The Car Accident Experience

Summary

Feminist Survival Project: Episode Summary – "The Car Accident Experience"

Release Date: May 28, 2025
Hosts: Emily Nagoski and Amelia Nagoski

In the "Car Accident Experience" episode of the Feminist Survival Project, hosts Emily and Amelia Nagoski delve into the intricate interplay between physical trauma and the psychological responses that follow. Drawing from Rich’s personal encounter with a minor car accident, the episode unpacks the layers of physiological stress, somatic experiencing, internal family systems, and the concept of neuroplastic pain. This comprehensive discussion offers valuable insights and practical strategies for feminists feeling overwhelmed by their responsibilities and the constant pressure to do more.

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1. Rich's Car Accident Experience

The episode begins with Rich recounting his recent involvement in a minor car accident. He describes the physical aftermath and the immediate emotional turmoil:

Rich [00:40]: "The experience I had was relatively short and easy. I was in a very minor car accident. It was substantial enough that my airbags deployed, but it was not so substantial that I got even whiplash."

Despite the accident being minor, Rich emphasizes the intense physiological stress he experienced:

Rich [02:18]: "My physical state when I got out of the car was, like, big fight or flight. Big adrenaline, big cortisol, shaky, followed by massive dorsal shutdown."

2. Physiological Stress Responses

Rich elaborates on the body’s immediate reaction to trauma, highlighting symptoms like nausea, dizziness, and emotional shutdown:

Rich [00:57]: "I have what you would colloquially call a seatbelt injury... I have a little bit of stiffness in my shoulder still."

He reflects on a past incident at age 20, drawing parallels between his experiences:

Rich [04:08]: "When I was 20, I was walking my bike across a crosswalk and a car just like blasted through the crosswalk and hit the front wheel of my bike."

3. Somatic Experiencing and Trauma Processing

The conversation transitions to somatic experiencing, a therapeutic approach that focuses on the body’s responses to trauma. Rich shares how he applied these techniques post-accident:

Rich [06:09]: "Somatic experiencing, which basically you're taking the motor patterns that got activated and letting them complete."

He describes allowing his body to naturally process the trauma:

Rich [09:31]: "I lay down and listened to my body, and I just noticed that my shoulder wanted to lift... I allowed my body to follow its instincts because its instincts are my survival."

4. Internal Family Systems (IFS)

Rich introduces the concept of Internal Family Systems (IFS), a therapeutic model that involves dialoguing with different parts of oneself. He explains how he engaged with a part of himself that remembered a traumatic childhood experience:

Rich [18:57]: "I went and spoke with previously injured parts that might want to participate in this injury and let it know that... I am still safe."

Amelia supports this by sharing her own experiences with chronic pain and how similar techniques have aided her recovery.

5. Understanding Neuroplastic Pain

A significant portion of the episode is dedicated to explaining neuroplastic pain—pain that persists after the physical injury has healed, arising from the brain’s heightened sensitivity. Rich provides clear definitions and examples:

Rich [25:10]: "Pain is not caused by injury. Pain is caused by that perception of something wrong by your nervous system."

He offers relatable examples, such as phantom limb pain and chronic conditions like shingles, to illustrate how the nervous system can generate pain independent of physical harm.

6. Strategies to Manage Neuroplastic Pain

Emily and Amelia discuss various strategies to address and alleviate neuroplastic pain. Rich emphasizes the importance of compassionate self-dialogue:

Rich [35:07]: "The pain you experienced looking at the fire was, you're unsafe because I remember what happens when things get hot."

Amelia adds practical advice, highlighting techniques like mirror therapy for phantom limb pain and the use of apps like Curable for guided interventions.

Amelia [37:12]: "I have had huge success addressing chronic pain that is neuroplastic and using the techniques that Curable uses."

7. Integrating Behavioral and Cognitive Interventions

The hosts explore the synergy between behavioral and cognitive interventions in managing trauma and neuroplastic pain. Rich underscores the importance of utilizing all available tools without expecting miraculous, immediate results:

Rich [36:25]: "It's about utilizing every tool that there is to heal your nervous system."

Amelia echoes this sentiment, emphasizing patience and persistence in applying these strategies.

8. Personal Reflections and Insights

Throughout the episode, both hosts reflect on their personal journeys with trauma and chronic pain. Rich shares his realization about his heightened bodily awareness and its impact on his professional life:

Rich [14:09]: "Let me acknowledge that I have an advantage."

Amelia discusses her experiences with chronic pain and the resilience required to overcome it using the discussed techniques.

9. Conclusion and Key Takeaways

In wrapping up, Rich synthesizes the episode’s core messages:

Rich [43:33]: "All pain is real. Some pain is because you have tissue damage to your body. Some pain is because your nervous system is trying to keep you safe."

Emily and Amelia reiterate the importance of recognizing the different sources of pain and adopting comprehensive strategies to address them. They encourage listeners to seek medical intervention when necessary and to utilize behavioral and cognitive tools to support their healing processes.

Amelia [44:35]: "Definitely 100% do, there are... all those resources that everybody has access to where they can learn those tools."

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Key Quotes:

• Rich [00:40]: "I was in a very minor car accident. It was substantial enough that my airbags deployed..."
• Rich [09:31]: "I'm allowing my body to... do the thing that it wants to do in the way that it is possible to do."
• Amelia [37:12]: "I have had huge success addressing chronic pain that is neuroplastic..."
• Rich [43:33]: "All pain is real. Some pain is because you have tissue damage to your body..."

