Life and Death Stakes: A Chronic Pain Case Study - An excerpt from chapter 7

Chapter 7: Final Remarks on Posture Therapy

“Change is elusive because it requires a leap of faith. It requires trust in yourself… Our world is full of well-intended experts… But our experts’ beliefs fail if they don’t match your reality, your wisdom, and your instincts.” - Pete Egoscue

The previous chapters are a thorough starting place for understanding posture therapy, but there is much more to learn for the interested parties. This comes not just from the hundreds of exercises designed to improve posture. The real skill and art come in the form of functional testing and fitting those hundreds of exercises into the proper sequences to effectively relieve symptoms while accurately predicting the ones likely to worsen symptoms. This kind of finesse only comes with experience.

In this chapter, you’ll find the broader aspects of applications and contraindications. I firmly believe that just about everybody can benefit from applying posture therapy to their lives in one way or another when the time is right. That being said, just like any other treatment protocol, there are proper and improper situations and conditions in which this technique should be relied upon as the primary impetus for change. Sometimes, it’s the appropriate treatment but not the proper time. There is a necessary nuance to this aspect of posture therapy. I’ll do my best to present some practical general guidelines to help navigate the murky waters of chronic pain.

This chapter also addresses what I see as the only real drawback of standard, non-psychedelic posture therapy: the length of time it can take to see results in some cases. 

On one end of the spectrum, we can consider a client of mine who had among the most severe forward head position I’d ever seen, along with awful neck pain. He sent me pictures three days after starting his routine and when I saw the notification I thought maybe he had some kind of problem he needed help with. Instead, I opened the image to see that his head had returned to an almost neutral position, and he reported that the pain was gone! I was dumbfounded as I’d never seen a deviation that dramatically out of whack get fixed so quickly. But this case is the exception, not the rule.

More often than not, people with truly treatment-resistant chronic pain will need several months to achieve significant, life-changing results, but it can even require years. Most people who start posture therapy make it to the end and find relief. But some people don’t, and after reaching a “tolerable” pain level they choose to chase the repeated instant gratification of treatments that only reduce symptoms temporarily instead of doing the work to continue fixing the root causes. A small portion of people progress incredibly slowly for reasons we’ll get into when we talk about contraindications.

When it comes to treating treatment-resistant chronic pain, the stakes of taking too long to make the pain stop can be life or death. I’d like to share a case study with you that demonstrates how critical it is to find ways to decrease the amount of time people spend betting on such high stakes.

The High Stakes of Severe Chronic Pain

Most people I’ve worked with one-on-one are already at a point where the options available through the medical system have been exhausted to a large degree or even completely. Sometimes, they’re at the point where a last-ditch effort at invasive surgery is on the table. Other times, they’ve already had one or more surgeries, and either it didn’t work, or it simply caused the pain to move to another area of the body that began compensating after the surgery. Sometimes, there are no further options at all, and people are at a point of hopelessness like I was before I found posture therapy.

When I first started providing clients with one-on-one posture therapy services, I saw success after success. And thankfully, I still do for the most part! The feeling I get from empowering others to reduce their own pain is unlike anything I have experienced before. I don’t heal these people. They heal themselves with a little bit of guidance from me. And that’s what I want! I’m no longer dependent on anyone else to stay pain-free, and this level of empowerment is what I aim to teach my clients to achieve.

But in the spring of 2022, I got my first truly tough case: a woman in her mid-twenties whose neck had been injured in a car accident the year prior. Before her accident, she was in great health. She was extremely physically active and worked at an unusually high-level position for her age. She was a high achiever in most aspects of life. Yet, a few months after her accident, she was not healing. Instead of getting better, she was getting worse. The pain started spreading from her neck to other areas of her body. The physical therapy and various pain management techniques available to her through insurance mostly provided temporary relief, but the trend was a steady increase in overall pain levels.

Her doctors couldn’t find any causative reasons based on her scans, much less anything operable, as the initial injury had healed. Diagnoses like fibromyalgia and chronic fatigue syndrome were starting to be considered. She had started trying alternative treatments to no avail, aside from some minor improvements with a bodywork person of some kind who specialized in pelvic floor work. I think it was this provider who told her that they thought it might be something to do with her posture, but they couldn’t provide much concrete guidance on the subject. She started researching this new avenue and found my YouTube channel. That’s how we met. 

