How to unlearn pain
July 16, 2024 8:56 PM Subscribe
This Might Hurt is a documentary about a revolution in the understanding and treatment of chronic pain that has been quietly brewing over the last few decades. We know that millions of people around the world suffer from chronic pain and other debilitating bodily symptoms. Medication (such as opioids) don't often help, or carry intolerable side effects, and traditional cognitive-based psychotherapy doesn't seem to fare well either. Can we do better? Increasing evidence accumulated over the last few decades suggests that focusing on hidden powerful emotions may make all the difference, at least for some people. It all dates back to an iconoclastic New York City physician named John Sarno, (NYT link, archive.today version here) whose mission to rid the world of back pain inspired a legacy of controversy and devotion.
Sarno's work has been further elaborated upon and developed over the years. Dr. Howard Schubiner, a Michigan internist and sometime disciple of Sarno who has dedicated his career to the treatment of chronic pain, has contributed to the development of several kinds of psychotherapy techniques, including Emotional Awareness and Expression Therapy. EAET has been shown to be vastly superior to CBT for chronic pain in preliminary studies.
Other kinds of medically-unexplained symptoms seem to respond to more intensive emotion-focused treatment. The CBC program White Coat, Black Art reported on a woman who was off work for 8 years and "got her life back with unique kind of talk therapy". (Link to audio) Intensive short term psychodynamic therapy (or ISTDP) appears to have significant benefit for a number of chronic physical symptoms, including tremors and paralysis. (The history of ISTDP, and its colourful inventor, Dr. Habib Davanloo, is not without controversy, but the evidence for its efficacy continues to accrue.)
Sarno's work has been further elaborated upon and developed over the years. Dr. Howard Schubiner, a Michigan internist and sometime disciple of Sarno who has dedicated his career to the treatment of chronic pain, has contributed to the development of several kinds of psychotherapy techniques, including Emotional Awareness and Expression Therapy. EAET has been shown to be vastly superior to CBT for chronic pain in preliminary studies.
Other kinds of medically-unexplained symptoms seem to respond to more intensive emotion-focused treatment. The CBC program White Coat, Black Art reported on a woman who was off work for 8 years and "got her life back with unique kind of talk therapy". (Link to audio) Intensive short term psychodynamic therapy (or ISTDP) appears to have significant benefit for a number of chronic physical symptoms, including tremors and paralysis. (The history of ISTDP, and its colourful inventor, Dr. Habib Davanloo, is not without controversy, but the evidence for its efficacy continues to accrue.)
Great post! I'm diving into this in my talk therapy right now too. I wanted more details on what EAET treatment looked like in the trial (linked above). Reading the references, here's a nice summary:
"This therapy draws from many other psychological techniques or therapies, including: a) pain neuroscience education or the “explaining pain” model, which identifies the brain as the primary pain organ and posits the reversibility of pain following changes in beliefs; b) pain exposure therapy, which encourages patients to engage in pain-eliciting behaviors so that they can unlearn their pain-related fear; c) exposure-based cognitive-behavioral therapies, which help patients process emotions underlying PTSD and other anxiety disorders; d) intensive short-term psychodynamic therapy, which challenges patients’ defenses to help them experience and express unconscious emotions; e) experiential therapies, which use techniques such focusing, empty chair, and 2-chair dialog to empathically facilitate patients’ awareness and expression of emotions; f) written emotional disclosure or expressive writing, which appears to have some benefit for centralized pain; g) assertiveness training, which has a long history of helping patients overcome their fears of expressing their power and strength in relationships; and h) rescripting therapy, which helps patients imagine and voice new, more powerful or less frightening endings to recurrent nightmares or intrusive memories."
"In therapy, patients are encouraged to recall a conflict person and situation and express their underlying emotions to the imagined / remembered other person, using words, voice tone, facial muscles, and body. Such expression amplifies emotional experience, clarifies motives, and reduces fear of expression. Patients need to express the “right emotion at the right target” rather than secondary emotions at substitute targets. Patients benefit by “rescripting” their story, accessing or creating new, adaptive emotions (e.g., anger, sadness, love) that were not originally expressed."
