change your brain, change your pain

Ever have a migraine with stress? Physical chest pain after a break up or loss of a loved one? These associations between physical and emotional pain are common and well-known. But what about knee pain after that big move? Sure, you lifted a box wrong and maybe that was your first bout of physical activity in a few months - but now it’s been a year and that pesky knee pain is still there. What about back pain after a job loss? Maybe you don’t even associate the physical pain with the timing of emotional pain/stress. The pain you are experiencing is real and may have started from an injury or disease process, but your emotional health is also real and working on both allows you to experience whole body healing.

First, let’s talk science and then we’ll get into how to respond and relieve pain that is exacerbated by stress and negative experiences. Pain is experienced in three ways - sensory, emotionally and cognitively. Sensory - the experience of the noxious stimulus - when you felt that “pop” after lifting a box and twisting your ankle. Your brain tells you to STOP putting weight on your ankle. Emotionally - the negative emotion that we experience when we feel pain, it brings tears to your eyes, makes you feel tired and allows your body to cope with the negative experience of pain. Lastly, cognitively - our brain influences the meanings and consequences of an injury or pain. This allows us to feel fear or anxiety about spraining our ankle again - we may not volunteer to help a friend move because of the fear/anxiety that lifting boxes might cause another injury. These are all ways we experience pain neurobiologically, and help us to prevent future pain. All in all - pain is good. We want to to know when something is too hot or too painful otherwise we would all have a lot more bumps and scratches! But, chronic pain is experienced repeatedly (getting in/out of bed, walking, etc.) and can be worsened when we also have emotional pain. (3)

Research has shown that activity in the anterior cingulate cortex (area in the brain that regulates emotional reactions) increases activity of the vagus nerve during stressful experiences (anteriorcingulate cortex-vagus nerve pathway). The vagus nerve starts in the brainstem and runs down the neck to the chest and abdomen. When the vagus nerve is overstimulated, it can cause pain and nausea (1). By physically stimulating the vagus nerve (e.g. deep breathing and placing a heavy hand on your chest), it can work the opposite way - helping calm and activate the parasympathetic nervous system to decrease the negative way you are experiencing the stressful situation.

You may be thinking, if I already have chronic pain and stress, can I fix it? YES! Due to neuroplasticity! This fancy fun word (just me?) means that we can retrain our brain. Neuroplasticity refers to the brain's ability to form and reorganize neural connections. As the brain develops, learns or adapts, wire-like extensions grow from one neuron to connect with another. Connections are strengthened that are used more frequently, while less used connections grow weaker. (2) After a stroke, you can retrain your muscles by using new connections, or rewiring your brain. Will you function the same as you did before? Maybe not. For example, do you still have that scar from when you hit your head when you were 8? Yes. You may still have emotional or physical “scars” but you can re-train your brain to heal and therefore experience less overall pain so you can move better, live better and prevent further damage.

How do we do that? According to research (3) consistent fear of pain (having chronic pain and therefore fear of any movement will lead to pain) leads to anxiety of pain and therefore our brain’s experience of pain is dysregulated. The anterior cingulate cortex-vagus nerve pathway was proven (3) to be overstimulated by acute physical pain, emotional pain, and social rejection. This means that the heartache you feel after the loss of a loved one, or the low back pain that worsens after losing your job, is REAL physical pain…AND real emotional pain.

On the contrary, positive emotional states REDUCE pain. So, if we can’t stop life and pain from happening, so how do we get to this positive emotional state? See the exercises/activities described below! We activate the positive brain receptors just like our pain has activated the negative ones. However, that does NOT mean that you should suppress your negative feelings. There is also research that supports that lack of awareness, expression and experiencing of negative emotions is associated to GREATER pain and dysfunction. This means we should experience these negative emotions and be motivated to adapt and move forward. (3)

OKAY! Now that we understand the science behind the pain we are experiencing, here’s some practical ways you can reduce pain. If you need more guidance coping with emotional or physical pain please see a physical therapist to address your original injury or physical pain, and a mental health professional to help heal the underlying emotional pain/stress that only complicates your physical pain.  

1. Yoga/Mindfulness Exercises

Practicing mindfulness and teaching your body how to relax can have a significant impact on your perception and experience of pain. Plus, it helps decrease stress levels and overall improve your health! Try doing these 3 exercises once in the morning and once at night. Bonus points if you do them at lunch time too! If you can’t do these every day, try practicing these exercises before a stressful event or situation. Going to the in-laws? Having surgery tomorrow? Try using these mindfulness techniques. They will help calm you by activating your vagus nerve and decreasing that fight-or-flight response, therefore reducing pain or stress you might experience.

  • Diaphragmatic breathing - place one hand on your stomach and one hand on your chest. Practice breathing, feeling your belly rise when you inhale and fall when you exhale. Try not to let your chest move. Close your eyes and focus on fully inhaling and exhaling for 10 breaths.
  • Yoga Flow - look up a nice relaxing yoga flow on YouTube and stretch out those muscles!
  • Lie still on your back with your eyes closed. Tighten all your muscles without moving. Starting with your toes, SLOWLY relax each muscle in your body. Focus only on the muscles you are relaxing, try not to let your mind wander. This is a good one to do right before bed too!
2. Stay Active!

Take a walk. Research shows that people who increase their activity alone experience a reduction in low back pain. If it’s nice outside, get that vitamin D and get outside! If not, you don’t need a treadmill or a gym membership to take a walk. Head to your local grocery store, mall, any indoor flat surface and WALK! These places are also great because there is plenty of people watching and places to rest.

Do Yoga or Tai Chi - mindfulness exercises and staying active all in one! Plus, it works on your posture and core control, also helping with chronic back pain.

3. Eat Healthy

Eat lots of protein and healthy fats to improve neuron function! Getting the right nutrients helps your body and your brain function better - allowing those neurons to form faster and better connections.

4. Emotionally and physically engage with a loved one (this includes pets!)

Hold hands, kiss, hug, snuggle. Physical and meaningful touch releases those nice, feel good hormones in your brain. We do this naturally when we experience acute pain. Watch any movie with woman in labor - she is almost always holding (or very tightly squeezing) her partners hand. This also works for chronic pain - so Netflix and chill actually has some pain relieving benefits, who knew?

5. Don't suppress emotions - experience them

People who suppress their negative emotions instead of experiencing them and talking about them are more likely to experience physical pain. This is because those negative feelings exist no matter who you are! If you aren’t able to express these negative emotions, those feelings can materialize into physical pain, especially if you have chronic pain.

6. Talk with a mental health professional

Being able to talk through your negative emotions in a judgment free environment with a licensed professional is priceless! This can significantly improve those positive associations, decreasing physical and emotional pain.