How Chronic Pain Gets Stuck in the Nervous System

In his mid-20s, author and therapist, Alan Gordon developed debilitating low back pain and then headaches. And a slew of doctors gave him a slew of diagnoses. But his pain got worse and spread to other parts of his body. He stopped hanging out with friends. He couldn't hold a job and he moved back in with his parents.

When his mom gave him a book about the mind body connection with chronic pain, Allan literally threw it across the room. His pain was real and he didn't need anyone telling him that it was just in his head. And decades later, after healing his chronic pain and running research studies on chronic pain, he would tell you that he was right, at least partially.

Chronic pain isn't just in your head and it's not just anxiety and it can't be magically cured by just meditating more. But what he did learn, the piece that massively decreased his back pain was that pain can't exist without the brain. When we hurt, we all feel pain in that part of the body. Our back, our neck, our knees. But the only reason we feel pain is because the messages get sent up to our brain where our brain interprets them. If you had a complete spinal cord injury and you hurt your leg, you wouldn't feel any pain because that message couldn't make it to the brain.

So, where am I going with this? There are two types of pain. Acute pain and neuroplastic pain. One of them is caused by an injury and the other is caused by a nervous system dysfunction where pain signals and your brain's interpretation of them become wired through fear to make your pain louder and louder. So, how do you know if your pain is real? Simple. Do you feel pain? Yes. Then it's real. Alan's pain, like yours, was real.

Chronic neuroplastic pain can literally be seen in the nervous system using fMRI scanners. It shows up in brain areas like the anterior singular cortex, which monitors for danger, the insula which tracks internal body sensations and assigns meaning to them and the amygdala which fires off fear and anxiety emotions in response to threats. What's different about acute pain versus neuroplastic pain is that neuroplastic pain doesn't respond well to medical interventions like surgeries or physical therapy. Hundreds of thousands of chronic pain patients know from experience that interventions just seem to make it worse.

Now, I'm not a doctor, but chronic pain specialists agree that chronic pain can be fueled by psychological processes. Alan Gordon says it's about 85% of the time. So, I'm here to summarize that information from his book, The Way Out, to make it easier to access. And here's the good news. There are excellent treatments for neuroplastic pain. It's what led Alan Gordon to develop a protocol called Pain Reprocessing Therapy. And PRT is backed by high-quality scientific research. In one PRT study, 98% of participants saw some decrease in their pain levels over the course of the study and 66% of participants ended the study either pain-free or nearly pain-free after PRT treatment. Brain imaging also showed changes in the brain networks tied to pain processing. And those amazing results were still there when researchers checked in a year later.

So, even if you have a diagnosis for the source of your chronic pain, will you at least consider for the next few minutes that your nervous system's response to your physical pain might be aggravating it? I hope you'll give this video and Alan Gordon's book a chance to help you. Our bodies are resilient and sometimes we need to change our relationship with pain in order to relieve or release it. I'm going to share with you some common signs that your pain might be fueled by a nervous system response and seven techniques that Allan recommends for turning off neuroplastic pain. And I'm going to tell you about my editor who pointed me to this book who had had chronic back pain for a year and a half, had spent a ton of money trying to fix it. And um within a few weeks of reading this book and doing the exercises, her back pain is practically gone.

Okay, so pain happens in the body and the brain. If I burn my hand while I'm cooking, I feel pain. My brain interprets that signal as dangerous. My hand could get damaged, and it quickly reacts by pulling my hand back. When we sprain an ankle, the injured body part sends a message of pain to the brain so that we'll be gentle and let that part heal. Pain messaging is a really important part of protecting our body from further injury. So that brain interpretation is "I might be in danger" and it signals that pain to make you be more cautious to treat that ankle with gentleness. But what if that pain signal switch gets stuck in the on position? That's what we call neuroplastic pain. The messaging from the body and the danger signals from the brain can get confused. Pain isn't always tied to actual bodily injury. It could be triggered by the brain's perception of danger. The nervous system pathways that interpret danger and the nervous system pathways that interpret pain are really highly overlapping. So pain can feel like fear and fear can feel like pain.

