When I was in my early thirties, I started getting tension headaches for the first time. My head felt like it was throbbing, and nothing that I did seemed to alleviate the pain. Advil worked sometimes, but not all the time. A cold washcloth on my forehead was better than nothing. Ativan helped knock me out, but sometimes I would still wake up with the headache. Around this time, I also started getting hot flashes and fever-like symptoms. The combination of the symptoms led me to believe that something was wrong with me, so I did what I always do when I think something is wrong with me. I went to my doctor.
At the doctor, I got a check up and blood tests that came out normal. How could this be? I thought. Something is wrong with me and it’s not showing up. My doctor mentioned that it could be stress. I dismissed this idea as I did not feel overly stressed. The headaches and hot flashes continued and I resumed playing detective. I Googled my symptoms, which led me to remove certain things from my diet including coffee and gluten. At one point I even went on a completely raw diet, which was quite interesting but in no way helpful. I tried supplements of various kinds including Magnesium and Coenzyme Q10. Nothing helped. At some point the intensity of the symptoms gradually dissipated due to no reason that I was consciously aware of. However, the headaches would stick with me for the years to come.
It’s hard to quantify how often I got headaches. Those who suffer from chronic anything know that it just becomes part of your life and you accept it. I accepted my headaches as something that I gained in my thirties and attributed them to my new adult body and the hormonal changes that came with it. I think they came in cycles. Sometimes I might go a while without getting a headache whereas other times they would come in droves. There didn’t seem to be any rhyme or reason to explain when they arrived and when they didn’t. I tried to notice patterns, but the erratic nature of the timing made it difficult. I began to attribute my headaches to stress, not eating enough, not drinking enough, drinking alcohol, and not sleeping well enough. However, there were plenty of times that I was stressed, hungry, dehydrated, imbibing, and not sleeping well and managed to be perfectly fine. Still, all of these things became red flags anyway.
I found three natural solutions that would cure my headaches; running, massages, and sex. I know this sounds weird, but hear me out. I realize the idea of going for a run while your head is pounding sounds miserable. But, somehow I came across this and it worked, every single time. This became my new solution, better than Advil or Sumatriptan. It really worked! Until, it didn’t. At some point, I began to get headaches because I went running. What do massages and sex have in common? They both appeared to cure my headaches for whatever reason. Again, over time the benefits did not seem to be long-lasting and I found that they would only provide a temporary fix. Once the activity was over, my headache would return.
In the summer of 2019, I moved in with my mom and brother. I had been saving money while in grad school and free rent was a huge way to do it. Immediately after moving in, I started sleeping terribly. I knew it had to do with the fact that I was now on the second floor which was much warmer than the first. Also, my brother would come home late from work and wake me up, for example by playing the piano at midnight. So, I started sleeping with earplugs.
My running seemed to be affected by my lack of sleep. I didn’t feel like I was performing to my potential during training or racing. One completely out-of-the-blue night, I had this terrible pain in my left leg that plagued me during the night. I tossed and turned the entire night, totally aware of this new pain in my body. The next morning, I couldn’t even touch my toes on the left side. My leg had totally tightened up. I began to wonder how this could have happened and my mind immediately went to the fact that I had a soccer game the previous night and must have done something to cause this. While I didn’t remember anything specific or traumatic happening the previous day, I knew this had to be it. I always knew it was a bad idea to play soccer when it could cause an injury that would pull me from running. This tightness in my leg turned into a full blown hip injury that stayed with me for about a year.
That fall, Yuch and I went to London for three months and in some kind of miracle, I slept well the entire time there. My bedroom was cool and dark. Unfortunately, my hip and running still felt bad. I began to notice that I felt really out of breath when running. An 8:30 pace felt fast, and speed workouts with the Ranelagh Harriers felt increasingly difficult. I caught a cold which took six weeks to get over (that’s exactly half of my time in the UK). I got the opportunity to run in so many new and interesting places during our trip and I felt depleted on nearly every run.
Returning to the states, my bad sleep trend resumed as I had left it. I continued to feel crappy while running and decided to see a physical therapist for my hip. He told me my core was likely not strong enough and gave me exercises that would strengthen my core and therefore my hip. I got blood tests that confirmed I had extremely low iron and proceeded to go on an iron supplement. I felt like I was making huge progress. The iron had to be the reason why my running had felt so bad the previous summer.
