New Program Day 11: Pain Reprocessing

Day 11: Pain Reprocessing

In the comic strip "Peanuts," there was a classic running gag. Lucy baited Charlie Brown into trying to kick a football, then pulled it away at the last second. Over and over, she convinced him that this time, she’d let him kick it. And then of course, she didn’t.

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We can conclude two things from this:

First - no wonder Lucy couldn't get any therapy patients.

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And second - poor Charlie Brown came to associate fear with kicking a football. The fear ran so deep, he even panicked when his girlfriend asked him to give it a try.

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Neuropsychologist Donald Hebb coined the phrase, “Neurons that fire together, wire together.” If you experience fear with a certain action over and over, then that action becomes paired with fear. The two go hand in hand in your brain.

Pain and Fear

Somatic Tracking involves attending to the physical sensations in your body, free of fear, and free of resistance. You’re just checking in, with detached curiosity, and watching. Wherever your attention takes you, you follow.

But what if your attention brings you to your pain? It can be very difficult to attend to this sensation without fear. Everyone finds pain unpleasant. But if you're a chronic pain sufferer, then your pain has likely scared you so many times, that it has become paired with fear.

Ultimately, our goal is learn how to attend to neural pathway pain without fear. This further communicates to our brains that these feelings are safe, which works to deactivate our danger signals.

In the following clip, I’m doing a Somatic Tracking exercise with Libby, a chronic headache sufferer. We’re halfway through the exercise…when her attention brings her to the pain in her head. Given her history of headaches, she naturally panics. But instead of engaging with the fear, she explores the sensation mindfully. Watch what happens:

Click here to download the mp3 audio file​

Graded Exposure

Although Libby was able to successfully attend to her pain without fear, she did so in a controlled environment, and with some guidance. Generally, unpairing pain and fear can be challenging.

Graded exposure is a technique that can help us unpair pain and fear in a safe and gradual way. Richard Dreyfuss and Bill Murray famously parodied this approach in the movie, "What About Bob?"

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Graded exposure uses small, increment steps to safely regulate anxiety. It can help us teach our brains that a stimulus we've come to associate with danger is actually safe.

As you learn to attend to pain without fear and without resistance, you're giving your brain the message that these sensations are safe. Like Charlie Brown said, "You can deactivate your brain's danger signals and develop new neural pathways by fundamentally altering your relationship with pain-related fear." Come to think of it, that may have been Snoopy.

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I guess no one is answering questions on these forums but I'll try again:

"Your brain is interpreting a safe message as if it’s dangerous, and processing pain as a result."

What safe message? When I sit or walk I feel pain. The pain is the only message I'm getting! I'm sitting here right now and my low back is in pain.
What message? I just feel pain. ???

 

Hi rbmunkin, I dont want to speak for Alan, but I think he may mean that you are sitting and walking and instead of your brain sending you a message that you are perfectly safe sitting or walking, your brain is sending you messages that it is in danger doing these safe activities and therefore you feel pain. I too feel a lot of pain when I sit and stand and if I walk too much. Im sorry for your pain

 

Thanks. A lot of this stuff is kind of confusing to me and abstract. I need to come up with some simple "to do" things to counter the TMS. Like when I feel pain, do such and such. Do I push through the pain, ignore it, do the activity anyway even though it usually makes the pain worse? While telling myself it is safe, it is safe. I kind of need simple bullet points on simply what to do when in pain. I guess I'll go over all the days so far and try to come up with such a list.
Sorry for your pain also

 

The "safe message" would be a normal response to an activity done by someone that doesn't suffer from TMS. To someone without TMS, walking is safe, sitting is safe, the brain is interpreting these as safe practices. With TMS, your brain has a learned response to pain. If you have pain sitting, then the brain will interpret the sitting as a dangerous activity rather than a safe one. One key point with TMS is patience. These neural pathways and learned responses have been going on for several years, sometimes decades with most of us. They don't change because you watched a 7 minute video of a woman that felt better because Alan coached her through an episode. This takes work, diligent work if you want to create new neural pathways and recovery. Personally, I've been working on this for years with good success, however, the new tools that this program is teaching me are incredible and are already taking me to new levels.

