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About Rosemary McIndoe

Rosemary’s Experience Of Chronic Pain


These days, it is hard to remember what it was like to be in pain day after day for over 2 years, yet I did experience this. How much harder it must be for treating practitioners, co-workers, employers, and loved ones to understand the experience of chronic pain. I hope this brief account of my journey with chronic pain will shed some light on the experience for those who have not had chronic pain.

Surgery
It all began in 1984 when I developed severe neck, shoulder and arm pain. For the preceding two months, I had experienced pins and needles down my left arm following certain movements of the neck. Two weeks after the pain started, and treatment had been unsuccessful, I was hospitalised because the pain was so intense. A GP had manipulated my neck, a physio attempted to use traction, and I had several nights with morphine injections to get some sleep. When I was admitted to hospital, the neurologist said that I would need to have a test called a myelogram in which a dye is injected into the cerebrospinal fluid. We were shocked to hear that the myelogram and CT scan were abnormal. The neurosurgeon's diagnosis was a neurofibroma (a type of tumour), and the neurologist's diagnosis, a prolapsed inter-vertebral disc or a neurofibroma. It was a terrible week as I tried to take in what I had been told and, at the same time, cope with a severe reaction to the myelogram. The surgery was scheduled for a week later when I had recovered from the myelogram. I had been told that the neurofibroma would make me a quadriplegic if it wasn't removed, and that the surgery itself held some risk of paralysis. The morning that I was told this, I lay in bed trying to comprehend the implications of this diagnosis. I had walked these wards as a physiotherapist about 15 years before. The roles were now reversed as I was the one in bed and I had been told I might not be able to walk out of the hospital.

During the week prior to surgery I could not absorb the full implications of what I'd been told, because I was so ill after the myelogram. Fortunately, it was a prolapsed disc, not a tumour, and the surgeon was able to remove it. I recovered, much as expected, over the next few months. I had a lot of attention from friends and relatives, and was very relieved to have had the problem diagnosed and cured. The surgical procedure of Decompression alleviated the intense pain, and the post-operative pain subsided over the weeks following surgery. I returned to a completely normal lifestyle, carrying heavy suitcases through Europe the following year.

However, eighteen months after the surgery when I returned from a conference in Europe, I had a car accident. I was hit from the rear as I waited to do a right-hand turn. The following day, I was a bit stiff and sore but I thought that the damage was minimal. It was only a week or ten days after the accident, that the neck pain became strong. As the weeks passed, it became worse and worse. I was often tearful and I seemed to find it more and more difficult to cope. Then, my understanding about injuries was that they gradually improved but this turned out to be the opposite; my condition deteriorated as the weeks passed.

Beginning the journey into chronic pain
A month after the accident I returned to the neurosurgeon as the pain had not subsided. He recommended that I wear a hard collar to rest my neck. The prescribed 2 months in the collar seemed like an eternity, but after 2 years of pain, this became insignificant. There was a further shock six weeks after the accident when I was hospitalised because I had difficulty walking and my balance was disturbed. The cause of this remained undiagnosed, and I left the hospital ten days later confused and frightened. I had 2 myelograms in one week and because these showed no structural problems that could be causing the difficulties with my walking and balance, the condition was called “hysterical”. It took some time for my normal walking pattern to return, and once I started to get about and resume household chores, the pain returned with renewed intensity.

The weeks, and then months, passed. There was more bad news; my father had a brain tumour. It was serious and it could not be fully removed in the surgery. Daily visits to the hospital over the next two and a half months brought back memories of my surgery, and my hospitalization following the car accident. Dad had radiotherapy but he did not recover and he died just two and a half months after surgery. My pain was unrelenting and my life gradually collapsed around me. It is difficult to recall now just what it was like but I started a book whilst I was recovering. I wrote about one day when I attempted to prune the fuchsias in the hanging baskets in my backyard. The garden was one pleasure left in life, the pleasure of watching plants growing and flowers blooming. I spent just ten minutes pruning the branches of the fuchsias, and had to lie down for 2 hours to recover.


