Chronic Pain: Is There A Way Out?
Join me as I try to cure my chronic migraines
Chronic pain is an epidemic in the United States. In 2021, an estimated 51.6 million U.S. adults (20.9%) experienced chronic pain, and 17.1 million (6.9%) experienced high-impact chronic pain. The types of chronic pain people experience varies from migraines, to back pain, leg pain, fibromyalgia, and more. But most medical schools provide only nine hours of formalized pain education. Of their 4-6 years of medical school, doctors receive roughly only nine hours of education on pain.
I have chronic daily migraine, which means exactly what it sounds like. Every day, I have a migraine. Alternatively, many people get infrequent, but severe episodic migraines. I also get severe episodic migraines, but at least the ones in between are not completely debilitating. I have gone through periods of success with prophylactic medicine, like Topamax, which I stopped because the side effects were too intense, and Emgality, a monthly injection that worked for a while, and then—didn’t. All the others, Botox, amitriptyline, Reglan, cyproheptadine, and whatever else I’ve forgotten didn’t work at all. Pregnancy and nursing offered unexpected relief for about eighteen months, but as soon as my daughter weaned last March, the migraines came back with a fury, as if to make up for lost time.
Before getting pregnant, my daily migraines were low-grade, maybe a 4-6 on a scale of 1-10, but now they’ve intensified. After all the hormonal and bodily changes following pregnancy, my old ways of coping are not working. I went to see a new neurologist, Dr. Dario Zagar, who has the most holistic approach to addressing chronic migraine that I’ve ever experienced (I’m medically promiscuous, so I know.) He prescribed new medicines to try, a newly released non-medical device called Nerivio (I’m skeptical), and he encouraged me to read The Way Out by Alan Gordon, LCSW, which professes chronic pain can be managed by retraining the brain. There is much buzz surrounding his book.
The Way Out
Alan Gordon is the founder and director of the Pain Psychology Center and author of the book The Way Out: A Revolutionary, Scientifically Proven Approach to Healing Chronic Pain. Gordon is not a medical doctor, but he has dedicated his career to curing chronic pain, and has many more than nine hours of education on the matter. The premise of his book is that there is a mind-body connection that affects how the body experiences pain. No, this is not some kind of snake oil with weird supplements or unproven eastern medicine.
Gordon emphasizes that there are two kinds of pain. There’s the kind that you get when you sprain your ankle or get a cut. That pain indicates injury and healing and should go away in a reasonable amount of time depending on the injury. Chronic pain, or what Gordon calls “Neuroplastic pain,” is pain caused by the brain incorrectly sending pain signals to the body repeatedly until it becomes chronic. These misrouted signals are the product of fear, particularly the fear of pain, which becomes a loop.
In our culture, we experience a great deal of fear and anxiety at work, in the news, on our phones. According to Gordon’s premise, this constant hyper-vigilance can cause chronic pain in some people where there is no injury or biological explanation. For them, the brain is going haywire from all of the stressful input and sends danger signals to the body and is executed as pain. Even for patients who have a bulging disc in their spine, or pain from an old injury that won’t quit, it’s often not the cause of the pain. After all, many people have wear and tear on their bodies, including bulging discs, and don’t have chronic pain, but our culture is so indexed on finding tangible explanations for pain, that we prescribe all variations of solutions, cortisone shots, nerve blockers, anti-epilepsy drugs. According to The Way Out, the average patient suffering from chronic pain is unsuccessfully treated for ten years. Regardless of your position on the premise of this book, obviously what medicine is doing for chronic pain sufferers is not working.
Pain Reprocessing
Gordon’s solution, Pain Reprocessing Therapy (PRT), involves techniques that reframe thinking so that the brain can stop being constantly overstimulated, and to know that it is safe even when it is. Gordon and his team conducted a study to prove that his PRT theory using these techniques can cure people of their chronic pain using. You can read the study here.
PRT involves:
Practicing somatic tracking: acknowledging pain when it is happening without bias, i.e. without thinking, “Oh God, this is miserable, why won’t it go away!” Instead paying attention to the specific sensations and locations of the pain and how it might change. Simple awareness, that’s it (to start).
Avoidance behaviors: don’t push through the pain. If you have back pain and it hurts to sit, don’t force yourself to drive long distances without breaks.
Sending messages of safety: reassuring yourself you are safe even when the brain is sending danger signals (like anxiety, frustration, anger, fear). You can say to yourself, “You are safe, brain, we’re ok.”
Reducing overstimulation: probably the hardest and most important, finding ways to reduce the inundation of stressors every day.
Avoiding feeling trapped: don’t put yourself in a position where you cannot deal with pain if it happens, for instance book an aisle seat on an airplane if you think you might need to get up and walk around.
Handling uncertainty: don’t let the brain become too worked up when uncertainty occurs, reassure yourself that even if you are running late or missed a deadline, you will be ok.
Catching your fears: catch yourself worrying about things in the moment before they have a chance to overwhelm. If you are running late, don’t catastrophize to the point that your entire life will be damaged. Remind your brain it is safe.
Embracing positive sensations: make a point to acknowledge good feelings, like warm sun on your face, or how nice it feels to stretch in the morning.
These techniques are intended to create good new habits that create positive associations even when you’re in pain so that the brain doesn’t always consider pain a dangerous circumstance. These habits are intended to create new neural pathways so the brain can stop sending false alarm signals to pain receptors which cause pain despite a lack of injury. In my case, I’ve had migraines for most of my life, since childhood, and are not the result of any kind of accident or head trauma. Thus, it would seem I’m a good candidate for Nueroplastic pain and trying PRT.
Normally, I’d be skeptical, but since a medical doctor I admire “prescribed” this reading not long after another one of my medical providers mentioned it, I decided to give it a chance.
No Risk
If it doesn’t cure my migraines, none of the aforementioned techniques will be bad new habits to acquire. If I’m successful at implementing them, perhaps I’ll see improvement in my depression and anxiety, at the root of which, are always ruminating, negative thought patterns. It’s a no risk therapy, since there’s no cost (I borrowed the book from the library), no medicine, no side effects, no doctors appointments, no copays, no insurance pre-authorization: it is up to me to literally change my thinking patterns.
Subscribe to follow along on my journey as I track my pain days, how I cope, and how I implement the PRT techniques. I’ll be updating this series every week or so to let you know how I’m doing, if there are any improvements or relapses and how I generally feel about this therapy. If you have pain too, you can try it with me (but I recommend reading his book, as this synopsis is not enough to get you started.)
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Very interesting. I will follow your progress.