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This episode serves as a compelling exploration of how physical incidents can cascade into profound psychological experiences. By intertwining personal narratives with evidence-based therapeutic approaches, Emily and Amelia Nagoski provide listeners with both understanding and actionable strategies to navigate their own trauma and pain.

Transcript

[Amelia]

Hi, this is Amelia. I'm going to be doing lives again Fridays at 4 in May and June at our YouTube channel, YouTube.coministsurvivalproject I'll be answering questions, singing songs, and talking about Murderbot. I hope you can join us.

[Rich]

Are you ready?

[Amelia]

I'm ready.

[Rich]

I think this one was Rich's idea. I'm not sure. And it's going to be short and easy because the things I'm going to be talking about are comparatively short and easy, because the experience I had was relatively short and easy.

[Amelia]

Love it.

[Rich]

And the experience I had is that I was in a very minor car accident. It was substantial enough that my airbags deployed, but it was not so substantial that I got even whiplash. I have what you would colloquially call a seatbelt injury, because, of course, I was wearing my seatbelt, and it prevented me even from touching the airbag. But, like, I have a little bit of stiffness in my shoulder still, and I did. I did some things that probably facilitated the speed of healing and the prevention of some of the worst consequences. And I thought I would just real quick talk about it.

[Amelia]

Great. Awesome. That seems very practical and stronger than the fire E. Yeah, exactly.

[Rich]

Let me say that minor, though. It absolutely definitely was. My physical state when I got out of the car was, like, big fight or flight. Big adrenaline, big cortisol, shaky, followed by massive dorsal shutdown.

[Amelia]

Yeah.

[Rich]

Nauseous, dizzy. My bag was on the ground. A police officer asked for my ID I had to try three times to pick up my bag because it would, like, my fingers wouldn't close.

[Amelia]

Yeah.

[Rich]

Like, I was in a big state. This is shock. Right?

[Amelia]

Right.

[Rich]

The paramedics came and talked to me, and, like, I'm doing fine. I think I'm probably gonna have whiplash in this shoulder, but I'm doing all right. And the paramedic, bless this person, had this, like, very calm, warm presence, which is exactly what you want. You don't want somebody barreling in and being a really intense expert about, like, let me save your thing. And he was so. Yep. Yep. You seem like you might feel a little nauseous. Like, that might be. And, like, yeah, I've totally felt a little nauseous. And I was like, but. But I'm. But I'm all right. And Rich drove me home because I was obviously in no shape to drive myself home. Yeah. So that's. So I recognized that this was a state of physiological stress that was not familiar. The intensity of the wave of chemistry that I was experiencing was out of all Proportion with anything I've experienced certainly in the last 20 years, the closest experience I've ever had. I've never been in a car accident before at any scale, but when I was 20, I was walking my bike across a crosswalk and a car just like blasted through the crosswalk and hit the front wheel of my bike.

[Amelia]

Ooh.

[Rich]

Trashed it. Pulled me down to the ground with it at like 20 miles an hour. Yeah. So I. It was a very fortuitous situation because I, like, picked up my bike and walked out of the crosswalk the rest of the way. There was an off duty cop there to write down the license plate of the car. There was an off work nurse.

[Amelia]

Who.

[Rich]

Was like, how are you? And I was like, I'm fine. I'm just going to sit down for just a minute and then I'm going to ride home. And she was like, I'm gonna call an ambulance for you. And so I got trans. It's the only time I've ever been in an ambulance. I got transported to the hospital. I was strapped to a board, the whole thing. The whole, like, spinal cord injury risk situation. Grandma and grandpa came and picked me up and we had dinner at the Friendly's in Newark. Yeah. And I absolutely did get whiplash from that experience.

[Amelia]

Sure.

[Rich]

So one of my fears was that my brain, being the genius that it is, was gonna be like, hey, I recognize this tension in your shoulder and neck. That's like whiplash. Would you like whiplash? Let's make that happen. So it was really important to me to disaggregate those experiences in my brain.

[Amelia]

Yeah.

[Rich]

And also to help my body move through the worst of what it was experiencing so that it didn't have to cling to the physical injury as a way to cope with whatever emotional trauma I might have been experiencing.

[Amelia]

Right.

[Rich]

So my first thought was, remember in an unspoken voice.

[Amelia]

Yeah.

[Rich]

Peter Levine begins this book, this science dense book about somatic experiencing with a story about being a pedestrian hit by a car.

[Amelia]

Yeah.

