Episode 11: Metacognition in Motion: My Pain, My Path

Navigating Pain: A Personal Journey with Dr. Zev Nevo

In this deeply personal episode of 'Mind Your Body,' host Dr. Zev Nevo shares his recent struggles with severe pain and an upcoming spine surgery. He discusses the emotional and physical challenges of being both a physician and a patient, offering insights into the mind-body connection and the importance of metacognition. Dr. Nevo also reads a compelling poem he wrote during a moment of intense pain and reflects on the reciprocal compassion he has received from his patients. The episode concludes with a hopeful outlook on the power of shared experiences in healing and future plans for expanding mind-body rehabilitation programs.

00:00 Introduction to Mind Your Body

01:08 Personal Experience with Pain

01:59 Facing Surgery and Its Emotional Impact

05:42 The Poem: A Reflection on Pain

12:21 Understanding Pain Through Metacognition

15:17 Conclusion and Future Plans

About Dr. Nevo
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LINKS:

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

Transcript

Hey everyone. Welcome back to Mind Your Body. I'm Dr. Zev Nevo, your source for pain and trauma-informed psychoeducation and the exploration of mind body rehabilitation. Today's episode comes from a very personal place. You know, typically we dive deep into specific aspects of pain education, mind-body connections, and practical strategies.

But today, I'm pivoting slightly from our regular schedule to share my own very recent experience with pain. I believe this to be a paramount and imperative topic to show that as doctors, we too are human beings and are trying to figure it out When we ourselves experience pain, illness, or injury, especially for those of us working directly in this field.

So I've been going through it again. [00:02:00] A significant flare up of pain over the past few months has led me to a decision I didn't expect to make again, and certainly not so soon. I'm scheduled for another spine surgery this week. This feels like a profound sense of deja vu, a strange echo of the past as it's been four years since my last one.

This past period has been a rollercoaster of mixed emotions, especially over the last two weeks. 

My pain, which we call intractable when it reaches this breaking point, made the decision to pursue surgery feel like the only viable option left. It's one thing to stand here on this side of the microphone, sharing insights and strategies. It's quite another to be the one on the operating table living through the very challenges that I speak about.

It's forcing me in a sense quite profoundly to not just be an armchair quarterback, but to actually practice what I preach. And let me tell you, at times it has been [00:03:00] incredibly helpful. I've been able to consciously work to reappraise some of those really intense pain sensations to create a little space around them.

But my nervous system certainly wants to push me into survival mode. I can deeply appreciate the subconscious tensing and guarding that happens, that primal clenching, that holding pattern that our bodies adopt when they feel under threat. And in those moments, I learned to say, "thank you" to my mind and my body for simply trying to keep me safe.

It's really a fundamental protective instinct, even when it feels overwhelming. I've also noticed in a very visceral way how being in constant pain keeps your other tolerances and thresholds at a razor thin edge. Your patience wears thin, your tolerance for minor annoyances plummets. Everything else, all the small daily frustrations start to feel so [00:04:00] petty compared to the pervasive throbbing pain that demands your attention.

Being up at all hours of the night unable to find comfort certainly affords a unique perspective. It allows you to contemplate profound ideas of gratitude for moments that you once took for granted times when you could just lay your head on a soft pillow and not have that simple act aggravate throbbing pain, tingling and weakness on one side of your body. It makes you realize how precious undisturbed rest truly is. Being in a hospital for pain control as a patient is without a doubt, a truly humbling experience. And for me, being a physician and a patient sometimes creates a peculiar dynamic.

There's often this unspoken assumption from the staff, "Oh, he's a doctor. He knows what's going on," leading to a more hands-off approach. But honestly, in those moments, all I really wanted was to be cared for as myself as a [00:05:00] human being in pain,to be nurtured and taken care of without the weight of my profession.

I have this profound need to step outta my doctor's shoes and simply be cared for. Yet my job seems to be imprinted on me like a tattoo. It's inevitable and unavoidable, and whether I like it or not, that is how I am seen and perceived. It was during the night that I presented to the emergency department sitting in a chair in horrific pain, yet instinctively showing no emotion on my face, which I've gotten pretty good at doing as I waited hours to be triaged that I found myself actually writing a poem.

