Bodymind (re)learning for wellbeing and ease: a path towards healing and freedom from persistent pain and other symptoms

“The tree which fills the arms grew from the tiniest sprout; the tower of nine storeys rose from a small heap of earth; the journey of a thousand li commenced with a single step.”

-Lao Tzu, Tao Te Ching

“The healing is in the return, not in never having wandered to begin with.”

-Sharon Salzberg

If you have pain right now, and that pain has persisted for more than three months, you are not alone. Around 1 out of 5 of humans share your experience. And, most importantly: healing and freedom from chronic pain and other symptoms is possible. I know both from clinical and personal experience. After almost 10 years of persistent back pain I am now pain free - you can read more about my recovery story here; and I have witnessed my patients recover from a long list of symptoms and diagnoses, including fibromyalgia, dysautonomia, and CRPS. 

Many people who experience chronic pain and other symptoms (myself included not too long ago) are surprised to learn that ‘chronic’ does not mean that it will last forever. In fact, let’s start by changing a word: from chronic to persistent. 

While most of the content below refers to persistent pain, it encompasses other persistent symptoms, such as fatigue, constipation, diarrhea, bloating, nausea, discomfort in the bladder (urinary frequency or urgency), paresthesias (numbness, tingling, burning), tinnitus (ringing in the ears), globus sensation (lump in the throat), unexplained persistent cough, and syndromes/diagnoses, such as irritable bowel syndrome (IBS), interstitial cystitis or overactive bladder (OAB), myalgic encephalomyelitis (ME)/chronic fatigue syndrome (CFS), fibromyalgia, postural orthostatic tachycardia syndrome (POTS), hypersensititvity syndromes (to touch, sound, smells, foods, medications) and post-COVID syndrome (“long COVID”). It also encompasses conditions and symptoms traditionally classified as “mental health conditions”, like anxiety, depression, and eating related struggles. 

If you’re experiencing any (or many) of these symptoms or syndromes, you’re in the right place. Keep on reading, there’s hope for recovery.

Modern neuroscience and clinical experience are showing that freedom from persistent pain and other symptoms is possible for many, through an integrative mind-body approach to address the source at the deepest level. This approach incorporates practices to (re)learn wellbeing and ease, and train your bodymind away from persistent pain, reduce or be fully free from your symptoms, and reclaim your life. It harnesses the power of bioplasticity, the ever changing adaptability of our bodymind, and neuroplasticity. Let’s take a look at how this is possible, and how you can get started.

You can start by clicking on the buttons below to explore how you can benefit from a mind-body approach, and/or keep on reading to learn more about bodymind (re)learning. And if you’d like to explore how you and I can work together to help you grow in wellbeing and ease, and to heal, contact me. 

A brief note: everything shared here, as elsewhere on this website, is offered as a possible map or framework, or a guidepost of sorts, for you to explore and make sense of your experience, and perhaps discover new possibilities for healing through a different understanding. Like my dear friend Deb Malkin says, understanding things differently changes the way we experience them. What I offer here is not meant as a universal or absolute truth, as a singular understanding or as the only path. It is my wish that you can create the space and choice to take care of yourself, determine what is useful for you, and make decisions that best meet your needs, including the possibility of exploring something else that best supports you. And if you choose to engage in a mindbody approach, it doesn’t preclude making use of other tools that you find supportive, nourishing or health- and well-being enhancing. Also, because I continue to learn and unlearn, my understanding is in constant shift and evolution - sometimes my website will be somewhat behind in the updating ;)

In the text below and elsewhere on my website, you’ll find multiple links and references throughout the content. My mention of someone's work doesn’t always mean we know each other, that I endorse them unequivocally or that they endorse me. It means that there's a particular idea that I find relevant and I want to give credit where credit is due. (h/t Kelly Diels).

The biopsychosocial model of pain and beyond…

The biopsychosocial model includes three domains in which potential influences of pain can occur.

Bearing this in mind, here is a simplified description of contributors in the different realms:

• Biological contributors: bodily events that activate nociceptors (danger receptors) or drive tissue states outside the safe homeostatic zone, including genetics, inflammation, injury, excessive load, tissue pathology, and system dysfunction; epigenetic changes in response to environment; temperamental disposition.

