May 23, 2021
[00:00:00] Hello, this is Deb and welcome to podcast episode 15. And I asked some people if they had questions about all this stuff I'm talking about neuroplastic pain and learned neural pathways. And so I got a few questions that I thought I would answer today. So the first question is from Ali.
[00:00:22] And she says, knowing that persistent pain is a learned neural pathway. And that the brain gets better at producing pain over time how do we reduce fear? And have confidence in turning it around if we are aware that our neural pathways are getting better at it. I guess there is some fear in the actual process of pain being produced rather than any structural fear.
[00:00:53] That is a great question. And that question is really all about fear. What I talk to my clients a lot about is them wanting to know is this neuroplastic pain or is this structural pain? And that concern about wanting to know is what creates fear and overwhelm. So for me, the process is twofold. We have the overall bodymind sensitivity to threat.
[00:01:32] So, whether you call that hypervigilance. Or whether you call that being attuned because of trauma. What we have is just kind of your general disposition reactivity of your nervous system. And different activities that we take kind of attune the nervous system in different ways. And we're probably not aware of that.
[00:01:58] So do you ruminate or catastrophize? Do you think this question over and over and over again? Right? Which is my brain just getting better and better at producing pain over time is a fear-based question. Right. So then when you feel pain, Your first thought is. Oh, God, my brain is just getting better and better at producing pain over time.
[00:02:26] And when we believe that that thought is true we're going to feel something in our nervous system. So the good news about that is that you are having a sensation in your body created by this thought and this belief that the brain gets better at producing pain over time.
[00:02:47] That sentence is not untrue. We have this idea of what wires together fires together. I got that backwards. What fires together, wires together. But also what is true is what fires apart wires apart. But because we have a general negativity bias that's developed evolutionarily,
[00:03:15] we sometimes get very concerned about this, what fires together, wires together. But we're not really spending a whole lot of time thinking about the upside of what fires apart, wires apart. So you have to tell both sides of this story. And get more of a bird's-eye view of the brain. So the basic concept is the brain will deliver you the experience that you're expecting to have because that's metabolically conservative. And what we wire together fires together. So that is delivered faster and with more ease. But you can wire it apart from you. And so this process of unwiring learned neural pathway pain is the part where I spend most of my time in.
[00:04:23] Why obsess about the fact that your brain learns pain really well. Your brain also can learn how to play the flute really well. We want our brains to learn things well. So your brain just happened to learn some pain really well. We also want that same brain to learn how to make a souffle really well, talk to your neighbor really well, study for a test really well, sing a song in the shower really well, smile at a baby really well. So our brains just do what brains do. When we have fear about what a brain is doing, our body is reacting to the fear of that thought or belief. So we want to get into the fear.
[00:05:22] And that's how you're going to rewire your brain away from producing pain. So we need to unclump our conditioned responses, get into the thoughts and feelings, understand what the beliefs are about the sensations that we feel in our bodies. It's like we have a little storyteller inside of us, always delivering us the story of what's happening.
[00:05:53]But what's important to understand is that very little of that story is fact. So a fact might be you have a brain. A fact might be when I think this thought "the brain gets better at producing pain over time" I feel the sensation of fear. I feel a tightness in my chest. I feel tension in my shoulders. I feel a stabbing pain in my left eyeball. That is the circumstance.
[00:06:33] I mean, we can train it that's this part, we're going to unlearn by learning something new. Because if we just let the brain do stuff, it just does stuff. It makes conditioned responses all the time. It doesn't just like, hang out and wait for its orders. It's just surviving right. The brain's job is to create and maintain allostasis, is to create and maintain the livingness of your being. So if you're alive, thank your brain. It's doing a really amazing job. And we have to learn, work a little hard to train the brain to give us more of what we want. And less of what we don't want. So that whole part is kind of this storytelling experience that we create, this internal conversation that we create between the brain and the body. The brain slash nervous system and the body.
