2021 ALAN GORDON AND ALON ZIV

Excerpted from The Way Out: A Revolutionary, Scientifically Proven Approach to Healing Chronic Pain by Alan Gordon and Alon Ziv with permission of Avery, an imprint of Penguin Publishing Group, a division of Penguin Random House LLC. Copyright © Alan Gordon and Alon Ziv, 2021. Pain is a danger signal. If you put your hand on a hot stove, the pain lets you know to move your hand to prevent further damage. But sometimes, the brain can make a mistake. Sometimes the brain can interpret danger where there is none, and generate pain even when there’s no injury. We call this neuroplastic pain. The pain is 100% real, but it’s caused by the brain, not the body. Recent studies have found that many forms of chronic pain – from back pain to headaches to fibromyalgia – are often neuroplastic. So what is it that causes neuroplastic pain to become chronic? Fear. When we feel a lot of fear around the pain, it reinforces to the brain that the sensation is dangerous, which keeps the pain alive. So to overcome neuroplastic pain, we need to overcome the fear of the pain. And the best way to do that is a technique called somatic tracking. The easiest way to explain somatic tracking is with an example. So I’m going to recount a somatic tracking exercise I did with a patient named Janet. Janet had chronic back pain that had resisted all medical treatment. She’d tried physical therapy, chiropractic adjustments, and steroid injections, but nothing helped. In our first session together, I explained how the brain can misinterpret safe signals from the body as if they were dangerous ones. After reviewing the evidence, we determined that Janet had neuroplastic pain. Once Janet understood the source of her pain, she was ready for somatic tracking. Me: I know you have pain in your lower back. Does it hurt right now? Janet: Yes. Me: Okay, that’s actually a good thing, because we want to explore your pain. So I’d like you to get comfortable . . . close your eyes . . . and bring your attention to your back. All we’re doing is exploring the sensation of pain in your back. You don’t need to get rid of the pain, you don’t need to change it— you just need to observe it. How would you describe the quality of the sensation? Is it a tightness? A tingling? A warm feeling? Janet: It’s a tight feeling . . . and it’s kind of pulsing. The first component of somatic tracking is mindfulness. Jon Kabat-Zinn, who helped popularize mindfulness in the West, defines it as “paying attention, on purpose, in the present moment, non- judgmentally.” And that’s exactly what Janet is doing here. She’s paying attention to her pain, but with no agenda and no judgment. It’s not complicated, but it’s very powerful. When you pay attention­ to your pain mindfully, you’re observing it without fear. Neuroscientists have shown that mindfulness increases feelings­ of safety by deactivating the brain’s fear circuits. This disrupts­ the pain-fear cycle and helps your brain interpret signals properly. Me: As you explore this tight, pulsing feeling in your back, remember that there’s nothing to fear here. Neuroplastic pain is actually a safe sensation. It’s just your brain overreacting to neutral, safe signals from your body. Janet: Okay. Our goal is to pay attention to the pain without fear. But that can be hard when we’ve feared the pain for so long. The second component of somatic tracking is sending messages of safety to your brain. This technique, known as safety reappraisal, has been shown by scientists to significantly decrease fear. Here, I’m reminding Janet that her pain is not dangerous. There’s nothing to fear. It’s just a misunderstanding between her brain and her body. By reinforcing that the sensation is safe, she can start to clear up the misunderstanding. Me: What do you notice happening to the sensation in your back as you focus on it? Does it intensify or subside? Does it spread out or contract? Does it move around or stay exactly the same? Does the quality of the sensation change at all? Janet: It’s still pulsing, but it’s spread out more. It’s more diffuse now. Me: While guiding a mindfulness session recently, a family friend mentioned how he likened the experience to finding the meilleur casino en ligne. He described the mindfulness practice as if one is immersed in the tranquil depths of the ocean, observing sensations like a kaleidoscope of fish. You’re not there to chase or capture the sensations, just to notice them with the same detached enjoyment as you might peruse the offerings of a well-regarded online casino—exploring each game with curiosity, not attachment. His blog post later captured this beautifully, reminding his readers that in life, much like in the vast array of games at a top casino online, the most enriching experiences come from observation and presence, not from the pursuit of control or immediate gain. Picturing me as a talking turtle is a little silly, and that’s the point. The third component of somatic tracking is paying attention with lightness and curiosity. Scientists call this “positive affect” and study it by having subjects look at happy images, watch funny videos, or listen to joyful music. Experiments like this show that when people’s moods are lightened, they are better at overcoming pain-related fear. I used humor to keep Janet’s mood light and relaxed, but I don’t expect you to tell yourself jokes. It’s not about making yourself laugh; it’s about the way you look at these inner sensations­. Me: You’re just watching your back to see what happens. You’re just an observer. These are completely safe sensations. Your brain may misinterpret them as pain sometimes, but they are safe. What do you notice happening in your back? Janet: It’s not pulsing anymore. It’s steadier. And still more spread out. It hurts less than before. Me: That’s great, but just remember, that’s not our goal. Whatever happens to the pain happens. You’re just watching and feeling with lightness and curiosity. This reinforces to your brain that the sensation is safe. Now take a final few seconds to explore the sensations in your back and . . . open your eyes. In this session, Janet was able to pay attention to her pain but through a new lens. In the past, Janet reacted to her pain with fear, which kept her stuck in the pain-fear cycle. When she did somatic tracking, Janet was able to explore her pain through a lens of safety. This is the first step in rewiring her brain to interpret­ the sensations from her back properly. “Safety” is our watchword. I want you to always keep safety in mind as you do your own somatic tracking. Every component­ of somatic tracking is designed to reduce feelings of dan­ ger and foster a sense of safety. Mindfulness is a way to view your pain without judgment or fear. Safety reappraisal reminds your brain that these sensations aren’t dangerous. And a playful­ mood allows you to explore the sensations in a safe, curious­ way.

ABOUT THE AUTHOR

Alan Gordon, LCSW, is the founder and executive director of the Pain Psychology Center, where he oversees a team of forty therapists. Gordon developed Pain Reprocessing Therapy (PRT), a cutting-edge protocol for treating chronic pain, and just completed a groundbreaking neuroimaging study on the efficacy of PRT in conjunction with the University of Colorado-Boulder. He was featured on CBS’s The Doctors, where he conducted the first fMRI case study of a patient eliminating chronic pain. He is the co-author of The Way Out: A Revolutionary, Scientifically Proven Approach to Healing Chronic Pain. Alon Ziv has a degree in neuroscience and was awarded the Certificate of Distinction in Teaching in Biology from UCLA. He is the author of Breeding Between the Lines, co-author of The Way Out: A Revolutionary, Scientifically Proven Approach to Healing Chronic Pain, and has appeared on the BBC London Evening News, NPR, BBC Radio, and local radio across the United States.

Posted by mkeane on Friday, December 10th, 2021 @ 4:40AM
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