WHAT IS CHRONIC/PERSISTENT PAIN?

“Most of the time pain is your body’s way of protecting you — reminding you to take your hand off a hot stove or rest a sprained ankle. Pain is critical to survival. It sets limits and teaches us to avoid repeated dangerous mistakes.

But sometimes, the pain protection system starts to misfire. It constantly sends pain signals to the brain that serve no protective function. When this lasts [or comes and goes for] more than a few months, it’s called chronic pain.

According to the National Institutes of Health (NIH), about 20.4% of U.S. adults have chronic pain. That means approximately 50 million people have chronic pain in the United States alone. Chronic pain affects more Americans than cancer, heart disease and diabetes combined.” (Mayo Clinic)

WHAT WE KNOW ABOUT PAIN:

1. The body can experience pain (inflammation, spasm, etc) even in the absence of physical damage or structural problems.
   
2. Even “abnormal” findings on an MRI don’t usually line up with the physical symptoms: 64% of people with NO back pain have disc bulges, protrusions, herniations or disc degeneration. Structural changes/wear and tear are expected with age and are usually unrelated to pain ("wrinkles on the inside").
   
3. Surgeries for chronic pain are often ineffective and are, in many cases, no better than placebo surgeries.
   
4. The brain is what decides whether we experience pain or not. The body sends information and the brain/nervous system decides whether it is dangerous (create alarm bells - pain/sensations/symptoms) or not (no pain/sensations/symptoms). Neuroplastic pain is when the brain learns to keep the “alarm bells” on long after structurally-caused pain should have healed/subsided. fMRIs show that pain from injuries show up in a specific part of the brain, but that when pain becomes chronic, it shifts to parts of the brain associated with learning and memory.
   
5. Fear fuels pain: Dozens of studies show that the more fear around the pain/symptom, the more likely the pain/symptom is to continue. This can include fear of more pain; fear of movements, activities, and behaviors; fear of losing jobs, relationships, experiences, ability to function; etc.
   
6. People with challenging childhood experiences, trauma, or personalities that are more hypervigilant, perfectionistic, self-critical or put pressure around performance/control, and/or who suppress/avoid emotions, are much more likely to develop chronic pain.
   
7. Curiously (and revealingly), people of different ages, gender, and cultures have dramatically different rates of chronic pain and experiences of pain in general.
   

What about other chronic symptoms? Go here for more information about symptoms ranging from fatigue, anxiety, long covid, fibromyalgia, dizziness, POTS, headache, spasms, repetitive stress injuries, etc (or see below for list).

*Feel free to reach out for citations, studies and more info!

WHERE TO START:

TEDx TALK: Chronic Pain and Anxiety: Why Doctors Get It Wrong & How to Hack Your Brain | Brad Fanestil (how healing the nervous system is the whole point!) - Start here!

TEDx TALK: Why Things Hurt - Lorimer Moseley, Physical Therapist and clinical pain neuroscience researcher and educator. A wonderful speaker with a great sense of humor.

NPR ARTICLE: Can You Reshape Your Brain's Response To Pain?

PODCAST: Tell Me About Your Pain by Alan Gordon, Alon Ziv & Curable - this podcast changed my life. A great place to learn about 21st century mind-body medicine, science, and tools. Includes pain education basics, scientific studies, Pain Reprocessing Therapy practices, and coaching sessions with real people. They talk about "the brain" but I think it's even more powerful to think about their teachings in terms of "the nervous system".

– BOOK: The Way Out by Alan Gordon is also great and goes into greater detail about Pain Reprocessing Therapy, the science, practices and journey out of chronic pain, one I use personally and keep on the shelf of my office.

LEARN MORE/GET SUPPORT:

BOOK: Explain Pain Protectometer Handbook - Lorimer Moseley and David Butler

Great pain education and workbook that really helped me to finally understand the layers of mind-body stuff feeding my pain cycle and realize how many options I had for calming down my nervous system/overactive pain system. Simple, illustrated, and great humor. Worth the price. Their Explain Pain book is very pricey (textbook level) but also amazing, much heavier and more detailed on the neuroscience of pain.

RESOURCE: Pain Reprocessing Therapy - a system of psychological techniques that retrains the brain to accurately interpret and respond to signals from the body, breaking the cycle of chronic pain. Although various treatments aim to manage pain, PRT stands apart as an evidence-based treatment to eliminate pain. Their newsletter is a great resource (some available online).

