Episode 14: Splitting U.P.

Breaking Up with Pain: Redefining Your Relationship with Physical Discomfort

In this episode of Mind Your Body, Dr. Zev Nevo delves into the critical distinction between pain as a sensation and suffering as the emotional response we attach to it. Dr. Nevo discusses why our brains resist breaking away from familiar patterns of pain and offers practical advice on how to emotionally and physically detach from pain. He emphasizes the importance of creating a healthy relationship with pain by focusing on activities we enjoy for our own sake, and not out of fear of pain, while also making space for fun and serenity in our lives. Packed with insights and actionable steps, this episode aims to empower listeners to nurture their mind-body connection and improve their overall well-being.

01:17 The Concept of Pain and Suffering
01:58 The Brain's Love for Predictability
04:00 Real World Scenario: Sudden Pain
05:52 Navigating Pain Responses
13:28 Creating Space for Fun and Serenity
15:27 Conclusion and Final Thoughts

This essential pre-roll message serves as a clear disclaimer, stating that the podcast provides pain and trauma-informed psychoeducation for informational and entertainment purposes only, and does not constitute medical advice. Listeners are reminded to always consult a qualified healthcare professional for specific medical conditions or symptoms.

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LINKS:

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

Transcript

Episode 14 | Splitting U.P.

Hello and 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. I wanna propose a concept today that may sound jarring at first. Let's split up. What I'm proposing is a breakup between the U of you, your self identity, and the P of your pain.

 Before we dive in, let's get one foundational concept straight. Pain is a sensation, and suffering is the meaning and emotion that we attach to it. This is a critical distinction that can change everything. While we may not always control the sensation, we have immense power over our suffering.

So why is this breakup so hard? It is all about our brain's [00:02:00] love for predictability. There are many emotions that people experience during breakups of relationships. Often it's a mix of negative ones like resentment, sadness, fear, and hopelessness. But there's also a flip side: a monumental opportunity to take time to explore our own sense of purpose, to discover who we really are and to expose ourselves to a greater sense of emotional and physical safety. Almost no one feels breakups are easy, but have you ever thought of exactly why they aren't? Psychologically, our brains love to establish patterns, routine, consistency, and most importantly, predictability.

This is a core survival function. A predictable life is a safe life, even if that life is painful. [00:03:00] The relationship, even a toxic one, is a known quantity. It allows us to stop actively searching, to quiet the energy-draining engines of courtship that require us to be on high alert. The same is true for our relationship with pain.

Our brains are hardwired to predict. When we have a longstanding pattern of pain, our brain has a clear narrative for what to expect. While it's clearly uncomfortable, it's familiar, it's a known quantity. This is why breaking up with pain is so hard. It pushes us into a state of uncertainty and instability.

It feels as if our goals and dreams have hit an impassable wall of bricks. This is the struck nerve that activates our nervous system's alarm bells making us feel overwhelmed and helpless. Sound [00:04:00] familiar? 

To make this real, let's consider a real world scenario. You are living your normal life. While there are daily struggles, price of groceries, unfolded laundry, unpaid bills, an invitation you don't really want to attend later this week, a looming deadline, a child who seems to defy every request, you are hitting most of your checklists, and you feel relatively content. Ebb and flow in your life are the norm.

But overall, you got this. 

You then notice a sock on the floor partly hidden underneath the couch and bend somewhat awkwardly to pick it up. As you stand, you feel a sudden sharp pain in your lower back and an electric shock of pain shooting down your leg into your foot. Within a moment, your entire perspective changes. You bring your attention and awareness directly to your [00:05:00] pain, and a million questions and worries and concerns seem to flood your conscious brain. On a deeper level, in the control room of your brainstem and limbic system, there is a recognition of threat to your body. How much threat? Ah, that depends on you. More on that later though. Logically, you just bent down to lift a sock. Something you have done in one form or another, numerous times in your life.

So what happened? Why now? Why me? How long will this hurt? Will it get worse? What about all the things I had to do right now today, this week, this month? Wait, how long will this actually last? Will it worsen? Um, what do I do now? I need help! You can see how pain can trigger a whole host of thoughts and feelings.

Our memory centers flip through [00:06:00] thick, dusty photo albums, scanning for memories of other times. We have felt this kind of pain. Yes, I've had pain in my lower back when I was younger, but never in my leg. I mean, I twisted my ankle once, but it felt nothing like this. 

 Or, is this my stupid sciatica again? Not again! Last time I went through hell, I tried so many treatments and nothing helped. I had to cancel my plans and miss work. I can't go through that again. No matter what the conversation in your mind is, we are actually dealing with a sudden crisis that threatens our safety and insidiously embeds uncertainty into our lives. At the heart of it, this is what is most distressing. 

 We start to walk away from the couch and notice that while not continuous, with each step, there's a moment that a sensation of shooting pain from our back down our [00:07:00] leg is still coming back, still reminding us something is off and it feels very wrong.