[Rich]

And he talks first about, like, some guy who's like trained in first aid, come over and like, start yelling him about, like, his orientation and time and place. And. And Peter Levine, being who he is, is like, can you please just stand over there? Just, I need some distance. And then a pediatrician came and sat next to him and said, the ambulance is on its way. How are you feeling? Just had this warm, kind, loving presence. And because she had that calm, warm presence, he was like, can you hold my hand? And she came in the ambulance with him. And he started in the ambulance. He's already ready, doing. Practicing somatic experiencing, which basically you're taking the motor patterns that got activated and letting them complete. So when animals in the wild are sedated, for example, they generally come out of sedation in the stressed state they were in before they were sedated. And they will lie there, like, shaking their paws and stuff and shuddering and breathing. And that's because their body is when. When I talk about completing the stress response cycle, the original science of that comes from somatic experiencing. And so in this case, it is literal motor patterns that get activated in the bracing against impact. So when I got home, so I did the same thing that Peter Levine did in the ambulance, which is I lay down and I listened to my body, and I just noticed that, like, my shoulder wanted to lift. And, like, I'm like. I just, like, allowed that to happen. There's no, like, intentional motion happening. I'm not choosing for my shoulder to go up, but I noticed that it's feeling that urge. And instead of being like, no, no, you need to, like, control your body and not look weird. You need to not move your body in an uncontrolled way. You need to allow. No, no, I'm going to allow my body to follow its instincts because its instincts are my survival. So, like, I'm lying down and I'm letting my shoulder tense, and I notice that, like, with the tensing and raising of my shoulder comes my hand. And then, like, my other hand, it's like it's attached with a string. It comes up with it. And eventually I'm lying in bed with my hands softly curled and relaxed, but, like, over my face, the way you would block your face from somebody trying to hit you. And my hands stay really relaxed, but my shoulders and upper arms get so tense that they're, like, shaking. Right. So this is. I'm allowing the motor patterns that got activated to complete the process of shoving away the threat, which is not an adaptive response when the threat is a car.

[Amelia]

Yeah, yeah, yeah.

[Rich]

But it is. It's the one that is hardwired in your body. So I'm allowing my body to, like, do the thing that it wants to do in the way that it is possible to do. And I should add that I've had somatic experiencing therapy with a practitioner.

[Amelia]

Yeah.

[Rich]

Where? So one of the exercises you might do, for example, is the practitioner will hold up their hands with their palms facing you, and you put your hands against their palms while you're activating something or other in Your body, and you push them away, and they're offering just barely any resistance. All the resistance is coming from inside your body and your muscles, and it feels like you're working so hard to push their hands away. And all that work is work that your body is longing to do for you to protect you from whatever threat you are pushing away. Does that make sense?

[Amelia]

Right. You're dealing with the stuff in your body in a separate process from the one that actually protected you, which was the technology in your car.

[Rich]

Yeah, exactly. 100% crumple zones, airbags, seatbelt. Especially seatbelt, frankly, was like the. Like, at that slowest speed, that's the thing that's gonna, like, make the most difference. And so I'm lying in bed. Rich has never seen me do se before. Oh, I think.

[Amelia]

No wonder he wanted you to talk about it.

[Rich]

Yeah. Because I. Because I was like, I know this looks weird. I know. This is. I know, like, do not worry about it. This is good. This is healthy. I'm lying there with my hands shaking. Like, there's, like, I'm having a seizure. Like, it looks like something is wrong and like, something is wrong because your.

[Amelia]

Body'S acting like something's wrong. Yeah, yeah, yeah.

[Rich]

As far as my body's concerned, something is wrong and it needs to help me, and I am giving it that opportunity to help me. And I'm, like, crying for no reason, even though I don't have my shoulder. Even then, it wasn't so much pain as it was just, like, tightening.

[Amelia]

Yeah.

[Rich]

I don't know how much experience you have with back spasms.

[Amelia]

I have plenty of experience with that.

[Rich]

But there's a sort of, like, tightening that presages a spasm.

[Amelia]

Yeah.

[Rich]

That's, like, the context for spasms. Let me note that the very next day, I had the opportunity to talk to a medical provider who prescribed muscle relaxers to help manage the spasms. She had lots of experience with people who come in multiple days after an accident in so much pain, they believe their back is broken, even though their back was fine immediately after the accident. One day after the accident. But it takes time for your muscles to respond in the way they are going to. And prophylactic or preventative treatment of muscles with, like, in less than a day after the accident has happened, she's like. Like, if you could take it, like, the day of, that'd be even better. So in another 32 years of driving, maybe. Hopefully I won't, but maybe I'll have this experience again and I will know.

[Amelia]

Get the muscle Relaxers right away.

[Rich]

Muscle relaxers right away. Just as, like, a medical adjunct to this trauma processing. Because the trauma processing helps to minimize the physical sequelae, the physical consequences of what's happening, but they can't prevent the reality of an actual physical injury that happened. A lot of traumas do not have lasting physical injuries.

[Amelia]

Right, right, right.

[Rich]

So that's. That's. So that's basically what I did.

[Amelia]

Trauma also happens just from witnessing others in an accident when you have no threat.

[Rich]

Yes. And your body's gonna have the same sort of, like, longing to protect you.

[Amelia]

Right.

[Rich]

And all you have to do is notice the urges in your body and grant it permission to do the thing it wants to do.

[Amelia]

Yeah.

[Rich]

And I have to say, the first inkling of neurodivergence I ever had was with my SE provider.

[Amelia]

Yeah.

[Rich]

Because she was complimenting me on the ease and facility with which I was practicing, like, noticing what my body wanted and allowing my body to do the thing. Because I'm, like, hyper aware of my internal experience. Like, it's easier for me than it is for other people. Let me acknowledge that I have an advantage.

[Amelia]

You're at the end of the bell curve when it comes to that stuff.

[Rich]

Truly so. And what I finally recognized is that while it was a strength, it was a personal strength that I have this facility in noticing my body's state and communicating about my body's state and allowing my body to do what it needed to do. That facility was alienating in the context of a professional workplace.

