Episode 18: Pain Attention

Reframing Pain: Understanding Chronic Pain's Messages

In this episode of 'Mind Your Body,' Dr. Zev Nevo, a trauma-informed physician certified in physical and regenerative medicine, explores the complex relationship between pain and mind-body health. Dr. Nevo discusses how chronic pain can become a sensitized signal, not just a warning of physical harm but an attention-grabber that indicates unaddressed needs, boundary challenges, or misalignments with core values. By differentiating between pain as a smoke alarm (danger) and an alarm clock (a call to attention), listeners are guided on recognizing and interpreting pain signals to foster self-awareness and wellbeing. Practical advice is offered on how to pause, engage the prefrontal cortex, and build a more trusting relationship with our body's messages.

00:00 Introduction to Mind Your Body

00:59 Rethinking Pain: A New Perspective

01:35 The Science Behind Pain and Sensitization

05:25 Chronic Pain: Alarm Clock vs. Smoke Alarm

08:59 Understanding Pain's Messages

16:50 Practical Steps to Reframe Pain

18:04 Conclusion and Final Thoughts

This essential pre-roll message serves as a clear disclaimer, stating that the podcast provides pain and trauma-informed psychoeducation for informational and entertainment purposes only, and does not constitute medical advice. Listeners are reminded to always consult a qualified healthcare professional for specific medical conditions or symptoms.

About Dr. Nevo
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LINKS:

• Body and Mind Pain Center
• Mind Body Rehabilitation
• Substack

Transcript

Episode 18 | Pain Attention

 [00:01:00] What if the very thing you've been fighting, avoiding and fearing is actually trying to tell you something vital. What if your pain isn't a relentless enemy but a desperate messenger? Stick with me because today we're going to challenge everything you thought you knew about your body's most persistent signals.

[00:01:22] Hey everyone, and welcome back to Mind Your Body. I'm Dr. Zev Nevo, your source for pain and trauma-informed psychoeducation and the exploration of Mind-Body Rehabilitation.

[00:01:35] How often do we think of pain as a warning signal, a blaring and often frightening warning to us of danger. Quite often this is how the signaling purpose of pain is described, and it makes sense. We certainly are alerted by our nervous systems when we sustain injury and for good reason. It allows us to attend to our injury [00:02:00] and remove ourselves from danger, whether that's pulling away from a hot stove or scheduling an appointment to get our pain evaluated.

[00:02:10] We know something feels off and we feel compelled to do something about it. In fact, our brain learns from past experiences of getting burned by pain and establishes a series of thought based and body tension based protective mechanisms that manifest as pain habits. These aim to forewarn us of potential harm.

[00:02:39] Or even in anticipation of prior triggers of pain, be it movements, positions, or activities. What's fascinating is that when pain has a history in your body and becomes chronic,

[00:02:56] the pathways adapt and often becomes [00:03:00] sensitized, both at the level of the injured tissues as well as the brain processing centers.

[00:03:07] The pain we re-experience aims to teach us new lessons from our experiences, whether that we're failing to address the true source of pain or that our injury or condition is worsening. We interpret it almost instinctively as an escalating threat. However, in exploring the regions of the brain involved in processing chronic pain, we find something really interesting. We find overlap in repeated studies looking at over and underactive brain regions present in chronic pain individuals.

[00:03:49] What is remarkable is the similarities in the processing of both physical and emotional pain along similar brain [00:04:00] pathways and the inhibition of other brain regions that we similarly see in patients who have experienced trauma. Think about that for a moment. The brain can process a physical injury in ways that mirror profound emotional wounds and vice versa.

[00:04:21] It speaks volumes about the integrated nature of our experience, doesn't it? In essence, sensitization involves becoming hyper alert to stimuli and much more reactive once they present. Sensitization can also increase the amplitude of sensations, extend their perception for longer periods. And increase our emotional, and yes, even physical protective guarding mechanisms that react to actual or perceived [00:05:00] threats.

[00:05:00] It's like your body's internal threat detection system has had its sensitivity dial turned all the way up even for things that aren't truly dangerous. You might find yourself flinching at a sudden movement or tensing up in a familiar position, not because there's imminent harm, but because your system is anticipating it.

