OVERCOMING

CHRONIC PAIN

KSENIA CHOATE
 TIMELINE
Age 6-16: occasional headache every now and again
Age 16-18: several times a week
Age 18-25: 1x daily
Age 25-35: 2x daily
Age 35-now: 3x daily
 10/10
Giving birth to a stuck baby without anesthesia
9/10
Headache
ACCOMPANYING SYMPTOMS
Sensitivity to light, noise, smells, and touch
Loss of appetite
Pain behind eyes
Inability to sit still, need to pace during attack
Runny nose
Swelling in eyelids
Increased breathing and heart rate
Shaky hands
General weakness
Irritability
Teary eyes
Difficulty thinking, concentrating, and speaking
Sensitivity to motion (moving head, moving around)
Feeling cold
Feeling sleepy
Tingling in hands
 TRIGGERS
Anxiety/stress
Eating too much/feeling too full
Being hungry
Not getting enough sleep
Oversleeping
Eating hard foods (e.g., nuts)
Physical exercise
Leaning head against walls
Shopping
Driving
Flying
Being outside during certain time of day
 ATTEMPTED REMEDIES
Meditation
Deep breathing
Drinking a lot of water
Caffeine
Changing diet (eliminating sugar/grains/meat/dairy/caffeine/chocolate)
Therapy (multiple psychologists)
Physical therapy (two different clinics)
Massage therapy
“Alternative methods”
Medications
Treating other chronic conditions
Standing desk
MRI to rule out tumors (2x)
Acupuncture
Chiropractor
 SPECIALISTS

Acupuncturist
Chiropractor
Dietitian
Physician/general practitioner
Physical therapists
Massage therapist
Headache specialist (neurologist)
U of U Orthopaedic Center
 MEDICATIONS

Muscle relaxants
Antidepressants
Anti-anxiety
Anti-migraine (long-term and “rescue”)
Anti-seizure
Over-the-counter painkillers
 IBUPROFEN: DRUG OF CHOICE

This medicine may cause the following problems:

Bleeding and ulcers in the stomach or intestines

Higher risk of heart attack or stroke
Liver damage
Kidney damage
Vision problems

Source: U.S. National Library of Medicine - Ibuprofen Consumer Information

WHAT’S THE POINT OF ALL THIS PERSONAL INFORMATION?

To illustrate that my condition wasn’t trivial and that even severe cases can be
helped. There is hope.
 WHY WE HAVE PAIN

Pain doesn’t always mean that something is physically wrong with our body.
IMPROVEMENTS IN PHYSICAL CONDITION VS PAIN
TEDX: WHY THINGS HURT
BOTOX INJECTIONS
https://techcrunch.com/2017/10/08/curing-the-incurable/
CURABLE
 IDEA BEHIND CURABLE

Our brains become trained to feel regular pain

to avoid emotional discomfort and/or

because we expect to be in pain due to previous experiences.

Brains can be “un-trained” and these harmful patterns interrupted resulting in

successful pain management.
 IS IT ALL IN MY HEAD?

Image credit
SCIENTIFIC ADVISORY TEAM
 WHO ELSE IS IN?

My neurologist, yay!
 CURABLE

Four-prong approach:

1. Education
2. Brain training
3. Expressive writing
4. Meditation
 ROAD TO NEURAL PATHWAY PAIN
1. Fear of various aspects of life (emotions, intimacy, confrontation, exercise, certain foods,
people, objects, etc.) caused by events, traumas, sensitive nature of the person, etc.
2. Hypervigilance (the state of being constantly on the lookout for pain and its triggers)
3. Panic
4. Neural pathway pain (pain caused by the brain)
5. Feeling pain reinforces the idea that the triggers are the cause of pain
6. Cycle of pain is created
BREAKING THE CYCLE OF NEURAL PATHWAY PAIN

1. Fear: things we fear are, in fact, harmless

2. Hypervigilance: pain is not inevitable, and we don’t have to have it or expect it
3. Panic: stay calm, everything is okay
4. Neural pathway pain: episodes get lighter and shorter
5. Not feeling pain following old triggers reinforces the idea that the triggers were NOT the
cause of pain
6. Cycle of pain is broken
 ?/10
Giving birth to a stuck baby without anesthesia
 BRAIN AND PAIN

Based on … what we call environmental context, your brain has the capacity to
turn up or turn down pain, sometimes quite dramatically.

- Tor Wager, PhD, Neuroscientist and Director of the Cognitive and Affective Neuroscience Lab at CU
Boulder
 BRAIN AND PAIN
When people have injuries that lead to chronic pain, one of the ideas is that
people can have this response where they are really frightened and really
worried about it. They go, “What does this mean? … This means something is
really wrong with my back. I'm going to be disabled. I don't know why this is
happening.” What they really need is some way of making sense of that.

There are multiple different kinds of cognitive therapies that have a core
element where the idea of what you have to do is accept the pain and say “Ok,
well this hurts, it's just pain" and it's not so important.

