• When stresses overwhelm the coping capacity of your nervous system, your body will go into flight or fight physiology.
• You have choices regarding what you input into your nervous system.
• If your attention dwells on disturbing topics, you’ll remain agitated, which fires up the physiology of your whole body.
• You may not be aware of the many ways you’re continually keeping your physiology fired up.

Anger and anxiety are words that describe agitated physiological states and are sensations generated by your body’s response to threats. When states of agitation are sustained, your body’s physiology causes physical damage to your tissues, sensitizes your perception of sensory input, and detracts from your capacity to enjoy life. Mental and physical pain will also increase. To some degree, you are in charge of the information going into your nervous system, and what you choose to input into your nervous system will affect your body’s chemistry (output).

What are you choosing to input?

Living creatures stay alive by scanning their environment and interpreting the resulting sensory input to determine whether a situation is safe or dangerous. Your nervous system coordinates your body’s internal and external responses to adapt and move on. Much of this process of adaptation involves your autonomic nervous system, which regulates your internal organs and the makeup of your body’s chemistry. When you feel threatened, your body reacts by upping its rate of energy consumption (preparing to fight or flee) and kindling inflammation (putting the immune system on guard against wounds). When this physiological state is sustained, you have a significant chance of becoming ill, as you are consuming resources to surivive.¹

Humans have the additional input of consciousness. Any threatening thoughts or concepts will cause your body to go into fight or flight. Consider the various ways we upset ourselves that we have conscious choices about. Simply recognizing the effects and choosing different calming input can significantly change your body’s physiology to a healing state of safety.

UNSOLVABLE PROBLEMS

A common means of becoming and remaining upset is focusing on situations that we have no control over. It is an effective way of maintaining an unpleasant physiological threat state. Dr. Fred Luskin, director of the Stanford Forgiveness Project and author of Forgive for Good,² has a term called, “the unenforceable rules.” His point is that it is fine to wish people would behave in a better manner, but you can’t control other’s behavior; especially at a societal level. It is easy to complain about politics, abuses in almost every arena of life, the unequal distribution of wealth, human trafficking, blatant misuse of power, the educational system, and bullying.  There are endless societal problems to be upset about, and it is a deeply justified reaction.

When these unpleasant thoughts rise to the level that you are reacting to them, you are consuming energy that you could otherwise use to actually make a difference in your own sphere of influence. Unfortunately, when you are agitated, your inflammatory markers are elevated,³ which increases the speed of nerve conduction;⁴ the brain is sensitized, and any pain will be magnified.

Here is a letter from a person who has been suffering from chronic pain for many years.

…… violence in nature is difficult for me, but human cruelty to others is incredibly upsetting. I have been this way since childhood. I am very sensitive, and I almost do not feel at home on this planet. I feel wired and tired at the same time.

Her outlook is understandable, and I think most people feel this way. However, she is “wired and tired” from being in a sustained flight or fight state.

Healing occurs only by stimulating your physiology to move into a state of safety. and It is almost impossible to accomplish while remaining agitated about situations you have no control over.

COMPLAINING

Another way we  remain agitated is by complaining, engaging in malicious gossiping, being judgmental, and giving unasked-for advice. How can this input bring your body’s physiology into that of feeling safe? When you are suffering from chronic pain, your overall life outlook may be clouded, and these behaviors may become more frequent. Although you have legitimate issues to be upset about, you are also reinforcing unpleasant neurological circuits in your brain. A better alternative is choosing to place your attention on more functional or more positive neurological circuits.

WHAT ARE YOU WATCHING?

What about what we choose to watch? Violent movies and video games fire up your nervous system and consequently your whole body. You have to ask yourself why would you choose to do this to yourself? It is a surefire way of being in a heightened state of flight or fight. Unfortunately, with repetition, it may become normalized, and you may not appreciate your body being in this state, although it has detrimental effects on your mental and physical health.

THE NEWS

Another behavior to consider is how much time do you spend watching the news? It goes without saying that most newsis upsetting. Although it is fine and important to have a feel for current events that affect our daily lives, watching the news for hours is counterproductive. You are sedentary (exercise is anti-inflammatory)⁵ and you are not viewing material that is creating a sense of relaxation and peace.