[00:05:25] But what if I told you that pain signaling in individuals with chronic pain can sometimes present as a tool to grab our attention? Instead of a smoke alarm, think of the function of an alarm clock. Both a smoke alarm and an alarm clock have loud, obnoxious sounds that aim to alert us of something. But the meaning behind each is different.

[00:05:57] One signals danger and threat, [00:06:00] and one signals us to pay attention because there's something we are at risk of neglecting. Nobody enjoys the jarring sound of an alarm. It's almost universally disliked, but the meaning behind each is profoundly different. One signals danger and threat, an urgent crisis demanding immediate escape.

[00:06:26] The other signals us to pay attention. Because there's something important we are at risk of neglecting. Consider the difference in how you react to each. A smoke alarm sends your heart racing, triggers adrenaline and primes you for fight or flight and alarm clock. While irritating doesn't typically induce panic. You might groan, hit snooze, or even resent it, but you don't generally fear for your life.[00:07:00] 

[00:07:00] That subtle but crucial difference in internal response is key to understanding chronic pain. I n the case of an alarm clock, the meaning or purpose of the setting of the notification can be a way to get us out of bed in the morning, to remind us to attend an appointment or a meeting, have us practice a certain goal or routine.

[00:07:27] Or maybe to take our supplements or medications. It's not intended to be threatening, but rather assists us in paying attention to the meaning behind the alarm. It's a prompt, a nudge, a scheduled reminder from our past selves to our present selves. When an alarm goes off, we pay attention and ask ourselves:

[00:07:55] "Wait, what day is it now? What time is it? Did I set this alarm? [00:08:00] Is there context for why this went off? Especially now?" what we're doing is we're giving meaning, purpose, and context to the alarm. It may not be pleasant, but it was necessary to avoid something even more negative. This could be coming late to work, missing out on an important appointment or meeting or missing a time sensitive event such as catching a flight or a concert. We accept its temporary discomfort for a greater good.

[00:08:36] Not only do we tolerate the alarm, we actually set this voluntarily in advance. Understanding that the discomfort of hearing the alarm is necessary to grab our attention at a particular moment in time in the future. We've made a conscious choice to prioritize its message.

[00:08:59] [00:09:00] Now in the setting of chronic pain, our nervous systems can use pain as a method of waking us up or alerting us of an important message, even in the absence of active tissue damage or injury. This is an essential feature of neuroplastic pain as pain becomes a valid source of holding our attention. It can be used quite easily to trigger if we aren't paying attention to our internal needs. 

[00:09:30] Think of a parent reminding their child over and over and over again to take out the trash, to do their laundry, to do their homework. It's not meant to be a threat, but it's repetitive because until the action is done, it continues to necessitate reminders to acquire the child's attention, to act on it.

[00:09:53] Similar to retraumatization responses, body memories increase our [00:10:00] perception of painful stimuli. Why? So that we hopefully take a specific action or series of actions to adjust course, or else. The "or else" isn't necessarily physical collapse, but perhaps continued suffering, stagnation, or a perpetuation of cycles that are not serving us.

[00:10:25] So what are some of the potential messaging that pain may be trying to inform? Some common categories fall into the following, not establishing or maintaining boundaries. This applies to people pleasing or feeling taken advantage of in a situation or a relationship. Your body may be saying, "Enough!, you need to protect your space and your energy."

[00:10:57] Another example is not living [00:11:00] authentically to our core values in various life domains. This could be financially, spiritually, relational, creatively or energetically. Are you showing up as your true self or are you compromising vital parts of who you are? A third example is overwhelm or pushing through fatigue states.

[00:11:23] This includes physical fatigue as well as mental, emotional, or cognitive fatigue. This particularly applies to people who are overly self-critical, high achievers, or who practice self-sabotage behavioral patterns in order to reach an arbitrary measure of success. Your body might be calling for rest. Not just physical, but mental and emotional rest to recover and find respite from the relentless [00:12:00] pursuit. So how do we identify if our pain is there as a warning or an intention grabber? The answer is do the same thing we do when we hear an alarm. We don't instantly jump to panic. First we identify the source of the sound. Then we logically name and label the sound. So we're adding identifiers, which require access to language.

