What is Pain: Emotional? Physical?

The problem with pain – is a big topic in our media right now. There is so much talk about the opioid crisis, questions about what is chronic pain, and wonderings about how we got here. The conversation is large and happening in all sorts of places. In my practice, I deal a lot with pain. I have many clients who struggle with chronic pain, or have been hurt and the acute pain keeps them from activities they love leading to depression or anxiety, or the trauma of the injury disrupts their nervous system, leading to a host of problems. In addition, I see a lot of opiate addiction as a result of prescription medications. Many do not even know how they got to the place of addiction, let alone how to get out of it. I often get questioned about how to deal with pain, especially when opiates are not something available or wanted. This week we’ll be looking closer at pain and what to do about it. 

What is pain anyway?

For most they would answer, this is the signal your body gives when it is hurt or there is something you need to avoid because of potential hurt. However, pain is not always physical and physical problems do not always cause pain (Turk and Winter, 2014). Physical and emotional pain run on the same circuits and whether the pain started as a physical problem (injury/disease) or an emotional problem (depression/grief/anxiety/trauma) the result can feel the same. Physically painful. 

Due to mental health stigma, lack of understanding of the body’s “warning” systems, and heavy marketing of pharmaceuticals many who experience pain sensations turn to drugs. Unfortunately, many of these pills to fix the problem make it worse. Pain medicines often lower your threshold for pain, thus causing a cycle that creates the need for more pain meds. 

Since it feels physical, and our society lacks understanding of how the mind-body connect, we turn to physical solutions. Often at the expense of solving the problem or trying options that may be more powerful. Now, this is not to say medications and physical medicine do not have a place in pain treatment, however many people do not engage in the other half of health – mental health – as part of pain management. Thus, they are left with only half the equation, half the treatment, and often lots of frustration. 

“But it’s so physical you say, it must be a physical problem.”

Maybe. According to Apkarian, Bushness, Treede, and Zubieta, “… emotional state can influence pain perception, and a recent study shows that negative emotional states enhance pain-evoked activity in limbic regions, such as ACC and IC”, (pg. 474, 2005). In a meta analysis on questions related to how humans experience pain, their study looked at areas of the brain responsible for pain sensations. Findings from the many studies in their analysis suggest that pain is felt in different areas of the brain for acute versus chronic pain states and that cognition and emotions influence how, when, and why we experience pain. They also showed evidence for non-medical pain management treatments, such as distraction and acceptance. Yet, for many they never think to turn to or are offered options for non-medical pain management, and end up in the opiate cycle of addictive patterns and need. 

We know our mind and our bodies are connected. Most would say “yes, Stacy you are right”, but not everyone understand’s just how closely connected they are. In my world of somatic psychology we do not even consider them to be separate entities we can speak of. The mind lives in every cell of the body and every biological cell in your body is responding to the environment you are in, including your thoughts and emotions, all the time, every minute of every day. 

When you consider that your physical structure is actually a mental structure with a physical container it becomes easier to see how much your thinking and feeling – which are subjective to the environment around you – play a role in what you feel physically. In my graduate research  I studied how the physical body is influenced by psychological trauma. This trauma could be an event(s) or negative thinking patterns or a chronic sense of overwhelm. All create a similar physical response in the endocrine system that responds as though you were physically hurt or fighting off a disease. The bodymind senses a problem, inflammation rises, and your immune system gets ready to fight. However, in the case of psychological trauma and chronic stress states there may be no tangible predator and your body begins attacking itself. This leads to chronic inflammation – heart problems, cognitive issues, joint pain, digestive issues, chronic pains states like fibromyalgia, and more. The cellular structures sense a problem, however it may not be a physical problem per say, but … it becomes one. The end result is the same … sensations of pain. 

Non-medical pain management treatments.

Many people want to know why pain syndromes are on the rise in our society. This is a complicated issue with many facets, however if we take a global look we can see a number of ideas and areas you may be able to influence your own behavior and help decrease pain in your own life. 

Pay attention to what you allow into your psyche. We “share” pain.

Humans are biologically pack creatures whose brains developed to connect to other mammals. Our brains respond to others in pain. When we are exposed to others in pain, we feel it in our own systems. Even if we do not feel the pain as a physical process, our personal sensitivity to pain is activated (Liu, Meng, Yao, Ye, Fan, and Peng, 2019). By watching that daily news program, listening to stories on the radio of atrocious things happening around the world, and by reading about torturous things we are activating our own pain system and could be elevating our own sensitivity to pain from other sources. 

Food and environmental toxins: another source of inflammation.