• Psychological contributors: the things we think, say, believe, predict, feel and do; our relationship with ourselves; our attachment templates, learned through early experiences and relationships; our personality traits, more or less stable ways in which we respond or relate.

• Social contributors: any interactions you have with others and the roles you play in your social world, involving family, friends, work environment, access to care, community, culture and society.

According to the biopsychosocial model of pain, “Pain involves the intricate, variable interaction of biological factors (genetic, biochemical, etc.), psychological factors (mood, personality, behavior, etc.), and social factors (cultural, familial, socioeconomic, medical, etc.).” Moseley, G.L. & Butler, D.S. (2017)

In my experience, the way we experience and relate to pain also involves the spiritual realm. By spiritual I mean how we integrate meaning and purpose in life through a sense of connectedness with self, other human beings, other-than human beings, community, nature, Earth, art, and something greater than ourselves (whether secular or religious). And as beings in a complex and intricate ecological web, this dimension also plays into our experience of pain and wellbeing.

The more I learn, the longer I’ve been practicing medicine, the more I realize how little we know and how complex we are. Like my friend Deb Burgard says, what we know is akin to one star in the midst of the whole universe, or one grain of sand in the vast expanse of a beach. And speaking of health, pain, and complexity, Betsan Corkhill has written about it so articulately. Below is a short excerpt, and you can read the full text here.

“Getting to grips with complex systems can make your head hurt […] it becomes easier to simplify, safer to compartmentalise, and we can go so far down this route we lose sight of the complexity. People and life are messy […] We’ve thankfully moved into an era where anyone taking a purely biomechanical approach is considered outdated. However, even the bio-psycho-social model doesn’t grasp it all. As Cabaniss says, ‘It chops the patient into three neat packages.‘ These artificial boundaries can result in silos of fragmented care that distract attention away from the person as a dynamic whole embedded in their environment. As a result those living with long-term medical conditions often acquire multiple labels and go down individual pathways of care […] It’s clear that we need to change our thinking to create new approaches […] Health and Social Care systems that aim at nurturing health and promoting recovery. Humans are complex beings. The human body consists of a range of systems from cell to whole, plus trillions of microbes that all interact in complex ways, embedded in complex environments in an uncertain, complex world.”

I know that, as we lean into a more complex understanding, the confusion and uncertainty can feel daunting, and we can find ourselves yearning for simple and straightforward explanations or prescriptions. And yet… this space of unknowing, of uncertainty, opens up possibilities for unlearning that which no longer serves us well, or for learning new concepts, skills and practices that can help us grow in ease and wellbeing. It also engenders an expansiveness for curiosity, awe, wonder, hope, faith, and reassurance, because there is still so much to explore and discover, so much that is yet to be known.

Explore a little more with me?

How does persistent pain happen?*

*This applies to many other symptoms, like anxiety, fatigue, etc.

Pain as a protective mechanism - your bodymind doing its best to look after you

Pain is part of a really sophisticated system that serves to protect our bodyminds. When there is an outside threat (whether that be a threat of physical injury or a threat to our safety, authenticity, dignity or belonging), or we injure ourselves, our brain sends out pain messages to let us know that there’s something wrong. This allows us to act and try to avoid or repair any damage, such as pulling our hand away from something hot to prevent burning ourselves, resting an injured limb, or choosing to change our behavior to avoid being outcast from our group.

In persistent pain, the brain keeps sending out pain messages, even when there is no tissue damage, after an injury has healed or when there’s no injury at all. This is one of the challenges of pain, there are many situations in which pain does not seem to match the amount of damage to your tissues, but it still really hurts, and it’s still very real.