My iron levels returned to normal. Unfortunately, my hip did not seem to be improving with the physical therapy exercises that I was now doing religiously every day. In fact, my hip seemed to be worsening! After being sent home due to COVID-19, I was now doing remote grad school and spending a lot of time sitting at my computer. This had to be the reason why my hip was worsening instead of getting better. I set my laptop up on my dresser and began to spend the majority of my classes standing up. But after a while, this began to exacerbate my hip, too. I decided it was not good to spend a lot of time sitting or standing, so I transitioned to a combination of the two.
That summer something happened that was extremely eye opening. On the drive back from a week at Buck’s Lake, I noticed my left leg was particularly sore. I decided it must be due to the long drive. By the time I got home the sole of my foot was radiating with pain and it was painful to walk on. Arriving at home, we immediately began a conflict with my brother and the evening ended in a raging headache and going to bed early. In the morning, I awoke to all of the previous symptoms gone, but a new one had had arrived. My butt was extremely painful to the touch and I could not sit down without feeling pain. This was the last piece of evidence I needed. I realized my body was completely out of control and not making any sense, so I decided to go for a run. I ran for 3 miles and felt better than I had in a long time.
I had heard about psychosomatic pain before. On my first date with Yuch in 2015, he told me about his experience with it and all about Dr. John Sarno, the man who coined the term tension myositis syndrome (TMS) to describe physical pain caused by psychological affliction. Sarno’s theory is that the brain produces physical pain as a distraction from repressed psychological emotions, and this illness is the common cause of chronic back pain, migraines, etc. Common symptoms include no clear reason for the physical pain (as shown by MRIs, blood tests, etc.) and pain that “moves around”. It made sense to me, despite the fact that there wasn’t a clear mechanism to explain how this actually happened.
I realized that my hip “injury” was not a physical injury (involving muscle or structural damage) after all (as evidenced by my ability to run without pain once accepting this psychosomatic diagnosis). Moving in to my childhood home and starting grad school had been a stressful experience for me, and this must have caused the pain that I was experiencing. As I began to become more mobile and pain free I realized that I did in fact have some tightness in that left hip. It became clear to me that I must have had tightness there all along, but my brain had magnified it to be something much much bigger.
My hip pain of nearly a year went away completely. My iron levels were back to normal. But, the stress in my life continued. My mom was diagnosed with Mild Cognitive Decline, my brother with ASD was continuing to wreak havoc in the household, stomping around at the slightest noise despite me and my mom’s constant effort to tip toe around the house. I made it my priority to manage all of my mom’s appointments in addition to our meetings with a family psychologist.
I was not able to de-stress in my usual way – with exercise. Running continued to feel terrible, even though my hip was better and my iron levels normal. I felt completely depleted, and I wondered if there was something more serious wrong with me. My legs throbbed, I would get headaches after every run, I couldn’t focus on my schoolwork, and I couldn’t sleep. A short easy run left me completely wasted, often forcing me to lie down during the day. However, napping was impossible and I would lie awake twitching, often feeling even worse than I did before lying down. I saw a sports medicine doctor who diagnosed me with Overtraining Syndrome (OTS), despite the fact that I had not overtrained. I stopped running, which is the only known “cure” for OTS.
My second semester at SFSU had begun, and I felt like I was drowning. The workload was not drowning material, but my fragile emotional state was incapable of handling it. A simple assignment that I could not wrap my head around (coincidentally, a literature review on OTS) caused me to doubt myself, panic, and consider dropping out of school. I constantly told myself that I had made a big mistake, that I was stupid, and that I was not cut out for this. I cried for days with so much emotion that I had a constant headache that made me cry even more. I am a hugely productive person, and being incapable of “producing” was pretty much my worst nightmare. Not only could I not work, I couldn’t even relax. I was physically and psychologically in hell.
I decided I need help to get through the rest of the school year. I called Kaiser and quickly got in touch with my psychiatrist and a therapist. I was prescribed Zoloft, a medication for anxiety and depression that I had taken many years ago. I stopped in 2008, the year that I started running. Even before starting the Zoloft, I began to feel better. I knew that help was on the way and that I wouldn’t indefinitely cry myself into a useless puddle, incapable of finishing grad school. Zoloft takes about 4 weeks to start working, but I was already starting to feel better. This is called the placebo effect.
