New insights into chronic pain and illness
Welcome to the Living Proof Blog
Living Proof is inviting a series of guest bloggers to share some of their favourite thoughts and ideas on neuroplastic conditions, speaking from their own experience, either as people who have recovered, or as healthcare professionals using this approach to successfully treat their patients.
Overcoming fear when returning to running
April 2024
This month's blog was penned by Dan Hindsley, amateur triathlete and Ambassador for Living Proof. Dan talks us through the mental script he used when trying to return to running - in the hope that this will help others who are adopting a neuroplastic approach to recovery from chronic pain but struggling with returning to sport.
For 15 years I had believed that I was unable to run due to a diagnosis of degenerative disc disease. I had already experienced a lot of success with the neuroplastic approach, however when it came to running, there was always a lingering doubt, a thought that continued to arise saying, “what if you’re wrong, what if you are going to cause yourself irreversible damage?”
At this point in my recovery journey the space between pain ‘flare-ups’ had drastically reduced. Most of the time I was enjoying a pain-free life. Occasionally there would be a painful episode, however I could normally link these to stressful life situations and calm the symptoms with a combination of breathing techniques, meditation and journalling.
Despite all the success, when running, that niggling doubt kept returning. I would set off running and my overly alert brain, trying its best to protect me, would be scanning the body looking for any sensations that would confirm an underlying fear that I was doing damage.
Any tension was over-analysed, and my body would become even more taut in a negative feedback loop that would often result in me hobbling home with my lower back as stiff as a board.
I was convinced that this pain was a neuroplastic symptom, yet I couldn’t stop it from happening!
A breakthrough...
I tried to push on through the pain, but that didn’t work. I tried telling the pain to go, but that didn’t work. I tried getting angry with the pain, and that didn’t work.
Things began to improve when I decided to work with the pain. If the brain was trying to protect me then I needed to find a way to re-assure it that no damage was being done.
Through lots of trial and error, I landed on a mental script that seemed to both provide my brain with the logical information it needed to be re-assured whilst cultivating mindfulness.
Whilst running, whenever I felt tension in the body, I ran through this script and before long I was enjoying pain free runs! I wanted to take the opportunity to share it in the hope that it might work for someone else.
The script goes as follows...
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Have I given my body chance to warm up with a walk/jog? Yes
Have I had an impact to cause structural damage? No
Have I twisted or landed awkwardly? No
Have I over-extended? No
Have I run too fast or too far? (building distance by 10% a week should not cause any pain.) No
OK – In which case, this is just tension in my body caused by fear.
Therefore, I need to relax and return to the present moment.
I would then repeat this affirmation: My body is designed to run, it has evolved over millions of years to do just this!
I would smile, look around at the scenery and focus on slowing and deepening my breath.
I would continue to repeat this exercise over and over until it became almost automatic.
The path to pain-free running was not immediate but I believe that the continued repetition of this script helped re-wire those old stubborn neural pathways.
The practicalities...
On a practical level, I built the distances very slowly. For example, at the start of the process I would walk for 10mins, jog for 5 mins and walk for 10 mins. I would do this on a treadmill three times per week.
I gradually increased mileage by extending the jogging sections (aiming at roughly a 10% increase per week).
I began to join the local 5k park runs which I loved. I continued to build the distances and completed several half marathons. I found a love of fell running and started to include sprints and hill repeats into my training sessions.
Finally, I completed an Ironman 70.3 distance triathlon to sign myself off as ‘recovered’.
Covid put a stop to my full distance Ironman but not before I ran a back-pain free marathon in training.
I hope that this little mental script can also help someone else on the mind-body recovery journey to overcome their fear and return to running!
Bringing Mindfulness to Our Thoughts about Our Health
March 2024
Our blog this month comes from Sarah Howarth, mindfulness teacher and Ambassador for Living Proof.
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When we experience chronic pain and symptoms, it’s very natural to respond with fearful thinking. We often wake up consumed with thoughts about how our symptoms will be today – and how they will impact our lives. So much of our mental energy goes into trying to make sense of our symptoms and what causes them - and into seeking solutions.
In his book, Unlearn Your Pain, Dr Howard Schubiner neatly summarises these thought patterns as falling within the ‘6 Fs’: fear, focus, frustration, figuring out, fixing and fighting. If the 6Fs resonate with you, I empathise strongly. The 6Fs dominated my thinking during my decade-long struggle with chronic bladder pain – and this is completely understandable, completely human. Chronic symptoms are a challenging experience – and we naturally want to bring an end to our suffering.
The problem with fearful thought patterns
The problem is, though, that responding to symptoms with fearful thinking and intense focus sends a powerful message to the brain: that something is terribly wrong. That we are in danger and need protection. Neuroscience explains that when the brain perceives danger, it can generate symptoms to alert us. Fear-based thinking can, therefore, fuel the fire of chronic symptoms. We can unintentionally prolong and intensify our pain.
