Chapter 22

Limbic Retraining:
Calming the False
Alarm in Your Brain

So much of what you read and hear about in the pain treatment world is about how to get rid of and control pain. When you Google “What can I do for chronic pain?” you get a plethora of treatment recommendations. These include: all kinds of prescription and non-prescription pain medications; nerve blocks, spinal pain pumps, and spinal cord stimulators; trigger point injections; bioelectric therapy and TENS units; physical therapy; herbs; chiropractic; and more. All these treatments have the same goal: eliminate the pain, get the pain under control, get the pain to go away. All these modalities have merit and usefulness.

And, as I wrote about in my previous book on digestive distress called Trust Your Gut, much of our traditional Western medical approach to chronic pain involves violent war metaphors. Clinicians fight disease, wage war on chronic pain, and patients struggle valiantly to conquer the disease. The medical weapons arsenal includes lasers, radiation, chemicals, electricity, and pills. The primary goal is to kill the pain.

When chronic pain has caused such suffering and has turned your life upside-down, it’s understandable that you would hate your pain.

It’s Normal to Hate
Your Chronic Pain

This quote captures the feelings I hear conveyed by so many of my patients who suffer from chronic pain:

“I’ve struggled with chronic back and shoulder pain for ten years. On some days I can get up and go through my workday more or less unencumbered. But on some mornings, I just can’t get out of bed no matter how hard I try. This is because I may awaken with headaches, body aches, shooting pains down my legs, and a feeling like I’m dragging a hundred-pound weight on my chest. This suffering is not only painful but also unpredictable. When my body has caused me so much suffering, how can you blame me for hating it? I hate it for holding me back from everything I want to do in life. I know I shouldn’t feel this way—and then I hate myself for feeling this way.”

Learn to Befriend Your Body

This may sound counterintuitive, but a key way to conquer your chronic pain is to quit fighting it. A nonviolent approach to healing certainly goes against the mainstream attitude toward illness. As we just reviewed, clinicians wage war on chronic pain, and patients struggle valiantly to defeat the disease. So much of what you read and hear about in the pain treatment world is about how to get rid of and control pain. The primary goal is to kill the pain, which is why painkillers are so often referred to.

This misguided attitude toward illness is fueled by the fact that people tend to hate their pain. This antagonism is quite understandable.

It’s quite normal to hate your pain when it has caused so much suffering, so much disruption. It overwhelms you and leaves you feeling hopeless. If you feel like this sometimes, know that you are not alone.

It is also quite common to view pain as the enemy. It must be fought against at every turn until it is defeated. For if the pain is the enemy, then it must be defended against, braced against, guarded against. If there is an enemy in your midst, you must become hypervigilant against this ongoing threat.

While it is easy to understand why you hate your pain, you need to know that this response is counterproductive. If we look at how hate actually functions in your nervous system, we can see how it can worsen chronic pain.

What Happens Physically
When You Hate Your Pain

Several things happen physiologically when you hate your pain sensations. First, you wake up the limbic system, the threat-perception circuitry that resides in the deeper part of your brain. The limbic system is the security guard of the brain. Once it perceives a threat, it reacts by setting off an alarm telling the autonomic nervous system (ANS) to activate a fight/flight response. Your hate is interpreted by the brain as a threat, so it gears up the body to go into action—sensitizing your muscles and nerve channels. This makes your pain worse. Remember that your ANS is already dysregulated, a major cause of chronic pain in the first place. It suffers from an imbalance between the activating (sympathetic) and calming (parasympathetic) branches. Every time you feel a surge of hate toward your pain, the ANS becomes even more dysregulated—causing a vicious cycle. This is how hate increases your pain. Viewing pain as your enemy is counterproductive.

Hating your pain also backfires by increasing negative pain conditioning—like Pavlov’s dog. Pavlov conditioned dogs to salivate when he rang a bell. He did this by ringing a bell every time the dogs ate. They initially salivated because of the food, but their bodies became conditioned to associate the bell with eating. After a while, the sound of the bell made them salivate.

Likewise, humans with chronic pain condition their nervous systems to overreact. Because chronic pain evokes such strong emotional responses, conditioned responses to pain happen all the time. For the chronic back pain or headache sufferer, pain conditioning can cause added distress that intensifies and maintains the symptoms. A twinge in the low back, cramping in the gut, or a deep dull ache in the forehead can lead to powerful conditioned reactions of anger, despair, anxiety, agitation—and even hatred. These conditioned emotional responses can create a cascade of physiological changes that maintain and worsen the pain.