In the United States of America our food options can be a source of increasing inflammation in our physical structures. As noted above, when inflammation rises so does our susceptibility to other problems that may seem unrelated but need medical attention. The Standard American Diet (SAD) is very sad, indeed. Most of the foods we are offered are loaded with chemicals, sugar, and salt. On their own these ingredients may not be a big deal but the enormous amount of them in our food, cleaning, and hygiene products is too much for our system. In addition to what we may consume by mouth or through our skin, the mass production of single crops creates a high need for pesticides and chemical trails that get into our water supplies, poison the air we breathe, and lands on our skin through indirect contact. 

Learn to read food and product labelsand remember cheap food is not always good food. Keep in mind that bigger is not always better and more does not always equal care. As many in our culture look to food to fill emotional gaps in our life, find the “sweetness” of life, or “fill up” when we are feeling empty, lacking, alone, bored, or fearful it is important to examine how you use food. The “value” sized cheap chips loaded with “cheese” flavors may be creating an empty feeling you will not be able to fill no matter how much and how often you physically eat. 

If you are confused or feeling overwhelmed by these concepts reach out – there is support and education to help you learn more and work through these issues. 

Another source of stress in our life … ease!

What, you say. How can this be?! Well, the more comfortable we get the harder it is for us to find our own confidence, esteem, worth, and strength. When things are easy we do not have the opportunity to “test” ourselves and learn about our edges. These edges are important for self growth and expansion. Instead, we stay in our comfort zones and let other people’s lives distract us from living our own. 

We stay in the same cultures, doing the same things, and operating on autopilot. This creates boredom and a lack of engagement. Then we look to other things to “fill us up”, see the food paragraph above. We also start to consume media, mood altering substances, tech / internet / using devices, and other items that are not healthy in large quantities. When this overindulgence happens we shift our internal chemistry and we can create situations in which our bodies are overpopulated with bacteria and flora that is not helping us. This imbalance can create a decrease in our body’s ability to create the neurotransmitters, hormones, proteins, and enzymes we need for optimal mental and physical health. 

The more we watch, listen to, and read about tragedies around the world, see images of others in physical and emotional pain, and engage in mindless distraction the more we feel lost. Remember our systems are created to connect, thus our passive engagement with these things creates a physical response in our system, even if indirectly – we are being impacted by everything we consume, in every way we consume it. Guard your consumption well. 

Living in a Fear based culture … real or imagined / accurate or created. It all ends the same in the body – inflammation. 

Lastly let’s talk about stress. In our society we talk a lot about stress, but instead of decreasing it, it often seems like it gets harder to control, even when we know about it. Many of us are not great at setting boundaries and struggle to find the limits to what we want to give, engage in, participate in, and be involved in. We feel pulled to say yes to the groups we are part of (schools, friends, religious, community, kid activities, non-profits). We haven’t learned to say no … or say yes appropriately for our personal system.

Understanding outside influence and group dynamics to set up our fear based culture

Many of us continue to get asked to “do more with less” at work, school, in our household budgets. We are fed lines about what we should want, need, have and do not know what the “spin” is. Some of us are not good at checking the source. We consume media, conversation, social media as though it is true. We figure if the information is coming from a source we like, trust, or feel is “like” us it must be true. We forget that many of these sources are mining our data, targeting us, and working to activate us toward something – usually something that gives that group profits or power. As a result of being overwhelmed we narrow our focal areas and become more rigid and polarized. This is a classic outcome of group dynamics. Social sciences have been studying how groups form, polarize, strengthen, and implode for decades. We have many great examples of group dynamics to study throughout the years. As a result of this polarization and rigidity we become more fearful about “others”. This fear results in a physical change in our bodies. 

Fear is a response we need. It is really helpful when we need a warning system. It is very good when we need to run and get away, however when we are engaged in the activities listed above we can create a sense of fear in the world based on the messages being “spun” to capture our dollars, attention, and engagement. This fear, the kind that is created in the mind based on what we see, read, hear, has the same physical responses in the body as fear based on being chased by a mountain lion. As a result our physical body reacts and feels something that prompts us to move away or fight. This is caused by an increase in adrenaline, norepinephrine, and cortisol. When we are not actually running away, we do not have the opportunity to metabolize the stress chemicals pumping through our system. As a result our system stays “revved up” and inflammation begins to rise. When it is chronic and there is no opportunity to metabolize the hormones, the inflammation states create physical health problems – again, see the above list. The quick result is often a pharmaceutical and all its side effects.

Couple all the above with a lack of exercise and movement, which helps our bodies metabolize out the inflammation states, and you have a recipe for a physical disaster. Add the fuel around mental health stigma, feeling overwhelmed, being too busy, and suddenly it is clear why it is easier to go to a medical doctor and get a pill. Pills are easy and often very effective for the symptom. They just aren’t always the answer for the problem. Often the problem is a behavioral change(s) that will take time to implement and willingness to do the hard work of self examination and radical acceptance. This work does not always result in zero pain, but neither does the quick answer, it just masks it for periods of time. Mental health treatment for pain helps us engage in our life to the best of our abilities and can increase our quality of life even if we continue to experience chronic pain states. 