Once we understand the neuroscience, we see clearly that a radically different response is needed: we need to train our brain away from fearful thinking and focus on symptoms.
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Mindfulness and thought patterns
We can begin to retrain our brain by bringing mindfulness to our thoughts. During a mindfulness practice, when we notice the mind has wandered off into thought, we acknowledge this and then re-route our attention back to the breath or other focus.
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Being mindful about our thinking patterns is not about self-judgement: try to avoid criticising yourself for very natural and normal thoughts.
Instead you might consider your fearful thoughts as visitors – greet them with compassion but refrain from inviting the thoughts in to set up residence in your mind. Remember that the more often you think a thought, the more entrenched the neural circuit in the brain for that thought becomes. The brain will believe the messages it receives most often and so it’s important to be intentional about the thinking patterns and self-talk we cultivate.
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Combining mindfulness with brain training
Once we become aware that our thoughts have drifted towards fear and preoccupation with symptoms, we can begin to train the brain towards a more helpful focus. For example, you might re-route yourself to:
1. Healthier thoughts backed by neuroscience
Remember that thoughts, even our most repetitive ones, are not necessarily true. We can challenge our thoughts with a reminder of an alternative, science-based perspective. For example, if you notice a fearful thought like “I’ll never be able to recover”, you might remind yourself that “this pain is caused by learnt neural circuits – and thanks to neuroplasticity, I can unlearn them”.
This is not simply telling yourself to ‘think positively’. Negative thoughts and doubts will always arise: we are only human. But as Alan Gordon (LSCW), expert on pain reprocessing, advises, we don’t have to ‘buy into’ every negative thought; we can question and challenge it by considering other perspectives.
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2. Your evidence list for neuroplasticity
Once you have compiled a list of all the reasons your symptoms are likely neuroplastic*, this list is an excellent place to re-direct yourself to whenever fearful thinking creeps in.
Evidence is powerful. It is reassuring. We can weaken and break down negative thought patterns when we dwell on counter-evidence.
3. Your emotional landscape
Try to catch yourself whenever you are ‘thinking physical’ (trying to figure out the physical causes of symptoms) – and engage in ‘thinking emotional’. This means exploring whether stress, emotions or other psychological processes might be signalling danger to your nervous system and what steps you might take to relieve some internal pressure. This helps to break the link in your mind between symptoms and physical causes.
4. A safety mantra
Many of us use safety messaging whenever we notice our thoughts becoming fearful. This is a message of reassurance used repeatedly to calm the brain and the nervous system. For example, I often used to say silently to myself, “I see you, pain. I know you are here to protect me because my brain senses danger. But actually I am safe.”
5. Leaning into the body
It’s so easy to get lost in the thinking mind, following thoughts down a rabbit warren of fear. We can interrupt this habit by dropping into the sensing body. We might tune into our senses and note sights, smells and sounds around us. We could feel the sturdy, reassuring support of the ground below us. Or we might focus on the sensations of the breath and use breathing patterns that promote relaxation such as an extended exhale. You can also shake, do a little dance – anything to interrupt your fearful thoughts.
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6. A pleasant or positive distraction
You can counteract negative thinking by directing yourself towards an activity or thought or sensation you find pleasant or engaging. For example, when I woke up thinking about my pain, I would deliberately lean into the pleasant feeling of my bedsheets against my skin. Or I might pick up a word puzzle. Or think through a fun interior-design project. These were some of my favourite distractions but find what works for you. Re-discover what brings you joy and ease and signals safety to your brain.
At first it may feel unnatural to seek out and dwell on pleasant and positive experiences as chronic symptoms can make us gravitate towards the negative. So, we have to be very intentional and practice this way of being until it becomes more habitual.
Making mindfulness and brain-training work for you
Whichever re-direction method you use, notice how it feels to shift away from fearful thinking towards a more hopeful perspective. Does it bring any sense of relief, ease, safety – even just a little?
If not, that’s ok. Neuroplastic practices take time and patience. Consistency is key: stick with the process of catching and re-directing your thoughts. With repetition, consistency and a heap of self-compassion, overtime we can change our thinking patterns to support our recovery.
(*If you haven’t yet created your own evidence list for neuroplasticity, you might like to check out this podcast by Betsy Jensen, Physiotherapist and Somatic Coach. Betsy explains what an ‘evidence file’ is – and how to create one for collating all the evidence for your symptoms being neuroplastic.)
The Power of Leaning into Sensations
February 2024
Our February blog comes from Charli, one of our Ambassadors and the 'star' of our first film on chronic pain, released in 2021.
