Episode 29: Running on 18%

When Pain Gets Worse: Allostatic Load, Nervous System Dysregulation, and Expanding Your Window of Tolerance

Dr. Zev Nevo recounts a 90-minute visit with Emma, 26, who has had chronic pain since childhood but recently developed severe sensory overwhelm, brain fog, dissociation, and functional decline despite largely unchanged imaging after seeing 10 specialists. He reframes her worsening as reduced coping capacity and increased nervous system reactivity, explaining allostatic load, high-functioning freeze, psychophysiological coherence, and the window of tolerance, and noting traits like being a highly sensitive person. He emphasizes a “both/and” approach: structural findings (e.g., hypermobility, possible craniocervical instability) can coexist with nervous system dysregulation, and surgery can act as major stress/trauma. The plan includes validation, psychoeducation, HRV assessment/HeartMath, Safe and Sound Protocol, gentle manual therapy, coordinated care, and homework (battery check-ins, interoception, self-compassion, boundaries, and an anger journal).

00:00 Grocery Store Breakdown

00:24 Meet Emma’s Story

02:24 Why Now Despite Scans

03:48 Capacity Not Symptoms

04:28 Allostatic Load Explained

06:02 Phone Battery Analogy

06:58 High Functioning Freeze

08:54 Window of Tolerance

10:25 Inside the Clinic Visit

16:18 Tools and Treatment Plan

18:15 Anger as a Signal

19:33 Both And Pain Model

22:18 Surgery as Stressor

23:22 What We Did for Emma

25:42 Key Takeaways Recap

26:57 Science of Safety

28:28 HSP and Sensory Sensitivity

29:54 Healing Takes a Team

31:15 Three Practices to Start

33:21 Final Encouragement

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

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Episode 29 | Running on 18%

[00:00:00] You know that feeling when you walk into a grocery store and suddenly everything feels wrong? The lights are too bright. The sounds are too loud. People are moving around you, and it's like you're watching it all through a fog. You used to love grocery shopping.

[00:00:19] Now you can't make it through without feeling like you're going to collapse. That's where Emma was when she came to see me. Twenty-six years old, had been dealing with pain since she was a kid. Back pain, joint pain, the kind of thing doctors kept telling her she was too young to have. But recently, everything had gotten worse. Not just the pain, her whole world had shrunk.

[00:00:49] She couldn't go to the grocery store anymore. She'd have these episodes where she felt like she was crawling out of her skin.

[00:00:57] Brain fog so thick she'd forget [00:01:00] words mid-sentence. And the scariest part? She'd look at herself in the mirror and not feel like she was really there. Her mom, sitting next to her in my office, said something that stuck with me. " Every night she has a little breakdown. She just wants to go back to a year ago when things were better."

[00:01:21] But here's the thing, and this is what I want you to really hear today. A year ago, things weren't better. Emma had pain then too. She'd been dealing with it for seventeen years. So what actually changed? That's what we're going to unpack today. Because if you're listening to this and thinking, "That's me," if your pain feels like it's gotten unbearably worse even though your scans look the same, even though structurally nothing has changed, you need to hear this.

[00:01:53] I'm Dr. Zev Nevo, and this is Mind Your Body, where we explore the hidden connections between your physical [00:02:00] pain and your nervous system, your emotions, and your life. Today, I wanna take you inside that ninety-minute visit with Emma. Not because her story is unique. Actually, it's the opposite. It's because I see this pattern over and over, and I think if we can understand what was really happening with her, it might help you understand what's happening with you

[00:02:24] So let me paint the picture for you. Emma's sitting there, and she's convinced her body is falling apart. She's been to 10 specialists: neurology, rheumatology, cardiology, ENT, spine surgeons. She's had MRIs, CT scans, EMGs, X-rays. And yes, there are findings. There's always findings. A disc bulge here, some reverse curvature there, maybe some hypermobility.

[00:02:57] But none of it explains why now? Why [00:03:00] after 17 years of managing her pain is she suddenly unable to function?

[00:03:05] Before I even bring her into the exam room, I'm reviewing her intake form, and I'm already seeing the red flags that tell me this isn't just a structural problem. Her pain scale, nine out of 10. Her PEG scale, that's pain, enjoyment of life, and general activity, is 29 out of 30. That's as high as it gets.

