Pain Reprocessing Therapy FAQ
How do I know if I have neuroplastic pain/TMS?
Neuroplastic chronic pain is more common than structural chronic pain. Although there is no definite checklist to determine if you have neuroplastic pain, there are some questions you can ask yourself to help determine if pain is structural or neuroplastic. Yes answers to more than one of these questions is a good indicator that pain is most likely neuroplastic.
- Has your pain lasted longer than 6-8 weeks?
- Have traditional medical treatments been ineffective or given only temporary relief?
- Does pain become worse with stress?
- Have you experienced symptoms in multiple parts of the body? Has it moved around?
- Is your pain inconsistent? Is it sometimes more severe than others? Does it get better or worse throughout the day?
- Do you think about your pain all the time? Does it worry you?
Alan’s post on gathering evidence that pain is neuroplastic:
Today I wanted to talk about one of the most important components to healing: gathering evidence that your pain is neuroplastic.
In order to overcome chronic pain, it’s important to overcome the fear of the pain. But it’s hard to overcome that fear if we think that there’s something wrong with our bodies. So, it can be really helpful to gather evidence that our pain is being caused by our brains and not our bodies.
I mentioned that periodically I was going to be posting excerpts from our upcoming book. Here’s a section from Chapter 4 called “Building a Case”. It involves two case studies showing how to gather evidence that the pain is neuroplastic as opposed to structural:
Rebecca was a college senior with a solid work ethic, a promising future, and a slightly unhealthy obsession with her dog.
A couple months before graduation, Rebecca started getting pain in her wrists. It became a daily struggle and soon she developed a conditioned response: typing. The longer she typed, the worse her pain got (not an ideal situation for a college student). She bought an ergonomic desk and keyboard, but it didn’t help.
By the time she made it through finals, she was deep in the Pain-Fear Cycle. She spent the next couple of years terrified of typing, looking for the rare job that didn’t include computer use.
When I first met with Rebecca, we started searching for evidence that her pain was neuroplastic. Unfortunately, she had no exceptions (typing always caused her pain), so we kept looking.
Here’s what we came up with:
First, she didn’t have an injury preceding the onset of pain. Her symptoms just appeared one day, out of nowhere. That’s very common with neuroplastic pain.
Second, the pain came on during a pretty stressful time. She was about to graduate and had no idea what she wanted to do with her life. (That is, outside of updating her dog’s Instagram.)
Third, she had a history of both neck pain and knee pain. Both lasted for months. Multiple unrelated symptoms are indicative of neuroplastic pain.
Fourth, both her wrists started hurting at the same time. That’s huge! Outside of an injury or disease, when two symptoms arise in mirror image of each other (both hands, both feet, etc.) that’s a dead giveaway.
With these four pieces of evidence, we were able to conclude that her pain was neuroplastic.
Barry’s pain started with a rather bizarre injury. He was waiting for a cab outside a bar, and was randomly punched by a drunk stranger.
It cracked two of his teeth.
Even though the culprit was arrested and paid for Barry’s dental bills, the damage was done. Barry developed pain in his mouth that lasted for the next six years.
Barry was determined to figure out what was causing his pain. He met with dentists, oral surgeons, and neurologists. Consequently, he was diagnosed with myofascial pain, trigeminal neuralgia, and burning mouth syndrome (yikes!).
By the time I met Barry, he’d tried every treatment imaginable from dental splints to root canals. Understandably, it was hard for him to believe that his pain was neuroplastic - every diagnosis he’d been given and every treatment he’d received reinforced that his pain was physically caused.
So, we started off by looking for evidence.
Here’s what we found:
First, despite his many diagnoses, his mouth had healed. Over the years, Barry got X-rays, MRIs, and CAT scans, and every image showed the same thing - there was no discernable sign of damage.
Second, his pain was a lot better in the mornings. When symptoms follow a pattern where they’re better or worse based on the time of day, that points to neuroplastic pain.
Third, there was the Tony Robbins incident.
This might be my all-time favorite piece of evidence.
A couple years ago, Tony Robbins, the renowned motivational speaker, gave a talk at Barry’s corporate retreat. The speech was so powerful, so full of hope, that Barry’s pain completely disappeared! For two full weeks, he was pain-free.
