Today I'm sharing an article in the Los Angeles Times from Nathaniel Frank. It is about a new study that is published in the Journal of Pain, basically saying that a majority of neck and back pain comes from nociplastic or neuroplastic causes. I'll link to the article and the study and I'm sharing my takeaways from the article and how you can apply this data to get curious about your pain in a new way that can change everything. I'm sharing my parts of my conversations with clients and what I'm cheekily calling the way through. Hey Alan Gordon, don't sue me. But it's the idea that we move through physiological and emotional pain and it can feel like a storm moving through us if we release the fear about pain becoming permanent. It's a concept I enliven in my clients all the time. Have a listen and ENJOY some science backed release and my own spin on mind body pain reprocessing and healing.
Episode 19 of my podcast - Hard Times Happen
https://podcasts.apple.com/us/podcast/move-with-deb-episode-19-hard-times-happen/id1595415545?i=1000546605315
Study on Painkillers and Emotional Pain
https://www.theguardian.com/lifeandstyle/2020/feb/18/painkiller-emotional-pain-acetaminophen-paracetamol
Application of a Clinical Approach to Diagnosing Primary Pain: Prevalence and Correlates of Primary Back and Neck Pain in a Community Physiatry Clinic
https://www.jpain.org/article/S1526-5900(23)00544-8/fulltext
LA Times Article - Opinion: That pain in your back? It’s really a pain in your brain.
https://www.latimes.com/opinion/story/2024-01-29/chronic-pain-health-wellness-mind-body
[00:00:00] Welcome to the curiosity cure podcast. I'm your host, Deb Malkin, master certified life coach, body worker, hypnotist trained in pain reprocessing by the pain psychology center, queer elder, fat human on planet earth here to help you evoke the power of simple neuroplasticity techniques rooted in shame free curiosity.
[00:00:29] So you can feel more better. more of the time in the body you have today and build the rich, full life that you want to live. A quick disclaimer, this podcast is not a replacement for medical care. I am here to provide insights and techniques that can compliment your healthcare journey, but always consult with your healthcare provider for personalized advice.
[00:00:57] Hello and welcome today I wanted to share an article in the Los Angeles Times from Nathaniel Frank. It is about a new study that is published in the Journal of Pain, basically saying that a majority of neck and back pain comes from nociplastic or neuroplastic causes.
[00:01:23] I'm going to read to you the article. You can then go read it yourself and I'll also link to the study. One of the things that I believe is important is being able to identify whether you're dealing with primary pain or secondary pain because the treatment plan changes. Dr. Schubiner and the other people in the study are coming up with ways for clinics for these types of places to have diagnostic criteria.
[00:01:55] So I'm going to read the article. As a chronic pain sufferer. I sometimes surprise people by telling them that my pain doesn't have a physical cause. It's a mind body thing, I say, related to stress and emotions. To many, this sounds like admitting to being a little bit crazy. And when I up the ante by suggesting they've probably had this kind of pain too, some become outright angry, interpreting my words to mean their pain is all in their head, all of which makes a new study published in the Journal of Pain a big deal. It offers robust evidence that the overwhelming majority of chronic back pain and neck pain cases among the most chronic common pain complaints come from the mind. Despite the fact that most diagnoses site a physical cause such as bulging discs or bone spurs.
[00:02:53] In the new study, doctors assessed 222 consecutive pain patients at an orthopedic care clinic in Louisiana, everyone who showed up, as long as they could complete a questionnaire. Just 12% showed evidence of a structural problem as the root of their pain, 88%, on the other hand, had what the researchers called primary pain, which refers to symptoms generated by neural circuits in the brain, rather than by structural damage to the body.
[00:03:25] Based on this and prior research, the authors believe that a process in the brain initiates the non structural pain. The sensations could be the residual pain from a bodily wound that healed but didn't notify the brain, or the brain may have generated pain in the absence of any injury, perhaps an effort to protect the patients from emotional wounds by occupying their attention with physical sensations instead.
[00:03:54] The role of the brain and emotions in producing pain has long been known and has been validated by neuroimaging that shows the brain processes physical pain and emotional distress in the same regions. Observational studies indicate that people feel more pain when primed with negative emotional stimuli, and additional research has shown that the therapeutic interventions that help patients understand and reinterpret their pain can significantly reduce the symptoms.
[00:04:28] The theory is that pain is a danger signal. So as we come to feel safer and less threatened, our nervous system shifts out of fight or flight mode and stop firing the pain signals. As a result, scientists now believe that all pain is essentially brain pain. The idea is that just as the brain generates sensory experiences, such as vision and hearing, it also generates pain by consulting our memories, expectations, and emotions, as well as whatever physical inputs our nerves may sense, creating pain when it determines we are under threat. While our nerves detect sensations, it is the brain that decides if we'll experience them as pain.
