Your Road Map to Breaking Free From Chronic Pain

Pain does not equal tissue damage.

Pain is an alarm system

Pain is an alarm to a sensation from the environment received by the brain that is being interpreted as a threat to your body. At the time of an injury, a subconscious part of the brain will sense tissue irritation/inflammation in an area and signal the sensation of pain to your conscious parts of the brain. As the inflammation/irritation resolves, the pain signal to the conscious levels of the brain stops (note the black arrows in the figure below). It’s a good thing we have pain. It helps us to survive and helps us to not do silly things like touch a hot stove.

Pain is related to your brain’s map of the area

There are many different types of nerves that signal sensation types to the brain. When a sensory nerve gets stimulated , it sends an electrical signal to the spinal cord, and then up to the brain carrying information about the type of stimulation and it’s intensity.

The part of the brain that is in charge of the sensations and movements for the different parts of the body is called the sensorimotor cortex.

From there it is also up to the brain to determine what the sensation is and whether or not it is a threat to the organism and what to do about it.

Pain comes from the brain and is related to how easily a nerve fires

The brain sets the level of stimulation needed to produce a pain response. The brain also sets the level of stimulation of a nerve that is needed to produce a signal to the brain

The brain also sets the level of stimulation for a nerve that is “Safe” And not harmful to you as an organism.

Sometimes the area of the brain that is in charge of our survival (known as the limbic system, where the fight / flight response is) will develop a connection to the area of the brain that is dedicated to the movement control and sensation of the body part. The brain can set the level of stimulation that tips a signal from the environment into pain lower than what is “ normal .” This can happen especially if the incident that caused the pain in an area involved some sort of trauma (either emotional, physical, or both) or happened at the same time as a period of heavy amounts of life stress.

If pain has lasted more than three months, it is mostly likely driven by changes in ‘brain volume control’ than ‘issues with the tissues.’

The brain can perceive a threat with certain movements or activities and give a pain signal even if there is no stress or injury to the tissues anymore. For example, someone can have perfect squatting or lifting form but still feel pain because the brain has learned to signal pain because of a lifting injury many years ago. Sometimes, especially if the pain signal persists for a long time, a learned pattern can form a "rut" in the subconscious brain that needs to be relearned and retrained.

The brain influences muscles, heart rate, breath rate, the digestive system and the immune system

The brain’s perception of the environment, movement, recalling memories or even your emotional state / emotional experiences produces subconsious responses in the body.

Changes in background muscle tone or tension, movement patterns, dysautonomia, autoimmune or IBS symptoms can therefore be impacted by these conditoned loops with your primitive brain. This can over time solidify these loops or “errors” in the system and change your posture control, breathing patterns and movement patterns over stressing and overloading your joints and tissues.

Pain lives in the same area of the brain as emotions.

Emotions have corallary body sensations. If there is a conditoned pain loop, emotional states and pain can often occur at the same time and continue to feed into and perpetuate these loops between the memory, emotional and survival centers and our sensory -motor centers of the brain.

How to begin to move forward:

1. Learn About Pain Science. Just by consciously learning more and understanding what pain is, where it comes from and how it behaves has been shown in research studies to improve a persons pain experience and begin to re-establish healthy physical activity and movement habits when compared to groups of people who did nothing or just did an exercise program. Here are some resources I recommend to get started. If you’re not up for reading a book, most of these books are available on audiobook. You can also do a search for free podcasts interviews that the authors of these books did on your favorite streaming app.
   
   Mosely explain pain
   
   way out Alan Gordon healing chronic pain

   Unlearn your pain by Dr. Howard Schubiner
   
   The body keeps the score David Van Der Kolk
   
   What my bones grow healing from complex PTSD - Stephanie Foo
   
   Strong like water - Aundi Kolber

   This is the Pain Recovery Program created by Alan Gordon, director of Pain Psych Ctr, who wrote a great book The Way Out.  It is a FREE 21-day tutorial that includes a group participation feature.  

   Pain reprocessing self guided materials/find a therapist: https://www.painreprocessingtherapy.com/free-resources
   
   
   Podcasts
   Ezra Klein’s interview of David Van Der Kolk
   
   Stuck but not broken Poly vagal theory podcast by Justin Sunseri
   
   Episode 45 Best of You Podcast Strong like water
   
   Mount Sinai health podcast the road to resilience

2. Build space around your pain to retrain the threshold. Use the 2 point pain rule to begin to increase your activity level. You can do anything you want a long as you stay within 2 points of your starting level of pain. If pain starts to increase to that point, stop. Rest for 15-20 minutes. If that doesn't work then stop the activity. This concept is called the envelope of function. By respecting the boundary in the "survival brain" you will be able to do more after about 2-3 more tries. Sit with your sensations. Don’t push through. Otherwise your brain will keep turning up the volume to grab your consious brain’s attention.

3. Begin a mindfulness practice focused on breathing and counting your breaths to switch off the “flight/flight” part of your brain. Learning to sit and notice the (often neutral) sensation of your breath can help train your brain to learn to sit with other sesnations that may be unpleasant without reacting, like pain.

Breath Counting 3 minute “brain-body reset” (you tube)

commit to 5-15 minutes a day. Once you get the technique down, try this practice when in a heightened emotional state or when experiencing pain

4. Begin a body scan practice to begin to remap your brain, reframe sensations and to grow a healthy brain-body connection.

Soma Healing 45 minute body scan mediation (you tube)

Commit to 5-15 min a day. Once you get the technique down, try this practice when in a heightened emotional state or when experiencing pain. Notice and observe your sensations without reacting to them emotionally.

Commit to short, small moments of awareness and resetting throughout your day.

small bouts of block practice through the day provides the quickest learning of neural skills and establishing new pathways that are used preferentially over old ones.

5. Begin a regular consistent pain reprocessing practice : https://www.painreprocessingtherapy.com/free-resources

Not all sensations are pain. Give yourself some space, once your sympathetic reaction settles using the breathing techniques to get curious about the sensations. See if there are alternative labels for the sensations you are feeling. Try to use low threat words that are not asscoiated with injury (ie try to avoid burning, stretching, pulling, pressure etc). You can even just label it the generic term “sensation.” Some examples may be “I am sore because I am building strength,” “I am stretching and building flexibility” or “My muscles are engaging and stabilizing me better.” Above all, reassure the primitive survival part of your brain that you are safe and that the involved part of your body is safe.