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Trauma Rewired
Chronic Pain and Complex Trauma; The Neurosomatic Connection
00:51:50
A significant portion of the population lives with chronic pain, yet its origins and effective treatments remain some of the least understood aspects of healthcare. Pain is inherently subjective—unique to every individual—and rarely attributable...
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- [00:00]
Elizabeth Kristoff
Chronic pain is deeply tied to the health of our nervous system, our ability to regulate emotions and the impact of past experiences. It's more than just a response to injury. It is an output from the brain. It's shaped by sensory inputs, emotions, memories. That's why understanding how trauma and stress impact the nervous system is so important to addressing chronic pain. And pain doesn't just affect the body, it ripples out to influence our mental health, our social connections, our overall quality of life. And chronic pain often creates this feedback loop, leading to isolation, depression, and even changes in our brain function that then make the pain worse. Even if you don't live with chronic pain, this episode is a really interesting exploration of the neuroscience of the mind body connection. And it's through the neuroscience of chronic pain that we've come to understand a lot of concepts like neurotags, the networks of neural connections that shape not just our pain, but also our beliefs, our behavior, our emotional responses in all areas of life. And we're going to dig into all of this today with Matt Bush. From pain as an output to the emotional and neurological underpinnings of human behavior. And this conversation goes well beyond pain management. So if you love neuro and the science of how the brain and the body are interconnected, get ready because we're going to take a deep exploration today.
- [01:23]
Matt Bush
Foreign.
- [01:27]
Elizabeth Kristoff
Welcome to Trauma Rewired, the podcast that teaches you about your nervous system, how trauma lives in the body, and what you can do to heal. I'm your co host Elizabeth Kristoff, founder of Brainbase.com an online platform for training the nervous system for resilience. And I'm also the founder of the Neurosomatic Intelligence Coaching Certification, an ICF accredited educational course to equip therapists and coaches to bring the brain and the nervous system into their work for deeper levels of healing and really lasting transformation.
- [01:56]
Jennifer Wallace
And I'm your co host Jennifer Wallace. I'm a neurosomatic psychedelic preparation and integration guide and I bring neurosomatic intelligence into your peak somatic experience. And I'm also an educator at the Neurosomatic Intelligence Coaching Certification. And today we are joined by Matt Bush of Next Level Neuro and he's also one of our lead educators at nsi.
- [02:17]
Workshop Host (Possibly Elizabeth Kristoff or another NSI Educator)
Imagine being the kind of leader in your organization, in your business, in your community, in your own life who stays calm, grounded and fully present even in the most challenging conversations, truly hearing others and guiding clients or teams. From reactivity to resilience At a time when burnout and overwhelm are at an all time high. People are craving this kind of leadership and it all starts with a regulated, adaptable nervous system. If you're a coach, a therapist, or an organizational leader ready to elevate your practice, join us for a free online workshop, Rewire and Rise Building Resilient Leaders with Applied Neurosomatic Intelligence. It will be January 15th at noon Central with me and with one of our lead NSI educators, Matt Bush. In this session we're going to go beyond understanding how your nervous system works. You'll learn how to work with it directly to calibrate responses and build capacity to lead with resilience. Plus, we'll stay after live to answer your questions and share details about the next cohort of nsi. You can sign up now at neurosomatic. Com. We would love to see you there and connect with you live. A replay will be available after the workshop. You just have to register@neurosomatic.com.
- [03:29]
Matt Bush
Thank you for having me back. I'm super excited for today's talk on the podcast. This topic is near and dear to my heart because we've worked with so many people over the years who have chronic pain and are able really to reduce that, change it drastically, even remove it completely based on neuro training. So I think we all individuals here on the podcast, but also listeners, have someone in our lives, a family member, a friend, a colleague who deals with some type of chronic pain. And the more that we can understand the input, interpretation, output loop and how it becomes chronic, the easier it is to be able to work with those issues and conditions and really make a lasting difference. So glad to be here.
- [04:12]
Elizabeth Kristoff
Yeah, I feel like this is a long overdue conversation and I think to start it out we need to look at the work of Lorimer Mosley, who has been really foundational in transforming how we understand chronic pain. And Mosley's a clinical scientist and a researcher in pain neuroscience that really demonstrated through the years of research that pain doesn't just come from a physical injury or tissue damage. And that changed the way that we see this traditional view of pain and created a new perspective where we're really looking at it as more of a complex experience that's shaped by our brain's interpretation of various inputs from sensory information or our past experiences, or our emotional state and perceived threats. And again, that brings us back to the input, interpretation, output loop that pain is not just a response to physical damage, but has everything to do with how we take in information about the world outside of us and inside of us how our brain interprets that information and then the output that is created. And so I want to first dive a little bit more into that, Matt, because I think sometimes it can be really hard for people to start to understand that pain is not necessarily coming from a physical injury and that it is an output rather than an input.