[00:12:33] What this does is that it helps increase prefrontal cortex input, which then applies logic and rational thinking. This counters the reactive measures and actions of our limbic system, which primarily aims to help us survive, and that's all. Next, try to apply context to the sound.

[00:12:59] Ask: [00:13:00] "why now? Did I do something physically now or in the recent past that would explain my current pain? Was there a recent non-physical context such as a social context or emotional distress that seems to always increase my pain in one or more areas. Have I been dealing with more stress? Have I enabled overstimulation and pervasive invasion of my mind's real estate by browsing endlessly on social media, or listening to the divisiveness and devastation that is ever present on the news?

[00:13:40] Have I been paying attention to self-care, self introspection, diet, nutrition, physical activity, and the quality of my sleep? Am I utilizing my physical and non-physical energy [00:14:00] capacity efficiently and effectively?" These questions help us to create pause. To recognize and normalize all sensations as inherently neutral, not automatically negative or positive for that matter, but filed in A "TBD" to be determined folder until it can be filed appropriately.

[00:14:26] This makes us more accurate with interpreting our pain sensations and deciphering the meaning into a general category of warning versus attention seeking and then further subcategorizing them under a spectrum of threat intensity, or the specific area of our life that we need to pay attention to right away.

[00:14:52] It's about learning to trust your body, not just to warn you of danger, but to guide you [00:15:00] towards deeper self-awareness. It's like learning to distinguish between the fire alarm, such that is present in acute injury, and the oven timer, which is telling you it's time to check your internal balance. Notice what we tend to change within ourselves internally and externally when we experience pain. Do we tend to allow ourselves to finally rest, take time for ourselves, create more firm boundaries, energy and space for ourselves. Or does it perhaps unlock access to previously unattainable care, concern, love, and attention that we craved? What are the first things we cancel or plans that change when we have a headache, fatigue or back pain? Those are typically the low hanging [00:16:00] fruit signalers of what has been most distressing for us, and that which required an immediate pivot in our lives to establish and sustain respite and relief to establish and sustain respite and relief from an inner struggle and pent up tension that has manifested itself in the form of pain.

[00:16:25] Pain can give us the reasoning, the valid excuse, and way out of difficult situations and open up more space for caring for ourselves in whatever way we need to, without concern or worry about judgment or determination of self-worth based on others' reactions.

[00:16:46] It gives us permission to prioritize ourselves. So what are your personalized, actionable steps for this week? L isten to your alarm clock, identify a recurring [00:17:00] pain sensation you experience. Instead of immediately labeling it as a warning, try reframing it as an attention grabber. What might your body be trying to tell you about your unmet needs, boundaries, or authenticity?

[00:17:17] Become a detective of context. When pain arises, use the contextual questions we discussed. Pause. Engage your prefrontal cortex and ask, "why now? What non-physical stressors are present? Am I neglecting self-care?" Honor the pause. Practice filing new sensations into that "TBD" folder. 

[00:17:46] Resist the urge to immediately categorize them as bad or negative. Allow yourself to observe them neutrally before attaching meaning. This builds a more [00:18:00] accurate and trusting relationship with your body's signals. This episode was a deep dive into shifting our perspective on pain, moving beyond the sole focus on danger to embracing its role as a profound communicator. We've explored how chronic pain, particularly neuroplastic pain, often acts like an internal alarm clock, not to signal immediate physical threat, but t o draw our attention to unaddressed needs, boundary challenges, or misalignment with our core values.

[00:18:35] By distinguishing between a smoke alarm and an alarm clock response, we can empower ourselves to listen more accurately to our body's messages, engage our rational mind, and cultivate a deeper, more trusting relationship with our innate wisdom. The ultimate take home point is this: your pain [00:19:00] might not be your enemy.

[00:19:03] It might be your most insistent and necessary messenger. Until next time, my advice to you is: Protect the sacred mind-body connection, reflect on the lessons you've learned, and share your newfound wisdom with another person who needs to hear it, and I'll see you next time.

[00:19:22] Thank you very much.