Moving forward

Understanding the effects of what you are inputting into your nervous system is important in calming it down. Initially, they may be so ingrained that you can’t see them or the effects they are having on the quality of your life. It takes practice to notice and is also challenging to change. How much of your life has been consumed by them. Are they productive?

You may notice that as you back away from these activities, you may feel more anxious, as you are less distracted. Anxiety is unpleasant and it takes practice to learn to tolerate it. Eventually, as you quit fighting this sensation, it will be less powerful and integrated into your daily life. It is a stepwise process and a learned skill.

Quit upsetting yourself

Here are some suggestions regarding changing your input in order to quiet down your threat physiology.

• Create a list of societal issues that are deeply upsetting to you. Feel how enormous and terrible these problems are. Express your feelings on paper – and tear it up. This can be done repeatedly. Paradoxically, you have more energy to take action in some domain you have a say in.
• Stop engaging in the following activities:
  • Watching violent movies or playing intense video games
  • Complaining about the states of various world affairs that are particularly upsetting to you.
  • Complaining about anything. If you can’t do something constructive, don’t spend time with it.
  • Giving unasked-for-advice or being verbally critical. Consider how you feel when someone does this to you. Both parties are on the defensive, social connection is compromised, and your nervous systems are fired up.
  • Malicious gossiping. Consider why are you engaging in it? You are in a small or big way, robbing a person of his or her reputation. You certainly are not creating a sense of peace and safety.
  •  Spending long periods of time watching the news. Limit yourself to maybe 30 minutes a day or just skim the daily headlines.

Become a light

Your individual contribution to the human experience lies in creating positive changes in yourself and being available to others you care about.  However, you can’t reach out if you are consumed by pain and frustration. You may be so deeply involved in dealing with the negatives of the human condition that it may not seem possible to be any other way. But you have a choice.

Not only is a constructive mindset —not to be confused with mindless positive thinking—attainable, it is possible in the worst of circumstances.

Exhibit A is Man’s Search for Meaning , written by Viktor Frankl,⁶ an Austrian psychiatrist who survived the WWII concentration camps. He bore witness to the worst horrors of the human experience, lost much of his family, and still found meaning and purpose in the midst of extreme suffering. The question he kept asking was, “What is life asking of me now?” Few of us could pull this off, but he demonstrated it could be done. Keeping perspective on a given day when the challenges seem unsurmountable is in sharp contrast to feeling like a victim.

The Swerve  by Stephen Greenblatt⁷ tells the story set in the mid-15^th century of the discovery of an ancient Greek manuscript. Greenblatt defined “The Swerve” as an event that is so significant that it altered the course of human history. The manuscript written in 60 BC contained the poem, The Nature of Things by Lucretius. Somehow, Lucretius figured out that matter was made up of particles called, “atoms.” The Church realized that if this was widely known, that there was a more powerful force than their authority, they would lose their hold on the population. Indeed, after this poem was discovered, it seemed to be a factor in ushering humanity out of the Dark Ages.

The most remarkable aspect of Lucretius’ poem is that he concluded, even while living in the midst of the misery and brutality of ancient times, that all each person can and should do is to live a full, rich, and meaningful life.

Both of these books drive home that the world—then and now—is full of extreme suffering. It is easy to become focused on what is wrong or we can step up and do what we can to alleviate it. Living life with sense of purpose improves your quality of life and contributes to happiness.⁸ It also pulls you out of threat physiology and allows you to refuel and regenerate.

Recap

Healing from chronic illness requires your body to be in a state of safety. You can’t heal while consuming your body’s resources while in threat. In a way, accomplishing this by carefully avoiding upsetting input is the easiest aspect of solving your chronic mental and physical pain.

Awareness of the effects of various inputs is the starting point. Then becoming more aware of the numerous ways you engage in these activities is important. As you use your brain’s survival circuits less and nurture more pleasurable ones, you will be able to experience a more gratifying life. To have a good life, you must live a good life.