Though his symptoms returned, this was a huge piece of evidence. This is called an exception - an instance where the pain behaves differently than it would if it were actually caused by a physical problem. And along with his other pieces of evidence, it allowed us to conclude that there was nothing physically wrong with Barry’s mouth.
The above excerpt is from “The Way Out: A Revolutionary, Scientifically Proven Approach to Healing Chronic Pain”. To learn more about the book or to pre-order it, click here:
How do I get better?
Pain happens when your brain interprets safe sensations as dangerous. To recover, the goal is to teach the brain that all sensations are safe. Somatic tracking and leaning into positive sensations are two of the most powerful techniques used to retrain your brain to view sensations through a lens of safety.
Alan's post on making the brain feel safe:
I know that many of you have tried so many different techniques and so many different approaches to overcome your pain. Sometimes it can even feel overwhelming with all the different things there are to try.
I remember one day back when I was in chronic pain, I dedicated an entire day to doing things that I thought would help with my pain. I was more motivated than I’d ever been. “This is the day,” I declared, “that I really start my recovery…”
For eleven straight hours, I meditated, I stood up to the inner bully, I felt my feelings, I attended to my internal state, and I gave myself positive self-talk. I did everything I thought I was supposed to do, and at the end of the day… my pain was even worse!
The thing is, I was doing all those things with a sense of pressure and intensity. And despite my best intentions, my poor, primitive brain was feeling even more danger than when I started. Making your primitive brain feel safe is often less about what you do, and more about the energy with which you do it.
This upcoming Wednesday, we have a new podcast episode coming out that’s all about how to truly make your primitive brain feel safe. In the episode, I talk to a chronic pain sufferer who’s worked really hard to get rid of her pain but has had little improvement.
I talk to her about what it really means to make her brain feel safe, and then I do a somatic technique to show her what it *feels* like when she’s in that safe state. Then Alon and I talk about how you can use this technique to make your own primitive brain feel safe.
Once you’re able to experience what it feels like when your primitive brain is safe, that state becomes easier to access. And you can spend more and more time there. Eventually your danger signals get deactivated, and the pain fades away.
This is one of my favorite episodes so far, and I hope you find it helpful. I’ll post it on Wednesday as soon as it becomes available.
How Can I Heal My Pain by Making My Brain Feel Safe podcast: https://www.curablehealth.com/podcast/make-your-brain-feel-safe
How do I achieve outcome independence?
To break pain, you need to break fear. Outcome independence isn’t something that comes easily. Changing deeply ingrained habits requires practice, discipline, exposure, and repetition. Alan’s FB post on outcome independence can be found here:
Today I wanted to talk about one of the most important, and one of the trickiest components to overcoming pain: outcome independence.
As I’ve talked about before, it’s the fear, frustration, and preoccupation around the pain that keeps the pain alive. In fact, I’ll take it one step further. The very purpose of the pain is to bring us to that state of fear, frustration, and preoccupation.
Why would your brain want to bring you to those negative emotions? It’s not because your brain is trying to hurt you, it’s because fear, frustration, and preoccupation have become very familiar to your brain… and our brains always gravitate toward what’s familiar.
So, to break the pain, you need to break the fear. And this is where outcome independence comes in.
I came upon outcome independence by accident. In 2004, I had chronic back pain, and I would take long walks every night. I would constantly monitor my symptoms: How soon would the pain start? How quickly would it intensify? How bad was it when I got home?
If I had a “good” walk, I’d feel confident, hopeful, and good about myself. If I had a “bad” walk, I’d feel scared, frustrated, and despairing. This went on for two years. Finally, one day, I’d had enough. I was sick and tired of my mood, my outlook on life, and my feelings about the future being so dependent on the pain.
And I was done.
I changed my definition of success. A “good” walk was no longer one with less pain, it was one where I felt okay regardless of the pain. I took pride in my growing ability to determine my own mood. I celebrated the accomplishment of feeling good about myself even when the pain was bad. I broke free from the prison of fear.
And much to my surprise, within a couple months, my walks were pain-free. Without even knowing what I was doing, I eliminated the pain’s fuel source: fear.
Outcome independence is not something that comes easily. It’s hard to change deeply ingrained habits, and you’ll falter often. But with practice and discipline, with exposure and repetition, you can get there.
And it all starts with a single decision: I’m done letting my pain determine how I feel. I’m done letting my symptoms dictate my mood. I’m done being afraid.
How long will it take me to heal?