[00:03:28] And then I see the review of systems: anxiety, depression, irritability, all rated 10 out of 10. No current medications for mental health. History of counseling, but clearly something's not working. This is someone whose nervous system is screaming. Now, here's where I said something to her that I want you to really sit with.

[00:03:53] I told her, "I would argue that it's not the symptoms that got worse, but it's the reactivity to the [00:04:00] symptoms and your ability to cope with them." Let me say that again because this is the core of what we're talking about today. It's not that your pain got worse, it's that your capacity to handle it got smaller.

[00:04:14] Now, I know what you might be thinking. "Wait, Dr. Nevo, are you saying it's all in my head?" No, that's not what I'm saying at all. So let me explain what I actually mean because this is really important. Let me introduce you to a concept called allostatic load. Allostatic load is the cumulative amount of stress that you've encountered in your life.

[00:04:37] And when I say stress, I don't just mean I had a bad day at work. I'm talking about everything from the moment you were formed as a fetus to what your parents went through to what your grandparents went through. Yeah, you heard that right. We're talking about intergenerational trauma. The stress your grandmother experienced during the Depression, that can show up in [00:05:00] your DNA.

[00:05:01] It's called epigenetics, and it's wild. So you're born with a certain baseline. Then you add childhood experiences. Maybe you were a high achiever. Maybe you had some injuries. Maybe there was family stress. Then you add adult life, demanding jobs, relationships, physical trauma like surgeries or infections.

[00:05:26] All of this goes into what I call the allostatic load bucket, and here's the thing, that bucket has a limit. For Emma, that bucket had been filling up for 26 years. Childhood pain, being told she was too young to have these problems, working 80-hour weeks at a Big Four accounting firm. Then last year, she took an antibiotic that made her feel worse.

[00:05:51] She had a surgery. Her roommate had a psychiatric episode. She stopped getting her period for two years because of stress. [00:06:00] The bucket overflowed. Now here's how I explained it to Emma, and I think this might land for you too. Think about your phone. If your phone starts the day at 100% battery, you can use it all day, right?

[00:06:14] You can scroll, you can take calls, you can navigate, whatever. But if your phone only starts at 18%, by noon it's dead. And you can manifest all you want that it should keep working. You can beg, you can plead, it ain't gonna work. You have to charge it. We don't feel lazy when we charge our phones. We don't feel guilty when we fill up our cars with gas.

[00:06:40] But somehow when it comes to our own energy, physical and mental, we think we should just be able to push through. Emma wasn't waking up at 100% anymore. She was waking up at 18%. And then she was trying to do a full day's worth of living. No wonder she was crashing. And here's where it gets [00:07:00] really interesting.

[00:07:01] Emma looked fine on paper. She had a job. She was living independently. She was functioning. But what she was actually doing, and I see this in so many high-achieving people with chronic pain

[00:07:13] is what is called a high-functioning freeze state You know how when an animal is threatened, it has a few options: fight, flight, or freeze. Freeze is that last-ditch survival mechanism where you just play dead. You shut down. But humans are clever. We figured out how to freeze while still moving. We compartmentalize.

[00:07:37] We create this part of ourselves called the going-on-with-normal-life part. That part shows up to work, pays the bills, smiles when it's supposed to, but underneath, you're in overwhelm. You're running on fumes, and it comes at a tremendous cost. Emma would get through her workday, and then she'd come home and just collapse.[00:08:00] 

[00:08:00] Weekends weren't for rest. They were for recovery from pushing through overwhelm all week. Sound familiar? So how do we fix this? Well, first we have to understand what's actually happening in your nervous system. I use this analogy with patients all the time. Think about driving a car. You can drive from here to the airport by slamming on the gas, then slamming on the brake, then slamming on the gas, and then the brake.

[00:08:28] You'll get there, but you're going to wear down the car, and it's not going to feel very comfortable. A lot of us operate our lives that way. We go all in, pedal to the metal, and then we hit a wall and crash. Then we wait to recover just enough to do it all over again. That's not healthy. That's not sustainable.