[00:07:38] So we want to assess our own sensitivity to threat. Are you hypervigilant? Do you ruminate or catastrophize? So getting good at noticing what our body mind does when we feel fear can help you understand what's happening biologically or like cognitive somatically. Those are words I've been playing with because we feel something in our body based on a thought. But also the feeling of things in our body if we have overwhelm that can also dampen our cognitive abilities. Right. You ever feel that sensation? That your brain is going offline. That you can't think. That's a cognitive somatic experience. That's what I'm calling it. Those are the words that are helpful for me.
[00:08:36] I have a lot of unpleasant somatic experiences when I am feeling fear. Which then can perpetuate the fear of the symptoms being structural. But we also want to go to the doctor and rule things out.
[00:08:53] I twisted my ankle the other week and I had a lot of fear. I had a lot of pain the first day and I couldn't make any decisions. What I was noticing is just my brain was running on a wheel. It's like a hamster on a wheel. And the pain just really freaked me out. And I realized that I could not make any decisions while in this fear pain state. So I had to tell myself that I was safe. That no matter what was happening with my ankle, I would figure it out. Because my brain was off to the races thinking, oh, I can't drive home. I can't do all of these things that I have planned out for the next week.
[00:09:47] Maybe this means that I'm going to perpetually have ankle pain and it won't heal. And I won't be able to roller skate or hike or like, you know, my brain just wanted to go all those places. Understandable. I was feeling a lot of pain. I did have things that I needed or wanted to do. That I thought that pain was going to prevent me from doing it.
[00:10:17] But what I recognized was I am not in a decision-making place right now. My brain is not available to help me decide what to do. So I was able to say, Just go to bed. Calm myself down. I said, what do I need right now? I probably need food. I probably need water. Maybe I need pain medication. Maybe I need to distract my brain by watching a television show. And I need to give myself messages of safety so that my nervous system stops telling me that there's a threat. So that my internal alarm could quiet. So the next day I woke up early. I felt calmer. And I Googled where the urgent care was and I realized, oh, it's only eight minutes away. And I could call a Lyft. They open it this time. I can have breakfast first which I had in my room. And I was like, well, there we go all of that cognitive ability that was not available to me the night before, because I was in fear pain overload.
[00:11:44]I was able to think and make decisions. The pain level was still about the same. Put my foot on the floor and it hurt a lot. One of the things I noticed was when I wrapped it in an ACE bandage it hurts less. So I was like, okay. I feel pretty confident that I can walk out of this hotel room. Or limp out of this hotel room.
[00:12:11] Make it into a lyft, get to the urgent care place where somebody will help me. And at the very least take an x-ray and give me a set of crutches. And I will figure everything out. So that was a lot of self-talk. But once I got the fear under control, all of my cognitive magic came back to be available.
[00:12:42] And I had to listen to the fear thoughts that I was having. But not believe them. So that my internal safety monitor would stop ringing the damn alarm bell. So acute or structural, all pain is created in the brain. And it is felt in the body. The brain interprets the neutral nociceptive input. So it's neutral as in we don't know what the response will be until it is interpreted. Right. Otherwise, it's just nociceptive input. So the difference between structural and acute is somewhat the story that we're telling and somewhat the story that our body is telling. And it is useful when you have a sprained ankle to feel pain. Cause that signals the body to stop moving. And to heal. So I knew that I sprained my ankle. And I was like, these stories make sense together. Now I could probably train my brain to experience that nociceptive input differently. And certainly people have done that.
[00:14:19] I teach in my course. I have my first week is on pain science and there are some examples of people shooting nails into their hand with a nail gun and not feeling pain. Not because there's something wrong with their nerves. But because their brain did not interpret that as dangerous for whatever reason, whether they've shot a nail through their hand before.
[00:14:46] And they're just like, oops. It's an individual process. That's why pain can be so variable. Because you are the one interpreting the experience. So twisted ankle. Feeling pain. Stay off ankle. Body can heal. Persistent chronic neuroplastic pain is brain giving messages to not do something because of fear long after the body has healed. But the healing of the body and the tissue, that message has not really been delivered because the fear pain message is the one that we've attuned our nervous system to listen to, to find. And also when we feel pain we are designed to believe it.