[00:05:15] The implications for healthcare are profound. Chronic pain is among the top reasons people seek medical care. More than 1. 5 billion people worldwide suffer from chronic pain, including 50 to a hundred million Americans.
[00:05:33] For the most part, these patients are spending billions of dollars pursuing physical treatments. If the cause is nonphysical, the money is wasted and the suffering only mounts. And here's my aside comment. The most awful thing I see in people who I work with is the harder people pursue treatment, the more vigorously, people pursue a physical treatment, oftentimes will see the pain spread. So it will increase and spread around the body because the root cause is not really being addressed. Going back to the article, and not only are we failing to alleviate the pain, we are creating dangerous side effects that include the opioid crisis, as well as surgeries that may be unnecessary and can leave patients worse off.
[00:06:22] Of course, sometimes chronic pain does have a physical cause and distinguishing between when it does and when it doesn't is crucial. To address this key challenge, the researchers at the Louisiana Clinic devised a rule out, rule in diagnosis method that should be adopted far and wide. The process starts with a thorough patient exam and review of scans to rule out physical causes of the pain.
[00:06:47] There is a nuance, just because an anomaly, a squished disc in your back, for example, shows up on a scan, it is not necessarily the cause of pain. As the study explains, research repeatedly shows that the majority of people without pain show similar anomalies.
[00:07:06] In other words, doctors diagnosing the source of chronic pain need to be aware of the poor correlation between scary scans. And pain, the rule in process further clarifies whether a patient has structural or mind body pain consists of taking a detailed history of the patient's pain and life doctors need to know of prior treatments that should have resolved structural causes have failed if treatments associated with a placebo response brought relief, if a patient's history contains significant stress or adversity, if they have other ailments associated with mind body causes like headaches, gut and bladder conditions, fibromyalgia, chronic fatigue, tendonitis and more can have such associations.
[00:07:57] And they need to know if the pain is inconsistent. Does it move around in the body or come and go? Is it triggered by biologically irrelevant stimuli like the weather, smells, or sounds? These variables don't track well with structural causes.
[00:08:14] I'm going to jump in here as well. When we talk about weather, smells or sounds those are, sensory input that can be interpreted by the nervous system as a threat. They're irrelevant because they are not related to the structural cause, but it makes sense for people to feel increased pain if they have an already sensitive threat detector. I just wanted to say that because there are plenty of people who are triggered by smells, sounds, and the weather, and I don't want to dismiss that, but as you can see, your pain increasing because of the weather kind of proves that it is nociplastic or neuroplastic pain. So in some ways, it's a positive indication that there is a brain nervous system element to it.
[00:09:06] The process may sound a bit subjective, and it is, but no more than any other diagnostic approach. Medicine is not an exact science, and doctors must act on imperfect information. Quote, we deal in probabilities, unquote, says Dr. Howard Schubiner, lead investigator of the Louisiana study and a clinical professor at Michigan State University College of Human Medicine. Using the careful criteria developed for the study offers as well grounded a basis for action as anything. When there is strong evidence using these criteria, a physician can be confident that what they're seeing is a mind body problem.
[00:09:47] The existing medical paradigm assumes a physical cause for most chronic pain. The findings in the Louisiana study suggest that that's often wrong. Fortunately, my pain, meaning the author's pain is much improved after years of pain education and good therapy helped my brain dial down my nervous system.
[00:10:08] Everyone deserves access to this new pain paradigm and that requires ending the stigma still associated with mind body symptoms and understanding them as a universal human condition. Not as the lot of people who are a little bit crazy.
[00:10:25] Clicking over to the study, wanting to read a little bit about the perspective of the study and I'll link to it says, we developed an approach to diagnose chronic primary pain, which was applied in a physiatry clinic to 222 patients with CBNP, chronic back and neck pain. Most patients, 88. 3 percent had primary pain despite almost universal anomalies on spinal imaging. This diagnostic approach can guide educational and psychological treatments tailored for primary pain.
[00:11:03] Okay, what is interesting about this study is other than the inability to complete a questionnaire or language barriers, there were no exclusions of people. And this is in a small city of 82, 000 people in Louisiana. This was done between June 2020 and May 2021. So, people were not segmented out by race education, economic class. So that is super interesting. The sample was 73. 9 percent female. 86. 4 percent white 12. 7 percent black and 0. 9 percent Native American. Averaging 59. 6 years old and had a median pain duration of three years. Most patients reported lumbar pain where 19. 4 percent reported cervical and 3. 6 percent reported thoracic pain.