- Tor Wager, PhD, Neuroscientist and Director of the Cognitive and Affective Neuroscience Lab at CU
Boulder
 BRAIN AND PAIN
So you have something, you have an injury that hurts, you stop doing things, …
you start avoiding things that are associated with pain, things that make it hurt.
Maybe there's social activities, maybe there are physical activities. Those things
in themselves are beneficial and you’ve taken those things away and now you
are focusing on the pain signals again more and more over time. And so the
pain becomes more and more disabling.

- Tor Wager, PhD, Neuroscientist and Director of the Cognitive and Affective Neuroscience Lab at CU
Boulder
 BRAIN AND PAIN
One of the goals of multiple kinds of therapy that can really work for people is to kind of
unwind this negative spiral of avoidance of avoiding more and more stuff. That has physical
effects and it has effects on your brain. ...

The kinds of things you habitually pay attention to and think become stamped in with time. So if
you have a back injury and there is a lot of fear of doing things and moving, this is very natural,
but it will elicit some pain and elicit some fear and the more it happens the more your brain
wires to do that more easily and do that more automatically. It also wires to attend to the pain,
so over time you become hyper-vigilant to those signals. And now this doesn't mean it's your
fault if you are a patient. This is a natural process, you know, the things you do become more
and more automatic overtime, including thoughts. So one that is helpful for many people is to
try to unwind that and replace those thoughts with other more beneficial thoughts and replace
avoidance with engagement.

- Tor Wager, PhD, Neuroscientist and Director of the Cognitive and Affective Neuroscience Lab at CU
Boulder
 BRAIN AND PAIN
People get better. That’s why I do this work, … We know by looking at the people around us that
people can get better. Some people get better quickly, and some people get better more
slowly, but I’m absolutely convinced that chronic pain and chronic symptoms can better by
paying attention to our thoughts and our emotions and our psychology. Even for people who
are struggling and struggling and struggling, it doesn’t mean that they’re not going to get
better. Oftentimes, it’s just that they need to do a little bit more work, they need to take these
tools and employ them a little bit more. But I’m absolutely convinced that a huge percentage of
the population who’s struggling with chronic symptoms can get better by treating it this way.

- John Stracks, MD, Integrative Family Physician, Assistant Clinical Professor of Family Medicine at
Northwestern University in Chicago.
 BRAIN AND PAIN
Fibromyalgia is chronic widespread pain. ... It's fascinating, because frequently, the pain will shift
from place to place in the body. Obviously, a structural problem doesn't shift from place to
place ... if your arm's broken, it doesn't shift to your other arm. Fibromyalgia pain does, which of
course, bespeaks a neural pathway disorder, where the brain is pulling the strings and
controlling this pain - turning it on and off, on and off in different places.

- Howard Schubiner, MD, Internal medicine specialist and director of the Mind Body Medicine
Program at Providence Hospital in Southfield, Michigan. Clinical Professor at Michigan State
University's College of Human Medicine.
 100% PAIN-FREE?

It depends.

I am not 100% pain-free, but the intensity and duration of the episodes have
diminished dramatically. I have not taken any painkillers for the last 2.5 months.
I have pain-free days. I believe it will only get better. And even if I stay at the
current level for the rest of my life, I will consider it a success.

.
OTHER CONDITIONS THAT CAN BE HELPED
Irritable bowel syndrome
Nausea/vomiting
Anxiety
Depression
Muscle spasms
Rashes
Tremors
Food/sound/light/chemical sensitivities
Chronic itchiness
Chronic fatigue
Vertigo
Dizziness
Vision problems
Tingling in extremities
 STARTING THE JOURNEY
Rule out structural problems and address them if you have them.

Start working with the program regardless of whether you have them because even if
you do, your brain might be sabotaging you by convincing you that you should be in pain
(remember the chart “Improvements in physical condition vs pain”).

Remember that even if there is a structural issue, the amount of pain you are
experiencing may not be proportional to the degree of physical damage.

Remember that this process is a journey, not a quick jump from point A to point B.

If you are not convinced and need to know about all the existing scientific evidence,
check out resources, such as those at the end of this slide deck.
 RESOURCES
● Curable program/app: https://www.curablehealth.com
● Like Mind Like Body (the Curable podcast): https://www.curablehealth.com/podcast
● Curable Community on Facebook (for Curable subscribers)
● The impact of psychological factors on recovery from injury: a multicentre cohort study:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5504249/
● Co-occurrence of posttraumatic stress symptoms, pain, and disability 12 months after traumatic
injury: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5777683/
● How Trauma And Abuse Affects Chronic Pain:
https://www.anxiety.org/effects-of-trauma-psychological-factors-on-chronic-pain
● The Experience of Chronic Pain and PTSD: A Guide for Health Care Providers:
https://www.ptsd.va.gov/professional/co-occurring/chronic-pain-ptsd-providers.asp
● The Connections Between Emotional Stress, Trauma and Physical Pain:
https://www.psychologytoday.com/us/blog/somatic-psychology/201004/the-connections-b
etween-emotional-stress-trauma-and-physical-pain