Central Sensitization, Chronic Pain, Fibromyalgia, Nervous System, Pain Science

Central Sensitivity Syndromes

A really important concept for anyone struggling with chronic pain, fibromyalgia, or other chronic health conditions is the idea of “central sensitivity syndromes” (CSS for short).

The term refers to any kind of condition that can be caused by a change in the way the nervous system processes pain (a process known as central sensitization).

I have described central sensitization in more detail in other posts.  (Here, I will just say that sometimes, the nervous system can begin to function differently after physical injury or trauma.  Basically, the more chances our nervous system has to “practice” sending pain signals, the better it gets at it).

Central sensitization is why you can still have pain after an injury is healed.  Your tissues are no longer damaged, but your nervous system has not forgotten the “memory” of the pain.

So… how does this happen?  What kinds of injuries or traumas are necessary to cause it?  And what symptoms can it cause?

The answer to is: central sensitization can happen in many different ways, and sometimes the things that trigger it don’t have to be very “severe.”  And there can be a wide range of symptoms, in different parts of the body.   It can be different for each individual person, depending on genetic makeup, co-existing health conditions, psychology, and, of course, the event that triggered it.

This is why the term “central sensitivity syndromes” is so helpful– there are so many health conditions, which on the surface might seem very different, yet all have central sensitization as their root cause.

***

To my knowledge, the term was first coined by physician and researcher Muhummad Yunus, who, along with his colleagues, conducted an important 1981 study linking fibromyalgia to other health conditions caused by nervous system sensitization.

Since then. Dr. Yunus has contributed to a really impressive list of studies establishing central sensitization as the likely cause of a wide range of conditions, including:

  • fibromyalgia
  • irritable bowel syndrome
  • temporomandibular disorder (TMJ)
  • restless legs syndrome
  • chronic fatigue syndrome
  • complex regional pain syndrome (CRPS)
  • chronic pelvic pain
  • migraine

Central sensitization can create different types of symptoms, from one person to another, in different parts of the body.   This one common cause can have many different manifestations.

In fact, the effects of central sensitization in the same person can change over time.   The effects can get worse as the condition progresses, or cause new symptoms in different parts of the body.

Additionally, as Dr. Yunus writes, central sensitization can also occur in the background when someone has another primary health condition which creates pain and stresses their nervous system out.  It can be a factor in conditions such as:

  • rheumatoid arthritis
  • systemic lupus
  • ankylosing spondylitis
  • osteoarthritis
  • diabetes mellitus
  • inflammatory bowel disease

Basically, anything that stresses your nervous system out and gives it a chance to practice sending those pain signals can cause it to become better at sending those pain signals.  So even if central sensitization isn’t the primary cause of your illness, over time it can become a secondary factor.

***

The good news, however, is that the effects of central sensitization don’t have to be permanent.  It can also get better.

That’s what my blog is all about– helping people find out about the ways I, personally, have managed to reduce the effect central sensitization has upon my life, as well as raising awareness about new avenues of research.

What helped me the most is an approach to physical therapy known as pain neurophysiology education.  However, there are other forms of treatment out there, including medications some people have found to be effective for the effects of central sensitization.

***

I’m going to write more on central sensitization and its treatment, as well as the work of Dr. Muhammad Yunus, in the future.

I hope this post was helpful for you, and that you stay tuned!

Creative Writing, My Story, Treatment Approaches

The piece that didn’t fit

When I was young, all I wanted was to fit in, to be perfect.  To do what adults expected of me.  I never had a single cavity, I never missed the school bus.   I was always teacher’s pet.

Then, when I hit adolescence, the reverse.  My depression; my eating disorder; I couldn’t function, couldn’t fit in to any kind of mold.  I missed school; my grades suffered.   A few teachers saw who I really was, but in general, I don’t think anyone would have considered me teacher’s pet.

I (mostly) came to terms with these issues…. right around the time my health issues began.  So, really, I have always had trouble fitting in to some kind of external mold; to meeting the expectations of those who’ve never known what it’s like to physically suffer.

Even as a patient, I have come up against the feeling that somehow, I am not meeting someone else’s expectations.  My once-favorite doctor once grew frustrated with me for still saying I was in so much pain, and told me she had patients with much worse problems than me, and basically told me not to come back to her office.

(I have been meaning to write more about this doctor, because it’s from reading copies of her office visit notes that I first came across the term “central sensitization.”  Yet she never actually said the phrase to me– instead, she was one of the people who told me there were psychological explanations for my pain, and kept telling me to go see a therapist.  It’s so strange–she knew the term, but didn’t seem to fully understand what it meant).

I had a similar experience when I was “lucky” enough to become a patient at a well-respected pain management clinic run by a major Boston hospital.  I ran into conflict, right off the bat, with the physical therapist who ran the exercise sessions, because she didn’t agree with my rational for wanting to do a warm-up before exercising.

This is something my high school running coaches– in fact, even my gym teachers, all through school– had always drilled into my head.  Do a warm-up, or you’re much more likely to get injured.  Yet here I was, at a place for the already-injured, having someone tell me that I was “causing problems,” simply for wanting to take care of my body.  (There wasn’t enough time for me to do a warm-up and get through all of my exercises… which I later came to understand that she probably needed me to do, in order to get reimbursed by my insurance company).

