Dr. Howard Schubiner explains chronic pain

Photo of clouds shows how reversing pain pathways dissipates chronic pain.

Dr. Howard Schubiner explains the concept of chronic pain, and its association with stress, as well as the neurological and physiological mechanisms behind the creation of learned nerve pathways.

While chronic pain can be devastating, it is often not what it seems. Pain can be caused by tissue damage, however many people with stubborn chronic pain have no tissue damage.

Stress and emotional reactions to stressful life events can produce nerve pathways of pain, fatigue, insomnia, anxiety, and depression. These pathways can be reversed.

What is the first responsibility of a doctor?

When a doctor approaches a patient with a medical problem, we want to know what’s causing it. Pain is the most common symptom that people have any medical symptom whether it’s fatigue, whether it’s trouble with sleep, anxiety, depression, constipation urinary frequency.

Any symptom is basically caused by one of two things. Number one, is it some kind of tissue damage? Everyone knows if you break your arm, it’s going to hurt. Doctors are generally pretty good at finding what’s causing the damage.

But a lot of symptoms don’t have tissue damage. It could be something else and that is nerve pathways. Very few doctors understand that nerve pathways can cause real and severe pain or other symptoms.

What are nerve pathways?

A nerve pathway is millions of brain cells that create something to happen in the body. When you learn how to ride a bike, that’s a nerve pathway. When you sign your name, the way you walk, the way you chew, those are all nerve pathways.

Pain can be a nerve pathway. When fatigue or anxiety or sleep problems occur, the brain is activating those pathways and there doesn’t have to be any tissue damage to create these symptoms.

People also have no-pain pathways in the brain. Our job is to help people get rid of their pain by stopping them from activating these pain pathways - which are activated by fear and stress and triggers - and start activating these no-pain pathways.

When we do that the pain is turned off. These no-pain pathways are activated by knowledge, by power, and by confidence.

How does the brain interpret pain?

When an injury occurs in the body, the nerve pathways are sent to the brain and the brain has to interpret those nerve pathways.

The way the brain works is it the amygdala, the danger center of the brain, and other areas like the anterior cingulate cortex and the prefrontal cortex interpret pain as either danger or no danger.

All pain actually occurs in the brain. The conscious awareness of pain is in the brain, even when there’s a tissue damage type of problem. Most of the time when there’s an injury, the nerve signals go to the brain and the brain interprets those nerve signals as dangerous and that something is wrong. It creates a fear and that danger signal creates this pain pathway and then pain develops and the pathway will become learned.

This danger signal is triggered by physical injuries. But it’s also triggered by emotional injuries or emotional events. Research has shown that emotional trauma triggers the exact same danger pathways that create pain in the brain.

What kind of stress creates pain?

What we see in our patients is that stress occurs in life, as for most people.

But most of our patients have more than the usual stress. Not all of them but a lot of our patients have had very difficult childhoods. They may have divorce, abandonment, neglect, or abuse of some kind.

That stress and those hurts that occur in childhood create pathways of danger. Sensitivity to danger, sensitivity to fear. Usually in childhood there may be no symptoms, and there may be no pain at that point in time. Some children clearly develop sleep problems, anxiety problems, headaches, stomach pain.

Often times there are no symptoms because what’s happening is that the stress is interpreted by them as being normal and the symptoms are not emerging.

But the fear pathway is developing and then later in life when another stress occurs - say you have a young woman with an emotionally controlling or emotionally abusive father and then she becomes a teenager here and she gets a boyfriend who turns out to be emotionally abusive - and then she may start to get headaches.

Then later in life, other stresses may occur. She may marry somebody who’s also emotionally abusive or cheating on her or she’s worried about him harming her children. At that point, new pain pathways begin to form. Pathways of irritable bowel syndrome, pathways of pelvic pain, or a variety of other painful nerve pathways.

And then later in life maybe there’s a car accident. So there are emotional hurts and now a physical hurt but the car accident being a physical injury is still triggering those danger signals, triggering the fear pathways that have been sensitized through her life.

So new symptoms may occur such as back pain, neck pain and then new stresses may occur. There may be problems with work or jobs or whatever. Then it becomes anxiety, depression, and fatigue.

When we see this pattern, people say, ‘Well, why would a car accident cause all this?’

Most people heal from a car accident and the body does heal but the nerve pathways can create tremendous pain when you are living in this pattern.

How can these pain pathways be reversed?

The are four steps in the general treatment program for nerve pathway pain, mind-body pain.

The first step is education. It’s understanding that when there’s pain but no tissue damage, these kinds of symptoms are caused by nerve pathways that are reversible. Those pathways can be controlled, they can be changed. It’s believing that and it’s having confidence that you can overcome that

The second step is behavioral work. We find when patients are afraid of their symptoms, pain causes fear and fear causes more pain. That often evolves into a vicious cycle of horrible and severe pain. By understanding that they can get better, that these nerve pathways are not going to harm them, and that they can control them, then they can stop being afraid of the symptoms. When they stop the fear, they can learn to take control of them and apply a variety of techniques for making the pain go away.

The third step is emotional work. There’s a whole variety of emotional techniques including expressive writing and also of intensive short-term dynamic psychotherapy where people are actually expressing the emotions that are creating this danger signal.

The fourth step is making changes in their life so that they can be powerful. They can learn that they don’t have to be prey to the kinds of situations that have hurt them and harmed them in the past.

Sarno Clinic advances the Dr. John Sarno method for healing chronic pain.