Chronic Pain

– by Lee Smith, Ph.D.

In many cases chronic pain is another example of how brains and bodies change through the repeated interplay of several systems. If you do something over and over, you’ll get better at it. Chronic pain can be the neuroplastic outcome of a brain and body that has learned to be in pain and to suffer.

The question might arise of whether chronic pain has a legitimate physical basis or whether it’s a psychological issue, and the answer is, yes. Many ingredients are needed to bake a cake, and a lot is baked in to chronic pain as well. The experience of acute physical pain is a result of injury to or illness in some tissue(s) of the body. Pain sensations also activate stress responses, emotions and thoughts.

Acute pain is a good thing because it tells us when something is doing us harm. It’s a protective signal that says, “Look out! Something is harming me”!! Because harm is also a threat, pain signals bring in our old friend, the stress system. Pain and stress are the dynamic duo of survival. Stress activates the immune and inflammatory systems, and it gets us energized, tense, edgy and on the look out.

A lasting, painful injury can recruit a cast of players. They rehearse their lines together, polishing their act, playing off of one another. And wouldn’t you know it; chronic stress can sensitize our nervous systems to pain signals.

In some cases chronic pain can become a case of ‘brain’s gone wild’. The mind-brain can become unintentionally ‘talented’ at being in pain as the cast of players become interlinked, ‘texting’ each other like teenagers.

When we have a pain-evoking and ongoing injury, we are exposed to ongoing and repeated pain messages about the injury. Our nervous systems can become increasingly on guard, watching for pain, and increased sensitization to pain can develop. Neurochemical changes can lead to nonharmful stimulation producing intense pain. An overprotectiveness develops from these private lessons, and the body-brain learns to react with the same stress and threat, emotion and thought, from a mere nudge or light touch.

As this learning settles in, any one of the players can set the others to howling. A new financial or social surprise can produce stress and pain. The persisting pain and stress can cultivate mood changes. Chronic pain may take centre stage, but there is a strong cast of players also at work.

Stress plays a critical role in the development and maintenance of chronic pain. People who are chronically stressed from childhood maltreatment, trauma, loss or difficult circumstances are understandably more vulnerable to developing chronic pain conditions.

Research shows that when we are more accepting of the presence and existence of pain, we’re much less catastrophic and feel more control of our life.

It’s not a matter of just saying to yourself, “Just stop feeling the pain”. That’s about as helpful as telling a novice to just play piano. And being hard on yourself just adds to the stress.

Chronic pain following an injury is very real. Damage to tissue is real and may not be subject to complete resolution. Learning to live with chronic pain equates to finding ways to accept it’s presence in your life and working with your pain to reduce it’s interference. Living with chronic pain involves learning about your stress reactions and facing all of the facets of the experience of pain. Through this exploration, through unwinding the chronic pain learning with new adaptive learning about what’s going on, through learning how to regulate your stress, the mind-body can be retrained. Yoga, mindfulness training, relaxation skills, and cognitive therapy are all helpful routes to better living through neuroplasticity.

Gratitude

– by Lee Smith, Ph.D.

We read and hear in the media about all sorts of things that we’re doing ‘wrong’, that we should do more of, less of, and on and on. Do we crave some sort of disembodied scolding, the wagging finger expression of some quasi-parental concern for us? Maybe. Or might we be drawn to ideas that may help us to sort things out and to become a little more content and safe in our lives? To this loud chorus I’m going to add my little voice today.

I want to survey for you a body of recent research that has really delighted me. This research would seem to be revealing that marked improvements in our well-being can result from something that we can do even just once a week for only a few moments – just a few moments! Continuing to do this for a couple of months seems to bring about some striking and lasting changes. That the research shows that people have less depression and more contentedness from completing this brief mental activity, which requires less than five minutes a week, is amazing to me.

What could we possibly do with our brain in such a short period of time that would act like a kind of inoculation or correction against all of the other troubling stuff that goes on in our mind? Further, what little act of attention would produce a strong tendency to be less confrontational, more cooperative, kinder and gentler?

And there are no costs, no nasty side-effects or contraindications, does not cause drowsiness or constipation, you can operate heavy equipment and you won’t be kicked off a plane for doing it.

Our colleague, Dr. Seuss, prescribed just this balm for the spirit long ago: “It’s a troublesome world. All the people who’re in it are troubled with troubles almost every minute. You ought to be thankful, a whole heaping lot, for the places and people you’re lucky you’re not.”

Gratitude is a sense of thankfulness and joy for someone or for something you experience, whether a gift, a kindness or a moment of awareness of some natural beauty. Gratitude might be a passing state, but it’s also something of a trainable trait, a “life orientation toward noticing and appreciating the positive in life.”

Researchers asked people to write one sentence for each of five things for which they feel grateful and to do this once a week for two months. After these two months of keeping a gratitude journal, as compared to control groups, people felt more optimistic, had fewer physical complaints and were exercising more. The changes weren’t just subjective because spouses also noticed positive shifts. In other research, people suffering neuromuscular diseases felt happier, slept better and felt more refreshed.