Let me tell you an interesting story from the book. A construction worker stepped on a nail. It went all the way through his boot and the pain was intense. He screamed and his co-workers rushed him to the hospital. When the doctors cut off his boot, they discovered that the nail had not touched his foot at all. It had slipped right between his toes without penetrating the skin. But here's the thing, the pain he felt was real. And that's because the fear, the perception of danger, and pain pathways, they all overlap in the nervous system. Research shows that when people expect pain, brain areas involved in fear become more active, and this changes how painful stimuli are processed. So for example, in experiments where participants learn that one signal like a like a bell predicts a shock, the brain shows increased activity in regions like the insula and prefrontal cortex before the stimulus arrives. And then people report more intense pain when they expect it.

Okay, so why does this matter? What what am I getting to? Modern neuroscience reveals that pain is a complex brain process. It's not a simple body signal. Brain has 44 different regions involved in pain processing. And these can get wired to interpret pain signals in an unhelpful way. And what this means is that pain isn't just a direct result of a physical sensory input. The brain interprets danger and then produces the experience of pain. Expectations, anxiety, and fear can amplify or even generate pain while reducing fear can lessen pain responses. So neuroplastic pain is when the nervous system gets wired to perceive more danger, which makes it feel more pain, which makes it perceive more danger and it gets stuck in this loop of constantly escalating pain.

Now, whether or not pain was initially caused by a physical injury when we add these four mentalities that increase your perception of danger they tell your brain to dial up the pain. First one is meaning making. When we come up with a reason why we're experiencing pain, that turns up the dial. So this pain is because of my bulging discs. What if it never goes away? What if I can't work? All that meaning making increases our pain sensations. Next one is fear. So worry, pressuring yourself, self-criticism, and hypervigilance that can all increase your experience of pain. The third one is conditioning. So, in the same way that vomiting after eating a certain type of food will cause you to avoid that food in the future, even if the food didn't make you sick, your brain can also make true or false associations with pain. So, for example, if you believe um that the chair is making your back hurt, then your back will start hurting when you even just think about sitting in that chair. That's an example of a conditioned response. Okay, here's number four. Avoidance behaviors. Um, I made like 30 videos on this for the anxiety course, but in the context of chronic pain, when you feel like your pain is going to be bad, you might avoid it by using heating pads or by changing position or avoiding certain types of chairs. And when you avoid that thing and you don't die, that avoidance behavior reinforces to your brain that the pain is actually dangerous. And then your brain actually dials up the anxiety or the pain.

Okay. So, do you see how pain can get stuck in the nervous system? It's important to understand that because you can't address neuroplastic pain by fixing the body through surgery or other physical means. In the same way that trauma or threat can get your nervous system stuck in high alert, which can result in chronic anxiety, fear around being in pain can also get your nervous system stuck on high alert, resulting in chronic pain. Alan Gordon says, "I still have bulging discs. I still have high cerebrospinal fluid pressure. I probably still have a partially torn rotator cuff, but I don't have any pain. I eliminated all 22 of my symptoms."

So, if the pain feels like it's coming from the body, how do you know if your pain might be neuroplastic? In the appendix of the Way Out book, Alan shares 12 guidelines that can help you determine if your pain is neuroplastic. And I've added one of my own to this list. Um, I'm just going to share a few with you, but you can check out this in the appendix or you can email me if you want the uh download of this poster. The pain began during a time of stress. It began without an injury or the symptoms are inconsistent. Uh, you might think that you always have back pain, but then you realize that when you're watching an amazing movie, that back pain is gone. That might be an indicator that your pain is neuroplastic. Another indicator is symptoms spread or move into multiple parts of the body. Doctors can't find a reason for your pain. Uh, symptoms are triggered by stress. When you're stressed out, they're much worse. Um, you have a history of trauma. Children who experience childhood trauma are much more likely to have chronic pain in adulthood. And this can include, you know, big T trauma like uh physical or sexual abuse or something less traumatic that made you feel unsafe like an anxious or depressed parent. Anything that made the world seem like a dangerous place can make your brain more likely to develop neuroplastic pain. Um, so can certain personality traits. Traits like self-criticism, worry, perfectionism, people pleasing, or anxiousness can all put the brain on high alert. Another common thing is if the pain is attached to high stakes. So, for example, if you're a pianist and you develop wrist pain, that's going to trigger more fear because that's connected to something that's super important to you.

