www.midmichigan.org Articles, tips and recipes for healthy living by MidMichigan Health HOME HEALTHY LIVING HEART HEALTH ORTHOPEDICS BEHAVIORAL HEALTH CANCER CARE WOMEN’S HEALTH Fear, Pain and Joy Posted by MidMichigan Health on October 18, 2021. There is a famous example of the fear, pain and joy concept told by Howard Schubiner, M.D., a leading pain researcher, of a construction worker who stepped on a nail that went through the sole of his boot and came out the top of the boot. Upon seeing the nail emerge through the top of his boot, the man began to scream in pain. He was taken to the emergency room, where he was given strong pain medication before they were able to get the boot off his foot. When they got the boot off his foot they discovered that the nail had gone between his toes and left no mark on his foot at all. So why did he experience pain? Because his brain was expecting it based on what he saw. That is the power of the brain – to create the sensation to protect the body from perceived danger. This is an example of the power of the brain to create pain based on fear and expectation. It neuro-circuits in the brain causing the pain responding to danger signals. Because the sensation of pain is one of the brain’s responses to danger signals, any experience that increases the potential of danger signals can increase the possibility of pain signals. Fear is one of those things that can increase the danger signal. For example, if a person has had an injury in their foot that resulted in pain while weight bearing, then they may, very understandably, fear bearing weight in the future. That fear will then turn on the danger signal in the brain and increase the likelihood of pain being experienced. It can become a vicious cycle. This type of pain is real pain, because all pain is real pain. Anyone who says “it’s all in your head” is being insensitive and judgmental. The truth is, all pain starts in our head, as a response to the danger alarm that says something is wrong. This danger alarm might be triggered from a structural injury to the body, or the fear of expecting pain, or the fear of social rejection, or the emotional pain of a traumatic memory, or anything that the alarm system perceives as a danger. This type of response is an unconscious response in the brain, not a choice that people make. One way to check to see if pain is related to the neuro-circuits is to use the imagination. If someone imagines doing the thing that has caused pain in the past and experiences pain or fear while imagining the movement or the situation, it is a good sign that it is learned neuro-circuits in the brain causing the pain. This is good news because the brain can be rewired. Once people know that their brain may be creating the sensation of pain, it can free them to change it. There are a number of ways a person can rewire the brain. One good way is to reduce the fear related to anticipating pain. Self-talk and affirmations can be used to reduce fear. Once a person knows that all or some of their pain is neuro-circuit pain, and that it is not structural damage, they can say to themselves “I am strong and healthy. There is nothing wrong with this part of my body. I am okay. I am safe. There is no danger.” This can help turn off the danger signal. In comparison, when a person says, “There is something wrong with me. I am damaged,” the alarm system is turned on, which will perpetuate the pain. It may sound simple, but for many people this is the beginning of changing the brain, rewiring neuro-circuits to stop the fear of pain, stop the tripping of the danger alarm, and break the cycle. But just like learning any new skill, which all involved making neuro-circuit connections, it can take time and rehearsal. This rewiring can become even more powerful when combined with other tools to rewire the brain. Another tool is the use of deep breaths, which lets the danger alarm know that things are okay. Another tool is the use of laughter and humor. Participating in mindfulness, playfulness and joy can also rewire the brain to turn off the fear signals. Participating in any of these activities, or even imagining these things, during the previously feared movement or situation can help rewire the brain. For more information on this, Dr. Schubiner has created a series of easy-to-understand animated video beginning with “What is pain.” For those who need more intense treatment for mental health conditions, MidMichigan Health provides an intensive outpatient program called Psychiatric Partial Hospitalization Program at MidMichigan Medical Center – Gratiot. Those interested in more information about the PHP program may call (989) 466-3253. Those interested in more information on MidMichigan’s comprehensive behavioral health programs may visit www.midmichigan.org/mentalhealth. 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