- [05:38]
Matt Bush
Yeah, certainly. So as an easy example, you can think about if you've ever had to go into a really stressful meeting, maybe with a boss or a subordinate, a partner, and you start to develop pain before that meeting even happens. Like, could be stomach pain, neck pain, headache, all kinds of stuff that our body can create as a way of telling us, I don't feel safe, we need to slow down or be cautious. And those examples of acute pain when there is no injury, can become chronic as well. That's not to say all chronic pain is coming from some type of perceived threat alone. Like, it's all in your head. That's not what we mean to say at all. But there is this very real sense that the brain is creating pain based on its predictions and based on its previous experiences. And we'll talk a little bit about how those are integrated together. But one other note I wanted to make here just at the very beginning, is if you actually look at the research on what's called asymptomatic orthopedic injuries, which means someone goes in for an MRI or an X ray not having any pain, no dysfunction, no movement problems, but they're participating in a study, they go and take an mri. On the mri, we can see potential damage to their joints or connective tissues that is severe enough that if they were experiencing pain, it would be surgically operable. Like, it would be recommended to have surgery to repair that damage that's inside their body. But in these cases, in these research studies, these people are experiencing zero pain on a daily basis. They don't even know that they have the injury. This is kind of the flip of what we were just saying, right, that pain doesn't come from injury. But it's important that we understand this because we want to differentiate and dissociate the ideas of injury and pain. So in these research studies, they're seeing very real injuries that are resulting in zero pain for the individuals that are experiencing them ever. On the flip side of the coin, the opposite is also true. We can have pain, such as the examples before, when there is zero physical injury present in the body. So we want to spread those ideas far apart. Pain and injury are not the same thing. They don't have to be connected in the human body and in the nervous system. And the sooner we can grasp that, then we can dive into a little bit deeper conversation about, well, then why is the brain generating pain? And that's where we'll get into, you know, the interpretation, the processing, the prediction, the previous experiences and what makes it chronic rather than just acute, only coming up in a stressful situation. What makes it continue on an ongoing basis day after day, month after month, that we're not able to kind of get to it with our normal, you know, medical procedures.
- [08:34]
Jennifer Wallace
You know, I really enjoyed going down the rabbit hole of Laura Moore Mosley because he has a really great TED talk on pain that we will link to this, because he really says that pain is an illusion, like 100% of the time that happens really quickly and it's outside of your awareness. And like Matt said, that's not to say that your experience of pain is not real. It is real, and it's also an illusion because your being this incredible predictive machine, it's always going to choose the path that's most biologically advantageous for our survival. And so I really love this example that he gives. We're going to call this the snake stick example. So you're walking through a forest, you're in the green belt, you're taking a walk, and you are. You feel a brush against your leg, and your brain starts to put into context what's really happening here. Have I been here before? What's happening? It sends a signal really quickly from your skin and nociceptors, travels all the way up to the brain. And then your brain starts to ask all these questions. Where am I? Have I been here before? Am I in a safe environment? Has anything ever happened to me here before? And then through all of this deduction, you realize you've just hit a stick because you're just on your walk. But the one time that you're walking in the path that you always walk through and you get bit by the snake, that is gonna send a completely different interpretation to your brain. That's really gonna be the memory that lasts. So once you understand or once your brain understands and has received a danger message in the brain and like, then your brain has to think, what does this mean? And what do I do here? And so pain is the end result, designed to protect you. And like we're talking about, this is not about your tissues. So from a clinical perspective, your brain is looking for this predictability, and it's looking for any piece of credible evidence that you are in danger. And then it changes the pain on the spectrum of pain. And so what's interesting here is that, so the next time you're on this walk in your normal path and you cross a stick, instead of your brain going, oh, yeah, that's just a stic, it has the memory of the snake bite, which could have potentially killed you. So now the stick, stick is inherently threatening and sends the pain threat way up, like you just got bit by a snake. And then maybe that lessens your world a little bit, where you don't go out and you do your hikes, where you do your walking anymore, because that equals pain. And so maybe one of you wants to get into what nociceptors are.