"To further reduce both stress and pain, patients are encouraged to identify the needs and feelings that might be expressed in actual relationships. Healthy communication often involves a combination of assertion balanced by connecting feelings, but also may involve setting new boundaries or even distancing oneself from others. Planning for and role playing such interpersonal encounters occurs in session, followed by actual attempts in real life."
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7309024/
posted by jebs at 3:23 AM on July 17 [2 favorites]
"This therapy draws from many other psychological techniques or therapies, including: a) pain neuroscience education or the “explaining pain” model, which identifies the brain as the primary pain organ and posits the reversibility of pain following changes in beliefs; b) pain exposure therapy, which encourages patients to engage in pain-eliciting behaviors so that they can unlearn their pain-related fear; c) exposure-based cognitive-behavioral therapies, which help patients process emotions underlying PTSD and other anxiety disorders; d) intensive short-term psychodynamic therapy, which challenges patients’ defenses to help them experience and express unconscious emotions; e) experiential therapies, which use techniques such focusing, empty chair, and 2-chair dialog to empathically facilitate patients’ awareness and expression of emotions; f) written emotional disclosure or expressive writing, which appears to have some benefit for centralized pain; g) assertiveness training, which has a long history of helping patients overcome their fears of expressing their power and strength in relationships; and h) rescripting therapy, which helps patients imagine and voice new, more powerful or less frightening endings to recurrent nightmares or intrusive memories."
"In therapy, patients are encouraged to recall a conflict person and situation and express their underlying emotions to the imagined / remembered other person, using words, voice tone, facial muscles, and body. Such expression amplifies emotional experience, clarifies motives, and reduces fear of expression. Patients need to express the “right emotion at the right target” rather than secondary emotions at substitute targets. Patients benefit by “rescripting” their story, accessing or creating new, adaptive emotions (e.g., anger, sadness, love) that were not originally expressed."
"To further reduce both stress and pain, patients are encouraged to identify the needs and feelings that might be expressed in actual relationships. Healthy communication often involves a combination of assertion balanced by connecting feelings, but also may involve setting new boundaries or even distancing oneself from others. Planning for and role playing such interpersonal encounters occurs in session, followed by actual attempts in real life."
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7309024/
posted by jebs at 3:23 AM on July 17 [2 favorites]
I was diagnosed with CRPS (Complex Regional Pain Syndrome) last spring. It had started with a minor foot injury. By the time I was diagnosed, about a year later, I had been housebound for several months and was considering bunion surgery.
These days I'm no longer afraid of my shoes. I've gone back to work and I'm rebuilding my life. I feel better, physically, than I have in years. I still have occasional symptoms, but they are mild and I don't let them stop me.
The thing that helped me the most was Dan Buglio's YouTube channel, Pain Free You. It's never going to be easy to unlearn pain, but Dan makes it simple and cheap. I still have an excess of anxiety (I suspect that's true of most people who experience chronic pain), but it's improving. Unlearning pain has given me the tools to also unlearn worrying and ruminating and catastrophizing.
posted by temporal_cj at 3:43 AM on July 17 [3 favorites]
These days I'm no longer afraid of my shoes. I've gone back to work and I'm rebuilding my life. I feel better, physically, than I have in years. I still have occasional symptoms, but they are mild and I don't let them stop me.