Now, this list was really eye-opening for my project manager and editor, Mary, who introduced me to the book. She began experiencing upper and lower back pain that checked all but three of these indicators. And when she put into practice what Alan teaches for rewiring her relationship to pain, she very quickly found relief. Here's her experience. "Hi, Emma. So, yeah, three years ago, my daughter got engaged and she gave me a 9-week lead time before the wedding. So, I was stressed out. Within a few days of her engagement, I started experiencing pain in my shoulder and in my lower back. And it would last almost all day. I noticed that it got worse if I was standing for too long or sitting for too long. And the pain stuck around for 32 months, even though I tried all sorts of things to fix it. I tried massages, saw a chiropractor, I got PRP injections, acupuncture, physical therapy. I bought new exercise equipment. I bought a new office chair. I spent almost $4,400 on all these things that didn't work. Then I came across this audio book in my free library app and I tried Alan's somatic tracking meditation for three days in a row and I noticed that my pain was down to about 20% of what it had been. So I now do his somatic meditation every morning for about five minutes and then if the pain pops up again during the day which it sometimes does maybe twice a week, I'll give it another 30 seconds of curious attention and almost always just goes away."

Now she convinced me to read the book and I loved it. I'm convinced as well. And if you'd like to learn more than what's just in this video, I'm making a chronic pain playlist. Um, I got to interview Alan Gordon and he also shared his somatic tracking exercise and I've also interviewed another doctor about chronic pain. So, you can just check out the link in the description for that.

Okay, before I get to the techniques for turning down the volume on that pain, we're going to talk about three barriers that we have to get past if we're going to successfully address the pain neurologically. Okay. The first barrier is that physical pain serves an important purpose of helping us not exacerbate a real injury. So when we feel pain, the natural conclusion is that some physical problem must be causing it. And it takes a little bit of effort to teach the brain that pain can sometimes be a false alarm. So we have to create space to entertain the possibility that chronic pain can be treated in non-physical ways. Now second, we may have formed a conditioned response that results in pain. So, for example, Allan's brain formed a conditioned response to sitting. Within moments of sitting, his back was in pain. Hard and short chairs were worse for him than soft or tall chairs. But chairs weren't causing the pain. His brain made this incorrect connection that sitting was a dangerous activity and the pain started as soon as he sat. Okay. The third barrier, and this is probably one of the biggest one, is a medical diagnosis. So, doctors are experts, right? Well, yes, they are. They're experts in looking for structural causes of pain. And when you look for a structural issue, you'll probably find one, even if it's not the root cause of pain. Um, most people with chronic pain are given a structural diagnosis like bulging discs or disc degeneration or arthritis or wear and tear. And then once they have that label, every sensation gets interpreted through it. My back hurts because my discs are damaged. The problem is that this interpretation often doesn't match what we know from research. Large imaging studies consistently show that a huge percentage of pain-free people have bulging discs, herniations, degeneration, or arthritis. So, what they did is they took like 100 people off the street and they found that when they scanned their backs, most of them had these problems, but most of them also weren't in chronic pain. And these findings, this degeneration and these bulging discs increase with age even in people with zero pain. So what we're seeing is that someone might have chronic pain and then they do this scan and they have something in their back and these are often incidental. They just aren't connected. So we end up with a paradox. One person has bulging discs and no pain. Another person has the same imaging and severe persistent pain. And this tells us something important. The structure alone cannot explain the pain. But the diagnosis can fuel chronic pain. Once someone's told by a doctor, "Your pain is caused by bulging discs." Several things happen in the brain. The brain assigns threat. They say, "Oh, my this diagnosis sounds dangerous. My spine is damaged. I could make it worse. I need to protect my back." Now, these scary messages activate fear and threat circuits in the brain. Then the brain becomes hypervigilant. Normal sensations like stiffness, muscle fatigue, tension are now constantly scanned for. Is this my disc? Did I injure myself more? Should I stop moving? And this attention plus fear amplifies pain signals. Over time, the brain learns movement equals danger. And you develop this conditioned response that keeps your pain active. And then third, pain becomes predictive, not reactive. So you think, oh, if I sit in that chair, it's going to hurt my back. And the brain's like, did you say pain? Let's go. So this is neuroplastic pain. The brain produces pain to protect you even when there's no new injury. This isn't imagined. It's not in your head. The pain is real. The brain regions lighting up are real. The suffering is real, but the source isn't ongoing tissue damage. It's a learned danger signal reinforced by the diagnosis and fear-based interpretation. When an expert tells you something's wrong with your body, it can be really difficult to be willing to try a mind-based approach. But it is worth trying. It's less expensive. It's less invasive. To give these techniques a try, I hope you'll at least consider that the way your brain is processing pain signals might be contributing to your chronic pain. And there are some really practical strategies for overcoming these inaccurate signals in order to heal from chronic pain. Okay. And of course, I recommend that you read Alan Gordon's book, The Way Out. It goes into like so much more detail than I can do in one video. It is great book. He's not sponsoring this. I just liked the book.