 References

1. Smyth J, et al. Stress and disease: A structural and functional analysis. Social and Personality Psychology Compass (2013); 7/4217-227. 10.1111/spc3.12020
2. Luskin, Fred. Forgive for Good. Harper Collins, New York, NY, 2003.
3. Shields GS, et al. Psychosocial interventions, and immune system function. JAMA Psychiatry (2020); doi: 10.1001/jamapsychiatry.2020.0431
4. Chen X, et al. Stress enhances muscle nociceptor activity in the rat. Neuroscience (2011); 185: 166-173. Evans, Patricia. Verbal Abuse: Survivors Speak Out. Avon Media Corporation, Avon, MA, 1993.
5. Sallis R, et al. Physical inactivity is associated with a higher risk for severe COVID-19 outcomes: a study in 48440 adult patients. Br J Sports Med (2021); 0:1-8. doi: 10.1136/bjsports-2021-104080
6. Frankl, Viktor. Man’s Search for Meaning. Beacon Press, Boston, MA, 1959.
7. Greenblatt, Stephen. The Swerve. Norton and Co., New York, NY, 2011.
8. Cole SW, et al. Social regulation of gene expression in human leukocytes. Genome Biology (2007); 8:R189. doi: 10.1186/gb-2007/8/9/R189

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• Understanding the nature of chronic disease and the principles behind the solutions, allows you to fully engage in your care.
• Characteristics that keep us alive are what also create disease states.
• Chronic pain is a neurological diagnosis that has profound effects on your body’s physiological state. Existing in flight or fight breaks down your body.
• Survival depends on the protection of anxiety and anger. Letting go of trying to fight or change them releases energy to live your life.
• The essence of chronic illness is living in sustained threat and the solution lies in finding safety.

Here is a review of some characteristics of staying alive, which are the same ones that cause illness and disease.

Your health is dependent on the amount of time your body is in a physiological state of threat compared to feeling safe. Life is dependent on feeling safe in order to regenerate and also dealing with threats in order to survive. But, when you are exposed to sustained threat physiology, your body will break down.¹

Physical and mental symptoms are the result of each organ system in your body uniquely responding to your body’s chemical makeup.² In addition to the multiple physical symptoms, the sensations created by the flight or fight inflammatory state are called anxiety and anger. They are the result of threats, not the cause. They are also powerful, uncontrolable, amoral, destructive, and necessary to maintain life.

The starting point

Picture a complex circuit board that has trillions of etched-in circuits that represent your lifetime of programming. These circuits are not alterable for several reasons. First, they are memorized, similar to riding a bicycle.³ Second, any time you spend trying to analyze and figure them out is counterproductive. The more attention you pay to these patterns of activity, the more they are reinforced. Finally, as the powerful unconscious brain is estimated to process 20 million bits of information per second⁴ (compared to your conscious brain only processing 40 bits per second), rational interventions alone, such as talk therapy, cannot hope to make a dent in these circuits. It is like trying to move a high mountain peak with a shovel. It is not going to happen and much of your life’s energy is consumed in the process of trying.

It sounds discouraging. You have these permanently embedded pain circuits in your brain and the harder to try to fix them, the more they are reinforced. They are also necessary and much more powerful than your conscious brain. So, what do you do?

Solving the unsolvable

Understanding that you cannot solve or improve these unpleasant circuits is the first and necessary principle behind the solution. You must put down your shovel and move on. Instead of trying to “fix yourself,” new strategies are needed to create fresh circuits in your brain. Most of these approaches utilize methods that connect with the unconscious part of your brain with repetition. It’s similar to diverting a river into a different channel. You begin with small steps to create these new channels, but eventually the water’s flow will aid the process.

So why would we ever take anxiety or anger personally? They are inherent for survival but have little, if anything, to do with who we are. By letting go of trying to solve an unchangeable situation, you’ll experience a huge energy surge that allows you to move forward.

The second principle is that since it is impossible to fix your pain circuits, you must develop or shift onto a new set of circuits that aren’t painful. There are many ways of stimulating these changes, and the process is called, “neuroplasticity.” It is similar to installing a new virtual computer on your desktop. With repetition, it is remarkable how quickly these changes happen. Since your brain will develop wherever you place your attention, you must move towards your vision instead of continually trying to fix yourself. As you embrace wellness, you’ll crowd out pain.

Third, you cannot move forward until you have let go of the past. This is difficult because when you are trapped by a chronic disease, you are legitimately angry. However, you are also stuck. There are ways to effectively process anger and there are tremendous benefits to learning these tools.

