Pain is an odd thing. It is the body’s warning system, and when the pain is not visible to the outside world, we often try to ignore the call that pain is sending us until the pain is screaming and we must respond.
When someone breaks their arm, there is pain. The process of mending that bone usually requires a cast to be created to support the healing of the bone, with a hard structure to keep the bones “set” and as a protection for the soft tissues. This cast, or hard structure, is a reminder to the individual that they need to take care, and often it is restrictive, maybe even decreasing their range of motion. When you see someone with a broken arm, you may tend to respond by acknowledging that condition with either an avoidance of contact (concern about a potentially painful bone break), or you might even help them reach for the book in the library, non-verbally noting that they need a little support.
In issues like fibromyalgia, pain, and sadness, there is no outside symbol of the healing process. Nobody is cued by a cast or band aid to help you reach for the book in the library. In fact, you might join the outside world and negate that you are having pain by using numbing agents or distracting behavior. And, truth be told, the healing process is not something that we, in Western medicine, have a big tool set to support. An integrative approach to healing is always more useful than looking at one intervention.
In this case study, we offer a client Western psychiatry, neuroscience, and Ayurveda. The boon of all three modalities working together to create a healing web is exponentially more useful than a narrow band of only one intervention.
As this is a long road back to balance for this client, there is a positive prognosis. We do not say cure, as the arrow has been shot and the disease is in process, so we cannot know the outcome of this karma. We do know that she is reporting relief from pain and a sense that her mind is clearing. This is our goal with our current treatment plan. We keep revising and assessing as her response to treatment continues over time.
Summary of Client Intake
C.C. was a forty-year-old Caucasian female, legally separated from her husband of thirteen years with whom she shared joint custody of their two children, nine and thirteen years old. She was well-groomed, made little eye contact, and was soft spoken.
C.C. reported being a devout Catholic and said that her faith had been a source of support throughout her life. She presented for treatment stating, “I am not sure you can help me.”
She was referred for Ayurvedic consultation from her psychiatrist, secondary to a recent spike in her depressive symptoms and ongoing issues with pain management. C.C. was diagnosed with fibromyalgia two years earlier along with a concurrent feeling of malaise. Over the past year, she had reported increasing symptoms of “moving pain,” nervousness, and sadness, mild to moderate in range. She was taking medication for sleep support which had been prescribed by her psychiatrist, and an anticonvulsant prescribed by her rheumatologist for the fibromyalgia diagnosis.
Upon intake, C.C. reported the following experiences, all current and ongoing for two or more years:
- Increase in the “pain in my bones” (and joints)
- Extreme fatigue that “comes and goes”
- Trouble getting to sleep
- Difficultly with focus; describes her mind as “foggy”
- Sadness; avoids social situations like family events and engaging with co-workers
The client described the following qualities: pitta-type inflammatory response as seen in majja dhatu with fibromyalgia and sometimes sharp pain, mobile aggravated vata as observed with restless legs sleep issue and the reports of “coming and going” of fatigue and pain. She also reports kapha-like heaviness with fatigue and sadness, and foggy thinking (tamas in quality of the mind). We can break these symptoms down further, but for now this gives us a general landscape to work from as an adjunct Ayurvedic health counselor or Ayurvedic practitioner.
The initial plan was to support her and move very slowly with health goals. Her ability to tolerate change, even for the better, was low. She needed to first build a container of support within herself while working with the dhatus.
Primary Therapy Focus
- Reduce heat in system
- Balance agni
- Contain dispersed energy in the mind and body
- Support internal source of control and natural strengths by building ojas
Client’s Strengths: Willingness to receive support from others (healthcare providers) and fidelity to treatment plan recommendations. Adaptability and willingness to try new things.
Diet and Lifestyle
C.C. reports that she does not like to eat breakfast. She generally has a cup of coffee on her way to work. For lunch, she has a sandwich or gets fast food. In the evening, she makes dinner for the family, for example meat, corn or green beans, and rice or potatoes.
Client describes no regular exercise program, but she will take a walk with her friend on occasion, depending upon pain.
Client reports some digestive discomfort with gas and bloating with loose stools and diarrhea on occasion. She was experiencing tikshna agni, or sharp, quick digestion with excess air.
When asked to rank her stress level from one to ten, client reported “six or seven” due to money issues, child care management, relationship conflict, pain management, and loss of motivation. C.C. was an under-reporter and had some awareness of this as a pattern of not valuing herself in relationships or expressing the intensity of pain and sorrow.
Client reports her typical stress response is a quick temper, and will often break out with adult acne or rosacea. She was experiencing high pitta with rajas in the mind and rasa and raktu, or plasma and blood.
C.C. does not have a meditation or regular prayer practice. Yet she does enjoy going to church when she feels able to do so.
Mornings: C.C. reports waking Monday through Friday at 7 a.m. She reports having busy mornings getting the children to school and herself to work. When she is not working, she is “cleaning house and trying to get caught up.”