So basically, from the age of 14 on, I have been familiar with the feeling of not meeting other people’s expectations… of not even fitting into any kind of mold they can understand.

But you know what?  I’m okay with it.  Because it’s this constant feeling of not fitting in, of being forced to look outside of what’s conventional, that has driven me to discover new things.

How long would it have taken me to discover the term “central sensitization” on my own, if I hadn’t decided to take matters into my own hands and request copies of my records?  I have no idea.  I do know it never came up in any of my science classes, except for about a 5-second mention in one of my neuroscience lectures.  (And if I wasn’t already familiar with the term, I might have missed it).

I do believe that I will have the power to help people someday as a physical therapist, and I think my specialty, if you can call it that, will be to help the “hard cases.”  The people who couldn’t be easily helped, and who, like me, didn’t fit easily into some kind of mold.

And it’s my experiences of not fitting in, of being forced to look “outside of the box” for answers, that will allow me to empathize and help them the most.

…my seeming failures were really just weird-ass portals to something beautiful… all I had to do was give voice to the story.

I am including this amazing talk by the writer Lidia Yuknavitch above, because ever since I discovered it the other night, I haven’t been able to stop listening to it, and she really inspired me to get my thoughts down into this post.

In her talk, Lidia describes how the many “failures” in her life were actually just the beginning of something new… it just took her time to begin to see them that way.  And, she says, if she had given herself permission to “belong,” to believe in herself sooner, she might have been able to recognize them for what they were sooner.

She has so many great quotes– you really have to watch it for yourself– but here, I want to make sure I record:

There’s a myth in most cultures about following your dreams. It’s called the hero’s journey. But I prefer a different myth, that’s slightly to the side of that or underneath it. It’s called the misfit’s myth. And it goes like this: even at the moment of your failure, right then, you are beautiful. You don’t know it yet, but you have the ability to reinvent yourself endlessly. That’s your beauty.

If I could, I’d go back and I’d coach myself. I’d be exactly like those over-50-year-old women who helped me. I’d teach myself how to want things, how to stand up, how to ask for them. I’d say, “You! Yeah, you! You belong in the room, too.” The radiance falls on all of us, and we are nothing without each other.

That’s it, right there:

The radiance falls on all of us, and we are nothing without each other.

My Story

Things you can ask me about

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Something you might not know is that I spend a lot of time answering emails from readers looking for advice on their own health issues.  I do my best to offer advice and get people pointed in the right direction.  It means a lot to me to feel as though my experience has served a purpose, and that some good can come out of what I’ve been through.

I’ve been meaning to write some more personal posts telling about my stories with various running injuries, compartment syndrome, etc.

However, in the meantime, I thought I would just offer this general list of health conditions I feel I can offer some advice on.

I want to be clear about the fact that I do not currently possess any medical certifications.  But I can offer you advice as a fellow chronic pain sufferer and as a friend.  (And my physical therapy prerequisites mean I have a better understanding of medical terminology than the average person).

Basically, what I can do is relay lessons from my own experience to help try to get you pointed in the right direction, and help you try to find the right people who do have the necessary certifications to help you.

Some of the conditions I’ve listed below are actually not things I’ve experienced personally– they are either topics I’ve become knowledgeable about through the course of my own research, or health conditions experienced by my own family members/friends.  (I enjoy helping people, so I tend to naturally fall into the role of “coach”).

So, with that being said, here is a general list, with links to my writing or further resources when relevant:

Chronic pain/central sensitization

Fibromyalgia (physical & mental symptoms)

Sacroiliac joint dysfunction

CRPS

Biomechanics (how to set up your life better to reduce pain)

Running injuries (muscle strains, shin splints, etc.)

Compartment syndrome

Chondromalacia patella

Ovarian cysts/ovarian torsion/abdominal surgery

Pelvic pain/pelvic floor disorders

Digestive problems (irritable bowel syndrome, fibromyalgia-related, various tests you can ask your doctor for)

Aquatic therapy

***

Because I am not a medical professional, there is a limit to the extent I will be able to provide support.  I will let you know when there is a question I do not feel qualified to answer.  Really, my goal here is to help you determine your next step, and help you get moving on your way again.  And it means a lot to me to be able to do so.

You can email me at sunlightinwinter12@hotmail.com, or check out the rest of my contact info.

Hope to hear from you!

Chronic Pain, Creative Writing, eating disorders, Favorites, My Story, psychology

Fighting a health issue without judgement, for the first time

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They say one of the worst things a blogger can do is to begin all your posts with an explanation of why it’s been so long since your last post.

Normally I’m able to stop myself from doing this, but I’m going to let myself do it this time, since it’s actually relevant to what I want to say.

The reason I haven’t been on here in so long is I had a crazy past few months dealing with the most insane dust and mold allergies.

I had been living in a super old 1700’s farmhouse that had not been well-maintained.  A good friend had been living there for years and needed a roommate, and the rent was super low.  So I moved in with him, following my return from California.

I had never really had significant allergies before, beyond suffering from pollen one or two weeks out of the year.

