Kelsey Roseth has gone mountain biking and hiking, swimming and snowboarding. She has ridden on friends' four-wheelers and horses.
The 30-year-old North Dakota native has a natural affinity for an active, outdoors lifestyle.
But for the past seven years, it has been a lifestyle with limits.
"All those things are really hard right now," Roseth said last week.
Ever since Roseth was hurt in a lifting accident at age 23, she has experienced chronic lower back pain. Twice, the pain has become acute because of herniated discs. One of those incidents began in March and continues now. She's scheduled for surgery later this month, and is confident about the difference that will make.
"Then I'll go back to my good, old comfortable chronic pain," Roseth said, laughing.
During an interview last week, Roseth was with her husband, George Peterson, also 30, in the living room of their home in Duluth's Woodland neighborhood. They were sitting on a couch they had searched for carefully, one with short legs that allows Roseth to sit up straight, sparing some of the strain on her back.
To accommodate the pain, she recently has been sleeping on all fours, "which is super awkward," she said.
Roseth was in pain that evening. She later revealed that before guests arrived, she had been lying on the couch all day. "I'm sitting up now because I'm trying really hard," she said.
Yet until she said that, Roseth didn't betray any signs of discomfort. Instead, she and Peterson chatted amiably, sometimes laughing at shared humor.
The positive attitude evokes a deliberate choice Roseth has made, with support from Peterson, in responding to one of the most common health conditions people experience.
According to the U.S. Institutes of Health, more than 100 million Americans battle chronic pain, at an annual cost of $600 billion in terms of medical treatment and lost productivity.
In the past, treatment of that pain largely relied on drugs, particularly opiates, and that is widely agreed to be a factor in the nation's crisis of opioid addiction.
But the medical profession has turned away from chronic pain treatment focused on medication, said Dr. Ifeyinwa Igwe, a physician in the Essentia Health Pain Rehabilitation Program.
"There's a shift in everybody's thinking to realize we have to have a more holistic approach," Igwe said, in the elegantly accented English of her native Nigeria.
A patient enrolled in Essentia's pain rehab program comes two days a week for eight weeks, Igwe explained. The program includes not only information about medications but psychotherapy with pain psychologists; physical therapy; alternative approaches such as acupuncture and yoga; and potentially interventions such as injections and surgery.
"The goal is to have more tools in your box," Igwe said. "If you don't, then the only option you know becomes medication."
Roseth uses prescribed opioids as a last resort, not as a regular course of treatment. She hasn't chosen to try marijuana, although it's legal in Minnesota to obtain a prescription for marijuana as a treatment for chronic pain. It's something she and Peterson had discussed, she said.
"The thought process is the same as with opioids," Roseth said. "It doesn't fix anything, it just relieves the symptoms."
She wants as little as possible to do with the side effects of medication, she said.
But learning to manage chronic pain hasn't come easily.
The hard choice
Roseth used to get angry when reading materials saying it was just a matter of being positive.
"I'd be thinking, 'You can't just turn that on,' " she said. "I haven't been able to just become positive. It's not like I woke up and just decided life is wonderful. ... For me the choice was - it was a really hard choice. You can either be in pain and be miserable or you can force yourself to be positive for a little while and just deal with it."
She switched from "acute pain relief" to "chronic care" three years ago in a chronic pain program. That means day-to-day management that includes breathing exercises and meditation, daily stretching, walking for 15 minutes a day, a heating pad, an ice pack and a TENS unit, which is an electronic device that inhibits the body's pain signals.
Peterson has walked the path with her.
The couple knew each other as middle schoolers in Fargo, N.D., but didn't keep in touch. Even when both attended Minnesota State University Moorhead at the same time, their paths didn't cross. But they reconnected via Facebook five years ago when Roseth was recovering from her first back surgery. That led to getting together for coffee, then dates and serious conversations. As they became closer, Peterson came to realize, he said, that Roseth was in her battle with chronic pain for the long-term and "might not ever be normal."
The couple, who married in August 2015, had moved from Fargo to Two Harbors and then to Duluth.
"We both wanted to move somewhere that was really beautiful, and it was lucky because we're close enough to Fargo where we can go home and visit family, but then we're far enough away where this is like a whole other world," Roseth said.
Roseth, who majored in English and broadcast journalism and had worked as a TV news anchor in Fargo, found work at Compudyne and then at Out There Advertising. She now works as a freelance journalist. Peterson, a sociology and criminal justice major, first worked for the Minnesota Department of Natural Resources at state parks on the North Shore and now is a program manager at Northwood Children's Services.
Although both love active outdoors living, they've adapted to what Roseth is able to handle. She has developed interests in photography and birdwatching. Sometimes, she'll drop Peterson off at a trailhead for a hike and engage in those pursuits before meeting him at the next trailhead. They still go tent camping, but with modifications such as a cot she can lie down on. If something doesn't work, they try something else.
"I remember one time we tried to go camping, and it just didn't go well," Peterson said. "Kelsey was in pain, so ... her physical (was) affecting her mental, and she was upset. It was a rough trip. So it was like, 'What are we going to do differently next time? How can we make this work?' "
Work schedules were adjusted, too. Roseth went from full-time to part-time at the advertising agency before choosing to go freelance. The reduction in hours has allowed both of them to have more well-rounded lives, she said.
"When I was working full-time, I'd really just come home and pretty much be on the couch all night," Roseth said. "George would be responsible for just about everything around the house."
But the support goes both ways, Peterson said. "It seems like I often look to you for emotional support," he told her.
Although she used to be reluctant to talk about her struggle with pain, Roseth has become less reticent. She wrote an article that appeared in the August 2017 edition of Northern Wilds magazine and was surprised how many people she heard from who have similar plights.
"It turns out there are a lot more people in pain than I thought," Roseth said.
Her message isn't one of denial, but a refusal to be defeated by pain.
"The only thing that's helpful for pain - really, truly helpful - is distraction," she said. "And having fun. If you're enjoying yourself, you can really kick through some pretty bad times."
To learn more
Essentia Health Pain Rehabilitation Services can be contacted at (218) 786-8120.