Fourth, The DOC Journey is simply a framework that organizes your thinking and presents tools in a way that you can apply them in a focused manner. The steps in healing are:

• Awareness – you have to understand a problem before you can solve it.
• Treating all aspects of pain simultaneously – it is similar to fighting a forest fire. Every treatment can contribute to a good outcome, but nothing will work in isolation.
• You take control of your care. Since chronic pain is complex and you are a unique individual, each person’s situation is incredibly complicated. You are the only person that can possibly solve it with guidance. If you are not in charge, nothing can happen.

Fifth, a core concept of The Journey is awareness. It includes awareness of:

• Your emotions
  • Suppressed emotions are especially problematic
• The impact of your actions on others and theirs on you
• The nature of chronic pain
• The principles behind the solutions to chronic disease
• Your specific diagnosis
• Your vision of what you want your life to look like

Finally, since your sense of well-being and health is dependent on the composition of your body’s physiological state, all of your efforts are intended to stimulate it directly or indirectly into a safety state. There are three areas of focus:

• Input – how you process your stresses
• The state of your nervous system – calm or hypervigilant
• Output – it is desirable to remain in balance or safety and minimize the amount of time you are in a threat state.

The desired safety state allows you to feel content and secure, have a slower metabolic rate (rate you burn fuel), less inflammation, and lower levels of stress hormones. Optimizing your body’s physiological state from threat to safety has a profound effect on your health and quality of life.

Recap

The solutions to solving and preventing chronic disease lie in understanding the principles behind them. Embedding these of concepts allows you to continually practice them. This is in contrast to randomly learning techniques to fix yourself. The process gives you control of regulating your body’s physiology from one of threat state to safety.

Questions and considerations

1. Consider that it is your whole body that responds to your immediate set of circumstances in order to optimize your chances of survival. Your nervous system is the processing center for sensory input and an integral part of the reaction. There is absolutely no separation of the mind and body and why even the use of the term, “Mind Body” is inaccurate.
2. Why would you take your powerful survival reaction personally? It is intended to feel so unpleasant so as to force you to act. It is what you possess and not who you are.
3. You’ll be taken on a journey that will allow you to depersonalize this flight or flight reaction. It is just a part of your daily life.
4. Take some time to review the above principles of solving chronic disease. They will eventually enter every aspect of your life and become automatic. As you spend a lesser amount of time in a threat state, you will be able to move forward into a new life and thrive.
5. You can’t fix chronic disease. You must let go and move into wellness.

References:

1. Torrance N, et al. Severe chronic pain is associated with increased 10-year mortality: a cohort record linkage study. Eur J Pain (2010);14:380-386.
2. Schubiner H and M Betzold. Unlearn Your Pain, 3^rdMind Body Publishing, Pleasant Ridge, MI, 2016.
3. Hashmi, JA et al. Shape shifting pain: Chronification of back pain shifts brain representation from nociceptive to emotional circuits. Brain (2013); 136: 2751 – 2768.

4. Trincker, Dietrich. 1965 lecture at the University of Kiel. German physiologist

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The ability to process anxiety in a healthy way is critical to maintaining your quality of life. It is even more important for someone who is experiencing chronic pain. Anxiety is a reflection of your body chemistry changes when you are in an arousal state. Your senses are heightened and your perception of pain is heightened. (1)

There are several principles I have learned from my own experience and working with my patients:

• Untreated disruptive anxiety always gets worse. It will NEVER get better on its own.
• Anxiety is the pain. It is simply indicating, “danger” whether it is real or perceived.
• Anxiety is highly treatable if it is acknowledged and treated as a physiological problem and not psychologically.
• Anxiety is both normal and necessary–it will never disappear. Every living creature is programmed to avoid situations that would potentially affect its survival.
• It is important to separate the threat from the chemical reaction (anxiety).
• Mental pain is more disruptive to people’s lives than physical pain.
• The harder you try to suppress fear, the stronger it will become. (2) White bears
• Avoiding anxiety becomes its own stressor.
• It is necessary to learn to live with anxiety; is it not solvable.
• The way to decrease anxiety is to utilize methods that lower the stress hormones. The ultimate answer is to learn to switch over to “play” chemicals. It is a set of learned skills and not “mind over matter” or “positive thinking.”