[Amelia]

Yeah.

[Rich]

Because nobody else is speaking in that language. No, not only that, professional people feel like it's inappropriate for me to talk about in terms of, like, my body's experiencing this response to that sentence that's like. Like nobody wants to hear that. They don't want to hear about my body's state. Nope.

[Amelia]

It's true.

[Rich]

So that was my first inkling that, like, I might. I might not belong in a professional work setting.

[Amelia]

Yeah.

[Rich]

So if people want to, there's all kinds of information all over the place. You can read books about somatic experiencing. There's videos of somatic experiencing, including being able to watch people's therapeutic sessions to see what happens to their bodies while they're visualizing stuff that doesn't even necessarily have anything to do with the actual, literal trauma that happened to them.

[Amelia]

I want to warn people away from diving deep into Peter Levine's work, stick very closely to the somatic experiencing work that he does.

[Rich]

Absolutely.

[Amelia]

That's because he does other stuff that is not great.

[Rich]

Yeah. So, Peter Libyan, there are so many examples of people who are really successful and great at one specific thing.

[Amelia]

Yeah.

[Rich]

And that leads them to feel confident that they can be good and great at other things without putting in the many years of training and research and development of expertise that they put into the thing that they were originally really good at.

[Amelia]

Yeah.

[Rich]

So it is like a lesson for me to stay in my fucking lane.

[Amelia]

Yeah.

[Rich]

Because Peter Levine doesn't always stay in his lane. And he's, he's not great out of his lane, but in his lane.

[Amelia]

Truly transformative in the somatic experiencing lane. Peter Levine. Transformative, reliable.

[Rich]

Yes.

[Amelia]

Evidence based.

[Rich]

Evidence based. So detailed in the science. Yes. Really great, so helpful.

[Amelia]

But don't, don't, don't, don't, don't, don't explore. Yeah. Don't explore his other work.

[Rich]

Yeah. Not necessary.

[Amelia]

No.

[Rich]

So that's one thing I did is I practiced Somatic Experience. So, one, I access medical care. Two, I practiced somatic experiencing to allow my body to protect me in the ways it was holding onto. I granted it that permission and that helped to prevent a worsening. And I also did internal family systems parts work with the part of me that remembered being 20 years old and alone in the emergency room for the first time in my life. Well, for the first time in my adult life, there was a time I fell out of bed and cracked my head open when we were three, four, small. And I'm sure I went to the emergency room because it was like late at night or something. I don't know. Yeah. But like, as an, like, as a grown person, my first time in the emergency room and I was alone and, and I didn't take muscle relaxers and I didn't trust my body or know or have anything like the skill set that I have now. Though I did have the loving presence of our grandparents. And I had the pleasure and delight of a Sunday friendly at Friendly's.

[Amelia]

Yeah.

[Rich]

And probably chicken fingers and fries.

[Amelia]

Ice cream is so healing.

[Rich]

So healing. Truly, if dairy is a thing for you, if dairy is not bad for you, Ice cream.

[Amelia]

Yeah.

[Rich]

So I did internal family systems parts work with the part of me that was alone at the emergency room when I was 12.

[Amelia]

Hold on one second. I am now imagining being our grandparents and getting a call that you're at the er, you were hit by a car, your bike was hit by a car, you're in the emergency room and they go and they pick you up and they're like, let's go get ice cream.

[Rich]

Let's go to Friendly's.

[Amelia]

Let's go to Friendly's. Like, I can just. That seems so. That makes so much sense to me.

[Rich]

I have a picture of them from that day. Yeah.

[Amelia]

Yeah. That just feels so, like, correct.

[Rich]

Yeah.

[Amelia]

Of, like, exactly what they. I mean, you're. It's the same as if you were eight.

[Rich]

Yeah. Let the record show I have a particularly warm and positive random relationship with our maternal grandparents. They lived two doors down from us when we were growing up, and they.

[Amelia]

Not our whole childhood, but we were.

[Rich]

Like middle school, middle school, high school kind of thing. And they liked me in a way that not a lot of people did.

[Amelia]

Yeah.

[Rich]

Because I was not always easy to like, you're a lot.

[Amelia]

It's true.

[Rich]

I am a lot. And Grandpa in particular was very, like, sort of fascinated by me. And he, like, asked, like, they would take us shopping before every new school year, and we'd go to the mall and I'd pick a shirt, and Grandpop would say, what do you like about that shirt? And I truly try to answer his question about what I liked about that shirt. And you would say, I don't know. I just like it.

[Amelia]

Yeah.

[Rich]

So. And I felt attended to by his inquiry. Like, I didn't feel judged or anything. Like, he. He was really curious to know what the heck is going on inside this human being's head. What is it like in there? Yeah. So I. I really liked our grandparents.

[Amelia]

Yeah. I can also now, like, I'm old enough and with step kids that are old enough to, like, imagine myself as a grandparent getting that call and being like, it doesn't matter if the kid is 20 now.

[Rich]

You're gonna.

[Amelia]

You're gonna do the same thing as if they were six.

[Rich]

Yeah. You're gonna go pick them up, be.

[Amelia]

Warm, go have comfort food.

[Rich]

Yeah.

[Amelia]

Yeah. That makes so much sense to me.

[Rich]

Yeah.

