Chronic Migraine Pain: The Way Out
Part 1 of Pain Reprocessing Therapy
Recently I introduced you to the much buzzed about new book (2022) called The Way Out: A Revolutionary Scientifically Proven Approach to Healing Chronic Pain by Alan Gordon, LCSW. In it, he promises that a special therapy called Pain Reprocessing Therapy can cure anyone with chronic pain that is not directly related to injury.
Strategy and Suggestions
To get myself started, I came up with a game plan for each one of the techniques described in Gordon’s Pain Reprocessing Therapy (PRT).
Somatic tracking: So far, I seem to only do it in bed. After a hectic day of chasing a toddler, among other life responsibilities, I have more time to think. I focus on the pain with no agenda. I might think, “I feel the pain at the bottom of my skull in the back on the left. It’s piercing, but if I stay still I don’t feel it.” I continue describing the pain in full sensory detail for up to 5-minutes. Typically, when we are in pain, we think, “Ah, this is so excruciating, when will it end?” But we don’t take time to pay attention to what it’ really feels like, which reinforces the brain’s preconception that everything is bad when we are in pain.
Avoidance Behaviors: I have 2 known triggers for migraines that are not “Neuroplastic pain.” One is alcohol, so I stay away from it except on special occasions. The other is menstrual migraine. For me, those are the absolute worst. They don’t respond to meds and take me all the way out. To mitigate it, I take birth control consecutively so that I only have 3-4 periods per year. Another avoidance behavior is taking medicines that provide relief, even if it’s temporary. For someone with back or shoulder pain, you might avoid doing things that trigger the pain. Don’t try to muscle through it. Get comfortable asking for help.
Sending signals of safety: I have started compulsively telling my brain that “we are safe,” even in the face of stress and aggravation. When something comes up, I say to myself, “This is annoying/stressful/stupid but it is not threatening. We are safe.” Another thing you can say to yourself, especially with other types of bodily pain is, “My back/neck/foot doesn’t feel as comfortable as I would like it to right now, but it will be comfortable again.” The use of the word comfortable sends signals of comfort to the brain, instead of saying, “This is excruciating,” which reinforces the brain’s danger signals.
Reducing stimulation: I love news and knowing what is going on in the country and world. But it is too much. I can’t keep an unending loop of news, podcasts, articles, etc. going all day anymore. In the mornings, instead of listening to Morning Joe, I put on music. Later in the day, I allow myself 30-45 minutes to catch up on The New York Times and WaPo’s morning briefings, and read any linked articles that catch my attention. When I’m cooking or doing something mindless, I listen to an audio book. I have always kept my phone on silent, so that I’m not constantly triggered by incessant dings. If work, email, messages are a problem for you, email batching might be a good technique, and if you use an iPhone, turning on focus settings. You can also use apps, like OneSec, that make you think twice about opening social media apps, or even putting your phone in black and white, which makes it much less interesting to look at.
Avoid feeling trapped: this is a hard one because it means letting go of my social life. A chronic pain sufferer’s worst fear is the fear of pain, and being in a situation like a party or event where there’s alcohol, loud noise, and other triggers is hard. I’ve already been doing this technique a little too much, and need to find balance. I can’t let the fear of pain keep me home for the rest of my life. But for someone with other kinds of pain, it might mean booking an aisle seat on a plane so you can get up and walk around, and not literally be trapped at the window. Or if sitting for too long is a problem, get a stand-up desk, or invest in a better chair.
Handling uncertainty: this goes hand in hand with sending signals of safety. Sometimes my husband and I are too reactive to each other instead of staying calm and asking questions. It’s so hard to catch myself in that moment, but it’s easier to catch him in that moment! If I can say to him, “Hey, take a breath,” then it gives me time to do that, too. After we talk it out, I remind my brain it is safe. This is hard to do with family, especially kids when emotions run high, but not letting uncertainty overwhelm you is the key. You won’t always be successful at it, but the more you practice, there will be less opportunities for uncertainties—which are a statistical certainty in everyone’s life—to trigger pain.
Catching your fears: similarly, when I go down a rabbit hole of self doubt or fear of failure, I have to “catch” it, or catch myself in the act. “No one is reading my Substack!” I might think. “Should I just quit?” Then I remember no one is successful without practice, patience, tenacity, and consistency. Consistency is also important for PRT. When you have these fears, what if I get fired, what if I look like an idiot at the meeting, answer yourself. What if? What if you have spinach in your teeth while making a presentation to executive management? Well, it’ll be embarrassing and you may never forget it, but accept that it happened and move on. Don’t let it control your life even more by triggering pain on top of humiliation.
