Day 3: Identifying the Source Over the past couple of days, we've talked about how and why neural pathway pain develops. This begs the question - how do you know if you have it? Not all chronic pain is caused by learned neural pathways in the brain. Some people have structural issues that need to be addressed medically. Often though, structural abnormalities in the body are incidental, and not the source of physical symptoms. For example, 64% of people with no back pain have disc bulges or herniations. 61% of middle aged-adults with no knee pain have meniscal tears. Wear and tear is a normal part of life. Don't Guess. Assess. I’ve done many intakes with pain patients, and one of the first things I do is assess whether their symptoms are likely to be structurally caused or due to learned neural pathways. These are some of the questions I ask: Do you have multiple symptoms? Do you have a history of anxiety? Did the pain come on during a stressful time in your life? Was there an initial injury or did the pain come out of nowhere? Are the symptoms inconsistent? What other diagnoses have you been given? Here’s an assessment I did with a woman at the 2017 Pain Conference. We were able to help her determine that she has neural pathway pain despite having been diagnosed with disc bulges, scoliosis, spinal stenosis, and arthritis: So, do you have neural pathway pain? Probably. Chronic pain caused by neural pathways is more common than structurally-caused chronic pain. But it’s always important to be thorough. The best way to confirm that your pain is not structural is to meet with a physician who specializes in identifying and diagnosing neural pathway pain. Here’s a list of doctors state by state who have this specialty: http://www.tmswiki.org/ppd/Find_a_TMS_Doctor_or_Therapist (Find a TMS Doctor or Therapist) The Belief Paradox As we talked about yesterday, pain is a danger signal...and to overcome neural pathway pain, it's important to teach your brain that the pain you're feeling is not dangerous. But if you believe that there's something structurally wrong with you, it can be very hard to feel safe. How can you communicate a message of safety to your brain if you think you're causing physical damage every time you sit, or walk, or type? Accepting that your pain is not structural is a key part of recovery. Here comes the paradox part: I’ve been telling you that the best way to eliminate your pain is to convince yourself that it’s not structural. The paradox is that the best way to convince yourself that your pain is not structural is to eliminate your pain. Once you’ve seen that your brain has power over your pain, it’s much easier to accept that it’s caused by neural pathways. This is a chicken-and-egg situation. But don’t worry, you can beat the paradox by taking small, incremental steps. The more evidence you get that you're structurally sound, the easier it is to believe, the more you believe, the easier it is to get evidence. It becomes a positive feedback loop. In tomorrow’s post, "Breaking the Pain Cycle," we'll take the first step down this path, by addressing the driving force behind neural pathway pain.