chronic pain and fear

from evy's notebook

A year ago, I didn't listen to my body when it hurt and tingled and ended up with a nerve injury that continued for many months. Up until last month, I still had regular discomfort in all four of my limbs and switched doctors to someone more experienced in nerve issues and chronic pain. She suggested I might have neuroplastic pain, which is pain caused by fear of pain instead of physical injury. I hated hearing that, since I've been taught to listen to my body and not always trust doctors, and I also felt excited to hear that, since healing fear might be easier than healing nerve damage. And a month later I have barely any pain!

I read a book called The Way Out, and learned that pain is largely our brain's interpretation of sensory input. If there is perception of danger, we experience pain so that we'll stop doing that. When we twist an ankle, the pain prevents us from walking on it more. When I see a cut I've already had for an hour, it starts to hurt because I'm now aware of it and want to keep it from infection. But sometimes we perceive that a sensation is dangerous when it's not. Just as prevalent as anxiety is these days, so is neuroplastic chronic pain.

In my case, I think I had real nerve injury in my arms. I became scared of pressure on my limbs because the way my muscles felt was similar enough to the pain I felt at the time of my injury. Even as the tingling and numbness in my limbs reduced -- which showed the injury was healing -- I was still experiencing regular discomfort and avoiding many activities like riding a bike or going on my phone in bed (I hope I can keep avoiding that one though).

The author of The Way Out did a scientific study with many participants experiencing long-term chronic back pain. He taught them to observe their pain in a more mindfulness-oriented way -- noticing with curiosity, wondering what kind of pain it felt like, not trying to push it away. This can be really hard, especially if the pain is intense! Sometimes people started with just a few seconds a day of mindful observation. The idea was to retrain the brain to be less scared of the pain, to avoid the feedback loop of feeling more pain when noticing the pain because of the fear of the pain. By the end of the study, two thirds of participants had no more back pain and the other third's pain was greatly reduced.

The pain I was experiencing actually wasn't that strong, so I let myself just experience the discomfort without being afraid of what it could turn into, without being afraid of it going on forever. While I still experience discomfort these days, it's way less strong than it was before. And that's how I know the pain was neuroplastic.

I was afraid to try this technique, because I didn't want to do things that would further injure me if the pain actually wasn't neuroplastic. The way I got around that was deciding not to do things that would aggravate the injury, but rather observing the pain that already existed and trying to change my relationship with it. If changing that relationship reduced the pain, then that became a good sign that the pain was actually (at least partly) neuroplastic.

The signs that pain might be neuroplastic are: it started during a time of stress, it was related to an injury that seems to have physically healed, it's symmetric on both sides of the body, it moves to different parts of the body at different times, it has completely gone away during an especially happy moment/period of life.

I'm really glad to have learned about neuroplastic pain and want to tell everyone I know! Everyone experiences pain sometimes, and many of us experience some sort of chronic discomfort. I hope that by talking about this, I can help someone the way this book helped me.