[00:08:51] And that's not how we heal. What we want is smooth transitions. Gas, ease off, [00:09:00] brake gently, gas again. That's what is referred to as psychophysiological coherence. It's not just about your heart rate varying, it's about it varying smoothly. This brings me to another concept I want you to understand, and it's called window of tolerance.

[00:09:19] Imagine there's a zone where you can handle life's challenges without getting overwhelmed. That's your window of tolerance. When you're in that window, you can deal with stress, you can process emotions, and you can function. But when you go above that window, too much activation, too much stimulation, you go into fight or flight, or that high-functioning freeze state we talked about.

[00:09:44] And when you drop below that window, that's where you get dissociation, depletion, that feeling of not being in your body, that hopelessness and helplessness. Emma was spending most of her time outside her window. [00:10:00] Either she was in a hyperactivation, feeling like she was crawling out of her skin, everything too loud, too bright, too much.

[00:10:09] Or she was in shutdown, feeling like she couldn't move her face, couldn't connect, couldn't be present. The goal isn't to eliminate stress. The goal is to expand your window of tolerance so you can handle more without tipping over the edge.

[00:10:25] So now let me take you inside the actual visit because this is where theory meets practice. This is where I have to navigate introducing these concepts to someone who came in thinking she needed an MRI or an injection, not a conversation about her nervous system. So I bring Emma in, and the first thing I do before I touch her, before I order any tests, is acknowledge what she's been through.

[00:10:50] I say to her, "First of all, let me acknowledge that you've been dealing with a lot. Reading through this form, I know I'm not [00:11:00] even getting the whole story. I can't imagine the extent of how all these symptoms have impacted your quality of life." And I see her shoulders drop just a little because when you've been to nine doctors and nobody's figured it out, you start to feel like you're crazy.

[00:11:17] Like maybe it's all in your head. So I tell her my intent for today, to learn about the nature of her symptoms, but more importantly, how they've impacted her, what her goals are, what she's hoping to get back to. Because here's the thing: Pain is never just about the pain. It's about what the pain has taken from you.

[00:11:39] We go through her medication history. She's only on Lyrica now, a low dose. She tried Gabapentin but had a terrible withdrawal. She tried Lexapro, same thing. Baclofen made her dizzy. And I'm noticing a pattern here. She's very sensitive to medications. Her body is reactive. Her nervous system is on high alert.[00:12:00] 

[00:12:00] So I ask her about what's really helping, and she tells me acupuncture has been the most effective thing. It's helped about fifty percent. She's also doing chiropractic. That's helped about twenty-five percent. And I'm thinking, "Good, she's finding some relief." Her nervous system is responding to gentle, regulating interventions.

[00:12:22] But then she says something that really catches my attention. She says, "With the acupuncture and the Lyrica, I feel like my nervous system is just less reactive, like it doesn't feel as sensitized all the time." Did you catch that? She used the word nervous system on her own. She's already making the connection between her physical symptoms and her internal state.

[00:12:46] So I lean into that. I ask her, "You mentioned your nervous system. What does that mean to you when you say nervous system?" And she says, "It's like my sensitivity levels. I feel like maybe some [00:13:00] of the pain stuff could be the same, but I'm reacting more to it. I'm noticing things a lot more. I'm very reactive to everything.

[00:13:08] Every little thing will bother me." This is the moment. This is where I start to introduce the framework because she's already telling me that it's not just the pain. It's her response to the pain. Her capacity to cope has been overwhelmed. So I ask her if that includes sound sensitivity, and she says yes.

[00:13:32] She used to love grocery shopping, but now she can't go to the grocery store. Everything feels warped like Alice in Wonderland. Things are moving around her. She gets overwhelmed. This is classic nervous system dysregulation. Her window of tolerance has shrunk so small that even normal stuff, sounds, light, movement, feel threatening.

[00:13:53] Now, here's where I could have just said, "You have anxiety. You need therapy." But that would have shut her [00:14:00] down because she's not here for therapy. She's here because she thinks something structural is wrong with her neck. So instead, I start with psychoeducation. I explain what's happening in her brain and body in a way that makes sense.

[00:14:15] tell her, "So chronic pain is unique because if we put somebody who's had pain for a while under a brain scan, we'll see vastly different areas of the brain light up compared to someone with acute pain. Your brain has learned to interpret signals differently, and when your nervous system is dysregulated, it amplifies everything."