You get to choose how you will live, what you consume, and what you do with the time you have – Which will you choose? 

Get Moving: The links between physical exercise and psychological states

This week, in the last of the series on self regulation, we are going to talk about exercise and movement. For many exercise is something extra they must do every day, but in reality movement is part of what regulates your body throughout the day. 

It starts with breathing. As you breathe you regulate your sympathetic and para sympathetic parts of your nervous system. You do this through what is known as heart rate variability. Many of us who work in the exercise and health care fields use this number to understand how healthy your cardiovascular system is, however in my world of somatic psychology I can also use it to program movement to help you change your psychological states. This manipulation of your physical system allows for another option to change how you feel without the same level of concentration changing your thoughts may take. 

Mind & Body as One

Lots of people talk about the mind – body connection and how important is is to your health. To me there is no separation. If we want to know if you are stressed we would look at your cortisol levels in your saliva, depressed check out your blood serotonin levels, how well you are absorbing the nutrients you need to make the neurotransmitters to feel content, pleasure, calm, and control your impulses (physical and thought based) we could examine your feces. 

The body and mind do not have a connection point. They are one thing. The mind just has the ability to abstractly consider your experiences and decide what you would like them to mean. This ability gives the impression that the body is separate from the mind, but the mind has nothing to make meaning of if it does not have the body experiences to decipher. Understanding this oneness helps make more sense of our need for movement to regulate our emotions. 

My Research Findings

When I was doing my doctoral research, it was hard to find the bridges to understanding how our physical health intersects our mental health. There were studies with some longevity looking at how aerobic exercise helped depression, anxiety, bi-polar, and even schizophrenia. We could see how exercise impacted stress levels and anecdotally I heard many stories of people who were helped by regular exercise. However, so many people struggle to work out it was hard to understand how psychological struggle was associated with lack of exercise when we know how helpful it is. Turns out there is correlation between how physically stressed your system is and how hard it is for you to exercise. In my research I found that those who struggled with panic disorder (that feeling like you are having a heart attack, going to die, cannot breathe, and are so scared that you cannot think. Sometimes even feel as though you are losing your mind) is the hardest disorder to get enough physical exercise to meet your needs. Problem is, physical exercise is what helps metabolize the chemicals out of your system and decrease your feelings of panic and stress. As the cortisol, adrenaline, and other stress hormones rise in the system, they feed the symptoms creating a self fulfilling cycle of increasing stress levels. Thus making it harder and harder for the person to physically exercise.

Anxiety and Stress

For the person without panic, but with anxiety and stress overload, struggling to exercise is often linked in a similar fashion just not at the same level. It is hard to motivate and get out the door when your physical system is already so tired and feeling overwhelmed. People will describe feeling heavy, lethargic, slow thinking, or in contrast “tired but wired”. As a result exercise seems too hard and it is much easier to grab a substance to unwind or sit and watch TV. 

Depression

Depression is similar but different. In a depressed system every thing feels hard to manage and the body is very fatigued. It is a similar stress on the physical system, but depressed, a different manifestation of difficulties. When feeling depressed we often struggle to see the point of doing anything. People describe feeling heavy, lethargic, overwhelmed, increased sensitivity to pain, and inability to take care of basic living tasks. These make getting on the treadmill pretty darn hard. 

Kbands

How to Help Yourself Start Exercising

One thing interesting from my research was the fact that the more substance use disorder diagnoses someone had the more likely they were to exercise and the less likely they were to buy into barrier beliefs to accomplishing the tasks of working out. What they told me was, they had to move – they’d lost their license and had to ride bikes, walk, and “there isn’t much to do in jail”. As a result they were exposed to movement regularly and therefore saw and felt the benefits and kept the habit going while they could. As a result of their insight it became apparent that exposure was important to helping others begin the process of working out regularly. Enter movement specifically designed to help mental health diagnosed disorders – depression, anxiety, PTSD, phobia, bi-polar, ADHD. I routinely prescribe physical movement along side traditional therapy interventions because the research is pretty clear, exercise helps. It teaches us a lot about ourselves. 

The research links between physical movement and mental health is growing. There is more and more research coming out everyday looking at how the physical system changes as a result of our thinking and how our thinking is changed by our movements. 

So today, just move. Take a moment, get out of your chair or bed and walk around. As you move the body notice what movements might feel good. Based on your current mental state do you want to move slow or fast? Do you want to be close to the ground or jumping? Do you want to be “quiet” in your moments or “loud”? Move slow or explosive?

Use your inner awareness of your current mental health state to determine what movement would be best for you right now … Now go do that.