- [11:16]
Matt Bush
Yep, I would love to follow up on that. So we've mentioned Lorimer Mosley now a few times. He's a great presenter. A lot of his work is on YouTube. And so for his version, the Snake and the Stick story actually comes from him. It's one of his personal experiences, walking through the jungle, essentially of Australia, and bumping up against what he thought was a stick, when it was actually a snake. Didn't feel any pain until it was almost too late and he got faint and had to sit down. And then the next time brushes up against a stick, brain absolutely freaks out, thinks that it's a snake, only to find nothing's really happening. So how Jen just described the way that our brain can confuse the feelings and the predictions is often based on previous experiences. And a lot of that comes from this type of nerve receptor that we call a nociceptor. So, no, see is the same root as the word noxious. It's something that's dangerous to the body or perceived as dangerous. And the scepter part just means that it's a nerve ending, a receptor. Okay? So it's bringing in sensory information. So nociceptors or nociceptive signals are constantly being sent into the nervous system from all parts of the body. They never really turn off, which is quite interesting because we have to remember that all nerves are always active. In the human body, nerves never shut down. They don't get turned off like a light switch, because if they were to turn off, they actually begin to die. So nerves have to stay active. Just like in your home. The electrical wires always have electricity running through them. It's just a matter of whether they can reach their end target of a light bulb, a television, a microwave, or if that circuit has been cut. But they're always activated. Right? You would never want to touch a hot wire in your home. So in the body, nociceptors are always active as well. But what makes a huge difference as to whether the nervous system really perceives them as a current threat, or whether they're just maybe like a low grade buzz going on in the background is the intensity of their activation or what's called their amplitude. How much nociceptive signaling is coming in at any one time really is what the brain is basing some of this predictive response on. So Mosley actually published an article way back in 2007 called reconceptualizing pain. According to modern pain science, this is way back when, you know. But he created this diagram in this graphic that I want to talk us through really briefly because it encapsulates this whole idea of input, interpretation, output, but it uses different terminology that really builds us a good illustration and a good context to have the rest of our conversation. So the graphic begins with a picture of a brain sitting at the top of the page. And the brain is asking, how dangerous is this really? Okay. And you have these arrows that are pointing into the brain. They're giving it the inputs. And the inputs are these. First of all, there's the sensory input coming from the body that would include proprioception, which is movement information, basic somatosensory inputs, which is feelings of temperature, touch, pressure. Right. Things that our body and our skin can feel, and also nociception, the current amount of nociception coming in, that's the sensory input that the brain is receiving. Plus, at the same time, it's also aware of and perceiving our previous experiences. So in earlier podcast episodes, one of the things we've talked about is that our brain is a predictive organ. It's not only looking at what has just happened or what is currently happening, but it's actually trying to make some of these judgments about whether I'm safe or unsafe. That based on its prediction. And the prediction that it accomplishes comes from a little equation. We say prediction is equal to the current sensory inputs plus our previous experiences. Right. Another way to say that is it's interpreting the current sensory input through the lens of previous experience. So when it feels that thing brush against your leg, it's like, is that a stick or is that a snake? Depends on my previous experiences, how I'm going to answer that question. Right? So the brain is taking that overall prediction of what it's feeling in regard of answering this question of how dangerous is it really? But it's also adding in five or six Other things. Okay, Number one is cultural factors. Like, what's the culture that you were raised in? What's the culture that you currently live in is that really shapes your beliefs about danger and your perceptions about your environment. And so all of that is to say cultural factors play a huge role in how your brain perceives danger. Like, what is danger is influenced by that. Okay. There's also your social and work environment. Like, what would happen socially or in my work if I were to be injured or if I were to be in pain? There's expectations about consequences. Like, if I'm in pain all the time, what does that mean? Am I going to have to go on regular doctor visits? Am I going to be able to do the things that I want to do? Am I going to have to pay a lot of money to take care of this chronic illness or chronic pain? And then there's also your beliefs. That's kind of your worldview, your mindset of, like, how are things going to work out? Your actual knowledge about how the body works and what pain is, what it means. And then also a balance of your logical brain versus your emotional brain. Which part of your brain becomes more loud and starts to run the show when you are in pain? So all of that stuff is taken together, like, put it all in a blender, mix it up, then your brain is presented with all of that combined information to try to answer the question, how dangerous is this really? Okay, so it's not just about the sensory inputs from the body. It's all of this stuff. Based on all of that combined, your brain creates some type of meaning, like a story of what does this mean? What's happening? That's going to generate its expectations, possibly some level of anxiety about what's going on. And as that all filters back into this brain, asking the question of how dangerous is it really? If the brain says really dangerous, unsafe, high threat, then it's automatically going to generate outputs to start to protect you. The number one output there being pain. Okay. But also changes to your emotions, levels of anxiety or depression, hormone changes, immune system changes, changes to your sympathetic nervous system. Basically all the stuff we talk about on this podcast, as far as outputs. Right. It's going to generate an output to protect you.
- [18:06]
Elizabeth Kristoff
Yeah.
- [18:07]
Matt Bush
If it perceives you're in danger. And if not, it's going to go, yep, keep doing what you want to do.
