Social Worker
Social Worker
Christie Uipi, LCSW (she/her) is a psychotherapist specializing in the treatment of chronic pain, anxiety, and depression. She is the Executive Director of The Better Mind Center. Christie pursued extensive clinical training at the Pain Psychology Center in Los Angeles, where she worked alongside Alan Gordon to develop Pain Reprocessing Therapy.
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February 9, 2023
Anyone suffering from chronic pain knows the weight of all you have to manage: appointments, hopes, expectations, and—perhaps most notably—fear.
Many chronic pain sufferers exhaust countless treatment paths that leave them not with the relief they were promised, but instead with those persistent fears: what to try next, how to get through the day, and whether their quality of life is suffering. But perhaps the greatest fear is that they’ll never get better.
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It turns out, all of this fear actually has a measurable impact on our pain levels. The pain-fear cycle can cause our brain to perpetuate pain even after an acute injury has healed. Here’s what to know about how to put an end to it.
The brain is involved in all of our pain experiences.
Acute pain, like the pain we feel after an injury, is our brain’s way of telling us that our body needs help. If you sprain your ankle, nerves in your ankle communicate to your brain, which then generates the feeling of pain as a result. In these situations, it’s entirely natural to be afraid of the feeling of pain. It’s fear that directs your focus to the area of your body that needs rest or medical attention.
If our brain keeps ringing that alarm far after the threat has passed, however, our pain can become chronic. Sometimes our brain’s threat system can even get triggered in the absence of any precipitating injury at all. Regardless of how it begins, the brain can get stuck in “alert” mode, causing ongoing pain and an ongoing fear reaction1.
This debilitating cycle can contribute to chronic symptoms of many kinds, including back pain, neck pain, stomach pain, pelvic pain, headaches, migraines, dizziness, fibromyalgia, repetitive strain injury, tendonitis, and more. Pain that begins or persists in the absence of structural damage to the body is called neuroplastic pain2.
Neuroplastic pain is a common and well-documented phenomenon. Studies like this one demonstrate that the parts of the brain that process pain change over time from circuits related to tissue damage to those related to emotions, and studies like one demonstrate that our pain experiences are strongly modulated by these neural mechanisms. Research indicates that upwards of 85% of all chronic pain is neuroplastic in nature3.
Let me be clear: Neuroplastic pain may concern the brain, but that does not make the pain experience any less real than the pain caused by acute injury.
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How to know if you’re stuck in a pain-fear cycle.
If you are wondering whether you are stuck in the pain-fear cycle, ask yourself the following questions:
- Has your pain persisted long after an injury “should have” healed?
- Has your pain worsened or spread over time?
- Does your pain come and go?
- Have traditional medical treatments failed to provide relief?
- Do you have pain in multiple areas of your body?
- Do you have a history of other chronic pain symptoms?
- Did your pain start during a time of stress?
- Do you feel like your medical care team no longer knows how to help?
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It’s important to consult with a physician to rule out a structural or pathological source of your symptoms. But if you are lacking a clear diagnosis and answered “Yes” to some of the questions above, you may be experiencing neuroplastic pain perpetuated by the pain-fear cycle.
While this cycle can be exhausting and isolating, the brain’s involvement in our pain experience is actually a good thing. It means there are tools that can help us reprocess pain and start to feel better.
How to interrupt the cycle and start to heal.
Our brains are remarkably adaptable. Try some of these tips to interrupt and reverse the cycle and start breaking free from pain:
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1.
Recognize the pain as a faulty alarm.
The first step to reducing neuroplastic pain is reducing your fear. This may sound simple, but our natural human reaction to pain is to be afraid of it—so it’s easier said than done! Start by affirming to yourself what the pain is, and what the pain is not. Neuroplastic pain is a faulty alarm. It is not indicative of danger or damage to my body. Take a deep breath, close your eyes, and gently notice the sensation of the pain. Affirm to yourself, “These sensations are safe, and my body is calm.”
2.
Make a plan to address your avoidance.
When we injure ourselves, it is appropriate to avoid certain activities that might aggravate the injury. Once our bodies heal, those activities would become safe to engage in once again. But if your pain has persisted even after your body has healed, you may continue to avoid the activities that you once swore off. Moreover, those activities may have increased or generalized over time.
You may end up relating to your body with fragility and hesitation, which can reinforce the “alert” mode that perpetuates chronic neuroplastic pain. It’s important to start slowly exposing yourself to the activities you once feared (so long as you have medical clearance, of course!). Take it easy and focus on all the small wins.
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3.
Begin using your body joyfully again.
Most chronic pain sufferers have done just about everything under the sun to feel better. It can start feeling like your recovery is a constant, tiring project, which only adds more stress to your plate. One of the best ways to reduce vigilance and increase confidence in your body is to play.
It’s hard to be fearful when you’re having fun. Start a gentle yoga practice, find a local water aerobics class, or put some music on and dance in your living room. If that feels inaccessible to you right now, close your eyes and simply imagine moving your body in a joyful way. Your brain will still reap the benefits!
For some people, taking these simple steps can interrupt the fear cycle and start providing relief, but others may want or need more one-on-one help. Pain Reprocessing Therapy has been proven4 to significantly reduce or eliminate neuroplastic pain symptoms and a trained therapist can help. Sometimes a little personalized guidance can greatly support your recovery process, so don’t hesitate to reach out to a center that can help.
The takeaway.
If you’re in the pain-fear cycle, your suffering is far from “in your head.” But embracing the brain’s impact on our pain experiences can offer hope for healing. With practice, you can learn to respond to your symptoms with a sense of calm and confidence, and start conquering your pain.