Episode 6: The Pain Experience - Part IV

Exploring Polyvagal Theory: The Power of Co-Regulation in Pain Management

In this episode of Mind Your Body, Dr. Zev Nevo delves into how our nervous system continuously scans for safety or threats, and how this impacts our experience of pain. He introduces the concept of co-regulation, the dynamic process where individuals help each other manage emotional and physiological states, and discusses its profound implications for those suffering from chronic pain. Utilizing Dr. Stephen Porges' Polyvagal Theory, Dr. Nevo explains the three circuits of the autonomic nervous system—ventral vagal, sympathetic, and dorsal vagal—and how these influence our stress responses and pain perception. He emphasizes the importance of relational safety and supportive connections in managing pain, advocating for an integrated approach in healthcare that fosters empathy, connection, and validation. Tune in to gain practical insights into how social and emotional contexts are fundamentally intertwined with physical health and learn how to nurture your mind and body for optimal wellbeing.

00:00 Introduction to Mind Your Body

01:09 Understanding Pain and the Nervous System

02:29 Exploring Co-Regulation and Relationships

04:26 The Polyvagal Theory Explained

07:45 Neuroception and Chronic Pain

16:14 Practical Implications for Managing Pain

19:44 Conclusion and Final Thoughts

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LINKS:

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

Transcript

Episode 6 | The Pain Experience - Part IV

Hello and a warm welcome back to Mind Your Body. I'm Dr. Zev Nevo, your guide on this exploration of pain. In our ongoing series, we're undertaking a really important journey. We're unpacking how our incredible nervous system acts like a hypervigilant radar, constantly scanning 24-7 for anything that signals safety or threat.

We've taken a close look at how pain isn't just a simple, "ouch" message from a hurt body part. It's a far more nuanced experience that's shaped by our brains and our interpretation of those signals. We've already delved into two key areas of the safety-threat detection system. First, we explored interoception.

That's our inner [00:02:00] sense, our body's internal awareness of what's happening inside. Think of it as your body's way of talking to your brain about hunger, heart rate, muscle tension, all those internal sensations that we feel. Next, we ventured into the world of our external environment, examining how we use our five senses: sight sounds, smell, taste, and touch, to gauge whether our surroundings are safe or dangerous. But, today we're going to explore what I find to be the most compelling and often the most overlooked piece of this puzzle. That is the intricate ways that we sense safety and threat between us in our relationships with other people. This is where the concept of co-regulation comes into play, and it has profound implications for how we experience pain, especially for those living with chronic pain.

[00:03:00] So let's break down co-regulation. In essence, it's the dynamic process where we help each other manage our emotional and even our physiological states through the simple act of connecting. Think about it in everyday terms. Remember that time you were incredibly stressed about a work deadline or a personal issue?

What happened when you finally sat down and talked it out with a trusted friend or a family member? Didn't you feel a wave of relief? Didn't your shoulders unclench a little? Maybe your heart rate slowed down. That, my friends, is co-regulation at work. It's the power of human connection to soothe our nervous systems.

It's how we borrow each other's calm when we're feeling overwhelmed. And this process isn't just nice to have, it's absolutely crucial for our wellbeing, and it's deeply tied to how we experience pain. [00:04:00] Because as we've emphasized, chronic pain is rarely just about the physical damage in the body alone.

It's intricately woven into the fabric of our nervous system activity, our emotional landscape, and our overall sense of safety. Our relationships have the power to either amplify or dampen those pain signals depending on whether they make us feel safe or threatened. To truly grasp this, we need to delve into The Polyvagal Theory, a groundbreaking framework developed by Dr. Stephen Porges. Now, I know it sounds a little bit technical, but I intend to make it clear and relatable. So Polyvagal Theory gives us a map for understanding how the autonomic nervous system or ANS, that's the part of our nervous system that operates largely automatically controlling things like our heart rate, breathing and digestion, how it responds to the cues of [00:05:00] safety and danger that it perceives in the world around us.

Instead of the old idea of just "fight or flight", Polyvagal Theory reveals that we actually have three main gears or circuits in our ANS, each with its own purpose. The first branch is the ventral vagal circuit, our connection gear, is the key to our social nature.

It's all about the science of feeling safe, connected, and engaged with others. When this circuit is dominant, we feel calm, grounded, and able to navigate stress with resilience. We can make eye contact, have a relaxed conversation, and express our emotions freely. Think of it as the state where we feel most fully human and most comfortable in our own skin.