[Amelia]

Okay, continue.

[Rich]

So internal family systems. Go to the part of myself that was alone in the er. The. The doctor who talked to me was like, were you wearing your helmet? To which my answer was, I was walking my bike. And he says, fair enough.

[Amelia]

Yeah.

[Rich]

I literally wasn't riding my bike. I don't have to wear my helmet, walking my bike. So I remember that moment in particular. So that's my anchor into that moment and that experience of my body. And I, like, go and talk to not just that self, but to that injury that's happening in my body that's forming over the next several days in September of 1997. If you can put yourself back in that historical moment. And I go and, like, I make sure, like, I tell that injury the story of the ways I was cared for and the ways that I truly did heal and, like, all the access to health that I had and all the, like, the evidences of strength that I have experienced in the meantime. And my goal was to make sure my body knew I didn't need that injury. That old injury, that old pain. I didn't need that right now. Even though, like, there might be cues signaling it that, like, oh, you're not safe. In a similar way, let me help keep you safe by locking up these muscles.

[Amelia]

Like, Clippy showing up in. In word.

[Rich]

Right.

[Amelia]

Being like, it looks like you're trying to write a letter. Like, your Clippy's being like, it looks like you've experienced a crash of some kind.

[Rich]

Yeah. An injury specifically to your left shoulder and neck.

[Amelia]

Yeah. Like, do you. You want me to.

[Rich]

Would you, like, help with this?

[Amelia]

With doing this thing that. We've done this before and I know.

[Rich]

How and I have. Yeah. Yeah. Clippy be like, do you. Do you want help with this injury? And I went and talked to the Clippy that lived in my neck and shoulder and was like, no, we're good. Like, look at how safe. Look how much access we have to safety. Look how well that healed so long ago and how much strength our body has, how much wisdom the immune system has.

[Amelia]

Look at.

[Rich]

Look at the trust that you can have in me to take care of this body. And indeed. So here's a hilarious way that I can tell that that was helpful. And if people are like, what the fuck are you talking about, Emily? This is Internal Family Systems, which is Dick Schwartz, Richard Schwartz. His most recent and I think, comprehensive book is no Bad Parts, which explains how Internal Family Systems works. And basically, you go and talk to the parts of yourself that it's like, you're not afraid. A part of you is afraid. You are not angry. A part of you is angry. And that angry part of you and that fearful part of you is trying to protect you. It's on your side. It's just trying to protect you in a way that might be potentially activating some unwanted consequences. So that's. I went and talked to a part of me that was maybe potentially putting me at risk for unwanted consequences, and I prevented that. And the way that I have a sense that I may have been helpful is that. So the accident happened on a Sunday, Wednesday. I experienced pain in an unrelated but adjacent part of my body, sort of between my spine and shoulder blade on the same side, further down which is an injury I experienced in 2018. So Clippy was like, I see you've got pain in your left shoulder and neck. Can I help you with that?

[Amelia]

And you were like, no.

[Rich]

How about. Do you mean this injury?

[Amelia]

Is it this one? How about this one?

[Rich]

Is it this one? And one of the ways that you can tell that pain is neuroplastic, which is to say that it is about the shape that your nervous system has been sculpted into by big experiences, is because the pain, like, moves around in ways that cannot be accounted for by an injury. And there is nothing about the injury that I experienced from my seatbelt that would have been giving me a muscle spasm.

[Amelia]

Yeah.

[Rich]

Down between my shoulder blade and my spine. Like, down at, like, the bottom wing of my shoulder blade and spine days later. Days later. And in an area that's not related. In a place that has never indicated that it was injured before and in a place that absolutely was injured seven years ago.

[Amelia]

Yeah.

[Rich]

It was like, do you mean this? Is it this? And like, I was like, oh, I forgot about that one. That's. That's. I'm gonna have to. Let me go talk to that part. That part of me that remembers that injury and is like, do you mean this? And because I never experienced the whiplash, I didn't experience any pain that seemed related to the thing that happened when I was 20, but I did experience pain related to 2018. Sort of tells me that, like, doing the parts work was part of what prevented my body from recreating pain from an unrelated situation. Does that make sense?

[Amelia]

It does to me, because I am already on board with the neuroplastic pain and understanding that pain is not caused by injury. Pain is caused by that perception of something wrong by your nervous system.

[Rich]

Right. Have we ever done, like, an episode on neuroplastic pain?

[Amelia]

I don't think we've done an episode on neuroplastic pain.

[Rich]

And I'm not sure that we need to. A whole episode about it, because we can just do this, which is.

[Amelia]

It's the sentence I just said.

[Rich]

Yeah. There's a book called the Way out, which explains all of this in vastly more detail. If you are experiencing pain after a physical injury has healed.

[Amelia]

Yes.

[Rich]

Chances are the pain is not about tissue damage. It's not about the injury. It's about the ways your brain has learned to associate basically any sensation at all in that part of your body to a threat.

[Amelia]

Yeah.

[Rich]

So a sensation that, before your injury, your brain would have just been like, that's a sensation that's happening. Now that you've had an injury there, your brain, in an effort to protect you and keep you safe, is over. Interpreting any sensation that comes from that body part as being pain.

[Amelia]

Yeah. So many years ago, I. I think also in 2018, maybe I burned my hand. It was a second degree burn on the back of my right hand.

