Posted on December 21, 2013 by Kristian Amlie
What has happened
Here I am, just a short time before Christmas, and it’s been more than eight months since I started working in an IT company again after I was cured of my persisting wrist problem. For those not familiar with the back story, I recommend that you read my account of what happened to me in this article. I want to share with you how my time has been and whether I have had any more problems after I started working again.
Those familiar with the original article will know that RSI (Repetitive Strain Injury) is not the proper term, but rather Psychogenic Pain Disorder or Persistent Somatoform Pain Disorder. I use the term in the title mostly because it is catchy and people tend to have an idea what it is.
So let’s answer the most important question first: Am I okay? A big resounding YES! For those of you who might worry that the treatment is not permanent, and is just another way of using placebo to ignore the problem until it comes back, I can tell you that this is simply not true. The treatment works, is permanent, and has no side effects.
Let me recap the story from the start: What happened on my first working day after my last article? Of course I was a little nervous on this day. I had very confidently told my new boss, who also hired me, that my pain disorder was a thing of the past and I was fully cured and ready to start working. This is also what I told myself. But some doubt always remains, and when I finally sat at my desk, knowing that my new income would depend on me being there day after day, a little bit of that old fear started to come back.
In terms of pain, the first day was fine, however as the next few days progressed I started to feel that old familiar feeling in my wrists again. But I was ready, I knew the transition would not be pain free. After all, being in a work environment, working with computers, was a situation where I had not yet had time to retrain the amygdala. My feelings at the time were mixed and ranged from slight panic to complete control. I felt a little bit confused because I had been so problem free when sitting at the computer at home, and suddenly the symptoms started coming back.
Fortunately I had a session scheduled with my physical therapist the second week after I started working. Talking to him was very reassuring, and he said that he was not the least bit surprised that I felt symptoms again. He said that this is something that happens to everybody that reenter the IT job market after a prolonged period of psychogenic pain disorder. As I described in the first article, amygdala uses association to trigger pain, and I had not been in such a job situation since I started the treatment. It was only natural that I would get a pain response. He also said that this is something that passes for everybody. I knew the tools, I knew the approach, I just needed to apply them once more.
And I did. It was a little tough to begin with, because I felt like I had taken so many steps backwards, but I knew the reason, and I had much more confidence in the method, having seen it work before. And it didn’t take many days before the results came. In many ways it was almost like being cured a second time, although it didn’t take nearly as long this time around.
After that I was free of it once more. I saw my therapist one more time after that, but we both agreed that it was time to end our regular sessions. I didn’t have anything left to cure! An unbelievable good situation to be in for me!
In the next six month period I would be as good as free of pain. Occasionally I had small relapses where I could feel it coming on, but almost always, it would recede shortly after I did one of the relaxation exercises. Only once did I have an occurrence that lasted more than a day, and I attribute this to a particularly stressful time back then.
Gradually the relapses have been further and further apart, and I have trouble remembering now, when the last time was. Not in the last two months, that’s for sure. But I think there’s also the fact that even if I get a little pain in my wrist now, I don’t notice it anymore. If you think about it, this is how most people relate to pain: If you get a small, only slightly irritating pain somewhere in your body, you don’t bother to take much note of it. Why would you? Such small occurrences pretty much always disappear after a few minutes anyway. This is a sign of a healthy view on pain. People suffering from psychogenic pain disorder tend to select the other extreme: blowing every little brush of pain completely out of proportion, and worrying sick about it. This is simply not necessary, our bodies are not that fragile, and it points the pain spiral downwards, instead of upwards. It takes time to unlearn this way of thinking, but as I experienced, it can be done.
All this sums up to the resounding YES I gave in the beginning. I really do not think about pain anymore. It’s really starting to feel more and more like a distant memory, and I am fully cured. And if that can happen to me, it can for sure happen to you!
In October I had the honor of being invited to speak at a small conference arranged by the institute where I met my physical therapist. The crowd were therapists only, but they seemed very interested to hear a story from someone who had experienced the syndrome first hand. They told me that as therapists it is very common to be met with disbelief when trying to present psychogenic pain as a diagnosis. I am not surprised by this at all. We like to think that our brains are perfect and symptoms have to be an indication of something wrong in the rest of the body. In addition, being told that something is of psychological origin can easily be taken as an insult to our personality, and the patient may feel that the “physical” sensation of pain is not being taken seriously.
I told them that for me, one of the most important factors for accepting the diagnosis was to see real evidence. It’s a hard thing to prove conclusively, but what I needed was to see evidence that made physical injury appear “illogical”. Much of this evidence is reflected in the tests I listed in the original article, particularly the pain that moves and the press test. In addition to these “do it at home” tests, I had an MR scan of my wrist, which was clean, and I had numerous hours of treatment of muscles, ligaments and nerve paths, all of them giving either no results, or very inconsistent results. Physical injury just didn’t seem likely.
The second thing that was important to me was to have the therapist carefully explain how the process works in the brain. The process is also outlined in the original article. This helped me put my pain sensations into context, and explain why they felt and behaved the way they did. I learned that the pain is not a conscious choice, and suffering from it was not a flaw in my personality or anything like that. This knowledge was also necessary to understand the treatment that would follow, and to realize that medication or surgery would not help me, I needed to work on the cure over time, using the provided mental tools.
Overall it was a fun day, and I also got to see seminars about topics that I’m not used to. Some of it was too advanced for me, obviously, but it was an interesting insight into how physical therapists work everyday, and how psychogenic disorders blend into this.