But this winter, it came out of nowhere.  I thought I was sick at first, and had to take antibiotics for a sinus infection, but even once that was treated, some of my symptoms never went away.

Thankfully, my primary care physician referred me to an allergist (even though I was convinced I wasn’t the kind of person who had allergies) and sure enough, I tested positive for dust and mold allergies.

By then, things had gotten so bad that I could barely sleep– I was so congested it was hard to breathe.  I’d wake up feeling like I couldn’t get enough air.  My sleep schedule got all messed up, and I started relying on things like Benadryl and Nyquil, which of course left me exhausted the next day.  And during the day, dealing with my symptoms felt like a full-time job.

In the midst of all this, I realized I had to find a new place to live– a pretty intense and financially-involved decision to make when you know you’re not in your right mind.

Somehow it worked out.  It took another month, but I finally ended up moving, and am gradually doing better (my allergy doctor said it might take a few weeks).

I’m a little upset at how much time I lost on this problem– really, I wasn’t able to be productive for much of the winter, until things finally came to a head in March.

However, if I look back, I can see that some good came out of this, in a way.

This was really the first time I experienced a health issue and pursued treatment on it without stopping to judge myself, or the way I was handling it.

***

I mentioned in a previous post that, in the past few years, I came to realize that many of the same issues that contributed to my eating disorder were also affecting the way I handled my health issues.

Specifically, in an unconscious way, I was afraid to devote too much time or effort to “fixing” something with my body, because I was afraid it would trigger the same obsession that caused me to starve myself while running 40+ miles a week, until I eventually developed compartment syndrome.

With issues such as my chronic pain, and then my SI joint issues, I only tried to fix the problem to a certain extent.  I’d go see a specialist, I’d go to PT, I’d do my exercises.  But then I wanted to stop, be a normal girl, focus on other things.

I finally identified this pattern 5 years into my SI joint problem.  I realized, you know what, this problem has completely taken over my life anyway.  It doesn’t really make sense to try to “limit” the time I spend trying to fix it, because things are so limited for me right now anyway.

So I gave myself permission to do whatever it took, and started my SI joint blog as a way to keep track of the things I researched.  And it was during my research for this blog that I first came across another patient saying constant chiropractor adjustments made her worse.  That planted the seed in my mind, and I ultimately came to realize that the same was true for me as well.

With my allergy stuff… I got right to it.  I scheduled an allergy test, and when the first office of the sprawling medical practice couldn’t fit me in for over 6 weeks, I called around until I found an opening in 2 weeks.  I made all the lifestyle changes my doctor recommended, and then some.  And then I moved.

Of course, it was a little easier to proceed without judgement from others in the context of allergies.  After all, we don’t suspect people of “making up” allergies for some kind of gain. You can’t get workers comp for it, and there aren’t any super fun drugs.

But even so, I felt that the biggest difference this time around was in my mind.

I had it in my head that I was a “normal” person, experiencing a problem, and I did what it took to get better.  I didn’t waste time on “whys” or “what ifs.”  I didn’t ask if I deserved to get better, or worry about what the doctors might think of me.  I simply had a problem, and I did what it took to find a solution.

When I first started having chronic pain at nineteen, I thought I deserved it…  I’d starved and abused my body, even though I should have known better, and that the pain and the compartment syndrome and maybe even my SI joint problems were the price I had to pay.

Now, at age 32, I never felt that way about my allergies on any level… I just saw them as a crazy fluke of biology, a random stroke of unfortunate genetic luck that was completely not my fault.

So… it’s interesting to feel this way.

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Does anyone out there know what I mean?

Have you ever come to realize that your own negative beliefs and fears about yourself were affecting the way you pursued treatment?

Don’t let them.  Believe in yourself– believe that you are normal, and that answers are out there.  Because they are.

Creative Writing, My Story, Quotes

The things I don’t have easy answers for

My friend C. once wrote that vulnerability does not always have to mean a state of weakness:

In order to function in my everyday life, I have to be vulnerable and explain why my body “doesn’t show up” when it needs to and that sometimes exposes me to feelings of powerlessness. At the same time, it exposes me to my own courage, resiliency, and even to these words.

Think about that. Isn’t that something radical and beautiful? Being vulnerable is a state that I am placed into because of my body but it is also a position of boldness.  It is the same condition that allows you to love, explore and seek out meaning in your life, and relate to each other’s humanity. That’s not weakness; rather, that’s power.

Can being forced to rely on others actually be a good thing– something that forces you to connect?

This question struck a chord within me, after a lot of the things that have happened in the past few years.

***

You may have noticed that I say much more about science than personal stuff on this blog.  Partly, of course, that’s because it’s public, and to say too much about my life would be terrifying.

But at the same time– despite how complicated it is, and how many classes I had to take to get to this point– the science is actually much simpler to me, compared to trying to manage relationships when you have chronic pain.

During the five years that I struggled with sacroiliac joint dysfunction, I lost friends.

Looking back now, I realize that it probably wasn’t just because of my physical issues.  It probably would have happened anyway–my health problems were just the catalyst.