[00:15:52] So we're designed to believe that something is wrong when we feel pain. And then all the pieces that go into the story of what the pain means we get from lots of places. We get those stories from your doctor. We get those stories from your neighbor or watching your parent in pain or watching other people suffer.
[00:16:17] Or just these kind of passer by stories about being fat and having too much pressure on your joints and what this might mean. And oh, You know, this thing happened to so-and-so and it was terrible. Or. I feel so much better when I weigh this much versus that much.
[00:16:40]All of those bits of data, words, they get interpreted, they become part of the evaluators of the sensation. So it all gets put together. And then we get the experience that we're expecting. We're not hearing from the body that this pain is not necessary. So we have to kind of go looking for the gaps in the pain story and build a new story around it, knowing what we know about how the brain works. And knowing what we know about persistent pain.
[00:17:25] So yes, go to the doctor. If you're having a new pain and something happened, and you're concerned go to the doctor, but don't keep digging and digging and asking the same questions over and over again. Or going to one doctor then going to another doctor then going to all these doctors. Um, if you understand what is colloquially known as TMS? Or neuroplastic pain. If you understand this concept that pain is an interpretation of neutral nociceptive input why not just use those tools. But we often have an emotional experience around getting a diagnosis. So these are all the things about awareness.
[00:18:25] About understanding what our thoughts and beliefs are. This is why that is very helpful. Cause we want to understand. What is the story that we are providing to our brain about the experience we are expecting to have. The brain really is like going to give you what you want. That's all it's job is to do.
[00:18:50] So we need to train it and teach it to give us a different experience. The human brains love surety and when we keep asking this question, is it structural or is it not structural. Our relationship with wanting to know something or not knowing how to decide something can keep us in distress and be what keeps pressing the fear panic button over and over again.
[00:19:22] So human brains love surety and learning to believe first that we are safe. Even while having symptoms is the main skill. So going to the doctor to get a scan isn't going to be what keeps you safe. It's what you decide to do with that information. So using our thinking brain helps to keep us in the reality of what we know as we do the work of rewiring our safety brain. And this can happen quickly. But it requires repetition. Rewiring is like all learning. It takes place when the system demands it. So brain focus and attention is kind of the name of the game. Your brain is the follower of your attention and delivers you the experience you're looking for.
[00:20:19] The brain is a loyal dog. That just so happens to be in charge of the full body simulation machine that you are. So it's not a really smart design, but it's what we've got. So because the brain's interpretation of neutral nociception is interpreted by the safety system and delivered to you as a simulation of what you were expecting to experience. We need to offer the body mind evidence enough to create a prediction error. So it's finding holes in the matrix and this doesn't have to be dramatic. When you do that activity and it doesn't hurt what are all the things you're not noticing? That is the most rich data of your wellness right there.
[00:21:10] And then you want to practice, practice, practice. I'm going to practice, noticing the holes in the matrix .You want to practice noticing when you don't feel pain, practice noticing what happens in your body, when you place your attention someplace else. And we want to practice with the kind of experience you want to be having in general.
[00:21:37] So lighthearted. Kind. Caring. With self delight. Spacious. Silly. Open-hearted, willing to fail. Knowing you're okay. And then we want to take breaks, let our bodyminds integrate that new information. And then we want to practice again. And we want to keep doing that. Shifting focus and attention to neutral or pleasant sensations. Finding the gaps in the pain experience. And giving our bodies messages of safety. Maybe that sounds easy. Maybe that doesn't sound easy. Maybe it's like entirely confusing.
[00:22:29] That is okay. Part of my practice is to find the 70 billion ways of explaining this to you. So hopefully something I said in this Ali will help you understand it more. But I think the , Too long didn't listen version of it would be stop focusing so much on what fires together, wires together. And spend at least the equal amount of time with what fires apart, wires apart. We want to spend more time building the neuropathways we want to be having than thinking or worrying about the ones that we don't want to be having.
[00:23:23] Now it's time for a question from Esther. Esther says. I'm quite sure the reason for my back problems is the knowledge of not being slash feeling supported. Okay, knowing that what can I do to not be pinned down by this anymore? And move freely. I'm in stuck mode or stuck modus. I'm in stuck modus, and that causes a lot of stress as well.
