Written by: Miriam Gauci Bongiovanni, Executive Contributor
Executive Contributors at Brainz Magazine are handpicked and invited to contribute because of their knowledge and valuable insight within their area of expertise.
“Could your symptoms be psychosomatic?” my best friend asked me, after I’d been going on and on about the different symptoms I was suffering from as a 28-year-old. My answer was a clear ‘obviously not’. How could she dare to tell me that I was making these symptoms up? I was in agonizing pain, and had been for several months. Not only that, but things were getting worse and worse, with new symptoms developing in different parts of the body.
My leg, sciatica, shoulder pain and neuropathic pain had been blamed on several injuries, muscle imbalances, a flat foot, potential nerve damage, and finally fibromyalgia. Every specialist I visited came up with a different theory. In reality, nobody had a clue. A couple of them even warned me that I should never engage in sports again (I had been a passionate rock climber before all of this started).
It was only months later that I came across some books and resources that helped me understand what was really happening to me. After hundreds of Google searches, I stumbled upon a concept which I felt might apply to my case: it was TMS (Tension Myoneural Syndrome), also known as MindBody Syndrome, and lately as Neuroplastic Pain. Luckily, my gut instinct told me to bookmark the resource and get back to it later; today, I shudder to think what would have happened to me if I hadn’t! In short, after 6 weeks of intense work, which involved deep self-awareness, emotional work and some radical mindset shifts, I resumed rock climbing and reached my previous level within a couple of months. I got my old life back again – and more!
The solution to all of my chronic symptoms was simple – but it required a level of open-mindedness, determination and fortitude which sadly, few people possess when faced with debilitating chronic symptoms. This is because most sufferers have had their hopes crushed due to misinformation (and because the word ‘chronic’, in itself, implies that the condition will inevitably last…)
That said, chronic pain psychology and pain neuroscience are finally being taken seriously, and more people are opening up to the relevance of the mindbody connection these days. It’s being proved over and over again that certain mental states – such as the tendency to be catastrophic about pain, or hypervigilant – can make the symptoms worse [1][2].
I was lucky to have stumbled upon this knowledge early enough, before I sank deeper into my depressive state. But I believe that nowadays, these things shouldn’t be a matter of luck; education and support should be available to all chronic pain sufferers. And this has been my mission since then.
Why chronic pain can be ‘tricky’ to resolve
Chronic pain is widely misunderstood, due to its inconsistent or inexplicable nature. Sometimes, no damage or abnormality is identified through tests and scans, and doctors are clueless as to why the patient is in such pain.
In other cases, specialists pick up on a minor abnormality or a past injury and blame that as the reason for pain. Sometimes they just blame it on poor posture or the computer screen. But numerous sufferers actually present multiple symptoms that are physically unrelated (i.e. they cannot be blamed on the same structural cause). Sometimes, pain comes and goes, and maybe also disappears for certain periods of time, only to flare-up later. In short, the nature of chronic pain is often inconsistent and unpredictable. It is no wonder that patients are sometimes told that they might even be imagining it!
But chronic pain is never ‘just in your head’!
What I learnt as I studied the Neuroscience of chronic pain is that pain is never just in your head. That said, all kinds of pain (both acute and chronic) are registered by the brain, in the sense that we won’t be able to feel any pain or sensations at all if it weren’t for our functioning brains!
Pain is a danger signal whose purpose is to warn us that something could be wrong – so that if we accidentally touch a very hot surface, for instance, we would be quick to back away (the outcome would be quite drastic if it weren’t for this very practical bodily function!)
But sometimes, our brains can make mistakes. As Alan Gordon explains in his latest book, The Way Out:
“Normally, pain is helpful [...] it’s an important danger signal that helps protect our bodies. Neuroplastic pain, on the other hand, is a mistake. Neuroplastic pain is caused by the brain misinterpreting safe signals from the body as if they were dangerous. So, we feel pain even when there is no damage to the body.”[3]
And so, in a sense, chronic pain is a case of the brain learning to ‘overreact’ to a stimulus or trigger. This trigger can be anything, from a physical activity or movements to sitting down, visiting a specific place or even the weather.
And yet, these are simply ‘triggers’, and not the direct true cause of pain. Depending on your symptoms, you can have one or more triggers. Unfortunately, more often than not, the trigger is something you come across every day and that cannot be totally avoided.
Neuroimaging is nowadays confirming this theory, and also highlighting that such pain is not simply in one’s head. This is because there are real physical changes taking part in the brain that are associated with increased pain levels:
“Neuroimaging has provided evidence of structural and functional brain changes in the majority of chronic pain syndromes. To date, cLBP (chronic low back pain), FM (Fibromyalgia), neuropathic pain and TMD have been the most widely studied pain syndromes using this technology. The expression that ‘pain is in a patient’s head’ no longer reflects the idea that chronic pain is a largely psychological problem. Rather, it can now be taken more literally, because neuroimaging studies have repeatedly demonstrated extensive alterations in brain structure and function in chronic pain states.”[4]
The real causes for MindBody Syndrome and Neuroplastic Pain
I don’t believe in coincidences. The ‘brain mistakes’ described above don't just happen to the individual out of sheer bad luck. TMS chronic pain, instead, develops due to a variety of factors. And most of these factors are emotional. Many healthcare professionals are aware of the link between anxiety, depression, stress and chronic pain. Yet very often, they do not quote this connection as being the principal cause of unexplained pain, although some do recommend managing stress and anxiety. This is because as yet, there is very little education about the subject. We believe that stress can make pain worse – and it does – but it is harder to accept that negative emotions on their own can lead to the onset of pain. My chronic pain symptoms developed after a particularly stressful time in my life: one that involved long term feelings of insecurity, resentment and rage. I had been repressing these feelings for the sake of remaining positive and ‘not making a fuss’.