Okay, so let's talk about seven strategies to decrease neuroplastic pain to train your brain that you're actually safe. See if I can find the right page. Here we go. First one, make an evidence journal. To convince your very smart thinking brain that it might be getting something wrong about your pain, you need to give it evidence. So, I want you to start writing this down. One type of evidence to watch for is exceptions. So, for example, if your back starts aching when you sit, but you make it all the way through a thrilling movie or sports event without pain, that's an encouraging exception. It means that your brain was distracted from the deep down fear that normally fuels your pain. So, write that down in your phone or in your journal. To find other evidence, go back to that list of 13 guidelines. Add to your journal any notes that align with that list. So, for example, when your pain comes on, notice and note your stress level. You may find a correlation. Or think about when your symptoms first started. Did they come out of nowhere like Mary's did when her daughter got engaged? If you note just a few pieces of evidence, it's likely that your pain is neuroplastic. This is actually good news.

Okay. Second thing to do is practice somatic tracking. If you do only one of the techniques, do this one. Um, in fact, it's such a key part of pain reprocessing therapy that I'm making a separate video of this guided practice so you can come back to it quickly until you get the hang of it yourself. Um, check the link in the description for that video. But in a nutshell, somatic tracking is intentional mindfulness of your pain. You get grounded. You notice the sensation of your pain without judgment. And you get really curious about it. You just watch the pain like you're watching the colors of a sunset change. I want you to observe it without catastrophizing. Describe it. Maybe it's tight or tingling or pinching. You'll notice if uh the pain changes or moves to another part of the body or maybe it dissipates. Uh this whole practice can be done in a couple of minutes. The goal of somatic tracking is not to just get rid of the pain. And here's why. When we approach pain with the belief that it's bad, we tell the brain that it's scary. And the brain essentially reacts with, "See, I knew pain was scary. Don't you see how scary this pain is?" And that makes the pain continue or escalate. But on the other hand, mindfulness deactivates the brain's fear circuits. So when you just practice curious exploring of that pain, the brain actually learns that your body is actually safe and eventually it will stop overreacting to whatever neutral signals it picks up in the body.

Now let's talk about number three. Um, a few minutes ago, I told you about how avoidance can fuel anxiety and pain. Usually, avoidance keeps us stuck because it lets us escape our fear instead of facing it safely. But Alan points out that occasional avoidance behaviors can be an effective tool for overcoming fear. Here's what he said in the book. "Avoidance behaviors are really common with chronic pain patients. Anything you do to reduce your pain or to keep from triggering it in the first place is an avoidance behavior. When you have high levels of pain, your brain is feeling a lot of danger. That means it's pretty much impossible to have a corrective experience. So, we're not even going to attempt somatic tracking. If you have to use a pillow or a hot water bottle or massage the body part that hurts, do it. When your pain is high, you want to engage in some avoidance behaviors." While in general, I teach people avoidance isn't helpful. I think what he's saying is when we work on our pain or anxiety, we want to keep it within our window of tolerance. We can't just force ourselves to learn how to swim by jumping in at the deep end. So be gentle with yourself. Keep yourself in the growth zone, not the high alert or panic zone.