- [18:12]
Elizabeth Kristoff
It's so interesting, as you were talking and as Jen was giving this snake stick example, I was just thinking so much about. You can really see how trauma patterning starts to come into this. And when we're talking about all these different sensory inputs, it's not just somatosensory or maybe just something that we see visually, but also our movement patterns and giving that proprioceptive input, social cues, the environmental cues, all of those different contexts that you were talking about and how all of that can start to signal threat and pain could be just one protective output that comes from past experiences that are priming us to experience a lot of that threat. You know, it can be many other protective outputs as well. And I just also couldn't help but think about how many clients we work with that have pelvic pain, persistent pelvic pain, even though there's no injury, TMJ and jaw clenching in these patterns of bracing that are so associated with trauma. And the link, there's just so many links between our developmental trauma and those experiences and then the outputs that we experience of pain or just the protective outputs in general. And I know we'll dive a little bit more into its connection to CPTs and mental health, but I want to talk a little bit about neurotags as well and how we can use this concept of neurotags that we talk about on here quite a bit to really understand these pain outputs too.
- [19:42]
Jennifer Wallace
This is a really powerful reframe for the clients that we work with, because danger signals, they're a really high priority from the brain. And so understanding pain neurotags has really transformed the way that I work with clients, especially when I'm addressing chronic pain and beliefs that are tied to chronic pain. Because by recognizing pain as a neural output shaped by perception, clients can really start to detach from a fear based relationship with pain. And by educating clients about pain neuroscience, individuals can reduce pain related fear and reframe their understanding of pain, which has been shown to improve pain outcomes. Because when we're talking about the main contributors of pain and disability, we're really talking about the main contributors being anxiety, catastrophizing and nervous system sensitization, which also I think could be interchangeable with nervous system dysregulation. And through lowering the threat, the overall threat with clients and working through emotional expression, we have really been able to diminish quite a bit of the pain that the body is physically experiencing in really localized areas. Like Elizabeth just gave the example of jaw back, pelvic floor. And so, you know, just having these reframes about what we believe, this can be really powerful. And so based on the input that the brain makes and it has to make the decision for the output. And that output has a story around it. And so if that story equals a danger output and it's gonna need protection, then the output is going to be pain.
- [21:21]
Elizabeth Kristoff
So let's talk a little bit about neurotags, which is this huge component of pain science. But it's also something that we use in NSI to understand a lot of different neural patterning that happens in the brain and helps us to see that it's not so simple as like survival brain, limbic system, frontal lobe, that all these things are interacting together in these, well, myelinated pathways, responses of firing. And we look at emotional flashbacks as a neurotag, we look at how beliefs live in our body and our nervous system as a neurotag. So let's kind of lay that out for people a little bit as it relates to chronic pain. But then also it's this just this big foundational concept of understanding how to work with the nervous system in the brain to create change in emotional areas and in our beliefs as well.
- [22:08]
Matt Bush
So neurotag is a term that was coined by Lorma Moseley and David Butler, another great pain researcher out of Australia. They co wrote a book called Explain Pain years ago and they created a new version, just more recently called Explain Pain Supercharged. And this idea of a neurotag, it came from a series of words and understandings throughout the years. If we go back to the beginning, the idea was like a neurosignature. The terminology was utilized and it was the idea that a neurosignature is an interconnected network of different brain areas and parts of the nervous system that are working to generate the experience of pain or really the experience of any feeling or sensation that we have but pain in our case. And they use signature with the idea that your signature on a piece of paper is different than every other person's signature. So kind of like a neuro fingerprint would be unique that your neuro signature of these pathway activations or your neuro fingerprint would be unique to you. And a neuro tag carries forward with that same idea of uniqueness. But this idea of a tag is kind of like an imprint that can be activated over and over and over in exactly the same way. So a neurotag is a specific neuro network, these interconnected brain and nervous system areas that all fire together as a group to create a particular experience. So if you have a recurring pain in your low back, it's the same neurotag firing over and over and over again to generate that recurring pain, if you have a recurring migraine or recurring pain in your big toe, it's the same thing. Okay, so you could think of a neurotag as each body area that hurts or each type of pain that you experience. But neurotags aren't limited to only creating pain. Neurotags generate behaviors. They generate the actions that we take. They generate our feelings and emotions. Like, you could just as easily have a neurotag for anxiety, or you could have a neurotag for your fear of public speaking, or you could have a neurotag for procrastination. It could be virtually any output that the nervous system builds is based on a neurotag. So these tags are not directly tied to injury. Okay. Rather. Or instead, they're shaped by the sensory, emotional, and contextual input all happening at the same time. So the way we describe in a kind of normal language is to say every neuro tag, think of it as an active memory. It's a previous experience. This tag, or this network that has been built in the past is now being activated again. And it's being activated with three major components. There's always a physical, emotional, and cognitive component to every neurotag. So when you feel pain, yes, you feel the physical pain, but there's also an emotional feeling that goes with that and a series of cognitive thoughts that are layered on top. And you'll continue to experience or kind of loop through the cognitive thoughts and the emotions as you go through the physical pain at the same time. So you stimulate any one part of the neurotag. The whole thing comes back up to the surface to be experienced by the nervous system as a whole. And again, not triggered by injury, but triggered by the perception of threat and utilized as an output that's going to try to protect us from whatever the nervous system is perceiving as that danger.