But according to Dr John Sarno, the American Doctor of Rehabilitation Medicine who first came up with the concept of MindBody Syndrome, the more you repress unpleasant emotions, the more likely you are to experience pain. It’s as if the pain or symptoms are there as a replacement for these unacceptable, unconscious emotions.
Dr Sarno’s books and works are well known for helping people make full recoveries from chronic back pain, leg pain, tension headaches, fibro symptoms and a host of other chronic symptoms – including those symptoms blamed on disk herniations. He’s really the hero who put the mindbody connection in the spotlight in relation to chronic pain.
The pain/fear cycle
To add fuel to the fire, once they get pain, people tend to start fearing the pain itself, and worrying what it could mean. This in itself will generate a host of other negative emotions and depressive feelings, which only serve to increase pain perception.
Not only that, but we start to interpret the pain area as dangerous, and the generation of pain becomes a ‘learnt response’ – this is where the brain learns to fire the pain signal when there is no real injury or damage, and we develop neuroplastic pain.
It’s a vicious cycle that many chronic pain sufferers end up slipping into, without knowing it. Too often, the blame is put on external factors like posture, a small imperfection in the body, or a past injury (but acute pain from injuries hardly ever lasts longer than 4 to 6 months – unless it transitions into chronic neuroplastic pain).
All this leaves sufferers feeling fearful, powerless and frustrated – the worst emotional state to be in if you’re aiming for recovery, since these emotions breed more pain if they’re continuously being indulged in.
Start with open-mindedness and curiosity
As a Chronic Pain Coach, I encourage people to get started with an attitude of open-mindedness, and allow the possibility that their unresolved chronic pain isn’t necessarily due to structural damage or illness.
Because they’ve often been given different possible explanations for their pain (some of them structural), this can be a difficult process. And yet, when someone has already tried all sorts of treatments and nothing has worked, a mindbody approach to chronic pain will start to feel more acceptable and promising.
It all starts with asking the right questions and doing some self-awareness work. Can you link the onset of pain with a stressful or highly emotional event that preceded it? Do any abnormalities found on scans really correlate to the pain area? Do you find yourself thinking very negatively about your pain, obsessing about it, and always thinking of the worst case scenario?
The pieces will come together bit by bit, and if you suffer from MindBody Syndrome, you will know it if you actually take the time to educate yourself about it. Of course, it’s always paramount to rule out serious medical conditions first, such as infections, tumours or other serious illnesses that require medical intervention.
But we do know that there is an epidemic of chronic pain out there. We know that most sufferers are not being educated about the Science behind chronic pain and are not given the right psychological support.
And that’s why I founded PainOutsidetheBox, my pain coaching and educational venture. Sufferers deserve to learn the truth about how the pain developed and why it still persists. They also need to realize that it’s possible to take an active role in recovery, and not simply rely on passive treatment. This is because nobody else can change your mindset – you alone can work on changing that over-activated pain response, with the right guidance.
You can check out the free resources on my website here, and also book a one on one coaching call or package with me so I can guide you on your journey of recovery. Mine is an ambitious venture, but I feel that slowly, the world is opening up to the mindbody connection in relation to chronic pain and other symptoms – and Neuroscience is going to continue backing this up!
Miriam Gauci Bongiovanni, Executive Contributor Brainz Magazine
Miriam is a certified Holistic Life Coach and MindBody Practitioner specializing in chronic pain recovery. After having overcome debilitating symptoms herself by working with the mindbody connection, she continued to study the psychology of chronic pain and pain neuroscience. Miriam founded her coaching and educational venture, PainOutsidetheBox, as part of her vision to educate people on the connection between chronic pain and the brain. Miriam now coaches clients internationally, empowering them to eliminate pain, resume physical activity and reclaim their lives. She is also the author of an internationally-accredited MindBody Syndrome Practitioner Course delivered by the MindBodyFood Institute, and runs a self-paced Pain Recovery Program for chronic pain sufferers on her website, www.painoutsidethebox.com.
References:
[1] Ann JMcDermida, Gary BRollmana, Glenn AMcCainb, ‘Generalized hypervigilance in fibromyalgia: evidence of perceptual amplification’, PAIN®, Vol. 66, Issues 2–3, 1996. [2] Robert J. Gatchel, PhD, ABPP and Randy Neblett, MA, LPC, BCB, ‘Pain Catastrophizing: What Clinicians Need to Know’, Practical Pain Management [3] Alan Gordon & Alon Ziv, The Way Out: The Revolutionary, Scientifically-Proven Approach to Heal Chronic Pain, Vermillion (2021), p. 31. [4] Katherine T Martucci,1 Pamela Ng,1 and Sean Mackey*,1, ‘Neuroimaging chronic pain: what have we learned and where are we going?”, Future Neurol. 2014 Nov; 9(6): 615–626. Link. (my emphasis, my additions in brackets).
