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What’s the key to breaking the pain cycle?

This excerpt is taken from an episode of the "Tell Me About Your Pain" podcast. You can listen to the full episode below, or on Apple Podcasts, Spotify, and Google Podcasts


Alan and Alon discuss the science behind the “pain-fear cycle" and speak with real chronic pain sufferers to examine how it plays out in the real world. Amber, who suffers from chronic neck pain, calls in to share her fears and worries about how her pain dominates her life. Meanwhile, Emily struggles to let go of the idea that her pain is purely physical in nature. Alan and Alon guide their guests to let go of these fears to break the cycle of chronic pain.

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Alon: Something that we're going to talk about a lot on this podcast is the importance of making your brain feel safe.

Alan: The thing about fear is, fear is not just a byproduct of the pain; it can actually keep the pain going. Earlier we talked about how the brain can cause pain even if there's nothing physically wrong with you. It's your brain misinterpreting safe signals from your body as if they're dangerous. So when you have fear around the pain, it further reinforces to your brain that it actually is dangerous and it keeps it going. It’s this pain-fear cycle over and over, and your brain eventually learns this pain. That's how it becomes chronic.

Alon: Exactly and we call this kind of pain neuroplastic pain - ‘neuro’ because it has to do with your brain and your nervous system, and ‘plastic’ which means learned.

Alan: So this is neuroplastic pain as opposed to structurally caused pain.

Alon: Exactly. We mentioned this a little bit already but we cannot emphasize this point enough - neuroplastic pain is real pain. A lot of chronic pain people have been dismissed, have heard people say, “oh it's all in your head.” That is not what we're saying. This is real pain. Neuroplastic pain is a false alarm. But false alarms are just as loud as real alarms, and neuroplastic pain is just as painful as structurally caused pain.

Alan: I was thinking when I was talking to Amber about my own pain that you know how hard it was for me. Do you remember the fear that I had around my own pain?

Alon: Your fear was all-consuming. I remember going out to eat with you at our local diner. We were in our mid-twenties and we were single, so I was really bearing my soul to you about a new girl I was dating. The thing that I want the audience to know is that Alan is a really great friend and a really great listener. He, in fact, listens to people professionally as a therapist. But when he was in pain, he was not a great listener. So I remember this one time really telling you about this new girl I was dating and I was explaining all these feelings I was having. Then I look at you for advice and you said, “Maybe we should move to that other booth. I think that would be better for my back. This chair is really hurting my back.” It was clear that you were so consumed with your pain and your fear that a chair was going to make it worse, that you hadn’t even really been able to take in what I was saying.

Alan: Yeah I don't even know if it's the kind of thing that you could understand unless you've had chronic pain, but once it’s really bad and you're consumed with it, you can't even think about anything else. I remember you got so good at looking at me and knowing when I wasn't there. You would see this look in my eyes and you would say, “You didn't hear a word I said, did you?”

Alon: There was like a distant look in your eyes. To go back to the false-alarm analogy, it's hard to pay attention to someone when there's a really loud alarm going off inside your body.

Alan: So pain leads to fear and fear fuels the pain even more. This is the key to breaking the pain-cycle. If you fundamentally change your relationship with the fear around the pain, the pain will eventually fade. Of course this is easier said than done, but we are going to give you the tools to do this.

[this is an excerpt only - for the full episode, listen to the podcast above]

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