Back pain and stress: making the connection

After years of trying every treatment imaginable, eventually even back surgery, what’s a girl to do to do about her chronic pain? Go searching on the inside.

Here’s the story. I have been struggling with chronic pain for 17 years, since I was 15. Over those 17 years, I have:

  • Tried medication after medication
  • Tried various forms of physiotherapy
  • Tried various forms of massage
  • Tried chiropractors, active release therapy, and medical acupuncture
  • Tried yoga and pilates
  • Tried a four month elimination diet, where I tried to eliminate anything from my body that would cause inflammation
  • Tried a naturopath (yummy corn-silk tea, anyone?)
  • Tried a mindfulness meditation class (MBSR)
  • Tried injections (trigger-point, epidural)
  • Tried osteopathy and cranial-sacral work
  • Been to 25+ medical professionals (I’m guessing here, but it seems about right – about 6 PTs, 8 massage therapists, 3 chiropractors, 2 osteopaths, 8+ doctors)

I have multiple types of chronic pain: back, hip, pelvic. At age 32, I hit the point where it seemed like there was nothing else to be done about my back pain but one thing: surgery.

The back surgery helped with a couple of minor issues but afterward, my back still hurt. It hurt as much as when I first started having back pain, seven years ago. It is hard to admit this to people. People assume that after you have an invasive surgery, take time off work, etc. that you will be healed, or at least on your way to healing. I’ll admit it, I thought this too. I thought that the surgery would at least heal my back pain, and I could turn my attention to other issues. Because of other people’s expectations and my own expectations, it is incredibly difficult to speak about this dream not coming true.

And the key question is: after surgery fails, what next?

To continue my story, we need to go back to last year for a moment. Last year my massage therapist pointed me to the work of Dr. John Sarno. Sarno is a pioneer in the field of mind-body medicine. He came up with the idea of Tension Myositis Syndrome (TMS), claiming that tension in the body, caused by emotional distress (e.g., anger / shame), could lead to chronic pain. He theorized that tension in the body leads to oxygen deprivation in tissue, which leads to pain.

In the Sarno book I read, Healing Back Pain, he makes himself sound almost desperate. The book was written in a way that sounds incredibly defensive, as if he is trying to anticipate any objection the reader might have, and counter it in advance. Unfortunately, at least in this book (I can’t speak for his others), his means of countering is through anecdote.

As much as his theories intrigued me, anecdotes from Sarno were simply not enough to satisfy my scientific mind. Heck, I’m a person who’s taken courses on the philosophy of science and studied hard-core engineering for four years! Let me tell you, Karl Popper and his contemporaries would not have been satisfied by anecdote, nor was I. “If he worked on this for decades,” I thought, “where are the properly designed experiments?”.

Thus, despite my interest in Sarno’s concept, I put the book down and dismissed him as a quack, and his theories as bunk.

Months passed, my pain continued, I had the surgery, and the surgery failed to heal all but the tiniest part of my pain.

Feeling like I had exhausted all options, all I had left was that deep curiosity yet suspicion of the work of Sarno. I started reading on the TMS Wiki, a resource for Sarno-ites, looking for proof that there was actual science behind this.

I found two people: Dr. Howard Schubiner and Abigail Steidley. I listened to an interview that Abigail did with Dr. Schubiner, and determined they were both credible and interesting. I quickly bought Dr. Schubiner’s book Unlearn Your Pain, as well as Abigail’s Mind-Body Toolbox for Pain Relief (an audio course). Both were able to provide tons of evidence that there is something to this idea. (I wanted to provide a list of the evidence here, but it really requires more context. I recommend Schubiner’s book for an excellent start, and I list other resources at the bottom of this post.)

What I know now, in a nutshell:
Psychosomatic disorders do exist, and pain can be psychosomatic.

That doesn’t mean that my mind is inventing the pain, or that the pain isn’t real.

In a simple way, it means that my stress is being stored in my body as pain, and that my stress is strengthening the pain pathways in my body.

When pain is real but isn’t pathological in nature, Schubiner calls it Mind-Body Syndrome (MBS). I am becoming more and more convinced that at least part of my chronic pain, back and otherwise, is Mind-Body Syndrome.

