The essence of escaping from the grip of chronic pain is feeling safe. In this state your body is full of wonderful chemicals such as oxytocin (love/bonding drug), serotonin (antidepressant), GABA hormones (anti-anxiety) and dopamine (rewards). This scenario not only creates a deep sense of well-being, it is healing. Connecting to your own capacity to heal allows you to regulate your body’s chemistry to maintain a favorable environment.

Anxiety and anger are measures of the levels of your body’s survival hormones. The source of the mental or physical threat doesn’t matter. With prolonged exposure to elevated levels of these chemicals, people get sick. It has been documented for over 50 years that people dealing with chronic stress become seriously ill much at too young of an age. (1,2,3)

There is research showing that cultivating optimism, having a sense of purpose, and feeling hopeful has the opposite effect with a decrease in pain with improvement in mood and function. (4) One paper had participants visualizing their best self for five minutes a day for two weeks with significant improvement in all of these variables. (5) Your brain will develop where you place your attention. It is also the reason that never discussing your pain, giving unasked for advice, being critical, or complaining is so important.

 

 

Play

We discovered in our workshops that shared play is a powerful force allowing participants to escape from their chronic pain. It frequently happened quickly after people began to relax, let go and laugh. I was initially perplexed how this was even possible and it happened in every workshop. I now realize there was a shift from threat to play chemicals and also a re-awakening of that part of the brain. Re-programming your brain off the embedded pain circuits through stimulating neuroplastic changes in the brain through repetition, is the basis for much of the DOC process. But a much faster change can occur by shifting on to pre-existing play circuits. Everyone has them. That is how your brain initially develops and consciousness evolving from language and play is the core step. All mammals have play as a part of their development. They may be deeply buried but your play circuits are in there. (6)

As you use your play part of your brain more and spend less time on your pain, your brain will physically change. In chronic pain, your brain physically shrinks and fortunately re-expands with healing. (7) Any skill that is not nurtured will fade but can be re-awakened.

I used to play trumpet in high school

An example of how this works is to consider a skill you had in middle or high school. Without repetition, it has faded but the memory is still there. I played trumpet in high school and some in college. I could still play reasonably well through medical school and it all disappeared in the midst of the rigors of residencies and fellowships. I recently picked it back up and although I have no lip strength or dexterity, I still remember the basic techniques and hope to re-connect with them quickly. It is doable, whereas if I were to try to learn a completely new instrument, it would take much longer.

My wife started playing the guitar again after a 30-year hiatus and within a few weeks was able to finger-pick like the old days and begin to move forward. One day, it just hit her. Your play circuits are still there waiting to be re-vitalized.

A deliberate decision

Many years ago, I was pondering my own journey out of pain and considering some additional approaches. It hit me that the words, “work” and “play” are somewhat arbitrary. I has realized that my vacations were spend just trying to recover from the rigors of work and I didn’t have the energy to fully engage in enjoying myself. It was clear that much of the problem was how I viewed work and my strong reactions dealing with the challenges of being a spine surgeon. I made a decision that I would work on removing these labels from my life.

 

 

First of all, I loved my work and spent most of my waking hours doing it. Why call it work? Then I decided to just enjoy the whole experience. My whole team relaxed. I enjoyed my patients, fellows and colleagues more. We had a lot of fun to the point we would have to work on toning it all down in clinic. Finally, one of my mentors pointed out that challenges are an opportunity to practice your stress-coping skills and part of any endeavor. I began to embrace them head on and my reactions to the daily stresses dropped dramatically and I had more energy to engage with the day. I could write a book on the number of changes that occurred in my life with that simple paradigm shift.

I am not talking about obsessive play to distract yourself from your pain. I tried that for several decades. You can’t outrun your mind. Rather, it is mindset of curiosity, using tools to remain calm when triggered, deep gratitude, listening and removing the judgement of the current experience as good or bad, etc. The result is a sense of contentment and peace. I could never find it while I was chasing it.

Moving forward

You cannot attain this state without first understanding pain and then letting go. Our workshops were successful because of the sequence of awareness, hope, forgiveness and play. How can you play if you are angry? You can only become less angry but you won’t experience that chemical shift. The DOC process offers a framework and sequence in order for you to discover your own pathway from pain to play.

 

References:

  1. Tennant F. The physiologic effects of pain on the endocrine system. Pain Ther. 2013;2(2):75-86.
  2. Torrance N, Elliott AM, Lee AJ, Smith BH. Severe chronic pain is associated with increased 10-year mortality: a cohort record linkage study. Eur J Pain. 2010;14(4):380-386.
  3. Rahe R, et al. “Social stress and illness onset.” J Psychosomatic Research (1964); 8: 35.
  4. Hausmann, LRM, et al. Reduction of bodily pain in response to an online positive activities intervention. Jrn of Pain (2014); 15: 560-567.
  5. Meevissen,YMC, et al. Become more optimistic by imagining a best possible self: Effects of a two week intervention. Jrn of Behavior Therapy and Experimental Psychiatry (2011); 42: 371-378.
  6. Brown, Stuart and Christopher Vaughan. Play: How it Shapes the Brain, Opens the Imagination, and Invigorates the Soul. Penguin Group, New York, NY, 2009.
  7. Seminowicz, David A., et al. “Effective Treatment of Chronic Low Back Pain in Humans Reverses Abnormal Brain Anatomy and Function.” The Journal of Neuroscience (2011); 31: 7540-7550.