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Tag: stress response

Why Does Chronic Pain Happen? These Scientific Principles Can Empower Your Healing: Part 2

Posted on by Andrew David Shiller, MD
                                                                                                   Watch Part 1/2 HERE

                                                                         For more videos subscribe to our YouTube channel here

Summary:

Science is revealing why chronic pain and associated problems happen.  Understand this stuff and you’re on your way toward healing and feeling better. Chronic pain and illness don’t just happen.  They are processes that develop over time.  The body-mind learns chronic pain.  And it learns the things that go along with chronic pain, like anxiety, depression, insomnia, irritable howel, high blood pressure, and so on.   Just like your body-mind learns to be sick and suffering, you can unlearn sickness and suffering.  You can learn to heal.  If you want to feel better, then tune in to these videos and share them with others.

Did You Know:

  • Dr Shiller gives regular free mind-body training sessions on zoom. You can get the schedule and register at www.mindbodygroove.com
  • You can learn more about Dr Shiller’s practice and schedule a telemedicine or in-person consultation at www.drshiller.com
  • Movement Toward Health is an affordable and effective training program to teach you to heal and feel better and improve your functioning.  It will teach you to integrate breathing techniques, mindfulness, and mindful movement techniques that are drawn from Dr Shiller’s 30+ years learning, practicing, and teaching these approaches to people suffering chronic pain and chronic illness. To get more info and be notified of the next start date CLICK HERE .

Related Posts:

Full Transcript:

Okay, so we have been talking about some of the basics of about why chronic pain and chronic illness are learning experiences, the physiologic, biological changes that happen from the interconnection of all your body systems that bring about the suffering, that bring about the dysfunction, that bring about the disability, and these are things that when you understand them, you can start to choose to unlearn them and to reverse them and start to actually install patterns of responsiveness to life in your mind/body system, in your biochemical metabolic nutritional system, and your movement system. So, let us continue.  There are other aspects of neuroplasticity, right? So, like, you have protective responses in your body, you can actually say that the stress response is a protective response, because when that limbic system that says not safe to be, fires on, really what it is doing is making you vigilant so you can look out for further danger, and that is why so many people who have chronic stress, whether it is from some horrible trauma that develops PTSD or if it is just from living under chronic stress are a little bit hyped up, and they might be irritable emotionally, they might be just having a hard time sleeping, they might be developing digestive problems or cardiac problems, because their body is rehearsing a stress response, and that is a protective response.  The person so to speak is looking to protect from danger.  Meanwhile, the danger is over, but the system is stuck.  Hope that makes sense.  Similar things happen with your motor system, the nerves, muscles, joints, bones, the whole system that helps you move through space, move towards what you care about, and move away from what might be dangerous.  If you put your hand in a hot stove, immediately you have a reflex that causes you to withdraw your hand, that reflex is plastic.  If you have perpetual or persistent pain coming into a particular part of your body, those reflexes that create muscle contraction, tightening of connective tissue, shifting in joint position sense actually becomes set into the system. I told you about a woman who had some pain in her shoulder and after a while, two years, she was holding her arm like this, that is a protective withdrawal response.  Maybe, I need to sit back a little bit so you can see that, but basically, she was walking around like this all the time, it is a protective withdrawal response, okay.  Imagine you have got that in your hand and you are trying to reach out and type.  Every day, you try to type and you are working against contraction, you are working against yourself.  Same thing happens when someone is trying to walk.  That is part of what perpetuates the problem, protective responses in your mind/body system, protective responses in your neuromuscular system, and the other aspect of it is changes that happen in your hormones, your immune system, your gastrointestinal system, whether it is from chronic stress, chronic pain or whatever, that feeds into dysfunction in your gastrointestinal tract, and this is something that is showing up in all of the research of last 10 or 15 years or so, and that feeds into problems with the brain, because when the gastrointestinal tract gets dysfunctional, it creates a situation where there is biochemistry and immune changes that can feed into and worsen anxiety and depression, can feed into and worsen pain transmission.  There is this intimate connection that is in every part of your body, it is a learning process, it is the way your body presumably is trying to protect itself, but it gets a bit haywire and becomes chronic pain and chronic illness, and it is a learning process through neural networks that are all talking to each other, nerves, organs immune system functioning in a system that gradually learns to become dysfunctional, and so what I am suggesting is that there are ways to make it less dysfunctional, and that is what healing is about, but it takes time and practice. I want to take it to the next step, right. We talked about neuroplasticity as one mechanism of that, how the connection and communication among nerves of various regions of the brain or various parts of the body, the spinal cord, the immune system, the gastrointestinal system, it is all neuroplastic and it all responds to persistence of distress of pain of noxious painful stimulus.  There is another level of it, which is actually genetic, right? And we tend to think of, well, genes are just genes and what my genes say or what my body does, but what we know from the past few decades is that is not at all true, that we have genetic tendencies and that gene on your chromosome is surrounded by even greater amounts of material that is intelligent so to speak and it responds to your experience, it is called epigenetic material, and it determines whether your genes are turned on or turned off, and what we are knowing more and more and understanding with greater clarity is that if you are subject to persistent stress, persistent insomnia, persistent in pain, persistent emotional distress, it shifts gene expression, it is another aspect of the learning process, which can work against you or it can work for you. In summary, the processes by which chronic pain and chronic illness take place, they take place overtime, they are learning processes.  There are neural networks, there are circuits that work together through various organs, various areas of your brain, nerves that fire together wire together.  If you want to recover from chronic pain and chronic illness, what is really important is getting out of this mindset that someone else is going to come in and fix you, getting out of the mindset that someone has got some magic bullet that is going to change it all and realize that your habits, how you choose to think and work with your mind/body connection, what you choose to eat and how you nourish yourself biochemically, and what you do with your physical system can potentially retrain your brain, your body, your whole system to be more healthy, to recover a greater degree of function and health that gets taken away by that chronic process that generates chronic pain and chronic illness.  The mindset shift is one of being proactive of realizing that you know what, you need to be in charge.  You might have great healers that help you, you might have doctors that give you just the right medications or do just the right procedures, and I am not saying stop that stuff, but what I am saying that there is a piece about ownership and taking responsibility and learning, that is going to empower you, because you might go to a great therapeutic person, whatever they are, and you might see them once a week or once a month and they do something and something shifts.  Maybe, it is psychotherapy, maybe it is hands-on therapy, but what are you doing in between, and so what I am suggesting to you is to start to learn what you can do for yourself, what you can do to teach your body and direct the learning process, so that your system moves towards recovery and healing. Okay, so, this is the first video.  There is going to be another video that is going to get a bit more practical about it, and so stay tuned for that, and I hope you have enjoyed.  In the meantime, feel free to leave comments, leave questions, and hopefully I can respond.  Thanks so much.
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Why Does Chronic Pain Happen? These Scientific Principles Can Empower Your Healing: Part 1

Posted on by Andrew David Shiller, MD
                                                                                                  Watch Part 2/2 HERE

Summary:

Science is revealing why chronic pain and associated problems happen.  Understand this stuff and you’re on your way toward healing and feeling better. Chronic pain and illness don’t just happen.  They are processes that develop over time.  The body-mind learns chronic pain.  And it learns the things that go along with chronic pain, like anxiety, depression, insomnia, irritable howel, high blood pressure, and so on.   Just like your body-mind learns to be sick and suffering, you can unlearn sickness and suffering.  You can learn to heal.  If you want to feel better, then tune in to these videos and share them with others.