Another physiological effect related to pain and conditioning is state-dependent memory. This is the phenomenon where one aspect of a terrible experience sparks a vivid flashback of the entire memory—like my friend who drilled through his finger. Now, every time he sees a drill, it makes his finger hurt. State-dependent memory occurs when some sensory aspect of an experience backs all the experiences associated with the original trauma. Your sensation of pain may have become part of a state-dependent memory that calls forth the emotions of hatred and agitation. This becomes another vicious cycle, where the current pain and agitation triggers a state-dependent memory of all the previous times when this suffering has occurred. This makes the pain much harder to treat.

When hating your pain becomes habitual, that habit is reinforced by negative neuroplasticity. As we discussed earlier, neuroplasticity is the capacity of the brain to build new neural connections in response to repetitive actions. When chronic pain becomes connected with feelings of hatred and agitation, new nerve patterns form in the brain. Going forward, the painful sensations get automatically connected with emotions of agitation and hate, every time.

Going AWOL: Dealing with
Pain Through Dissociation

Yet another common reaction to the sensations of chronic pain is to escape by disconnecting from it. Often people distract themselves from it with other activities, including eating, drinking alcohol, or taking drugs. The clinical term for this is dissociation, which we discussed in Chapter 4, “Awareness.” A popular method of distraction is to stare at a screen. You can watch television or a movie, play a game, or mindlessly surf the web. People learn to dissociate from the sensations of their body, cut their mind off from the discomfort—until it becomes so painful that they can’t ignore it anymore.

With acute pain in the short term, this is a useful strategy that we all use. For example, when we bump our shoulder or elbow, we will sometimes rub the area. This provides a distraction by applying a competing sensation. But in chronic pain, dissociation can become a problem. A good example is the case of a former patient named Fred. He was a postal worker who had complex regional pain syndrome (CPRS) in his foot. Fred tried to cope with his pain by mentally dissociating his foot from the rest of his body. As a result, he started walking differently, keeping balance differently, and this ultimately made his pain much worse.

The Better Alternative:
Befriend Your Body Through
Limbic Retraining

Although hating your pain is understandable, it causes a destabilizing effect on your nervous system and is guaranteed to make your pain worse. Instead of this harmful and counterproductive attitude, you need a way to pay attention to your pain sensations in a manner that is therapeutic and helpful. You need a more constructive mindset to respond to your symptoms, one that creates positive state-dependent memory and positive neuroplasticity. What’s needed is for you to befriend your body, to become its ally. Healing becomes possible when you learn how to care for, appreciate, and show kindness to the sensations that have been plaguing you. That’s where Limbic Retraining comes in.

Limbic Retraining is a powerful method for rewiring the pathways of nerves and hormones that are central to the physiological communication system that we call the pain network. This is a deceptively simple yet very effective tool for healing your chronic pain.

The key to Limbic Retraining is developing an attitude of curiosity, acceptance, and patience toward the pain sensations you are experiencing. This is the middle ground between fighting the pain and ignoring it. Instead, just notice it, observe it, and feel it. Allow the sensation to be there exactly as it is.

It may seem disorienting and a bit of a shock to reach out with kindness to an old foe.

Sid, a patient in his late forties with chronic arm and shoulder pain, was asked to experiment with sitting with the painful sensations in his hand and arm for just a short time. His response: “There is no way I will just notice that pain without trying everything in my power to fight it and defeat it! If I were to allow that pain to be there without trying to make it go away, then I am terrified that the pain will win and I will be rendered a powerless, defeated, hopeless victim.”

I’ve had many patients like Sid who expressed an initial reluctance to do an about-face and try such a shockingly different approach. However, it is also shockingly effective and shockingly simple.

How to Do Limbic Retraining

1.Sit in a comfortable and balanced position where you won’t be disturbed for at least five to fifteen minutes.

2.Focus on the uncomfortable sensation in your body—the head, neck, back, gut, or wherever the pain is. If helpful, you can use your hands to help you visualize how large the area of distress is.

3.Rate the intensity of the discomfort on a 0−10 scale, where 10 is the worst pain you have ever experienced and 0 is no pain at all.

4.Now, on the same 0−10 scale, rate the intrusiveness of this pain sensation. In other words, how much does this pain interfere in your daily life right now? Is it just a mild irritant, or is it so front-and-center that it demands your complete and full attention to the exclusion of everything else?

5.Now, focus on the sensation without thinking about it. This exercise is calling on your sensory attention, not your ability to think. For example, imagine what it would feel like if somebody gently put their hand on your arm right now. Focus on the sensation exactly as it is, letting yourself be curious about it. I use the term curiosity here very intentionally. Curiosity implies steady, focused attention to something while staying calm and non-reactive. You can’t be curious and anxious at the same time.

6.Imagine that you are going to pull a chair up right next to the sensation and just observe it exactly the way it is, without trying to change it, move it, analyze it, or make it go away. This would be a good time to remind yourself: “I may not like this sensation, but I’m remembering that it has been medically evaluated and that it is not going to harm me. So, for at least the next few minutes, I’m going to let it be there exactly the way it is and just observe it.”