***

I was 25 when I first developed these problems.  I have written elsewhere about how terrified I was; how confused.  I had just gotten answers for my chronic pain problem, and now, all of a sudden, I had this pinching sensation in my low back and I could barely walk.

For a while, everything went out the window.  I couldn’t climb stairs; it hurt to climb into the shower.  At times, my physical appearance slipped.

I went to meet friends for coffee in sweatpants.  On Saturdays, I had to wait until the very end of the day to use my gym pool, because it was filled with swim lessons the whole rest of the day.  This meant I’d show up at social events late, sometimes with my hair wet.

I had to plan ahead. Sometimes it hurt so much to drive that I preferred to take public transportation.  I wasn’t always the easiest person to coordinate with; I admit it.

Some of my friends were happy to stand by me, and our relationships were unchanged.  Yet, with others, it seemed I could no longer keep up, and I stopped getting invited to things.

The most painful part of this that it wasn’t just my casual friendships that slipped away.

***

Instead, some of my most cherished friendships turned into a scenario where instead of a friend, I started to feel like an unpaid therapist.  I’d be available to listen for hours, when the other person needed someone to talk to about her problems on a Sunday afternoon, or a weekday evening.   On Friday or Saturday night, I wouldn’t actually be invited out.  But sooner or later, I knew that next phone call for help would be coming.

To an extent, I think it comes down to the amount of strength people have to offer.  As the saying goes, “People cannot give you something they don’t have themselves.”

I noticed it’s the people who were the most unhappy in their own lives, the ones who felt they were under the most pressure to conform and live up to superficial standards, that were the most likely to let our friendships be affected.

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found via The Mind Unleashed

Over time I came to realize it wasn’t a reflection on me.  Yes, maybe there were a few things I could have done differently to be easier to make plans with, but my real friends took it in stride.  They stood by me, and were still willing to be seen in public with me, even if (God forbid) I was wearing flats and I wasn’t wearing makeup.

Now I understand that these things just happen.  If a friendship couldn’t withstand my having physical limitations, it wasn’t meant to be.  What it really means is that person, at that moment in time, did not feel secure with her own life, and did not feel she was in a position to have anything to give.

As my friends and I hit our late 20’s, there was just something about the age of 30 approaching.  We all felt the pressure looming over us: the end of our free, hippiesh 20’s.  The growing pressure to find a career we were going to stick to for the rest of our lives.  Find a husband.  Settle down.  Have kids.

As one friend put it, it was almost as though 28 and 29 were the age we realized for the first time that, in fact, someday we were going to die.  We’d always known it in the abstract, but now we were beginning to understand that we weren’t special; we were just like everyone else.  (Looking back now, I know this sounds a little absurd.  But somehow it was a truth that hit us all, at the same time).

In the face of this growing pressure, people changed.  I think it’s worse for women.  In fact, I know it’s worse for women.

So I don’t take it as a rejection; I take it as a sign that my friends weren’t okay with where their own lives were at.  When you’re able to be there for someone else, and put your own needs aside, it means you’re strong.  And I am grateful that, despite everything– despite my ever having dared to create the spectacle of showing up in public without makeup– I am still the kind of person who has the strength and security to be there for other people.

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Ultimately, I am the one who chose to walk away from these relationships, although it’s not like I really felt I had much of a choice.

It just got to the point where the dissolution of the friendship seemed inevitable.  I saw the writing on the wall and decided to focus my efforts on the people who were there for me; the people who had something to give.

With my extra free time, I reached out to people I’d been meaning to get to know better, but had always been too busy.

I discovered that acquaintances I’d known for years were actually amazing people, and some of them became my new best friends.

once you realize your worth stop giving discounts

Honestly, I was sad for a long time, and it didn’t all come together overnight.

It took a while for my new friendships to solidify.  I had to wade through a period of loneliness first; it took time to reach out to new people and build new relationships.

And sometimes I wanted to run back.  But I didn’t.  There was no going back.

Over time things came together.  I can honestly say now that for everything and everyone that I’ve lost, I ultimately found something new, and something that fit me better for this stage of my life.

But It took time.

I still have the positive memories of my old friendships.  I’ll always be grateful.

Now, I understand that life isn’t perfect, and people will usually hurt you in an attempt to heal themselves.  It’s because they feel like something is missing, and they don’t know what to do to find that missing piece.  It isn’t personal.

But it is okay.

I will always have the good memories.  I can still love the people I loved, even if I had to walk away in order to make room for something new.

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Central Sensitization, Chronic Pain, Favorites, Fibromyalgia, Nervous System, Pain Neurophysiology Education, Pain Science

How Clifford Woolf discovered central sensitization (and why you shouldn’t blame yourself for chronic pain)

You’ve probably noticed that my blog is all about central sensitization— the process through which the central nervous system can change over time and become more sensitive to pain.

Personally, I find learning about central sensitization to be empowering.  I spent years trying to find an answer for the pain and other symptoms I felt, only to be told by various medical professionals that my problems were in my head, the possible result of depression or anxiety.

I knew, deep down, that this just wasn’t true.  It’s not that I was unwilling to believe that mental health factors could play a role.  But it just didn’t resonate. I didn’t feel anxious or depressed.  I felt like I was in pain, and wanted it to stop.