 

Thank you rbmunkin, I feel the same way. I need one of those lists too, lol- Im serious though. i think it would be really helpful. What ive tried in the past is to do just a little more when not in pain hoping my body sees that it is safe and then when im in pain to try to not get to upset or hope the pain goes but to breathe into my body and ask where is the pain and what does it feel like- it is hard because my go to is to be upset the pain is there and to worry when itll leave

 

I guess what I need to figure out is what is that "diligent work"? I'm not even clear yet what to DO. What "work" to do.
I ordered the Unlearn Your Pain book and the Unlearn Your Anxiety" book. So I hope they help with this.

 

I wondered this same thing.. What IS the safe message being misinterpreted? I have pain when I walk or sit too long..

 

I am confused also...how often do we do this exercise ? If you feel pain all day then what ? Attend to my breathing and then the pain all day ? Confused.

 

One thing that is extremely important to understand is how this all ties together. TMS theory has evolved for a long time. From Dr. Sarno's first book to his last, you saw the theory develop from "we may be on to something here" to "this covers so much more than pain and is a very real cure". All that said, Alan can correct me if I'm wrong, the pain starts initially with TMS, the psychological part, tension myositis syndrome. The brain creating pain via the autonomic nervous system to create a diversion from subconscious and unconscious thoughts that it feels need to keep buried. Once this pain is established, it's our focus, our every thought. Now that this pain is a part of our mental structure, here comes the cycle of fear, the cycle of pain, the neural pathways. This goes on for weeks, months, years and now it's a part of our every day lives. At this point, we can change the acronym of TMS from "Tension Myositis Syndrome" to "The Mindbody Syndrome". This is where the program we are currently studying becomes so important.

I feel that it is very important to initially deal with the initial aspects of repressed rage, etc if for nothing else, to understand fully the cycle of what you're dealing with and where it came from. However, I've found that once you're years into the pain cycle, these newer tools we're learning will be the ones that help the most. Also, I hate using the term pain cycle as I know many of us here have pain, but it's not our main issue. I can attribute anxiety, panic, sensitive stomach, numbness, tingling of extremeties, dizziness/vertigo, neurological issues, I could go on and on, all to TMS over the years. Back pain is a pretty easy one for me at this point in my recovery. As a matter of fact I woke up the other morning with horrible back pain out of nowhere. Using these new techniques that Alan has so graciously given us, I was able to work my way completely out of it within and hour. I'm developing the same skills with the chronic dizziness I've experienced on and off for pretty much my whole life as well. Onward and upward with an attitude of positivity and patience!

 

This is an excellent reply and very well thought out... My only issue is this "repressed" rage. I had all the dysfunctional family history and also possess rhe typical personality type of a TMSer... But have ALWAYS been very aware and tuned in to my emotions, especially the negative ones, which now dominate my life.. But due to CURRENT stressors and pain. I'm ANGRY and frustrated ABOUT my pain ruining my life... Nothing repressed. It's current rage.. Which causes my "old injuries" to reproduce symptoms... If that's even possible.
It just seems the more I work at this, the more pain and fear (and depression) I feel. Ready to give up!

 

thank you alan for this program. this just makes so much more sense to me than just exploring repressed emotions. its about safety, lessening the anxiety response and being okay w pain. my anxiety has significantly decreased since applying these principals. although i still have pain im much less anxious about it. which is an amazing feeling.

 

It's absolutely possible for old injuries to come back with symptoms. the brain doesn't forget and if you're textbook TMS as you and I are, it will ALWAYS be looking for new ways to attack. This is why it's SO important to develop the tools to be able to notice this for what it is, as soon as possible, so that no new neural pathways are created.

