The Mind-Body Couple

Decoding Pain/Symptom Flares Part 1: 4 Main Causes of Flares

• Tanner Murtagh and Anne Hampson • Episode 71

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What if understanding your pain or symptoms could actually be the key to healing? On this episode of the MindBodyCouple podcast, we tackle the often perplexing realm of pain and symptom flares, sharing insights that could transform your approach to chronic symptoms. We discuss the first part of our series on pain and symptom flares, focusing on the 4 main causes of pain or symptom flares.


Tanner Murtagh and Anne Hampson are therapists who treat neuroplastic pain and mind-body symptoms. They are also married! In his 20s, Tanner overcame chronic pain and a fibromyalgia diagnosis by learning his symptoms were occurring due to learned brain pathways and nervous system dysregulation. Post-healing, Tanner and Anne have dedicated their lives to developing effective treatment and education for neuroplastic pain and symptoms. Listen and learn how to assess your own chronic pain and symptoms, gain tools to retrain the brain and nervous system, and make gradual changes in your life and health!


The Mind-Body Couple podcast is owned by Pain Psychotherapy Canada Inc. This podcast is produced by Alex Klassen, who is one of the wonderful therapists at our agency in Calgary, Alberta. https://www.painpsychotherapy.ca/


Tanner, Anne, and Alex also run the MBody Community, which is an in-depth online course that provides step-by-step guidance for assessing, treating, and resolving mind-body pain and symptoms. https://www.mbodycommunity.com


Also check out Tanner's YouTube channel for more free education and practices: https://www.youtube.com/channel/UC-Fl6WaFHnh4ponuexaMbFQ


And follow us for daily education posts on Instagram: @painpsychotherapy


Discl...

Speaker 1:

Welcome to the MindBodyCouple podcast.

Speaker 2:

I'm Tanner Murtaugh and I'm Anne Hampson. This podcast is dedicated to helping you unlearn chronic pain and symptoms. If you need support with your healing, you can book in for a consultation with one of our therapists at painpsychotherapyca or purchase our online course at embodycommunitycom to access in-depth education, somatic practices, recovery tools and an interactive community focused on healing. Links in the description of each episode. Hello everyone.

Speaker 1:

Hi everybody.

Speaker 2:

It's like that I started a little different. Yeah, no, every podcast, me and Anne are like I'm like hi, everyone, welcome back to the podcast. And then Anne's like hi, everyone, welcome back to the podcast. And then Anne's like hi, everyone, welcome back. And then I'm like we have a really exciting topic today.

Speaker 1:

Yeah, we feel like we're. We apologize that it's always the same intro. We actually don't know how to start it differently. We think about it every time, of what?

Speaker 2:

to do we feel quite relaxed the whole podcast as we record it.

Speaker 1:

But like the beginning, we we're like is this awkward?

Speaker 2:

are we being weird right now? Yeah, for everyone's reference, you're getting goofy tanner today because I'm sick uh, I guess that's a good thing it's not a bad thing no, but I'm just I'm a bit loopy, yeah, like I'm.

Speaker 2:

I'm I'm dawdling already and we're uh, okay, okay, let's get going into it then all right, um, but I guess before topic though, we wanted to mention our course oh, yes, the course has been up now for, yeah, a week and a half yeah, so we have launched it on our embody community site, um, and it's pretty exciting it's exciting. It's being received well. Yeah, People are watching the videos doing the practices, which is great.

Speaker 1:

Again. I just like to put out there that mine are the best.

Speaker 2:

Your practices are the best.

Speaker 1:

Yeah, but we're super excited that this is out there and available and that people are interested and people are using it. So that's why we created it to kind of create a program that people can walk through on their own, exactly, yeah, so it's pretty cool so now a little bit of education, actually, that we took from the course ah, okay this is another two-part series. Ah, yes, tenor is really into the two-part series here. So is alex alex costan, our producer.

Speaker 2:

He loves the two-part series. Every time I'm like hey, man, we're doing another two-part series. He's like I'm so excited.

Speaker 1:

He's excited about the, the two-parters okay, so explain what is this part one then today.

Speaker 2:

So this two-part series is on pain and symptom flares, and part one is four main causes of pain and symptom flares.

Speaker 1:

Yeah, and one thing, one thing I want to say like I know we've talked about pain flares before on this podcast, but it's an important thing to keep learning about, keep revisiting and actually keep kind of lessening fear around. So it's important to kind of have this topic in the mix again.