That’s why, when I first heard the phrase central sensitization and looked up what it meant, I was so struck.  Because there was a way to explain why my nervous system was acting funny, and causing me to feel things other people didn’t feel, that wasn’t based on my mental health.

So.  How do we know about central sensitization?

A neuroscientist named Clifford Woolf discovered the process of central sensitization back in the early 1980’s.  In 1983, he published a well-known and often-cited letter to the respected scientific journal Nature outlining his theory, entitled “Evidence for a central component of post-injury pain hypersensitivity.”

Although the scientific community didn’t quite accept Woolf’s ideas right away, ultimately he ended up sparking a new wave of research, and his theory of central sensitization is generally accepted today (although much more work still needs to be done).

Basically Woolf ended up discovering central sensitization more or less by accident, in the process of researching something else.

(Now, I’m not a huge fan of animal research, so I don’t love what I’m about to describe to you.  But I am grateful for the results, so for the sake of understanding, here we go).

Woolf was studying the “withdrawal reflex” that caused the rats to jerk their paws away from a painful stimulus.  He tested them over and over again, over the course of a day, and he noticed that he started to get different results at the end of the day.

After a long day of testing, the same rats were much jumpier.  It became much easier to trigger their withdrawal reflex.  They would jerk their paws away even at things that shouldn’t have been painful, or wouldn’t have caused them to react that way at the start of the day.

Woolf realized he was seeing completely different behavior in the same rats, and under the exact same conditions.  Only one thing had changed: their nervous systems had been “practicing” the withdrawal reflex all day long, and were now responding to stimuli differently.  He hypothesized that somehow, the central nervous system had changed to become more responsive to pain, after exposure to repeated stress.

Woolf’s theory was pretty revolutionary at the time. Generally speaking, the scientific community believed the central nervous system always processed pain the exact same way, like a simple machine performing the same task over and over.  Woolf’s discovery turned all of that on its head, by suggesting that actually, the central nervous system can be changed and shaped by its experiences.

His ideas were not widely accepted right away, but his work, along with that of others such as Muhammad Yunus, has now formed the basis for a wide body of research on central sensitization and chronic pain that’s going on today.

***

We do still have a long way to go.  Much more research is needed, not to mention new treatments to be based on that research.

However, the reason I wanted to go into detail and describe the rat experiment for you guys is this:

If you have chronic pain/fibromyalgia, people are going to tell you it’s in your head.  Unfortunately, even sometimes people who have a passing understanding of central sensitization will imply tell you it’s in your head.  In my experience, people can understand the concept of the nervous system working differently in principle, yet still think it must somehow be related to mental health.

So this is what I want you to know: central sensitization happens in rats.

Your thoughts, beliefs, and fears about pain, and your mood– those can all play a role in your experience of central sensitization/chronic pain.

But those things don’t cause central sensitization, any more than they did in the rats in Clifford Woolf’s lab.

Remember that the next time you feel someone isn’t taking you seriously.  You can’t create your whole experience of pain by “overthinking” any more than a rat can overthink something.

In some ways, your nervous system is its own being.  There are aspects of your nervous system which have way more in common with a rat nervous system than with your conscious, human mind.  (I know, think about that!  That’s evolution for ya).

So if you have chronic pain, don’t blame yourself.  Don’t scold yourself for overthinking; don’t wonder if you’re crazy.  Your body is just doing what it was always going to do, in response to whatever stress/pain/injury you experienced.

There are ways to move forward– promising ways, which I talk about on this blog.

But to me, the first step is to stop blaming yourself.   You are okay.  You didn’t cause your own central sensitization, any more than the rats caused what Clifford Woolf observed in the lab.

Neil Pearson, Nervous System, Pain Neurophysiology Education, Pain Science, physical therapy

A successful experiment with acute stress

In my last post I outlined some ideas from Neil Pearson on how to stress our bodies in positive ways, in the hopes of re-shaping the way we process pain.

I continued my experiment at the gym last night, and I think I stumbled upon the beginnings of what something like that would feel like.

Normally, when I go to the gym, I’m pretty much there to use the pool.  It’s the one form of exercise I never have to “pay for” in any way afterwards, in terms of pain or stressing out my SI joints.  I usually just do my warm-up and cool-down in the pool as well.

So usually, I don’t hang around–  I’m just in and out.  I head straight for the pool and then make an immediate beeline to shower and leave because, well, I’m freezing.  It’s fun, but it’s also kind of rushed.  Some days I feel like kind of a robot.

With the lessons from Neil Pearson’s post in mind, I decided to switch things up a little bit.

***

Last night, instead of heading straight to the pool, I first stopped by one of the empty dance studios. I had it all to myself– a big room with a smooth, polished wooden floor and one wall that was all one big mirror.

I had my headphones on, listening to a playlist of music I really liked.  And I picked up one of the yoga balls, and just started dribbling it back and forth, to the beat of the music, like it was a basketball.

Now, if you think about this in terms of exercise, it’s not particularly hard.  It doesn’t require a ton of strength, and I wouldn’t technically call it cardio.

But, if you think about it in terms of the nervous system, it actually was a bit challenging.