The fact that you said this...I'm ANGRY and frustrated ABOUT my pain ruining my life tell me that you are very outcome dependent at this point. Go back and focus on the day that Alan focused on Outcome Independence. Click the link this just created and he goes further into the subject. One more thing, I am a negative thinker as you are. Not by choice, it's simply how I was wired by my grandmother who was the biggest influence in my life growing up; everything is bad, everything is scary, be afraid, never take any chances! This is a hard thing to overcome but I truly believe that what you think about, you bring about. The universe provides with what it thinks you want and if all it hears are negative thoughts then you can count on being a magnet for the negative. STOP YOURSELF! Don't allow it anymore! Be conscious of damaging thoughts. You're here, that means you're in the right place at the right time with the right people to help you.

 

this has been the hardest part, "what to do". So far, the only pain relief i'm noticing is that, for example, i'm a mountain biker who developed pudendal neuralgia (burning stabbing pain in lower pelvis). Biking excessively can cause this, but i got it from something else (a medical procedure). Anyway, PN is generlly a death sentence for bike riding. When my PN doctor told me "no more riding", and then told me to basically rest the nerve, and dont do anything to irritate it, i became very depressed. The next day, while following his plan of basically living in a bubble, my pain got much worse. it was worse for a couple months, until i said SCREW THIS and went out and got a special saddle, and started riding again. Keep in mind, i hadnt heard of TMS yet, so i was still in terrible fear of riding, because usually it would cause a horrible flareup. However, this "living my life" as opposed to sitting on the couch, popping pain pills and being hideously depressed, was starting to lessen my pain. Again, i hadnt heard of TMS yet. Over the course of a year, i would gradually start riding more miles. At first it was about 3, then it got to 5-6 miles. However, it always seemed like at the 5 mile mark, i'd feel burning and i'd turn around and go home. That became a habit in my brain unconciously. My brain was saying "you can only do this for about 5 miles, and then i'm going to send you burning signals to stop". Not to mention, every time i rode, i would have this cycle of fear. I'd have fear before i got on the bike like "how many miles am i gonna last? will this screw up my friend's rides too if i need to turn around and go home?" Then after each ride, i'd be crossing my fingers like "omg i hope i didnt damage the nerve!!!" My riding was surrounded by fear.
When i finally learned about TMS, i started telling myself "ok, try not to be scared, and pretend it's the old days where you had awesome long rides with your friends. you arent damaging the nerve, it's just hypersensitive. and you MIGHT flare up, but you know you'll return to baseline and be fine. it's not dangerous". When i employed these thoughts, suddenly i was doing 9-13 miles. As of hte last few months, i've done 15+ miles, and recently a 27 mile ride! Sometimes i get pain early in the ride again, and i think it's those fear thoughts in the back of my mind. I know i'm going to flare if i push it too hard, but these days when i do, they seem to be weaker flares. So far, practicing TMS for biking has been the only major clue that it's working. I still have substantial pain during the day, like at work or home, etc. This is where i have to keep working at it.
I suggest you keep the exercise going, just try not to think about "will this hurt me later?" Try your hardest to pretend you never had TMS and keep walking like you used to.

 

i get this anger and depression too, because of how much the pain ruined my life. My life was revolving around this pain from the moment i got out of bed, until i went back to bed at night. My brain was obsessed, angry, sad, shameful, etc. I started to blame myself for having pain. I would tell my loved ones 'i'm broken, sorry i'm not fun anymore. it's genetic, nothing i can do about it, and since i'm in my 30s, i potentially have 50 more living years of awful pain". These are the type of thoughts that Alan is saying we need to stop.