Here’s a crucial bit of information that might be a surprise: the brain (and nervous system) constructs all pain. Yes, that’s right. The feeling of pain does not come from peripheral structures (like our back or our stomach), but from the brain. While our body is constantly sending messages to the brain, and some of these messages are danger messages, the brain interprets these danger messages, and decides whether or not to create pain in response to keep us safe. The brain takes hundreds of factors into account (remember the biopsychosocial model & the model of complexity) when creating pain in fractions of a second, including whether it’s been primed or sensitized to pain (your threat/fear/pain system has become highly active), and something called predictive processing (also known as predictive coding). Predictive processing is a theory of brain function in which the brain is constantly generating and updating a mental model of the environment, which is then used to generate predictions of sensory input that are compared to actual sensory input. That is, the brain continually generates models of the world around it in order to predict the most plausible explanation for what’s happening in each moment. In other words, we experience, in some sense, the world we expect to experience.

If your brain assesses that a part of your body (or all of you) is in danger or under threat and needs protecting, then it will make part of your body (or all of your body) hurt, and/or it will generate difficult emotional experiences. You will experience pain when your brain concludes that there is more credible evidence of danger than there is credible evidence of safety.

This helps us understand how the expectation of pain (often unconscious) will create pain. And, while we have no say in the moment, we can definitely influence this fascinating process through learning different neural pathways and activating positive bioplasticity.

The concept of neuroception can be useful here. Neuroception is a term coined by Stephen Porges, author of the Polyvagal Theory and the Safe and Sound Protocol to describe the process through which neural circuits distinguish whether situations or people are safe, dangerous, or life threatening. Because of our evolution as a species, neuroception takes place in primitive parts of the brain, without our conscious awareness. The detection of a person as safe or dangerous triggers neurobiologically determined prosocial or defensive behaviors. Even though we may not be aware of danger on a cognitive level, on a neurophysiological level, our body has already started a sequence of neural processes that would facilitate adaptive defense behaviors such as fight, flight, freeze, fawn or flop.

What primes or sensitizes our bodymind to persistent pain?

Our bodymind, including our brain and central nervous system, is sensitized to pain when our danger system is on, or when we are exposed to a stimulus that has previously become part of our threat conditioning responses. This can happen as a result of a diversity of circumstances, such as a history of childhood adversity and trauma, adult stress, conditioned responses, repressed emotions, and personality traits like perfectionism, people pleasing, and fearful thoughts. For some people, an event involving injury to an organ or tissue creates a neural pathway that can then reinforced by the sum of other circumstances that activate the danger system.

A crucial distinction here: a lot of the information you’ll find around nociplastic pain and other symptoms highlights fear. But when we say “fear” we might be under the impression that we must necessarily be consciously afraid of something, and our threat response doesn’t quite work that way. Joseph Ledoux, a neuroscientist, suggests that we lean into language of threat conditioning to more accurately explain the process through which our nervous system activates protective responses. He quotes Jerome Kagan: “Neuroscientists use ‘fear’ to explain the empirical relation between two events: for example, rats freeze when they see a light previously associated with electric shock. Psychiatrists, psychologists, and most citizens, on the other hand, use... ‘fear’ to name a conscious experience of those who dislike driving over high bridges or encountering large spiders. These two uses suggest... several fear states, each with its own genetics, incentives, physiological patterns, and behavioral profiles.” and goes on to point to the fact that the mechanisms through which the brain detects and responds to threats are distinct from those that make possible the conscious feeling of fear that can occur when one is in danger. Threat conditioning is carried out by cells, synapses, and molecules in specific circuits of the nervous system involving the amygdala. On later exposure to the conditioned stimulus, it activates the association and leads to the expression of defensive responses that prepare the organism to cope with the danger signaled. There is no need for conscious feelings of fear to intervene.

A somewhat simplified example from my own experience: when I first injured my back, sitting down was excruciatingly painful. There was a threat conditioning response in my bodymind associating sitting down and chairs with pain. Years after my injury had healed, sitting down continued to elicit pain. Consciously, I knew sitting down was not dangerous, and I wouldn’t have said I was afraid of chairs. But my brain predicted that sitting down would cause pain, and every time I sat I indeed experienced pain.

