Last week we left you with some thoughts about the roles we take on in life and how those roles are changed-sometimes irrevocably-by a diagnosis of chronic pain. Hopefully you have by now (especially since we missed last week due to the Thanksgiving holiday) had some time to think and even journal about these ideas and their meaning in your own life.

One of the things that we hope you took away from our last discussion is the idea that somewhere in your pain and suffering.. your physical pain and its emotional cost...there is often a gift, albeit a gift that frequently arrives in a decidedly unappealing package. Sometimes, in fact, this gift is something that we desperately need and could not acquire in any other way. Like a fierce wind that carries us away from everything we know and love, it can bring great turmoil to our lives, yet it can also take us to a place that is inaccessible by any other means. 

For example, think for a few moments about the way in which we make the choices that dictate much of our adult lives; the choices that determine the roles we will "play" for many years to come. When we think about it logically,  the idea that we can make these choices at all, at any age, is rather irrational, if not completely insane. Yet life's journey dictates or at least expects  that we not only make them, but make them at an age when we are still enmeshed in the struggle between the excitement of independence and the safety of childhood, with only the briefest experience in making decisions with anything even approaching far reaching consequences. We are barely out of our teens when most of us make the choice of  a life partner (?), a profession or career path, where we will make our home, and when or if to start a family-far reaching decisions, certainly, that will determine not only the circumstances of our lives, but our degree of fulfillment, personal satisfaction and happiness for many years to come. 

Amazingly, however, when people make choices that are based on strong values and a childhood that contained stability, clear boundaries and plentiful, unconditional love, tempered with realistic expectations of respect for authority and oneself, it seems that these choices can and often do work. Not that anything lasts forever; things can-things must and always will change. But change does not necessarily mean chaos or despair. Change that happens for the right reasons, that takes one in the direction of purposeful growth and deeper understanding however, painful it is, does not destroy the spirit; it enriches it. It does not diminish a person or the choices she made before... it grants her a deeper appreciation of what once was her life and the lessons it taught her.  It is part of the human journey as it was meant to be.

Sadly, though, many people who live with chronic pain today came from a place very different from that which we just described . A very large percentage of chronic pain sufferers, in fact, came from homes where there was physical and/or emotional abuse, terror, neglect, insecurity, and chaos. Their lives contained little or none of the safety and stability that children require to grow into the happy adults they hope and deserve to become. For reasons that vary only slightly,** many- if not most- of them approached adulthood with a deep, abiding fear that one day the ground beneath them would simply give way and there would be nothing and no one to stop them from hurtling helplessly into the abyss. They grew up traumatized and deeply wounded, subconsciously believing that the only way to escape their pain was to find and attach themselves to people and situations that seemed to offer the comfort, stability, safety and unconditional acceptance that they were denied earlier in life. 

Unfortunately,  it is never possible to fulfill childhood needs in adult relationships and pursuits; trying to do so inevitably causes more pain and disappointment, as well as it prevents the person from recognizing and developing skills to fulfill her adult needs. The result is a person who is trapped in roles that were never appropriate, living in a state of learned helplessness and suffering deeply as a result. From there, the road to chronic pain, fatigue, anxiety, depression, and a host of other chronic conditions that deprive the person of any semblance of peace or happiness is not far away at all. 

But don't, whatever you do, despair. Things can and do change and in a few days we will continue this discussion, and begin to talk about how....

But for today, if you feel ready, why not start your journal by spending some time exploring the roles you play in your life today,. Are you a wife, husband, daughter, or son? A sister or brother? Mother or father?  Spend some time thinking about how these roles provide a framework for your behavior, ideas and ideals, and, too, how your ideas and ideals, have been shaped by the roles you have filled in your life.And what of your professional roles? Whether you continue in your profession at this time or have been forced to take time off due to your pain, how have these helped you to define your self-image and/or maintain your self worth until now? 

Tip: Remember to brainstorm first-getting your thoughts on paper quickly and without editing. Then review your ideas for insights and new levels of awareness. 

We realize that some of the people who read our journal also search the Internet for specific information about disease processes, medication, types of therapies and other content specific to chronic pain, which we consciously do not provide on our site. We also realize that the number of sites which promise the answers to these kinds of questions is quite large, and that many of them fall short of providing the answers most consumers of health care information seek. Some are too technical and geared towards professionals; some require very costly membership to obtain any information; some are geared more towards promoting a specific institution or care option than providing information and some are just not very well put together. And then there are those that are very, very good.

