Post #4 in the series "Reprocessing Chronic Pain"
I have now had two full weeks mostly pain free. I have felt it coming on several times but it hasn't escalated into an actual pain experience. I hasn't upset or frustrated me. It hasn't derailed my day or stopped me from doing anything. I'm able to reassure myself that there is no danger in my body. I can feel the sensations and remind myself that they aren't harmful, that they aren't anything to worry about, and that I am going to be ok. And then they fade. I still use my tried and true soothing strategies -- heat, ice, rest and some OTC pain meds. But I used to grab for them like lifelines, with a felt sense of fear, discouragement, and resignation. I HAD to have them to protect myself from more pain and distress. Now I use them to support the feeling that I am safe -- that I am taking really good care of my body so my brain doesn't have to freak out. I feel comforted, calmed, and empowered using the same tools. It's like the difference between grasping for a life preserver when you are nearly drowning, or choosing to use a swim noodle when you jump into deep water.
When it comes to psychophysiologic disorders (PPD),* healing depends on and starts with increasing a person's felt-sense of safety. The perception of safety or danger, known as neuroception, happens below the level of conscious thought and awareness. It registers deep in the primitive part of our brain in the amygdala and other related structures. The brain receives messages from inside and outside the body. It references them against past experience. And it assesses the overall state of the organism (sick or healthy, strong or weak, calm or distressed). It pools all of that data to determine how loud an alarm signal it needs to ring. This all happens instantaneously. Thus, though we may not be aware of danger on a conscious level, the nervous system senses it, remembers it, expects it, and associates it with context. The body can go into a stress response in reaction to danger that we are not aware of. And it can get locked into that state if the threat persists. That causes a cascade of biochemical, metabolic, and musculoskeletal changes - to help us fight, flee, or freeze - and symptoms begin to appear.
Feeling safe is multi-faceted, complicated, and highly individual. It relates to the physical body, the emotional self, and the inter-relational or social self. It's important to understand that there is only one fear circuit in the brain. This means that the brain does not make a distinction between physical threat and mental/emotional/social threat. All are considered dangerous and merit an alarm response. And any alarm response can trigger or exacerbate physical symptoms.
Cultivating a sense of physical safety involves determining that there is not a structural problem in the body that explains the symptoms. Only a physician can evaluate a person to rule out structural problems that merit medical intervention. What can complicate this, however, is that many physicians are not aware of PPDs or they haven't seen the data showing how often medical findings -- from herniated disks to repetitive stress injuries -- are not consistently correlated with pain. Medical professionals are trained to make diagnoses to explain pain. Among the diagnoses I've been given are fibromyalgia, chronic myofascial pain syndrome, degenerative disk disease, failed back surgery syndrome (yes, that's a medical diagnosis), SI joint dysfunction, piriformis syndrome, pelvic instability, trigger points, muscle strain and weakness, and even PTSD. Clinical experience and now multiple peer reviewed studies have shown that none of these is an adequate explanation for the pain that people experience. They can be present without pain. But if a doctor tells you that you have one of these conditions, and that's why you are in pain, it is going to reinforce your sense of danger.
Once I came to believe that the pain I experienced was in fact PPD or neuroplastic pain, the door to healing was opened. I reminded myself that my 2012 spinal fusion surgery had, in fact, repaired and stabilized my spine. It has fully healed. There's no nerve impingement. Focusing on that marked a significant change of mindset from my earlier view that all the surgeries were a mistake, that they did more harm than good, that my doctors has misled me, that I'd suffered a series of traumas. I'd believed there was residual damage from all the cutting through muscle and soft tissue. I was told I had scar tissue, rigidity in the fascia, trauma in the tissues. I thought that was why it hurt. Now I believe that the surgery fixed me and left me stronger. I've started thinking and talking about "my titanium spine" as a source of strength and power. I feel grateful to my surgeon (who is an amazing guy and provided excellent care) rather than resentful or abandoned the way I felt when I was 26. It makes all the difference.
I also stopped going to the chiropractor. She's lovely and very talented, but she was treating me based on a belief that something was structurally wrong and needed weekly adjustment - vertebrae out of place, SI joint instability, and soft tissue irregularities. Those beliefs are not consistent with healing using a psychophysiologic model. And in my case the proof is in the pudding. Two years of chiropractic (like dozens of other interventions over 3 decades) hadn't yielded much improvement. The pain still cycled as it always had and sometimes I felt worse after an adjustment. And I felt no sense of control - I needed her to fix me. Now the pain has been minimal for two weeks and I have tools to stop it if it shows up. (And they don't cost me 90 bucks a visit).
Another level where we experience danger or safety is psychological or psychosocial, including thoughts, beliefs, emotions, and relationships. Do I feel safe from mental or emotional harm? Am I at risk of being criticized, bullied, oppressed, or excluded? Do I feel seen, heard, understood, and accepted by those around me? Can I be authentic? Do I have the safety of belonging in a group, or am I on my own? The felt-sense of psychosocial safety is based in part on current perception (what is happening right now) and in part on memory and association (what has happened in similar situations in the past? What am I predicting?)
For me, expanding my sense of psychosocial safety involved a lot of changes - in my lifestyle, my work, my relationships, my habits, my self-talk, and my beliefs about my own worthiness. This work has been ongoing most of my adult life but especially in the last decade, when I worked with a Somatic Experiencing practitioner and began a consistent Buddhist meditation practice. Those experiences formed an essential foundation for the progress I've made most recently.
Healing may also involve a reckoning with the past. We are all impacted by how our nervous system got wired at a very early age, or how it has been impacted by trauma. In infancy and early childhood, how safe was your "holding environment?" A child needs not only to be protected from harm but also to be understood, comforted, encouraged - able to simply be her authentic self and know she is accepted and loved by those she relies on. This early experience creates a baseline, a tendency to expect danger or to expect safety. That colors every experience and interaction that follows in her life.
And, that baseline can be changed through understanding of trauma and repeated "corrective experiences." The nervous system is plastic. Given the right supports, it can rewire toward safety regardless of what has come before. I've been blessed with a number of these corrective experiences and I have learned to read my body's signals (rather than my cognitive process) to determine when I feel safe and when I don't. My mind might think everything is fine, but if my stomach is in a knot, or my heart rate increases, or pain pops up behind my shoulder blade or in my neck, I have to stop and assess - what's going on here? Do I need to get out of this situation, or do something to change how it is going? What do I need to feel safer here?
In short, it essential to understand there are levels to the work of feeling safer in our own skin. At the cognitive level, it matters what you believe. There are many stories of long-time pain sufferers whose symptoms disappeared after simply reading a book or seeing a practitioner who convinced them that what they had was in fact a PPD. Then there are brain training tools like somatic tracking, graded exposure, and messages of safety, which can reduce habituated danger signaling. And there's the deeper work involving trauma, emotional repression, relationships, and personality patterns. Each person's healing path will involve a different combination of approaches, tools, and resources. It's a process, like the proverbial peeling of the onion. And I really, truly believe its possible for everyone.
In case you missed them, you can read the first three posts in this series here. You can also explore my earlier blog posts on chronic pain and food and body image, going back to 2019. To be notified when a new post is published, please subscribe. You can learn more about me on my website. And you can reach me at dana@danabarronphd.com. I'm also on Facebook and Instagram. And please forward this to anyone else you know who is dealing with chronic symptoms of any kind.
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