Episode 5: The Pain Experience - Part III

Exploring Pain: Understanding Our External Environment

In this episode of 'Mind Your Body,' host Dr. Zev Nevo delves into the complex relationship between our senses and pain perception. Building upon previous discussions on interoception and pain as more than mere sensation, Dr. Nevo explains how our sensory experiences and nervous system responses to our external environment influence our perception of safety and threat. Through vivid examples, such as a child's reaction to a thunderstorm, he illustrates how factors like sight, sound, smell, touch, and taste shape our emotional responses and pain mechanisms. He also highlights the role of the limbic system, the impact of early life experiences, and the concept of learned helplessness in chronic pain. The episode emphasizes the importance of reinterpreting sensory inputs with curiosity to mitigate chronic pain and enhance wellbeing. Dr. Nevo previews the next episode, which will explore safety in interpersonal interactions and co-regulation for healing.

00:00 Introduction to Mind Your Body

01:09 Exploring Pain: Internal and External Awareness

01:50 The Role of Senses in Perceiving Safety and Threat

03:34 Emotional and Sensory Memory in Pain Perception

08:51 Neural Pathways and Habit Formation

12:06 Conclusion and Next Episode Preview

About Dr. Nevo
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LINKS:

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

Transcript

Episode 5 | The Pain Experience - Part III

Hello and welcome back to Mind Your Body. Today we're continuing our exploration of pain. In previous episodes, we discussed how pain is more than just a simple sensation. It's a complex interplay of physical signals and how we interpret them. We explored pain's role in survival and introduced the concept of the nervous system as a constant radar system scanning for safety and threat.

Last time we focused on interoception, our internal awareness of our body sensations. Today, we're gonna focus on the second part of that radar, our external environment. This is how we use our senses: sight, smell, taste, touch, and hearing to assess whether our surroundings are safe or dangerous. It's how we make [00:02:00] decisions about whether to approach a situation or to retreat.

Think about a young child's reaction to their first thunderstorm. They may experience fear in response to the loud thunder and flashing lightning. This is also seen in pets. They don't always understand the safety of their environment and react to the unfamiliar. Anything that's perceived as different can trigger our nervous system's alarm bells. There's a balance between curiosity and fear. Curiosity encourages us to explore, while fear makes us want to avoid potential threats. When we perceive a situation as a threat, our focus narrows to survival mode and curiosity diminishes. Understanding how our nervous system functions can help us gain more control over our reactions.

Our nervous system is constantly adapting throughout our lives, shaped by our experiences, [00:03:00] both conscious and subconscious. It's important to note that even before birth, factors like intergenerational trauma and fetal stress can influence the development of the nervous system. Experiences such as neglect, even without physical abuse, can also have a significant impact, potentially contributing to attachment disorders and personality traits like self-criticism, perfectionism, people pleasing, and conscientiousness, which are often.

Observed in individuals with chronic pain and related conditions. So what's the connection between danger and pain? Well, pain is fundamentally a response to a perceived threat to our wellbeing. In chronic pain, this process occurs in the limbic system, the area of the brain involved in mood, memory, and emotion.

The limbic system is often the initial responder to environmental changes that suggest danger to us. [00:04:00] In this second domain, our five senses constantly gather information through light, through sounds, through smells, through sensations that are tactile and through tastes, which our brains then categorize as neutral, positive, or negative.

Consider the color gray, often perceived as neutral and less likely to attract attention. In contrast, colors are used strategically to influence emotions, a principle applied in design across various contexts from logos to retail environments. Smells also have a strong connection to our emotions. Hotels and casinos use sense to create specific atmosphere and restaurants may vent food smells outdoors to attract customers. People utilize perfumes to elicit scent memories. Sounds significantly impact our emotional state. Different music genres evoke [00:05:00] different feelings and certain sound frequencies can trigger a sense of danger. High frequency sounds like sirens and screams can be alarming.

While low frequency sounds like thunder or growls can also signal threat. However, conversational speech typically falls within a middle frequency range, which studies show is associated with feelings of safety and connection. Vocal prosody, the melodic singsong quality of speech, also plays a role in how we perceive safety and connection.