Obviously, few people wish to personally sort through all of these sites to find the right kind information for their particular needs. Quite honestly, neither do we. But just to be nice, we have decided to do it for you anyway. Because of the number of sites involved these reviews will be brief and contain far less detail that we normally provide. Nevertheless, we hope we will do a satisfactory job of sending you in the right direction for the information you need. Contact us, please, if we do not.

Now, without further ado, we will begin. The sites are presented in no particular order. We have included URL's and mission statements where available, and rated the sites based on our own totally subjective rating system of 1-5, with "5 being the very best.

American Academy of Pain Management:

url: http://aapainmanage.org/

Mission Statement: The American Academy of Pain Management is an inclusive, interdisciplinary organization serving clinicians who treat people with pain through education, setting standards of care, and advocacy.

Overview: This organization quickly identifies itself as one that is meant for the health care professional who practices-or has an interest in practicing- in the area of pain management. The Academy's membership is extremely limited; for example, in the states of California and New York respectively only one health care facility or practitioner is listed. This, however, could be more an issue of "politics" -which are as ubiquitous in the medical community as they are in any large corporation or industry, than a commentary on the site's value. Nevertheless, it did create a bit of reticence on our part to swiftly embrace their ideas or ideals. Membership is open to health care practitioners only and at $195.00 per person ( $50 for a full time student )is a bit too pricey for our taste.

One high note: The site publishes what appears (from a cursory review) to be a well written and not too technical quarterly magazine called "The Pain Practitioner" which is very inexpensive for a medical journal of any kind at $35.00/year. Even better, you may download copies of archived "cover to cover" content free of charge. If you have a big hard drive or a USB drive that's sitting around waiting for something to do, it is probably worth downloading one or two if you are oriented towards content that targets the medical community. Although I have not had time to read it as yet I just downloaded an issue from early 2008 entitled "Fibromyalgia" which we will review in a subsequent post. Also available is a free monthly newsletter with archives dating back to December 2006.

Impression: Not for anyone looking for a "down and dirty" answer to anything, but the site's publications seem interesting, and at a cost of $0.00 for downloadable content, may well be worth your while if you do not mind wading through a bit of medical jargon to find the information you really want.

Our rating ***

American Pain Foundation

url: http://www.painfoundation.org

Wow! This is a truly awesome website! Focused entirely on improving the lives and outcomes of therapy for people in pain, it contains an enormous amount of information, support resources and communication tools wrapped up in a simple to follow navigation structure and an attractively presented site. It is by far far the best resource for people living with chronic pain that I have encountered on the web-bar none.

The site contains a Pain Information Library with links to information on pain conditions, coping skills, travel tips and support resources-among others. They host an online community named "Pain-aid" which features both chat rooms and message boards, and an interesting adjunct to their main site entitled simply "Manage Your Pain". Created in conjunction with the "American Academy of Pain Management" and the "American Society for Pain Management Nursing", it features the "Let's Talk Pain Coalition", whose mission is "to unite the perspectives of patients, caregivers, and healthcare professionals.... and encourage people to talk more about pain, listen actively and act in ways that improve care for the millions of people who live with pain." This interactive website provides visitors with comprehensive information and tools to enhance the dialogue between those affected by pain and healthcare professionals. Included in these interactive tools are a number of video clips featuring highly respected pain physicians, including Scott Fishman, Chair and President of the American Pain Foundation, and Chief of the Division of Pain Medicine and Professor of Anesthesiology at the University of California at Davis, giving advice and suggestions to physicians about talking to patients about pain, pain treatment and pain management. Another section of "Manage Your Pain" is called "Care Central" which offers caregivers and patients the opportunity to create their own website, blog, journal, or on line resource for family and friends free of charge. There is also a link to a downloadable generic "Pain Journal" that encourages people living with pain to keep an ongoing diary of their pain experience, pain intensity and pain triggers, as well as other behavioral indicators such as sleep, appetite, mood, and activity.

And this is just one part of one section of the site!