She was on a leave of absence from her job under the Family Medical Leave Act (FMLA). She was living off savings and a portion of her usual paycheck from a short-term disability policy she had through her employer. She could no longer perform her duties at work while suffering from constant pain, attending several medical appointments per week, and performing physical rehabilitation for hours on end every day. 

On top of all this, she had to do it while hobbling around like someone 60 years her senior due to how badly pain restricted her overall movement.

At this point, she had less than 50% of the range of motion in her arms. Her neck was restricted to less than 25% of the full range of motion. She could rotate her spine only a few degrees each way. She had to turn her entire body to look to the left or right. Her neck, shoulders, hands, upper spine, lower spine, hips, and, most recently, her ankles were in constant pain. She was terrified that it was only a matter of time until the pain spread to the rest of her lower body, just as it had invaded her entire upper body. Her balance had been impacted ever since her neck injury. Getting up from a seated position or the ground was a monumental effort. Like walking a high-wire, any abrupt movement was met with severe consequences. She had almost completely disengaged from her social life because it was simply too painful and stressful to leave the house unless absolutely necessary.

Her story echoed my own to such a large degree, and I felt just as anxious to get underway with her therapy as she did.

We started working together every week. Learning the exercises was incredibly difficult for her. She moved through each exercise slowly and deliberately to ensure proper form. Switching from one exercise to the next was exhausting for her, and what would have been a 30-minute routine for most people might take her 2-3 hours or more. But she did it every day. She was determined to make progress. 

 She was up to about 60% range of motion in her arms within a few weeks. She was having an easier time returning to a standing position after being seated or on the ground. 

A couple of weeks later, she could rotate her neck more, and she didn’t have to turn her whole body to look to the left or right, like before.

A month later, she was getting to where she could raise her arms well above her shoulders. On a good day, getting up from the ground was no longer an ordeal. She told me that she had gone for a short bike ride up and down her street one day, one of her favorite forms of exercise. She actually left the house to have fun a few times, had met someone, and started dating. But as it goes with recovery from chronic pain, her progress was far from linear. She still had bad days where just getting through her routine was all she could manage for the day.

Then, she had a setback in her progress due to a fender-bender. I could see the impact her mental health had taken. I could empathize with it as well. During my recovery, I experienced dozens of setbacks, and I implored her to stay the course. Thankfully, this wasn’t a major setback. Within two weeks, she started seeing some minor progress again.

A week later, she reported that her FMLA time was ending soon. Her employer wasn’t willing to bring her on part-time, and her time was still mostly consumed with just trying to keep improving. Her insurance company denied her long-term disability claim, saying that none of her scans showed anything corresponding to the level of disability she reported. Since her doctors couldn’t explain why she was in pain beyond suggestions of fibromyalgia and chronic fatigue syndrome, her claim was rejected. It didn’t matter that she was in pain. It mattered only that her doctors couldn’t explain the severity and exact causes. 

This is Something I Could also Empathize With

I had been through a situation just like this with taking FMLA time, short-term disability, and having to fight tooth and nail to get long-term disability. While I did return to work part-time after my FMLA time, my return to work meant I could no longer focus exclusively on my recovery, and I soon began regressing quickly until I could no longer perform my job duties. 

We even had the same long-term disability company. My long-term disability was initially denied for the same general reason that my client’s was. I had spent hundreds of hours dealing with them, so I knew all too well the endless red tape, paperwork, and faceless bureaucracy they were using to weigh her down. But more importantly, I knew how to navigate it. She knew all this from my marketing material and our conversations during our sessions, and she asked for my advice.

I advised her that she could do what I did: find a disability lawyer as soon as humanly possible, one that doesn’t charge you unless they win the case. Gather copies of the most relevant medical records and have them on hand to give to the lawyer right away. I told her to ask the lawyer if she should apply for Social Security Disability now or later. After she found an appropriate lawyer she would need letters from as many of her practitioners as she could manage, arguing her case. So, the next step was to call each office to find out who could help.  

Those were the two main components that won me long-term disability. I offered to write a letter to the insurance company describing her condition and what was necessary to keep her on track for improvement. As our time together had resulted in the most tangible progress she had made since her injury, I thought my words might hold some weight.

