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Originally posted by mala


...Another weakness is that the video portrays pain as a problem with a dysfunctional brain that can be “retrained,” which is definitely too optimistic. Brains are not terriers. Although it makes sense to try, there is no good evidence that it actually works, and it is virtually certain that it often does not. There are many possible reasons why.


...For instance, stressors and mood disorders can be virtually invincible.

...Most people with chronic pain aren’t just a little stressed, they are a lot stressed, and often by major life challenges and social problems that they literally cannot solve.

...For instance, it is next to impossible for impoverished single mothers of children with serious health problems and inadequate social services to support them to meaningfully “reduce stress,” and advising them to do so borders on insultingly naive paternalism.

...Most people find it extremely difficult to troubleshoot their own mental health., even when their problems are theoretically more manageable. So while it’s correct to tell patients to “learn to reduce stress” and “consider how your thoughts and emotions are affecting your nervous system,” that advice is simply impractical without more and better information. “Consider” is just not concrete enough.

...The video’s low point is a recommendation to “recognize deeper emotions” — even more impractical, to the point where many patients will dismiss it as a flaky talk, far too touchy-feely. I understand what the authors were going for, and it is the tip of an iceberg of an important concept — healing by “growing up” — that I will discuss below, but the video simplifies it to the point of absurdity

...How do we convince people in pain that we understand that they are in pain but it’s not just about the tissues of their body?

...A key conceptual shift that we think is really important is that you can understand that pain is the end result...

...pain is an output of the brain, designed to protect you … it’s not something that comes from your tissues.



...Advice! What are the practical applications of this knowledge?
Pain is “another *%$@!! growth opportunity” — another reason to mature as a person, and a particularly good one.

...For many people with severe and chronic pain, learning coping skills are a necessity. But personal growth may provide an even greater opportunity than merely coping with pain. We may not control our brains, but we have do have considerable indirect leverage. We can’t micromanage every sensation, but we can tinker on a large scale. We change the context and direct our experience of life on a large scale. For instance …

...Huff, puff, and blow your pain down. We can alter our physiology with deep, vigorous breathing, instantly creating new feelings — and your brain will go along for that ride, and perhaps re-interpret your experience of pain. See The Art of Bioenergetic Breathing.

...Create new social contexts by doing something as simple as playing a team sport — because other people are counting on you, the painful consequences of intense exercise are usually re-contexualized as tolerable, even desirable, and you can put up with quite a lot more. You can’t think your way to that kind of pain tolerance — but you can place yourself in a situation where it is a likely outcome.

...This is why Haven puts on experiential workshops: to thoroughly “tinker” with your context, especially your social context, because humans beings are so interested in each other that our social experiences utterly dominate our consciousness. Change your social experience, change your brain!

...Reduce fear and anxiety, increase confidence, especially with education. Fear and anxiety probably have more power to aggravate pain than any other emotional state, and acquiring knowledge and perspective are superb treatments.

...A confident and happy brain amplifies pain signals less than an anxious, miserable brain.

...This explains lots of interesting results in pain research (not to mention clinical observations), such as the fact that the most powerful factor predicting how soon people return to work after an episode of low back pain is whether or not they expect to return to work...

...the fact that education alone probably helps to resolve neck pain.

...So do not let health professionals scare you. Seek out as much information as you can find, because nothing causes more anxiety than uncertainty. These are real defenses against pain.

...Early intervention is critical to prevent acute pain from turning into chronic pain

...It is clear that chronic pain involves significant neurological changes, both in nerves and in how pain is processed in the brain. Once those changes occur, recovery is much more difficult, at an incredible cost in suffering and medical expense. Persistent pain should not be ignored. Deal with it sooner, not later.

...The brain cells that produce pain get better and better at producing pain. They become more and more sensitive…

...Respect opiates — but don’t be afraid of them. All of this suggests that a more enlightened, progressive approach to medicating pain is also required.

...Patients and doctors alike shy away from the powerful pain medications for fear of their addictive properties. Due to simplistic, obsolete views of how pain works, a widespread attitude that pain should be tolerated instead of treated, and a fear of drug addiction that verges on the hysterical — and is irrelevant to rational, medical treatment of serious pain — countless people are deprived of medication that could not only relieve enormous suffering, but actually serve to treat serious chronic pain conditions by helping to interrupt the vicious cycle of fear and pain.

...if you believe that you have a problem, you will definitely have one.

...Be kind to your nervous system. Create pleasant, safe sensory experiences — positive inputs. Seek comfort. Be a hedonist. If your brain thinks you’re safe, pain goes down — and pleasure feels safe. So be “nice” to your CNS in every way that you can think of. Make your life — or a joint — feel safer, gentler, more pleasant. Do it in general ways (soak the whole system in a hot tub), but also more specifically: pleasantly stroke a sore knee, give a screaming shoulder the “comfort” of a sling for a while, or cautiously but thoroughly move a troubled joint to demonstrate to your brain that it’s okay. (See, brain? We can do this! No big deal!)

...Finally, fix the fixable — and be honest about what is fixable. Most people aren’t quite as stuck as they think they are.

...Some problems really aren’t fixable, but a lot of your worst and oldest problems probably are, and they are the source of most stress, anxiety and depression — which means that they also have a direct impact on how much you hurt.

...There are many examples of difficult problems that can usually be fixed with some hard work and maybe some leaps of faith: bad marriages and toxic friendships, bad jobs and bad bosses, a house or city or climate you don’t like, poverty, addiction, insomnia and many more. Finally taking action to fix such problems is the most direct route to easing your brain’s interpretations of pain.

...Change something — almost anything! — about how a painful area feels. Make it as feel different as you (cheaply) can. Sensation is one of the factors the brain uses to set pain levels. If you can make a body part feel significantly different in any way, it may help (but especially if you can make it feel safe, protected, stabilized).

...In fact, this probably explains why many treatments for pain problems are popular and seem to help sometimes, despite being unreliable and generally minor.

... Classic examples: taping, bracing, strapping, splinting, salving, vibrating, heating, icing. Regardless of how they supposedly work — there are many overly complex explanations — most of these methods mostly just change how a body part feels.17 The benefit of novel sensory input is probably not much more profound than being distracted by a loud noise … but we can add it to the toolkit, with reasonable expectations. Use any cheap, convenient, creative method — there’s little reason not to.

...Don’t dramatize your pain. This one needs a whole section…

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