I don’t play basketball.  I don’t think I’ve tried to dribble a ball in years.  It’s awkward to try to dribble a giant yoga ball… but it’s kind of fun.

However, it does require quite a bit of coordination, especially as some of the songs on my playlist had pretty different beats from each other.  With each new song, I had to completely switch up my rhythm.

I ended up getting really into it, dribbling and jamming out to my tunes for about 45 minutes.  And I think I managed to reach exactly the kind of state of “acute stress” Neil was describing in his post.

It was a difficult new activity for me, but it was fun.  It was challenging, but in a controlled way.  I felt as though I was pushing the limits of my nervous system, in terms of coordinating movement patterns that were unfamiliar to me, while at the same time limiting the overall stress to my system.  (In fact, I think I probably was reducing my overall stress at that point– it was the end of a good day, I had all the time in the world, and I really love my music).

I think this is the kind of activity that, when performed regularly, could have a positive impact on reshaping the way the nervous system regulates pain signals.  It’s “distracting,” in a healthy and fun way.

Obviously these would be topics for further research, but I think two additional components of what I did, which add to its helpfulness, are

  1. That I found the activity enjoyable, and
  2. That I was listening to music, which on its own can also reduce our perception of pain

This is what I find so fascinating about Neil’s approach to chronic pain treatment— an activity can be therapeutic not just because it makes us stronger, or increases our endurance, but because of its impact on the nervous system.

It’s okay to treat pain and the nervous system as your top priority, not just as a side effect or the means to an end of another exercise program.

***

I find the concept of treating nervous system directly to be so fascinating, and I hope you do too!  If you want to know more, I would definitely suggest checking out more of Neil Pearson’s work.  And, as always, let me know if you have any questions or comments!

 

 

 

 

 

Central Sensitization, Chronic Pain, Favorites, Pain Neurophysiology Education, Pain Science, physical therapy, Treatment Approaches

The core message of pain neurophysiology education

In the traditional model of physical therapy, the physical therapist prescribes stretches and exercises for the patient in order to improve function in one part of his or her body.

For example, if you have back pain, your PT will probably give you strengthening exercises to build up the muscles in your back and your core.  If you have a knee injury, she’ll  probably give you exercises to strengthen the muscles around the knee.  This is why when most of us picture physical therapy, we imagine a patient grunting and sweating in a gym while the therapist looks on.

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Pain neurophysiology education, however, draws from a different treatment model.  This model is not based on the idea that the patient’s pain is coming an injury in one specific part of the body.  Instead, it targets the sensitized nervous system directly as a source of pain.

The best way I can try to describe this is with graphs.  The first graph below shows the way most people imagine pain to work.  It also shows what most physical therapists are imagining when they prescribe stretches and exercises to improve a patient’s function:

acute pain graph

You can see how, as the intensity of the injury diminishes (represented by the black line) the intensity of the pain diminishes as well (represented by the red line).  This matches our experience of pain in most minor situations: getting a tooth drilled, pulling out a splinter.  When the stimulus goes away, the pain goes away.

However, in situations involving chronic pain (generally defined as a painful experience that lasts for at least two to three months) the pain response works differently.  Prolonged exposure to a painful stimulus actually produces changes in how a person’s nervous system works.  It’s as if it sets off a feedback loop in which pain signals continue to be produced independently of the level of injury.  For this reason, pain persists even after the initial injury has healed:

chronic pain graph 2

This second graph is an accurate representation of the state I was in when I was first introduced to pain neurophysiology education by my physical therapist Tim.  I had a very high level of pain, but it was not correlated with a high level of injury in my body.  This is why I hadn’t seen much improvement with any of my past physical therapists– my pain was coming from my nervous system, not from a specific injury in my body.

“If pain is the patient’s primary symptom, then pain relief should be the primary goal of treatment.”

I once read something along those lines in a blog comment section, and it really stuck with me.

Most physical therapy programs are designed to improve function of a certain part of the body.  But when your pain isn’t coming from a problem with a certain part of your body, you can stretch and strengthen until the cows come home.  It still won’t change your level of pain.

This is why none of the physical therapists I had seen before had been able to help me.  They were all stuck on the idea that I needed to strengthen my back; strengthen my abs; strengthen everything.  Of course, in some ways they were right.  I wasn’t in the greatest shape.

But what Tim was able to identify is that there was a common denominator behind all of the pain I was experiencing in different parts of my body.  Rather than looking at each one as unrelated, he recognized them as the symptoms of an overactive nervous system, or, as he taught me, body alarm system.

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The goal of PNE is basically to help the patient’s body “remember” what an accurate pain response is supposed to be.  There are a few ways to accomplish this, and I will be discussing them in upcoming posts.  But the general goal of these various techniques is to help the patient’s nervous system get back in touch with with the reality of what’s happening in his or her body.

This graph shows the general goal of treatment:

input to nervous systemThe blue arrows represent the input you want to give to your nervous system.  You’re basically saying to it, “Hey.  Hey you.  You are freaking out for no reason.  This is reality, and it’s over there.”