Our brain is incredibly skilled at establishing associations. If the flickering light of a candle preceded a migraine, future exposures to flickering lights might again precede a migraine, and we’ll likely avoid flickering lights in the future. We quickly become convinced that this kind of light is bad or harmful and causes pain - consciously, we might not feel fear of flickering lights, but we’ve tagged them as “dangerous stimulus” or trigger. If going for a run preceded a period of intense fatigue and brain fog, our brain can make a link between exercise and “crashing” and label exercise as dangerous. To add another layer into the mix, there are lists of things that others (doctor, blog, community, relative) have advised to avoid, as they trigger the symptom / condition, activating a nocebo effect. And we may in fact find that future exposures to a stimulus we’ve learned to tag as “dangerous” will indeed trigger the event we feared.

The nocebo effect, traditionally defined as the onset of negative side effects in individuals who anticipate harm from biomedical treatment, or a worsening of symptoms due to negative expectation, describes a phenomenon of very real physical symptoms or manifestations stemming from a belief that exposure to something (whether substance, event or circumstance) harms. This means that when we have come to believe that something will hurt us, it might very well hurt us through pathways involving our thoughts and behaviors, our autonomic nervous system, our immune system and inflammation pathways, our hormones and other organs and systems. The good news is that these pathways and symptoms are dynamic states, amenable to change when we start shifting our beliefs and relating differently to our experience.

We can better understand how persistent pain happens by learning about neuroplasticity.

What is neuroplasticity?

Neuroplasticity is our brain’s ability to form new nerve cell (neural) connections throughout our life, adapting to the environment with changes to the nerve structure, function or chemical activity. Neuroplasticity means our brain is constantly learning, evolving and changing. The consequence of this is that whatever we repeat – thoughts, feelings, behaviors – will change the connections and structure of our brain. Factors which can change our brain include traumatic events, chronic illness, chronic stress, social interactions, meditation and other relaxation activities, emotions, learning, paying attention, new experiences, and exercise.

“Neurons that fire together, wire together” Carla Shatz

Some neuroplastic changes occur beneath our awareness and control. One such change, associated with changes that amplify pain signal transmission and linked to the development and maintenance of persistent pain, is known as sensitization. 

Central nervous system sensitization happens when the nervous system starts to adapt adversely to pain signals, after prolonged stimulation of nociceptors. The nervous system then goes through a process of changes that increase our reactivity and vigilance to less stimulus, amplifying pain signals. One more factor contributing to central sensitization is the use of opioids, commonly prescribed to treat pain. Opioid exposure can induce long-term alterations in pain sensitization that facilitates the initiation or maintenance of chronic pain. So things that were a little painful are now more painful, and things that weren’t painful are now painful.

This increased sensitivity can also apply to other processes in our bodies, such as perception of smell, touch, vision, sound, and taste, as well as emotional distress, anxiety, fear, and stress.

To sum up, through neuroplasticity your brain becomes increasingly more skilled at producing the pain you’re feeling. The good news is that your brain can also unlearn these pain neural pathways, and you can intentionally harness neuroplasticity to this aim.

Neuroplastic pain / nociplastic pain

Nociplastic pain is the semantic term suggested by the international community of pain researchers to describe a third category of pain that is mechanistically distinct from nociceptive pain, which is caused by ongoing inflammation and damage of tissues, and neuropathic pain, which is caused by nerve damage. The mechanisms that underlie this type of pain are not entirely understood, but it is thought that they involve pain creation or augmentation by the central nervous system through pathways that involve predictive processing, threat conditioning, sensory processing and altered pain modulation. The symptoms observed in nociplastic pain include multifocal pain that is more widespread or intense, or both, than would be expected given the amount of identifiable tissue or nerve damage, as well as other CNS-derived symptoms, such as fatigue, sleep, memory, and mood problems. This type of pain can occur in isolation, as often occurs in conditions such as fibromyalgia or tension-type headache, or as part of a mixed-pain state in combination with ongoing nociceptive or neuropathic pain, as might occur in chronic low back pain.

The amazing thing about nociplastic persistent pain is that can be reversed, or unlearned.

Like any other kind of pain, it is always and absolutely real, it is never imagined.

A note on terms:

Because the term nociplastic alludes to underlying mechanisms and points to effective treatments that can bring about neural repatterning, it is my preferred term.