[00:14:37] I talk about allostatic load, the cumulative stress she's carried throughout her life. I explain that it's not just about what's happened to her recently, but what her body has been holding onto for years, even generational trauma. And I can see her nodding. She's with me

[00:14:54] Then I introduce the concept of the highly sensitive person, HSP. I tell her it's [00:15:00] not a diagnosis, it's a trait,

[00:15:02] and people with HSP tend to feel pain more intensely. They're empaths. They absorb other people's emotions. I ask her, "Do you find yourself to be someone who's like an empath? If you're with someone who's going through pain or emotional things, you can feel that really strongly?" And she says, "Yeah, I do." And now she's starting to see herself in this framework.

[00:15:25] She's not broken. She's wired differently, and that wiring makes her more vulnerable to chronic pain. But it also means she has the capacity for deep healing if we address the nervous system. So I explain the survival states, fight, flight, freeze. I talk about how her nervous system has been stuck in sympathetic overdrive and how that affects everything from her gut to her ability to hear calming sounds.

[00:15:52] I tell her about the vagal state, the shutdown state, where you feel helpless, hopeless, dissociated, and she lights up. She says, "Yes, [00:16:00] I feel like I can't move my face. I'll dissociate. It feels like I'm not even there. I'll be in a conversation and forget where I'm at." This is huge because now she's recognizing that these aren't just random symptoms.

[00:16:15] They're her nervous system trying to protect her. So I introduce the tools, heart rate variability training with Heart Math, Safe and Sound Protocol, a music-based listening therapy that stimulates the vagus nerve, Pain Reprocessing Therapy to desensitize her to movements that trigger fear. But I'm careful.

[00:16:36] I tell her we're not jumping straight into desensitization because when someone's nervous system is this activated, you can't just throw them into exposure therapy. You have to build safety first. I say to her, "We need to start with assessing where you're at. We'll do a Heart Math assessment to look at your heart rate variability and coherence.

[00:16:57] We'll use some gentle manual therapies, like rib [00:17:00] raising and craniosacral work, to help balance your nervous system. And we'll use Safe and Sound Protocol to see how your body responds when we impose safety." And here's the key moment. Her mom, who's been sitting quietly, speaks up. She says, "Every night she has a little breakdown because she goes back to a year ago when things were better.

[00:17:21] But in our eyes, it wasn't better. She was always having problems, but she just wants to go back to a year ago." And I turn to Emma and I ask her, "You told me yourself you've been having pain for about seventeen, eighteen years. Would you say your quality of life was optimal a year ago?" And she says, "I had pain, but I was able to deal with it.

[00:17:43] It was more physical. I wasn't dealing with these neurological things. I wasn't having these breakdowns. I wasn't in constant fear." So I tell her, "I would argue that it's not the symptoms that got worse, but it's the reactivity to the symptoms and your ability to cope [00:18:00] with them that's put you in a state where you feel more helpless."

[00:18:04] And that's the reframe. That's the moment where she starts to see that this isn't about going back in time. It's about building new capacity to handle what's here now. Now, there's one more thing that happened in that visit that I think is really important. Emma's mom mentioned that every night Emma would have these breakdowns.

[00:18:23] She'd say, "It's not fair," over and over, "It's not fair." And I looked at Emma, and I said something that I think she needed to hear, and maybe you need to hear it, too.

[00:18:36] I told her anger is the correct emotion. When you feel like your boundary has been crossed, when you're experiencing what feels like injustice, why me? This isn't fair. Anger is appropriate. It's the right response. The question isn't whether you should feel angry. The question is how you express it.

[00:18:58] Because if you bottle it up, [00:19:00] if you push it down, if you tell yourself you shouldn't feel that way, that anger manifests in your body as tension, as pain, as that feeling of being stuck. Emma needed permission to be angry. She needed to know that her feelings were valid, that she wasn't broken for feeling this way.

[00:19:19] And I'm telling you the same thing. Whatever you're feeling about your pain, about your situation, about how your life has changed, it's valid. You're not wrong for feeling it. Now, here's something else that's really important. Throughout this whole visit, I'm also doing a physical exam. I'm looking at her imaging.