A monotone delivery may be less engaging than a more soothing conversational tone, similar to how a parent uses lullabies to soothe a dysregulated child. Dr. Stephen Porges' research on this has led to the development of the Safe and Sound Protocol, which utilizes specific sound frequencies 

to [00:06:00] stimulate the ventral branch of the vagus nerve and promote a sense of safety. Tactile, or touch, sensations can also be perceived as safe or unsafe. Individuals with sensory sensitivities such as those with Autism Spectrum Disorder may have specific preferences for textures as certain sensations can be over or under stimulating, which then can potentially lead to feelings of anxiety.

Inattention, seen in ADHD, can also be related to a mild form of dissociation in response to an environment that's perceived as unsafe. We constantly utilize our senses to assess our environment for safety. We might smell smoke and initially perceive a threat until we identify its source as cooking.

While we rely on our intuition, it's important to recognize that it can be [00:07:00] very much influenced by past experiences. If a sensation has been consistently associated with either positive or negative experiences, this can create a habit or a bias in terms of how we interpret it. When we first encounter a sensation, we try to categorize it.

For example, we identify a color as "blue" based on our previous learning. However, our personal preference for blue is a separate judgment. The color itself is neutral. Similarly, an object like a worn out doll can hold sentimental value for one person, but appear totally insignificant to another.

The meaning that we assign to what we perceive is individualized and is shaped by our past memories and categorizations. We [00:08:00] develop preferences for various sensory inputs, including colors, foods, and sensations. This is relevant to pain because if we've repeatedly experienced pain in a specific area of our bodies, we may begin to interpret any sensation in that area almost automatically as negative.

The more emotion that we associate with a sensation, the more strongly it's encoded in our brain. The hippocampus tags the experience in the amygdala creating a stronger memory and a stronger propensity to recall that memory when it's presented again through a sensory cue. This explains why emotional events are often more vividly recalled. Our brains prioritize conserving energy. Walking with a limp, for instance, requires more energy than [00:09:00] walking without a limp, leading to fatigue.

Rehabilitation often aims to restore efficient movement patterns to reduce energy expenditure just with standing or ambulating. Similarly, constantly reevaluating every sensation is mentally taxing. The brain creates patterns, therefore, and neural circuits to automate responses. However, when these patterns then perpetuate pain or trigger threat responses for long periods of time long past when the initial threat or the structural cause of injury has healed, and is an exaggerated threat response in the current moment, we then need to intervene. Changing these habits requires conscious effort, metacognition, or thinking about our thoughts to override our initial [00:10:00] reactions. We can develop a sense of learned helplessness, but just as we find alternate routes in traffic, we can create new neural pathways to change our habits. Unused neural pathways are pruned. The brain discards them in order to conserve energy, similar to how we might forget information we crammed for a test shortly afterward. Therefore, when scanning our external environment, we must pay attention to our senses while also being aware of how past experiences might be influencing our perceptions of safety and threat in the present moment. But we must do that through a lens of curiosity and ease. Attending to our sensations with a lens of urgency, creates a persistent state of heightened alertness, which impedes our ability to invite [00:11:00] curiosity and ease, and often is exactly what perpetuates our negative interpretations of the sensations that we experience and that we feel.

So accurately interpreting our present moment sensations that we receive from our external environment through all of our senses involves influence of our consciousness to interpret sensations and give it meaning creating an overall lens or perception or perspective of positivity or negativity and aligning that somewhere along the spectrum of how positive it is or how negative it is.

 And we do that by relating that sensation to our past experiences and memories,

thereby creating a domino effect of reactions and responses and thoughts, and ultimately behaviors that correspond to the initial way [00:12:00] either positive or negative that we have utilized to interpret that sensation.

In the next episode, we'll discuss the third domain, the interpersonal domain. We'll explore how we assess safety in our interactions with others and how co-regulation contributes to healing, connection, and wellbeing. Thank you so much for joining me today and always, and I look forward to you joining me on the next episode.