Anticipatory Grief / Education Focus: Pain

Updated: Aug 7, 2020

Here is to another month of ZOOM, a word I have come to love and hate, as I am sure we have all. At InsideOut we are always trying to make it interesting and fun and hope to come up with more ways to inspire you and keep you healthy and fit.

This newsletter changed course during the last 4 weeks. Some feedback from our last newsletter was key in my approach this this one. Most of you don’t know me and I didn’t even sign off the last newsletter with my name. It was an intentional omission, trying not to make it about me or too personal - but the comment gave me pause to reflect. I have always been discreet and private, especially is regards to Jay’s work. So in this newsletter I thought I would share more of myself, my thoughts, and some words of encouragement. Jay and I are quite different you see, in fact we are an unlikely couple. He is the hyperactive energiser bunny to my introverted and more intense nature. We always had a goal of working together in some way and would never have thought it would be in these circumstances.

We are a cup half full kind of family. We are very close – and lockdown has been surprisingly easy from that front, in that we are very grateful. We used to long road trips and 12 hour days in the car (visions of the bush, mountains and desert). I must point out though, that the last few weeks have been really, really hard. This lockdown rollercoaster is real and I was having a real caronacoaster dipper the last few weeks. Not being able to see family and friends, go out on our road trips, camping, restrictions and rules but most of all the strong sense of powerlessness to suffering that has eaten away at our souls. I am acutely aware that our difficulties are “first world" problems, that we are very privileged in our perspective of the world - which makes watching the pain around us deeply hard to swallow. Our emotional reserves have run low, as with many of you reading this.

I follow many news sources, one being the “Good Things Guy”. I had an Oprah “aha” moment when I listened the podcast on Anticipatory Grief. I realised this summed up my feelings and helped me again realise that we are not alone. We are all struggling to stay motivated, in work, in life, and in health. The world is in a state of chaos, polarisation and pain - and we all feel a bit hopeless. I know I do. It is rather hard to admit when I am the eternal optimist. Little over a week ago I had a real low. I allowed myself to be sad. I wallowed in “world“ pity thinking about the condition of the people all over the world and what they must be experiencing. Loss of life, loss of health, loss of freedoms, loss of income. I realised with the podcast that I was grieving and I learned for myself that it does not have to be about personal loss, but that I am feeling the collective loss of those around me, friends, family and strangers.

So what do we do with these feelings? Sure, I started with my usual Marie Kondo’s tidying up magic, but the joy was limited as I had already decluttered during early lockdown. I have officially run out of things to organise, minimise, and optimise. I am usually focussed on solutions, being proactive and try not give to much time thinking of the problem. This is why it was hard to allow myself to be sad. I have come out of the experience realising how much I needed it to move on.

Then one of the many announcements we had waited for arrived, we can travel locally for a weekend! This is our small light in this dark tunnel (co-sponsored by Eskom). We need to look towards the light. Find your light, your inspiration, whatever it may be. We need to grieve to reach acceptance. Grieve the real losses, but also the anticipatory losses. I know and deeply believe that sometimes the greatest magic in life is born of the darkest times. So read that book, watch that series, wallow if you need, but then look up. There is hope, you are not alone, and you will get through this.

I am Carmen, the “wife” as you may know me 😊. I prefer to be quiet in the background, but I am also known to have a lot to say – sometimes too much. I am a Physiotherapist, a profession I consider a privilege and deeply passionate about. I believe that to help someone on the outside – we must often look inside too. I have listened to Jay for years talk about you awesome ladies. You have been such a source of inspiration to us both and we thank you for that - I thank you for that .

Education Focus – Pain

“An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage” (International Association of the Study of Pain, 2011)

The understanding and treatment of pain has changed dramatically in the last 10 years. What used to be understood to be a sensory experience has been proven to be much more than that. The full experience of pain is not just about what you have “hurt” but also the full experience, emotional and historical associations, fears and perceived fears. By extension, the management of pain must look at these factors too.

Professor Lorimer Mosely and Dr Adriaan Louw are two of my favourite presenters on the subject and I highly recommend a google search if you interested on more information on the topic, their YouTube videos are excellent.


I have noticed that there is an uptick of cases of injuries/pain with associated upregulation of the nervous system. I believe this may likely to related to the increase anxiety and stress. Upregulation of the nervous system basically means the nervous system becomes more active, more sensitive. It is a basic human response to stress, “fight or flight”, that we are more alert and aware, to what we feel. It is our bodies way of protecting us. Pain is in itself a warning system to us that something is wrong and needs attention, such as, but not limited to, an injury or pathology. Once we know the source of the pain and can determine its threat level, our experience of the pain can increase or decrease, just like a fear response. We are often afraid of what we don’t know or understand and a google search can often play into those fears. A lifetime of experiences plays an important role in your brains ability to determine threat. At the moment the heightened levels of stress and uncertainty will increase associated fears in turn causes a more intense experience of pain.


What do you do if you are in pain? First determine the source. Did you get injured? Is it postural? Is it a chronic pain or an old injury? Understanding your pain, the source of your pain and the factors that may contribute to increasing it you will be able to manage and treat it better. Sometimes you need help on that journey and need help treating it – remember to ask lots of questions, understand your pain and be part of the solution.


Understanding educating yourself on your body and its limitations will help you lead a more conscious and healthy life. Somethings you will be able to “fix” (for example an ankle injury) and somethings will always be there and need management (such as arthritis). Most importantly don’t ignore pain or just cover it up. It is our bodies way of warning us to pay attention to something.


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