Change the Brain; Relieve the Pain; Transform the Person
Section 4: Pain Gone Wild
All Roads Lead to Unpleasantness
Everything about pain is an unpleasant experience. When a pain signal reaches the brain, it generates changes in hormones, the state of arousal, the excitatory automatic processes, sensory and motor centers and emotional centers of the brain. The graphic on page 37 of the Neuroplastic Transformation workbook depicts this. When we cannot escape pain because it keeps returning, people lose the expectation of relief and a growing sense of anxiety begins. When the pain is a constant companion, most people experience hopelessness and depression. The overall experience of persistent pain is that of pain unpleasantness, persistence and constancy, mingled with depression and anxiety.
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This tends to lock in the trauma experienced during the injury, its treatment and recovery. The pain generates overwhelming anxiety, stimulating anatomical pain and emotional centers, releasing excitatory neurotransmitters, activating perpetual nerve firing, releasing more inflammatory substances and placing the peripheral body in a constant state of “red alert.” In a sense the pump is primed for fight and flight and the experience of destabilizing terror is just another increased pain episode away.​​
The Survival Response: The Amygdala Rules
Unrelenting pain, never healing and constantly present, frequently leads to a derailment of a person’s life that should be seen as the slow motion part of the injury. We all expect pain to leave once we are stabilized, but persistent pain does not behave this way. As it becomes clear the pain is not leaving, a sense of disbelief sets in. The pain is disabling and the person gradually loses contact with friends and co-workers, work-related identity, social context and family. Fear takes hold. Medical tests and treatments that lead to more pain and partial or poor outcomes augment this fear. As the intensity of the pain increases so does the intensity of the fear. People experience their pain in the survival center of the brain called the Amygdala.
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When the amygdala turns on, the upper parts of the brain involved in upper level functions are turned off. By design, danger detection leads to anxiety and fear and preparation for fight and flight before higher cognitive functions can mull over what to do. Our brains react first and analyze later, when danger is detected.
Recognizing the Reponse
Look at page 39 of the Neuroplastic Transformation workbook. Read throughout the text. The graphic and accompanying text explains the resonance that occurs between the amygdala and the hippocampus, locking in traumatic memory. Persistent pain causes us to become stuck in the loop between the amygdala and the hippocampus. This prevents the higher functioning parts of the brain from modifying the pain. It traps a person in their wild amygdala. The emotions here are extreme, and we tend to relive events in their extreme, when caught in this region of the brain. Higher language centers do not work and without words it becomes impossible to integrate this experience into your life story, known as your personal narrative. Putting words on the emotions and events can be helpful. Just recognizing that you are stuck in your amygdala, begins to activate effective problem solving, language, emotional regulation and planning centers in your brain to modify the raw and reactive experience of being in your amygdala. The treatment itself and the failure of that treatment can cause the same result. The person experiencing this feels traumatized and the stress is never integrated into the personal narrative.
Taming the Amygdala
If the emotions that either accompany or worsen your pain are too frightening to face, ask why this is so? Do not give into the fear. Ask yourself what is so frightening about what you are feeling? What is so terrifying about the pain? Is it the fear that you will not be able to do what you have planned? Is it that you will have hours or days to pay for some perceived excessive activity? Is it that the things you have learned to diffuse your pain will not work and that you will have no defense against it? Is it that the pain will never leave you and that this will make you miserable for the rest of your life? Question the validity of these ideas and feelings. Pain always varies in intensity. If it doesn’t feel like it does vary, then assume that your emotional conflicts are playing a role in the experience you are having about your pain. Attack the pain from that end. Start examining what you are feeling emotionally and question why this has such a grip on you. Are these emotions completely unique to your pain or do you have them under other circumstances, as well? If they are unique, try to figure out why your pain has brought up these feelings.
Connection, Integration and Perspective
Some treatments themselves can be painful. It is important to be comfortable with being a little uncomfortable. It is often helpful to try some things that cause you to relive the trauma. If this is tolerable, try to continue, as this may be what you need to work through it. It is imperative to release any negative or upsetting emotions associated with the traumatic incident. Healing must occur throughout your body. Emotional release often occurs in conjunction with reconnecting to our bodies through manual therapy, sound or music therapy, movement or exercise. Be patient with yourself and your body. Injuries can happen in an instant, but healing may take months or years. Nurture yourself during the process. Tend to yourself. Eat well to give your body the building blocks it needs to heal. Be sure to rest. The body needs rest and time to heal. This doesn’t mean spending the day in bed, but instead should punctuate periods of activity with periods of rest, pacing the day and advancing activity. Restorative rest is essential. Sleep may be difficult either constitutionally or from the pain or both. Explore as many non-medication approaches to enhance restorative sleep, as possible. These can include relaxation exercises, muscle tension and relaxation, soothing thoughts and images, soothing sounds, white noise and meditation.
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