I think that unrelenting and uncontrolled anxiety is intolerable and the one of the worst aspects of being a human. It will infiltrate every corner of your life. I find it tragic that such a treatable problem is so often not adequately addressed because of the incorrect perception of what it represents. It is actually your gift of life.

1. Chen X, et al. “Stress enhances muscle nociceptor activity in the rat.” Neuroscience (2011); 185: 166-173.
2. Wegener DM, et al. “Paradoxical effects of thought suppression.” Journal of Personality and Social Psychology (1987); 53: 5-13.

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Dr. Gordon Irving was the medical director of the Pain center at Swedish Hospital in Seattle, WA. He developed a wonderful set of resources for dealing with chronic pain. His version of a structured program was STOMP (Structuring Your Own Management of Pain). He and I co-edited this guide that will link you to many resources, which will enable you to take charge of your care.

“You Can Only Lose Brain Cells”

Historically scientists have thought that a person was born with a maximum number of neurons and you would slowly lose them over a lifetime. Although the brain activity the first few years of life is intense it has been clearly shown that the brain can change at any age—for better or worse.

Neuroplasticity

Neuroplasticity is the term that refers to the ability of the brain to adapt and change. It is your choice whether you want to direct in a positive or negative direction. Your brain will develop wherever you place your attention. Several of the ways it can occur are:

• Growth of new nerve cells (neurons)
• Shrinking of neurons from disuse
• Increasing or decreasing the number of connections per neuron
• Laying down or losing layers of insulation (myelin). This layer improves the speed of nerve conduction
• Substitution of an injured part of the brain with an already functioning area. The new area takes on new capacities.

The bottom line is that your brain is constantly in a dynamic state of change every millisecond, depending on how much it is stimulated—or not.

• There is an incredible upside potential because the nervous system has a large capacity to continue to positively change if it is kept active and creative.
• The terrible dark side is that when your brain shrinks or atrophies when suffering from chronic pain, then you have less ability to act rationally to pull yourself out of the hole. It is still a solvable problem, but you need help and tools.

Brain Changes are Measurable

With the advent of modern brain scans that can actually measure brain size and activity we are able to document these changes and they happen quickly.

A recent study showed that certain parts of medical students’ brains would significantly enlarge within a few months after starting school. (1)

It has also been shown that the brains of patients in chronic pain shrink. Fortunately the brain also re-expands with successful resolution of their pain. (2)

Brain Shrinks??

Why would your brain shrink in the presence of chronic pain? Conceptually, your nervous system gets stuck on repetitive thought and pain patterns that grow into monstrous circuits, and less time is spent on creative ones. The brain area that enjoys good friends, music, art, wine, etc. gradually shrinks with disuse. There is a huge amount of neural activity involved with these enjoyable endeavors that just does not occur in the presence of unrelenting pain.

Once pain circuits are laid down in your brain they are permanent. They may become less functional but they are not going to disappear. Once you know how to ride a bicycle or walk you cannot unlearn the skill.

Creating Detours

So what is the solution?  You must lay down alternate pathways or detours around the existing problematic pathways, or you can create a shift on to more enjoyable ones. Once you learn the tools and choose the ones that are the best fit for you it is remarkable how consistently the pain will diminish and may even disappear.

There are three aspects of healing:

• Awareness – You must understand chronic pain as it relates to you before you can solve it.
• Treating all aspects of your pain simultaneously – similar to fighting a forest fire.
• You take charge – each human is incredibly unique and complex. You are the only one who can find your own solution.

Welcome to a big adventure and the evolution of your new brain. It will be you that will do the brain building. The STOMP program is a variation of the DOC concepts, and you will discover additional approaches to help move you forward. They are both frameworks for you to organize your thinking and break your problem down into its component parts. The best news is that the healing journey is largely self-directed and you will learn to find the best resources that will work for you. We have found that chronic pain is not a life sentence to be managed, but is solvable.

1. Dragananski, et al. Temporal and spatial dynamics of brain structure changes during extensive learning. The Journal of Neuroscience 2006; 26: 6314-6317.
2. Apkarian AV, Sosa Y, Sonty S. Chronic Back Pain is associated with decreased prefrontal and thalamic gray matter density. Journal of Neuroscience 2004; 24: 10410 -10415.

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