Musings on language and frameworks for making sense of our experience and healing...

The language we currently have in Western healthcare is wildly limited in describing our human experience. And this is recursively linked to our wildly limited understanding of how we heal, which in my book is actually great news, as long as we can stay humble, curious and irreverent about what we think we know to be true. Why great news? Because so many possibilities are yet to be explored!

I’m currently geeking out on the sciences of complexity (more resources coming soon), and finding NOI group Tim Cocks’s exploration on the topic of pain really thought provoking through the emerging framework of Explore Pain. Among the topics I’m learning more about: embodied predictive processing, with special attention on the interplay and interconnectedness of the nervous, endocrine and immune systems and a look at the complex, adaptive system that is the ensemble of them; neuroimmune and neuroendocrine interactions in pain; the very nature of subjective experience itself; the nature of homeostasis and allostasis; how and why emotions arise; new treatment approaches that go beyond the simplistic and the singular.

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In the current dominant Western health paradigm (and even in some of the more progressive mindbody medicine spaces), there is a pervasive separation of our experience into seemingly discrete entities (the biological, the psychological, the social). This separation happens in language and understanding because in our culture we like to divide the whole into parts to study it; though in actual experience it’s impossible to separate, because our being involves an intricate web of phenomena intersecting and interacting with each other, and we are complex systems. And so we’re constantly struggling to reconcile and integrate these seemingly separate spheres. The same artificial separation in our understanding has the effect of fragmenting our approaches to healing, thinking about the nature of health and illness with a fundamental dichotomy– as though “mental” and “bodily/physical” health or sickness were different entities, and the social might be partially included almost as an afterthought. Medical and health specialties are divided, and even the name “mindbody medicine” speaks to the need of intentionally making the connection evident. But from the perspective of other cultures or medical systems, these are facets or dimensions of the same set of processes, though there is still a lot of mystery around how sociocultural aspects, thoughts, relationships and behaviors shape our experience in health and illness, and how we come to embody sociocultural narratives of health and illness. Something else I’m geeking out on: the writings of Laurence Kirmayer.

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How do we name pain involving a neuroplastic component? How do we allude to the complexity of the experience of pain?

I’m grappling with the dilemma of using a name that will allow to make a distinction and identify pain with a strong neuroplastic / threat conditioning component amenable to full recovery, while at the same time not falling back on a dichotomy of mind vs. body. For now, for clinical diagnosis, I use nociplastic pain and primary pain.

• Nociplastic pain is the semantic term suggested by the international community of pain researchers to describe a third category of pain that is mechanistically distinct from nociceptive pain, which is caused by ongoing inflammation and damage of tissues, and neuropathic pain, which is caused by nerve damage. The mechanisms that underlie this type of pain are not entirely understood, but it is thought that they involve pain creation or augmentation by the central nervous system through pathways that involve predictive processing, threat conditioning, sensory processing and altered pain modulation play prominent roles. The symptoms observed in nociplastic pain include multifocal pain that is more widespread or intense, or both, than would be expected given the amount of identifiable tissue or nerve damage, as well as other CNS-derived symptoms, such as fatigue, sleep, memory, and mood problems. This type of pain can occur in isolation, as often occurs in conditions such as fibromyalgia or tension-type headache, or as part of a mixed-pain state in combination with ongoing nociceptive or neuropathic pain, as might occur in chronic low back pain. Because the term nociplastic alludes to underlying mechanisms and practices / treatments that can bring about neural repatterning, it is my preferred term.

• In the most recent World Health Organization International Classification of Diseases (ICD-11), chronic pain has been included and specific pain diagnoses provided. Under the new system, chronic pain is classified as either chronic primary pain or chronic secondary pain. Chronic primary pain is defined as pain that persists for longer than three months and is associated with significant emotional distress or functional disability and that cannot be explained by a clear underlying cause, or pain (or its impact) that is out of proportion to an observable injury or disease. This new definition applies to chronic pain syndromes that are best conceived as health conditions in their own right.  Examples of chronic primary pain conditions include fibromyalgia, complex regional pain syndrome, chronic migraine, irritable bowel syndrome and non-specific low-back pain. This diagnosis can be helpful for epidemiological purposes, and allows different descriptors. However, it doesn’t speak to the underlying mechanisms or point towards an effective treatment.

For some symptoms or diagnoses alluding to the function of certain organs or systems, I might also use “functional symptoms / syndrome” (e.g. functional neurological symptoms like non-epileptic seizures, or functional digestive symptoms such as irritable bowel syndrome).

For our work together, we will start from whatever language makes sense to you, while at the same time engaging in an exploration of whether this language elicits an experience of safety, validation, and possibilities for healing, and whether it enables expanding and deepening your understanding of the many threads at play in your lived experience. And if you feel like you’d like to explore new language that will evoke the felt sense and healing you want to cultivate and grow, we’ll do that.

You might have encountered the following terms: psychophysiologic pain, psychosomatic symptoms, mind-body syndrome, TMS (tension myositis syndrome or tension myoneural syndrome), FND (functional neurological disorder), central sensitization syndromes, and more. Let’s make sense of them together.

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Having shared the above reflections on terms or diagnoses that might be your starting point on this journey (or a stop along the way), in getting to the work of healing and naming our practices and approach, we know that we focus on grows. So as I think, write, speak and engage in collaborative explorations and conversations and practices for healing and liberation, I’m leaning away from terms like “pain” and moving towards terms that describe the embodied experience and emphasize the oneness and interconnectedness of our bodymind and our ability to adapt and heal through intentional practices including mindfulness and different forms of somatic awareness.

To describe what I do, I’m currently landing on bodymind (re)learning for wellbeing and ease, positive bioplasticity / embodied neuroplasticity.

Let’s try out new language together!

What other terms for our work together would you like to add to the list?