Across ages gratitude increases well-being regardless of personality type. Youth who are more grateful have a higher grade point average, greater life satisfaction and more social involvement. They also have less depression and less envy than their less grateful and more materialistic counterparts; materialism is associated with more envy and a lower GPA.

The positive emotion evoked by being grateful on purpose increases our resilience, it firmly disposes us to be in relation to others with more warmth and it becomes reciprocal very quickly. Expressing your gratitude to your partner encourages mutual positive ‘maintenance work’ on your relationship.

Gratitude inspires a sense of life being well-lived. Among the elderly, gratitude is associated with a decrease in death anxiety.

Touch in to gratitude regularly. If you’re feeling irritated, if you’re feeling like your head might explode over some tension or misdeed, a moment of grateful reflection may be the most radiant gift that you can either give or receive.

Raiders of Health

Do you remember this scene from Raiders of the Lost Ark: After Indiana Jones takes an improbable pounding chasing the bad guys, we find him a little worse for wear in the berth of a ship with the enamoured Karen Allen. Her glow is met by his fatigue, her kiss by his snore, but just before he sleeps she scolds him, “You’re not the man I knew ten years ago”, to which he replied, “It’s not the years, honey, it’s the mileage”.

True that. What might we learn if we were each fitted with a sort of life odometer that displayed our ‘mileage’, the amount of wear and tear we accrue as the months and years bounce by?

One thing we would see is that chronic stress gets that odometer ticking. And a remarkable body of research is showing that stress gets under our skin, so to speak, during sensitive periods of our development and changes our long-range vulnerability to depression and anxiety, addiction, social isolation, disease, injury, dementia and death. Ughh!

The biological processes of a developing child’s body and mind are shaped and changed by the conditions that the child encounters. Early life adversity, as it’s called, such as physical, sexual, and emotional abuse, harsh discipline, parental unresponsiveness and neglect, poverty and witnessing violence subjects a child to an environment full of threat, shock and danger.

Danger is biologically important information. Evolution has it that we naturally adjust in whatever ways those adjustments can be made so that we can most optimally meet future conditions. Because nature doesn’t have a crystal ball, the adjustments that get made are based in the conditions that are commonplace in the child’s life. Development tunes the body and mind, reflecting the way it is. Human and animal research has clearly established that if danger is present with some frequency, then the developing stress and immune systems learn and morph to mirror the requirement to deal with danger, and these changes can persist apparently for the duration of the individual’s life.

Adults who had suffered early life adversity react with more and longer lasting fear and have stronger and longer stress reactions. The diseases and problems of adulthood that are clearly associated with stress, such as heart disease, are more prevalent in those who suffered childhood adversity. A Johns Hopkins Medical School study followed medical students/physicians for 40 years and found, in that affluent and educated population, that those who had suffered childhood adversity had 2.4 times the rate of coronary heart disease by age 50.

Childhood maltreatment is borne through a person’s life at the levels of cells and systems; it becomes a part of how we are. Chronic childhood stressors program changes in certain types of immune cells that result in over-responding to injuries and infections. These changes get embedded in the way DNA cranks out the battle materials when threats from viruses and wounds occur. These and other changes produce more inflammation and less responsiveness to the signals that would down-regulate the stress response.

Behavioural changes also get baked in to the cake and further undermine long-term health. Effected adults more often participate in unhealthy, high mileage lifestyles including poor diet, smoking, alcohol abuse and less exercise. They tend to be more socially isolated due to the learned tendency for vigilance to threat and mistrust of others.

No child is responsible for the conditions in which they grow up and so it’s most important that health policy catch up with what science is telling us about stress, emotional health and physical health. I’m sorry to say that the Conference Board of Canada, self-described as,”The foremost independent, not-for-profit, applied research organization in Canada” mentioned “stress” only once, as an afterthought, in their Canadian Heart Health Strategy document from January 2010. Their slogan, “Insights You Can Count On”, suggests instead that we cannot yet count on seeing policies that embrace the reality that emotional health is a major and very costly public health issue.

Intuition

“Go with your gut reaction!” The more savoury interpretation of that often heard advice is to trust your intuition. I’ve said this to people and often I’ve drawn on the idea myself. And doesn’t it indeed feel like an act of trust, trusting something in yourself that you just can’t quite put your finger on? Ah, but is our intuition faultless and truly trustworthy?

We may like to believe that our intuition taps in to some deep, sage-reservoir of wisdom and truth, guiding us in our decisions. And although intuition may prove to be wise at times, research is showing that intuition is largely a sense of things that flows from the feel of familiarity, from the automatic creation of ideas assembled from the most readily available associations and from biases born in evolution. Leaving to intuition big decisions about careers or relationships or purchases may be the stuff of human folly.

Daniel Kahneman, a psychologist and Nobel winner, recently summarized the research on thinking and intuition in his new book, Thinking, Fast and Slow.