Speaker 2:

Yeah. So in this part we're going to talk about kind of the four main causes that we see. Yeah, in the next part we're going to talk about kind of the four main causes that we see.

Speaker 1:

Yeah, in the next part we're going to tell people what do you actually?

Speaker 2:

do about it.

Speaker 1:

How do you handle them? Usually, the two-parters go yeah, good work, tyler, exactly. Yeah, it's well thought out.

Speaker 2:

Yeah, so you know, as our nervous system becomes more regulated.

Speaker 1:

Yeah.

Speaker 2:

We retrain our brain, we change our thoughts and beliefs about our body. For a lot of people, their pain and symptoms start to reduce.

Speaker 1:

Yes, that's the hope when we do the brain retraining.

Speaker 2:

That's the goal here. That's why you're all listening to this podcast.

Speaker 1:

Yeah.

Speaker 2:

But it's important to know that healing is not a straight line.

Speaker 1:

No, and I think everyone that I meet I have that conversation with them that it's not a straight line and it can be a bit of a. It can feel like a bit of a blow when we experience it not being a straight line at first.

Speaker 2:

I think that's what it is. Is people hear this? I heard it, yeah, but then all of a sudden, when you have a flare, it's like you really need to hear it Because you're like what is happening? This is awful Because they are pain and symptom flares. They're terrible.

Speaker 1:

Yeah, so it makes sense that, like if you're doing this work and maybe starting to see some results, and then there's this pain flare to feel really thrown for a loop and feel really overwhelmed and again it's like what we know and learned it's so hard to access that in the flare because it's a difficult thing.

Speaker 2:

Well, exactly, and when we have a flare, we just become very dysregulated, naturally, yes, and so it can take a lot of work. Yeah, now it's just normal to know that you're not going to heal, like it's not possible to heal and not have a pain flare. Why is that? Do you think it's just alan gordon talks about it your, your, your brain. It doesn't really go down without a fight. Like you're trying to change something that's been wired into your brain and nervous system and it's not gonna be smooth sailing. You, lots of people can heal, I believe that, yeah, but it's gonna be a little bit bumpy. So let's dive into the four main causes of pain and symptom flares. Okay, number one conditioned responses.

Speaker 1:

Yes, for sure.

Speaker 2:

Yeah, we talk about this a lot.

Speaker 1:

Yeah.

Speaker 2:

When we have chronic pain, chronic symptoms, our brain constantly isn't making associations. It's an association making machine. This is what it does, and it starts to make associations between what conditions, such as movements, positions, foods, time of day, days of the week and what can increase or decrease our pain and symptoms.

Speaker 1:

Yeah.

Speaker 2:

So it basically links the two together? Yes, it links these conditions together. The problem is that, unfortunately, with neuroplastic symptoms, the condition responses are inaccurate, they're not correct, and when I learned about this when I was first healing, it was really exciting. Yeah, because I always assumed walking equals back pain, moving my arms certain ways equals shoulder pain.

Speaker 1:

Yeah.

Speaker 2:

I was so convinced of that connection. But part of mind body healing is starting to understand what are my condition responses, what are the things that have been linked to my pain or symptoms, because we want to break these over time. Yes, we have another two part series in the past that we did on, you know, the rule book. Yeah, and breaking the rules or conditioned responses. People can go back and listen to that. But a big part of why pain and symptom flares occur is these conditioned responses.

Speaker 1:

Right and it doesn't mean that progress isn't still being made. So I always really let people know if flares are happening. You're not backtracking. Progress is still being made and we can work with the pain flare, but that's right. You might be coming up against all these different conditioned responses that now need kind of challenging or breaking, which means pain will flare at those times.

Speaker 2:

So whether you're doing the graded exposure work, intentionally or unintentionally, your brain runs into a condition that it's labeled. It's likely it's going to produce some of that.

Speaker 1:

Totally, and it's almost a signal that it's like okay, work is to be done here. Can I recognize why the flare is happening, what the condition response is and how to create safety with that?