We highly recommend that anyone who is living with chronic pain or knows someone who is visit this web site more than once and peruse their offerings. You will not be disappointed.

Impression:   Need we say it again? This site is a real treat. The only negative worth mentioning is the rather sparse collection of literature in their "Pain Information Library" which I suspect they have simply not had the time or human resources to fill, given the enormity of the undertaking they have already completed. Hopefully they will continue to be able to meet their own standard of excellence.

Our rating: *****

And that is all for now, folks. Join us next Friday for a few more-just as informal-site reviews.

And thanks, once again, for visitng Your Healer Within. If you like what you have seen so far, join our site- It's free and it entitles you to some really great discounts for as long as you remain a member

Far better is it to dare mighty things, to win glorious
triumphs, even though checkered by failure than to rank with
those poor spirits who neither enjoy much nor suffer much,
because they live in a gray twilight that knows not victory
nor defeat.
Theodore Roosevelt, 1858-1919, Twenty-sixth President of the USA

We have all heard at one time or another that setting goals and working systematically towards achieving them is the only certain way to have the success in life that we desire. Yet few of us actually do it.

For one thing, most of us never received any formal education or training on how to set goals. Certainly it is not taught in our middle or high schools, at least it was not when I was a student. Nor do I think that the students of today fare any better than did those of my generation in learning this essential life skill. Perhaps some hi-school seniors are fortunate enough to have a counselor who provides them with a smattering of information right before they set out to join the workforce or earn a college degree, but that is about it.

Of course, many people think that they have goals, and name things like "Get a law degree", "Open a day care center" or "See the world." when enumerating them. But when asked to state the specifics of their goal planning process, or their action plan...the distinct, time-sensitive and measurable steps they plan to implement in order to achieve their (usually rather nebulous) goals, most of these individuals falter. They have a vague idea of what needs to happen; to get a degree in jurisprudence, for example, one must first graduate from high school, gain admittance to a "good" college" and a "good" law school; study hard and then graduate. Yet each of these intermediate steps can be broken down into hundreds of distinct action items, each of which must be prioritized and completed before it is possible to reach the desired long term goal. Ignoring those steps is the number one reason why so many people fail to get what they want out of life.

But everyone knows that, right? Not one of us actually believes that it is possible to achieve major life goals by completing a few well-timed maneuvers. On some deeply rational level we know that life just does not work that way.

So, why is it, then, that most of us behave as if it did? Why do so many of us go through life with the absurd belief that we can have the things we want without taking the requisite steps to achieve or acquire them? Even more to the point, why do we behave as if we believe that those steps do not even exist? So many of us look at someone like Donald Trump, and assume that his real estate empire just "happened." We see the unparalleled popularity of President Elect Barak Obama and assume that he managed a political miracle by virtue of his extraordinary charisma and oratorical style, thinking not at all about his years of planning and hard work, or the fact that each step of his seemingly meteoric rise to the presidency was planned and executed with the tactical skill of a four-star general.

Why we think and behave this way is a complex issue. One one hand, we do not plan out our goals because we never learned how to do so. On the other, many of us never learned that it was important to do so. Life in the "Information Age" has ingrained in many of us a desire for and a staunch belief in the plausibility of immediate gratification. Thoughtful contemplation has been all but erased from our repertoire of responses, replaced by a "run with it" mentality that demands instant answers and immediate decisions. There is no room in this mentality for planning; it is extraneous to the process. All a person needs to succeed is the right information, the right connections, and the right resources- all of which are accessible to anyone with a laptop, a Blackberry and limitless bravado.

Unfortunately, what we are seeing today in the financial services sector and in the many off-shoots of that collapsing industry in the United States and abroad is in large part an example of how things turn out when planning and goal setting are abandoned for the promise of immediate results.. What you can and will see in your own life when you do not take the time to plan and strategize....to map out goals that are based on your values and put together a reasonable series of prioritized action steps which have as their explicit focus the attainment of those goals....is a mini-implosion that mirrors the collapse of the American economy today.
Meaningful goals are based on values, the framework upon which we create our future. Goals, in turn, give substance to our values; they clarify and delimit our purpose in life and clearly define the path we must take to become the person we were meant to be. Setting goals is not just an exercise that one does to please a mentor, a parent or a teacher. It is an integral part of a well-lived life.