How we see things is often primed by context and by what has gone before. Seeing EAT leads you temporarily to complete SO_P as soup and not soap and the opposite would happen if you had first seen WASH. Somewhat weightier, voters endorsed increased school funding when the polling station was located in a school vs. another location, and this effect was greater than the voting difference between parents vs. others.

When people do a word association test in one office that includes words such as Florida, forgetful, bald, gray, wrinkle, they take more time to walk down a hallway to get to another office. The priming of the idea of old age slows behaviour. Even mood can be primed by what has gone before.

Evolution has equipped us with biases in how we size up other people in terms of dominance (for example, a strong chin) and likability or friendliness, using face shape and expression. But in our modern world, the body of research shows that our rapid judgements about people based in appearance are often not checked and looked at more closely. For example, physical appearance has been shown to have a significant influence on voting in elections, even though there is no relation between facial features and competence in government office.

Our intuition is shaped by familiarity. Safety is a big deal in survival and evolution, and so our minds today seek and soften to the scent of familiarity. Repeated exposure to things (hello advertising) fosters a feeling of safety and ease. Preferences shift in favour of the familiar, and we become less inquiring and critical.

Our minds store vast troves of experience that are highly associatively linked, forming ideas, concepts, narratives and clusters of impressions. Overall, our mind continuously updates (but rarely revises) grand ideas about how the world is and who we are, keeping it all straight if not correct. From this, with effortless ease our mind invents causes and intentions, neglects ambiguity and suppresses doubt.

If something passes by us we have intuitive feelings and opinions about it with no questions asked. We leap to conclusions, we have answers to questions we don’t even understand and we draw on evidence that we can only vaguely explain. Our intuitions set us up to be overly optimistic about things we like and to overestimate benefits and underestimate costs.

Making decisions that support your best interests may require some time, research and serious thought. The evidence shows, however, that our minds are quite naturally lazy; we’re more inclined to intuit from the hammock than get sweaty. Heed Einstein: “Sometimes one pays most for the things one gets for nothing”.

Lifestyle

“If you keep going in the direction you’re headed, that’s where you’ll end up.” That nugget from a Buddhist monk kind of ‘rhymes’ with one of Yogi Berra’s quips, “If you don’t know where you are going, you might wind up somewhere else.” Yogi’s gem hints that we all harbour some, perhaps unstated, destination that we’d like to reach, and I’d guess that for most of us we’d like to be headed toward health, happiness and togetherness.

But what if, on honest appraisal, you can see that there are distinct signs that you’re headed in some unwholesome if not dangerous directions?

Some change of course may be important. Our most common efforts seem to entail medications as well as materialism; that we’ll “become” the person we want to be if we just buy THIS. Therapy for many of us might seem too tough or too costly or too vague an undertaking. Are there other ways?

Recent research shows that your lifestyle itself can be significantly beneficial for (or destructive of) your mental health. Lifestyle choices in exercise and diet, and your involvement with your community, nature and technology can all have considerable effects on your mental and physical well-being.

Your mind is so intimately interconnected with both your body and your world that where one stops and another starts is unknowable. Not surprisingly, then, recent research is showing us that beneficial changes in physical health seep in to our emotional well-being, that connecting with each other and with the world in particular ways will enrich your mind and your heart.

Exercise is therapeutic for many physical disorders and can reduce vulnerability to depression and neurodegenerative diseases, including age-related cognitive losses. Exercise increases brain volume and cerebrovascular health.

Something else to chew on: A diet that includes (1) multicoloured fruits and vegetables – a rainbow diet, (2) fish and/or supplements of omega-3 fish oils and which (3) reduces your caloric intake helps mind and body significantly. The accumulating evidence pointing to adult neuroprotective benefits of omega-3s and possible decreases in attention-deficits, aggression and vulnerability to psychosis in adolescents recommends that everyone look into this supplement and check the few risks that have been reported. The “globesity” epidemic is associated with medical and cognitive problems, and over-eating weighs complexly on the minds of many.

Time in nature and obtaining exposure to full spectrum light may be increasingly important as we spend more time with our eyes locked on to one electronic device or another. ‘Mental health screen’ sounds like a new app, not a gut check. Technopathologies, techno-stress, on-line compulsive disorders, screen sucking, data smog and hyperreality – “a simulated life-world that seems more real than reality” – creep our lives and give little that soothes. In contrast, nature nourishes like nothing else and offers a stillness and silence that whispers wholesome truths, if you listen patiently and carefully.

Warm-hearted gratitude, kindness, reciprocity, acceptance, belonging, love and compassion are all resonant to our deep nature as social mammals. Richer relationships reduce health problems, from common colds to neuropathologies, as well as psychological problems. Our recreational activities, play and playfulness, may blend time in nature, good time with people and meaningful pursuits, all of which decrease stress.

And finally, the new embrace of the ancient practices of yoga (wisely-taught), tai chi and meditation may be one of the timeliest trends witnessed in participatory health care – the taking of responsibility for one’s own health. After all, no one else can richly regulate the course of your life for you. Living as if your life really matters by exercising an attentiveness to one’s lifestyle can, day by day, help any of us chart healthier choices and live the benefits that follow.