The thing that helped me the most was Dan Buglio's YouTube channel, Pain Free You. It's never going to be easy to unlearn pain, but Dan makes it simple and cheap. I still have an excess of anxiety (I suspect that's true of most people who experience chronic pain), but it's improving. Unlearning pain has given me the tools to also unlearn worrying and ruminating and catastrophizing.
posted by temporal_cj at 3:43 AM on July 17 [3 favorites]
Thank you so much for this post, greatgefilte. And thanks to commenters who have posted helpful ideas and links! Like many people, I have struggles with chronic pain and I’m looking forward to digging into these resources.
posted by hilaryjade at 5:23 AM on July 17
posted by hilaryjade at 5:23 AM on July 17
Full disclosure: I have recommended some of these treatment approaches to my own patients. By far the biggest barrier is getting people to consider the possibility that their emotions could explain, or exacerbate, their symptoms, rather than looking to an external diagnosis or physiological cause. When this happens, I usually ask two questions:
1. If you would want us, the professionals, to be really careful and attentive in your medical care, why wouldn't you want to pay the same amount of attention and care to your own emotions, rather than ignoring their power? (Often what comes up is that a patient has been mistreated, ignored, or neglected by someone in a position of authority in the past, and this has created very understandable mistrust and skepticism of physicians!)
2. At this point, you've had X number of investigations and Y number of treatments for your condition, and yet you're still not feeling well. What do you have to lose by looking inwards?
For those who are looking for low-cost ways to pursue these sorts of treatment:
-The Pennebaker Writing Protocol is a low-cost, easy way to release some of the power of unexpressed emotions.
-The Curable app invokes some of the aforementioned approaches
-Freedom from Chronic Pain offers a money-back guarantee
-I have an educational license for "This Might Hurt" and would be happy to share a viewing link to MeFites who may not be able to pay for it. MeMail me.
(I don't have any financial or other formal links with anyone I've referenced.)
posted by greatgefilte at 5:39 AM on July 17 [7 favorites]
1. If you would want us, the professionals, to be really careful and attentive in your medical care, why wouldn't you want to pay the same amount of attention and care to your own emotions, rather than ignoring their power? (Often what comes up is that a patient has been mistreated, ignored, or neglected by someone in a position of authority in the past, and this has created very understandable mistrust and skepticism of physicians!)
2. At this point, you've had X number of investigations and Y number of treatments for your condition, and yet you're still not feeling well. What do you have to lose by looking inwards?
For those who are looking for low-cost ways to pursue these sorts of treatment:
-The Pennebaker Writing Protocol is a low-cost, easy way to release some of the power of unexpressed emotions.
-The Curable app invokes some of the aforementioned approaches
-Freedom from Chronic Pain offers a money-back guarantee
-I have an educational license for "This Might Hurt" and would be happy to share a viewing link to MeFites who may not be able to pay for it. MeMail me.
(I don't have any financial or other formal links with anyone I've referenced.)
posted by greatgefilte at 5:39 AM on July 17 [7 favorites]
I would caution:I know somebody who got super into this stuff and now essentially doesn’t believe back injuries are ‘real’ and it’s super annoying and we all avoid mentioning any physical ailments around him if possible. I’m not saying the aboveposted stuff isn’t legitimate, but it does seem to inspire some crackpottery around the edges.
posted by showbiz_liz at 5:50 AM on July 17 [8 favorites]
posted by showbiz_liz at 5:50 AM on July 17 [8 favorites]
Nothing imaginary about mine. L4/L5 herniation combined with bone spurs. Essentially like taking a cheese grater to my spinal nerves. For over a decade my feet and legs have been half numb and half on fire 100% of the time. Physical therapy did little or nothing. Eventually you adapt and learn to somewhat ignore it. I'm not to pick up anything heavier than a gallon of milk. I walk watching each step because my reaction time is rather poor making me prone to prat falls. Self-medication can also be efficacious...
posted by jim in austin at 6:48 AM on July 17
posted by jim in austin at 6:48 AM on July 17
And if those don't work. The occasional ketamine infusion can work wonders temporarily.
posted by neonamber at 7:21 AM on July 17 [1 favorite]
posted by neonamber at 7:21 AM on July 17 [1 favorite]
Nothing imaginary about mine.