For epidemiological and descriptive / classification purposes, the term primary pain, used in the World Health Organization’s International Classification of Diseases (ICD-11) can be used as well, though it doesn’t point to the underlying mechanisms or effective treatments.

For some symptoms or diagnoses alluding to the function of certain organs or systems, I might also use “functional symptoms / syndrome” (e.g. functional neurological symptoms like non-epileptic seizures, or functional digestive symptoms such as irritable bowel syndrome).

For our work together, we will start from whatever language makes sense to you, while at the same time engaging in an exploration of whether this language elicits an experience of safety, validation, and possibilities for healing, and whether it enables expanding and deepening your understanding of the many threads at play in your lived experience. And if you feel like you’d like to explore new language that will evoke the felt sense and healing you want to cultivate and grow, we’ll do that.

You might have encountered the following terms: psychophysiologic pain, psychosomatic symptoms, mind-body syndrome, TMS (tension myositis syndrome or tension myoneural syndrome), FND (functional neurological disorder), central sensitization syndromes, and more. Let’s make sense of them together.

How can you know if your pain and/or other symptoms are nociplastic?

Most persistent pain is nociplastic, but because all pain feels like it’s coming from the body, it can be difficult to distinguish between structural pain and neuroplastic pain - nociplastic pain and symptoms are just as real as those stemming from an injury or tissue damage. Still, there are some signs that point to nociplastic pain and symptoms that can be reversed through a neural repatterning approach. Below is a short list that can help you make this distinction*. You can also explore a more detailed questionnaire to help you determine the likelihood that your symptoms are nociplastic, and a list of conditions that are commonly nociplastic in origin or have a significant nociplastic component and can be reversed through a neural repatterning approach.

*This list is by no means a substitute for medical diagnosis, I highly encourage that you see a physician with experience in the field of nociplastic pain / mind-body medicine for accurate and individualized assessment. Please know that even if you’ve been diagnosed with a “structural” condition, or have a diagnosis or illness that is thought to explain your pain, a mind-body approach can still be a path towards greater ease and wellbeing for you. And even if you answer no to every single one of the questions below, there are still infinite possibilities and potential for healing. If you’re curious about how this approach can help you, let’s explore it together, contact me.

• You’ve been diagnosed with one or more of the following: “functional” digestive or bladder condition, fibromyalgia, ME/CFS, intractable migraines, or repetitive strain injury

• Your pain or other symptoms started during a stressful time or after a stressful life event, or are triggered by stress

• Your pain or other symptoms originated without injury or have persisted long after the injury has healed

• Symptoms are inconsistent (e.g. sometimes walking will be super painful but other times it will be fine; sometimes fatigue will set in after exertion but sometimes it doesn’t)

• There is a large number of symptoms in the absence of a systemic disorder (such as lupus, rheumatoid arthritis, or multiple sclerosis) that can explain them

• Symptoms spread or move

• Symptoms fluctuate with external triggers (like the weather, or certain chairs, or day of the week)

• Symptoms are symmetrical (e.g. you experience numbness in both hands)

• Pain or other symptoms are delayed, meaning you don’t experience them while doing an activity, but a while after doing it

• Childhood adversity

• A concurrent diagnosis of depression or post-traumatic stress

• Certain personality traits

Childhood adversity

People who have experienced trauma or adversity in childhood are more likely to develop persistent pain as adults. This includes: physical, sexual, or verbal abuse; physical or emotional neglect; mental illness or addiction in a parent; imprisonment of a family member; witnessing abuse of mother, sibling, or father; arguments or tension in the family; losing a parent to separation, divorce, or death; community violence, racist abuse, identity based discrimination and oppression; poverty; bullying at school; lack of affection or communication in your family; early medical trauma; family secrets. These experiences shape our perception of the world as a safe or threatening place, and heighten the activation of survival energy; as discussed above, our brain creates pain when there is more credible evidence of danger than of safety, and repeated experiences of danger will make us more vigilant.