Seeking solutions
I had suspended my PhD candidature and I attempted to continue my part-time studies in psychology to keep my mind occupied. I had followed instructions to rest my neck, but there was no improvement, and therefore I began to explore other avenues such as meditation, acupuncture, physiotherapy, and a pain clinic. There was a 9-month waiting list for the pain clinic and even if I didn't have chronic pain when I applied, I certainly did by the time I entered the program. There was a six-month wait to see Ainslie Meares, a psychiatrist (author of “Relief without Drugs”). He had ceased his practice of psychiatry and hypnosis and had become a meditation teacher, assisting people with cancer, anxiety and other disorders to develop peace of mind.

Physiotherapists attempted to mobilise my neck week after week, and my arm pain increased. The waiting period for acupuncture treatment was 6 weeks and this seemed like a long time. I went along not expecting pain with the needles (How could I possibly experience more pain?) but after insertion of needles across the back of my head, down my neck, down both arms, and down my back, I wondered whether I would return for a second appointment. I did, and I learned to relax as the needles were inserted. I did not experience dramatic relief, and I had not been promised this. There was some reduction of pain in my arms, and at least I felt I was doing something to deal with the problem.

I commenced a
meditation course at the Council of Adult Education, but had such difficulty sitting through the class that I gained little benefit, until the final session, when we lay on the ground to meditate. I began to catch glimpses of what meditation could bring. I am still meditating, and still discovering more.

Fourteen months after the accident, I was accepted into the program at the
pain clinic. By this time, I had experienced severe depression; anxiety about my future, the lack of diagnosis and treatment, and my failure to recover; anger with myself for failing to get better, and with the doctors for their inability to help me; and loss of self-esteem. I had begun to doubt myself - perhaps I was imagining it, was I going crazy? Was I a malingerer? But why should I malinger? No-one had told me why I still had pain saying it was just a soft-tissue injury.

At the pain clinic, they seemed to understand what I was experiencing and the assessment was extensive. I saw the doctor, physio, OT, and psychologist. It was really important to have the support of their understanding and experience but I still needed to learn the lesson about taking charge and managing the problem myself.


More complications
In the second year of my chronic pain experience, I had further complications. I commenced a swimming program, and swam a kilometre several times a week. Over the subsequent weeks, my right shoulder gave me more and more trouble. Eventually, I was diagnosed as having a winging scapula, due to paralysis of Serratus Anterior (a muscle involved in stabilizing the shoulder girdle). Again, the reason for this was never established and it is only after my own research and experimentation that I now understand how this happened. I have been able to put this understanding to good use in the courses that I teach.

Taking charge of the problem

It was during this year that I began to take charge of the problem; I realised that it was up to me. An essential part of recovery was developing a belief that I could heal myself. This belief grew after I had attended a retreat with Ian Gawler who had recovered from advanced cancer. He was an inspiration, and I felt I must be able to find a way to recover from chronic pain.

This was one of the major turning points. The feeling began to grow stronger that I could find a way out of this pain. I refused to contemplate a continuing life with pain. I wasn't going to just “learn to live with it”, a favourite expression amongst some of the specialists.


My exploration led me to discover the benefits of massage for relaxation, and deep tissue work for releasing connective tissue and stiffness, and therefore pain in the long term. I began to use the Feldenkrais method, both “awareness through movement”, using tapes and attending classes, and “functional integration” with a physiotherapist who was training as a Feldenkrais practitioner. This was one of the most helpful methods I used, and I still find it very beneficial. I also had some lessons in the Alexander technique which were helpful. TENS (Transcutaneous Electrical Nerve Stimulation) provided great relief in the short-term. I saw a psychologist who helped me make sense of my experience and began to put my fractured life back together and I was able to release anger and depression with a somatic therapy called Radix.

It was a slow and painful process as there was more pain involved in getting beyond the pain. I realised I had to move my neck and body, regardless of whether it hurt, to slowly restore mobility and strength, and release patterns of spasm and tension. Even though it was slow, the conviction that I would make it, seemed to grow.