The role of the physical therapist is basically to help the patient’s nervous system realize it doesn’t need to be on high alert all the time, and to slowly help it calm down.  The idea is that as time goes on, the discrepancy between what the person’s nervous system feels and the actual level of dysfunction in his or her body will slowly shrink.

Now, to be honest, I’m not sure you will ever be able to fully reverse the process of central sensitization.  It’s probably possible, but it hasn’t happened yet for me.  That’s why I didn’t draw the red line going all the way back down to the bottom.  An overactive pain response will always probably be somewhat of a factor for me, but it is a million times better for me now than it used to be.  I’d much rather have the red line close to zero than soaring way up high, totally out of touch with my physical reality.

P.S. I adapted this post from Part 3 of my series on my own patient experience with pain neurophysiology education, entitled “How a physical therapist helped me through my lowest point.”  I’m experimenting with different ways to present information, to find out what works best for people.  Definitely check out that series if you’d like to know more!  I would love to hear any comments or questions you might have.

Photo Credits:

  • Strength training equipment pic: colonnade
  • Balance training equipment pic: kbrookes
Central Sensitization, Chronic Pain, Creative Writing, Pain Neurophysiology Education, Pain Science, physical therapy

There is reason to hope.

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I saw a comment on Twitter today which really broke my heart, so I wanted to write this and make it clear:

If you are experiencing pain hypersensitivity (through central sensitization), there is every reason to hope.

If your nervous system has changed one way, it is possible to change it back.

It won’t be easy, and the way forward won’t always be obvious.  But you can do it.

If you are experiencing central sensitization (as the result of an injury, a trauma, or other extreme physical or emotional experience) you have become more sensitive to pain than you used to be.  Your body is using pain as a way to protect you, but it is treating you like you are made of glass.  It is trying to protect you from everything.

Scientists are still researching the myriad of ways in which this happens.  So far, they have identified multiple different mechanisms within the nervous system which can cause this extreme response to pain.

However, the good news is that we don’t need to know everything, yet, about how this process occurs to start treating it.  (Although our treatments will only get better in the future, with more knowledge).

But you can start, right now, by learning what your body is capable of, and identifying the things your nervous system is warning you about that aren’t actually dangerous.

For me, it took a really smart and capable physical therapist who had studied with Neil Pearson.   I expect that you will need a guide as well– someone who you trust, who can walk you through and help identify the ways it is safe for you to try to push through the pain.

Your best bet will be a physical therapist who has advanced knowledge of recent pain science.  (A PT with this knowledge might not easy to find, at first, but luckily it’s becoming easier and easier.  If you email me at sunlightinwinter12@hotmail.com, I can help you get started).

What you need is someone you trust, who you will believe when they tell you your body is capable of more.

Someone who is able to think flexibly and come up with more than one way to do an exercise, if you tell them the first way they gave you doesn’t seem to work.

Someone who will understand that it’s not only about what they learned about the body in school…  it’s also about you, your nervous system, and your experience as a patient.  Your nervous system has to be convinced that your body is safe, before it’s going to stop making things hurt.

Changing your beliefs about pain can have a direct impact on the pain you ultimately experience.  When you truly learn and understand that your body is giving you pain in order to protect you, it stops being so threatening.  This is known as changing your pain from the top down— from the brain to the body.

But then, of course– it’s equally important to keep working on your pain from the bottom up– from your body to the brain.   

If you have chronic pain, or have suffered from some type of injury, your muscles are probably tightened into protective spasms.  This, in turn, will make them weak, if it goes on for long enough.

If you are weak, you are going to have pain and be at risk for additional injuries.  (This is why I went on to develop so many additional problems after I first suffered from compartment syndrome as a teenager, because I had ended up so out of shape).

So you have to work on the pain from both angles.  You need to calm your nervous system down, and help it understand that not everything is dangerous.  But you also need to give your body what it needs, and do everything that you can to help it function optimally.

***

Doing both of these things is a balancing act.  Getting back in to shape is not about pushing through the pain.  It is not a “no pain, no gain” mentality.

Instead, it is about being mindful.  Being careful.  (And again, ideally, having a trusted coach by your side).

To respect your nervous system, and to accept your body where it is currently at.  Not trying to do too much, too soon, but instead starting where you can.  If you can only walk for 5 minutes, walk for 5 minutes.  If you need to ice your injured knee before you work out, ice your injured knee.

It’s about bringing all of these different things together, and figuring out what works for you.

***

I touched upon this once in an earlier post, and I have to say, I think I phrased it really nicely:

“There is a middle way, where you learn to respect your body’s pain without automatically assuming you are injured.  This means you respect the pain and don’t try to push through it, but you also know not to freak out because you recognize that your nervous system sometimes gives you false alarms.  It’s about being okay with the possibility that maybe you strained something and need to take it easy, while knowing that you probably didn’t.”

This is the balance you eventually need to find, and having a trusted coach by your side who can help you understand what’s going on in your body can make all the difference.

This is the physical therapist I hope someday to be.  The person who understands and can walk you through, even when the path ahead seems scary.  I have been there myself and I know what it’s like.

I also know what it’s like to regain trust in your body.  To go from feeling as though you are made of glass, to knowing what you are capable of– while also knowing your body has limits, and learning to honor them.