Depression and post-traumatic stress

Many people struggling with depression experience physical symptoms. If you have been diagnosed with depression or you are experiencing sleep disruption, fatigue, challenges with coping, loss of interest or pleasure in usual activities, changes in appetite, difficulty with decision making or suicidal thoughts or plans that are not secondary to a medical diagnosis such as cancer or neurodegenerative disorder, there is a high likelihood that your pain and other physical symptoms have a nociplastic component and can improve or completely resolve with a mindbody approach. In fact, we can consider depression as a condition that can be treated through bodymind (re)learning, harnessing bioplasticity and neuroplasticity.

Post traumatic stress often presents with a physical symptom too. Sometimes the physical symptoms will happen shortly after significant trauma, but for some people they will develop years after the traumatic event as a result of a more recent triggering event. If you have experienced developmental trauma or live with complex post traumatic stress, you may also be experiencing physical symptoms associated with it. Once again, this has to do with neural pathways of danger and fear.

Personality traits

Personality traits refer to relatively stable characteristics inferred from a pattern of behaviors, attitudes, feelings, and habits. Certain personality traits are common in people with nociplastic pain and other psychophysiologic or functional symptoms. Some of these traits are: perfectionism, an overactive inner critic, conscientiousness, goodism, people-pleasing, conflict avoidance, anxiousness, constant worrying, and fearful thoughts. All of these traits put the brain on high alert, making it more likely to create pain.

There are some important considerations here:

• Many people can have these personality traits or features but don’t develop chronic pain, and many people who develop chronic pain don’t have these personality traits. And sometimes it’s a chicken and egg kind of situation, where we have a population of people who have been experiencing pain for a long time, and we find that they display a set of traits, and some of them may have predated the pain, and some may have developed as a result of coping with persistent pain. There is strong evidence that state factors (such as chronic pain) may influence or distort trait measurement, so we can’t assume that personality measurement after chronic pain onset reflects a stable pre-pain personality.  

• When we think or talk about “personality traits” it might feel as something fixed or permanent that can’t change, and we also might have a judgmental stance of “bad” traits. It’s important to think about this differently, and recognize that we have all developed habitual responses and patterns of thinking, feeling, relating and being with to best cope with the challenges we’ve faced in life. So something I’ve found useful in doing this work is getting curious about how those habitual patterns have developed, how they’ve helped to take care of me, with a sense of compassion, and even a sense of awe. And then ask how can I expand my repertoire and cultivate other ways of thinking, feeling, relating to myself and others, being with that best support me at this time and that help me grow in flexibility. 

• If you find yourself relating to some of these personality traits, and wishing to address them, know that there are many mindbody practices and tools that can help you build capacity for distress tolerance, emotion regulation skills, flexibility, and resiliency.

Keep this in mind as you read the following.

Personality traits may influence development and adjustment to ongoing pain. According to Naylor et al., the most distinguishing personality features of chronic pain sufferers may be:

• High harm avoidance, a tendency to be fearful, pessimistic, catastrophizing, sensitive to criticism, and requiring high levels of re-assurance. It makes us more likely to develop conditioned fear/threat responses and require more reassurance and encouragement. People with high harm avoidance can be emotionally reactive and vulnerable to interpreting ordinary situations as threatening and minor frustrations as hopelessly difficult.

• Low self-directedness, which often manifests as difficulty with defining and setting meaningful goals, low motivation, and problems with adaptive coping.

Evidence for this personality profile is found across a wide variety of chronic pain conditions including fibromyalgia, headache and migraine, temporomandibular disorder, trigeminal neuropathy, musculo-skeletal disorders and heterogeneous pain groups. High harm avoidance is also found in those suffering anxiety and depression. In line with the fear avoidance model, these negative appraisals may then lead to pain-related fear which results in avoidance of feared movement and activities. Consequently, this avoidance then results in disuse, disability and depression, further exacerbating the pain experience and maintaining a vicious cycle of fear and avoidance, which is often characteristic of chronic pain sufferers.

The existing literature on chronic pain populations also describes a higher prevalence of “personality disorders” than in non-pain samples. Of note, we know that what is diagnosed as “personality disorder” is most often the result of developmental trauma - so developmental trauma mediates some personality traits that have developed as effective coping mechanisms and that can later on contribute to persistent pain. There’s also a link between insecure attachment and the development of chronic pain or greater disability.