- [25:40]
Elizabeth Kristoff
Yeah. And that's why when we talk about emotional flashbacks as being when there's enough triggers or threshold, when an activation threshold has been reached for that neurotag, we're cascade back into a whole different reality because there's that emotional, physical, and cognitive component of the neurotag that then starts to change the filters the way we see the world. And pain can also be linked to to that experience. The pain could be part of the emotional flashback as well as the thoughts and other behaviors or anxiety as well as the somatic emotional experience. And I feel like this kind of leads us into looking at the link between complex trauma and chronic pain, because people with an ace score of 4 or higher are significantly more likely to develop chronic pain. And we can think about how those experiences have primed the nervous system Experiences of threat to perceive pain signals, maybe with more sensitivity to be more hypervigilant, have that activation of that pain output more easily. I think also too, though, it could lead to desensitization of pain, Especially if you have chronic dissociation. And so we don't hear the protective signals coming from the body until they have to get louder to get our attention. So sometimes that pushes us through into a state where maybe there was subtle pain protective signals coming. And we don't hear that until the experience is really intense. Because ultimately our past experience, the developmental trauma, the chronic stress, is really changing the way that our brain and our nervous system process and respond to this stimulus from the environment, from social interactions, to the signals inside of ourselves. And so that can keep us stuck, for lack of a better word, Although we know we're never really stuck. We're always adapting and changing, but stuck in the moment until we have new tools In a state of hypervigilance. It can have our F responses being activated all the time, and it can really start to amplify the pain signals and lead to the chronic pain experience over time. And we know that a lot of the brain regions involved with the processing of pain, the amygdala, the insula, all of these areas are also linked to our experience of a traumatic event as well. They're also impacted. Our hippocampus are impacted by the experience of a traumatic event. And so that overlap can lead to a situation where unresolved trauma can be exacerbating, heightening that pain perception. And then the pain is creating more threat, more dysregulation, more then creating more pain. And it becomes that cycle, that loop that we talk about a lot in here of the output becomes the input, and then we get held in that pattern.
- [28:42]
Jennifer Wallace
Dissociation and pain actually have a really interesting relationship. And when I am working with clients and they relate to having that high pain threshold or like high pain tolerance, it's really one of my first clues that we need to look at dissociation. And we also need to look at the lack of interoceptive awareness. Interoception is the ability to perceive and interpret internal bodily signals. And we talk about interoception on here a lot. And interoception itself is also predictive in nature, but it's not using real time pattern recognition. It's using that past experience to predict what's going to happen now in this experience. And so this dissociation, it can really make it harder to recognize and address early signs of dysregulation. And this leads to more chronic stress and then which leads on typically to more chronic pain. And so people with complex trauma often experience dissociation. It dulls their sensitivity to bodily clues. And this reduced interoceptive awareness, it can lead people to push through pain, eventually resulting in other protective outputs like exhaustion or immune dysregulation, where we are eventually forced to rest, particularly if something through that immune dysregulation leads to a chronic illness.
