On the Fear-Brain-Pain Connection
I am fascinated with how love and hate show up in my heart and in the world. This fascination is focussed spiritually for me in recovery, meditation and the work of people like Richard Rohr .?This fascination also involved my mental health and that of the men who I try to help in and out of recovery.?But it is also physical.?I am fascinated with how love and hate show up for me, and others, in athletic performance. ?
In many ways the body brings all three elements (mind, body, soul) together.?The body is the bridge between the mind and the soul. It’s the pathway where we find out the truth about ourselves.?It does not lie.?
With this as backdrop, I found myself this morning, on my pre-dawn run, listening to Ezra Klein talk to the foremost scientific expert on pain.?Klein is a 30-something brainiac.?He has led me to some wonderful books like Bewilderment by Richard Powers and Book of From and Emptiness (both about unusual boys enduring the loss a parent, ostracized by their peers, but proving to be extraordinary). ?
In recovery we often say the longest 18 inches is between the head and the heart. Self-knowledge is useless when it comes to addiction. Only a spiritual awakening of the soul can lead to real change.?And brainiacs often have the hardest time letting go of logic.?
Klein’s intellectual gift has been off-putting to my exploration of the love and hate.?He thinks too much, trying desperately to reason his way through spiritual matters.?But sometimes looking at the science does help. And to his great credit Klein does pause from the policy wonking from time to time to address something deeper, very often in himself.
I found myself listening to Klein this morning talking about his chronic back and neck pain with Rachel Zoffness, who is a pain psychologist at the University of California, San Francisco, School of Medicine and world expect on chronic pain management (defined as pain that lasts more three months).
Dr. Zoffness distinguishes between "harm" and "hurt".?
"Harm" is actually physical bodily damage.?
"Hurt" is physical pain which can and cannot involve harm.
To demonstrate the difference she describes two well documented construction incidents. ?
In the first, a worker jumped on a 7” nail. The nail went all the way through the man's boot coming out the other side.?He screamed out in pain. Everyone around him was traumatized. They called the ambulance immediately. The worker was screaming in agony the whole way to the hospital. In the ER, the poor guy was in so much pain he needs a fentanyl IV to finally calm him down enough so he could be treated.?When they finally cut his boot off, the doctors were shocked to see that the nail had gone between his toes.?There was in fact not a drop of blood. Zero harm.?But excruciating real pain.
In the second incident, a construction worker watched his nail gun misfire. The stray nail appeared to have have flown back to the wall behind him.?He went about his business for several days before complaining to his wife about a tooth ache.?She convinced him to go to the dentist. The dentist took x-rays. To his shock, the dentist discovered that the construction worker had actually been walking around for days with a 4 inch nail logged in his jaw.?Real harm, next to no pain.
What is going on here?
Pain is the brain’s warning signal for danger.?It depends on physical, psychological and social inputs.?Pain is never just “in your head.”?It is 100% real. But it can involve physical harm or not. What is important is what is going on in the brain, based on this web of information.
50 million Americans suffer from chronic pain in the US.?Opioids are useless in treating chronic pain.?80% of those 50 million have co-morbidity with acute trauma.?The body is in fact keeping the score, as is out lined in Bessel van der Kolk's popular book of the same name .
The experience of physical pain is very much related to the plasticity of the brain.?Experiencing trauma and/or chronic pain creates a neural pathway that actually turns the pain volume up.?Small, non-harmful events can trick the brain into seeing danger, and kicking off high levels of physical pain, even when there is no danger.
Thankfully, the plasticity of the brain allows us to actually form new positive neural pathways that open the window to a new reality. ?Dr. Zoffness works with patients who have long since given up hope. She has written a workbook to help those with chronic pain to make steady progress. And she reports having witnessed many miracles based on her scientific approach to treating pain as a psycho-social-physical warning system in the brain.
Back to love and hate.?God only knows, I have experience extreme pain in my life as the result of trauma and self-hate.?My process has been to laboriously cultivate unconditional love of self and others through days, months and years of hard work.? I am in a recovery program, have had amazing psychiatric help, and have experienced a spiritual awakening involving forgiveness of myself and all those who towards whom I ever held a grudge. At 58, I am happier than I have ever been in my life. But there is always more to do.
At the end of the podcast, Dr. Zoffness talks about how anxiety and pain are close bedfellows. During COVID there was not just a pandemic involving a rogue virus but an epidemic of suicide, opioid, and alcohol deaths. Psychic pain went into overdrive.
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If pain and anxiety are bedfellows so too are hate and fear. When I say I am fascinated by hate and love, I might as well say that I am fascinated by fear and love. Some say they are the two primary emotions from which all others derive.
There is still pain which resides deep in my body. My trauma was very much related to my physical being. I did not believe I deserved to take up space on this planet.
For the final leg of the journey, I have to rewire my brain using very physical means. I have found breath-work, with my instructor Iona , very useful in healing my physical body. Every Thursday morning at sunrise I go swim in the Boston Harbor with a group of friends. Each time I get in the frigid water, I feel profound fear and even pain. But as I stay in the water, breathing deeply, the fear passes and is replaced by well being.
These practices help, but in the end the deepest form of rewiring, for me, involves pushing my body to the limit. I ran as a boy and have now returned to it some 40 years later.
My long term goal these days is to run the Leadville 100 when I am 60.?In this pursuit, with the careful guidance of my coach Christopher, I’ve had to look closely how love and hate/fear/pain play out when I run.?I have a long history of self-punishment which is very counter to performance (and joy).? Courage, love, and a full heart are a daily practice when I run.
Christopher had me watch the documentary Breaking 2 .?I loved it.?
Eliud Kipchoge is so joyful in his running.?His life is very simple.?Yes he is the Michael Phelps of running.?The perfect body and the perfect stride.?But he always has that subtle smile on his face even at moments of maximum effort (there is tons of research that you run faster when smiling). Unlike Phelps, I don’t expect Kipchoge will go into crippling depression as a result of his running.?He runs with complete relaxation. He seems to feel no pain.?And his greatness is not a burden but a gift.
I am at the very start of my running training. I am not playing a finite game where there are winners and losers. I am playing the infinite game where no one run or race matters. The objective is to keep going, keep improving, keep working with courage and an open heart.
Each time I run, the pain melts away just a little bit more. I feel deeper and deeper love. And become more and more aware of the limitless joy and beauty which is my own body in motion.
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Pain scientist | Lecture at Stanford | Asst Clinical Professor at UCSF School of Medicine | International Speaker | Science Writer | Disruptor of Pain Medicine
1 年A beautiful and moving piece. I'm so glad the podcast resonated.