Episode #69- The Pain-Fear-Pain Cycle

This episode is all about how fear of pain causes the brain to CREATE more pain- the Pain-Fear-Pain Cycle.

The way you recover from pain depends on how you respond to pain signals in your body.

Many people with chronic pain tend to "catastrophize", or attach greater meaning or significance to pain.  There are also physiologic changes in the brain, making chronic pain sufferers more hypersensitive to perceived threats. 

These things actually cause the brain to create more pain signals.  Real pain that is felt in the body.

How you react to pain makes a difference, so listen today and see how you can learn to rewire your brain!

 

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Unstoppable Body and Mind Podcast Transcripts- Episode #69- The Pain-Fear-Pain Cycle:

“This is Betsy Jensen, and you are listening to Unstoppable Body and Mind, episode number 69, The Pain, Fear, Pain Cycle. In this podcast, we learned to upgrade our brain and understand the power of our thoughts, to heal and to create the results we want in our life. Become the person in control of your healing and make peace with your life.

 

Become Unstoppable Body and Mind. Hello, my loves. Today, we are going to talk about how when you react to pain with fear, it actually ends up producing more pain.

 

Now, if you've just tried listening to this podcast and want to watch it, I am going to be including some pictures and a diagram. So you can watch this podcast with video on Instagram, Facebook, or YouTube. Look for me, Body and Mind Life Coach.

 

Okay, so we're going to talk about how fear produces pain. And I like to start with this story about a construction worker who stepped on a nail that went completely through his boot. This is where I'll be showing you a picture.

 

The nail completely impaled through his boot, and he was in severe pain. He was rushed to the hospital, they gave him morphine, and then they cut off the boot and saw that the nail had completely missed his tissue. It had gone through that space in the toes and had actually not gone through his foot at all.

 

But the pain that his brain created was real pain. His brain, just like all of ours, did his best to interpret the signals from the environment, and his brain perceived that as dangerous. So pain is in essence an alarm signal, a danger signal.

 

Any kind of alarm or danger signal perceived in this area of the brain can cause the brain to create pain, real pain, that is felt in the body. Now, in his case, the danger signal was that there was potential injury, that there was a nail through his boot and supposedly his foot. So to stop what he's doing, to remedy the situation, to take care of it, to rest.

 

But we do know that these alarm signals, these danger signals, can be created from a number of different reasons, including emotions and what we're talking about today, fear. So fear can actually be a danger signal that causes the brain to produce more pain. So just thinking of how your body reacts when you're in fear, you might think of like tightening, you know, kind of hunching over with drawing.

 

That made sense to me as a physical therapist that the chronic tightness of your muscles is actually going to lead to more pain. I would see this with people who had been in a car accident, for example, and their neck was moved quickly and forcefully, and the muscles around tried to protect by tightening up. Unfortunately, the tightening would cause pain, and then the patient that I would see would be in more pain, which would cause the muscles to tighten up, kind of this vicious cycle.

 

There is research showing that people that have more fear about pain also report higher perceptions of pain. So your brain becomes hypersensitized when you have chronic pain. It's almost like the brain is always on the lookout for pain- what might happen, and more and more of your brain becomes focused on pain.

 

The prevention of pain, the avoidance of pain, the fear of pain, and pain starts to consume people's lives. So the brain activity of people who have chronic pain is more active when there is some kind of stimulus. And that could even be a sound that you don't like, like nails on a chalkboard.

 

People with chronic pain, their brain is more active when they hear something that's unpleasant. It's like their brain is always on guard and hypervigilant for anything that could be perceived as a danger. The perception of pain can be higher with fear.

 

There was a study where people were given a mild electric shock, and when fearful words or words that were pain-related were said before the shock was given, people did respond with higher perception of pain than they did if the words were just neutral words or even negative words that were not pain-related. And then there has also been a lot of research done showing that the brain actually produces more pain in response to the emotion of fear. One measure of fear that they talk a lot about in pain research is called catastrophizing.

 

So catastrophizing is something that happens quite normally with people when they've been enduring pain for some time. They tend to magnify or exaggerate the perceived threat or seriousness of pain. There's a lot of pain-related warrior fear and difficulty diverting your attention from the pain.

