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.
You hear about it all the time: someone’s back ‘goes out’. A colleague or friend seems to have a stiff neck on and off. Way worse, others seem to have permanent sciatica and hip pain, while a smaller (but still significant) group of people suffer from widespread pains or fibromyalgia.
The reality is, millions of people suffer from a myriad of chronic symptoms and seek an explanation and cure for their symptoms every year. Traditional approaches attempt to address factors such as posture, muscle imbalances, structural issues and diet, however, hundreds of thousands still have ongoing pain after trying multiple treatments (including medication). But what if there’s something else that’s being overlooked? What if chronic pain is simply a faulty alarm? In 2020, a clinical trial conducted by Yoni K. Ashar, PhD; Alan Gordon, LCSW and Howard Schubiner, MD, based itself on the premise that some chronic pain syndromes are linked to an ‘overreaction’ in the brain, which triggered the pain response as a kind of false alarm. Such faulty ‘programming’ can originate from a negative or lengthy experience with injury or illness, which impacts and alters our nervous system.
This ‘faulty alarm’ is known as central sensitization in scientific terms. It can result in increased sensitivity to painful stimuli, and sometimes to the experience of pain and other symptoms in the absence of structural damage (and long after any original injury or illness has healed).
“Central sensitization means that our central nervous system has become highly sensitive to potential threats to the body. That results in more pain, more often.
The ‘threat’ is anything that triggers your pain. That could be certain movements, changes in your routine, physical exertion, and so on ‒ the list is endless…” ¹
In the simplest of terms, if the brain believes that we may still need some form of protection, it can actually learn to keep reproducing symptoms in the body.
The role of stress and negative experiences
Besides a negative experience with injury or illness, it is also pretty common for chronic syndromes to occur following a negative or shocking experience in one’s life, as well as due to ongoing situations that are distressing to the individual, such as having an interpersonal conflict or a worrying issue that the person doesn’t know how to resolve.
Today, the effect of such distressing experiences on the nervous system is known as dysregulation: “Dysregulation could occur if a system alters its set point in response to a stressor and then fails to readjust to the normal level after the stress has passed” (C. Richard Chapman et al.) ² Besides pain, dysregulation can lead to a cocktail of other symptoms, the most common ones being chronic fatigue, IBS, tinnitus and other unexplained symptoms. Sadly, as symptoms themselves become our new stressor, this induces further emotional dysregulation. Add a couple of other ongoing life stressors to the mix, and you’d be dealing with a highly dysregulated nervous system that’s prone to generating ‘faulty’ signals.
The Fear-Pain Cycle
Since as human beings we tend to react to sensations of pain or discomfort with fear, frustration and helplessness, this very reaction keeps fueling the alarm, and creates a kind of feedback loop.
In other words, pain can trigger a fearful or negative emotional reaction, and in turn, that reaction itself can create more pain in future. The first strategy we normally think of is to avoid symptom-inducing activities in the first place. Initially, this can prove beneficial to give our nervous system time to calm down and recalibrate (and to make sure that any original injury has had enough time to heal).
But there is one problem with an ongoing avoidance strategy: when we engage in avoidance due to fear of pain, we keep reinforcing the idea that such activities (and the pain itself) are dangerous and bound to create pain. This is why the brain keeps firing the alarm. And sadly, many chronic pain sufferers end up limiting more and more activities as their nervous system gets more sensitized. It may start with avoiding a workout, but if things get out of control, it may very well end up with not being able to go to work or function in one’s daily life.
Why Pain Reprocessing Therapy could be the answer
The Boulder trial by Ashar et al. involved teaching a group of people with chronic low back pain specific techniques that calm down the stress and fear responses in the brain, mainly by focusing on changing the way they perceive the pain itself.
This change in ‘perception’ involved training individuals to view their pain more objectively ‒ even with curiosity ‒ instead of loading sensations with fear-based thinking and negative judgements.
Director of the Psychology Center Alan Gordon calls this approach Pain Reprocessing Therapy (in short, ‘PRT’), and fully explains the process in his book The Way Out. This trial led to very positive results: 66% of people from the group who employed PRT were pain-free or nearly pain-free after treatment, compared to only 20% of individuals subjected to a placebo, and just 10% who continued usual care. ³ Although participants in the trial all had chronic back pain, pain reprocessing can be effective not just for back pain, but also for a wide variety of chronic symptoms.
Sadly, there aren’t similar trials for all the different chronic pain conditions out there yet (it could take dozens of years and substantial financial support to trial PRT on all kinds of pain syndromes), but there is a growing community of individuals who are employing these techniques with great success for conditions ranging from localized chronic pain to fibromyalgia and other chronic symptoms like fatigue and unexplained gastrointestinal symptoms. Forums and online communities such as prtrecovery.org ⁴ and various social media groups run by PRT Coaches, ex-sufferers and Practitioners are providing ongoing evidence of success stories related to all kinds of chronic conditions.
My own experience as a Chronic Pain Coach
I overcame my own chronic symptoms through a combination of pain reprocessing and emotional release techniques. Based on my experience, I believe that the first step is always to educate oneself as much as possible about the various factors that can influence chronic pain. This enables individuals to make sense of why they have the pain and to let go of false assumptions that are not serving them. Over the years, I’ve had hundreds of clients and members who have overcome all kinds of chronic pains and unexplained symptoms just by adopting new habits and implementing pain reprocessing techniques that changed the way they related to and thought about their symptoms. The recovery time can be as fast as a couple of days, but it can also be very gradual. Factors like depression, ongoing stressful situations and traumatic experiences with injury or illness can create setbacks, which is why I believe the pain reprocessing should be combined with significant emotional work, and sometimes, therapy. But in all cases, a significant degree of improvement takes place upon achieving a mindset shift ‒ a shift from a state of fear and helplessness to a more curious and empowered state. It’s when one changes his or her relationship to one’s symptoms that the ‘magic’ happens.
This shift in mindset is often accompanied by a change in habits, as the individual becomes more physically active and less restricted in his or her activities.
New hope for the future? It all starts with education!
My aspiration is that in the future, every individual with unresolved chronic symptoms will have the opportunity to learn about pain reprocessing and the mindbody connection.
I myself came across this information quite by accident, and was initially plagued by doubt and confusion because none of my doctors and PTs had ever mentioned it to me.
As part of my work, I strive to educate individuals and to spread hope, so that they too can learn and experience the benefits for themselves. After all, pain reprocessing is a drug-free approach that’s safe and totally harmless. It doesn’t ‘hurt’ to try it.
If you’d like to learn more, check out my new online recovery program here, or schedule a coaching call to discuss your individual situation in more detail.
Chances are, there is hope for you still, if you’re ready to try something radically different.
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 mind-body 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] Precision Pain Care Rehab, Central Sensitization in Chronic Pain (Plus Treatments), 2021
[2] C. Richard Chapman, Ph.D., Robert P. Tuckett, Ph.D., and Chan Woo Song, ‘Pain and Stress in a Systems Perspective:Reciprocal Neural, Endocrine and Immune Interactions’, J Pain. 2008 Feb; 9(2): 122–145.
[3] Yoni K. Ashar, PhD; Alan Gordon, LCSW; Howard Schubiner, MD; et al, ‘Effect of Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain: A Randomized Clinical Trial, JAMA Psychiatry. 2022;79(1):13-23,