And I wanna share that with all of you now because I feel that it encapsulates so much of what I was feeling in a moment of intense pain. The pain is blinding. There's nothing else to see. The pain is deafening, muffled [00:06:00] background din doesn't penetrate. It sits in your space, disregards your comfort zone, never asked to be there, but assumes it's right, nonetheless. So I sit with it, waiting for it to leave, to move, to change. It pulses in place like a bell that no one asked to toll. I squeeze my eyes shut, but it's not visual to block. There's no smell to cover up, no blanket to protect me. I'm so vulnerable to its grasp, its relentless announcement of its presence.

 It's power like a vice pervading its unwelcome dominance over my body. I refuse to cower to its spell of vulnerability. I welcome those sensations as awful as they appear like biting into a rotten fruit or enduring the sting of a vaccine. This time it's heartless making me sweat, [00:07:00] but I know it's power depends on me enabling its dominance over me.

I am stubborn. I'm strong. It can hurt, but it can't force me to suffer. I breathe through the stabbing. I breathe in rhythm with the pulsations of pain that makes my bones rattle. I hold still and squeeze my eyes shut. I grab the wheel and reclaim my body. The body is hurting, but it's mine. It can hurt and that is there to protect me.

Just as a parent pulls a child out of a busy intersection. I need to honor and respect this process. Thank you for warning me my nerves are being compressed. They don't deserve that, and I will deal with them. For now, please keep letting me know that you are unhappy and I will respect this. It will certainly not feel pleasant, but I [00:08:00] completely understand the sentiment.

Pain is just a sensation that aims to steer me back to safety. I welcome the journey. Emergency Department. 2:07 AM. June 17th, 2025.

That experience was a moment of profound clarity amidst the chaos. I had written to colleagues just the other day: Practicing in pain seems to be a self-fulfilling prophecy. And in many ways this experience has definitely tested me to my limits, both physically and mentally.

To give you a clearer picture, my pain is from a herniated disc in my cervical spine, severely compressing one of the nerve roots and creating radiating pain into my right arm. When I talk about bathing in the experience of pain, it's about being able to better notice and pay attention and listen to its specific qualities.[00:09:00] 

So what I do is I observe how it travels. How it pulsates. how it creates other experiences of tightness or spasm, the profound fatigue that it brings, the cramping or heaviness. 

And then there's the guarding, the subconscious tensing of my shoulder, shoulder blades, neck and head, all acting in unison, even before I make a conscious movement, to cradle me to protect me. It's a testament to my body's incredible instinctual defense mechanisms, and I view all of these sensations with a sense of curiosity and wonder. This period, too, has brought a swirling mix of emotions. There's the fear. Fear of the unknown outcome of surgery, fear of prolonged recovery, fear of the pain returning again, [00:10:00] someday. There's the deep frustration of being back in this familiar territory after years of having to hit pause on life and practice.

 And there's the intense focus, the drive I have to figure out what to do to fix it in order to regain a sense of control and autonomy over a body that feels like it's betraying me. All of these thoughts, these feelings, these impulses are often running through my mind in a rapid cycle, sometimes simultaneously.

It's an overwhelming mental landscape. 

 Then there's the profound challenge of losing autonomy over my daily schedule, the inability to predict how I'll feel from one hour to the next, let alone one day to the next dismantles routines.

And with that comes the heavy guilt of having to reschedule patients who are depending on me for care. That feeling of letting others down, even when it's beyond my control, [00:11:00] is a real emotional burden that I carry. But this period has also unexpectedly shown me the incredible humanity and compassion that exists even from sources I didn't expect: My own patients, the very people I care for have offered me such kindness, wishes for success, thoughts and prayers, even heartfelt recommendations for supplements and tinctures to help me recover faster. That reciprocal compassion, it's so co-regulating and it's truly a blessing.