[00:12:03] But many patients had pain in multiple sites. Spinal scans indicated that 91 percent of the patients had disc bulges. 83. 7 percent had arthritis and 48. 2 percent had disc degeneration. This is just fascinating. As I've mentioned before in other podcasts, the international classification of diseases the ICD, now has a classification for primary pain. So this was a clinic ready approach for identifying primary pain and had a frontline physician apply it to an unselected series of patients seeking care.
[00:12:45] I think for you, my audience, the most important things to take away from this study and the article is first off believing that neuroplastic pain or nociplastic pain is a normal human experience. As I've said before, it is normal to feel pain.
[00:13:09] There are other studies that say over the counter painkillers can alleviate emotional pain, so it's so interesting. There are studies that show that there's basically this sense, as they said in the article that emotional pain and physical pain are processed in the same region of the brain and when we bring in the view of the nervous system, it, it makes a lot of sense, right? There's this quality of hurt that's being experienced by the subject, by the human. There was a study that shows taking painkillers can reduce the severity of emotional pain caused by rejection. So first off, it's just really important to say that there is emotional pain caused by rejection. That is an experience that is felt in the body. Like when we have that sense of heartbreak, it's called heartbreak because that's how we process that experience in our heart.
[00:14:19] And our heart is, you know, we all can locate where our heart is, and maybe we all know a little bit of what that feels like to have a heartbreak, to see something and feel pain. Maybe you're experiencing that now with the news and looking at images of what's happening in Palestine in Gaza whether you can look at images of war or people suffering and having a physiological experience. What we often do is suppress the emotional experience and any kind of suppression is also signaling to the nervous system that what I'm seeing and I'm reading and I'm feeling is a threat and I don't want to be experiencing it and then the body will also experience that because when we're amplifying something as danger or as a threat, the brain interprets that and will often give us the experience of pain.
[00:15:26] In this other article that talks about the study of taking Tylenol for emotional pain, it says instead of reaching for a pill, we should remember that pain is sometimes necessary to instigate change. Pain reminds us of things we need to work on. It drives us to change ourselves and the world. It says, so what do you do when you have a broken heart? Dutchevici recommends talking, and not necessarily with a professional. In fact, Dutchevici says that anyone, friends, a religious leader, your local bartender, are good options when trying to work through emotional pain. There is just one key ingredient, introspection. It's within human relationships that you get to work out some of your issues, and that's not going to happen with a pill.
[00:16:18] And I agree. I had an amazing conversation with one of my clients the other day, over text and they were telling me that they were interviewing for a job and that's a stressful experience and they had a pain flare up and melted down a little bit and then breathed through it and listen to a bunch of my podcast episodes and episode 19 in particular they said was helping.
[00:16:46] Episode 19 is called Hard Times Happen, and I was talking through my process of having flares and my mind body symptoms, freaking me out, and I walk people through this experience of my story and what I did about it. I think the important thing that my client is sharing with me and that I share often with you is, they said, I breathed through it and everything is going to be fine.
[00:17:18] I had said back, you got this, you're going to be fine and such a great job recognizing how all those pieces fit together. And I shared that I was cheering them on for their interview and I said, also, I'm starting to think of a meltdown as they melt through. Your physical and emotional body are releasing the stress that's being triggered. Let it flow right on through. They said, that's so great. It literally did feel like a storm moving through me. And I was able to remind myself that it was in motion.
[00:17:53] This is what I see a lot with people is what amplifies the fear around pain, whether it's emotional or physical pain is the idea that it's going to be there forever. That often comes up for me around pain. When I think about experiences that I've had in the past that trigger that feeling there's this sense of shame. Or the belief that this pain will happen again and so then I get to re experience that suffering. What I'm noticing and learning now what I really believe that is, is just my brain queuing me saying, hey, that thing that happened that was so terrible at that time. I don't want to experience that again and I'm going to keep bringing it up for you so that you are aware of that and know that and we don't do that again.
[00:18:43] And so I appreciate my brain, I appreciate my subconscious cuing me with this past pain. And when I don't try to suppress it and I allow both that experience and that fear to move through me, one, it proves that there's this movement that I'm able to move through and move beyond past painful experiences.
[00:19:07] It might cue me to do things like go to a coach or a therapist and work on things that are triggering this fear, work through past experiences or talk about them with a friend or talk about them with a new partner or new lover, right? Like be honest with myself about ways that I can change.
[00:19:33] And even just exploring things like childhood trauma, there's so many options for being able to turn around and look at what I'm experiencing through the lens of curiosity and softening my fear into hope possibility and the belief that, whatever it is that I need to learn, whatever it is that I need to understand, whether that's working on boundaries, whether that's feeling safe in connection with other people.