- [30:02]
Matt Bush
If you're a practitioner, therapist, coach or trainer who's been listening to trauma rewired and you're interested in working more with the nervous system, I would highly recommend you check out the Neurosomatic Intelligence certification. It's now open for enrollment. And the NSI certification is a 12 week program that takes practitioners on a journey of learning about the nervous system, about how it integrates with somatics, and how you can use regulation tools, sensory inputs, as well as vision, vestibular interoception exercises, and belief and mindset tools to help your clients adapt and retrain through previous trauma, somatic healing and nervous system regulation. Check it out@neurosomaticintelligence.com we'd love to see you there. Yeah, so I agree, and I want to connect the dots here between complex trauma and chronic pain. We know from research and applying the ideas and concepts behind it that CPTSD is much more related to long term somatic symptoms like chronic pain or gastrointestinal issues, autoimmune disease, chronic fatigue, much more so than acute ptsd. And one of the reasons that is one of the most important reasons is in a chronic pain situation, what allows chronic pain to become chronic, okay, is that the amygdala, where our threat detection is happening, the insular cortex, the anterior cingulate cortex, the hippocampus, all of these areas which are also activated during traumatic stress and traumatic experiences, they're tuned into a state of hypersensitivity. And use the word tuned. You could also say they're conditioned into a state of hypersensitivity. Okay? They've been kind of tweaked in the way that they function so that they're always on high alert, heightened state of vigilance, looking for and finding, perceiving threats more easily because of the previous trauma that has happened. And so from a state of complex pts, that is an ongoing environment or ongoing relationship of trauma, it conditions and conditions and conditions those threat Detection areas to be more and more active. But the survival brain, this threat detection area of the brain doesn't differentiate threats from the environment, Threats from other relationships, from threats coming from inside my own body. So it's quite easy for the nervous system to develop a hypersensitivity to internal threats, from nociception, from interoception, from poor or uncertain predictions that might occur inside the body, and interpret those as threats that need to be responded to with pain. One of the ways I describe this for our students Is to say chronic pain occurs often when normal mechanoreceptive information, which is a type of proprioception that tells us how we're moving and where we are in space, when mechanoreceptive information Starts to be misinterpreted as if it were nociception. So the brain and central nervous system think all movement is threatening. And when it starts to reinterpret normal signals as nociceptive signals, that tells you, really two things. Number one, the nervous system had to be conditioned into that interpretation somehow. It doesn't just wake up one day and decide, from here forward, I'm going to interpret all movement as if it's a threat that doesn't really occur Unless there's some catalyst. And it's far more likely to occur With a complex PTS situation Than with an acute PTS event that has occurred. Second thing that it indicates is that that sensitization that has happened, it takes some time for it to develop. That was point number one. But number two, it also takes some time to unwind it. So there's actually a process that happens in the nervous system where the spinal cord and the brain not only becomes more functionally sensitive to feeling or perceiving threat signals, but there's a physical change that happens, too. It's called sprouting inside the spinal cord, where more nerve endings are grown in the spinal cord to pick up on nociceptive activity. And the fancy term for this is called central sensitization. But in order to get out of chronic pain, Sometimes we have to desensitize the nervous system, which means having a physical adaptation to remove those extra sprouts that have been created. And that's going to take some time of doing Nervous system regulation, Using retraining, sensory tools, Working through lowering the threat and the stress the nervous system currently perceives. So you're reconditioning the brain areas. You're also retraining and adapting the physical structures of the nervous system at the same time. So CPTs is far more likely to increase all of Those changes and it makes it a little trickier to reverse them all because it takes a lot of time and a lot of regulation along the way.
- [35:27]
Elizabeth Kristoff
As you are talking, I just also want to always make sure I'm coming back to this idea too, that it's crazy to think about how dynamic our body is and how it's adapting all of the time and to remind us all with cbts that these adaptations were there for our protection. Right. And that our system was adapted, adapting in the best way that it could to keep us safe, to keep us alive. And it is a process to re pattern. And there's something to be in touch with that. There's nothing wrong with me for this. It's the way that my system adapted given the experiences. And I am neuroplastic dynamic being. And we can start to create change with that too. And I also want to make sure that we touch a little bit on the emotional expression components of pain too. Because it's something that I see underneath a lot of chronic pain clients is this real difficulty processing and being with emotions. And there was another big influence on my work with emotional regulation, which was Dr. John Sarno's work, where he really looks at how repressed emotions, anger, anxiety can lead to the manifestation of chronic pain. And that especially individuals who have perfectionistic or high achieving tendencies often experience pain as this subconscious way to avoid difficult emotions. And that sometimes that is a protective output against the emotional experience. Right. It's a distraction to focus over here instead of feeling that emotional experience. And I also think about all the constriction and bracing and the energy that's used in the body when we aren't able to express and mobilize emotions. And as I was reading Sarna's work a long time ago, it was a big moment for me of connecting dots because I also saw other protective outputs as a distraction from experiencing emotions. And I started to see my patterns of binging as a way to shift focus and repress emotions and, and get out of that emotional experience. And it wasn't until I started working with my body to be able to feel the sensations without a lot of threat, that interoceptive awareness and accuracy, to be able to mobilize that, that I was able to really start to move out of those patterns. And I even find with clients a lot of times there's a certain amount we can do with nervous system regulation and neuro tools. But until there's also that ability to be with, express and immobilize the emotions, the pain keeps coming back up to the surface. And so there's this real place, I think, to integrate the neuro and the somatics in, you know, helping the nervous system to regulate re patterning some of this, these neurotags and firing networks, and also to rehabilitate the emotional processing experience as well, so that we don't have to keep going into that pathway of repression and we can have the skill to dynamically be able to feel and express emotions and then we aren't stuck in that loop from this other direction over here as well.