[00:23:55]Thank you, Esther that's a great question. So, this is a question about the focus of the mind body. And what I see in your question is you're creating a conditioned response between the sensations in your back and now a meaning that you're focusing on. But that meaning is not the entirety of your experience. It is just where you are placing your attention.
[00:24:21] Your brain follows your attention and believes you, when you say you aren't feeling supported. But that can't possibly be the only truth. So, is there a way that you want to tell that story differently? You can think, how am I feeling supported? By calling a feeling of fact, you're making it impossible for your nervous system to shift.
[00:24:50] So, I'm not telling you the tell yourself that you aren't not feeling supported. Right. I'm not saying to tell yourself that you aren't allowed to feel that way. But, what are ways in which you do feel supported by yourself or others? How much time relative to the focus on the support you're not feeling do you give to where you are feeling supported.
[00:25:23]So I like to think of life as 50/ 50. Nothing can be all good. So you can't only live in all support. So we can think about interdependence. That lives all around us and we can call that support. Knowing that there's roads, schools, people who grow and pick your food. The people who stock the shelves at the grocery store you shop in. Other friends or teachers that you have now, or have had in the past. You have mountains of support that you can feel bolstered by if you choose to tell your story that way. And you have your own support your curiosity and your self-compassion, your desire to feel better and to get curious about how you do that. We have oxygen and gravity and sunshine and photosynthesis as support. So I could go on and on. And so this isn't me telling you that you're wrong. To not feel support. I am suggesting that this story about the back pain and the meaning you're assigning to it, itself, the story, is what keeps that neural feedback loop happening. So if you want to move freely, You bolster yourself with the belief that your back is fine. And you move. And while you're moving you give yourself messages of safety.
[00:27:01] You care deeply for your own wellbeing, from a place of self friendship. And you shift your focus towards what you are desiring. What fires together, wires together. And what fires apart. Wires apart again. That is the whole jam. Neuro-plasticity is simple. When we let it be.
[00:27:26] And is just a macro version of learning. It's just that when we're adults we think we should know things. Then when we are challenged, we often feel shame. And when we feel shame, Our nervous system likes to take us on a ride.
[00:27:44] All emotions are fleeting. And feelings are our friends. Your feelings are for you. They are not for anyone else. Pain is a protection mechanism of the nervous system. It is often a call to action. Sometimes that action is to listen to the quiet voice inside of you that is asking to be heard. So just like emotions are fleeting. So is physical pain. Let yourself feel some physical discomfort without letting the stories in your mind, run away with you about what it might mean. If your back hurts, move. Notice, any thoughts that arise when you are moving. Know that those thoughts are part of what your nervous system is reacting to.
[00:28:40] And if you're feeling pain it's because they're setting off the conditioned response of the pain you're expecting to have. When you allow a sensation to be there. And just place your attention on neutral or pleasant, sensory experiences, you're rewiring the brain towards a feeling of safety. Towards this feeling of neutral or pleasant, sensory experiences. So we want to send the brain where you want it to go while moving.
[00:29:15] Then notice and celebrate having moved without pain or with less pain. And you just keep doing it and noticing it and doing it and noticing. But not evaluating. We're not evaluating and scanning and assessing. We're just doing things and noticing. Getting curious. Giving messages of safety. Creating a lot of allowance for the human experience. When we don't tell ourselves on the inside that we need to be protected all the time then our system's need to press that alarm button will be decreased.
[00:30:05] So Esther, I hope that this answers your question. Neural rewiring is a thing that happens when we do it. You're not going to rewire your brain's messages around the movement without moving. It's going to be hard to do that. So have to make it a little bit of a playground. And do it when you have a sense of willingness. Right. We don't ever want to force ourselves. This is not telling our brains they're a bad dog and like forcing ourselves to do things because force is not listening.
[00:30:44] But we want to listen to tend to, not listen to agree. I don't know if that made any sense, but. I appreciate the opportunity to answer these questions. And I look forward to continuing to develop the skills to explain this idea of this internal conversation. and pain as part of being human. And how we can easily but with practice rewire our physical experiences. Thank you so much. I'll talk to you next week.