This is the balance you need to find.  It won’t be easy, but it is possible.

Central Sensitization, Pain Neurophysiology Education, Pain Science

Todd Hargrove: Seven Things You Should Know About about Pain Science

As I’ve mentioned recently, two things make me really happy, which I plan to focus on more in my blogging in 2017:

  1. Great explanations of pain and the nervous system
  2. Amazing writing and creative use of language

Well, this fantastic article on pain science by Todd Hargrove at Better Movement has both, so of course it had to be my next post.

This is one of those moments where I would just blatantly copy and post the whole article if I could, because it’s that good.  However, in the interest of avoiding copyright infringement, I’m not going to do that, and will instead highlight some of the quotes that really resonated with me.

Basically, the term “pain science” reflects an understanding of the concept that pain is more complicated than our body relaying us a simple message about something being wrong.

That brings us to our first quote:

Pain is defined as an unpleasant subjective experience whose purpose is to motivate you to do something, usually to protect body parts that the brain thinks (rightly or wrongly) are damaged. If you feel pain, it means that your brain thinks the body is under threat, and that something has to be done about it.

The key phrase here is “rightly or wrongly.”  Your brain will cause you to feel pain if it thinks some part of you is in danger.  And the brain is not always right about this– it’s not that simple.

Pain is created by the brain, not passively perceived by the brain as a preformed sensation that arrives from the body.

When a body part is damaged, nerve endings are triggered and send warning signals to the brain. But no pain is felt until the brain interprets this information and decides that pain would be helpful in some way – for example to encourage protective behaviors to minimize further damage and allow time for healing.

Pain is not a simple game of “telephone,” where your nerves send a direct message to your brain about what’s happening in your body.  Pain is something your brain chooses to have you experience, in order to motivate you to do something about it.

This is why there have been documented cases of people who were experiencing extreme injuries or states of physical trauma, yet felt no pain.  When I took my neuroscience course, my professor told us that this phenomenon was reported somewhat widely during World War I, where were soldiers who lost entire limbs in battle and yet felt no pain.  This is because, at the deepest level, their brains understood that they were now going home to safety, away from the battlefield.  In the grand scheme of things, the injury could actually be saving their lives.  That is why their brains did not need to make it more painful– they were already heading home to safety.

Pain is like learning

I have discussed central sensitization before– the unfortunate truth that the more chances the nervous system gets to “practice” sending pain signals, the better it becomes at doing it.

Well, here is another way of explaining things that I absolutely loved:

One unfortunate aspect of pain physiology is that the longer pain goes on, the easier it becomes to feel the pain.  This is a consequence of a very basic neural process called long-term potentiation, which basically means that the more times the brain uses a certain neural pathway, the easier it becomes to activate that pathway again.

It’s like carving a groove through the snow while skiing down a mountain – the more times the same path is traveled the easier it is to fall into that same groove.  This is the same process by which we learn habits or develop skills.  In the context of pain, it means that the more times we feel a certain pain, the less stimulus is required to trigger the pain.

I love this metaphor about carving a groove through the snow.  The more times you go over the same thought pattern in the brain, the more firmly you establish it.  This is true for learning a new skill, and it’s true for sending pain signals.

And again, it’s important to remember– this sensitization does initially serve a purpose:

Most of the time an injury will increase the level of sensitization, presumably so that the brain can more easily protect an area that is now known to be damaged. When an area becomes sensitized, we can expect that pain will be felt sooner and more strongly (so that we do not reinjure it).

There are many complicated mechanisms by which the level of sensitivity is increased or decreased…For our purposes, the key point is that the CNS is constantly adjusting the level of volume on the pain signals depending on a variety of factors. For whatever reason, it appears that in many individuals with chronic pain, the volume has simply been turned up too loud and left on for too long.

Basically, our bodies cause us to become extra sensitive to pain following an injury so that we rest the area.  (After all, as my neuroscience professor liked to ask, if you were a cave person with a broken foot, what good would it do you to go out and try to do battle with a saber-toothed tiger?  You’d get eaten.  Better to rest).

However, the problem with central sensitization is that, sometimes, our bodies don’t know how or when to stop– “the volume has simply been turned up too loud and left on for too long.”

The good thing about pain science is, of course, that it provides us with some really interesting entry points to try to break in to these complex pain problems and develop ways to treat them.  (I don’t know why I’m saying “us.”  I’m not part of the “us” yet.   But I so want to be).

So… not to worry.  Just because your nervous system has become sensitized and ended up one way, that doesn’t mean it isn’t possible to change it back.  (And that, my friends, is the main reason for my blog).

Further Reading

If you’d like to read more about pain science, well… I have so many things I think you should read!  But here is what is probably a more manageable list:

Anything and everything by Neil Pearson

Lorimer Moseley & Body in Mind

The nervous system and chronic pain

Understanding pain as your body’s alarm system

Understanding pain as an overprotective friend

What is pain neurophysiology education?

My new and updated “Resources” section!  I have been working on polishing it up recently, so you may find a few cool new things in there that weren’t there the last time you looked.

That’s all for now– please let me know if you have any questions!   Happy reading!