[00:19:39] I'm assessing for hypermobility, for craniocervical instability, for structural issues. Because here's what I want you to understand. It's not either/or, it's both/and. You can have structural findings and nervous system dysregulation. You can have a disc bulge and neuroplastic pain. You can [00:20:00] need manual therapy and need trauma-informed care.

[00:20:04] This is what I call the both/and approach to pain. Too many practitioners are in one camp or the other. Either everything is structural, and you need injections and surgery, or everything is in your head, and you just need to think differently. But that's not how bodies work. That's not how pain works. Emma had real findings.

[00:20:25] She had hypermobility. She probably had some craniocervical instability. Those things mattered. But what was making her suffer right now, what was making her unable to go to the grocery store, what was making her feel like she was losing her mind, that was her nervous system stuck in survival mode. We had to address both.

[00:20:46] This brings me to something I tell patients all the time. Findings are just findings. Our job is to understand which ones matter. Emma had been to ten specialists. She had stacks of imaging [00:21:00] reports. And yes, there were abnormalities. There always are. But here's what I told her. "You're fairly young, so you shouldn't have abnormalities that typically show up when you're sixty or seventy.

[00:21:13] But if you have things that are common for your age or that are related to your activity level or that are just normal variations, those are findings, but they might not be the meaning behind your symptoms." This is where clinical judgment comes in This is where we have to look at the whole picture: your history, your symptoms, your nervous system state, your structural findings, and figure out what's actually driving your experience.

[00:21:43] For Emma, the disc bulge at L5-S1, probably not the main issue. The reverse curvature in her neck, that's usually a sign of chronic muscle spasm, which is related to involuntary guarding. . The hypermobility, that matters for how we rehab her. [00:22:00] The potential craniocervical instability, that matters for precautions and treatment planning.

[00:22:07] But the reason she couldn't go to the grocery store, that was her window of tolerance being too narrow. That was her nervous system interpreting everything as a threat. Now, there's one more thing I wanna touch on because I think this is really important and not talked about enough. Surgery is trauma to the body, full stop.

[00:22:28] Emma had a surgery in September, a rectopexy for a rectal prolapse, and after that surgery, everything got worse. Now, was the surgery necessary? Likely yes . Did it fix the structural problem it was meant to fix? Also yes . But here's what also happened. Her body experienced a major trauma. Anesthesia, being cut open, the recovery process, all of that is a huge stressor on your system.

[00:22:56] And if your allostatic load bucket was already pretty full, that [00:23:00] surgery might have been the thing that tipped it over. This doesn't mean you shouldn't have surgery when you need it, but it does mean we need to recognize that surgery has effects beyond the structural fix. It impacts your nervous system.

[00:23:14] It can trigger old trauma. It can push you into overwhelm, and we need to address that as part of your recovery. So let me tell you what we actually did for Emma because I think this is where it all comes together. First, I validated her experience. I let her know that what she was feeling was real, that it made sense, and that she wasn't crazy.

[00:23:34] Second, I reframed what was happening. It's not that her body is falling apart. It's that her nervous system is stuck in survival mode and her capacity to cope has been depleted. Third, I gave her some concrete tools. We started with heart rate variability assessment to understand her baseline.

[00:23:53] We introduced Safe and Sound Protocol to start teaching her nervous system what safety feels like. We planned for [00:24:00] gentle manual therapy focused on nervous system regulation, not aggressive manipulation. And we coordinated with her other providers, her PT, her OT, her acupuncturist, because healing happens in community, not in isolation.

[00:24:15] And fourth, I gave her some homework, interoception practice, which is learning to notice when she's running low on battery before she hits zero. Self-compassion work, recognizing that she's not lazy for needing rest, that she's not weak for having limits. And boundary setting, learning to say no to things that drain her and yes to things that restore her.

[00:24:38] Now, I wanna be really honest with you about something. Emma didn't walk out of my office pain-free. She's not going to be pain-free next week or next month. What she did walk out with was understanding, a framework for what's happening in her body, some tools to start working with, a sense that she's not crazy, she's not [00:25:00] broken, and there's a path forward.