Also, i think old injuries are probably one of the most common places TMS attacks. Back when you hurt yourself, your brain remembers that pain. I think of neural pathways as roads that the brain signal uses, that leads to the painful spot. The road is super busy with traffic from the brain. Back when you hurt yourself, your brain built that road, and the road never goes away, but it can close down when you heal. However, the brain never forgets that it built that road. The road can go from a dusty closed off path, back to a busy road again. I picture Mind/body practices as a way to put a "do not pass" barrier on that road. Close it down.

 

It's not only being a negative thinker that hinders me, but the looming doubt of TMS over all... I've always been terrified of health issues and now that I'm over 50, age and the inevitable affects on the body terrify me.. I still have nightmares about my MRI.. And having had surgery on my back some 22 yrs ago... Was pain-free until about a yr ago.. Has programmed my brain to fear my back permanently... I can't understand how I was fine for over 2 decades.... I can't deny that I had unprecedented emotional issues and near homelessness occur in the past year and the loss of a 20 year relationship with someone I had a very deep bond with.. Someday I will figure this all out.

 

I feel all those same ways too... About myself. Guilty for bringing others down, no fun anymore.. I often need help, can't lift heavy and daily necessary activity is hindered. I miss my "old self"... Super energetic, goofy sense of humor, always on the go... Im old, but 51?? I feel cheated out if ten years or so... I could maybe accept such limitations at 60, 65...but not now!!! I sound pathetic I know, but I can't even type this out without crying! Is it always this hard?? Does anyone else EVER feel so lost and overwhelmed??

 

I do have a question though. My reaction to pain is much less scary than it used to be, since learning all this. However, when it kicks in, i still take meds. (mostly gabapentin, and weaker painkillers). Basically, i have to, because i'm expected to still work my job, and i cant do that when in bad pain. So yes, i still pop meds whenever the pain strikes, but i feel i'm doing it simply to feel better, but i'm not expecting that the meds are "fixing" a problem. So even though i'm a lot less scared of the pain, i worry that my habit of popping a pill whenever it comes on, is reinforcing fear.
Like i said, i still need to work my job, and participate in life. Having pain in your crotch, rectum, and urinary tract, is some of the most awful pain i've ever had to deal with, worse than any other body part pain. It's not scary anymore, but if i dont take pain meds, i go into wounded animal mode and start snapping at my bf to "stay away from me!!!" then i go into an awful place (like i said, there's something especially hideous when that part of the body is burning). I hope i can beat this, while still taking meds, as long as i know i'm only masking pain, just to function. I know it's TMS.

 

Thank you Nicole.. I'm in tears reading your post. You GET IT. I feel hopeless and comforted at the same time... I wish I could let go of my FEAR of pain and the structural BS the doctors over the past two years have drilled into me... They DAMAGED my thinking, how I see myself, my confidence in my body's ability to repair itself... It's HORRIBLE... AND yet, while I refute their MRI findings as an explanation for all this, a little incredibly persistent voice inside my brain keeps saying "what IF they're right?".. What if my spine IS crumbling? What if I need surgery? What if I wind up in a wheelchair? Who will take care of me since I have no family? My nervous system is frazzled, overwrought and exhausted... And I know that can make initiate pain too... Im a train WRECK. Emotionally and physically.. I just don't know what else to try.

 

All the time. However, have you ever noticed that a good cry reduces your pain temporarily? It does for me. I used to never know why that happened, but since learing of TMS and feeling emotions, i think the crying is helpful. Dont hold it back, let it flow.
the last 2 years have been filled with thoughts like "i hope when i go to sleep tonight, i never wake up" or "i'm a damaged, broken human who was born wrong, and i dont belong on this planet." i would read about central sensitization (something that chronic painers develop because the whole nervous system gets jacked up) and think "well, that's it. it's incurable and my shit genetics have failed me, and now i've failed others. i'll NEVER get better."
those are the thoughts and phrases i'm trying very hard to to say or think. Now, as i stated abouve, i do take painkillers. If i dont (not sure i'd be able to keep a job) i go into wounded animal mode and i'm snapping, freaking out, and telling people i want to die, etc.