- [38:52]
Matt Bush
Yeah, well said. I mean, the whole idea behind Sarno's work, and I'm going to grossly oversimplify this, so forgive me, but just in case there's people who are not familiar, the idea is that suppressed or repressed emotions will create tension in the body. Tension will reduce blood flow, and reduced blood flow will eventually lead to dysfunctional movement patterns or stabilization patterns in the musculature and in the fascial tissues, which is going to lead to chronic pain. Not a big stretch. When you understand how all of these inputs and outputs work, it really makes a lot of sense for that reason. I think we've talked about this. But emotional regulation is really crucial to managing chronic pain because if you have unprocessed emotions, the nervous system can use pain as a way to protect you against the overwhelming feelings that are kind of stuck inside. Okay, and we already mentioned explain pain supercharged for Mosley and Butler, but they discussed there how, like your emotional states paired with your past experiences and even your personal beliefs can shape your experience of pain. And this is really interesting to me as a practitioner working with clients, because what I have to keep in mind, and what all practitioners should keep in mind, I believe, is that each individual's experience of pain is unique. There is no way for you to feel exactly what a client is feeling. If you don't work with clients and you're listening today, think about family members or friends who might be in pain. There's no way you can ever experience exactly what their pain feels like because it's not only based on the physicality of their body. It's not just physiology. It's also based on beliefs and previous experiences. And there's no way that we can share those with another person. I can't go back in time and live through the experience that you lived through. And because of that, I can't actually feel your pain. The reason I bring that up is for us to understand that the emotional states, the possibility of suppressed or repressed Emotions not regulating our own emotional state just adds more threat into the bucket. It just adds more layers of challenge. We'll use a nice word, more layers of challenge for the nervous system to have to process through and interpret everything else that's happening. So it can really exacerbate pain when fear, anxiety or negative beliefs are present or when we have those emotions that we haven't expressed.
- [41:35]
Jennifer Wallace
And I really want to go back to perfectionism as a trauma response for a moment because I witnessed this in a client that I have and I've witnessed it in, you know, people that I love who are in pain and just looking at their nervous systems and their outputs and you know, like we have repeated so many times, like these protective responses are not in our conscious awareness. And, and neither is perfectionism. And it is rooted in trauma as a survival strategy. It's developed to manage the feelings of inadequacy, fears of rejection, the need to control uncertain environments. And we talk about that a lot on here, on Trauma Rewired. And so for people who have experienced complex trauma, especially in their development and early relationships, they strive for that perfection because that becomes a way to secure love, approval, or getting safety by trying to meet other people's needs or expectations in this like flawless manner. But it also perpetuates emotional dysregulation, dissociation and self abandonment. And all of this just leads to emotional dysregulation, leading to the repression of the emotional body and that is increasing emotional activity or reactivity. Really, individuals that suppress their needs and emotions and focus instead on performance or achievement as a way to avoid potential criticism or rejection. This really overlaps with these high achievers and perfectionists, and those unprocessed emotions contribute to physical symptoms like pain. In essence, perfectionism acts as both a shield and a coping mechanism, diverting attention away from underlying emotional pain and creating patterns that may contribute to chronic stress and somatic issues. And I work with a client who really has a high perfectionistic drive and is often dissociated, is very emotionally reacted because they're not grounded and they don't express their needs and they really experience a lot of back pain and pain overall because like you said, all of that tension embracing in the body and what this does is it impacts everything. It really impacts their quality of life and keeps really not just in the physical pain loops, but in the loops of the emotional pain.
- [43:53]
Elizabeth Kristoff
Yeah, I think what Jen was just pointing to there is how all of this stuff compounds. Right? Our mental health is inextricably linked to our Physical health. And our physical health has impacts on our mental health. And so there's so many ways that all of this gets enmeshed. And again, we're back in these loops that we want to start to find our way out of because they impact one another so much.