[Rich]

Second degree.

[Amelia]

It's bad. It was a really bad burn. Yeah, it was nasty. And then months later, it was fully healed. I mean, it was healed as far as a burn heals in months. It was no longer giving me pain, but I chaperoned a camping trip with my church youth group, and there was a campfire, and I couldn't even look at the campfire without my hand.

[Rich]

Wow.

[Amelia]

Exploding in pain. Yeah.

[Rich]

That's a really good example. Another example that I love because it was. It was physically impossible for there to be pain caused by tissue damage. I had a root canal on the lower right side of my face, but it took a long time. It took a couple of months for me to get treatment. So I was in a lot of pain for a couple of months. Very specific jaw pain from this tooth that needed a root canal. And so now if I experience that same tooth pain, jaw pain from that specific place, Part of what happens with a root canal is they kill the nerve. There is no nerve ending in that place.

[Amelia]

Right.

[Rich]

So if I'm experiencing pain there, the mechanism of communicating pain from that place in my face to my brain doesn't exist. The pain is being generated directly in my brain. So I know for sure that that is neuroplastic pain that is being activated because I am in a stress state that resembles the state I was in for the two months that I experienced that pain.

[Amelia]

Yeah. Another example is shingles is a disease of the nerves. You get breakouts of the shingles themselves along the path of nerve. You can see the shape of the nerve under the skin by where the breakouts happen. And to this day. To this day, I still get itches and sharp kind of stabbing. Like I have a needle prick in the places where the shingles lesions were. Not because I still have shingles, but because that was a really dramatic and so specific.

[Rich]

Yeah, yeah.

[Amelia]

That like, I still have phantom pains of it just because the nerves.

[Rich]

Remember, phantom limb is another example of neuroplastic pain. People who've had a limb amputated will experience pain in the limb that is not there anymore.

[Amelia]

Yeah, yeah.

[Rich]

So again, it's just not possible for the pain to be coming from the limb. It's been Physically removed from the body. But the pain is real. Let's emphasize. Yeah, yeah, yeah, yeah. All pain is real pain. And it's all physical. It's your nervous system, the pain, this pain that is not related to the injury. So the pain you experienced at the time of the burn was the warning signal of your brain being like, there's an injury. You are unsafe.

[Amelia]

Yeah, yeah, yeah, yeah. Something's wrong. Go fix it.

[Rich]

But the pain you experienced looking at the fire was, you're unsafe because I remember what happens when things get hot.

[Amelia]

Yeah, exactly.

[Rich]

So one of the most effective treatments for phantom limb pain, and it's often itching and, like a stabbing sensation, is you put your existing limb in front of a mirror and. And you move your. So if it's your arm, you move your hand, you squeeve it and squeeze it, and you're seeing the mirror reflection like it's the opposite limb. So your brain perceives. And the fact that it's able to move it is a huge relief. And the phantom pain diminishes, at least temporarily and often longer term. David. I forget Lormer, Mosley, and I forget who else. They're these Australian physiotherapists who wrote a book called Explain Pain. And I read Explain Pain Supercharged, which does all of the science. If you're interested in the science, Explain Pain Supercharged is absolutely the book to read. If you're like, just tell me how to do it. The Way out is the book that is Just Tell Me how to do it. There's an app that I am a permanent subscriber to called Curable, that is about intervening on pain that is not related to an injury. If it's been more than three months since the physical injury and you're still experiencing pain, odds are it's neuroplastic. It's happening because your nervous system is trying to protect you rather than because there is any continuing to exist injury. One of the ways you can tell is that, like, the physical injury has healed. Another way you can tell is if it is bilateral in a way that, like, really is unlikely. Like, if both your wrists hurt in the same way at the same time. Like, you didn't identically injure both wrists simultaneously. Right. Like, that's. That's not how injury works.

[Amelia]

Right, Right.

[Rich]

So if it's. If it's bilateral in, like, a deeply suspicious way, if it moves around like, it's like, oh, you can prove that you're not damaged in this spot. Let me move the pain to this spot. If it Moves around like that. That's. That's also. That's a cue that it's probably your nervous system overreacting, trying to, like, keep you safe. Like, it is trying to help you out, and instead it is causing you pain.

[Amelia]

I have had huge success addressing chronic pain that is neuroplastic and using the techniques that curable uses before the app for curable existed. Yeah, me too. Using those techniques to. To completely get rid of back pain, neck pain, knee pain, all kinds of chronic pain. And I use those same techniques to address my burned hand and to, like, you know, get observational distance from the sensation of the burn. And I couldn't do it. Like, I couldn't get distance from it. My something wouldn't let me let it go. So I went back to the doctor, and it turns out it had been infected. So I could also use those same techniques to establish when there was physical damage, when it was just signal and not, you know, an actual alert to a problem. And if that doesn't work, then maybe there's actually.

[Rich]

Maybe there's a problem, and maybe it's.

[Amelia]

Maybe there's an actual problem.

[Rich]

That's a great point. Is that using the strategies to address neuroplasticity of the pain doesn't work. It can be an indication that there still is.

[Amelia]

Yeah, I did that with long Covid, too. I spent a long time using these techniques. Too long. Yeah.

[Rich]

Feeling like you were failing at the strategies, and you're like, oh, no, this is a disease of my mitochondria.