All of this knowledge is why I am now reflecting on my life, both personal and professional. It’s why talks like “I suck, and so do you” resonate so deeply with me. There are aspects of my personality and the way I carry myself in the world (including in my consulting career) that make me susceptible to chronic stress, which lead me to be in a constant state of fight/flight/freeze, which lead to me being in pain. 17 years in, I’ve reached a point where something’s got to give.

When people encounter stress issues, they frequently assume that they have to remove the stress from their life. Honestly, this is impossible in modern life. Personally, I would much rather work on my ability to cope with the stress. Abigail’s own story is that working on her ability to cope with negative emotions helped her heal her chronic pain, and so I am attempting to follow the same path.

I don’t know if others out there are interested in this topic. Because my career is such a huge, important part of my life, my first reaction when I discovered this situation was to think, “Wow, I have to share this with everyone else who does what I do and might be suffering!”. But honestly, I don’t know how many people are dealing with the same issues. What I do know is that all of the following pain issues have been linked to mind-body syndrome:

  • Back / neck pain
  • Pelvic pain
  • Irritable bowel syndrome / interstitial cystitis
  • Fibromyalgia, whiplash
  • Chronic fatigue syndrome
  • Tension headaches, migraine headaches
  • Carpal tunnel syndrome

This is not to say that these issues are never caused by actual physical abnormalities. But doctors say that if there is no evidence of tissue / nerve damage yet you still have pain—if your MRIs don’t really show anything and you’ve tried everything else Western medicine has to offer—you should consider the idea that your pain might be caused by mind-body issues.

If you think you might be dealing with a similar situation, do reach out to me – mere@ (thisdomain). I would love to share what I know and talk more.

Resources to learn more:

  • Audio course I’ve used:
    • Mind-Body Toolbox for Pain Relief by Abigail Steidley (this is wonderful and worth every penny; oodles of material delivered by a compassionate and educated coach)

More resources can be found on Abigail Steidley’s free resources page.

Interested in my posts on related topics? Try:

Coping With an Addiction to External Validation

In my last post, I wrote about the need to be vulnerable with clients. In an effort to simplify the post, I glossed over something rather important: the desperate need for external validation that many of us have, and how it affects us in the workplace. Let the vulnerability continue!

In her talk at the 2013 Dare Conference, “I suck, and so do you!,” Karen McGrane explains how consulting requires a facade of absolute knowledge, when in reality, most of us are very anxious about our skills. She describes that this duality is a “push/pull” situation, where we have to spend all of our time acting the expert, while we desperately seek validation from our clients.

Karen’s thoughts are echoed by the predecessor piece to her talk, a post on A List Apart entitled, “Give a crap. Don’t give a fuck.” In the piece, Karen also talks about external validation and the need to stop worrying about what others think. She says:

“Care deeply about your personal values and live them fully in this world. Don’t get caught up in worrying about other people’s checklists to tell you what good work means to you.”

Honestly, when I first read Karen’s article, and later saw Karen’s talk, my heart started screaming, “YES!”. Someone understands me. Someone gets what this is like. It’s completely true: all of my career, I’ve relied on the approval of my clients and colleagues to feel good about my work. Worse, since so much of my identity is wrapped up in my job, and being a consultant, this means that I’ve relied on the approval of my clients and colleagues to feel good about myself.

My need for external validation manifested in the following behaviors (just a sampling):

  • Being fearful of making a mistake, and having to admit to a client that I made that mistake (and as I saw it, therefore having to admit to them that I wasted their money)
  • Being fearful doing something that would upset the client and cause them to ask for a new consultant, or fire my firm outright
  • Being fearful of asking a client a stupid question and being perceived as too inexperienced and not worth my consulting rate
  • Being fearful of a client’s proposed design solution being better than my proposed design solution
  • Being fearful that clients wouldn’t like my designs and would think I was a bad designer
  • Etc…

As you can see, looking for external validation for everything I did led to an incredible amount of fear in my life.

That said, at the end of Karen’s talk, mostly all I knew was that I needed to work harder on not needing external validation. I had no idea how to do that, save just reminding myself now and then. Karen claims that self-compassion is the way out, but I’ve been doing a lot of reading on self-compassion lately and this doesn’t resonate with me as a solution for the problem of external validation. I think self-compassion is critical to coping with the negative emotions that are caused by criticism (self-inflicted or otherwise), but I don’t see it as a means to stop caring about what others think. (It’s quite possible that as I continue my self-compassion journey I will change my mind on this. I admit I am quite a novice.)