- [44:20]
Matt Bush
Yeah. So there's a really big impact on behavior. And just want to kind of illuminate a couple of these just for coaches and therapists who are working with clients that as a practitioner you want to be aware of some of these things because they can be tied to the chronic pain experience. So avoidance or withdrawal is the first one. So of course, like we all know pain kind of leads to avoidance behaviors. You can interpret that a lot of ways though. So when I say we all know that, what I mean to say is that if I have chronic pain, I might start to limit physical activity, but I also might start to limit social interactions. I want to prevent discomfort overall. Right. So over time that can result in higher levels of isolation, reduced mobility, even deconditioning physically or mentally. That basically pain is slowing me down from doing my life. The second one is changes in emotional regulation. Pain will increase stress, frustration, irritability, can make it difficult to manage emotions effectively. And then I can adopt other poor coping strategies or maladaptive coping strategies like substance abuse, self medicating, over reliance, even on prescription meds in cases like that. Or I can speak other emotional regulating activities that may not be helpful. It can reduce cognitive function. Like when we're in pain. Our pain experience occupies a lot of our brain. It takes mental resources. There's a phrase that I learned years and years ago that says pain will eventually become the cognitive output of highest priority. Which means when pain gets bad enough, you can't think of anything else. So when we're in pain, we kind of get this brain fog, or pain fog maybe. Right. It reduces concentration, reduces our decision making capabilities, lowers our problem solving ability, and that can really impair our work, our productivity and things like that. It can disrupt our sleep for a fourth connection. Creates a really nasty cycle where poor sleep creates more pain. More pain doesn't allow us to sleep. Well, emotional dysregulation can come into play at that point and further alter our behavior. And then another one is hypervigilance, like chronic pain can heighten our nervous system's reactivity, kind of as we talked about before, making us more sensitive to perceived threats, including non painful stimulus. So there is a phrase used in the pain science world called non nociceptive pain. And that's kind of what we've been talking around today is that when my nervous system perceives a threat, that's actually not coming from nociception, but it's perceiving it as if it were nociception, that hypervigilance can turn into physical pain experiences quite easily. So those you want to be aware of them know that they're possible and that they're just layers upon layers that happen when we undergo this type of chronic pain adaptation.
- [47:18]
Elizabeth Kristoff
I think the cool thing to think about here is because these things are so intertwined, we can make a difference in some of these other areas by starting to rehabilitate our pain through sensory input, rehabilitation, through repatterning our movement, our visual system, our interoceptive system. Like if I start to work with the pain, this will also trickle out into these other areas of life where you're seeing these outputs. And it can be a really great way to create change in our emotional well being. Right. We know our pain is closely linked to our mental health. If we have a lot of chronic pain, we're much more likely to have depression and anxiety or feelings of helplessness. And that of course, diminishes our emotional resilience. But I can start to work physically at this pain level to start to create some change there rather than having to try to address these issues cognitively, like, rather than going after my anxiety or my depression from a cognitive lens. And it really impacts our relationships too, because if we are in pain, again, like Matt was saying, it leads us to withdraw from social activities. It can also put a real strain on our relationships because it limits our presence. Right. If we're always thinking about the pain and caught in that pain loop. And it can create a rift between ourselves and other people because they might not understand that experience, like Matt was talking about also. And so I can also start to make some shifts really in my ability to be present and show up in relationships differently when I start to work with this. And then of course, there's many other areas of life that our pain impacts that increases our stress load, like our work, our economic stability. You could even have loss of independence if you're experiencing a lot of chronic pain. So there's a lot of reasons to start to rehab this, that then again, they don't just affect our body physically, but our quality of life, our whole experience of the world.
- [49:17]
Matt Bush
Yeah, I just want to reaffirm that pain is an output that is coming from the nervous system trying to protect us. But I want to also give a quick caveat because it's always multifactorial. It's so tempting when you're in chronic pain. And I've been in chronic pain myself. I've worked with so many clients, it's so tempting to look for just the one thing. If I can just get the one thing that's going to take away the pain. Maybe it's this injection, maybe it's this treatment, maybe it's this therapy, maybe it's these emotions, whatever. Chronic pain is never a single factor problem. It's always multifactorial. And this last section that we talked about really illustrates that, how it influences all the other parts of our life. So if you're trying to work through chronic pain or work with other people who are, please be aware of the phrase, when all you have is a hammer, everything looks like a nail. Any practitioner who says, here's the one answer that you need, I would be cautious of because there's so many parts of the nervous system. From all the stuff Jen talked about, sensory inputs, interoception, vision balance, the emotional processing, the sleep, hygiene, everything that we've been talking about today is part of the rehab and the adaptation. It is possible to move out of chronic pain 100%. I believe that. But it's a multifactorial journey and it's one baby step at a time of regulating your nervous system and working with your tools and then finding some practitioners who can help as well. So hopefully today has created an empowering perspective shift for you as a listener. And I just want to thank you guys again for having me back.
- [51:00]
Elizabeth Kristoff
Thank you. So well said. It's very true.
- [51:03]
Jennifer Wallace
Yeah, amazing. Thanks y' all so much.
- [51:06]
Podcast Disclaimer Voice
This podcast is for informational and educational purposes only and should not be considered medical or psychological advice. We often discuss lived experiences through traumatic events and sensitive topics that deal with complex developmental and systemic trauma that may be unsettling for some listeners. This podcast is not intended to replace professional medical advice. If you are in the United States and you or someone you know is struggling with their mental health and is in immediate danger, please call 911. For specific services relating to mental health, please see the full disclaimer in the show.
- [51:41]
Matt Bush
Notes.