Nobody is saying anyone's pain is imaginary here. Just because something is not caused by a specific injury doesn't mean it's imaginary, and just because something IS caused by a specific injury doesn't mean there aren't potentially other mechanisms involved in making things worse.
posted by We put our faith in Blast Hardcheese at 7:43 AM on July 17 [13 favorites]
Nobody is saying anyone's pain is imaginary here. Just because something is not caused by a specific injury doesn't mean it's imaginary, and just because something IS caused by a specific injury doesn't mean there aren't potentially other mechanisms involved in making things worse.
posted by We put our faith in Blast Hardcheese at 7:43 AM on July 17 [13 favorites]
I have also had an experience with being told that the pain might be in my head, and (after months of trying stuff and failing) taking the “it’s mental” idea seriously, working on my mindset, and having the pain resolve. Like others mentioned above, my pain started with a real injury and persisted for months after my inflammation had gone down. I was given the concept by a chiropractor/PT who I was somewhat suspicious of, but at that point I was willing to try any snake oil to be able to walk comfortably for more than half a mile. I didn’t use a formal method to retrain my brain, I just.. did my best to try to quiet it and be open to the concept that it might be a false pain signal. The pain went away after about a month of basically telling myself “give your foot a chance to succeed.” Truly bizarre.
posted by samthemander at 8:24 AM on July 17 [6 favorites]
posted by samthemander at 8:24 AM on July 17 [6 favorites]
As a young adult (30 years ago), I started experiencing lower back pain. It flared on and off for months. A close friend recommended a book of Sarno's, and the pain disappeared as I read it. Not only that, but by some strange coincidence, my severe seasonal allergies also stopped, and have returned maybe 3-4 times for short periods in the decades since.
Anecdotal evidence like this doesn't amount to much, but it sure worked for me.
Since then I've wondered whatever happened to Dr. Sarno, and just assumed that he'd disappeared into crackpot infamy. Even if it's effective, it all seems like magic.
Looking forward to reading this.
posted by dbscissors at 8:35 AM on July 17 [2 favorites]
Anecdotal evidence like this doesn't amount to much, but it sure worked for me.
Since then I've wondered whatever happened to Dr. Sarno, and just assumed that he'd disappeared into crackpot infamy. Even if it's effective, it all seems like magic.
Looking forward to reading this.
posted by dbscissors at 8:35 AM on July 17 [2 favorites]
Haven't opened the doc to watch it yet, but I'm curious for others who are familiar with Sarno -- have any of his acolytes developed a more sound explanatory reasoning? I am fairly positive on Sarno, read his book while dealing with sciatica and did some journaling and thinky stuff based on his work. Hard to point to any specific intervention as "working" when you're throwing everything against the wall to see what sticks, but I found the overall approach useful.
BUT I always felt like the physiological mechanism offered in his book -- essentially, you stuff down anger and your body decides to reduce blood flow to certain organs and tissues to deal with your psychological pain by transferring it to physical pain -- never seems well-baked, and had nothing much peer-reviewed or scientific in support of it.
Have those who came after him figured out a more plausible explanatory mechanism?
posted by kensington314 at 9:32 AM on July 17 [4 favorites]
BUT I always felt like the physiological mechanism offered in his book -- essentially, you stuff down anger and your body decides to reduce blood flow to certain organs and tissues to deal with your psychological pain by transferring it to physical pain -- never seems well-baked, and had nothing much peer-reviewed or scientific in support of it.
Have those who came after him figured out a more plausible explanatory mechanism?
posted by kensington314 at 9:32 AM on July 17 [4 favorites]
This is relevant to my interests. Thanks for posting it.
posted by gentlyepigrams at 10:13 AM on July 17 [1 favorite]
posted by gentlyepigrams at 10:13 AM on July 17 [1 favorite]
Nothing imaginary about mine.
