What keeps the pain cycle going?
When we experience nociplastic pain or other symptoms, our brain has started to turn on protection signals in a habitual way, even in response to situations or sensations that aren’t harmful.
Most of us humans, most of the time, will avoid doing something that activates intense discomfort. Our bodymind is also very clever, and responds to the way we think or talk about our body. Many of us who have experienced nociplastic symptoms have thoughts about the ways in which our bodies are fragile, damaged, or hurt. And many of us have unfortunately had these thoughts introduced or reinforced by healthcare professionals (however well-meaning they may be). The great news is we can change all this, harnessing the neuroplasticity of our brain.
As normal as avoidance is, when it comes to nociplastic symptoms, it can be a core part of the problem: fear and avoidance drive the symptoms, as we signal to our brain that our body is injured or fragile. And when our brain perceives our body as injured or fragile, it will create all kinds of protective responses. Every time we avoid what we perceive as a trigger we teach our brain to react even more intensely the next time we encounter this stimulus.
Anything that contributes to credible evidence of danger will contribute to your experience of pain, including fear and attention. When you experience persistent pain there are some behaviors which, while completely understandable, actually contribute to the pain cycle.
These pain creating behaviors include:
Hypervigilance: You may become very focused on your pain and are constantly aware of it. You might start thinking about it in regard to every action throughout your day and looking for potential threats. When you’re constantly in this state of high alert, you’re actually feeding back to your brain that there is danger, making you more likely to feel pain. If you’re someone who’s experienced significant life adversity, particularly in childhood, hypervigilance is probably something that preceded pain and primed your bodymind to experience it.
Pain catastrophizing: Worrying about your pain constantly and thinking about the worst case scenarios. This also reinforces the danger mode in your brain.
Avoidance: Hypervigilance and catastrophizing can lead to avoidance of any situation and behavior that you fear may trigger or worsen the pain, such as exercise, sitting in certain chairs, eating certain foods, etc. Unfortunately this can actually make your pain worse by feeding into the stress and pain cycle, activating a nocebo response (the opposite of the placebo response: when you believe something is harmful your brain and body respond to it by triggering stress and inflammation), and strengthening conditioned responses (e.g. the belief that exercise will make your symptoms worse actually makes your symptoms worse, not because of the action but because of the belief). Avoidance then escalates, and your life continues to get smaller, which in turn increases stress and pain.
Changing these behaviors can play a significant part in recovery. To recover, we need to start re-engaging in activities we’ve avoided, to help our bodymind unlearn the conditioned protective responses. For most people, graded exposure makes sense, at the same time as engaging in activities and practices to create a sense of calm and an experience of safety (this can include affirmations, visualizations, breathing practices, somatic exercises, mindfulness, lovingkindness and compassion, etc.). Some people notice an increase in ease very quickly, others may find it’s a longer process, with peaks and valleys. Outcome independence is crucial here: success is not determined by whether the difficult sensations subside in the moment, but by how you’re able to engage in experiences you’d previously avoided and shift how you relate to the sensations. In other words, practicing is success in and of itself. With time and practice, protection signals will subside.
The first step, before any considering any changes, is becoming aware of what we are avoiding, from a place of curious inquiry. There is no judgment here: avoiding what hurts is human. At the same time, we can’t change what we’re not aware of, so as you engage in the following exploration, you are deepening your awareness and growing in agency and freedom.
Take a moment to bring to mind things, places, situations or activities you associate with an increase in symptoms.
How are you trying to avoid triggering or increasing the sensations or events in your body that bring unease? (in other words, symptoms - whether this is pain, fatigue, brain fog, rash, etc.) This can include: activities or postures you avoid or limit as a consequence of your symptoms; activities or postures you engage in cautiously, tentatively, slowly, or bracing, as a consequence of your symptoms; or those in which you are constantly checking or monitoring the presence or intensity of symptoms; things others do for you as a consequence of your symptoms; additional situations or things you avoid or do to prevent symptoms; things you do to escape your symptoms once they appear or get more intense; other behaviors in response to your symptoms (e.g. initiating or avoiding conversations with loved ones, isolating, complaining, always talking about your symptoms with everyone, never talking about your symptoms with anyone); any other ways in which you try to avoid your symptoms or keep them at bay - sometimes this has gone on for so long that we forget the ways in which we’ve adapted or coped.
What thoughts or beliefs about your body are linked to an idea that you’re somehow fragile or unwell?
What thoughts or language reinforce a sense of fragility?
Now, see if you can craft a list of affirmations or images that offer a different perspective…
What statements or evidence would support an awareness that you are whole, strong, healthy, resilient?
What images or felt sense can you bring to mind that connect you to an experience of integrity, vitality, health, strength?
What thoughts or language can reinforce this sense of wholeness, wellbeing, and ease?
You can create a pinterest board, do some collaging, and/or visualize someone inspiring or a place in nature.
You can also practice with the guided practice “Moving into wholeness”. I’ve created a recording for this practice, created by Michelle Cassandra Johnson and available in her book Finding Refuge. You can find this practice, along with some others to support your journey, here. Read the next entry on how to break the pain cycle and (re)learn wellbeing and ease here.