So what can we do about this overarching need for external approval? Honestly, I’m not positive myself yet, thus I’m looking to share my journey with you.

Amy Pearson has a wonderful website and coaching practice where she trains people to give up the need for external validation, and that’s where I myself am going to start.

I think most people with this issue can recognize it immediately; however, Amy has a post where she describes 10 Signs You Might Be Addicted to Approval. Most importantly, she provides reality checks for each point. I recommend it as a starting point.

10 Signs You Might Be Addicted to Approval

10 Signs You Might Be Addicted to Approval (see full blog post)


What I find particularly interesting about Amy’s stance is that she sees the need for external validation as an addiction. Those of us with the addiction race from validation high to validation high, slumping in the middle while we seek more approval. She refers to a term from Martha Beck’s book Steering By Starlight, “fake joy”, to describe these temporary highs, which “take you to a place of ecstasy, then drop you off the edge of a cliff”. I can relate and find this a very useful way to think about things (despite being slightly skeptical of self-help books, ack).

Lastly, as I mentioned in my last post, knowing things in principle is great, but actually changing one’s behaviour is much harder. Amy’s reality checks are a good start, but I don’t know that I can just flip a switch and stop worrying about other people’s opinions outright. Nor do I think my goal should be to turn this concern off completely. That’s the problem about being a consultant, more than many other careers: your livelihood is completely dependent on what others think of you and your work. If you work at a product company, it’s different: your customers only judge you based on the end product. In consulting, you are the product. A consultant can’t just say, “I don’t care what my clients think” anymore. This is why Karen rightly points out that consultants are particularly prone to this issue. What your clients think about you matters deeply, yet you need to find a way to distance yourself enough from their opinions that you don’t implode.

My personal story has more or less led me to a state of implosion. My body is unhappy with me, and my mind is pretty unhappy with me too. I haven’t had a break-down like Karen describes in her talk, but I’ve been wearing myself down over nine years, and over the past few months I’ve realized that it has to stop. I urge you to reflect on your own situation and figure out if you need to take a similar step.

Resources I have identified thus far:

Self-Compassion Books

Although I don’t think that self-compassion is exactly the answer to solving one’s need for external validation, I do think it’s an incredibly valuable practice, so I’m including some links here.

  • Self-Compassion by Kristin Neff
    I am partway through this book and am really enjoying and appreciating it. Neff’s explanations make a ton of sense and have led to many ‘aha’ moments for me. She also includes exercises to do along the way to put the ideas into action.
  • The Mindful Path to Self-Compassion by Christopher K. Gerber
    After downloading samples of both books, Neff’s resonated with me slightly more, so I started with it. Still, both come highly recommended, so see which one resonates more for you.

Coping With External Validation Issues

  • by Amy Pearson
    Amy is a coach who helps people learn how not to seek external approval as much. Her blog is a great resource, and she also has self-study programs available. Although it requires a newsletter sign-up, her Find Out Your Approval Seeking Personality Type quiz is actually fairly interesting.
  • If anyone has recommendations for books on this topic (or anything else, for that matter), please do leave a comment or contact me. I’m eager to learn more.

Harnessing Vulnerability In Consulting

As a young person, I considered being vulnerable one of my fortes. I was very good about sharing my insecurities and emotions with others in hopes of connecting and bonding. However, once I became a consultant (which for me happened straight out of undergrad at age 24), I lost a lot of my willingness to be vulnerable.

Why did I feel the need to shed this vulnerability? In short, insecurity. I wasn’t sure that I was worthy of the role I was given at such a young age. I was nervous that my clients would be upset that they were given a young, inexperienced consultant. I was terrified of making a mistake, having a client come up with a better idea than me, or (gasp) losing an account because of something I did.

Looking back, the back pain that I developed in 2008, two and a half years into my consulting life, should not have come as a surprise to me. I was putting an immense amount of pressure on myself to completely control the tenor of every client encounter, to smooth over any rough edges, to wow them with my work, and never let them down. It should not have been a surprise that my brain started being unable to store all of the stress and tension, and it started finding a home for that tension in my body.

The trouble for me is that old habits die hard. I am still extremely hard on myself in my role as a consultant. I aim to be everything the client could possibly want, and hold myself to impossibly high standards, aiming never to let the client know I am fallible.