Actually, everyone's pain (and every experience) IS ultimately imaginary. See: westworld.
posted by lalochezia at 10:25 AM on July 17
It's kind of amusing how things go round and round. It was exactly thanks to cases of what we might now call chronic pain that Freud ended up inventing psychoanalysis, all the way back in the late 1800s. Even then he happened upon the idea that somatic symptoms might be somehow connected to or outright caused by psychological/emotional disturbances. My very superficial familiarity with non-western medicine suggests that he was far from the first to make that connection, and I'm sure if we looked farther afield we'd find it popping up in one form or another throughout human history the world over.
But I won't complain about this reinvention of the wheel if it gets that wheel out to more people who need it.
posted by obliterati at 10:58 AM on July 17 [5 favorites]
But I won't complain about this reinvention of the wheel if it gets that wheel out to more people who need it.
posted by obliterati at 10:58 AM on July 17 [5 favorites]
Someone recommended that "Healing Back Pain" book to me, and based on what I found when I searched, I decided it was probably quackery and skipped it.
But then, when I took a Qi Gong class the exercises seemed vaguely beneficial (and felt good) despite its, uh, colorful theoretical basis. So maybe I should give it a shot.
posted by Foosnark at 11:32 AM on July 17 [1 favorite]
But then, when I took a Qi Gong class the exercises seemed vaguely beneficial (and felt good) despite its, uh, colorful theoretical basis. So maybe I should give it a shot.
posted by Foosnark at 11:32 AM on July 17 [1 favorite]
I have just started this journey by reading "The Way Out", so I'm excited to check out some of the resources ya'll have linked here!
I have a serious injury (end-stage post-traumatic arthritis in my ankle), and my joint is never going to be "normal". But I'm also exploring whether some portion of my ankle arthritis pain is neuroplastic. I'd love to find a way to reduce my pain with these techniques, even if that's still in combination with my other tools (mostly my ExoSym device and my lace-up brace for when I need an ExoSym break).
The ExoSym 100% takes the pain away, but I also like to walk barefoot sometimes -- getting out of the water after a swim, meandering around my house, etc. The holy grail would be training pain-free in martial arts barefoot in a lace-up brace -- but I'll have to experiment and see what's possible.
posted by cnidaria at 11:53 AM on July 17 [1 favorite]
I have a serious injury (end-stage post-traumatic arthritis in my ankle), and my joint is never going to be "normal". But I'm also exploring whether some portion of my ankle arthritis pain is neuroplastic. I'd love to find a way to reduce my pain with these techniques, even if that's still in combination with my other tools (mostly my ExoSym device and my lace-up brace for when I need an ExoSym break).
The ExoSym 100% takes the pain away, but I also like to walk barefoot sometimes -- getting out of the water after a swim, meandering around my house, etc. The holy grail would be training pain-free in martial arts barefoot in a lace-up brace -- but I'll have to experiment and see what's possible.
posted by cnidaria at 11:53 AM on July 17 [1 favorite]
John D Sarno's books totally changed my life, and I've given them to others (including my husband) and they have done the same for many. I've incorporated his teachings to understand more than just back pain! And like someone mentioned above, at the time I got into mind body stuff I would have thought it was quackery were I not studying QiGong as a meditation exercise. The combination really opened my mind and healed a lot more than back pain. And I'm still a science nerd!
posted by kdutton at 12:55 PM on July 17 [1 favorite]
posted by kdutton at 12:55 PM on July 17 [1 favorite]
I’m not saying the aboveposted stuff isn’t legitimate, but it does seem to inspire some crackpottery around the edges.
There was a former site member who got booted, who happened to be a big John Sarno advocate; so I'm pleasantly surprised that this thread is going well. Then again, this was a guy whose crackpot status was pretty much visible from space, and he would recommend John Sarno in every thread about physical pain regardless of the suitability. It was one of like five regular topics he just plain would not shut up about (the superiority of European culture and the bourgeois nature of monogamy being two others).