Evenings: No real routine. C.C. said, “I’m typically feeding my family and attending sporting events for children,” or watching television and sometimes going online. Her bedtime varies between 11 p.m. and 2 a.m. depending on her restlessness or sleep medication.
Weekends: Sleeps in until kids get up; no routine.
Note: Significant change in daily routine with loss of job.
Client was working as an elementary school teacher until pain and concentration issues required her to leave that position. She now works part time as an office manager for a small insurance company. She reports “missing the kids” and her role as a teacher. Showing signs of grief and tamas.
C.C. was willing to try many of the options we discussed. Our general agreement was to work on reducing her fatigue, supporting her digestion, and stabilizing her daily routine. The issue was that we needed to take this program very slowly as to increase our opportunity for success and her fidelity to making these changes. The decision was made that she would join a supportive and educational Ayurvedic group therapy, “The Balanced Living” group, one time a week. We would meet monthly to work on her individual treatment goals, and check in with a bi-monthly email exchange.
- Stabilize daily eating pattern. Eat three meals a day, with the largest meal in the afternoon. Cook extra food at evening meal and bring with her to work for lunch.
- Only eat warm, moist food (made with easy-to-digest oils like ghee and coconut oil).
- Upon rising, scrape tongue and drink 8 ounces of room temperature water with a big squeeze of lemon to cleanse the system and support lymph and take 500mg of Triphala.
- Daily practice of diaphragmatic breathing three times a day. Start with three minutes in the morning, practice again on work break around 2 p.m., and again in the evening just prior to bedtime.
- Take another 500 mg Triphala with Golden Milk (turmeric 1000mg whisked with 3 or 4 cup soft boiled milk).
Update Thirty Days After Initial Intake
C.C. was having trouble with the dietary changes and wanted snacks. We introduced raw seasonal fruit as a snack two times a day at 10 a.m. and 2 p.m. just after her breathing practice. Other intervention steps continued and we added the following:
- Client to begin gentle yoga using "joints and glands” program, supporting the lymph and endocrine system, for twenty minutes in the morning every day when not attending work (especially on the weekends).
- Client to begin drinking licorice tea at 10 a.m. and 2 p.m. to support cooling and adding moisture to the body.
- Client to begin daily dry brushing and abhyanga with Sleep Easy Oil to support stimulation of circulation and nervous system. This is to be done prior to bathing either in a.m. or p.m., (evenings preferred), to support calming the mind and self-loving activity to encourage self-compassion and acceptance.
C.C. checks in about once a quarter. She continues on her Western medication protocol. There is one change, as her sleep improved consistently and her prescribing doctor’s recommendation was to discontinue the sleep medication. Her pain continues, yet is less intense (moving from a 6/7 to a 3/4 on our rating scale, over time).
We worked together for over a year on establishing a healthy and nourishing diet with all six tastes along with agni support. Our goal was to bring her agni into better balance and we see improvement with regular, well-formed evacuations, less heat in her system overall, and some weight stabilization (not an intended goal of treatment, but she was thirty pounds overweight and the weight loss has been appreciated). C.C. now takes CCF tea daily for digestive support, and uses triphala powder (1000 mg daily) to support her saliva, colon, and digestion. She uses a mouth rinse of triphala in a.m. to support saliva (bodhaka kapha) and 1000 mg p.m. for support with colon and waste management. There are many more tools that C.C. uses for digestive support including a seasonal churna in her ghee in her daily diet.
The sadness and lethargy is where we have focused the bulk of our efforts. Many studies in pain management note that by easing the symptoms of sadness and lethargy, we frequently see client’s report a decrease in pain, both in intensity and frequency. We leaned into C.C.‘s connection with her spiritual upbringing. She began to have a home prayer and rosary practice in the evenings. Once this was established, we explored readings from the Psalms, Upanishads, and other spiritual traditions as sources of a morning focus. Over the course of our yearlong work, C.C. began her day with pranayama and her day ended with a pranayama practice. The depressive feelings were reported, per her psychiatrist, to have decreased as evidenced by “brighter world view, and more balance in daily energy and sleep patterns,” and by C.C., “I can think about what is happening without as much worry” and “I do not feel as alone anymore.” On a "sadness rating scale," her overall score decreased from a self-report of 7 to current level of 3/4.
Pain is real; physical, psychological, emotional, and spiritual. It depends upon how you view pain as to how you might initially engage treating the pain. This seems to be the “miracle angle” in this case. C.C. was able to change her view; from “pain as something that was happening to me” to “my pain was a wakeup call for me.” She is working with the pain and allowing herself to be supported in her daily behaviors, food, internal practices, and support services. Her story inspires me as she could have said no to the treatment recommendations and gone on her way. Instead, she said yes and started the hard work of investigating how to care for herself and look within.