Episode 4: The Pain Experience - Part II

In this episode of Mind Your Body, Dr. Zev Nevo continues exploring the complex world of pain, diving into concepts like homeostasis, allostasis, and the role of the nervous system. Dr. Nevo explains different types of reflexes and how emotional states can manifest physically. Emphasizing the importance of learning the body's language, he discusses the impact of trauma on our nervous system and introduces the idea of interoception. The episode underscores the importance of accurately interpreting physical sensations and building emotional intelligence to manage pain and stress. Future episodes will delve into scanning our external environment and the role of co-regulation in relationships.

00:00 Introduction to Mind Your Body

01:09 Exploring Pain: Part Two

01:39 Understanding Homeostasis and Allostasis

02:41 The Body's Surveillance Systems

04:46 Reflexes and Their Complexities

06:57 The Mind-Body Connection

08:52 Emotional Intelligence and Pain Management

12:15 Trauma and Its Impact on the Nervous System

13:15 Dissociation and Chronic Pain

15:11 Conclusion and Next Steps

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LINKS:

• Body and Mind Pain Center
• Mind Body Rehabilitation
• Substack

Transcript

Episode 4 | The Pain Experience - Part II

Dr. Zev Nevo: Hello, and welcome back to another episode of Mind Your Body. Today we're continuing our deep dive into the fascinating and often complex world of pain. This is part two of our exploration. In our previous episode, we laid the groundwork by discussing how our minds and our bodies are constantly working 24/7, like an internal security system to ensure our safety and survival.

Think of it this way. Our primary mission, whether we're consciously aware of it or not, is to keep on living, to sustain life and to achieve this, our bodies are always striving to return to the mean. That sweet spot of balance we know as homeostasis a state of overall health and equilibrium.[00:02:00] 

Now our minds are also on a quest for balance. But it's a slightly different kind. It's called allostasis. While homeostasis is about maintaining a stable internal environment of function, allostasis is our ability to adapt and handle stress. Whether that stress is physical, emotional, mental, or even cognitive.

You can think of allostasis as our resilience in the face of adversity. Our capacity to navigate life's turbulence, those unexpected bumps in the road. To manage this constant balancing act, our brains have command centers, sophisticated surveillance systems that are always on duty scanning for potential threats.

This scanning happens around the clock even when we're asleep. You know [00:03:00] that jolt you feel when a loud sound suddenly wakes you? That's your surveillance system kicking in instantly, assessing danger. These surveillance systems operate across three main domains: What's happening inside our bodies, what's happening outside our bodies, in our external environment. And interestingly, what's happening between us - our interactions with others. That last domain, the space between us is what Dr. Stephen Porges through the Polyvagal Theory calls "co-regulation." It's a fascinating concept we'll explore later.

But let's start with the first domain. What's happening inside our bodies. We have a complex network of organs, our musculoskeletal system, and our nervous system, all working in concert, constantly sending and receiving sensory information. The central [00:04:00] nervous system, that's your brain and spinal cord, acts as the superhighway, the conduit for all these signals, transmitting responses to anything that might throw us off balance or simply to keep things running smoothly.

Think of your body as a finely tuned orchestra. Each organ is a musician playing its part, and the central nervous system is the conductor ensuring everyone is in sync. To keep this orchestra playing, we need adequate blood flow, chemical exchanges, and the release of neurotransmitters. It's amazing how these signals can travel to distant parts of the body and trigger responses either directly or in a domino-like sequence, what we call reflexes. Reflexes are like those instant automatic reactions your body has. Take the gastrocolic reflex, for example. You eat something and suddenly your digestive system is gearing up for action. Or remember when the [00:05:00] doctor taps your knee with that little hammer and your leg kicks out?

That's a somatic reflex, a localized response controlled by your nervous system. Now. Here's where it gets even more interesting. Sometimes the sensations we feel don't even originate in the area where we feel them.

A classic example is someone having a heart attack who feels pain in their left arm. This is what we call a viscero-somatic reflex, visceral, referring to the organ and somatic or soma referring to the body. Here's how it works: all those signals from your organs have to travel through the spinal cord on their way to the brain, and the same areas of the spinal cord that handle signals to and from your organs, also communicate with specific parts of your musculoskeletal system. So if an organ is injured or sending out a lot of signals, [00:06:00] there can be a crossover effect and you feel pain. In a seemingly unrelated part of your body. Imagine throwing a pebble into a calm lake.

You don't just see a ripple where the pebble lands, the ripples spread outwards, or think of an earthquake. The epicenter is where the quake is strongest, but the effects are felt far beyond. Viscero-somatic reflexes are similar. The disturbance in one area creates ripples in another. So to recap, we have different types of reflexes.

Somato-somato, one body region to another. Somato-visceral, body to organ, like a muscle spasm affecting your digestion. Viscero-visceral, one organ system to another, and Viscero-somatic, organ to body like that heart attack example. And why am I telling you all of this? Because it is crucial to understand that [00:07:00] our bodies also have physiological responses to our emotions, thoughts, and feelings.

There is an Emotional-somatic connection, a.k.a. "Mind-Body connection", and I'd argue it's present with nearly every emotion that we experience. 