If this works for ya, fantastic.
posted by EmpressCallipygos at 2:40 PM on July 17 [1 favorite]
There was a former site member who got booted, who happened to be a big John Sarno advocate; so I'm pleasantly surprised that this thread is going well. Then again, this was a guy whose crackpot status was pretty much visible from space, and he would recommend John Sarno in every thread about physical pain regardless of the suitability. It was one of like five regular topics he just plain would not shut up about (the superiority of European culture and the bourgeois nature of monogamy being two others).
If this works for ya, fantastic.
posted by EmpressCallipygos at 2:40 PM on July 17 [1 favorite]
It's kind of amusing how things go round and round. It was exactly thanks to cases of what we might now call chronic pain that Freud ended up inventing psychoanalysis, all the way back in the late 1800s. Even then he happened upon the idea that somatic symptoms might be somehow connected to or outright caused by psychological/emotional disturbances. My very superficial familiarity with non-western medicine suggests that he was far from the first to make that connection, and I'm sure if we looked farther afield we'd find it popping up in one form or another throughout human history the world over.
Indeed, one of the major criticisms of traditional Freudian theory and practice that led to the development of modalities such as ISTDP and Sarno's work is that Freud eventually encouraged a non-interventionalist stance on the part of the analyst, as opposed to the more active, challenging, and experiential approach he attempted with patients at first. (There's a famous, possibly true, story about a younger and more interactive Freud curing Mahler's chronic impotence in a single four hour session.) Anecdotally, what I hear from colleagues who practice psychedelic-assisted psychotherapy is that ketamine and the like appear to enable a similar healing process to take place by allowing safe contact with and processing of suppressed powerful emotions - I wouldn't be surprised if something similar developed in various pre-technological cultures that had access to psychedelic substances.
posted by greatgefilte at 3:52 PM on July 17 [1 favorite]
Indeed, one of the major criticisms of traditional Freudian theory and practice that led to the development of modalities such as ISTDP and Sarno's work is that Freud eventually encouraged a non-interventionalist stance on the part of the analyst, as opposed to the more active, challenging, and experiential approach he attempted with patients at first. (There's a famous, possibly true, story about a younger and more interactive Freud curing Mahler's chronic impotence in a single four hour session.) Anecdotally, what I hear from colleagues who practice psychedelic-assisted psychotherapy is that ketamine and the like appear to enable a similar healing process to take place by allowing safe contact with and processing of suppressed powerful emotions - I wouldn't be surprised if something similar developed in various pre-technological cultures that had access to psychedelic substances.
posted by greatgefilte at 3:52 PM on July 17 [1 favorite]
(There's a famous, possibly true, story about a younger and more interactive Freud curing Mahler's chronic impotence in a single four hour session.)
must not make snarky comment, must not make...
Yeah, a huge pile of pharmaceutical quality cocaine and combined with vigorous therapeutic manual palpitations and stimulation while wearing an electrified belt might do that for a fella!
...damn it!
posted by loquacious at 5:53 PM on July 17 [3 favorites]
must not make snarky comment, must not make...
Yeah, a huge pile of pharmaceutical quality cocaine and combined with vigorous therapeutic manual palpitations and stimulation while wearing an electrified belt might do that for a fella!
...damn it!
posted by loquacious at 5:53 PM on July 17 [3 favorites]
Meanwhile, opiates are actually a godsend for many people with chronic pain, and the horrific prohibition regimes that have taken root in many countries are causing vast amounts of suffering and death because chronic pain sufferers have to jump through hoops to get prescriptions, and can get cut off suddenly at any moment.
(I have zero respect for any article that talks about how horrible opiates are.)
posted by adrienneleigh at 9:27 PM on July 17 [1 favorite]
(I have zero respect for any article that talks about how horrible opiates are.)
posted by adrienneleigh at 9:27 PM on July 17 [1 favorite]
I thought of an analog for brain-induced pain that nearly everyone has experienced, since it can be hard to imagine or accept that your brain can cause pain by itself: that ringing in your ears that you get after a noisy event (Or for some of us, actual tinnitus, which sounds the same).
