Because every part of us is constantly being affected by inner and outer influences we are all in a constant state of flux. When we are in pain we often, consciously, or unconsciously work against this notion: The search for a path out of the pain can become a desperate search for a static state where everything is exactly right; where we imagine that we will be in control. But what if this is not the way to navigate? What if the one thing we need to master in our work with pain is instead the capacity for state change, as supposed to holding a fixed state? And what is the one pre-requisite for being able to do this?
The way we interpret the world around us, including whatever threats it might hold for us is highly individual. Standing on a precipice 600 meters above a fjord and looking down might be nauseating for one person, while another might feel the exhilarating expectancy before diving of the cliff with a paraglider. In the same way walking home from a movie a dark evening might be different if the film you just saw was a horror movie of frightening creatures creeping out of the shadows or a romantic movie. No matter the outer situation our mind has a knack for altering our perception and our physical reaction slightly based on our expectations. You might say that parts of our nervous system is, most of the time, responding not to the real world but to a subconscious interpretation of the real world. This interpretation is made by what is called our “neuroception”.
Neuroception is the term Dr Stephen Porges coined for the unconscious part of our nervous system which is constantly on the lookout, and whose main interest is to assess our degree of safety from both internal and external dangers. and when danger is “detected” whether real or imagined, signals are sent which initiate the stress reactions of the body which we know as fight, flight and freeze.
Most people will know what it feels like, physically, when our neuroception senses danger. To be in what we could call a “fear-brain”- state of mind is exhausting and narrows our experience of reality even further. The strange thing is that it is also possible ot become more or less acclimatized to this state of mind so much so that we tend to not be aware of it if it has become our default state of mind. This is one of the truly interesting parts of chronic pain science where there now is a growing amount of evidence as to how our subconscious perception of reality and our own degree of safety plays a vital part in every chronic pain condition. (For more info on this perspective of pain I highly recommend the resources at curable health.com)
The neuroception does not only base its evaluation of our safety on external signals around us, it also monitors our inner state, including the level of tension in our muscles or the rate of our heart beat. In some instances, especially in cases of severe trauma or abuse, the mind can also get hard wired into interpreting a rise in hart rate with a high degree of personal threat. This again can lead to stress reactions to any situation that involves a rise in heart rate, including completely safe situations like running to catch the bus or even playful activities in kindergarten or school.
And when we experience long term pain our neuroception tends to bombard us with signals that we are in fact in danger.
Stressors and sensitivity
When giving a talk about Pain at the Timani sertification at the Musician´s Health and Movement Institute the other weekend the topic of “Stressors” came up. Stressors, as in the things or situations in our lives which, depending on their number, can increase our sensitivity to pain.
Pain is a complex neurological phenomenon consisting of several systems in the body giving, receiving and interpreting information. These systems are all highly adaptable and the plasticity of these systems, their ability to change, can be both a blessing and a curse. (For the curious mind: Here is a nice article, only in Norwegian, sorry, about the different pain systems (article: smertens nevrobiologi))
The basic role of pain is to alert us to things which are potentially harmfull and to make sure we choose the most expedient way of action to avoid injury. But interpretation plays a big part in this process, like we mentioned above regarding our neurception. A big part of that interpretation is based and built upon previous experiences, experiences which might have made us more or less sensitive to certain types of physical or psychological stressors.
A stressor might be any social factor, lifestyle factor or health factor which is adding a strain in our life and, in the long run, increasing your sentivity. Stressors are always individual and very often situation-based, meaning that we can tolerate something in one context but not in another. Our subjective experience of pain is directly linked to our degree of sensitivity to these stressors and our ability to tolerate them.
The Cup of Tolerance
In his free downloadable “recovery strategies – your pain guidebook” Greg Lehman, physiotherapist, chiropractor and strength and conditioning specialist, adresses the psychosocial risk factors in pain and injury management from a neuroscientific perspective.
He introduces the “Cup of Tolerance” as a metaphore for when the stressors in our life exceeds our ability to carry them. Working with stressors involves becoming aware of them, and removing them or increasing our tolerance for them, or in Lehmans terms “building a bigger cup”. A first step is, however, becoming aware of our stressors.
But what if becoming aware of our stressors results in a feeling of despair and helplessness? Like one of the participants in this weekend certification shared “I became aware that most of my stressors are factors in my life over which I have no control”.
Fear = either – or
This is a great chance to address something important to remember when it comes to stress and pain:
When we experience pain from a state of unsafety our mind is very often caught in the fear-brain mode mentioned earlier, and here´s an interesting thing about this mode:
Fear-brain tends to collapse every situation into binaries:
“My only option is to stay or go, to confront or avoid, to put down my foot or let everything slide, to react in an xx-way or to shut down”.
In other words: when our brain is caught in fear and unsafety-mode it tends to be blind to the myriad of available possibilities that every situation actually holds and limits our choices to two or three which usually both tends to be extremes.
It also holds the notion that in an imagined future situation where we are addressing our stressors in some way “I” will be the only person who are changing and that the other people involved in the situation will be unaffected or only affected in a negative way by my altered reactions or actions.
Our fear-brain is blind to the fact that every change, no matter how small, has butterfly effects.
Therefor the pre-requisite for being neurologically able to address anything which might add to our present pain-situation is always to find a gentle way to navigate into a sense of safety.
What makes you feel safe? Here is a list with some of my favorite strategies. Make your own and use it as a way to support yourself when you want to work with addressing stressors from a state of flexibility and safety.
- A warm water bottle on my stomach
- Lots of physical safe contact from people I trust
- Close contact with the ground
- Hugging tall trees
- Lying face down on gras
- Touching different textures (rugs, cloth, floorboards, rocks, earth, grass, water, sand)
- Soft humming
- A burning candle
- A special selection of breathing exercises
- A special selection of mental exercises
- The presence of other self-regulating people
- Slow conscious movement