Everyone has a different experience. There is no exact timetable for healing. The good news is that you can and will heal.
What if I relapse?
Most people experience relapses. Sometimes a stressful event will trigger a recurrence. Other times, old behaviors such as being on high alert or engaging in negative thinking will resurface. Occasionally a new injury or belief of injury will cause a relapse. The best solution for a relapse is to practice outcome independence while treating yourself with kindness.
Here’s a post where Alan talks about how he handled a recent relapse:
Last Sunday I woke up with the worst headache ever. And I have no idea why. I wasn’t feeling stressed out, I got a solid 8 hours sleep… it was a mystery.
And I want to tell you what I did throughout the day, to show the practical application of some of the concepts I’ve talked about over the past few months. For the sake of simplicity (and my eternal love of structure), I’m going to break it down into five different stages:
1. The Search
The first thing I did was the thing that everyone does when they’re suddenly hit with a burst of pain out of nowhere – I tried to figure out why. The funny thing is, trying to figure out why usually isn’t very helpful. We mainly do it as a way of trying to reduce uncertainty – “If I’m able to figure out why I was slammed with pain, I can prevent it from happening in the future.” In other words, it gives us the illusion of control.
So, after a couple minutes of going down that problem-solving rabbit hole, I snapped myself out of it. I told myself, “For whatever reason, my primitive brain feels unsafe in this moment, so I’m going to address that.”
2. The Techniques
I wasn’t going to do somatic tracking. Somatic tracking is a great technique, but when the pain is too high, it’s counterproductive. Somatic tracking involves paying attention to the painful sensation in a curious, light, positive way, but when you’re in an 8 out of 10 pain, it’s impossible to pay attention to it with anything other than fear.
So I tried leaning into positive sensations. I focused on my breath, really trying to capture that light, easy feeling of the breath coming in and out. Annnnnd…nothing. I couldn’t focus on anything in an light, easy way. The pain was just too intense! Everything I did was really a way to try to make the pain go down. And you can’t lean into positive sensations as a means to an end. It’s not authentic.
3. The Surrender
At this point, I just surrendered. I had the following conversation with my brain:
Me: This thing is just going to run its course. There’s nothing you can do right now. So just… let go.
My brain: What?!?
Me: It’s okay, it’s temporary and it’s going to pass. You know your baseline is not having pain, this is just a fluke. It’s going to be okay.
As you can see, I was giving my brain messages of safety to the best of my ability in that given moment. That’s all I could do.
So, I laid there in bed for a while. I just breathed and let my mind wander. I may have fallen asleep for a few minutes…but after an hour or so, the pain was down to a 3 or 4.
4. Brace mode
You know that feeling you get when you’re out driving for the first time after being in a car accident? You’re gripping the steering wheel a little too tightly, you’re hyper aware of the cars around you, you’re constantly looking in the rearview mirror… that’s brace mode. It’s that hypervigilant fear of getting walloped by something because the memory of the first wallop is fresh in your mind.
And last Sunday afternoon I was definitely in brace mode. The pain had been so intense that morning, I was in a total state of high alert that it was going to come back.
So I decided to go for a walk. Movement is one of the best things you can do when you’re in brace mode – walking, stretching, yoga… it can help break you out of that frozen state of anticipation.
5. The Techniques Part II: Somatic Tracking’s Revenge
To overcoming your pain, you need to create new associations. Your brain is interpreting a sensation as if it’s dangerous, and you need to teach your brain that it’s safe…
So, it’s actually more valuable to have pain while simultaneously in a positive emotional state than not to have pain at all. That’s how you create new associations.
This is what I was telling myself as I was walking around the block, “I don’t need to get rid of the pain, I just need to enjoy myself.” So that’s what I did. There was a nice breeze out, a few birds were chirping in the distance, it felt good to move my body… Even though there was still some pain, I was feeling good.
The pain was feeling less scary, so I even tried doing a little somatic tracking. I checked in to see what the sensation felt like:
“Let’s see…it’s kind of a pressury feeling…a little sharp. Is it…itchy maybe? What is that? I know these sensations are safe… it’s simply a pressury, itchy, sharp, burny kind of feeling. I can create a whole new word for this sensation…it’s a pressitcharpburn! Hmm, kind of sounds like an obscure dinosaur species…”
I was doing somatic tracking and I was actually having fun with it.