[Amelia]

And then it was like, oh, yeah, your mitochondria don't work. And I was like, oh, oh, it's a structural problem, not a neuroplastic problem.

[Rich]

Yeah. So the language we typically use is that, like, there's structural damage or there's neuroplastic pain that is residual. There's neuroplastic activity that is activating pain that is not related to a structural problem, but rather to, like, a desire to protect you from another similar injury.

[Amelia]

Yeah.

[Rich]

Yeah. And sometimes you can tell because it goes away when you turn toward it with kindness and compassion. And you say, I recognize you're trying to keep me safe. Thank you. And. And I am safe. You can trust me.

[Amelia]

Right? Yeah. And when I first tried this, it took months to make a dent in the pain I was experiencing. That was in the 20 to 2010. 2011 is when I first tried this. And it took months to make any. Any change. And now if I feel a back spasm, I can turn toward that back spasm. And be like, I know, yeah, there was this stressful thing that happened, and I know you're warning me and you're telling me all about that, and I embrace it with kindness and compassion and let it know that I am actually safe. And I am the adult now, and I can and I do all the things, and then it just goes away. It just stops immediately.

[Rich]

And let me say, they make it really clear in the way out that, like, use your protective behaviors. Like, you don't have to just rely on the, like, compassion, kindness, and gratitude. You like heating pad. Put a heating pad on it if that's gonna help. Take a couple ibuprofen if that's gonna help you get through the day. Like, this isn't about being a fucking hero. Yeah. It's about utilizing every tool that there is.

[Amelia]

Yeah.

[Rich]

To heal your nervous system.

[Amelia]

To heal your nervous system. Not necessarily to heal whatever thing is telling you that it hurts, but to heal the whole nervous system. So, for example, also menstrual cramps. Part of menstrual cramps are neuroplastic.

[Rich]

Part.

[Amelia]

Getting this signal to get a little contraction, to get a little cramp. But when that cramp signal spreads throughout your abdomen and down your legs, like, that's the nerves getting signals that are meant for one specific area. One specific area was supposed to get that signal. And now all these other nerves and all these other muscles are affected, and I can have a nice, stirring conversation. That signal's not for you. Quadriceps. That signal's not for you. Abdominal wall. That's not your job. That's not for you.

[Rich]

So my inclination with that sort of experience is to be like, what is it. What is it that you need? Because you. You. You're not actually in pain. Quadricep. Because, like, the physical sensation is definitely coming from a biological process that I know is located up here. But you clearly need something. You want my attention? You have my attention. What is it that you need? And very often it's like, get some rest. Because my sleep has been so fucked.

[Amelia]

Up for so long.

[Rich]

Like, I'm always tired, and anytime I ask a body part, you. You want my attention? You have my attention. What do you need? Rest.

[Amelia]

Yeah. Sometimes it's not about. Sometimes it's just these signals are next to each other, and they got. They got. It was a contagion.

[Rich]

Yeah. And spreading activation is a technical term that neuroscience uses sometimes.

[Amelia]

Yeah. And so I just need to, like, have a. Have a conversation with my nervous system. Hey, nervous system. Don't. Don't do that just.

[Rich]

Yeah, just.

[Amelia]

I understand we're having a cramp because. Because it's a menstrual thing, and I get it. Cool. Do what you got to do. But you know what? All those other muscles, all those other nerves, you don't need to be involved. Don't fall for it.

[Rich]

Yeah.

[Amelia]

Don't join the cult of the cramp. So that's neuroplastic pain.

[Rich]

So I had, with the car accident, I had, obviously, a physical injury, and it is still healing. I have a very small amount of residual pain because it is still healing. My healing from physical injuries is very much a learning curve where it gets more, much better very fast. And there's like, a little bit of residual damage that just kind of takes a month. And I. I just have to be, like, really supportive of that body part for, like, as long as it takes, because the. If I get impatient, it's worse, and if I get frustrated, it gets worse. Whereas if I'm like, yeah, you went through something. Let's take it easy. Let's be cool. My. My body part will heal in the time that it needs. And yeah, it's my job to grant it patience and not scold it, because it's true that I went through something, and I'm not gonna minimize the thing it went through by being like, get over it. No, no, it was a real thing that happened.

[Amelia]

It was a real thing.

[Rich]

Yeah. You don't have to get over it. You go, you do. You do what you need. So I have. So there's a real physical injury that I got real medical care for. And I also granted my body permission to protect me in the way it wanted to. And I went and spoke with previously injured parts that might want to participate in this injury and, like, let it know that, like, nope, nope, this one injury is. Is. Does not mean that I am still unsafe from that previous injury and turning toward with kindness and compassion, recognizing that not all pain comes from tissue damage, but some pain does. Hi, Olive. Olive is here. Hello, Olive girl. So, yeah, so a short, relatively simple episode where we explain neuroplastic pain, but also, hey, sometimes there's tissue damage and there's stuff you can do. In addition to seeking medical intervention, which highly recommend.

[Amelia]

Definitely do, definitely 100% do, there are.

[Rich]

Also behavioral interventions, cognitive interventions for treating the trauma. One of my many, many helping professionals told me also that for comparatively minor single incident traumas like this, it actually can help to just, like, talk about it with everybody. It is. It is not recommended for, like, ancient traumas, ongoing traumas like. Like, talking about it can actually reinforce it.