The most important thing we can do to nurture our activated survival system is to establish a name to this pain and a cause for this disturbance. Many people pick up socks and don't feel pain. In fact, neither of you up until this past moment. What you do next is crucial. Do you start Googling your symptoms or using Chat GPT to diagnose yourself?

Do you endlessly peruse algorithms of sciatica based content on social media or Reddit forums comparing your situation with complete strangers? Do you try to walk it off or ignore it? Are you frightened? Are you frustrated? Are you angry? Or perhaps you collapse onto a heap in your bed, refusing to move, feeling [00:08:00] helpless about your situation?

The truth is there is no right or wrong response. Our natural tendency is to react to threat with a bit of all of these emotions and thoughts. Why? So we can protect ourselves. Memories of similar, painful experiences actually help us bring clarity and understanding as well as to recall what helped or didn't help us escape pain in our past.

For the most part, we seek help in the form of evaluation or treatment if our pain doesn't subside on its own. Research shows that having an appointment that is now scheduled in our calendars already helps us to start feeling less pain by releasing natural painkillers into our bloodstream and quieting down our defense systems.

Let's fast forward: You have an appointment with your doctor, regardless of how that experience actually goes, a topic for [00:09:00] another time, you're given a care plan: perhaps some positions to avoid. Perhaps medication to help with the pain, a brace, a referral for imaging, a recommendation for physical therapy, and a home exercise program.

Great. Now you've got so much more on your plate. How often do we blame ourselves if we miss a dose or accidentally move into those forbidden positions , or forget to do our exercises one day? Guess what? It's okay. Most of the time these recommendations are there as a resource for you.

Your body is healing passively. Are there steps to take to reduce pain and improve your body mechanics to reduce likelihood of future flare-ups? Sure. 

 But these plans are meant to give us guidance towards healthy practices for our bodies not to become a burden in of themselves. When patients return to me [00:10:00] for follow-up appointments after an initial evaluation, I often inquire how they have been feeling and what they have been up to. 

Unless they have been my patients for a while, most people initially describe their daily tasks as going to scheduled appointments, picking up prescriptions, avoiding movements, positions, activities, or turning down invitations or opportunities to socialize due to pain or fear of developing pain.

Sometimes it's severe fatigue, brain fog, or just feeling irritable and not in the mood. Sleep is often disturbed. Sometimes it's because of racing thoughts. Other times, pain itself frequently wakes them from pain. Then we discuss functional activities. They may discuss going to physical therapy appointments, but what about between appointments?

Their walks around the block, become walking as a [00:11:00] home exercise program or walking so I don't feel pain. Their stretching routines become necessary to avoid discomfort or tightness. Even going to a yoga or Pilates class becomes a chore in order to address their pain condition. Going to social events or traveling for vacations become an exercise in planning on what's needed to avoid pain and what to do when it inevitably arises.

Perhaps one is educated on breath work or mindfulness exercises. How many times are we deliberately approaching these in order to regulate our nervous systems or reduce our pain or just to feel better? The reality is this: when we approach mundane tasks during the day with a certain hypervigilance relating to our pain or our movements as it relates to our pain, we [00:12:00] then keep pain chained to us. It is an appendage that is ever present, even when we are following instructions and directions to mitigate or eliminate it. So what are the two most important things to take away from this idea of splitting up? First, I want you to start thinking about this.

Do things for you, not for your pain. Create an intention that you are not your pain. 

You're not just a body in pain. Participate in activities or movements just because you enjoy them, because it brings you contentment. And because it will help you. Pain is a dangerous signal, but if not felt in the moment, using predictive energy to anticipate it creates threat and drains you emotionally [00:13:00] and ultimately, even physically.

This can manifest as pain becoming a barrier for you to meet your physical therapy goals, cutting your walk short, or convincing you to cancel an outing or an opportunity to socialize with friends or loved ones. It may impact your attention or productivity at work, or hinder your creativity and confidence.

These aren't minor consequences. And second, I want you to remember to create space for fun, wonder and serenity in your life. What's often lacking from a patient's "How have you been?" response is anything they did or experienced in their lives that was solely for the sake of fun, excitement, wonder, playfulness, or quiet serenity.

We must create space for this in our lives. Not every moment of our day must we focus on [00:14:00] our survival. Schedule times in your day to do less. Or engage in play, creativity, or something that brings you laughter or joy, something that has brought you a sense of lost time and seems to be effortless for you.

This could be anything from reading or journaling , lighting a candle sitting in a rocking chair, smelling flowers, watching a funny movie, playing a board game, taking a hot shower with relaxing music on or just being without doing. What you need in this regard, only you can answer.

 It must make sense for you and your nervous system and your body. Not intellectually, but viscerally. It's a felt sense of ease and a deep sense of, "Yeah, this is me." Splitting up helps us create [00:15:00] a little bit of space and set healthy boundaries between ourselves and our pain.

We certainly need pain in our lives. It plays such a vital role in keeping us alive. But let's not let our desire to turn off its signaling keep us so chained to every thought, feeling, and action throughout our day. Until next time, please reflect on what you've learned. Celebrate newfound wisdom and protect your sacred mind body connection.