Did You Know:

  • Dr Shiller gives regular free mind-body training sessions on zoom. You can get the schedule and register at www.mindbodygroove.com
  • Movement Toward Health is an affordable and effective training program to teach you to heal and feel better and improve your functioning.  It will teach you to integrate breathing techniques, mindfulness, and mindful movement techniques that are drawn from Dr Shiller’s 30+ years learning, practicing, and teaching these approaches to people suffering chronic pain and chronic illness. To get more info and be notified of the next start date CLICK HERE.
  • You can learn more about Dr Shiller’s practice and schedule a telemedicine or in-person consultation at www.drshiller.com

Related Posts:

Full Transcript:

All right, greetings everybody, Dr. Shiller here.  So, there are some confusing beliefs in our culture that keep a lot of people sick and suffering and two of them are particularly difficult or toxic.  One of them is that you might think somebody else is going to fix you, and the second one is that there could be some sort of quick fix where your chronic pain or chronic illness is going to go away like right away when you start doing whatever it is that you might start doing to help it, and I just want to share with you why that is not a good way to think, why it is counterproductive, and how it is the opposite of how things really work, because what that does is potentially invites you to open your mindset to think about things in a way that is more productive that actually might bring you some real solutions that could help you.   The key thing is like this, chronic pain and chronic illness are learned, learned.  Okay that might sound kind of strange because when you think of learned, you might think like, “Oh, I sat down and read a book, and I wanted to learn French or how to cook or whatever it is you might want to learn.” It is not what we are talking about here, but we are talking about a process over time, where the physiology, the biology of your body actually practices and reinforces and develops certain patterns, and that is how chronic pain happens, that is how chronic illness happens, and the key thing is learning how that happens, so you can learn how to unlearn it, and you can re-learn how to live well and actually to help your body heal. Let us talk about that.  Let us talk about chronic pain for instance, like a lot of people who have chronic pain after some kind of trigger, there was an injury, maybe it was surgery, maybe it was an infection, maybe it was some kind of trauma or damage or a fall, and then what sometimes gradually happens is that the thing just gets worse over time, right? There can be worsening of pain in the actual region that got hurt and then there can be like a spreading of pain, so it might start in the person’s foot or hip and then it spreads to their back or whatever it is, goes to a different part of their body.  Sometimes, it can affect the whole body.   Sometimes, there can be issues with other organ systems that create secondary sources of pain, changes in the brain, the nerve, the muscle tissue. There can be things that drive chronic illness or even turn up pain sensitization, and that involves shifting in biochemistry of brain function, shifting in psychological function hormones, intestinal function, the balance of the immune system.  These are all things that can worsen chronic pain, that can create secondary sources of pain and that can generate chronic illness. Let us try to understand how that happens.  I just want to give an example of what I am talking about in case it is not clear yet.  A woman I will call Jane.  She was actually one of my first patients when I finished residency 20 years ago, and I learned so much from her and other people like her.  She basically had fallen down.  She was a teacher.  She got knocked over by some students.  She was trying to break up a fight, and she hit her head, she hit her shoulder, and she had what you described mild moderate injuries.  She was not really messed up from it.  She was not in the hospital, but gradually, she developed shoulder pain that spread all the way down her arm.  She started developing headaches.  She could not use her arm.  She held her arm like someone who had had a stroke.  She had headaches that were disabling.  She developed all sorts of psychological challenges.  She was in her mid-30s, and she was disabled.  She was not working, and she had gone to many doctors, and all of them tried what I was taught to do when I was in medical school in residency; let us try this thing, let us try that thing, let us try this medication. The thing is we were not really looking at what was going on with her physiology, and so let us talk about what that is, what happens physiologically, and what I am going to share with you is kind of a digest of what I have learned from reading medical research and basic science research.  A lot of this is stuff that is not in the clinic yet.  It is well known that a lot of basic science research does not make it to clinical practice for 10, 20, 30 years, because it is a whole other thing to like understand what is going on than it is to develop like randomized controlled trials with lots and lots of people that convince most doctors so that things get into practice. The challenge is when someone comes to you who has got this chronic problem, who has tried all the first-line things that the best neurosurgeons and neurologists and orthopedic surgeons try, and then they are still suffering, what do you do then? And so that is kind of how I have built my practice. So what do you do then? And that is the kind of patient I have been seeing for 20 years.  