My parents had to pay a doctor almost a thousand dollars for his time spent writing a 7-page dissertation on why I needed long-term disability, and this turned out to be the crucial piece of evidence in my case. I also advised her that I had to go without income for almost seven months while I waited for the lawyer and the disability insurance company to settle, so she needed to get this process started as soon as possible. I told her she would get through this, but it would be a fight. I knew money would be tight when she lost that partial paycheck, so I told her she could pay me for my time writing the letter when she won her case and got all the back pay as a lump sum.

Eventually, our session came to an end. She said she was ready to enact this plan we had devised together. I asked her to repeat it back to me to make sure she knew what to do and we scheduled our next session.

The following week, she missed our appointment. She had missed one session another time when she was busy with doctor appointments and whatnot, so I didn’t worry at first. When she didn’t respond after a day, I knew deep in my soul that something had happened. I began calling, texting, and emailing daily, hoping for a reply. After a week, I spent a day tracking her down on social media, hoping to find that she had posted about losing her phone or even being hospitalized. I sent her messages everywhere I could find her but received no reply. I googled her name and city but no news stories were coming up. Finally, after two weeks, a post appeared on her Facebook page, written by a family member, saying not much more than that she had passed.

I was devastated. This was my first time experiencing how quickly things can go wrong when pain isn’t healed quickly enough.

I messaged what family members I could find, hoping to learn more information, but never received a response. I don’t fully know what happened to this young woman, and I suspect I never will. But at the same time, I do feel like I know because I lived through a situation that mirrored hers so closely and had nearly taken the final solution thousands upon thousands of times.

This Experience Changed the Course of My Life

I felt despair at a deep level, and naturally, I began to wonder how this could have been avoided. Also, I was probably looking for someone to blame.

What if the medical system hadn’t failed her? The only reason we ever met was because she couldn’t get any meaningful help from the medical establishment.

What if she wasn’t facing financial strain because of disability? I still harbored resentment toward that insurance company at the time for how they had treated me, canceling my policy while I was still in a wheelchair. It was easy to direct blame at them. 

What more could I have done to help her faster? Was this my fault? Her progress was on track with my expectations. Even then, knowing how it ended, I couldn’t find anything I would have done differently in creating her posture routines. They were working. Even after a setback, they were working better than anything else she had tried. She knew this, and she had told me how relieved she was just to be progressing at all, over and over again.

From my own experience, I knew all too well that it just takes more time than a few months when starting from a place that severe. I also knew the only thing that ever noticeably sped up the process for me was psilocybin.

At this point, I had absolutely no formal training with psilocybin, just my own limited experience from well over a year before. I hadn’t told anyone outside of my parents and my girlfriend about how psilocybin had helped me get past my final hurdles and fully heal myself because I was afraid of the stigma that society put on psychedelics. My experience sounded crazy even to me when I thought about trying to explain it out loud! What in the hell would other people think? I wasn’t well-versed in the science of psychedelics at that point, I couldn’t explain what had happened to me, and it had never before occurred to me that this might work for other people. But my client’s death played a large role in spurring me to action.

I decided that I had to learn more. I needed to develop a protocol that made the kind of healing I had experienced repeatable, which meant lots of studying to make a testable hypothesis as to what had actually happened to me. The remaining chapters in this book distill many of the things I learned about while achieving this goal.

I had to learn how to facilitate psilocybin sessions, eventually finding a mentor who has administered over 3,500 doses of psilocybin in Eric Osborne, of Psanctuary. Chapter Ten discusses the protocols I developed to mitigate risks and guide people through a psychedelic posture session with optimal chances of success.

I also had to test that hypothesis on myself first. Cycles of refining and retesting the technique.  Then I was ready to try it with another person. And so on.

I did all this while continuing my work in standard posture therapy, seeing well over a hundred clients over that time. By the summer of 2023, I was ready to make the shift toward a career focused on psychedelics. 

I had to make connections in this area and spread the word. I attended the 2023 Psychedelic Science conference hosted by the Multidisciplinary Association for Psychedelic Studies (MAPS for short). From mingling with the 12,000 or so people there, it became apparent that while psychedelics were making a splash in the world of mental health, there were very few people out there talking about its potential applications to chronic pain. The mentions about chronic pain I could find were mostly in regards to reframing people’s relationship to their pain, not resolving it. I decided to start a podcast about psychedelics and chronic pain, as well as write this book.

But there’s one more important topic to cover before we shift fully into our discussion on psychedelics, and that is applications and contraindications. Posture therapy is excellent for many pain conditions. There are also comorbidities that can impede progress and increase the amount of time it takes to work.

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