To laugh often and much,
to win the respect of intelligent people, and the affection of children....
to leave the world a bit better...
to know that even one life had breathed easier
because you had lived,
that is to have succeeded.
Adapted from an original verse by Bessie Anderson Stanley

NEXT: MORE ON GOAL SETTING

"Dancing Woman by Herman Fink

For many years researchers have searched for an explanation for chronic pain, especially the chronic pain syndromes like fibromyalgia that generally are not preceded by an injury, trauma or disease. Along the way, they have learned much about what goes on in the brains and nervous systems of chronic pain sufferers; they have identified key substances in the body-such as the neurotransmitter "Substance P" that play a large part in the transmission and/or regulation of pain signals and have even proven-using scientific experiments comparing "normal" individuals responses to measured pain stimuli to those who suffer with chronic pain- that some key differences exist in how the two groups respond to pain. None of these studies, however, have given us more than a hint of an explanation as to why some people develop these seemingly random diseases and some do not, or why women are so disproportionately represented in the patient mix. Although some physicians have postulated that menopause, "empty nest syndrome" and/or a decreased ability to deal with stress brought on by both of these "conditions" may be a factor, these suppositions have never been proved.

Thanks to some recent research by doctors at the University of Iowa,however, the answers to some of these questions are becoming quite a bit clearer. The study, led by a neuroscientist Kathleen Sluka. and published in the September issue of "American Journal of Physiology" looked at the protein ASIC3, which is involved in both fatigue and muscle pain.

From an evolutionary standpoint, pain and fatigue are positive adaptations to extreme exertion; they signal the brain that it is time to slow down and rest before permanent tissue damage can occur. ASIC3, however, allows the body to keep going even in the presence of excess amounts of acid caused by exertion. As it turns out, men-who-again, from an evolutionary standpoint-were the "hunters and gatherers" who often were forced to travel long distances without rest in search of food for the tribe, have more ASIC3 than women.

In this study, researchers tweaked a few male mice, depriving them of the ASIC3 protein, and sent them on a long run, (most likely on a little mouse treadmill.) They tired more easily than expected., at about the same rate as normal female mice. Then they gave testosterone to some female mice who had a normal amount of the ASIC3 protein; when placed on the treadmill they demonstrated the same resistance to fatigue as normal male mice. Finally, they gave testosterone to female mice who were robbed of the ASIC3 protein and-any guesses? They, like the male mice who were deprived of the ASIC3 protein, performed on the treadmill at the level of a normal female mouse.

What does this mean? For one thing, it explains why otherwise normal, healthy women represent 85-90% of all people with chronic pain; it is not menopause or "empty nest syndrome" or our inability to deal with the stress of both, it is the simple fact that women have no testosterone. More importantly, the research demonstrates a direct correlation between fatigue and pain and explains why almost all patients with chronic fatigue syndrome experience pain, and almost all with chronic pain experience fatigue. Finally, it begs the question, "could women with severe chronic pain and fatigue benefit from treatment with testosterone? Or-given the decidedly unfeminine side effects of testosterone, is there some other mechanism by which ASIC3-with its ability to decrease pain and fatigue could be increased without the addition of testosterone?

Dr. Sluka's research is currently taking the latter approach, examining ways in which ASIC3 behaves in human subjects.

For now, though, we must take small solace in the fact that the next time we encounter a male physician who espouses the "psychosomatic" theory of chronic pain in women, we can assure him that he has no idea what he's talking about.....It's our hormones! Then laugh like Hell as he walks away, scratching his head in befuddlement.

Every once in a great while-perhaps two or three times in a lifetime, something happens to us that causes us to look at life  very differently. It can be any one of dozens of things, a death, a birth, a catastrophic disease (for instance, chronic pain), the loss of something we treasure... and so on. Usually these life altering events happen to you directly, but sometimes not; sometimes it is the emotional fallout from what happens to someone else that so profoundly changes how you see the world.