[00:25:02] That's what we're doing here. We're playing the long game. Expanding your window of tolerance takes time. Retraining your nervous system takes time. Building mental fitness takes time. But here's the thing. You're going to be living in your body for the rest of your life, so we might as well make it a place you want to be.

[00:25:24] And every small step you take, every time you check your battery, every time you practice interoception, every time you set a boundary, every time you acknowledge your anger, you're building capacity. You're expanding that window. You're teaching your nervous system that it's safe. So if you're listening to this and you're thinking, "That's me," here's what I want you to take away.

[00:25:47] First, your pain getting worse doesn't necessarily mean your body is getting worse. It might mean your capacity to cope has been depleted. Second, you're not starting every day at 100%, and [00:26:00] that's okay. The goal is to recognize where you're actually starting and adjust accordingly.

[00:26:06] Third, high-functioning freeze state is real. Just because you look fine on the outside doesn't mean you're not struggling on the inside. Fourth, anger is appropriate. Grief is appropriate. Whatever you're feeling about your situation is valid. Fifth, it's both and, not either or. You can have structural issues and nervous system dysregulation.

[00:26:30] Both need to be addressed. Sixth, expanding your window of tolerance is like building physical fitness. It takes time, it takes practice, and it happens in small increments. And seventh, you can't heal in the same environment that made you sick. If you're pushing through overwhelm every single day, no amount of treatment is going to fix that.

[00:26:54] You have to change the pattern. You know what all this really boils down [00:27:00] to? It's what I call the science of safety. Your nervous system has one primary job, keep you alive. And when it perceives threat, whether that's physical danger, emotional overwhelm, or just chronic stress, it's going to activate your survival mechanisms, fight, flight, or freeze.

[00:27:18] The problem is your nervous system can't tell the difference between a real threat and a perceived threat. It can't tell the difference between a tiger chasing you and your inbox overflowing. It responds the same way. So if you've been living in a state of chronic stress for years, and let's be honest, most of us have, your nervous system has learned that the world is dangerous.

[00:27:41] It's stuck in threat mode. And when your nervous system is in threat mode, everything hurts more. Your pain threshold drops. Your tolerance for stimulation drops. Your ability to regulate your emotion drops. The way out isn't to convince yourself that you're safe. It's to give [00:28:00] your nervous system experiences of safety over and over until it starts to believe it.

[00:28:06] That's what Safe and Sound Protocol does. That's what HeartMath does. That's what gentle, attuned manual therapy does. That's what being in relationship with providers who actually listen to you does. We're teaching your nervous system you are safe. You can let your guard down. You don't have to be in survival mode all the time.

[00:28:28] Now, here's one more thing I wanna mention because it came up with Emma, and I think it's relevant for a lot of you listening. There's this trait called highly sensitive person, or HSP. It's not a diagnosis. It's just a personality trait. But about fifteen to twenty percent of the population has it. 

[00:28:47] And if you're an HSP, you feel things more deeply. You pick up on subtleties that other people miss. You're more affected by other people's emotions. You're more sensitive to sensory input: [00:29:00] lights, sounds, textures. It's not a bad thing. In fact, it can be a gift. HSPs tend to be very empathetic, very creative, very intuitive. But here's the thing.

[00:29:12] If you're an HSP and you have chronic pain, you're going to experience that pain more intensely. You're going to be more affected by stress. Your window of tolerance is going to be narrower. Emma was an HSP. I could tell within the first few minutes of talking to her. She was picking up on everything, my tone of voice, the energy in the room, her mom's anxiety.

[00:29:35] She was processing all of it, and that's exhausting. If you're an HSP, you need to know that about yourself, not so you can feel broken or different, but so you can adjust your expectations, so you can build in more recovery time, so you can be more intentional about protecting your energy.

[00:29:54] One thing I really wanna emphasize is that Emma didn't come to me in a vacuum. She'd been working with other [00:30:00] providers. She had a physical therapist who was trained in hypermobility. She had an occupational therapist working on nervous system regulation. She was getting acupuncture. And I didn't tell her to stop any of that because here's the truth.

[00:30:16] Healing happens in community, not in isolation. I'm not the hero who's going to swoop in and fix everything. That's not how this works. What I can do is be one part of a team. I can coordinate with her other providers. I can add some tools to her toolbox. I can help her understand what's happening in her body so she can make informed decisions.