– They provide wonderful Practitioner Trainings (learn the latest pain science and Pain Reprocessing Therapy) and run 8-week educational Healing Workshops. I have completed their basic Practitioner Training.

– BOOK: The Way Out by Alan Gordon - details the approach, practices, tips and tricks for Pain Reprocessing Therapy. Expands on what they teach in Tell Me About Your Pain podcast.

– APP: Curable - Used by over a million people to cure chronic pain and symptoms. Includes customizable guided learning and exercises for pain education, journaling, meditations, online support groups and more. It's wonderful. - ASK ME about trying it free for 6 weeks.

RESOURCE: This Might Hurt: Unlearning Pain

I have not seen the film but the website is great place to learn — Dr. Howard Schubiner is one of the primary doctors associated with the Pain Reprocessing Therapy and Emotional Awareness & Expression Therapy, both of which have statistically mind-blowing rates of chronic pain resolution.

• List of non-pain chronic symptoms that can also be produced by the nervous system, and healed with similar mind-body approaches.
• Includes: Anxiety, long covid, chronic abdominal pain and spasms, chronic arm or leg pain, chronic back pain and spasms, chronic neck pain, chronic tendonitis, repetitive strain injury (RSI), complex regional pain syndrome (CRPS), depression, dizziness (including PPPD & MmDS), face pain, fibromyalgia, insomnia, brain fog, irritable bowel syndrome (IBS), painful bladder syndrome (interstitial cystitis), pelvic floor dysfunction, POTS (postural orthostatic tachycardia syndrome), temporo-mandibular joint dysfunction (TMJ), chronic inflammation, tension and migraine headaches, post-concussion syndrome, tinnitus (ringing or distortion in the ears), burning mouth syndrome, vulvodynia, coccydynia, some people with neuropathic pain, trigeminal neuralgia and other neuralgias, post-exertional malaise and chronic fatigue (ME/CFS), some people who are told their chronic pain is due to Hypermobility Ehlers-Danlos Syndrome (hEDS), and conversion disorders/functional neurological disorders, plantar fasciitis/foot pain.
• PODCAST: A New Way to Understand Long COVID, ME/CFS, POTS and More w/ Howard Schubiner, MD / Like Mind, Like Body - also touching on diseases like MCAS, Ehlers-Danlos Syndrom, Epstein-Barr virus, and chronic Lyme.

RESOURCE: The Steady Coach - Helping people with chronic dizziness (and other chronic vestibular symptoms) get strong and steady with mind-body approach to healing. Dr. Yonit Arthur, AuD

– PODCAST: Non-Pain Symptoms are Curable! w/Yonit Arthur, Audiologist / Like Mind, Like Body - conversation about vestibular symptoms and how the brain can create or amplify any sensation in any part of the body

RESOURCE/GENTLE MOVEMENT: Clinical Somatics (aka Hanna Somatics/Pandiculation) - great $45 online course that teaches the concepts of pandiculation exercises. Sarah's blog is also a wealth of well-researched information. Here is some specific content I often recommend to people:

– VIDEO: Why Static Stretching Doesn’t Work (And What to Do Instead)—Pandiculate!

– VIDEO: Iliopsoas Release (free 20 min sample sequence, combining multiple exercises found in the course)

LEARN ABOUT YOUR NERVOUS SYSTEM:

Trauma and the Nervous System: A Polyvagal Perspective - 9 min video giving a basic introduction and overview of how trauma, adverse childhood experiences, and chronic stress affects our nervous system and how those effects impact our health and well-being. If you are experiencing persistent pain/symptoms, this illustrates how the nervous system can get stuck in a loop.

BREATHWORK & NERVOUS SYSTEM EDUCATION: Conni Bielsalski

https://www.instagram.com/breathwork.alchemy/

All Conni’s offerings here

VIDEO: The Truth About How Your Nervous System Operates (fabulous 14 min youtube video explaining polyvagal theory in practice by Jonny Miller of Nervous System Mastery course)

LEARN NERVOUS SYSTEM BASICS: Polyvagal Theory - Deb Dana's Rhythm of Regulation (top collaborator with Stephen Porges to help translate his research into clinical and layperson accessible information)

PLEASE do reach out about referrals for other modalities and practitioners. I (and my clients) have tried a huge array of therapies, bodyworkers, etc. and I am happy to share more information and referrals.

PODCAST FOR BODYWORKERS: Treating the Brain and the Body w/Charlie Merrill, MSPT / Like Mind, Like Body - conversation about combining manual physical therapy with the mind-body biopsychosocial approach