I first noticed the actual effects of Zoloft on a bike ride. I had taken up cycling during my time off running, and I enjoyed listening to music while feeling the breeze against my skin. But, going downhill scared me and I typically braked the entire time. One day, I found myself biking down a long descent without braking. It wasn’t until after the bike ride that I realized what had happened. My anxiety had gone away.
When you’ve been living with anxiety for a long time, you don’t think of it as anxiety. Anxiety became a part of who I was, and it was something that I thought was unchangeable. I think I actually may have even been stubbornly attached to my anxiety. It’s not that I enjoyed it. I desperately wished I was a different. But I accepted that this was simply part of my make up. But wow, living without anxiety was amazing. It’s not like I suddenly became a dare devil. I’m a thoughtful and prudent person. I just didn’t have the same fear attached to everything that I did. Things became easier. As things became easier, I was able to welcome meditation, talk therapy, and a regular breathing practice into my life. Mentally, I felt great. Physically, I was still suffering. If mind and body are so intimately entwined, why were they not in sync?
Frustrated at my lack of physical progress, I contacted my sports medicine doctor. I had taken two months off and was feeling physically worse, not better. Breathing was labored while running, and my heart rate seemed consistently high. I couldn’t even dance without breaking into a hot flash. His immediate response was to once again send me to the lab for blood tests and to get an EKG. I guess I should have known better than to complain of labored breathing during COVID. I knew it was a waste of time and that nothing was going to show up. I knew my pain and fatigue was psychological, but I just didn’t know how to fix it. I had fixed my hip pain simply by accepting it was psychosomatic and telling myself nothing was wrong with me, but that method was not working this time. I was meditating and breathing every day, yet it didn’t seem to be making a dent in my physical situation. While writing my literature review on OTS, I had learned that the majority of sufferers didn’t even overtrain, but a commonality between them was that they had experienced some kind of major life event during the onset. Part of me still was not able to fully grasp the concept that my brain could cause such real sensations of pain. I decided I needed the lab & EKG as evidence for what was about to come next. As predicted, the results came back perfectly clear. So, I decided I needed to take the plunge and seek expert advice. I contacted the Pain Psychology Center in Southern California.
Upon contacting the Pain Psychology Center, I was set up for a 15-minute free consultation. I desperately wanted to tell them that I had OTS, and I imagined them responding “Oh yes, overtraining syndrome…we have seen many patients like you and this is indeed a common psychosomatic illness”. However, the person that I spoke to had never even heard of it before. She asked me to explain the symptoms. I told her. Fatigue, headaches, hot flashes, insomnia, labored breathing, elevated heart rate, and decreased performance. She told me that while she had never heard of OTS, it didn’t matter. It was just another syndrome, and all syndromes are just a group of symptoms. She confidently told me that she thought this was something they could help me with, and set me up for another free consultation with the therapist that I would be seeing.
I repeated my symptoms to the therapist. Like the receptionist, she had not heard of OTS. Like the receptionist, she was confident that she could help me. I told her I was just so frustrated because I was meditating and breathing every day, felt psychologically better than I had in a while, yet my body did not seem to agree. She said something like “During our time together, we are going to work on integrating these techniques (meditating and breathing) throughout your day”.
I felt hopeful. So hopeful that I started to gradually feel better already. With my excitement, I began exploring the Pain Psychology Center’s website. Alan Gordon is the executive director of the center, and created it after recovering from his own experience with chronic pain. I found out that he had a podcast, Tell Me About Your Pain, and began binge-listening to it the entire week before my first appointment. I absorbed every episode like a sponge. Then a light bulb went off. Alan Gordon’s description of psychosomatic pain was slightly different than John Sarno’s. While Sarno theorized that the brain could produce physical pain in response to repressed psychological emotions, Gordon discussed the brain’s ability to condition itself to physical pain. While he acknowledged that chronic pain could be psychological in nature especially at the onset, the mechanism involved in the persistence of pain added an additional layer that Sarno seemed to have missed. That layer was anxiety and conditioning.