Several months ago I found out that my older brother, who was 60 years old on September 7th,  has.Amyotrophic lateral sclerosis, or ALS.  Commonly referred to as Lou Gehrig's Disease after the noted baseball player who died from the disease in 1941, ALS is a progressive, disabling and debilitating neurologic disease which is uniformly fatal-usually by a year or two after the diagnosis. It is a horrible disease that causes progressive muscle weakness, speech difficulties, difficulty swallowing, and-eventually-total paralysis. Most people die as a result of paralysis of the respiratory (breathing) muscles or respiratory complications like pneumonia.

The incidence of ALS, which has increased somewhat over the past 20 years, is approximately 5 per 100,000. Five people in every 100,000! When I came across statistics like these in the past I always found myself feeling extremely sad for those 5, 10 or even 20 people in the ubiquitous 100,000....the inauspicious very few who were unfortunate enough to have just the right combination of genes, exposure and luck to develop any of the hundreds of rare, mostly unknown diseases like ALS. ( ALS found its notoriety thanks to  Mr. Gehrig, who was something of a hero in the days he played the game.)

Now my brother has it. The knowledge of this horrible fact has kept me dizzy and reeling from shock, disbelief and an almost inescapable sadness for months. Although we have not been close for over 50 years, since we were little kids watching Howdy-Doody and Buffalo Bob on weekend mornings while my parents slept in, I could not feel worse if I spoke to him every day of our lives.  Perhaps because I lost part of my life to a disabling neurologic disease (although my life and my prognosis are far better than he is facing), or perhaps  because it is in my genes -as my therapist once said-to absorb other people's pain like a sponge, I know this as well as I know my own name.

So, this is why I have been missing lately.  I apologize to anyone who was looking forward to starting a mentoring program in September. I have-I freely admit, done nothing in almost two months, not in my private life nor in my work. (Although I did have one pleasant, albeit exhausting distraction for almost 3 of the last 4 weeks..three abandoned kittens who were left on my doorstep for some reason I will never know. I just adopted out the last two a few days ago.

And maybe that was just the kind of distraction I needed to jolt myself into beginning to heal, because I have found myself feeling ever so slightly excited and somewhat motivated to do something  this week. I don't feel like doing anything..not yet. I feel like moping around in pain feeling frighteningly numb, just as I have for the past 2 months,  But as you can see from this rather choppy and sloppy journal entry, I am starting anyway.. "I don't feel like it" is, after all, no excuse.

As I tell my clients, when you are in grief, sadness, lonliness or pain, one of the best ways to begin the healing process is to get moving...

PS-Yes, those pesky Mentoring programs are still on their way...but please do not expect miracles. While I was away I actually decided to add a new option-one that is significantly less expensive but also less interactive for those who are interested in participating. Fitting that in is going to slow down our launch date by a little bit ( what else is new??). You can read about it in my next post.

"We made every deadline we ever set for ourselves....we just never met them on time.  "                                             Dave Matthews,  Entrepreneur

"I have a 'Play The Melody' philosophy. It means don't over-arrange, don't make life difficult. Just play the melody˜and do it the simplest way possible."

- Jackie Gleason-Comedian, Actor

So here is some simple, practical advice for keeping some of the depression doldrums at bay. (Click to view original URL)

When we have depression, one of the things we drop from our lives is a routine. Most humans need routine as it adds structure to our lives. During bouts of depression we find it hard to go about our daily lives with a sense of purpose and direction. Restoring your routines will help to counteract this problem.

Even the simplest things can appear to be beyond us and therefore get put aside. When this happens, we are in fact, only moving further away from a “normal” life.

To reclaim a normal life, return to doing normal things.

A major effect of depression is a feeling of losing control over ones life. We start to feel that everything is happening “to us” rather than through the choices we are able to make. By reinstating your routines you can begin to regain more control.

Start by writing a list of the day-to-day activities that you may no longer participate in.

I include a few simple suggestions below and possible remedial action you might take for each.

1) Brushing your teeth. Clean your teeth twice a day and use a mouthwash. There ARE going to be times when you smile, so make sure you are prepared! Even if the smile is accidental, there is no point in having a piece of lettuce between your teeth.

2) Remain well groomed. For men this would include having a shave every day, for women, putting on make-up (I know of some men and women who need both!). Trim your fingernails.

3) Personal cleanliness. Have a shower every day and use a deodorant, after-shave, cologne or perfume.

4) Clean clothes. Put on fresh clothes every day. Make sure your clothes are ironed; even if someone else usually irons on your behalf, taking charge of your own ironing will help in your recovery.