People with these traits may respond or adjust differently to pain, and as a result may be more likely to suffer more and exacerbate the pain experience. One example is attending to their pain and bodily symptoms in a way that leads to hypervigilance and amplification of symptoms, which are suggested cognitive-affective components in the development of chronic pain.

Other habits and patterns that can contribute to persistent pain are giving control to another person or some external factor or intervention, and allowing pain to adversely affect other areas of life. This is of great importance to treatment, because we know effective recovery is about experiencing a greater sense of agency, being in charge of our own healing, and reclaiming real estate, so to speak, from pain. You reclaim your life and then pain goes down, not the other way around. You are healing yourself - no external intervention or provider is healing you. If you seek help and/or engage in some kind of treatment or other, it is my hope that you can remember that you have the resources and ability to heal in your bodymind - the person working with you has a supportive role.

What keeps the pain cycle going?

When we experience nociplastic pain or other symptoms, our brain has started to turn on protection signals in a habitual way, even in response to situations or sensations that aren’t harmful.

Most of us humans, most of the time, will avoid doing something that activates intense discomfort. Our bodymind is also very clever, and responds to the way we think or talk about our body. Many of us who have experienced nociplastic symptoms have thoughts about the ways in which our bodies are fragile, damaged, or hurt. And many of us have unfortunately had these thoughts introduced or reinforced by healthcare professionals (however well-meaning they may be). The great news is we can change all this, harnessing the neuroplasticity of our brain.  

As normal as avoidance is, when it comes to nociplastic symptoms, it can be a core part of the problem: fear and avoidance drive the symptoms, as we signal to our brain that our body is injured or fragile. And when our brain perceives our body as injured or fragile, it will create all kinds of protective responses. Every time we avoid what we perceive as a trigger we teach our brain to react even more intensely the next time we encounter this stimulus.

Anything that contributes to credible evidence of danger will contribute to your experience of pain, including fear and attention. When you experience persistent pain there are some behaviors which, while completely understandable, actually contribute to the pain cycle.

These pain creating behaviors include:

• Hypervigilance: You may become very focused on your pain and are constantly aware of it. You might start thinking about it in regard to every action throughout your day and looking for potential threats. When you’re constantly in this state of high alert, you’re actually feeding back to your brain that there is danger, making you more likely to feel pain. If you’re someone who’s experienced significant life adversity, particularly in childhood, hypervigilance is probably something that preceded pain and primed your bodymind to experience it.

• Pain catastrophizing: Worrying about your pain constantly and thinking about the worst case scenarios. This also reinforces the danger mode in your brain.

• Avoidance: Hypervigilance and catastrophizing can lead to avoidance of any situation and behavior that you fear may trigger or worsen the pain, such as exercise, sitting in certain chairs, eating certain foods, etc. Unfortunately this can actually make your pain worse by feeding into the stress and pain cycle, activating a nocebo response (the opposite of the placebo response: when you believe something is harmful your brain and body respond to it by triggering stress and inflammation), and strengthening conditioned responses (e.g. the belief that exercise will make your symptoms worse actually makes your symptoms worse, not because of the action but because of the belief). Avoidance then escalates, and your life continues to get smaller, which in turn increases stress and pain.

Changing these behaviors can play a significant part in recovery. To recover, we need to start re-engaging in activities we’ve avoided, to help our bodymind unlearn the conditioned protective responses. For most people, graded exposure makes sense, at the same time as engaging in activities and practices to create a sense of calm and an experience of safety (this can include affirmations, visualizations, breathing practices, somatic exercises, mindfulness, lovingkindness and compassion, etc.). Some people notice an increase in ease very quickly, others may find it’s a longer process, with peaks and valleys. Outcome independence is crucial here: success is not determined by whether the difficult sensations subside in the moment, but by how you’re able to engage in experiences you’d previously avoided and shift how you relate to the sensations. In other words, practicing is success in and of itself. With time and practice, protection signals will subside.

The first step, before any considering any changes, is becoming aware of what we are avoiding, from a place of curious inquiry. There is no judgment here: avoiding what hurts is human. At the same time, we can’t change what we’re not aware of, so as you engage in the following exploration, you are deepening your awareness and growing in agency and freedom. 