 

In research, they'll sometimes group people who are high catastrophizing or they tend to have more of these catastrophizing qualities versus low catastrophizing people. And what they've found is that people who rank higher with catastrophizing also have increased risk of future back pain. People who catastrophized more before surgery were more likely to have post-operative pain and a longer recovery time.

 

People who catastrophize have a higher risk of their acute pain turning into chronic pain. After whiplash in one study, catastrophizing and fear of movement were significant predictors of both disability and depression. And catastrophizing has been shown to increase people's risks of new acute pain.

 

Now I'm going to read to you what some of these statements might sound like so you can identify how much you might be catastrophizing. This is from a measurement tool called the Pain Catastrophizing Scale. 

 

And you would rate your response from zero being not at all to four being all of the time.

 

So think about these statements as I read them. Are these things that run through your head? I worry all the time about whether the pain will end.

 

I feel like I can't go on. It's terrible, and I think it's never going to get any better. It's awful, and I feel that it overwhelms me.

 

I feel I can't stand it anymore. I'm afraid the pain will get worse. I keep thinking of other painful events.

 

I anxiously want the pain to go away. I can't seem to keep it out of my mind. I keep thinking about how much it hurts.

 

I keep thinking about how badly I want the pain to stop. There's nothing I can do to reduce the intensity of the pain. I wonder whether something serious may happen.

 

So you can see there are elements of worry about the future, fear, hopelessness, and all of these sentiments and thoughts are predictors that you will have more and more pain. People are more likely to catastrophize their pain if they've seen a parent or a loved one that suffered with chronic pain or illness or health conditions. And we're going to talk a lot next episode about how mindfulness actually helps decrease pain catastrophizing.

 

Remember the number one way to rewire your brain to produce less pain is when you have the pain signal to react with neutrality, with calm, and actually with a feeling of safety in your body, a visceral somatic feeling that you are safe. 

 

And this sends the message back to your brain that it does not need to worry about this and continue to produce pain. 

 

Now, if you've heard me talk about the thought model we use in coaching, we know that the feelings of fear that we have are coming from our thoughts and beliefs.  The fear is not coming from the pain signal in the body itself. We know this because people react very differently to pain signals that they receive. When you have a pain signal, that would be like the circumstance.

 

A circumstance is just something that happens in reality. So there's a pain signal. And then what's causing the fear is not the pain signal itself, it's the way of thinking about the pain signal, the way you're interpreting it.

 

So maybe you have a belief that there is some damage, and maybe you've been told that there is damage, and you have a diagnosis. And so when you feel that pain signal, you might even imagine the degeneration or the nerve or the area that they've told you was torn, and you might be thinking of that and creating more meaning behind that pain signal. And we know from neuroscience, the way we react to pain determines if the pain signal will be amplified or minimized.

 

There's one chart I want to share with you. If you're listening on the podcast, I'll try to include it in the show notes, at least on my website. I'll email it out if you're on my email list, and I did post it in my social media today.

 

I'm going to describe it as best I can if you're just listening, but look for that figure if it doesn't make sense. Basically, when you have a stimulus of pain, there's a pain experience. And then the chart splits.

 

It could go one of two ways. If you go to the side where there's a fear of pain, it could lead to avoidance of activity. That leads to disuse, disability, depression, and loops back around to the pain experience again in this cycle where the pain and fear of pain increase the pain experience itself.

 

On the other hand, when you have the pain experience and you do not react with fear, then there is confrontation and recovery. Confrontation is the period of time where your brain is learning that this pain is not dangerous, maybe the movements that you're thinking are dangerous are not as bad as you think. It's basically showing your brain that it's okay, which teaches it not to continue, to look for the pain, and not to continue to create the pain.

 

When the pain is experienced and goes down the route of no fear, then that is what leads to recovery. Now, I want to bring this up to you because it is very important to understand how much your fear is relating to the pain that you are feeling. Now, if you are in a lot of current pain, this may seem difficult to just not have fear.

 

And there are some specific strategies I talk a lot about on my podcast. And if you're struggling with your belief that this is a structural issue that's causing pain, then you should get on a free 60-minute call with me, and we can go through your specific case and really evaluate in your situation if this is work that will help you. All right, my loves, have a great week.

 

Bye. Thank you so much for listening. I hope you learned a little bit about your brain today that helps you in your life like it helped me.

 

Please be sure and subscribe and leave a review. And of course, be sure and share this podcast with someone you know that wants an unstoppable body and mind."