You know that noise is only in your head and not in your room, but it’s also definitely there and definitely unpleasant and you can’t just make it go away.
posted by antinomia at 12:37 AM on July 18 [1 favorite]
You know that noise is only in your head and not in your room, but it’s also definitely there and definitely unpleasant and you can’t just make it go away.
posted by antinomia at 12:37 AM on July 18 [1 favorite]
Thank you for putting this post together! This is an area I am very much interested in and I've been thoroughly enjoying going through the various links. From the CBC link, the work done out of Halifax is so inspiring and innovative.
I've forwarded this to a few folks and will no doubt send it to more. This is why I come to Metafilter, for posts like this.
posted by nanook at 5:11 PM on July 18 [1 favorite]
I've forwarded this to a few folks and will no doubt send it to more. This is why I come to Metafilter, for posts like this.
posted by nanook at 5:11 PM on July 18 [1 favorite]
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I had shoulder pain for 6 years. It started as an injury and just .. kept going. Since I had imaging showing tendinitis had occurred, there was a reason for my pain, so even after I started to suspect central sensitization the PTs would say that no, your pain is real. I mean yes, the pain is 100% real, and it's miserable! But it was also no longer being caused by the injury.
First, how did I know, so how might you know?
- The pain was somewhat diffuse within my shoulder, not in one pinpoint spot. Injury pain stays in one place, brain pain fills a joint or area, and can also shift locations a bit.
- Real exercise didn't usually hurt and often made it better, other things like cooking or using a computer are what made it hurt. I could go bouldering, hanging on my shoulder and using those muscles and tendons to haul myself up a wall, and I would get pain relief, but then I would try to cook a meal and .. intense pain!
- The pain would flare when I got irritated or stressed out, and go away when I calmed down. It took me a long time to notice and acknowledge this, it was the final clue and the clincher for me.
The protocol that finally cured my pain:
- Week 1: Time any activity that triggers pain to see how long it takes for the pain to start. For me that was cooking, knitting and using a computer. Keep diary of these times (I used a shortcut on my phone to make make it easy), and at the end of the week average the times.
- Weeks 2 and 3: Take that average (let's say on average it takes 6 minutes for the pain to start) and cut it in half. Now, every time you start one of your triggering activities you will also start a timer for, in this case, 3 minutes. When the timer goes off, stop what you're doing, change position, do some big movements (walk around, swing your arms around, etc) and then if there's no pain go back to what you were doing. Start a timer again first! If the pain starts earlier during your activity -- stop immediately and do the rest/movement thing.
- Each week after: Add 10% to the timer, and continue timing and resting/moving.
The idea is to never trigger the pain, so your brain forgets about it and has nothing to reinforce. After a couple of months I was able to ditch the timer. Now the only time that pain comes back is when I do something very provoking (trying to paint some rooms, for instance) without taking any breaks. And I get rid of it by stopping the triggering activity as soon as I feel pain. You may think this would lead me to lose strength and ability to perform the normal activities of daily life, but in fact I'm finally getting stronger because I'm doing push ups and pull ups and climbing without fear now. Ie., don't stop doing strength-building exercises, they're usually not the triggers for this sort of pain, anyway.
Be sure you rule out non-brain-induced causes of pain first before you try this because you certainly don't want to try a multi-month protocol for central sensitization if your pain is actually being caused by something like undiagnosed cancer that needs to be addressed quickly. Anyway, hope this helps someone. And yeah, I recognize that the protocol may interfere with a lot of types of work, but I'm going to skip the rant I want to do about how a couple of months of accomodations is entirely reasonable to deal with this kind of miserable pain and employers should be understanding of that, etc.
posted by antinomia at 1:00 AM on July 17 [44 favorites]