7.Now, give it time—as opposed to “I’ve done this for a minute—why isn’t the pain gone yet?” As you sit with the sensation, you may feel compelled to do something to fix it—whether that means trying to relax it away with deep breathing, or visualizing it going away, please do not succumb to that impulse! Don’t try to magically wish it away. This is the time to do a little twist on the adage, “Don’t just do something—sit there!” By not trying to do anything, you activate natural self-healing resources. Just sit with it and observe—and let this be an interesting experiment as you learn a new response to an old and stubborn problem. By focusing and observing the sensation without trying to fight it, you are activating parts of the brain that are not associated with threat and guarding.

8.Stay with the cutting edge. Continue to stay focused on the part that either hurts the most, or most grabs your attention. And make room for whatever happens next. This means that, for example, you may start focusing on a deep pain in your left lower back, but then after a while it migrates to a lighter, tingling ache in the right lower back, and then to a mild ache in your middle back. By staying with this most dominant sensation wherever it leads, you will maximize your inner healing resources for retraining the responses of your back, your nervous system, and your brain.

9.Remember—at times you may become so impatient or mad at the pain that you slip into fighting it once again. With practice, it will become easier to sit with it without struggle. Some patients have described this as “breaking through the wall”—just like the long-distance runner who feels out of breath and suddenly gets his second wind.

10.Sometimes the sensation may not change much, but you may end up getting a hunch or clue about something that is important to your healing. You may notice a revelation pop up, such as “I’m really upset at my spouse for not paying more attention to me.” Or “I’m really exhausted and need some rest.” Or “I’m in the wrong job—I really hate it.” When hunches or clues such as these emerge, pay attention to them. They might lead to a redirection or lessening of the pain sensations once you heed the message.

11.Don’t be surprised if Limbic Retraining feels challenging or awkward when you first start practicing. You are learning to change a natural reflex to avoid or struggle against pain. This often takes longer to learn than relaxation exercises or breathing techniques. After all, you are learning to counteract or re-do what has been a lifelong habit of fighting unpleasant sensations. With regular practice, you will be pleasantly surprised to notice how the practice becomes easier, and how you can enjoy learning to listen to the wisdom of your body as you stop fighting and hating it!

12.Repeat this process whenever your pain sensations become bothersome.

Now, why is that so important?

This exercise sends signals to structures deep inside your limbic brain. In a language they can understand, you are saying to the amygdala and related limbic brain structures: “This sensation that alarms you is actually no longer a threat.” As you repeat this exercise, the limbic brain starts to signal to the nervous system and hormonal system that these sensations of pain, ache, and pressure are actually not a cause for alarm. Over time this causes a change in the cascade of neurotransmitters and neurohormones that communicate with these painful parts of your body. You are establishing new patterns of positive conditioning and positive neuroplasticity. My patients are almost always amazed to discover how much their pain sensations move, change, and quiet down with Limbic Retraining.

Benefits of Limbic Retraining

Limbic Retraining helps you, the pain sufferer, to experience a very powerful and important message:

This symptom can change, and the intensity is temporary.

Other benefits from this practice continue afterward: 1) You start to remember and believe in the changeability of symptoms. 2) You can remember at other times, “These sensations are a nuisance, but they’re not going to harm me.”

Marcie is a twenty-six-year-old student who also worked part-time in an IT (information technology) firm doing web design. She presented to my office with severe left-sided neck and shoulder pain of three years duration. She described her neck and shoulders as “rock hard” and that every time she turned her head, she felt sharp stabbing pain that radiated from her neck and shoulders, down her back, along her spine, 7 to 8 out of 10. By the time she came to me, three years after diagnosis, Marcie felt increasingly irritable and distracted by her pain. She had also developed a headache resulting from the chronic neck and shoulder tightness.

She worked with me to learn about her chronic pain. She also learned a number of calming techniques and the “Neutral Spine” posture to more fully support the weight of her head and neck on her shoulders and back.

When introduced to Limbic Retraining, Marcie’s first response was, “Accept the sensations being there? After all the grief and misery it has caused me? I’d have to be crazy to do something like that!”

Eventually, since none of her other coping strategies were working, Marcie reluctantly agreed to focus on the outer edge of her tight, sore neck and shoulders. At first, she still tried to force it away. Then, she finally stopped fighting it and allowed herself to simply feel the ache and tightness. After about five minutes, her eyes began to well up with tears. “The achy tightness is almost gone. How can that be?”

I explained to her that her nervous system needed her to stop fighting the symptoms and begin to befriend and listen to them. Marcie recognized she was experiencing tears of joy because there was now hope that these stubborn symptoms could finally begin to change.