[00:20:10] Those are things that I am able to work on, maybe I've already excelled at that. And I can go look through my personal narrative and kind of update this story and think about, where are all the ways that I'm already succeeding at this? And then how do I talk to that part of my brain that is afraid of the past repeating?
[00:20:33] Sometimes I do that with hypnosis. I revisit the past and I take myself through a timeline. Maybe it's through mind body work and I sit with those sensations and allow them to be felt while creating this foundation of safety.
[00:20:50] Sometimes that's working with certain kind of self directed neuroplasticity in a gentle way. So that could be things like doing, bilateral stimulation for hemispheric synchronization, or tapping or things like shifting out into peripheral vision. So taking what we know about how to connect with the nervous system, the physiological ways of helping connect to the nervous system and pairing them with psychological ways, right? Thinking about creating safety, thinking about the nervous system, the fight, flight, freeze response, and the fawn response if you want to add that in as one. So there's different ways, top down, bottom up. I like to pair them all together, but there are approaches for working with strong. unpleasant sensory experiences. And the first part is just understanding that that is a normal human experience.
[00:21:59] Then the next part is understanding that imaging findings do not necessarily correlate to being the source of pain.
[00:22:10] There's a study that says people who have lower back pain, who seek treatment for pain and get imaging, it takes them 8 weeks longer to heal, to have a relief of pain than it does for people who did not seek imaging. So it doesn't mean that they didn't seek treatment, but they didn't get imaging done and the people who did not receive imaging, relieve their pain faster.
[00:22:36] That makes sense because when we imagine that there's some kind of damage happening in the body. We can't imagine having the pain be relieved unless there's some kind of physiological change. We almost set ourselves up because when we've identified the source of pain is being in the body, in the back, in the disc, then it's only logical that that needs to change 1st before pain. And then anytime you're feeling something in the body, you're going to be predisposed to want to protect the area, which often means limiting movement, which often means then reinforcing the idea that there's damage and that moving, will intensify damage.
[00:23:25] It keeps this loop of, fear, pain, limited movement going. One of the ways of ruling in primary pain is if you can do provocative testing. So that might mean just imagining doing the kind of movement that you think is dangerous, if that triggers some kind of pain, then that is proof of neuroplastic pain because you haven't even done the movement and you're feeling the sensation.
[00:23:55] And the opposite can be true, when we're starting to work on the healing trajectory, imagining moving without pain, becomes an important part of the process, whether we're calling that mental rehearsal or visualization, and we're teaching the brain that we're safe doing these movements. And sometimes that's where people start before they feel safe enough to actually do it with their body.
[00:24:20] All of this goes to say that there's no separation between the mind and the body. As we begin to decrease the fear response around unpleasant physical sensations, we can start to crack open the treatment trajectory and feel better using mind body techniques.
[00:24:39] And especially now, if it's filtering in through the medical system, how amazing is that? Oftentimes people come to mind body work because it is literally their last resort. They have done all the treatments. They've gone to physical therapy endlessly. They have taken pain medication sometimes for years, sometimes adding more and more medications.
[00:25:06] And they've had surgery or multiple surgeries and still the pain remains. I love what this Louisiana study shows is that it's actually possible for primary pain to be diagnosed by a doctor. And treatment to be applied and recommended before people have to go through all of those negative experiences and suffering for years in that study, people had been in pain for 3 years and in the boulder back pain study, I think the average was 10 years.
[00:25:40] In an upcoming, podcast episode with a former client of mine, Petra, who's now a mind body practitioner. She had been in pain for over 20 years before her recovery, which also shows that you can be in pain for a very long time and still recover.
[00:25:59] I never try to limit what's possible for people, in regards to recovery. Because I do not know. I have seen and read miraculous things. Getting to talk to Petra reminded me, if I had a sense of a limitation of what was possible for a client thinking that, oh, no, they can only improve to be, you know, this well. She's a very athletic person. She had previously been in a wheelchair but she mountain bikes and hikes a lot. One of the things when we had worked together We were working on wrist and elbow pain and if I had told her like oh, yeah, you know you'll feel better, but you won't be able to Mountain bike, because the mountain biking is too much pressure on your wrists and elbows and that's the trigger of your pain, then she wouldn't be pain free now and mountain biking.
[00:26:59] The authority that comes with a physician. Or a surgeon, or a therapist, or even a coach, is important to understand the impact of our words, of our belief. Any kind of limitation that we create for someone. So I love that I did not know how well she could become.