[Amelia]

Right.

[Rich]

And, like, make, like, just, like, ingrain it. Just, like, reinforce those pathways in your brain. Just carve it deeply in. The goal is to. With. With this relatively minor single incident trauma, to, like, talk myself into a story of healing.

[Amelia]

Yeah.

[Rich]

So part of doing this episode is me telling the story of all the ways that I have been supporting my body in healing, which includes honoring the fact that it did experience injury. And, like, look at how many fucking tools I've got.

[Amelia]

Look at all those tools and look at all those resources that everybody has access to where they can learn those tools.

[Rich]

They can learn those tools too. And like you said, it took you months to make a dent in your neuroplastic pain at first, but now it can happen in a matter of minutes.

[Amelia]

In a matter of a moment. In the matter of a matter of.

[Rich]

A moment, you just recognize, oh, that's neuroplastic pain. You can relax quadriceps. And they just do. Because they're like, oh, you called me out. No, that's cool.

[Amelia]

Yeah, yeah, yeah, yeah, yeah. Exactly.

[Rich]

Yeah. Because it's.

[Amelia]

They've practiced, and now they're. They're good at it.

[Rich]

Yeah.

[Amelia]

It does take time at first.

[Rich]

Let's just say one more time for the record, all pain is real.

[Amelia]

Absolutely.

[Rich]

Some pain is because you have tissue damage to your body.

[Amelia]

Yeah.

[Rich]

Some pain is because your nervous system is trying to keep you safe. And it is so smart. It remembers that time you got injured in this place. And so now when you have a sensation there, turns out it's neutral. If you have pelvic floor pain. Oh, so much pelvic floor pain. Not all of it, but, man, like, if you gave birth, vaginal birth, your body's like, I remember sensations here. That's pain. Right. And, like, your tissues have healed, but, like, you still have tons of pain. Neuroplastic pain, my friend. So this turned out to be the episode about the broad categories of pain. Strategies of intervention to prevent trauma, and neuroplastic pain. And to treat neuroplastic pain, if you have it, which both of us have had multiple times in our lives.

[Amelia]

Tons of. Yes.

[Rich]

It's just like buckets of neuroplastic pain.

[Amelia]

Yeah.

[Rich]

And the science is there. If you want to read the science, the how to is there. If you just want to read the how to. And all. All pain is real. Is that. Is that helpful? Stronger than the fire. Talking about. Talking about how to heal from pain is like, there's nothing more stronger than the fire than that yours is like, actual fire.

[Amelia]

Yeah. No, when you're saying that, my. My hand actually ached a little bit and. Did you.

[Rich]

You're like, yeah, it's cool.

[Amelia]

You're keeping like. I. I hear you. I remember we were burned.

[Rich]

We're not gonna do that again.

[Amelia]

Even see the scar still kind of.

[Rich]

I can't see the scar.

[Amelia]

I. I can see.

[Rich]

I'm sure you can.

[Amelia]

It's on the camera. You see where it's darker there? That's not shadow. That's my skin. That's because I see. It looks like a bruise poisoning. It looks like a ruse.

[Rich]

Yeah.

[Amelia]

It's because the skin is darker because I haven't been wearing SPF on my hands when I go outside these days. And that patch of skin.

[Rich]

Your hands are better.

[Amelia]

Sun poisoning. I need to. I usually. I often wear a glove on that hand because even SPF is not enough. Enough.

[Rich]

But I. Stop. Look.

[Amelia]

I have difficulty adjusting as the seasons change. I have difficulty adapting to change. I am autistic, and I am rigid and realizing that the season has changed enough so that I need to be now. It's the season where I wear the glove when I go outside.

[Rich]

Yeah.

[Amelia]

It's hard to remember and make that behavioral change. I understand that it's important, and I.

[Rich]

You could just wear it all year.

[Amelia]

It's not comfortable, and it is a pain in the ass, and it's better not to.

[Rich]

Okay, well.

[Amelia]

But I get that it's necessary sometimes. Whatever. Whatever. I'll just. Fine. It's fine. I'll figure it out. But that burn, like, had a lasting. That's what I'm saying.

[Rich]

Yeah. Lasting physical consequence.

[Amelia]

The tissue is no longer damaged, Right? The tissue's no longer damaged.

[Rich]

Well, it is insofar as your melatonin response is not available because it's like secondary growth forest is not the same as primary growth forest. The skin that grows back after your skin went away injury is not the same as the skin you originally had.

[Amelia]

Yeah. It has no oil glands and it has no hair, so it responds differently to stimuli, but it is not injured.

[Rich]

Yeah.

[Amelia]

Like, I can touch it. I can scratch it. It needs different care. That's all. But it does go. I remember fire. To be clear, it wasn't burned with fire. It was burned with sugar. But heat, it doesn't.

[Rich]

Yeah, sugar is very, very fucking hot. Very odd. We should not talk about that anymore.

[Amelia]

Yeah, it's fine.

[Rich]

Okay. Well, I hope this has been helpful for people. Not just if you experience a car crash and a seatbelt injury, but like any kind of injury, any kind of chronic pain that you may be experiencing, both in recognizing how pain can outlast injury and how to heal pain, regardless of its relationship to tissue damage that you may be experiencing. And. And that's all. And cue the ukulele. It is like a lesson for me to stay in my fucking lane.