Take a moment to bring to mind things, places, situations or activities you associate with an increase in symptoms. 

• How are you trying to avoid triggering or increasing the sensations or events in your body that bring unease? (in other words, symptoms - whether this is pain, fatigue, brain fog, rash, etc.) This can include: activities or postures you avoid or limit as a consequence of your symptoms; activities or postures you engage in cautiously, tentatively, slowly, or bracing, as a consequence of your symptoms; or those in which you are constantly checking or monitoring the presence or intensity of symptoms; things others do for you as a consequence of your symptoms; additional situations or things you avoid or do to prevent symptoms; things you do to escape your symptoms once they appear or get more intense; other behaviors in response to your symptoms (e.g. initiating or avoiding conversations with loved ones, isolating, complaining, always talking about your symptoms with everyone, never talking about your symptoms with anyone); any other ways in which you try to avoid your symptoms or keep them at bay - sometimes this has gone on for so long that we forget the ways in which we’ve adapted or coped.

• What thoughts or beliefs about your body are linked to an idea that you’re somehow fragile or unwell?

• What thoughts or language reinforce a sense of fragility?

Now, see if you can craft a list of affirmations or images that offer a different perspective… 

• What statements or evidence would support an awareness that you are whole, strong, healthy, resilient?

• What images or felt sense can you bring to mind that connect you to an experience of integrity, vitality, health, strength?

• What thoughts or language can reinforce this sense of wholeness, wellbeing, and ease?

You can create a pinterest board, do some collaging, and/or visualize someone inspiring or a place in nature.

You can also practice with the guided practice “Moving into wholeness”. I’ve created a recording for this practice, created by Michelle Cassandra Johnson and available in her book Finding Refuge. You can find this practice, along with some others to support your journey, here.

How do we break the pain cycle and (re)learn wellbeing and ease?

“The tree which fills the arms grew from the tiniest sprout;

the tower of nine storeys rose from a small heap of earth;

the journey of a thousand li commenced with a single step.”

-Lao Tzu, Tao Te Ching

Because pain and other symptoms arise as emergent phenomena in a complex system involving biopsychosocial and spiritual domains, the treatment also needs to address all of these. Different things will work for different people, and you’re invited to get curious about what your own recipe for healing (h/t Rachel Zoffness) will be. The most useful approach will be responsive to your particular story and honor your lived experience, values, needs, strengths, and resources.

There are usually no quick fixes, nor is there a one-size-fits-all approach (though exceptionally some people will spontaneously recover after simply reading about the neuroscience of healing), but there is so much hope for recovery through mind-body practices. Bodymind (re)learning for wellbeing and ease involves learning and practicing new skills and strategies, and a new way of being-with our experience, including discomfort. We cultivate patience, persistence, lovingkindness, compassion and courage, and start from a place of acceptance, respect and appreciation for our bodymind’s current way of looking after us.

Learning about positive bioplasticity and neuroplasticity, and about how we can repattern our neural pathways is an important element of this approach, in addition to reclaiming “real-estate” in our bodymind through joy, play, gratitude, lovingkindness and compassion, and creating an experience of greater safety - absolute safety is an impossibility as a human being living in this world, but we can actively become more resourced and resilient, and offer our bodymind more flexibility in shifting to states of greater ease and wellbeing.

A mindbody approach addresses many domains in your experience: decision making, pleasure, planning, problem solving, autobiographical and emotional memories, self-soothing, emotional awareness and expression, mindfulness, self-compassion, sleep and nourishment, exercise, connection and engagement, empathy and physical activity, experiences of embodiment, boundaries, and more. For many of us, it will also include support to heal the imprint, or living legacy, of adversity and trauma in our bodymind. Repeating cycles of different ways of thinking, feeling, acting and being helps to grow healing pathways, with lasting change over time.

If you’re interested in a consultation to find out whether/how a mindbody approach can help you (re)learn bodymind wellbeing and ease and find freedom from persistent pain and other symptoms, click here to learn more about working with me and how to schedule a session. I’d love to be your partner in this healing journey.