5) Eat sensibly. A loss of ones appetite, especially for sensible foods, is very common. Make the effort to eat as much fresh fruit, vegetables, fibre and nutrients as possible. If you find that your stomach is in a knot and the thought of eating fills you with dread, try taking these things in the form of a drink. Use a food blender, juice extractor or similar. There is a wide variety of these machines on the market. Adding an appropriate multi-vitamin supplement to your daily diet can also help. Don’t be afraid to allow yourself a food treat now and again, just be careful not to overdo it. “A little of what you fancy does you good”, with the emphasis on “little”.

6) Get out as often as you can. Even if, at times, all you think you can manage is going out into the garden, then you are, at least, getting some fresh air and a bit of sun on your face. Exercise is a great way to lift your spirits, so even going out to post a letter will help.

7) Keep in touch with family and friends. Losing touch with our loved ones leaves us feeling more isolated so make the effort to meet up with those people you care about and who care about you. Even if you feel that you can’t manage to see anyone face-to-face, phone them, write a letter or use email. If you don’t want discuss your life with people you know, you could consider the likes of internet forums as an outlet for expression. Talking to strangers is often easier.

Look after your personal environment. Housework not only improves the look of your surroundings but also provides good, low level exercise.

9) Don’t get bored. Do ANYTHING to fill in that gap. Do a crossword, read a book or magazine that you find interesting, polish the silver, polish your shoes, shave the cat. Just do SOMETHING. Make it an activity you have to concentrate on so that your thoughts are, at least temporarily, distracted from the depression. Even 5 minutes of concentrating on another subject is a welcome “holiday”.

Now turn your list into an action plan. Take the points you have noted down and make a chart with all the various activities you have listed. Each day, tick off each step as you go. Not only will taking positive action improve the way you feel, but by showing to yourself that you ARE taking action to defeat the depression, you will give yourself a well deserved feeling of achievement.

Allan Cowley is a Life Coach working on a one-to-one basis with clients throughout the world. He provides personalized online life coaching via his website. You can contact him through his website at: http://www.uk-success-coach.com/

Thanks to a major upgrade to the blogging/ web site creation platform and hosting service that we use for Your Healer Within-called -Squarespace- we have the ability to spruce things up a bit... add some color, change some fonts, switch up some images etc etc. using an incredibly cool new interface that I personally cannot wait to try. Unfortunately, I've been too busy this week to do much more than breathe, having encountered some major problems with my medical care-of all things! But tomorrow is Saturday so I don't need to worry about phone calls or e-mails until Monday. Finally I can play!

So don't freak out if the web site you have been visiting looks a whole lot different on your next visit. The concept and the content are the same. I'm hoping that with the new interface we can organize things a bit more coherently, giving you the ability to find what you want more easily, even if you don't feel like using the built in search option. Check out the drop-down menu's on the Navigation bar!

One more thing-If you have a website or are thinking of starting one, whether to air your views in a blog, sell an idea or a product, or just promote your beautiful self on the web, try Squarespace before you decide to create your site from scratch or try another hosting service. Even if you are fairly adept at coding and CSS, after you try Squarespace you will wonder why you bothered to learn them. It's that good.

I've been using this service on and off for a couple of years. At first, it was very good, but just a bit lacking in configurability for me, someone who knows virtually no HTML, so I had to go elsewhere. Then last year I saw an ad for their service again and decided to try it out once more. What a difference! I was thoroughly impressed and completely hooked.  To be perfectly honest, I didn't see much room for improvement. Nevertheless, I have been anxiously awaiting the release of version 5 since they announced it was on its way.  

And now it's here, and all I can say is WOW! It's phenomenal, beautiful, elegant, sophisticated and enormously powerful all at the same time. It simply  blows everything else out there right out of the water.

So give it a try. Squarespace offers a 14 day free trial and very reasonable pricing that ranges-depending on whether you want a small 0.5Gb personal site or a major 20Gb enterprise level CMS from $7.00-$175 per month. They have great on site manuals, videos and a big FAQ section, plus  their "ticket"  customer service system is fast, friendly and -surprise-helpful! Here's the link. http://www.squarespace.com

zzzzzzzzzz