Okay, here's number four. Neuroplastic pain is a fear response. You're going to calm your brain with messages of safety when it gives you a high pain experience. So, you're going to talk to it in a really gentle, loving way. You might say something like, "Ooh, this feeling is temporary. I'm going to be okay." Or, "My body is okay and I am safe. This pain is just a false alarm because my brain thinks I'm in danger." If we want to interrupt this pain-stress-pain cycle and help our brains feel safe, we also just need to manage our overall stress levels. And I have a lot of videos on this, but just slowing down in your life and doing less things can help decrease your chronic pain. Another way that we keep our brain on high alert is by trying to control uncertainty by worrying. If you have a big decision to make or you're not sure how something will turn out for a loved one, ruminating on the problem can convince your brain that the stakes are super high and everything will fall apart if you make the wrong decision. When you're in a place of uncertainty, you can give yourself another message of safety. Whatever happens, it's going to be okay. I'm sure we'll make it through.

Okay, two more to go. Number six, catch your fears. Alan Gordon identifies three thinking patterns that he sees in the majority of his chronic pain patients. Worry, pressure, and self-criticism. Worry is the fuel of anxiety. Pressure is like, "Oh, I have to make this pain stop or else." And self-criticism fuels the idea that there's something wrong with you. All of these keep fear really high. Um, and I'm going to add hypervigilance to this. Hypervigilance is when you're constantly scanning for any signs of the next pain period. These fears keep your pain on high alert, which makes your pain worse. These automatic thoughts are going to pop up, but here's three little things you can do with them. Just notice the thought, let the thought go without buying into it. So, you might say something like, "Thank you, brain, for cranking out that thought." And then replace the fear thought with one of the messages of safety I covered in number four. So, it's like, I know it's going to be okay. This isn't going to last forever. We're going to make it through this. Uh there's one more technique to help your brain not send the wrong signals about pain. And this one's a good one. Just as we're going to replace automatic negative thoughts with messages of safety, we're also going to strengthen the neural pathways for positive sensations by seeking out things that feel good. What you look for, you get more of. So, it's natural to scan for pain. Let's start scanning for pleasant sensations in the body. I think it's helpful to set a reminder on your phone to scan for these positive feelings throughout the day. It's as simple as noticing like how good a shower feels or paying attention to that soft relaxed feeling of your face. And just like anything you practice, embracing positive sensations often gets easier the more you do it. It's going to help your brain rewire to notice the good going on in your body, the relaxed and gentle feelings you have instead of just constantly scanning in a hypervigilant way for pain signals. Like looking for what's safe in your body, what feels gentle in your body can also help you make peace with your body so that you can see it as a friend.

Okay, so those are seven strategies for chronic pain. Before we wrap up, I just want to prepare you for setbacks. Alan says that almost everybody who starts this process will experience relief. They'll start to see really big improvements in their chronic pain and then they'll relapse. And that relapse can be really scary because when your pain comes back, desperate to be free of it, but you have to trust the process. A relapse is part of the process. So when it happens, just remind yourself like, "Oh yeah, I knew this was coming. Here it is, and I can work through it." Um, just keep doing the seven techniques. And after more repetition, you'll drop that desperate energy and add back in the positive, curious energy, and it can all click for you again. And you'll have strengthened your resilience.

Okay, I really am hopeful that Alan's process of pain reprocessing therapy will help you reduce your chronic pain. Uh so I encourage you to give it a chance. And if you do find this helpful or you have other questions, please leave a comment below. I'd love to hear what you're thinking. And if you'd like individualized help, you can contact the Pain Psychology Center. The link is in the description. So thank you so much for being here and please take care.