Speaker 2:

And part of the reason we're talking about these four main reasons pain and symptom flares occur is awareness. Is power here, like we need to have awareness of what's triggering me right now, what's triggering my symptoms? And so one thing that I was really on the lookout for, and I tell my clients to be on the lookout for, is what condition maybe your brain is viewing as dangerous and trying to protect you from. It doesn't mean that we can't slowly approach it and unlearn that, but it's really important to see that connection because otherwise we feel kind of lost. We're like this happened randomly, we don't really know the reason. It can induce a lot of fear and frustration. Yeah, so just be on the lookout next time you have a flare. For any of the listeners looking for you know what are the conditions that maybe my brain feels unsafe with right now.

Speaker 1:

Totally.

Speaker 2:

I didn't dawdle.

Speaker 2:

Now we're on to number two. Yeah, extinction Burst. Yes, people love all the posts that I've made on Extinction Burst. This is it makes a lot of sense to people. It really, it really clicks. Yeah, it's a little science-y. Yeah, alan Gordon talks about these a lot, the creator of pain reprocessing therapy, and when we talk about chronic pain and symptoms, they're they've been reinforced in the brain. They've been reinforced by negative emotions, negative thinking, avoidance behaviors, dysregulation and, as Alan often talks about, a reinforced behavior is not going to go down easily, it's not going to disappear easily, and so sometimes, out of nowhere, we'll get this intense burst of pain or symptoms. This happened to me. A lot of the four areas that we're talking about today. The other three aren't really making sense. Maybe it's an extinction burst.

Speaker 1:

How did you know, Tanner, that, hey, this might be an extinction burst over like a conditioned response or something else?

Speaker 2:

Well, I couldn't really pinpoint a conditioned response. I couldn't pinpoint the other two that we're about to cover.

Speaker 1:

Okay.

Speaker 2:

So it started to make sense. And the other thing you're looking for is extinction. Bursts typically happen when a behavior, a reinforced behavior, is starting to become extinct. So any reinforced behavior, as it starts to become extinct, you're unlearning your pain or symptoms. Naturally, the brain fights back a bit. All of a sudden you get this burst of symptoms out of nowhere, Right. Okay, All of a sudden you'll get this burst of symptoms out of nowhere, Right. And the thing about extinction bursts I know this is easier, easily said but not easily felt is they are actually a good sign.

Speaker 1:

They're a sign that you're making progress.

Speaker 2:

Yeah, it's just, it's not going to be smooth sailing on the way down.

Speaker 1:

There are going to be some of these extinction bursts that take place Well, and knowing that I think can be difficult in a time, like we know, pain flares are hard, but understanding that this can mean okay, we're in the right direction still and really leaning into that belief can be really helpful too. So it's kind of shifting relationship to the pain flare and perception of it.

Speaker 2:

I think that's why any post I ever do on extinction burst, when I talk about this with clients, it can be reassuring.

Speaker 1:

Totally.

Speaker 2:

It's a bit hopeful when we think of instead of viewing the pain or symptom flare as this negative thing that means you're never going to get better. Yeah, if it's an extinction burst, it's a good sign that you're moving in the right direction.

Speaker 1:

Yeah.

Speaker 2:

Number three Okay, you are outside the healing window.

Speaker 1:

Yeah, and I have to say I really like more and more the talk about the healing window because I think it's under sorry. It's important for each person to understand their own unique healing window when we're kind of pushing it too far or too hard or kind of going into dysregulation.

Speaker 2:

Yeah, so the healing window. It's a window. Imagine you hold one hand above, one hand below.

Speaker 1:

I imagine it side to side you imagine it side to side.

Speaker 2:

I always imagine it up and down. That's odd. We could go like this and people listening they can't see. But we're making a little box with our hands.

Speaker 1:

I'm doing it a bit reluctantly.

Speaker 2:

Yeah, but you participated, so I appreciate that. Anyways, whether it's side to side or up and down, it's a window, yes, and within the window it's not going to be comfortable, like you're dealing with a level of uncomfortable sensations. This could be pain or symptoms, like we're talking about today. Yeah, could also be emotions, dysregulation. It's uncomfortable, the sensations you're attending to, but when you're within the healing window you can tolerate sitting with it uh, so that's right.

Speaker 1:

So when we think of exposure, we want exposure to symptoms, we want exposure to discomfort with symptoms, but that's right.

Speaker 2:

We don't want it to feel completely out of control and like we're really terrified and that's why, when people are doing somatic tracking or somatic work with emotions or dysregulation, yes, you want to stay. Make sure you're staying within the healing window yeah now, over time, as you practice playing in that zone, it'll expand. Yes, like that's the hope. For example, like I can tolerate sitting with a pretty high level of anxiety in my body yeah and feel actually okay, like it feels uncomfortable but it feels safe.