The world of psychology learned about classical conditioning from Pavlov’s dog. From his research, Pavlov found that the dogs’ salivation was a learned response, when the dogs transitioned from salivating at the arrival of food to salivating at the sound of a metronome. My experience was no different. I had conditioned myself to feel all these physical sensations after exercise. Running was no longer just running, but a whole package of anxiety and fear that I would feel crappy. I reinforced these feelings by sending constant messages to my brain that running = danger and that days off = safety. I reinforced this anxiety by constantly Googling my symptoms, catastrophizing at the slight onset of a headache or any other physical symptom, reaching out to doctors, constantly associating physical pain with tissue damage and physical activity, and reading study after study on OTS. For years I had been throwing gasoline onto a raging fire without even realizing it. If I had been conditioning myself to associate running with fatigue and pain, I could condition myself out of it.
Deconditioning myself from my so-called “Overtraining Syndrome” was similar to how I recovered from my so-called “hip injury”. I constantly told myself that nothing was wrong with me, and instead of catastrophizing at each “bad” sensation I felt, I sent my brain messages of safety instead. My condition improved dramatically. I thought about what my therapist had said in the consultation about integrating meditation and breathing into my day. What did she mean by this? Another light bulb went off. What is the point of breathing for 10 minutes every morning, when I could take a few deep breaths throughout my day when I notice myself becoming stressed or anxious? I began to integrate breathing into my day at opportune times. It worked.
By the time it came to have my first appointment with my therapist, I had listened to most of the Tell Me About Your Pain episodes, had already begun deconditioning, and felt 99% cured. However, I decided to stick with the first couple of appointments anyway because knowing my luck, this was not going to be as easy as I thought. I was right. The pain came back, and my therapist provided me with several tools to approach it. One was somatic tracking which is similar to meditation. You sit with the pain (or “sensation”) and explore it from a non-judgmental perspective. (This is not recommended when the pain is full on raging!) I tried this at the onset of headache. I thought about what it felt like and where it was located. Did it radiate, or was it centralized? If I were to compare the pain to a color was it yellow, orange, or red? The pain began to shift. Soon, it had completely dissipated. I had used my brain to stop a headache in its tracks! I felt like it was a magic. But I am not a magician, and my therapist assured me that it was not magic. It was science.
From the moment I decided all my symptoms were psychosomatic in nature, I was 100% pain free for 2 weeks. Then the symptoms came back, and I continued to fight with all the tools in my toolbox. Sometimes they worked and I could stop the pain in its tracks. Other times I was not so successful, but I noticed the symptoms would be much less severe and didn’t last half as long as they used to. I stopped seeing my therapist and downloaded the Curable app, as $60/year is much more affordable than $180/50 minutes for a grad student. I continued absorbing information on psychosomatic pain and listened to a new podcast sponsored by Curable called Like Body Like Mind. Over time, the symptoms completely went away.
I no longer experience pain and fatigue after running and I don’t get headaches either. I used to associate alcohol with headaches. I can now drink alcohol whenever I want with zero worry attached. I used to associate running with fatigue and pain. I now experience the same fatigue and pain as everyone else does after a hard effort. I am running better than I ever have and it’s not because I’m physically stronger than I’ve ever been. It is because I am mentally stronger than I’ve ever been. I breathe deeply throughout the day when I notice myself becoming anxious or my breath rate becoming faster. It is rare these days, but in the event that I start getting a sensation in my head similar to what I might have called a headache in the past, I say “Thank you body for that alert. I hear you and I am going to take a break”. I do not catastrophize about the loss of productivity that will follow from the raging headache that I am about to experience.
My experience with chronic pain has helped me tremendously in other areas of life, specifically my relationships. I realize that I am anxious, that I catastrophize, and that I’ve constantly feared the worst. By doing the opposite, my relationships with people, myself, and the world around me has profoundly improved. I am, for the first time, truly loving life. If you have not experienced chronic pain or a chronic injury, it may be difficult to understand how miserable and all-encompassing it can be. It can be difficult to understand how amazing it is to not have it, to just feel “normal”. Life is hard as it is, but when you feel physically bad, it’s even harder. That being said, I am eternally grateful for my experience with chronic pain, because I now realize that I have a totally sophisticated and amazing internal alarm system. It tells me when I’m doing too much, when I’m struggling, and when I need to back off. The brain is an amazing thing. By learning to work with it instead of against it, I was able to shift from being a victim to being in total control. Too often we associate physical pain with physical activity that we did, whether it be lifting a heavy box or picking up a pencil. I’ve learned that our brains are capable of communicating so much more, and that it is time to think of the mind and body not as two things, but as one extraordinary and intimately connected machine.