And this entire journey, you know, it's been made bearable by the unwavering support of my incredible wife and children and my entire extended family. They've been my anchor through this turbulent time. And to my beloved patients and staff at the Body and Mind Pain Center. Thank you. Thank you for shouldering the burden of canceling and rescheduling multiple clinics.

Your support has been invaluable, [00:12:00] allowing me to focus on my healing while still striving to uphold our commitment to you. It's because of your understanding and resilience that I can continue my stubborn vision to bring a human and empathetic touch to what can often be a robotic sterile, and at times dehumanizing pain management specialty.

This experience has really forced me to ponder some fundamental questions about what it means to be a human being experiencing pain. It made me think deeply about the concept of metacognition. That's our amazing ability to think about our own thoughts, our feelings, our emotions, and our physical sensations.

And here's why that's so powerful. When we engage in metacognition, we are actively activating our medial prefrontal cortex. This part of the brain is crucial because it helps to mitigate activity within our limbic system, that [00:13:00] more ancient, emotional, and reactive part of our brain that screams danger. It allows for time and activation of our prefrontal cortex to add context, to add logic and rationality, which helps us discern and interpret our pain experience in the very moment, rather than just reacting in fear, it's that incredible human capacity to literally think outside the box with the box being our own heads, to partition our awareness almost as an out-of-body experience. It's about being able to notice where we are at, what state of mind we are in, even when that state is one of profound discomfort.

 And then instead of resisting or judging, to just allow whatever we notice to remain, to honor and respect its presence. To try to understand its role and its agenda. [00:14:00] In those moments of intense pain, it can certainly feel like my body is failing me, like it's betraying me. But then through metacognition, I can step back and remember that this sensation, this signal, is ultimately in place to protect me, to keep me alive, to keep me safe, even if I don't get it or understand its immediate purpose in that agonizing moment, I can grasp its underlying protective intention.

It's kind of like a pilot who flies through severe turbulence. The passengers might experience immense unease, fear and discomfort, feeling every jolt and bump, but they can rest assured that the pilot, despite the external chaos, is anchored and regulated enough to know what's needed to do the job and to land the plane safely. In those moments.

I strive to be that pilot for myself.

[00:15:00] I'm confident that this experience challenging as it has been, will truly help me gain additional resilience and further develop my capacity to connect with and make even deeper impacts on patients moving forward. I look forward to returning to my patients who truly are my pain families, and to continuing this journey with all of you.

So as we conclude this deeply personal exploration, if you're wondering how I'm feeling with everything going on, I think this summation is actually hopeful and optimistic in spite of the pain. I really look forward to leaning into the experiences of my current and future patients with additional battle scars of my own to help me comprehend even 1% more, what you are feeling in your bodies, in the context of your own lives and your own experience. I truly look forward to [00:16:00] returning and we are planning some really exciting programs for our practice, including expanding to offering more personalized Mind-Body Rehabilitation, chronic pain support, as well as creating micro-communities of people with similar conditions or experiences to share and learn from our own journeys, share resources with each other and heal together as a community.

And as the ancient Greek philosopher Aeschylus profoundly observed, "We suffer into truth." In essence, our experiences of suffering, no matter how painful, often serve to illuminate a deeper, more visceral and authentic sense of understanding and knowing in our lives. It gives us wisdom and experience. It makes us less fragile.

They help us to recalibrate, to see where we might have been misdirecting our physical and mental [00:17:00] energies, and where we should be placing more or less emphasis moving forward. It's like getting lost on a winding road, and all you have is a paper map. You need to pull over. You need to stop, compose yourself and actually look and read the map.

Then turn to face the right direction and keep driving towards your destination. It might seem like you're not getting any closer when you're immobilized and peering over that map, but in fact, this pause, this opportunity for self inventory, this moment of recalibration is helping you get there faster in the long run.

As opposed to continuing to travel aimlessly and without purpose. May we all find relief to relive. Until next time, be kind to yourself and remember that every small [00:18:00] step forward truly, truly counts. See you soon.