Dr. Lilia Graue on Pain and Recovery

Dr. Lilia Graue has had a private medical practice in Mexico City for the last 18 years. In addition to mind body medicine and psychotherapy, she has significant experience in the field of eating and weight related concerns. She lives with her partner and three cats, and enjoys baking sourdough, swimming, and practicing yoga and meditation.

Q: Hi Dr. Graue - thanks for joining us! We’d love to hear a bit about how you came to be interested in treating pain. What was the moment you knew this was the right fit for you?  

A: When I myself recovered from persistent pain through a mind-body approach, after almost 10 years involving an injury, three surgeries and multiple failed treatments, and almost having lost hope. 

In 2011 I suffered a back injury that resulted in a disc extrusion with neurological compromise. The pain was excruciating. I couldn’t walk, move, or sleep, and it got progressively worse. In 2012, after multiple failed treatments, I had surgery. There were complications from the surgery, and in 2014 I had surgery again. With rehab, I recovered from the neuropathic pain, and regained sensitivity, strength and reflexes. However, I was experiencing persistent lower back pain. Throughout the next years, I tried everything (or so I thought) — tons of PT with different approaches, medication (Lyrica, Tramadol, NSAIDs), surgery, acupuncture, mindfulness, hydrotherapy, osteopathy, psychotherapy, therapeutic yoga, supplements, healing sessions with a medicine man, sweat lodges, Reiki, massages, you name it.  My mindfulness and self compassion helped to live with the pain, and my yoga practice helped me find some ease and comfort in the presence of pain. The sessions with the medicine man helped me feel more whole and connected, as did acupuncture, but nothing really alleviated the pain. The only two things that seemed to help lower the intensity of the pain were swimming (as long as I had access to a pool two or three times a week) and CBD oil, which I discovered in 2018. Together, they made my pain tolerable most days, though I was still in pain most of the time, and often the pain kept me awake at night. I resigned myself to living with chronic pain and trying to cope as best I could with that reality. And then the pandemic came, and with lockdown I had no access to a pool or to CBD oil (due to changes in supply). My pain got worse and worse, until by the summer I was bedridden. As I shared my despair with close friends, three of them separately recommended the Curable app. Within a month I was experiencing some pain free days. I then joined a Curable group and 2 months into the program I was pretty much pain free. My healing process involved learning about the neuroscience of pain, retraining my brain with numerous strategies including safety reappraisal and somatic tracking, working on my relationships and boundaries, doing deep healing work for the imprint of childhood trauma, continuing to practice meditation (mindfulness and compassion) and yoga, graded exposure to exercise, journaling, being supported by my partner, family, and close friends, as well as by my Curable buddies, and deliberately cultivating joy, gratitude, and a feeling of safety. 

(You can read more about my recovery journey here (1).) 

Q: People coping with pain have often had negative experiences with providers. What is one thing you wish every care professional knew about chronic pain? 

A: All pain is real and people experiencing pain need to be treated with kindness, compassion, care, and curiosity about their lived experience.

Q: Pain treatment has made incredible advances recently. What do you think is the most exciting advance or research out there? How come?

A: Our current understanding of neuroscience and how pain can be unlearned through our brain’s ability to create different neural pathways, known as neuroplasticity. As we practice other ways of thinking, feeling, acting and being, transforming our relationship to pain, we can create new neural pathways. It opens possibilities that were unimaginable before. For me, some of these possibilities have included: sitting in any chair for as long as I like; traveling without fearing plane seats, strange beds or pillows (and without bringing my own pillow with me everywhere); exercising as much as I want, whenever I want and enjoying the feeling of being sore after a strenuous workout - so different from the pain I used to experience; greeting people and having long conversations that no longer include a ‘how’s your back doing?’; choosing whether I want to do (or not) certain things for reasons other than my pain (that one’s a challenge sometimes, to be honest). And the biggest one, that still feels close to miraculous: waking up every single day free of pain, and going about my day freely without fear that something will trigger pain. Most days I barely even remember that I used to have pain!

Q: What do you think are the biggest challenges for pain care today? 

A: Challenging the traditional understanding of pain: People are misdiagnosed with structural causes, prescribed surgeries or opioid medications which only make central sensitization worse and lead to further impairment; Others are dismissed as having "imaginary" pain and no one is well served by this approach. Another challenge is incorporating trauma-informed care that can help people make sense of how experiences of adversity can result in neuroplastic pain and other "functional symptoms."

Q: On the one hand, pain is very much a subjective experience. At the same time, one of the most distressing things to hear as a pain patient is that it's "all in your head." How do you approach this with the people you treat? 

A: I start by saying in no uncertain terms that all pain is real and the mechanism of how pain is created in the brain is exactly the same whether there is a structural cause or not. I go on to offer some pain science education at the same time as bringing forth examples from their own life. Depending on the person and context, I sometimes bring in a little humor, joking about how all pain is in our heads in a way, because the brain is inside our heads. I also highlight how our conception of the separation between mind and body is an arbitrary and not so useful one. If they have been dismissed in previous encounters with health professionals, I validate how distressful and harmful that has been, and ask what would be useful from me.

Q: Thanks for such an informative Q&A! Where can we find more about your work? 

A:  https://liliagrauemd.com/

Q: Last question: what do you like to do for fun when you aren't curing pain? 

A:I love baking (sourdough and all kinds of desserts), cooking, reading, playing with my three cats, hanging out with my partner, family, and close friends, traveling, and moving in ways that feel gratifying - my favorites are swimming, yoga, walking, and kickboxing.