Often we lack the language or awareness to fully grasp these connections. This is where emotional intelligence comes in. Developing this intelligence can significantly improve how we deal, not only with chronic pain, but also with understanding and interpreting the emotions that we feel. Think about it:

Have you ever been so embarrassed that you turn pale? Or have you seen someone's face blanch with fear? That's vasoconstriction. The blood vessels in the face constrict and blood flow decreases. On the flip side, when someone blushes from shame or embarrassment, or when we get red faced with anger, [00:08:00] that's vasodilation increased blood flow to the face.

We intuitively understand that these facial cues give us insights into someone's emotional state. Similarly, anxiety often manifests as a tightening in the chest, making it difficult to take a deep breath due to restrictions of our ribs and diaphragm expanding fully. Here's the crucial point.

We often experience these physical symptoms first, and then our brains try to make sense of them. That tightness in the chest might be interpreted as excitement or anxiety depending on the context and our overall sense of safety in that moment. Is our nervous system signaling safety or threat? So how do we become more attuned to our bodies?

It comes down to two key things. [00:09:00] First, we have to learn the language of our bodies. I often tell my patients to imagine a stranger sitting on their couch every day when they come home. You try to communicate, but they speak a different language. Or you simply ignore them. Either way, you're not going to understand why they're there, what they want, or what they need from you.

Ignoring your body's signals isn't a sustainable strategy, and simply speaking louder, trying to force or suppress sensations won't lead to understanding. The first step is to learn the language of those sensations to truly understand what your body is trying to communicate.

Once we start to understand the language, we might not always like what it's telling us, and we might not always be able to help it immediately, but at least we'll know why it's saying what it's [00:10:00] saying. So the initial step in interpreting a sensation isn't about coping, hiding, or distracting ourselves.

It's about accurate understanding. Understanding the nature of the sensation and whether our interpretation of it is positive, negative, or neutral. This accurate interpretation is fundamental to managing pain and discomfort. We need to decipher whether the signals are purely physical. Or if they're intertwined with emotions, thoughts, feelings, or even our overall state of mind.

Furthermore, it's crucial to recognize how physical sensations associated with pain can trigger emotional reactions, which then create further physical manifestations like tension and involuntary guarding, also known as muscle spasm. This creates a vicious cycle [00:11:00] that often perpetuates pain and discomfort. Developing that language of our body, building emotional intelligence directly enhances our ability to tolerate life's inevitable turbulence, whether it's physical sensations or emotional stress, good or bad. Our goal is to increase our endurance, our tolerance, our window of tolerance. We want to be able to experience those activated states of fight, flight, cry for help without being thrown into a state of overwhelm and depletion.

That state of depletion, that low energy state, is what Polyvagal Theory calls the "dorsal vagal" state. Think of a possum playing dead to a predator. It's a last ditch survival strategy. This state exists on a spectrum and people can get stuck in it [00:12:00] or have a very low threshold for entering it, leading to fatigue, depression, social isolation, and even impacting organ function, like an irritable bowel syndrome or a chronic fatigue syndrome.

Now, this ability to scan internally - this interoception - can be particularly challenging for people who have experienced trauma. Trauma can leave imprints on the nervous system, almost like memory foam sensitizing the limbic system, that part of our brain that processes emotions, mood and memory, and responds to threats.

It's like having a highly sensitive alarm system that goes off with the slightest trigger. We see this in conditions like fibromyalgia, where pain receptors themselves become more sensitive, firing more readily with less stimulation. This is not all in their heads. It has both [00:13:00] structural and neuroplastic components that reinforce each other.

So this first domain, our ability to scan inside of our bodies is profoundly affected by trauma. And one common response to trauma is dissociation. A spectrum of experiences where we disconnect from our bodies and our present moment. I want you to think of dissociation along a sliding scale. On the lower end, you have difficulty with focus, attention, and concentration.

Dr. Gabor Mate suggests that inattention as seen in ADHD can be a form of low grade dissociation, a retreat from discomfort. On the higher end of the spectrum, you have more extreme forms like Dissociative Identity Disorder, or out of body experiences.

Dissociation can also occur in the context of [00:14:00] chronic pain where we become so focused on anticipating pain, remembering past pain, and avoiding triggers that our interpretation of current sensations becomes distorted. It's like a smoke alarm that keeps blaring long after the smoke has cleared. And that's why, going back to our earlier analogy, it's important not to rip out the smoke alarm, but to make sure that it's working accurately. If it's giving false alarms, we need to retune and reset it, and that's precisely what we aim to do with neuroplasticity and reappraisal to help the brain learn that many sensations are actually safe. It's important to acknowledge that interoception practices like body scans or somatic tracking can be triggering for some, [00:15:00] especially those with trauma histories. That's why awareness of our nervous system survival responses is so crucial, and that's where we'll pick up next time. In our upcoming episodes, we'll delve deeper into those other two domains of our safety-threat radar system, how we scan our external environment and the critical role of co-regulation in our relationships.

We'll also explore in more detail those predictable survival states: Fight flight, cry for help and freeze, and how they influence our experience of pain and our ability to navigate stress. Understanding these dynamics is key to taking back control and building a more resilient and balanced life.

Thank you so much for joining me again on this journey of discovery. Until next time, this is Dr. Nevo. Take care and be mindful of your body's wisdom.  

Thank you.