By the time I got back to my place, there was probably still a little pain there, but honestly, I don’t even remember. I was feeling good, I wasn’t scared, and I was proud of myself for giving my brain messages of safety throughout the day. And over the next day or two, the pain was gone.
I hope this breakdown sheds some light on the different ways you can apply the various techniques.
Even if your day is filled with suffering, it’s still possible to give your brain messages of safety. And even if your day is filled with pain, your actions can come from a place of strength instead of a place of fear.
What about anxiety and depression? Are they part of neuroplastic pain?
Anxiety and depression and fatigue are non-pain danger signals. All danger signals are our brain’s way of trying to help us. Anxiety causes a release of adrenaline which allows you to run faster or fighter harder when you are in danger. Fatigue lets us know we need to rest and recover. Other danger signals include depression, numbness, itchiness, burning, and so on. As unpleasant as each of these sensations are, they all have some sort of survival value. Why do these danger signals get activated when we’re not in actual danger? This happens because there is an overlap in the brain between different systems that assess for threats. When we feel a lot of fear, these other danger signals can get activated when there is no actual danger. Since all danger signals are related, so when you teach your brain that one sensation is safe, your brain is more likely to interpret other sensations as safe too.
Alan’s post on non-pain danger signals:
Today, I wanted to talk about two things. First, how to overcome non-pain danger signals (such as anxiety, depression, and fatigue), and second, how reducing those danger signals can actually help with your pain as well!
All danger signals are our brains' way of trying to help us (although it often doesn’t feel like it!) For example, if you sprain your ankle, you feel pain. As unpleasant as that feeling is, it’s our brains trying to warn us: “You are at risk of causing tissue damage, please back off until we heal.”
Anxiety is another danger signal. This one has come in very handy throughout human history. Imagine it’s 100,000 years ago and you’re out on the hunt. Suddenly a bear jumps out! Your brain releases adrenaline and you feel a rush of anxiety, which allows you to run faster or fight harder than under normal circumstances.
We’ve developed other danger signals as well: fatigue lets us know we need to rest and recover, hunger lets us know we need to refuel, nausea lets us know that we may have just eaten a pokeberry (a berry that sounds adorable but is actually pretty poisonous.)
Other danger signals include depression, numbness, itchiness, stiffness… the list goes on and on. And as unpleasant as each of these sensations are, they all have some sort of survival value.
The question, of course, is why do these danger signals get activated when we’re not in actual danger? For example, why in the world would our brains trigger back pain when there’s nothing wrong with our backs?
The answer is because there’s an overlap in the brain between the different systems that assess for threats. So when we feel a lot of fear, these other danger signals can get activated even when there’s no actual danger. This is why you can feel pain when there’s no injury, or anxiety when there’s no bear, or fatigue even when you got 8 hours sleep on your Tempur Pedic Breeze.
So how do you treat these other danger signals such as anxiety, depression and fatigue? Ready for the most boring answer ever? The exact same way you treat neuroplastic pain.
It’s funny… human beings love labels. We love coming up with names for things. Back in the 1990s, there was a huge debate in the astronomy community over whether or not Pluto was technically a planet. Half of them said it was a planet, half of them said it was a "dwarf planet". People took very strong stances (lead astronomer Mike Brown’s current twitter handle is @PlutoKiller…) But the truth is, whatever you want to call it, however you want to label it, it’s a large body of mass that revolves around the sun.
We do the same thing with physical sensations. There’s pain, anxiety, fatigue, depression, nausea, numbness, tingling, burning, itching, weakness, etc. But regardless of what you label you give it, it’s simply an unpleasant sensation that your brain is interpreting through a lens of danger. And the goal is always the same: teach your brain that this sensation is actually safe.
You can use somatic tracking, leaning into positive sensations, or any of the other techniques we’ve covered. Whether you have neuroplastic pain or one of the other danger signals, the formula is the same: brain thinks sensation = danger, teach brain sensation = safe.
And the coolest thing is, all the danger signals are related. So when you teach your brain that one sensation is safe, your brain is more likely to interpret other sensations as safe too. In other words, when you use somatic tracking on your anxiety or fatigue, you’re indirectly helping with your pain as well!
Ultimately, the goal is to teach your brain that all sensations are safe. The good news is you already have the techniques, now it’s just a matter of applying them to whatever danger signal your brain happens to choose.
All quotes used with permission.