So, that is what I am speaking from, is that experience. Let us think about this underlying principle that we call neuroplasticity, and neuroplasticity means the brain, spinal cord, and nerves change over time.  In response to experience, they change their function, they change their connectivity.  Let us unpack that a little bit.  Let us talk first of all just about the sensitivity of nerves to pain.  So, you got a nerve in your finger and you get a bad injury on your finger and it burns or it hurts and that sends a signal up to your spinal cord, and from there, it goes up to your brain, and from the core of your brain where all the sensory and emotional and cognitive information is processed, it goes to the part of your brain that experiences pain.  The nerve itself when it is persistently stimulated reorganizes, it changes DNA synthesis, it changes synthesis of proteins and ion channels and various kinds of sort of physiologic biological properties that affect how that nerve responds to stimulation and how it functions, and so you can get spreading of pain around the area of injury and you can get a situation where that nerve sends out signals that are wrong.   That is the classic thing someone who has got nerve pain and you gently stroke the hand or something and it feels like fire and it burns or someone who has got neuropathy in their feet where they cannot stand the sheets, sitting on their toes at night.  So, they cannot sleep, that is sensitization of the nerves, and that is a physiologic change that happens over time in that nerve.  A similar thing happens in that whole tract going up to the part of your brain in the sensory cortex that says, how my hand hurts, because those interconnections, they are called synapses, right? So, one nerve talks to another nerve through a synapse.  So, the signal comes down the nerve and it gets to this junction that is called the synapse, it is between the two nerves, and what happens is the signal gets down, and if it is strong enough, it causes that nerve to release some juice into the space between the nerves, and that juice is chemicals.   It is neurotransmitter chemicals, and those contact that secondary nerve and stimulate the nerve to do various things.  If they stimulate it in a strong enough way that secondary nerve fires, and those two nerves are in relationship with each other, and the more that this one fires and makes this fire, the more they get used to firing, that is why they like to quote, “Nerves that fire together wire together.” What that means is that the synapse as it gets more frequently active, as it is stimulated with a strong stimulus, it gets more active.  So, they are kind of like good buddies talking to each other, they already know what the other guy is going to say, they are already in conversation, they remodel their connections.  So, it becomes more sensitive. Now, the function of your entire brain, spinal cord, and body is built on thousands of nerves talking to each other.  You have got regions of your brain that do certain properties, regions of your brain that do other functions, and the connectivity between all of those parts of your brain is what determines how well your brain or body works, and all of that is subject to this principle of neuroplasticity, where nerves that fire together wire together.  So, suppose that somebody has a horrible traumatic accident and part of that is that they develop a painful thing happening in their tissue or their body, it is an injury, a wound, a break, whatever it is, it is painful.  It is constantly sending a signal that is sensitizing.   Meanwhile, they also had a traumatic experience, and that traumatic car accident or bomb going off, whatever it was, God forbid, creates a situation where they are in a stress response, they are in a danger response.  Their system is stuck in that trauma, and that represents certain areas of the brain, often the limbic system, the frontal cortex that are interacting with each other and firing off this persistent pattern of “I am scared, it is not safe to be me.” All the information about your emotional reality is integrated with the information of your sensor reality, and so a traumatic experience that is practiced so to speak overtime, that becomes set into that person’s neurophysiology, habitually changes the pain transmission system, and that is probably, and it seems to be why we see it so often that people who have persistent or have had significant traumatic events often develop chronic pain, because the processing of pain and the processing of stress, a sense of danger, sense of lack of safety, grief, anger, frustration are intimately connected with each other.  So, that is just kind of one example of how habitual experience of trauma stimulates habitual experience of pain, and it is a vicious cycle, and that is a learning process that gets worse overtime in many cases, and the issue is how to unlearn that.  It gets richer and deeper though, okay. Okay, so we are going to take a break right now and cut this, and we will get to the continuation of this topic in the next video. Summing up, there is a foundation physiologically about why chronic pain and chronic illness are really learning processes and how you can, by understanding that, unlearn them, that is where we are going with this.  The whole idea is for you to understand how the learning process may have happened in you, so that you can make positive choices to unlearn the negative stuff and install learning for the positive stuff and actually bring yourself towards healing. So, please look out for the next part of the video of the same name, and we will continue with the topic.
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