Number two, the sympathetic circuit, our action gear. This is our classic fight or flight response. The body's alarm system. When we [00:06:00] perceive danger: a looming deadline, a threatening person, a near-miss while driving, this circuit, kicks in our heart rate and blood pressure increase. Adrenaline floods our system and we're primed for action.

Whether that's confronting the threat or escaping from it. It's a powerful system, but it's meant for short-term emergencies, not chronic activation. The third branch is the dorsal vagal circuit, our shutdown gear. This is a more primitive survival strategy. When we face a threat that feels so overwhelming and inescapable, our system can go into shutdown or a state of depletion. Think of it like a possum playing dead. In humans, this can manifest as feeling numb, frozen, dissociated like we're floating outside our bodies or utterly exhausted. It's a last ditch effort to conserve energy [00:07:00] and minimize pain, but it comes at a tremendous cost to our vitality and connection to the world.

Now, here's a crucial point. These three circuits aren't equal players. They're organized in a hierarchy or a ladder, a sort of evolutionary ladder. We start with the ventral vagal connection gear as our default state. If that feels unsafe or ineffective, we shift down to the sympathetic action gear. And if that feels futile, we then descend to the dorsal vagal shutdown gear.

Our nervous system is constantly making these lightning fast subconscious shifts throughout the day, depending on what it perceives as safe or threatening. And this brings us to the concept of neuroception, which is at the heart of Polyvagal Theory. Neuroception is your nervous system's, unconscious ability to detect safety or danger in your environment, and [00:08:00] crucially in the people around you.

It's like an incredibly sensitive inner radar that's always on, always scanning, always asking the fundamental question: Am I safe here? Am I safe with you? Think about those times you've walked into a room and instantly felt a sense of unease, even though no one said or did anything overtly threatening or conversely, those moments when you've met someone for the first time.

And felt an immediate sense of calm and trust. That's neuroception. Our nervous system is exquisitely attuned to subtle cues, facial expressions: for example, a genuine smile versus a forced one. We often look at the eyes at the crow's feet section of the eyes to determine if the smile is genuine or not.

 Tone of voice: a warm, inviting [00:09:00] tone versus a harsh, critical one. Next is body language. An open, relaxed posture versus a tense closed off posture. Eye contact: soft, gentle eye contact versus a piercing stare Rhythm of speech:

Is the speech a steady calming rhythm, or is the speech a rapid, agitated form of speech. These cues and countless others are constantly being processed by our nervous system, sending messages of either "all clear!" or "red alert!" all below the level of our conscious awareness. Now let's connect this directly to the experience of chronic pain.

People living with chronic pain often have a super sensitive danger radar. Their neuroception is dialed way up, so they're constantly sensing threats. Even when [00:10:00] they're actually safe. Their nervous system becomes sensitized to detect danger, even in contexts that are objectively safe. It's kind of like having a car alarm that goes off every time a leaf blows by.

It creates a self-perpetuating vicious cycle that can then intensify their pain experience. Their brain's threat radar is constantly triggered.

This then triggers the release of stress hormones and muscle tension, which can amplify pain signals. The increased pain further reinforces the perception of danger, and the cycle continues and continues trapping them in a state of chronic defensive arousal. And this is where the relational aspect becomes so vital. For someone with chronic pain, feeling authentically present in their interactions with others is paramount. They need to feel seen, heard, and validated in their [00:11:00] experience. Unfortunately, significant others and family members, while often well intentioned, don't always know how to act or interact in ways that are truly helpful.

 They might try to fix the problem, offer unsolicited advice, or minimize the person's pain, not realizing that these actions can actually trigger the threat response in the nervous system.

What someone in chronic pain often needs most is an anchor of safety in their relationships. They need to feel that their experience is acknowledged and validated, that they're not being judged or dismissed. They need space to express their pain and emotions without feeling like they're a burden. It's not about allowing them to experience pain as if it's a choice.

It's about recognizing the reality of their experience and providing the safety they need to regulate their nervous system, which can in turn influence their [00:12:00] pain perception. We go through a process of mirroring. We have mirror neurons which reflect the cues we receive from others. .

Furthermore, we can influence others by emulating those verbal and nonverbal cues. Mirroring is a tremendously powerful tool that helps connection take place. It aids in effective co-regulation, and this helps to increase release of nourishing chemicals in the brain like oxytocin. Decreased levels of stress hormones like cortisol and minimize overall sensitization and sensitivity to pain. Think about it, if someone is already in a state of heightened alertness due to chronic pain, and then they're surrounded by people who trigger their threat response: It's a recipe for increased suffering. That's why we as [00:13:00] healthcare providers and as a society at whole need to do a much better job of educating and providing resources and support to those who live and have relationships with people with chronic pain.

