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  • Writer's pictureCandy Widdifield

Understanding Chronic Pain

I recently attended a training with Dr. Howard Schubiner, MD, who specializes in treating chronic pain. His teachings echoed what was shared in the Resolving Chronic Pain Summit in January 2021, which shows us that the medical field is finally catching up to what we know in the brain retraining community (at least the doctors who are aware of modern pain science and the most recent research are catching up).


Pain is a decision made by the brain. When we touch our finger to a hot stove, it is not our finger that creates the pain, it is the brain. Obviously pain can be triggered by an injury but it is the brain's interpretation that determines whether or not we experience it as painful. There are many examples of people experiencing pain where there is no injury, and vice versa. A couple of the more salient examples of this include a UK construction worker who had a big nail go through his work boot in 1995. He was in extreme pain and rushed to the hospital, only to find out that the nail had gone between his toes and he didn't even have a scratch. Yet his pain was real. That's the brain. Another example of a construction worker who put a nail through his hand and yet experienced no pain whatsoever. Again, this is due to the brain's interpretation of the event. Predictive processing is a term used to describe this - the brain creates what we experience. Optical illusions are another great example of this predictive processing mechanism. (If you want to watch a short 4 minute YouTube video demonstrating this click here. It is called the rubber arm experiment - fair warning: it is a little wild!)


The brain learns and remembers past experiences of pain. The brain can become conditioned, which sensitizes us to future experiences. It is not uncommon for the brain to produce pain in the absence of tissue damage. In fact, according to Dr. Schubiner less than 10% of chronic back pain is structural in nature. Our mental and emotional state along with the patterns in our brain circuits play a large role in whether the pain neural circuits are turned on or off. It's not surprising that there is a correlation between increases in back pain and increases in anxiety and depression over the past 20 years. Much of the time it is emotional danger that the brain is alerting us to, but those signals can express in the form of physical pain. Fear and stress are classic triggers of the pain neural circuits. We see this a lot in children with anxiety, complaining of stomach aches and headaches.


All this being said, here are the key points to keep in mind: all pain is real (i.e. it's not "all in your head"), all pain activated by the brain, and pain can be triggered by tissue damage or simply by the brain itself. Injuries heal, and when we experience pain well beyond the point of healing, when it gets worse, when it comes and goes or moves around the body, these are all signs that those signals are being triggered by the brain itself rather than the injury site signalling to the brain. This means that: 1) The symptoms are real, 2) It's not your fault, 3) It's due to the way the brain is firing & 4) There is hope for recovery (not just managing it).


At this point you might find yourself saying, "Yeah but I have _____ condition." Schubiner, Lowry & Lumley et al. did a study that was published this year (2024) in the Journal of Pain demonstrating that many normal healthy people have abnormalities in their physicality. Abnormalities do not equal pain and those with abnormalities can still become pain-free.


Aging does not cause pain (it does cause stiffness however). Weather does not cause pain. It is the brain's interpretation of that stimulus that causes the experience. These are examples of myths that are often perpetuated by (well meaning) professionals who don't have the latest research and training. According to Dr. Schubiner, the incidences of having both a structural issue along with the brain generated pain signals is not common at all. Pain is a neural circuit that is firing in the brain, and it is reversible.

One of the ways to determine if your pain is brain generated is to do what is called low level provocative testing (some of you may know this as incremental training, systematic desensitization, or graded exposure). You can even start in your imagination. Imagine yourself doing the thing that causes pain and see how you feel. If you notice pain by just imagining it, then you know it is the brain that's causing it. If you are sensitive to temperature, start by looking at a cold pack or ice cube and see what happens. If bending over is an issue, look at something on the floor and think about picking it up, and so on. If imagining doesn't trigger it, then take it up a notch and do a very small amount or micro movement of what would normally lead to the unpleasant sensation, then check in with yourself. (If you are really uncertain if your issue is brain generated versus structural, and you feel that you need this reassurance in order to really get on board with the brain retraining processes, you could find a physician that is trained in FIT testing who can help you concretely determine this. Here is Dr. Schubiner's website which may be able to point you in the right direction.)


The strategies that Dr. Schubiner and his colleagues use to rewire the brain are very similar to most brain retraining programs. The first aspect is psychoeducation about what is actually happening in the brain. Then it is relabeling the experience to be brain-generated, and relabeling pain as "sensations". Along with that, he focuses on decreasing what he calls "the 7 F's": fear, focusing on it, fighting it, trying to fix yourself, frustration, trying to figure it out, and feeling forlorn (I think all brain retrainers can relate to these, and sometimes they happen below conscious awareness). He reinforces the idea that you are not broken and don't need fixing. There is nothing more to figure out once we understand this is caused by the brain. Retraining with self-compassion, gentleness, kindness & patience in the process is paramount. Then he emphasizes the importance of exposure training, starting small and working your way up,, all the while keeping the underlying understanding in mind and using positive statements of affirmation like, "I can do this; I am strong; there's nothing wrong with me; it's the fear that is causing the sensation, not ____, etc." He recognizes that the brain will test people along the way, and that consistent dedicated retraining from that place of self compassion is what will help people recover. He encourages people to start to view the sensations as opportunities for retraining. He also discusses the value of changing to a positive emotional state while retraining. It can be a sense of empowerment, taking back control, gratitude, or other elevated states. And of course he and his colleagues are getting amazing results doing this!


What this show us (in addition to the fact that brain retraining programs are great for chronic pain) is that there is more than one way to rewire the brain. As long as we have the underlying elements of awareness/understanding, relabeling, incremental training, changing our emotional state, and repetition, there is no set way that retraining has to be done in order to achieve results. For those of you with perfectionistic tendencies or who get caught up in the rigidity of "I have to do the program exactly as it is taught or I won't recover" hopefully this will help you to let some of that go.


Dr. Schubiner does acknowledge that, for some people, releasing stored emotions is a necessary component to healing, as is changing our beliefs about ourselves and how we treat ourselves. That is a blog for another day. He also talked about auto-immune conditions, mast cell activation syndrome, central sensitization syndrome, among other things being in the same category and treatable by the same processes. Hopefully this gives you some encouragement to recognize that research is showing you are on the right track. The key is to do it and keep doing it with loving kindness (like you're training a puppy). If you're stuck or struggling to implement the tools, seek out someone who can support you in this. This is the way forward and healing is absolutely possible!


Best wishes!


Caelum's Insights (A Functional Neurology Perspective):

Of all the nerves in your brain, cranial nerves 3 (oculomotor nerve), 7 (facial nerve) ,9 (glossopharyngeal nerve), and 10 (vagus nerve) evoke parasympathetic responses of the body. Of those nerves, 7, 9, and 10 are the nerves that innervate the tongue and are associated with taste. This is why the most common coping mechanism for stressful situations is comfort eating. The taste of the food is stimulating the parasympathetic nervous system through these three different parasympathetic nerves.

 

Also, fun fact. The sympathetic nervous system is associated with nerves at spinal levels T1 through L2 (start of ribs to just below them). The parasympathetic nerve roots are in the brainstem and in the sacrum (low back). Para means on either side of or around something. So our parasympathetic nerve branches are above and below the sympathetic in our bodies.



If you have any questions you would like answered in this blog or to be added to my coaching waitlist, please email me at candy.thriving@gmail.com


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