As you may have experienced by now, fear and attention to symptoms can often be the fuel to the fire. Much of recovery from neuroplastic pain involves paying LESS attention to your symptoms, or at least not worrying about them so much. This allows the brain to stop freaking out and helps to calm the nervous system.
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However, sometimes leaning into sensations and paying close attention to them can be the secret to unlocking your recovery. A growing body of research has shown that somatic tracking, as part of pain reprocessing therapy (PRT), the treatment approach developed by Alan Gordon, is beneficial in reducing chronic symptoms. I myself used this during my recovery and it brought me huge breakthrough moments.
What is somatic tracking?
Somatic tracking is a mindfulness-based practice that involves paying close attention to bodily sensations and using them as a guide for self-awareness. Unlike conventional pain management techniques that aim to distract from discomfort, somatic tracking encourages individuals to lean into sensations, exploring them with curiosity and without judgement. The aim is to observe these sensations through a lens of safety.
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Leaning into pain: A counter-intuitive approach
At first glance the idea of leaning into pain might seem counter-intuitive. However, research suggests that somatic tracking can reshape the way we perceive and respond to chronic pain. Alan Gordon has successfully used this in his practice and treatment for hundreds of patients. By leaning into sensations we teach our brains that these are not really dangerous. As you allow yourself to explore sensations without judgement, the nervous system quite literally turns down the volume and calms down.
Image credit: Alan Gordon, LCSW
The science behind somatic tracking and PRT
A 2021 study published in JAMA Psychiatry found that participants who engaged in Pain Reprocessing Therapy, (which included somatic tracking alongside cognitive and exposure-based approaches) experienced significant reductions in pain intensity and improved overall well-being compared to placebo and to those who underwent usual care, with gains largely maintained after 12 months.
I learnt the techniques of somatic tracking near the start of my pain recovery journey and used them throughout to support my recovery from not only my hip and back pain, but also chronic jaw pain and even IBS.
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How to start somatic tracking
To try out somatic tracking doesn't require specialised training; anyone can begin with simple mindfulness exercises. Start by finding a quiet space, close your eyes, and bring your attention to your breath. Gradually, shift your focus to a part of your body, notice the sensations in that part of your body. If discomfort arises, resist the urge to pull away; instead breathe into the sensation and observe how it evolves.
Image credit: Alan Gordon, LCSW
I like to give the sensations an image with detailed characteristics. What shape is it? Does it have a colour? What texture is the edges? What size is this shape? Is it moving? Once you have a clear picture in your mind of the sensation, simple observe it. Remember you are not trying to change it, you are just observing and watching what it does. Remind yourself you are safe and you aren’t doing anything harmful to your body right now. As you do this you may notice the characteristics of the image begin to change. If they don’t, that’s ok. Perhaps you can see if you can use your brain to change the image of this object. Do you want to make it smaller? Wider? Change its movement pattern perhaps?
Resources for further exploration
If you would like to delve deeper into somatic tracking and its potential benefits there are several reputable resources available. Alan Gordon demonstrates somatic tracking on Youtube and also speaks on the topic on the Curable podcast. There are many more resources out there, use the words ‘somatic tracking’ and ‘pain reprocessing’. Additionally, mindfulness meditation apps and online platforms often feature guided somatic tracking exercises.
Five Exercises for Mindful Running
January 2024
This month's guest blog comes from Living Proof Ambassador and amateur triathlete Dan Hindsley, and is aimed at people adopting a neuroplastic approach to recovery from chronic pain and illness. You can read more of Dan's articles on his Medium page.
As you begin to recognise the link between thoughts, emotions and physical reactions and your symptoms are subsiding - the time may come where you want to re-introduce activities that have long been avoided, such as running!
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If you have been cleared to undertake general exercise by a medical professional, perhaps you could try these 5 mindfulness exercises that I introduced when returning to running following a 15-year break due to chronic lower back pain.
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The thought of running used to fill me with fear and anxiety, however, practices such as these really helped to develop a mind-body awareness that I believe was an essential part of my recovery.
Dan completing his first triathlon in 2019, post-recovery from 15 years of debilitating back pain.
In my experience, these mindfulness exercises are ideally suited to gentle runs, where the objective is to keep your heart rate low and to run with as little effort as possible.
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Noticing the quality of your breath
As you run, bring the attention to the breath and notice its quality. Are you breathing through the nose or the mouth? Is the breath short and sharp or long and smooth? Can you gradually slow the outbreath as you run? Notice any thoughts or feelings that arise without judgement and then bring your attention back to the breath.
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Noticing your body alignment
As you run, experiment with your body alignment. See how it feels to lean your upper body forwards for a few steps, and then backwards for a few steps. See how it feels to raise your right shoulder and then the left. Hold your arms higher and then lower. After each little experiment return to a neutral position. Try to feel how these changes impact your overall running posture. Notice any thoughts or feelings that arise without judgement and then bring your attention back to the breath.
