The Psychosomatic Experience of Pain

Did you know that the origin of pain can begin in the brain rather than the body? I recently took a deep-dive into the science of pain in a two-day continuing medical education course led by Howard Schubiner, M.D. Dr. Schubiner directs the Mind-Body Medicine Program at Ascension Providence Hospital in Southfield, Michigan, and also serves as a clinical professor at Michigan State University College of Medicine.

The word nociception refers to the perception or sensation of pain. It involves processes that coordinate noxious stimuli from the peripheral and central nervous systems. The term is easily lost in all the technical jargon that has developed in the field of pain medicine. Personally, I was impressed with Dr. Schubiner’s ability to simplify issues in terms of diagnosis and treatment of chronic pain problems.

From Dr. Schubiner’s perspective, all pain is in the brain. The brain is the master processing center for all stimuli passing through the body and all the senses, including the feeling of pain. When we hit our finger with a hammer, we say our finger hurts. In fact, it is the processing of the stimuli in the brain that produces the interpretation, perception, or narrative that there is pain in the finger. Remarkably, there are stories of people who had nails through their fingers who perceived no pain at all, and other people who believed they had nails through body parts who experienced excruciating pain when in fact there was no structural assault.

Dr. Schubiner uses the term neuro circuit disorder (NCD) for situations in which the anticipation of pain has been encoded into the brain based upon past trauma. We can learn to turn off this type of pain. The circuit is like a defective smoke alarm that has become overly sensitive.

This fascinating perspective on pain rests on ancient philosophical notions that belief predicts perception. Because beliefs can be changed, there may be an opportunity for someone to "unlearn" their pain, just as the title of one of Dr. Schubiner’s books, Unlearn Your Pain, instructs.

According to Dr. Schubiner’s approach, the first phase of treatment for chronic pain is to determine which of three categories it best fits. The three causation categories are:

1. structural
2. neuro circuit disorder
3. a combination of structural and neuro circuit

He has developed protocols for testing to make a category determination. If the pain is inconsistent and there is no objective evidence of structural damage, it likely falls into the category of a neuro circuit disorder and has the potential of being abated through psychological interventions designed to retrain the brain. Fundamental to psychological intervention is fostering the feeling of safety, which fits nicely with the core principles in trauma-focused psychotherapy. The aim is to overcome a biological alarm system that has become overly sensitized to the perception of threat. For many chronic pain sufferers, utilizing psychological interventions is particularly helpful, especially if all available interventional medicine procedures have been explored.

Schubiner’s work is based on the mindfulness tradition and the highly successful work of physiatrist John E. Sarno, M.D. Sarno’s mind-body perspective drew heavily from psychodynamic concepts of emotional repression and the transfer of emotional pain into the somatic, physical level of the body. For example, if you are experiencing stress with a co-worker day after day, you might develop persistent pain in the neck.

Know that all pain is protective. Pain is created to warn us that something needs to be tended to in order to protect us and ensure our survival. If you do not feel able to express the emotions generated by dealing with a difficult co-worker, for instance, the body may bear the burden, creating tension in your neck and the perception of neck pain. If the neck pain is not experienced when you are not at work or not around your co-worker, you might be dealing with neuro circuit pain. This may mean you can learn techniques to "shut off" the circuit and thus experience less pain.

In my clinical training, I was taught to understand depression as something emotional that needed to be expressed. Anger, frustration, and sadness are often the prime, underexpressed emotional suspects leading to depression. It is the de-pression/ex-pression flip that is needed to lance the festering emotional wounds that can become stored, stuck, or manifested in the body as physical pain, and can lead to a psychological disorder or physical disease.

We too often carry stress and emotional trauma in our bodies that may manifest as a physical pain experience. Once the true source of our stress or trauma is identified and the emotions around it are expressed, our bodies may be able to physically let go of the tension.

It seems that the areas in the brain that process emotional pain are the same as the areas that process physical pain. It is an ancient axiom from medicine that when the mind is ill, the body is ill, and when the body is ill, the mind becomes ill.

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However, our psychological well-being need not be defined, confined, or limited by painful or debilitating physical conditions. Through self-awareness and the practice of mindfulness, we have the ability to utilize the immense power of our minds to manage and minimize our physical pain experiences. We can learn not to resist or be afraid of pain—we may, with time, even come to embrace our experience of pain as in the practice of Buddhism. We can then be in a better position to implement tools to better manage or overcome our somatic experience of pain.

Another important author who follows in Sarno’s footsteps is David Hanscom, M.D. His book Back in Control: A Surgeon’s Roadmap Out of Chronic Pain, offers an interesting perspective on severe pain conditions and the emotional connection. Increasingly in my practice, which specializes in car crash trauma, the importance of the psychological dimension of pain is being recognized by physiatrists and neurosurgeons, as evidenced by patient referrals for psychological evaluation and treatment.

The core of trauma therapy is creating a safe interpersonal space in which sources of stress and pain can be identified and processed with the aim of restoring a sense of psychological and physical safety. A big part of this is learning to relax the mind and the body, which involves turning off overly sensitive biological alarm reactions thought to be heavily mediated by the brain’s amygdala.

One book that offers a comprehensive understanding of the mind-body perspective on pain is Dr. Joe Dispenza’s You Are the Placebo. Dr. Dispenza talks about his personal victory over pain which began after a serious accident that left him facing major spinal surgery. He writes about the history of placebo in medicine and brain/body interactions and the importance of working on changing thoughts and beliefs.

Whenever I hear the word “placebo,” I think of what Herbert Benson, M.D., said about placebo being “remembered wellness.” Benson is a cardiologist and professor of mind-body medicine at Harvard Medical School who wrote The Relaxation Response (a term he coined). Benson worked in the same laboratory at Harvard that was once occupied by the famous physiologist who discovered the fight-or-flight response.

Important takeaways from this discussion for coping with or overcoming chronic pain are the importance of calming the mind, relaxing the body, practicing self-care, and learning to feel safe again after surviving an intense, emotional, or traumatic assault to the heart, mind, or body. Humans typically aim to exist in states of joy, happiness, and love. Trauma can rob us of these most basic experiences. However, we can learn to unlearn the lingering toxic effects that often form ghosts in our brains and that may create experiences of pain in our bodies.