[00:30:39] But she's the one doing the work. She's the one showing up every day, practicing interoception, setting boundaries, doing her exercises, going to her appointments, and her other providers are supporting her in different ways. The PT is working on movement patterns. The OT is working on functional capacity.

[00:30:57] The acupuncturist is working [00:31:00] on energy flow and nervous system balance. We're all working together. That's what good care looks like. Not one person with all the answers, but a team of people who respect each other's expertise and keep the patient at the center. Okay, so you're listening to this, and maybe you're thinking, "This all sounds great, but what can I actually do right now?"

[00:31:22] Let me give you three things you can start today. First, the phone battery check-in. Every morning when you wake up, ask yourself, "What's my battery percentage today?" Not what you wish it was, not what it should be. What is it actually? If you're at forty percent, you don't get to plan a hundred percent day.

[00:31:42] You have to adjust. Maybe that means saying no to something. Maybe that means asking for help. Maybe that means taking a nap in the afternoon. This isn't about being lazy. This is about being realistic. You can't pour from an empty cup, as they [00:32:00] say. Second, the interoception practice.

[00:32:04] Set a timer on your phone for three times a day. When it goes off, pause and scan your body. What are you feeling? Where are you feeling it? What's your energy level? What's your pain level? What's your emotional state? You're not trying to change anything. You're just noticing. You're building awareness because the more you can notice when you're starting to tip into overwhelm, the earlier you can intervene.

[00:32:31] You don't have to wait until you're at zero to do something about it. Third is the anger journal. Get a notebook. Every night before bed, write down one thing you're angry about. Just one. It can be about your pain, about your situation, about something that happened that day, whatever. Write it down and let yourself feel it.

[00:32:53] You don't have to do anything with it. You don't have to fix it or solve it or make it better. Just acknowledge it [00:33:00] because that anger is there whether you acknowledge it or not, and if you don't give it a place to go, it's going to show up in your body. It's not linear. There will be setbacks. There will be days when you feel like you're back at square one, but if you keep showing up, if you keep practicing, if you keep being compassionate with yourself, you will get there.

[00:33:21] Before we wrap up, I wanna share something personal with you. I've been doing this work for a long time, and I've seen a lot of patients like Emma, patients who've been told they're too young to have pain, patients who've been dismissed, who've been told it's all in their head, who've been through 10 specialists and still don't have answers.

[00:33:41] And every single time, I'm reminded of why I do this work, because pain is isolating. It makes you feel like you're the only one going through this, like no one understands, like you're somehow failing because you can't just push through anymore. But you're not alone, and you're not failing. [00:34:00] Your nervous system is doing exactly what it's designed to do It's trying to protect you.

[00:34:05] It's just a little overzealous right now. And the beautiful thing is nervous systems can learn. They can change. They're plastic, adaptable, resilient. You can teach your nervous system new patterns. You can expand your capacity. You can heal. It won't look like going back to who you were before the pain, because you can't un-know what you know now.

[00:34:31] You can't un-experience what you've been through, but you can move forward. You can build a life that feels meaningful and connected and alive, even with pain in the picture. That's what I want for Emma, and that's what I want for you. So here's my challenge to you this week. Pick one of those three practices I mentioned, just one.

[00:34:54] The battery check-in, the interoception practice, or the anger journal. [00:35:00] Do it every day for a week and see what you notice. And if you wanna go deeper, if you wanna understand more about how your nervous system works and how to work with it, check out the resources on my website at bodymindpain.com. 

[00:35:14] But for now, just start with one practice. Build from there, because healing isn't about doing everything perfectly. It's about showing up consistently. It's about being curious instead of critical. It's about treating yourself with the same compassion you'd offer a good friend. You deserve that. Your nervous system deserves that.

[00:35:36] Your body deserves that. Thank you for being here. Thank you for listening. Thank you for trusting me with your time and your attention. If this episode resonated with you, please share it with someone who might need to hear it. 

[00:35:50] Until next time, remember, your pain is real, your story matters, and healing is possible. I'm Dr. Zev Nevo, and this is Mind Your [00:36:00] Body. Take care of yourself, and remember, you're not broken. You're just human.