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Hi Everyone,

I thought I'd post this in case it might help anyone. It's a blog posting from Dr Batson's website at https://aliciabatsonmd.com/17-steps-to-healing-chronic-pain/ (17 Steps to Healing Chronic Pain -)

17 Steps to Healing Chronic Pain
Psychophysiologic Disorders (PPD or TMS) occur when the mind, under severe internal emotional stress, causes real symptoms in the body to the point that the symptoms begin to interfere with one’s ability to lead a normal life.

The main neural pathway between your mind (i.e. thoughts and emotions) and the experience of pain is the sympathetic nervous system (SNS) which is the fear response system in your brain and body. The road to healing is built on turning off the chronic activation of the sympathetic nervous system.

Recently, a colleague asked me how I ultimately turned off my sympathetic nervous system which prompted me to write it down. Below is my memory of the steps that were most important in my own healing and the tools I used to arrive at a place of security and peace – to arrive back at my Self.

1. Acceptance of the Diagnosis – not tentatively, but hook, line and sinker. This was not difficult for me because after all I had been through, it was a huge comfort for me to know that my body wasn’t broken after all; that with knowledge, diligence and patience, I had the power to heal myself. I couldn’t wait to get started. It was now just a matter of time.

2. Guidance from a PPD/TMS trained psychotherapist – what a relief it was to not have to explain to someone everything I was going through for the millionth time. My therapist had already been there, done that, knew it backwards and forwards. I was in safe hands.

3. Full belief that the body is designed to heal – even the brain – and when steeped in a nurturing and healing environment, does. While medical researchers used to believe that the brain could not heal, the paradigm has taken a big swing in the last few decades. This is called neuroplasticity and it is a well known and accepted concept in medicine now. With the help of our immune system, the body also heals after being injured. Even the largest bone in our body, the femur, only takes 6 weeks to heal following a fracture. Bones, muscles, ligaments, tendons and nerves all heal.

4. Getting good quality sleep at all costs – even if that means taking sleep medication, buying an ambient sound machine, sleeping without your snoring partner, ditching the alarm clock, turning off your phone or changing your work hours. No one can function well without sleep and the body’s stress hormone and immune systems simply don’t work well when sleep-deprived. Getting good quality sleep is part of nurturing your body so it can heal.

5. Temporary avoidance of anxiety-provoking situations and people. For those with high levels of anxiety like I had, I think it is important to practice honoring your emotions until you have learned enough tools and techniques and gained enough confidence to able to affectively self-soothe in stressful situations. Ignoring my emotions and inner thoughts was how I had developed chronic pain to begin with, so learning to acknowledge and honor my emotions was part of the healing process. I had to relearn how to keep myself emotionally and physically safe, regain the confidence that I had the power to do that in stressful situations and then, gradually, practice leaning in. While you will learn to adapt to most stressful situations over time, there are some situations in which you may never feel safe, nor should you – an abusive spouse, a threatening boss. I still don’t go to see scary or violent movies (exception being a good James Bond film !!) – while I would be ok in the end, I would not enjoy activating my sensitized sympathetic nervous system to that degree, so why do it? In these extreme cases, separating yourself from the situation is the safest and kindest way to take care of yourself.

6. Repetition of my self-soothing mantra. When my anxiety would start to escalate, I would repeat, ”It’s going to be OK, either way.” Everyone has a comforting sentence that speaks to them – you have to find what it is for you and repeat it over and over. Whenever I would start to develop fear around a person, event or situation, I would repeat this and soothe my fearful brain until I began to calm down.

7. Surrounding myself with supportive, compassionate, loving people with whom I could be honest about what I was experiencing. This helped me to not feel ashamed for what was happening to me, to love myself in spite of my situation, to feel unconditionally loved by others and safe in the security of my chosen community.

8. The conceptualization of my chronic fear thoughts as nothing more than a brain habit. I would wake up with fear thoughts and go to bed with them. If I couldn’t think of something more or less relevant to my life to be afraid of, I would make up something completely imaginary. Understanding that these fear thoughts were nothing more than a bad brain habit left over from a life time of traumatic situations depersonalized them for me. I knew I could break a habit. I didn’t have to take these fears seriously. They were nothing more than my brain on auto-pilot. So, now when I feel irrational fears creeping up, I just say, “Ok, that is my brain trying to scare me – let it go – these fears don’t represent my reality.”