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Noticing your connection with the ground
As you run, notice how your feet connect to the ground. Notice if you land on your front foot, midfoot or heel. Notice how far apart your footsteps are and then experiment with making your stride shorter and longer, wider and narrower. Do you push away from the ground with equal force on both sides? Can you run with more efficiency and less effort? Notice any thoughts or feelings that arise without judgement and then bring your attention back to the breath.
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Body scan
As you run, slowly use your awareness to scan from head to toe and notice if there is any tension in the body. If there is tension in the body, try and outline it and notice its shape. What colour would you give this area of tension? Can you change its colour? Can you change its size and shape? Allow the tension to be there and smile. Then practice shifting your awareness to parts of the body that are free from tension, such as your hands, face, scalp or feet. Notice any thoughts or feelings that arise without judgement and then bring your attention back to the breath.
Noticing your environment
As you run, notice what you can see, hear and smell. Notice the space between sounds. Can you take your awareness to the horizon? Can you feel the air on your skin? Can you become aware of the air surrounding your body? Can you zoom out and picture yourself running on this tiny rock spinning in space? Notice any thoughts or feelings that arise without judgement and then bring your attention back to the breath.
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Finally, as you cool down from your run and return to a walk, be grateful for whatever movement your body has allowed and smile!
Harmful Myths about Neuroplastic Disorders (formerly known as Psychosomatic Symptoms)
December 2023
Our inaugural blog post comes from one of Living Proof's medical advisors, Dr Dave Clarke MD, Clinical Assistant Professor of Gastroenterology Emeritus & President of the Psychophysiologic Disorders Association in the US.
There are many myths and misconceptions about neuroplastic pain or illness that are believed not only by the public but by most health care professionals, too. Recent studies have revealed the truth about these which supports a new and far more effective approach to this condition.
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Myth: Psychosomatic symptoms are “all in your head” and are not real.
Truth: Pain or illness not caused by disease or injury are generated by changes in nerve circuits in the brain and are just as real as any other form of illness. For this reason, the new term for this condition is neuroplastic pain (or illness). This term means that nerve circuits are capable of change caused by a blend of psychology and physiology. Neuroplastic pain can happen to anyone. (Psychophysiologic Disorders (PPD), mindbody syndrome, or Tension Myoneural Syndrome (TMS) are other terms that you will see for this condition.)
Myth: Neuroplastic symptoms have no definite cause.
Truth: Neuroplastic pain or illness is caused by past or present psychosocial stress that often is not fully recognised by the patient. This stress can be diagnosed as successfully as any other form of illness.
Myth: Neuroplastic pain or illness does not respond well to treatment so the best that can be hoped for is living with the condition.
Truth: The past or present psychosocial stress that causes neuroplastic pain or illness can be treated at least as successfully as other forms of illness.
Myth: Neuroplastic pain or illness is milder than other forms of illness.
Truth: Neuroplastic pain or illness can be just as severe as any other form of illness. Neuroplastic Pain can lead to hospitalisation, can persist for decades, and can cause dozens of symptoms simultaneously.
Myth: People with neuroplastic pain are psychologically weak or mentally ill and cannot manage normal levels of stress.
Truth: People with neuroplastic pain are psychologically strong but are coping with much higher levels of stress than they recognise. Once the stresses are uncovered and treated, the many strengths of these patients become clear.
Myth: Either you have a disease or injury, or you have neuroplastic pain.
Truth: Neuroplastic pain can contribute to pain or illness that is caused by disease or injury. Both can be present simultaneously. The best way to determine if there is a contribution to symptoms from the brain is to identify and treat past or present psychosocial stresses and observe the response. Many who have done this have been pleasantly surprised by their improvement.
Myth: Focusing on psychosocial stress is a distraction that can hinder recovery from disease or injury.
Truth: There is no contradiction and no harm from working on stress and on possible disease or injury at the same time. If significant psychosocial stresses are present, they deserve attention for their own sake.
Myth: Neuroplastic pain is uncommon compared to most other diseases.
Truth: Neuroplastic pain is very common and responsible for symptoms in about 20% of adults and 40% of people who see a primary care physician. Neuroplastic pain is nearly twice as prevalent as diabetes.
To summarise: Disease Or Injury Are Not The Only Causes Of Pain Or Illness.
The brain can generate real symptoms when high levels of stress are not fully recognised. This occurs in many people with strong, healthy minds, affecting one in five adults and two in five primary care patients.
How does the brain do this? Research shows changes in the nerve pathways in the brain (neuroplasticity). These occur in people with stress, trauma, and repressed emotions that often are linked to Adverse Childhood Experiences (ACEs).
Fortunately, new research shows Pain Relief Psychology achieves far better relief of pain and illness than older approaches.