The Nature of Persistent Pain

Chronic pain is undeniably real pain, and yet it’s also a story that our brains are telling us about ourselves. Since there are already fantastic resources available for delving into the scientific intricacies of chronic pain, I prefer not to duplicate what’s readily accessible. So, I encourage you to watch the two videos below and explore the additional resources I’ve listed further on to delve deeper into the science and research surrounding neuroplastic pain. I’m going to focus this article on what working with me around your pain looks like and what you can expect.

Wondering if your pain has a neuroplastic component?

If you have been wondering whether your pain has a neuroplastic component, you’ve come to the right place. If your doctor has thrown out words like mind-body, psychophysiologic, or the dreaded psycho-somatic (this term has such a bad rap!), then you are already beginning to become aware of learned pain. As I said at the beginning, all pain is real! I believe your pain. I have personal experience of this kind of pain. I know how real it is. That said, as you may have learned from the videos linked above, science now knows that all pain also originates in the brain – whether you break your leg or have mysterious chronic back pain. Don’t let the old idea of “psycho-somatic” deter you from investigating this further; please read on! I promise, it will be worth it to understand more about your experience of pain. Psycho-somatic was used as a term to dismiss people’s pain as not real, rather than what the new science says, which is that is absolutely real pain. It’s just not the same as acute pain from a physical cause.

So, what’s the difference? Acute pain from a physical injury or tissue damage, shows up in the motor areas of the brain, while chronic pain shows up in the meaning-making areas of the brain. Acute pain ceases along the road to healing (eg. a broken leg stops hurting before the bones knit back together), and chronic pain is self-perpetuating.

This article, written by This Might Hurt, explains which disorders are believed to come from neuroplasticity.

Reign of Pain is a self-led and free online course by an expert in the field. It has a component about how doctors diagnose neuroplastic and structural causes for pain in module 5. 

And this Questionnaire can help you decide whether neuroplastic pain describes your experience, and whether you would like to explore more.

This article is a great starting point for understanding the characteristics and patterns of neuroplastic pain.

What does it look like to work with me?

If you contact me to work on your chronic discomforts, we will go through a few steps and stages. First, we’ll meet over a quick call, to chat about what you are looking for and what I can do for you. We’ll get to ask each other questions, and determine whether we feel like a good fit to move forward, or whether I can point you to some more resources or other referrals. Thus, we may begin our therapeutic relationship at this meeting.

If we both agree to work together, then we’ll schedule an intake session. This is a 50 minute session (my regular session duration) where we begin to build our relationship more in depth. This looks like me learning more about your life up until now, and you getting to know my style of interacting, and getting comfortable with sharing. Though I try to collect some information about your history, by no means to I expect you to share anything much with me yet… as I know I’m still a stranger to you! It can take time to feel safe in sharing some things. Generally, I may ask about your family of origin, your current family and who you live with, your education and career, other mental or health problems that might be relevant to our work, the story of your pain, how you take care of yourself, your strengths, etc. I’ll also ask about what you want to accomplish with me – and it’s entirely ok if you don’t exactly know yet! I also like to leave you with something to take into your week. Sometimes that’s an insight, psychological concept to think on, or a Pain Reprocessing Tool to try out.

From there, we continue along similar lines at each session. I’ll ask about how you’ve been since last time, whether anything stuck with you or has been on your mind that stood out from our session. I’ll ask whether there’s anything you especially want to talk about this session. Together we will figure out a place to start. We’ll work on making sense of whatever is coming up for you, assessing your pain story for clues of neuroplastic pain, and pull in strategies or tools that may help you build skills to turn the volume of pain down, or off. I try to balance conversational style sense-making with implementing techniques and tools to change patterns that no longer work well for you. At the end of sessions, I often check in with you for feedback on how I am doing: what’s been working well and what can I do differently to help you more? Your feedback (It can be blunt! I can take it!) helps me find the right direction for us.

Are you worried about being awkward, or hesitant to open up to a stranger? Relationships take time to build, and change is not a linear. Know that I’m right there with you… an awkward person who stumbles over words, reaches clumsily for metaphors, and laughs at my own social foibles. This doesn’t have to be a perfect experience to be incredibly helpful! Come as you are!

Curious about Pain Reprocessing tools?

These are some guided audio examples of the two main tools of Pain Reprocessing Therapy, from the pleothora available online – Leaning into Positive Sensations, and Somatic Tracking. We will use these, and likely many more strategies to help you get where you want to go. Feel free to try them out.

Live in Ontario? This local MD can help!

The Pain Reprocessing Therapy Institute is where my own training occurred, and is a great starting point for learning about their approach to treating and their lens of understanding chronic pain. 

For residents of Ontario, we are lucky to have Dr. Jan Carstoniu offering free OHIP covered weekly group sessions on mind-body pain. These are gentle movement and psycho-educational sessions, both virtual and in-person. Virtual groups are Tuesday 1pm and Wednesday 10:30am. The in-person group is Thursdays 10:30am at the Northern District branch of the Toronto Public Library at 40 Orchard View Blvd. Visit the Mind Body Pain Clinics website to register or access replays. These sessions could be a great resource, or additional resource to psychotherapy with a pain therapists, such as myself.

Looking for more research to delve into?

These are a variety of resources in different formats. Choose based on how you like to consume information. Do you prefer to read? Books or snippets? Listen to podcasts or audio books? Watch videos? Take an online course? Use an App? Join an online community? There is something for everyone and I love connecting people to the right resource for them. This list isn’t comprehensive. There are probably hundreds of resources for unlearning you pain available online currently.

• https://www.instagram.com/alantgordon/
• The Way Out, a book by Alan Gordon and Alon Ziv
• Tell Me About Your Pain podcast by Alan and Alon
• Like Mind, Like Body podcast by Curable
• Reign of Pain, A free online course by Dr. Schubiner 
• TMS Wiki, another free online course by Alan Gordon 
• Youtube channel by Dan Buglio, pain coach
• Dr. Schubiner’s complete video series
• Curable App
• Tell Me About Your Pain Community: A Mindbody PRT Based Approach to Healing – This is a great community where you can get resources, and learn about other facebook groups supporting people are the same principles in different ways.

Want to connect?

Thank you for reading this far. I hope that all I’ve shared is resonating or useful to you. If you want to be in touch with questions about any of this, or to schedule a short introductory call, please send me a message! I would love to hear from you.