Embracing positive sensations: no matter how bereft we may be in life, there are always positive sensations. It might be that feeling of getting into bed after a long day, or how good warm water feels on your hands when you come in from the cold. Whatever it is, I make a point to not enjoy these moments unconsciously, but to deliberately acknowledge them. “This feels nice.” This one is especially important, because positive sensations can happen even while you’re having pain, and recognizing comfort while also experiencing discomfort helps the brain disentangle that negative-negative association. Good sensations can happen even when we are in pain.
Weeks 1-3
I picked up The Way Out from the library on Friday, December 15. I read it on Sunday night (it’s not long and is fluffed with cheesy analogies and anecdotes.) That night I didn’t sleep well. Every time I woke up, my head hurting, I compulsively somatic tracked. Somatic tracking is not to eliminate the migraine, but to better understand it. You can’t control what you don’t understand. As the days went on I was able to better control the constant impulse to focus on my pain.
The neural pathways I’m attempting to correct have been solidly in place for decades. There’s no reason to think that a couple days of positive thinking will be all it takes to make all the pain go away, so I must go into this process with openness and patience.
Gordon also warns against relapses. He says they are common and expected, and to not let that be discouraging. “Stay the course,” he advises.
How It Went
On an ill-timed drive for last minute shopping the Friday before Christmas, I noticed a spike in pain as I sat in traffic on Route 1. Thanks to the somatic tracking, I recognized that the pain increased at the same rate as my stress and aggravation. “This traffic sucks, but we are safe,” I told myself. Then I looked at my daughter snoozing in the backseat and made a point to appreciate the moment.
When Barnes & Noble had the book even Amazon did not, I made a point to appreciate the moment.
When I came home to find my dog hadn’t broken the baby latches and dragged the trash can out, debris strewn about, much of it eaten, I made a point to appreciate the moment.
At first, my migraines were milder than usual. I avoided rescue medications to see if I could do this all with my mind, but this naive thinking will only set me up for failure.
“This is the practice period,” I thought, while popping a Rizatriptan and 2 Aleve. The fact that my migraines were more like headaches isn’t a sign of anything, it just means they weren’t as severe.
A couple days after Christmas, I didn’t have any migraine pain for two days. It’s rare I get one day, much less two. I don’t know to what to attribute this relief, but sometimes a girl just gets lucky. Perhaps, if stress is as powerful as it is said to be, spending more quality time with my daughter and husband while he was off work played a part.
Algophobia
The word pain comes from the Latin poena, meaning "punishment, penalty, retribution, indemnification" (in Late Latin also "torment, hardship, suffering"). Pain doesn’t just mean “an owie.” Pain makes people feel punished, it is punitive. We often hear people say, “What did I do to deserve this?” We feel pain not just as discomfort, but unconsciously as a measure of our reputation and virtue, a barometer of our morality and integrity. But it is not. It is a signal that something is wrong in the body—an injury, or with chronic pain—the chronic fear of it.
I avoid taking rescue drugs when they aren’t absolutely necessary, which further compounds the “fear of pain.” It creates anxiety about what pills I can take, when, and how often. I wait until a migraine is so bad, it would be unreasonable not to medicate, but if I’d taken medicine at the onset, it never would’ve advanced and been easier to defeat. Excedrin has caffeine, so only take in the morning. Fioricet is a barbiturate, so don’t take before driving. Rizatriptan causes nausea so only take before bed. Zavzpret nasal spray tastes so bad, take it at least 30 minutes before lying down…
This constant mental maze increases the fear of pain because it is only when I’m in the most severe pain that I must navigate it. I figured one way to circumvent it is allowing myself to take whatever I wanted whenever I needed it. This turned into two-weeks of Rizatriptan every day. My neurologist would’ve had a stroke if he’d known. I got a prescription for tramadol, which does not cause rebound headaches, to hopefully break the pain cycle before using another migraine abortive. It got me through my week-long virtual residency with my Master’s program.
I confess, it was difficult to multi-task school with Pain Reprocessing Therapy. But what was effective, I suspect, is that I spent less time thinking about my migraines, while I got relief from tramadol and enjoyed the residency.
Now that it’s over, I’m revisiting some of the strategies. Avoidance, less stress and stimulation (less consumption of news), focusing on pleasant moments, facing uncertainty with the confidence of a stoned hippie, and constantly telling myself that I am safe.
Last night before we fell asleep, I told my 2-year old, “I know it sucks to go to bed now, but that’s ok. We’ll get up tomorrow and play again. For now, at least, we are safe.”
Stay tuned for PRT Part 2… →
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