9. Stopping the self-pressure and self-critical thoughts. If you want to scare the fear centers in your brain, there is no better way than to give yourself daily messages that you aren’t working hard enough, aren’t smart enough, aren’t a good enough daughter, sister, friend, or even, community volunteer. You just aren’t saving the world fast enough !! Part of healing from PPD/TMS is learning to send positive messages of loving kindness to yourself with equal persistence and passion as you did the negative thoughts. Learn to treat yourself as you would treat a child or dear friend.

10. Stopping the people-pleasing behavior. Many of us with PPD/TMS have spent our lives “sending ourselves to the back of the line”, as Alan Gordon, LCSW, and Director of the Pain Psychology Center in LA says. We are forever setting aside our own needs so that others aren’t hurt, angry, inconvenienced or disappointed. We must learn to prioritize our physical, emotional and spiritual needs. Only when our own needs are met can we truly be present for others in a loving way without carrying a load of guilt, resentment and rage into the relationship.

11. Learning to think of my pain symptoms psychologically, instead of physically. For example, “My arms are starting to tingle and feel weak – what is going on with me emotionally right now? Oh right, I’m feeling pressed for time. I’m feeling afraid of getting behind in my tasks and was telling myself I was not good enough for the job and would ultimately get fired.” This mindful awareness of the psychological origin of your pain ultimately gives you the opportunity for a loving-kindness rescue, “Alicia, it’s going to be OK, either way. You bring a lot to your job including spending a lot of time with your patients. You are valued and appreciated for who you are and for the quality you bring to your work. It is Ok to proceed mindfully even if you are a little slow. What matters is doing the job well, not fast.”

12. Learning to identify, accept (and even welcome), and be honest with others about my scariest emotions. Emotional repression is a signal to your brain, that you will be in danger if a certain emotion is allowed to come to the surface – you will be rejected, you will be fired, you will be harmed. Welcoming your deepest, most painful emotions is a signal to your brain that you are whole and OK, just as you are. Feeling a scary emotion does not mean you will act out that emotion – few of us ever fall apart or become “The Incredible Hulk”, as Alan Gordon says. Once we learn to feel our emotions, we no longer have to act them out and project them onto others.

13. Practicing mindfulness throughout the day. Mindfulness is “a mental state achieved by focusing one’s awareness on the present moment, while calmly acknowledging and accepting one’s feelings, thoughts, and bodily sensations…” When mindfully present, the time is always NOW. Moving through your day mindfully allows you to respond to whatever arises without reactive fear and without being preoccupied in ruminative thoughts of the past and future.

14. Nurturing the relaxation response in my mind and body. Due to years of sympathetic nervous system activation, many of us don’t remember or may never have known what it feels like for the body to be fully relaxed. Incorporating a daily relaxation practice as part of our self-care routine teaches us to feel fully relaxed. Once we know what that feels like and practice it, we begin to more easily carry that feeling with us throughout our day. This practice is different for different people. What makes you feel relaxed might make me feel anxious. For you, it might be road biking, hiking, swimming or for that matter, racing cars. For me, making meditation and yoga a regular part of my life helps me to live more often in a state of peace and calm – which is the antithesis of PPD/TMS.

15. Seeking Joy. Many of us with PPD/TMS have lived lives of too many “should’s” and “have to’s”. We have forgotten what it feels like to feel truly joyous, happy, elated. We must learn to have fun again – just for the sake of it. This stimulants our parasympathetic nervous system and the other parts of our brain that directly block neural pain pathways.

16. Gratitude for my lived life, as it is. Going through this amazing PPD/TMS journey changed me – for the better. I am so much happier, more fulfilled, more joyous, more at peace, more effective than ever before. It is only in times of personal adversity and challenge that we grow and become stronger. I could only be who I am by having lived the life I have lived. It is perfect as it is. I may not always understand it or even like it, but I do believe it is perfect.

17. And last, forgiveness – of ourselves and others – it has taken a long while for me to begin to cautiously approach this point and I’m still working on it. I do feel it is the ultimate place of arrival for our complete healing. Appreciation for our common humanity and shared struggles can only lead us to forgiveness and a complete “letting go”. As my journey continues, there will always be more work to be done…….

I hope this helps you in your own healing journey.