judgment, such as this pain is my fault, I can't handle stress, or this pain proves that I'm bad, it's a kind of punishment.

In each of those examples, we're adding mental, emotional spin to what's happening. In fact, in many of these examples of our emotional stress, we're adding to the present moment something from either the past or an imagined future, and in each, it makes the situation a lot worse.

Host: So, we're talking about how to manage our pain and let go of suffering. What do you use to cope with chronic pain?

Rob Adrian: It's helpful to talk about and think about this. You know, instead of mindfulness, I've begun to use the word awareness to describe the state of being that helps me manage life more skillfully, because that word mindfulness is too focused on the mental to encompass what's truly helpful and the wholeness that can restore us.

Awareness involves all of the body. We have parts of ourselves like breathing, feeling, noticing, etc. that allows access to a richness of experience in our deeper self. So, certain awareness practices can help us with this. And, I can give you some of those. One is it's so important is to acknowledge your pain and suffering. Respect all of your feelings. We've got to treat anxiety, pain, and difficulty by not resisting it. There's that old adage, what you resist persists, so don't resist it. You know, when you resist, you must treat that with respect, too. And when we give all of our feelings our full attention without judging one feeling to be good and another bad, even if we think it is, then we have a chance to reach compassion for ourselves and for what we're going through. And a shift can then occur within us where we can experience some space and some breathing room.

I would say the second, would be around enriching your life by taking pleasure as seriously as I take my pain, living each moment of life to the extent that I can pay that much attention to it. Try to do each thing for its own sake, experience every motion, every contact for what it is. I'll play my guitar and I revel in the tone of the guitar as well as the touch that I feel in my finger picking. And even holding the laundry is an opportunity to smell the freshness and noticing those things helps me deal with difficulty and stay present.

And finally, finding a refuge, finding a place to retreat to when you can't cope. It means looking all over your body for at least one place that doesn't hurt. And to try to go there when you need to feel a measure of relief. Those are some things that have been helpful to me, at least. 

Host: Those sound like really powerful techniques. We're sort of getting into compassion and self-care for managing chronic pain as well. Are there other self-care practices that you would recommend? 

Rob Adrian: One of the things that I think has been helpful to me is breathing. And to say to myself when pain or any kind of adverse experience happens, where I feel some kind of anxiety. Saying to myself, yes, you're here. Anxiety, fear, you're here. Okay, I'm going to sit with you. Let's just hang out for a while and breathe into that. Have some tea with it or, if you prefer a glass of wine with it, if you can, to just kind of let it be there. And then it can sort of morph into something else. It can change, I think. I know it can when I'm able to respect it that way. So the breathing and the acknowledging are so important, because we're so conditioned to fight or flight.

And, that reaction isn't really helpful in terms of dealing with pain and adverse, you know, feelings like anxiety, so acceptance.

Host: So, acknowledging what is and not fighting that, but allowing it to be. Now we touched on this a little earlier, but can you talk a little bit more about how we can find joy and purpose in life as we live with chronic pain?

Rob Adrian: I can tell you how I found meaning as one who deals with some of this pain. I have some chronic shoulder pain and it's not a prescription for everyone. For me, there's a deep inward taste of meaning that comes to me from being present with whatever life is in the moment. It's helpful for me to kind of get out of my head. And enter fully into my lived experience. To directly experience my doubt, my pain, my confusion, and then ask the question, what is this? What's going on with me? And that grounds me kind of in a meaningful stance. Just observing the feeling, meeting, resting in the physical reality of simply being there.

And the response usually is just this. So in working with what is this? The practice is not to focus on getting an answer, but to live with the question as is, to stay with the question, with the inward experience, eventually the question resolves itself for me. It resolves itself through the sitting with the physicality of my present moment existence, and to stay with that awareness.

And it may take me many sessions of staying with the question, but as I truly reside in the physical experience, at some point, it's like popping a balloon, where the anxiety, pain, and confusion can become manageable. And the need to know the meaning disappears and what remains, it's kind of abstract in a way, but it's true. What remains is just being and being present, truly present, feels to me inherently meaningful in the midst of what's happening. I ask, what is this? And then breathe into exactly what I'm aware of in the moment.

Let me just say, lastly, it's been helpful to work with my identity. Because we are all of us only temporarily able, meaning that as human beings, we will be at some point in a fragile physical state. And knowing that reality, I become aware that my identity can evolve into being someone who can model how to navigate through difficult things. In other words, I may lose my familiar way of being as an active physical person, but I can now concentrate on being a teacher in some ways by navigating his way through uncertainty.

And resting in that role has helped me as I've lost old ways of identity. And this is something that's come up to me as I've observed patients. It's not something that I just magically one day thought, oh, this is how I'm going to deal with my identity. It's watching those patients who are dealing with really terrible, sometimes physical things that they're having to deal with. And they're able to go, you know, I have grandchildren, I have other people in my life, and they're watching me go through this, and, I want to sort of do it with as much grace as I can.

And so as they've been able to move into that identity as teacher, as mentor, about how to navigate through difficult things, they find a new way of thinking about themselves, and it gives them some comfort and some meaning.

Host: Yeah, it's much easier to be your best self when everything's fine and there's no pain, but to model your best self when you're challenged with living with pain is another matter entirely. And we're all challenged living with the questions and unknowns that you're talking about and the anxieties they create. So I think these techniques are good for anyone.

Rob Adrian: They've helped me, I know, tremendously.

Host: And you've seen it make a difference for your patients.

Rob Adrian: Yes, I have. It's really a magical thing in some ways, because I don't go into these patients rooms and say, well, here's what you need to do. Most often they know how to deal with these things. And they get to the point where they say to me, you know, Rob, it is what it is. When I hear them say that, I know that they've arrived at some kind of acceptance of what they're experiencing. And they're not resisting it, but they're paying attention to it and learning from it. And they sort of move into a new space of acceptance. And, like I said before, meaning.

Host: Rob, thank you so much for lending your personal perspective and valuable expertise to this conversation and for the awareness strategies you've mentioned for managing chronic pain.

Rob Adrian: You're welcome. It's been a joy for me to be able to do that and remind myself of these things.

Host: To get more Memorial Hermann health and wellness content, visit the Memorial Hermann website at mhhs.org/wellness. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thank you for listening to this episode.