Another significant turning point was my return to work. I felt that I was again going somewhere in life. It was a new career as a rehabilitation consultant, and I had to let go the disappointment of not finishing my PhD, particularly since I was ready to begin writing my thesis. The increase in pain on returning to work was offset by the feeling that I was doing something for someone else; I was being useful again and I had a future. Unfortunately, it was many months before the pain subsided significantly, but I felt very different as my confidence returned and my life became normal again.

Recovery from chronic pain was about reconstructing my life, believing in myself and my capacity to heal. I discovered that no-one could remove my pain and put my life back together for me.

I had also discovered that traditional medicine had little to offer me. I had to break free from the idea that there was a specific diagnosis and cure. My faith in medicine was shaken, and I had to find another way of approaching healing. This involved working with the various therapists and doctors in partnership. They could not hand out simple solutions, instead, I had to develop new skills and new ways of approaching life and health.

From my experience of pain, and working with many clients since, I have learnt a great deal about healing. In this approach, there are no simple prescriptions and the solutions can only evolve over time as the practitioner/s, and person in pain work together. However, the person in pain is the most important one in the partnership, as he/she needs to take charge and actively search for a path out of pain.

I also learnt that rest does not cure chronic pain. Pain should not be the guide as to when to stop activity and movement, something that many physiotherapists and doctors often recommend. I found that pacing activities was important and that rest alone was disastrous. In subsequent years I have seen extreme cases of the damage that prolonged rest can do. One client was told to rest his arms to recover from RSI and he took this literally, sitting in a chair all day, using his arms for less and less as the months went by. When I saw him, he could not dress himself, pull up the bedcovers, or feed himself. He was having great difficulty walking and standing. Several days later he was diagnosed as having a deep vein thrombosis. When he was admitted to hospital, he could not press the buzzer by his bed.

Many years after this experience I can look back and see that it was an opportunity to change myself and my life in profound ways. It changed the direction of my life and set me on a path which has led to much satisfaction. It allowed me to bring together the different threads of my professional training and put them to good use in my work. It has not only changed my career, but my outlook on life as well. I keep myself pain free by doing the self-management program that I teach. I have been delighted to find that, in spite of significant degeneration in the neck and low back, I have good mobility, probably better than average for my age, and can work long hours at my computer and lift quite heavy things. This has been possible through the combination of activating and strengthening my low back and shoulder girdle stabilizing muscles, and learning how to release holding patterns and muscle tension. The secret is to enjoy the relaxation and exercise, both the aerobic component and the floor routine. I don’t need lots of equipment, just an exercise ball and my walking shoes. It is a simple but successful approach to long-term management.

Click here to read more in the article “Rosemary’s Reflections on Working with people experiencing Chronic Pain”. Top of page

Professional training and private practice

When I left school I trained as a physiotherapist and practiced physiotherapy for 3 years. It was then that my interests turned to teaching, and, after completing a teaching diploma, I taught in secondary schools for several years. My interest in teaching took me back to study Science and later to pursue post-graduate studies in Zoology. While I was doing my PhD in Zoology, I studied Psychology. It was during my second and third year of the PhD that I had the surgery and then the car accident. I was unable to complete the PhD as the break from my studies was too long, and I was drawn back to working in health care but this time as a psychologist and rehabilitation consultant. Not surprisingly, I became very interested in working with people experiencing chronic pain as my car accident had set off a chronic pain cycle. This experience of chronic pain became a turning point in my life, drawing me towards Complementary Medicine and various therapies such as the Feldenkrais Method, the Alexander Technique, a Neo-Reichian therapy called Radix, and the practice of meditation. In my development as a Psychologist I was drawn to hypnosis and later to a body-centred psychotherapy called Hakomi.

Psychology And Psychotherapy
My own healing journey has strongly influenced my work. Whilst practising in general areas of psychology such as Anxiety, Depression, Relationships, Grief, and Stress Management, I also specialize in Self-Management of Chronic Pain and Trauma Resolution. However, my greatest interest, now, is a depth psychotherapy, called Hakomi, which can be most helpful in working with physical symptoms such as chronic pain but provides a method for long-term therapy with clients interested in self-study for personal growth and life-enhancement. In my individual therapy I continue to use my basic training in Cognitive Behaviour Therapy, when it is appropriate, and Solution-Oriented Therapy for specific problems.