I’ve begun to identify two issues at work in this situation:

  • I have a lot of thoughts that lead to stress, tension and difficult emotions (e.g., “If I’m not perfect my clients will think I’m wasting their money.”)
  • I don’t necessarily cope well with the emotions that are caused by those thoughts (e.g., experiencing anxiety when presenting a new design to a client).

I want to speak about how to better cope with emotions in subsequent blog post. But for today, let’s talk about the thoughts themselves, the ones that eventually cause emotions. How can one reduce insecurity and the fear of being seen as fallible? How can allowing oneself to be more vulnerable with clients actually reduce the number of negative thoughts one has to cope with?

I started thinking about vulnerability in a professional context when I first saw Karen McGrane’s talk from the 2013 Dare Conference, “I suck, and so do you!“. In her talk, Karen talks about a common problem amongst many digital workers, but particularly among consultants — deep insecurity. She talks about the loop: “the idea that you’re only worthy if you’re doing things right, … that your value to the world is that you have the right ideas.” She talks about how important it is to have the willingness to be vulnerable and imperfect while consulting, and why self-compassion is paramount.

Karen’s talk made me take stock of my situation a little bit, and how much I was using external validation as a means to derive my self-worth as a consultant. Her stunning display of vulnerability, speaking about her own break-down and her journey towards self-compassion, lit a spark within me to explore being vulnerable again. However, I still didn’t really consider what it would mean to be vulnerable with my clients.

Enter my second step on this road: the book Getting Naked by Patrick M. Lencioni. The book is a fable about how a boutique consulting company uses vulnerability to create authentic, trust-filled relationships with their clients. The principles in the book are based on those practiced in Lencioni’s own consulting company. Specifically, he describes the need to avoid three key fears in consulting:

  1. The fear of losing client business
  2. The fear of being embarrassed in front of clients
  3. The fear of feeling inferior to clients

To do this, he describes a number of techniques, such as:

  • Asking dumb questions
  • Making dumb suggestions
  • Celebrating your mistakes
  • Admitting your weaknesses and limitations

He explains how each of the above techniques (and several more) actually can strengthen the bond between consultant and client:

  • Asking dumb questions: Say you ask five questions and three of them are dumb. Lencioni argues that the benefit of asking the other two good questions is worth it. He points out that the dumb questions will be answered quickly, and that no one will remember them for long.
  • Making dumb suggestions: As with asking dumb questions, the argument here is that  it’s better to make all the suggestions one has and not hold back on the client. It’s better to risk asking a couple of dumb suggestions than to not make any suggestions and miss out on the good ones.
  • Celebrating your mistakes: Making mistakes is inevitable. It’s better to call them out and take responsibility for them, rather than hide or downplay them. Lencioni points out that clients don’t expect perfection from service providers, but that they do expect honesty and transparency. (Not hiding mistakes I’m good with, but I am going to have to take his word on the “not expecting perfection” point.)
  • Admitting your weaknesses and limitations: Says Lencioni — since we all have weaknesses, it’s better to be open about them than to end up in a situation of having to do something we’re not good at.

Essentially, Lencioni is giving me (indeed, all consultants) permission, and indeed, a reason to be real and vulnerable with clients. He basically claims that all of the things I have implicitly been worrying about for my almost-nine-year long consulting career, like making mistakes, are things not to fear but to embrace, and that they will only strengthen the bond a consultant has with a client.

I am eager to test out Lencioni’s approaches for myself, being more vulnerable with clients, and not stressing so much about any dumb ideas / questions / designs I may throw their way during the process. As usual in life, this is something that’s extremely easy to say in principle, but much harder to do in practice. The fact is, however, that being easier on myself is critical to my physical and mental health, and that vulnerability seems to be a significant key to achieving this.

I hope this post may be valuable to some fledging (or not-so-fledgling) consultants out there. I would highly recommend both “I suck, and so do you!” and Getting Naked if you are interested in learning more about the value of being vulnerable as a consultant. Getting Naked is particularly great because instead of writing his ideas in a standard business book format, Lencioni delivers his message through narrative, in the form of a fable. If you do read, please let me know what you think and what implications there might be for your own consulting practice!

For the second in this series, see Coping With An Addiction to External Validation.