Speaker 1:

You've had exposure built up over time.

Speaker 2:

I've used somatic work to give myself little doses of anxiety, and I'm able to tolerate a larger amount of it now.

Speaker 1:

Can we talk about the healing window also with like exposure and activity, because I think that is another window that people need to be aware of. In terms of like, okay, I'm exposing my symptom, I'm exposing to my activity, but not maybe going overboard with the activity. Well, I think I'm exposing my symptom, I'm exposing to my activity, but not maybe going overboard with the activity.

Speaker 2:

Well, I think that's what it is. Is people become overzealous, yeah, and then all of a sudden they're approaching activity where they haven't done the smaller exposures beforehand, and then they face like an overwhelming amount of fear and then they get intense pain and symptoms. Yes, this is a thing that happens and a sign that you're outside of that healing window is you all of a sudden move very quickly into fight, flight freeze or shutdown.

Speaker 1:

Yeah.

Speaker 2:

It's okay to have some of that energy, but if it's becoming rapidly intense, really quick, that nervous system dysregulation can cause pain and symptoms. And this is why this is the third reason, the third way pain and symptom flare is going to occur Is people are pushing the line a little too much.

Speaker 1:

Totally, and it's almost. Sometimes I tell people make the line a little bit like shallower. I don't know how to describe that line. A little bit shallower, I don't know how to describe that but a little bit less than what you would want it to be to start. So almost smaller exposures than you would choose.

Speaker 2:

Yeah. And then make it a bit bigger, instead of overshooting it and doing too much too soon, like if people are just starting with this, with any sensation, with any activity. I don't want people to go too slow, but you do need to make sure you're not overshooting, because you likely will get a pain or symptom flare at that point.

Speaker 1:

Yeah, for sure.

Speaker 2:

Okay, we're moving right along, yeah.

Speaker 1:

Look at us go Okay. Number four Okay.

Speaker 2:

Difficult emotions or nervous system dysregulation? Yeah, when you know a flare occurs, it helps to question if any difficult emotion or dysregulation was occurring before or as the flare was beginning. Yes, lots of people know this idea, but when we lack an awareness and relationship with our body, we lack insight and awareness of our emotions, of our nervous system, and so it's really easy to miss this.

Speaker 2:

Yes, I had to really train myself to almost. In Dr Schubiner's training they talk about this like walk it back, like when your pain or symptom increased rapidly walk it back a day, an hour, a week, like what was taking place emotionally nervous system wise, because if that stuff gets too intense our brain may try to protect us by producing pain or symptoms.

Speaker 1:

Yes, and sometimes it can be even just looking at like is there pressure going on? Is there pressure going on in my own mind? Is there intensity going on? Because I think that's something that gets missed too, because people will be like, well, no big emotions or no fights or no, like it's hard to pinpoint stressors, but there's been just a lot of like intense living going on, or even intense way of thinking.

Speaker 2:

There is Intensity and pressure. Yes, like eight times out of ten. Yeah, I guess rarely I get symptoms anymore, but when I do eight times out of ten, it's that.

Speaker 1:

Well, and we have to teach ourselves to recognize that in ourselves Totally.

Speaker 2:

So we made it through all four yeah, in record time.

Speaker 1:

Well, and I think we wanted to outline these four as like podcast one to this, because, like you said, tanner, knowledge is power and so recognizing this, having knowledge is power, and so recognizing this, having this knowledge, is a big step forward in terms of solution or working with pain flares.

Speaker 2:

Yes, and in part two next week we're going to talk about what do I do when pain and symptom flares occur. Yeah, but we need to be aware of these four ways that flares occur. Yes, because that's going to tell you how you may need to respond totally like there's a lot of similarities and how you're going to respond no matter what, but there is some differences for sure.

Speaker 2:

Yeah, um, like those conditioned response, you might want to back up a bit from that. If it was more an emotion, you might have to do some emotional work and learn to feel safe with those. Like it's going to vary in our response, yeah, so thank you everyone for listening. Thank you for listening and we'll talk to you next week. Talk to you next week.

Speaker 1:

Thanks for listening. Thanks for listening For more free content. Check out the links for our YouTube channel.

Speaker 2:

Instagram and Facebook accounts in the episode description. We wish you all healing.