[00:27:26] And she's so well that she doesn't feel pain while doing these movements, she doesn't feel chronic pain while doing these movements and activities that she loves and so she gets to do activities that she loves and feeling safe at the same time. And even if she has a twinge, she still feels safe at the same time.
[00:27:44] If you are somebody that has experienced chronic pain, my invitation to you is to get curious about your beliefs about the reasons for your pain and just start to see what even subconsciously you're believing is happening in your body. What do you believe is the origin of your pain?
[00:28:08] And if we could shake up that belief, almost like it's in a snow globe, kind of shake it up and say, what if that wasn't true? Not because you're wrong, but because changing our belief about what's happening inside of our body and opening up curiosity to start to use these mind body tools and experiences is part of the process of recovery. We do that with a light and curious approach to any type of pain behavior. So that might be looking at all the ways that you limit your movement and activities because of pain or the fear of pain. Thinking about pacing in a way that actually limits your future possibility and potential.
[00:28:59] Sometimes that's because people think of pacing as a hard line in the sand. Like I can only do this much. And if I do more, that is a trigger for pain. We think about our triggers, we're almost telling our brain to tell our bodies, hey, this is what's going to happen.
[00:29:16] It's like creating a conditioned response. What we're doing in mind body work is changing the predictive code, is unraveling these pain behaviors and unconditioning these responses and conditioning in a response of safety, of nervous system regulation of calm, of curiosity, of being able to bring ourselves back into a ventral vagal state, working on fear, teaching our physiology, how to move through an experience and not be stuck in fear of an experience being something that is fixed, permanent, unchangeable.
[00:30:02] Then teaching us how to go deeper into exploring some of these non physiological roots, whether we're exploring emotional pain, whether we're exploring, the cues to our nervous system for change. So that could be looking at our relationships and thinking is there a boundary here that I need to set or keep or uphold. Are there things that are unspoken?
[00:30:28] Is there some past trauma that I could safely explore and look back on and heal my relationship with? Not necessarily with any person that has created any kind of trauma, but with the you that had experienced something. What we're doing is looking back on ourself who had experienced something traumatic or experienced multiple things that were perceived as traumatic in the past and looking back.
[00:31:04] Creating the safety in our today self to look back on those past experiences and neutralize the trigger. We can't ever go back and make them unhappen but creating a sense of soothing, self connection, self love, self compassion for that self who had gone through those experiences. And then looking at that and thinking, what do I need to know now?
[00:31:34] With my clients, I teach them when you're starting to notice a flare, asking your body, what do you need right now? What would be helpful to you? Asking your body, Hey body, what's going on? And waiting and listening, starting to develop that inner conversation with our subconscious that speaks through the body. And sometimes those are just physiological needs like I need to move. I need to eat. I need to go to the bathroom. Sometimes it's that and because of either the way that we've been raised or modern day schooling or work or the pressure that we put on ourselves to work, or even just enjoying being in a flow state and not wanting to break it by listening to our body's needs. Our body is trying to communicate something to us, and when we're not listening, sometimes it gets louder and it gets louder through the body. So starting to develop a collaborative, joyful, positive relationship with ourselves is one part of the process of working through neuroplastic pain.
[00:32:46] When we're feeling something and our first approach is, what did I do wrong? What did I do? How did I sleep? What happened that caused this pain? When we're only directing ourselves to look for the ways in which we are failing or creating this painful situation, we're directing the mind to look for specific physiological reasons for the mind body experience that we're having and that directionalizes the mind towards a physiological reason, and then we take our actions based on that that assumption. So widening out our curiosity and asking ourselves questions like, what would my body need from me today?
[00:33:31] Or what is it that is triggering a sense of fear? Or how can I soothe myself in this experience right now? If I can teach my body that we're safe, what would I need to think or feel or do to feel that sense of safety? Because I don't know. It's going to be different for everybody, but part of this is developing that sense of curiosity, questioning, love, and attention, and care that we absolutely can give ourselves.
[00:34:05] One of the things that I believe is having a guide through this process can absolutely make it less confusing, more clear, giving you very personalized steps for your mind body healing process. That's what I help create with my clients. It is personalized because everybody is different. Everybody's life experiences are different and it's important to treat yourself with love and curiosity and having a coach can help you reflect back what's working and what's not working and help you create your own bespoke way forward and way through, right? Alan Gordon calls it the way out. I might call it the way through.
[00:34:56] Feel free to book a curiosity call with me. I would love to hear your story and talk to you about mind, body healing and how we can work together. And for each podcast, I post a specific Instagram post, so you can just hop on there on that post and share with me anything that's been helpful, or any questions that have popped up from this conversation, because I would love to hear from you. Thank you. Bye.