What primes or sensitizes our bodymind to persistent pain?

Our bodymind, including our brain and central nervous system, is sensitized to pain when our danger system is on, or when we are exposed to a stimulus that has previously become part of our threat conditioning responses. This can happen as a result of a diversity of circumstances, such as a history of childhood adversity and trauma, adult stress, conditioned responses, repressed emotions, and personality traits like perfectionism, people pleasing, and fearful thoughts. For some people, an event involving injury to an organ or tissue creates a neural pathway that can then reinforced by the sum of other circumstances that activate the danger system.

A crucial distinction here: a lot of the information you’ll find around nociplastic pain and other symptoms highlights fear. But when we say “fear” we might be under the impression that we must necessarily be consciously afraid of something, and our threat response doesn’t quite work that way. Joseph Ledoux, a neuroscientist, suggests that we lean into language of threat conditioning to more accurately explain the process through which our nervous system activates protective responses. He quotes Jerome Kagan: “Neuroscientists use ‘fear’ to explain the empirical relation between two events: for example, rats freeze when they see a light previously associated with electric shock. Psychiatrists, psychologists, and most citizens, on the other hand, use... ‘fear’ to name a conscious experience of those who dislike driving over high bridges or encountering large spiders. These two uses suggest... several fear states, each with its own genetics, incentives, physiological patterns, and behavioral profiles.” and goes on to point to the fact that the mechanisms through which the brain detects and responds to threats are distinct from those that make possible the conscious feeling of fear that can occur when one is in danger. Threat conditioning is carried out by cells, synapses, and molecules in specific circuits of the nervous system involving the amygdala. On later exposure to the conditioned stimulus, it activates the association and leads to the expression of defensive responses that prepare the organism to cope with the danger signaled. There is no need for conscious feelings of fear to intervene.

A somewhat simplified example from my own experience: when I first injured my back, sitting down was excruciatingly painful. There was a threat conditioning response in my bodymind associating sitting down and chairs with pain. Years after my injury had healed, sitting down continued to elicit pain. Consciously, I knew sitting down was not dangerous, and I wouldn’t have said I was afraid of chairs. But my brain predicted that sitting down would cause pain, and every time I sat I indeed experienced pain.

Our brain is incredibly skilled at establishing associations. If the flickering light of a candle preceded a migraine, future exposures to flickering lights might again precede a migraine, and we’ll likely avoid flickering lights in the future. We quickly become convinced that this kind of light is bad or harmful and causes pain - consciously, we might not feel fear of flickering lights, but we’ve tagged them as “dangerous stimulus” or trigger. If going for a run preceded a period of intense fatigue and brain fog, our brain can make a link between exercise and “crashing” and label exercise as dangerous. To add another layer into the mix, there are lists of things that others (doctor, blog, community, relative) have advised to avoid, as they trigger the symptom / condition, activating a nocebo effect. And we may in fact find that future exposures to a stimulus we’ve learned to tag as “dangerous” will indeed trigger the event we feared.

The nocebo effect, traditionally defined as the onset of negative side effects in individuals who anticipate harm from biomedical treatment, or a worsening of symptoms due to negative expectation, describes a phenomenon of very real physical symptoms or manifestations stemming from a belief that exposure to something (whether substance, event or circumstance) harms. This means that when we have come to believe that something will hurt us, it might very well hurt us through pathways involving our thoughts and behaviors, our autonomic nervous system, our immune system and inflammation pathways, our hormones and other organs and systems. The good news is that these pathways and symptoms are dynamic states, amenable to change when we start shifting our beliefs and relating differently to our experience.

We can better understand how persistent pain happens by learning about neuroplasticity.

If you want to keep learning about this topic, and learn about what we can do to unlearn persistent pain, check out the entry on neuroplasticity or read the full text on bodymind (re)learning for wellbeing and ease.