Do you have chronic pain or symptoms that have not responded to conventional treatment?

PainOutsidetheBox aims at providing education and support to those individuals who have experienced chronic pain symptoms for over 4 months and who have been unable to find permanent pain relief via the usual ways.

It is for those who feel that their symptoms do not make sense, who have tried to treat their condition in multiple ways already with limited success, and who would now like to explore and treat the true cause of chronic pain.

MY APPROACH STARTS WITH EDUCATION FIRST

ONLY WHEN YOU UNDERSTAND WHAT’S HAPPENING TO YOU WILL YOU BE ABLE TO CHANGE THE OUTCOME

close to 90% of chronic pain sufferers have neuroplastic pain…

Neuroplastic pain, also known as primary pain, is pain that has developed due to changes in neural circuits within the brain.

According to a recent study by Schubiner et. al, “of the 222 back/neck pain physiatry patients evaluated, 88.3% were diagnosed with primary pain” (The Journal of Pain, 2024).

Neuroplastic pain can intensify and persist indefinitely unless the root causes are addressed and changed. This is why so many people often report that their symptoms have become ‘chronic’ or incurable - it’s because the underlying mechanisms that are fuelling symptoms are never truly addressed.

In order to understand why this happens, we need to understand how our brain and nervous system work.

The Fundamental Link between Chronic Pain and the Brain

Our subconscious part of the brain is responsible for a myriad of bodily functions, from breathing to blinking and digesting food.

As we go about our day to day lives, we never stop to think on how to walk, or when to blink - all this and many other functions are taken care of by our subconscious.

The brain communicates with the autonomic nervous system through the spinal cord, in order to help us react in the best possible ways to the circumstances we find ourselves in. For instance, if we detect a threat in our environment, the brain detects that threat and mobilizes the body for fight or flight. To achieve this, it fires specific hormones (such as cortisol and adrenaline) and suppresses other functions (e.g. digestion, which can slow us down and prevent us from dealing effectively with the said threat).

In other words, the brain is on our side, and its main function is to keep us alive.

How chronic stress and trauma alter the brain and create neuroplastic symptoms

Certain responses to events or stressors are automatic responses, and if they are particularly distressing or impactful, they may cause the brain to adapt and respond in certain ways.

For example, if we have a traumatic experience getting stuck inside an elevator, we might have panic attacks each time we find ourselves in a closed space.

In some cases, the brain can create pain or other symptoms to warn us of a perceived threat.

The process happens unconsciously, and often has to do with the same survival adaptation that happens after a distressing experience.

For instance, if a schoolkid doesn’t like his teacher, he may develop chronic stomach pain or IBS symptoms - which could be his ‘ticket’ out of school.

The problem is that today, many of us live in ‘survival mode’. That means that our bodies are on very high alert for threats - some of them real, some perceived.

Moreover, as we grow older, we adopt similar habits and patterns. We carry around the same fears and anxieties, and the brain becomes very adept at responding in the same old ways to these emotional responses.

Are you saying my symptoms are in my head?

Not at all. These ‘survival adaptations’ created by the brain produce very real physical changes in the body. In response to a distressing experience we may start generating different chemicals and producing different physiological responses.

Here’s a simple example. Do you remember a time when you experienced a shock? Do you remember how your heart started to race, and perhaps your legs and arms started to tremble? You may even have had digestive problems that day…

What happened back then was that your emotion (the shock) was creating very real physical changes in the body to help you deal with the situation.

Now imagine, you keep re-experiencing the same emotional triggers in your day to day life. Maybe you're constantly worried about something happening, OR you’ve just had a distressing experience or a transition in your life (even a ‘positive’ transition like marraige or having a baby can cause symptoms, because a part of our brain actually hates change!).

The body will respond to the emotional toll that these experiences take in you. And if the emotions are repeated, day in day out, then the symptoms can become conditioned in the body.

What happens in the case of Chronic Pain?

The brain can also be responsible for the generation of chronic pain long after an injury has healed, or even in the absence of injury or infection.

In layman’s terms, pain persists after tissue healing, due to the fact that the body’s alarm system remains activated, and are stimulated by a much lower intensity of stimulus”

Physiopedia, Pain Neuroscience Education

This happens because our experience of pain is ‘filtered’ through our brain through our emotions, memories and expectations.

But the good news is that everyone can learn how to process pain differently.

In recent years, research on Pain Neuroscience in complementing the TMS approach, and Practitioners and Consultants like myself are combining it with additional tools to fastrack recovery.

One of these tools is called Pain Reprocessing Therapy, and involves working with the brain’s neuroplasticity (the brain’s ability to form new neural connections).

The Science behind Neuroplastic Symptoms

The links between trauma, depression, catastrophic thinking patterns and the likelihood of developing chronic pain, especially in adulthood, have been reported in several research studies.

Perhaps the most famous Research involves the links between Adverse Childhood Events and chronic pain (Sachs-Ericsson NJ et. al, 2017, Lydia V. Tidmarsh 2022, & others), which proves that there is an increased predisposition to chronic pain conditions (including fibromyalgia), in those who underwent significant trauma in childhood, such as abandonment, severe criticism, loss, emotional or physical abuse.