We need to help them understand the complexities of the pain experience and the power of co-regulation. Let's make this real: Imagine someone who grew up in a household with a lot of yelling, criticism, and emotional invalidation. As an adult, they might find themselves chronically anxious in their relationships, always anticipating rejection or judgment.

Their nervous system is primed to perceive threat in social interactions. And if they develop chronic pain, this chronic state of threat can significantly amplify their pain and hinder their healing. On the other hand, consider the profound healing power of supportive, empathetic relationships. When we feel [00:14:00] truly seen, heard, validated, and accepted by others, our nervous system can downshift from "alarm mode" to "connection mode".

This is the magic of co-regulation. Co-regulation isn't some abstract concept. It's woven into the fabric of our daily lives. It can manifest in simple, yet powerful ways. A warm, comforting hug when we're feeling distressed. A friend who listens without judgment offering a safe space to express our emotions.

Someone who finds connection in community, whether that's at a yoga or exercise class, or at a religious ceremony or institution. A partner who offers gentle touch and soothing words when we're in pain, a group of people sharing laughter and joy, creating a sense of belonging. Even the presence of a [00:15:00] calm, attuned therapist, physician, nurse, coach or spiritual healer can help regulate a client's nervous system. Think about the way a caregiver instinctively soothes a crying infant using gentle touch, a soft voice and rhythmic movements. That's co-regulation in its most primal and essential form, and the need for this kind of connection and soothing doesn't disappear as we grow older. It remains a fundamental human need throughout our lives.

Conversely, it's crucial to acknowledge the detrimental effects of its absence: social isolation, chronic loneliness, and persistent stress in our relationships. Coupled with the divisiveness that's being driven in the media and in global events, can all contribute to the development and perpetuation of chronic pain. [00:16:00] When we consistently lack access to safe, supportive connections, our nervous system may remain trapped in a state of heightened threat, amplifying pain signals, and hindering the body's innate capacity for healing. So what are the practical implications of all this for managing pain? It underscores the critical importance of addressing the social and emotional context of pain, not just the physical symptoms.

Creating a sense of safety and fostering supportive relationships must become integral components of any holistic and effective approach to pain care. What does this look like? This might involve a multifaceted approach, including cultivating a strong and supportive social network, surrounding ourselves with people who are kind, empathetic, and validating can act as a powerful buffer against stress and pain. Practicing self-compassion and setting healthy boundaries. [00:17:00] Learning to be kind to ourselves to say "no" when necessary, and to protect our energy from draining relationships is essential for nervous system regulation. 

Exploring past relationship wounds and developing healthier ways of relating to others can have a profound impact on pain perception. Learning self-regulation techniques, practices like mindfulness, deep breathing exercises and gentle movement can help us calm our own nervous systems and increase our capacity for co-regulation.

 Education and support for families and partners, providing resources and guidance to help loved ones better understand our chronic pain and how to offer effective support. And here's a vital point to emphasize: Co-regulation isn't just about personal relationships. It's also a crucial element of effective healthcare.

Think about the [00:18:00] impact of a nurturing bedside manner. When a healthcare provider is present, attentive and empathetic, it creates a sense of safety for the patient. This in itself can and often does have a therapeutic effect, whether it's a physician performing surgery, a physical therapist guiding rehabilitation exercises, or even someone practicing energy healing, the patient's sense of safety and connection with the practitioner can significantly influence the outcome. When a patient feels heard, validated, and respected, their nervous system is more likely to be in that ventral vagal connection state, which is conducive to healing. Conversely, if a patient feels rushed, dismissed, or unheard, their nervous system may shift into a threat response, potentially hindering the effectiveness of the treatment. So, co-regulation is a [00:19:00] fundamental aspect of the healing process, regardless of the specific intervention. It's about creating a therapeutic alliance where the patient feels safe enough to engage fully in their own care.

Ultimately, understanding co-regulation and the principles of Polyvagal theory provides us with a transformative framework for recognizing the profound influence of our social world and the therapeutic relationship on our experience of pain. It shifts the focus beyond purely physical interventions and emphasizes the fundamental human need for safety, connection, and belonging as essential elements in promoting healing, resilience, and overall wellbeing.

 Thank you so much for joining me today on this exploration of the intricate link between relationships and pain.

I encourage you to take some time to reflect on the role of co-regulation in your own life and in your own healthcare experiences. [00:20:00] Consider how you might cultivate greater safety, empathy, and connection both for yourself and for those around you. It's a journey of profound self-discovery and healing. And it's worth it!

See you next time.