Hakomi
Hakomi is a Hopi Indian word which means
“How do you stand in relation to these many realms?
A more modern translation is “Who are You?”


Hakomi is a depth psychology which assists with self-exploration. It was developed by Ron Kurtz in the mid 1970’s as the culmination of his previous study in psychology, science and philosophy. The method is now referred to as Hakomi Integrative Psychology indicating the integrative nature of the work. Unlike many other branches of psychology which focus on the mind, Hakomi works with the body, emotions, movement, postures, and gestures as well as thoughts, images, memories, and dreams. It was previously called “Body-centred psychotherapy” to indicate the focus on the body. The method does not involve bodywork or any attempt to manipulate or change the body; it uses the body as a way of accessing aspects of us which are outside our awareness or conscious mind. This is one of its greatest strengths because the body can be a source of information that is normally unavailable to us. Work that may take months or even years in more traditional talking therapies can frequently be done in less time. Depth psychological approaches do take time because patterns developed in childhood are not changed easily. Hakomi can be used for Brief therapy from one to ten sessions or more, but is generally a psychotherapy designed for deeper exploration of who we are.

Ron has been influenced by modern theories and therapies as well as the traditional practices of Buddhism and Taoism. The Taoist concept of “going with the grain” and the gentleness, compassion and mindfulness of Buddhism are integral to the practice of Hakomi. Being a scientist, Ron has incorporated aspects of systems theory and information theory. He has also drawn on Reichian work, Bioenergetics, Gestalt, Psychomotor, Feldenkrais, Structural Bodywork, Eriksonian Hypnosis, Focussing, and Neurolinguistic Programming. Click here to find out more about Hakomi.

Trauma Resolution
Rosemary has also studied with the Hakomi Somatics Institute (now the Sensorimotor Psychotherapy Institute) which has a greater focus on the body, and has developed an approach to working with resolving trauma in the body called sensorimotor processing. This approach to sequencing truncated emergency responses is very effective in working with chronic musculo-skeletal pain. Whilst Cognitive-Behavioural Therapy can be helpful in changing self-defeating beliefs related to recovery, this work addresses the primitive responses to pain that are found in the body. With chronic pain these can relate to car accidents, injuries, surgery, and childhood sexual abuse. This work can be valuable for reducing activation (hyper-arousal/vigilance) and the opposite, a freezing response. It allows completion of the truncated emergency response by completing the unfinished sensorimotor sequences. This hierarchical approach to resolving trauma works from the bottom-up, completing the physiological sequences before the emotional and cognitive sequences. The higher level processing becomes much easier when the physiological sequence is processed first or simultaneously. It seems to be a missing piece in the chronic pain work, explaining the difficulties people seem to have in learning approaches to self-management and being able to move on in their lives. Click here to learn more about Sensorimotor Psychotherapy.

Hypnosis
I have completed the Australian Society of Hypnosis training and the Diploma of Solution Oriented Hypnosis in Ericksonian or Indirect Methods of Hypnosis. The Ericksonian methods, particularly, have had a strong influence on my practice.

Meditation
My background in meditation has included a one year meditation leaders training program led by Dr Ian Gawler (author of “You Can Conquer Cancer” and “Peace of Mind”). I taught meditation at the Melbourne Living Centre for 5 years, and in my own practice for a further 5 years. My main focus now is Buddhist approaches to meditation and I am particularly interested in the ways that Buddhism is being brought into Psychotherapy.

Physiotherapy
Although I no longer practice physiotherapy, I remain interested in body mechanics, movement, and neurophysiology as it relates to my work with chronic pain, trauma, and body-centred psychotherapy.

Self-Management Of Chronic Pain
The self-management of pain program has evolved over the last fifteen years and represents a synthesis of my training and personal experience. The potential for self-healing is often forgotten in this increasingly sophisticated technological world. These courses help participants awaken their own healing potential, providing them with skills for self-help and self-healing. During the course participants learn to take responsibility for designing and practicing their own programs of relaxation and gentle exercise. They also learn how important attitude is in maintaining their practices and healing themselves.

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