Despite all of this, Doctor of Rehabilitation Medicine Dr John E. Sarno was one of the first main proponents who insisted that the majority of chronic pain conditions were linked to chronic stress and emotional repression and who proposed a more specific treatment for neuroplastic pain. Sarno’s proposed treatment was based on accepting the Psychological dimension to pain and learning how to stop fearing symptoms by resuming physical activity and / or a more normal lifestyle.

Sarno’s 1987 survey focused on 109 patients who experienced back pain and reported 88% of patients as being pain free after treatment. His peers and followers have conducted serveral research studies since then to prove his theories, with incredible success.

A 2021 clinical Trial found that Pain Reprocessing has been the most effective tool in treating chronic low back pain, with far higher success rates compared to the Placebo group and a group undergoing conventional treatment (Yoni K. Ashar, Alan Gordon & Howard Schubiner, Jama Psychiatry).

Another recent initiative involved a trial whereby Physician-scientists from Beth Israel Deaconess Medical Center (BIDMC) developed a 12-week mind-body program for chronic pain, which they called “Psychophysiologic Symptom Relief Therapy (PSRT)”. The program had far higher success rates than conventional treatment:

”The PSRT group was superior to both usual care and MBSR for the primary endpoint of pain disability at every time interval and at the end of the 6-month monitoring period. Moreover, at the end of the 6-month period, 64 percent of patients with chronic back pain in the PSRT group were completely pain free (reporting 0 out 10 on a pain scale) whereas only 25 percent and 17 percent reported being pain free in the mindfulness and usual care arms, respectively.” (See Source).

This is not the only research that looked into the links between emotional factors and chronic conditions.

For years, research and case studies in Neuroscience, Psychiatry, Pain Management and other branches have linked factors like depression, trauma and chronic stress to a variety of chronic problems, including fibromyalgia, CFS and CRPS.

Through before and after MRIs, it has been proven that there are actual physical changes taking place in specific brain regions that are linked to increased pain levels in individuals. These same brain regions become less activated after the same individual undergoes a mindbody approach (see Casey’s case study in Practical Pain Management)

In short, the evidence is out there, and the more you look, the more evident it will become.

But up until lately, there hasn’t been a unified approach that is easy for the average individual to understand and - most importantly - implement in his or her day to day life.

Because, let’s face it, what’s the use knowing that your trauma or depression has led to chronic symptoms, when you don’t know what to do about it, and when the symptoms scare you so much that they’ve practically become your new ‘trauma’?

Why didn’t my doctors tell me about the TMS / Neuroplastic approach to chronic symptoms?

Unfortunately, psychology and medicine are still very separate these days.
Doctors are trained to treat the symptoms, and most often do not have the time or the education background to effectively ask you what was going on in your life around the time when your symptoms developed.

You may have been told that stress plays a part - but they never tell you how huge a part one’s emotional state plays, and what to do about it.

And it’s not simply ‘stress’ as you may think of it. There are usually more far-reaching factors involved in the generation of chronic symptoms, some of them beyond our conscious awareness.

Just because you have never heard of TMS, or your doctor has never told you that the pain could be psychosomatic, it doesn’t mean that it isn’t.

In fact, most chronic pain conditions have a psychogenic component. The sooner you accept this, the faster you will recover.

How do I know if the MindBody / TMS approach is for me?

Start by asking yourself the following questions:

• Does your pain tend to change location and intensity?

• Is your pain worse at certain times of the day?

• Have you had other chronic or recurring symptoms in your life? These can include chronic pain in other locations as well as other conditions like chronic anxiety, IBS, eczema, sinus problems, or anything which has been diagnosed with the fatal word ‘chronic’.

• Have you already tried the following without long-lasting success: Pain killers, anti-inflammatories, physical therapy, massage, steroid injections, ergonomic furniture, chiropractic care, diet changes?

• Do you experience the same pain at both sides of the body (for example both knees)?

• Do you experience different pain symptoms in unrelated parts of the body?

• Do you identify with of the following personalities? perfectionist, ambitious, catastrophic, people-pleaser (goodist), stoic (you hold in your emotions), legalist (you think you’re always right?), sensitive

• Have professionals told you that there is nothing else you can do from a medical perspective, apart from surgery perhaps?

• Are you willing to accept the possibility that you can get better, no matter what people have told you?

If you’ve answered Yes to at least 3 of the above questions, then there’s a very good chance that I may be able to help you.

For a more detailed Self-Assessment, please check out the TMS Questionnaire here.

Ready for the next step? Find out if I can help you

Who it is NOT for

My services and online programs are not for you if:

• you’ve had a severe injury in the past 6 months and are still doing physical therapy.

• you have been diagnosed with an infection or cancer

• you have NOT ruled out infection or cancer

Who are you?

To benefit from my services, you need to be:

• Willing to explore the role of emotions and habitual behaviour in relation to chronic pain.

• Committed to take responsibility for your own health by educating yourself and working on your self-awareness.

• Ready to work on changing habits and behaviours that may be affecting you negatively.

• Able to ‘think outside the box’ and form your own independent mindset.

• Open to the possibility that your pain will not last forever.

• Ready to stop believing that you’re the victim, that you’re unlucky and that your body is broken!

What’s next?

There are several options available to you if you’d like to start working on TMS/chronic pain recovery. The most important factor is that you educate yourself as much as possible on how these kind of symptoms can develop and why they become chronic.

This will help you identify what may have led to your symptoms and what is keeping them alive.

Next, you’ll have to work with some mindset shifts, and on building a couple of new habits.

Here are a few options I invite you to check out: