I read through the Pain Psychology Center website and I read your description. It said that you had experienced chronic pain. Can you explain what that experience was like?

When I was 11 I started having chronic migraines. A lot of the women in my family have chronic migraines so we always knew it was a genetic or hormonal problem. It’s funny how it’s just the women in the family.

When my menstruation started it got a lot worse. From the age of 15 to 27, I’ve been on at least 15 different types of birth control to try to control the migraines and the pelvic floor pain that I had started to develop during cycles. And I was also diagnosed with chronic ovarian cysts. This ended up not being true. On top of that I have always had IBS issues and I’ve always had really bad neck pain as a result of chronic migraines.

My migraines would exacerbate at times and take me out for two weeks where I would be throwing up, feeling weak and dizzy, unable to see, and I couldn’t walk straight. 

Around the age of 18, I started experiencing chronic hives. I would break out in hives anytime I would get really stressed and it could be painful at times. It’s difficult having a symptom that you can see. I have experienced a wide variety of symptoms. It’s like this constant revolving door of chronic pain symptoms and I didn’t know that there was an avenue for neuroplastic pain until I finished my master’s program. When I finished my master’s program, I was definitely a type A person that fits the criteria for chronic pain. I was the president of the honor society, I was doing research projects, I was working full time, I was going to school full time, and I was on a PhD track. When I graduated, I decided to defer and take a break so I could figure out all of my body’s problems.

I’ve been diagnosed with a lot of different illnesses at different periods of my life, but it wasn’t until graduating that I decided to focus on my body and that’s when I discovered this work. I had worked with Alan (executive director of the Pain Psychology Center) in a casual sense, but then I had people recommending me for a position that he was hiring for. It was a staff clinician position at the Pain Psychology Center and I did get hired for this position. I learned how to apply this treatment to other people and myself. This brought up a lot of imposter syndrome.

 Where are you right now with your chronic pain? Do you still have it?

I have no symptoms at all. I’m completely off of birth control. I’m completely off of my migraine medications. The only symptom that I have popping up every now and then is that I get hives when I am stressed. Through this work I have learned how to lean into that and reduce my urgency when I start to feel the sensation of the hives coming up. That’s what tends to happen to people. You experience the sensation building up and you start thinking “I have a 12 hour work day. I can’t have this happening to my body. I don’t have time for this”. The reaction is so visceral. When I learned how to respond differently, it was a game changer for me. I have had many times when I’m trying to get through a day and I start panicking. I call Alan and he walks me through it and back to baseline.

Other than the hives, I don’t have anymore pain symptoms. I haven’t had a migraine in 3 years. I don’t have any pelvic floor pain. When I do get the hives, they’re manageable. The pain is a 2 out of 10 whereas before it was a 10 out of 10.

That’s amazing. Do you attribute your healing to what Alan has taught about neuroplasticity and Pain Reprocessing Therapy?

The thing with Pain Reprocessing Therapy is that we are unlearning these neural pathways and we are understanding what’s happening in the body. We go through psychoeducation, we try to make sense of what we’re experiencing, and we try to teach our brain that we are safe, but there’s a lot more behind this process. Some of us tend to lean towards perfectionism and we do things with a lot more urgency. We need to learn to slow down and have self-compassion towards ourselves. It’s about listening to our needs rather than trying to power through the pain. It’s about prioritizing soothing the nervous system on a primitive level.

 Can you define Pain Reprocessing Therapy and neuroplasticity?

Neuroplasticity comes down to neural pathways in the brain being formed. We are wired to associate physical pain with injury. Typically we don’t have the neural pathways that allow us to process pain as being safe.

There is a diagnosis called congenital insensitivity to pain. It’s a very rare diagnosis where someone doesn’t get the signals of pain. These people have a lower life expectancy because they haven’t learned what limitations to place on themselves. They power through things that shouldn’t be powered through like walking on a broken bone. That tells us how much our pain signals come from the brain.

Normally when we experience pain, it’s just our brain telling us to address a specific problem. Sometimes this pain doesn’t go away even though the body part has healed. This can happen because of events in our lives or because we are hypervigilant in regards to our safety. Our brain goes to this default state of “something is wrong with my body” and then we start forming these neural pathways telling us we’re in pain. As long as we respond with fear and intensity, these pathways get stronger. We keep reinforcing that neural pathway. It’s like walking down a hiking trail. Hiking trails don’t just appear. People walk down them enough so it becomes an actual trail. Our fear tells us the pain is structural, but really it’s just these neural pathways telling us that something is wrong.

Pain Reprocessing Therapy is reteaching the brain how to process sensations of pain. There is a three stage model where we are trying to understand fear around the symptoms and our relationship with fear. We start with the passive stage where pain is really high so they rely on all their usual behaviors to keep them safe like medications and going to the doctor. Then there is an exploratory stage where we try to understand avoidant behaviors and become less afraid. We become more curious at this stage. Then we have the empowerment stage where our pain is decreasing, we don’t use avoidant behaviors as much, and we start returning to normal activities that we may have been afraid of.

If someone is in the passive stage, we are really prioritizing messages of safety. They’re not curious about their symptoms. If someone is in the exploratory stage, we do something called somatic tracking through a lens of curiosity. This is a form of mindfulness. We want to get them in the empowerment stage. Some people will backslide because this is not a linear process. We want them to trust the process. 

 Can you tell me about the Pain Psychology Center?

It was started in 2014 by Alan Gordon and a few other clinicians. When I was first hired there were 12 clinicians and now there are 44. I knew that the goal was working on these neural pathways and treating chronic pain, but I didn’t fully understand what that meant at the time.

We consult with a board of neurologists and some other physicians that are amazing. Dr. Howard Schubiner, Dr. David Clark, and Dr. Schecter are amazing resources for us and we have close relationships with them. They even come and train our clinicians. 

When I first started working there, I realized that we can really work with people who have all these chronic pain illnesses that I have always heard of like fibromyalgia. It’s wild to wrap your head around neuroplasticity and how it can be used to treat chronic pain.

The messages I was told from a young age is that all these chronic pain conditions are structural. I always believed that these things needed to be treated medically.

We have a sister site called Pain Reprocessing Therapy where we provide a 4 week training program for medical professionals. We train them on Pain Reprocessing Therapy and then they get a certification. All these clinicians and physicians are listed in the directory on the site so that someone can find a clinician in their state that is trained in reprocessing therapy. I lead the 8 week consultation groups after the training so that clinicians can keep receiving consultations on how to treat chronic pain clients.

Usually when people come to us for treatment, they have seen several doctors already and nothing has worked. We’re usually the last stop for a lot of patients. We have some patients who are ready to leave for another country so they can do physician assisted suicide. People who have been in chronic pain for a long time are scared and just over it.

I read through the Pain Psychology Center website and I read your description. It said that you had experienced chronic pain. Can you explain what that experience was like?

When I was 11 I started having chronic migraines. A lot of the women in my family have chronic migraines so we always knew it was a genetic or hormonal problem. It’s funny how it’s just the women in the family.

When my menstruation started it got a lot worse. From the age of 15 to 27, I’ve been on at least 15 different types of birth control to try to control the migraines and the pelvic floor pain that I had started to develop during cycles. And I was also diagnosed with chronic ovarian cysts. This ended up not being true. On top of that I have always had IBS issues and I’ve always had really bad neck pain as a result of chronic migraines.

My migraines would exacerbate at times and take me out for two weeks where I would be throwing up, feeling weak and dizzy, unable to see, and I couldn’t walk straight.

Around the age of 18, I started experiencing chronic hives. I would break out in hives anytime I would get really stressed and it could be painful at times. It’s difficult having a symptom that you can see. I have experienced a wide variety of symptoms. It’s like this constant revolving door of chronic pain symptoms and I didn’t know that there was an avenue for neuroplastic pain until I finished my master’s program. When I finished my master’s program, I was definitely a type A person that fits the criteria for chronic pain. I was the president of the honor society, I was doing research projects, I was working full time, I was going to school full time, and I was on a PhD track. When I graduated, I decided to defer and take a break so I could figure out all of my body’s problems.

I’ve been diagnosed with a lot of different illnesses at different periods of my life, but it wasn’t until graduating that I decided to focus on my body and that’s when I discovered this work. I had worked with Alan (executive director of the Pain Psychology Center) in a casual sense, but then I had people recommending me for a position that he was hiring for. It was a staff clinician position at the Pain Psychology Center and I did get hired for this position. I learned how to apply this treatment to other people and myself. This brought up a lot of imposter syndrome.

Where are you right now with your chronic pain? Do you still have it?

I have no symptoms at all. I’m completely off of birth control. I’m completely off of my migraine medications. The only symptom that I have popping up every now and then is that I get hives when I am stressed. Through this work I have learned how to lean into that and reduce my urgency when I start to feel the sensation of the hives coming up. That’s what tends to happen to people. You experience the sensation building up and you start thinking “I have a 12 hour work day. I can’t have this happening to my body. I don’t have time for this”. The reaction is so visceral. When I learned how to respond differently, it was a game changer for me. I have had many times when I’m trying to get through a day and I start panicking. I call Alan and he walks me through it and back to baseline.

Other than the hives, I don’t have anymore pain symptoms. I haven’t had a migraine in 3 years. I don’t have any pelvic floor pain. When I do get the hives, they’re manageable. The pain is a 2 out of 10 whereas before it was a 10 out of 10.

You mentioned that you fit the criteria for the personality type that tends to develop chronic pain. Are you saying there is a certain personality type that puts people at a higher risk for developing chronic pain?

I would say that, but it’s not based on outwardly personalities that are more obvious. We tend to think of these crazy high achievers that are doing a ton of things at once. You can also be that person who is so nervous and anxious about speaking up for themselves that they kind of implode. I see a variety of people. I see the lawyer who specializes in four different practices of law, who has never stopped working since they were sixteen. Now they are in their 70s and they have been in chronic pain for ten years.

I have seen the person who is a stay at home mom and hasn’t quite learned how to tell people that their feelings have been hurt or learned they are allowed to say anything for themselves because of internalized messages they learned growing up. They are type A, but in a way that are constantly defaulting to a state of people pleasing because that looks perfect. It all really comes down to this type A personality. That is the most common personality type that we see. The type A personality comes with a lot of strengths and a lot of downsides. I try to see it as a superpower or something to lean into.

I read that you specialize in mindfulness and guided meditations. Can you explain what these are?

I like to describe mindfulness as just observing in a non-judgemental way. Like if you’re at an aquarium and you’re watching a fish, you’re not judging the fish. You’re not thinking, “That fish is ugly. That fish doesn’t look right.”. That’s how I like to describe mindfulness. You’re in a state of observing without judgment. Guided meditation is an opportunity to have someone that you feel safe with get you into space that you struggle with getting into without any stimulation. The point is to lead someone into this observing mentality and now they have that resource. They know what I would say and they know what to relate it to.

 How exactly are mindfulness and guided meditation stopping pain in its tracks?

Chronic pain gets us preoccupied in this state of being preoccupied about whether or not this is a structural problem; Being preoccupied about how you’re going to problem solve the pain, being preoccupied about how you use to feel, wondering if this pain is going to be forever. You’re in this constant state of preoccupation with chronic pain. We feel frustrated, we feel intensity with every slight sensation. Whenever we start to feel the sensation of pain we start to think “Ugh I have this dinner tonight. I can’t be dealing with this right now”. With that sensation you’re automatically in a state of preoccupation. You’re already predicting what’s going to happen eight hours from now.

Your brain only goes off of the messages that you tell it. Mindfulness and that type of work really impact the nervous system. When you’re in a state of pain, your nervous system is turned up. The goal of mindfulness is to turn down your nervous system and get you to a place that feels authentically safe. You need to prioritize that message of “I don’t have to respond to this chaotic sensation of pain with more chaos. I can notice when I’m having this sensation and be okay and teach myself to respond differently”. By doing that we reduce the urgency of the nervous system. We soothe the nervous system in a primitive way and when we do that your soothing the part of your brain that is sending pain signals. If we soothe the nervous system we can change the way that we respond to pain. This helps us reduce pain long term overall. That creates a foundation.

You’re thinking about fixing your pain all the time, but that doesn’t help you long term. We need to create a foundation of how you respond to pain.

Can you explain what cognitive behavioral therapy and psychodynamic therapies are?

Cognitive behavioral therapy involves working on the cognitive approach which is our thoughts. It’s a lot of thought work and calling out the thoughts like “Oh I shouldn’t have gone out last night because now I have pain today”. We do this black and white thinking of “I am in pain now. I’m going to be in pain forever”. These thoughts turn up the nervous system. In cognitive behavioral therapy, we are calling out those thoughts and recognizing that they are false.

Psychodynamic work is working on things we have learned throughout our life that we are not fully aware of. We develop these internalized messages. We develop toxic positivity. I am helping clients dismantle and unpackage that. That’s a psychodynamic approach. I help people understand where they learned these internalized messages. People like to say, “My pain could be worse today” or “At least it’s not cancer”. Toxic masculinity is also something that needs to be addressed. Even systemic racism and things we grew up learning from our families about how we are supposed to act. We learn internalized messages from society as well. If you’re in your 30s and you develop chronic pain, society says, “You’re old and there’s something wrong with you”. Psychodynamic therapy is about unpacking these internalized messages that are getting reinforced over and over again.

Cognitive behavioral therapy is thought work and psychodynamic therapy is addressing messages that we are not aware of.

 I’ve heard a lot about trauma impacting the way we experience pain, specifically childhood trauma. How are chronic pain and childhood trauma related?

If someone experienced childhood trauma and a lack of safety, they learned as a child to be hyper attuned to their needs. There is someone or something that didn’t protect them so the child realizes “I have to protect myself”. They develop an unclear message of what it’s like to be truly safe. When a child protects themself, they do it through hyper attunement and hypervigilance. It all comes down to a lack of safety and this leads to chronic pain and other symptoms.

If I have a patient who tells me they have been screamed at their whole lives, they learn that is normalized. Yet their brain still processes being screamed at as unsafe. They grow up and get married and the person they marry may start yelling at them. They think they’re happy in this relationship, but they are having symptoms of chronic pain. This is confusing and it makes them feel as if there is something wrong with their body. They don’t realize that their childhood is being repeated and that they’re going into a place of fight or flight.

11. Something I’ve noticed with my chronic pain research is that there are so many resources out there. The problem is that these resources are not affordable or accessible to a lot of people. How can people who do not have a lot of financial resources pursue all these different treatments and therapies?

One on one support is really tough because a lot of therapists don’t accept insurance and the process can be really messy. The good news is there are a lot of free resources through technology. The internet makes these resources way more accessible. There are also apps that people can use. Curable is a good one. We have a healing platform that is being created on our end. We have TMSwiki which is our 21-day program online. There are podcasts and social media that provide information and support. At the Pain Psychology Center, we try to make it available for clients who really need the lowest rate possible. We have really well trained interns that we hire every year that can provide therapy at lower rates.

Language barriers are an issue as well. Not all of the apps and books are translated. The field is advancing but there are still barriers. For now, I recommend reading the books, listening to the podcasts, and using the online resources.

 When I was first diagnosed with chronic pain, I went to the Facebook support groups and I found people who had been in constant pain for 20-30 years. These people were talking about how chronic pain is this incurable life sentence. What are your thoughts on social media groups like this?

I have clients who ask me if they should stay with these groups and I like to ask if there are resources or content that is actually beneficial. It’s important to recognize what is soothing your nervous system and what is not. Look for things that soothe your nervous system and be as particular as possible.

You mentioned that some people are pursuing physician assisted suicide due to their chronic pain. Can you expand on that?

I have had a few clients tell me that if this doesn’t work, they plan on suicide. That tells you a lot about the desperation that people go through. I’ve worked with clients in different countries that have physician assisted suicide as an option. Being able to have a person make sense of their pain before you start the healing process makes a difference. You can already see it working. It’s like having a place to finally put their stuff when there hasn’t been a place for a long time. It’s powerful when someone actually cares about what you have to say.

How often are you seeing suicidal patients and when do you see them transition out of that?

This may sound kind of morbid, but whenever I have a client that expresses to me that they’re suicidal, I try to normalize it as much as possible. I say things like, “It makes sense. I don’t blame you. You’re tired of it and I don’t blame you at all”. I’m very direct with my clients. It is safe for clients to speak with me about those thoughts. They’re allowed to talk to me about the dark thoughts that come up when they wake up each morning in pain. They have been spending so much time trying to fix themselves and their thoughts, sometimes it’s better to just pause and say what you’re feeling out loud. This way we can work through those thoughts. It’s important for them to be heard and that can be so helpful. Before I know it, someone’s urgency around their suicidal thoughts diminishes and goes away without them even noticing. This happens because we’re talking about those thoughts and we’re no longer afraid of them. I’m not afraid to talk with clients about their thoughts and that makes them feel safe. A lot of people are afraid of sharing these thoughts because they don’t want to scare anyone or they’re thinking, “Is someone going to 5150 me?” We all want to have an escape route and that’s how a lot of chronic pain clients end up thinking about suicide.

As a therapist, I have to protect my clients to the best of my abilities and make sure that there is a plan in place

I listen to this podcast called The Happiness Lab and there is this one episode called “Don’t Think About the White Bear”. The head of psychology at Yale is who runs this podcast. The episode is about this idea that you can tell yourself not to think about something and it will go away. We know that this does not work. In the episode she interviews a professional golfer and they talk about the “yips”. The “yips” are something that happens where someone has so much pressure to do something perfectly (like hitting a golf ball), that the pressure comes up, keeping us from focusing, and we push that pressure aside and develop an involuntary nerve twitch causing us to screw up that thing we were trying to do so perfectly. Those are the “yips”. We actually need to allow some of that pressure in so that we don’t mess up.

She also interviewed a researcher who did some research with Holocaust survivors who never shared their experiences with anyone. After speaking with this researcher about their experiences, they started going to doctor’s appointments less often because they were having less health problems. There is a power in being able to verbalize the dark things that we fear and experience and having someone contain that for you and being able to say those things without scaring people. I’m big on getting clients to say those dark thoughts, no matter how scary it is to say them. I want to expose them to the thing that is inducing fear.

I’m sure you see a large variety of chronic pain clients. There are clients who have been in pain for one years and clients who have been in pain for 30 years. Do you treat patients differently based on how long they have been in pain or does everyone get treated the same?

They are treated the same and I really like to stress that because a client who is coming in with 30 years of pain is terrified that they are going to be so much harder to treat. Experiencing chronic pain almost makes you look for ways in which you are the outlier. I like to say “chronically unique”. I have clients saying, “I’m going to be different. I’m going to be really hard to treat”. Whenever someone says that to me, I say “I’ve heard this story a lot. I can promise you that I have heard this story five times this week already”. I want to get them out of this idea that they are chronically unique or that they think they’re the one person who is not going to be able to get out of pain.

It won’t be any harder to treat someone who has been in pain for 30 years. Those neural pathways have been ingrained for 30 years, but it’s not going to take 30 years to get them out of that. It’s the same process of prioritizing messages of safety and getting them to that exploratory stage. It comes down to where this person is at with their pain and how to unlearn these messages of lack of safety.

 What is your advice for someone who is newly diagnosed with chronic pain?

I’m biased. I’d tell them to just come to the Pain Psychology Center. We get a lot of people who have been in pain for a long time and they start turning to Google for answers. They usually stumble across the Pain Psychology Center website.

If someone is new to chronic pain, I like to help my clients understand their relationship with pain and fear. I want them to ask themselves, “How is the fear that I am currently experiencing inducing pain?” I want them to have a basic understanding of what being in high alert is and how they define their state of high alert. I want them to understand the role pain is playing in their life and how they are responding to it so that I can make some connections for them.

I’m teaching clients that all pain comes from the brain while empowering them to know that their pain is real. They’re not imagining the pain. I let clients know, “You’re not making this up”.

I’ve had a physician tell me that they think it is problematic to tell someone that their pain is coming from their brain. I told this physician, “I feel the same way about you. You’re telling the client that there is something wrong with their body and that is scary”.

The way we consciously and unconsciously respond to pain is fueling the pain.

Do you find that a lot of people with chronic pain have unhealthy habits that are fueling the pain?

When I train the interns, I encourage them to get to know their clients’ behaviors, learned associations, and avoidant behaviors. Learned associations are “When I do this, this will happen”. For example, “When I go for a run, my back starts to hurt”. I want to know if they experience pain when they walk or stand too much. Are they thinking, “If I spend too much time on the computer, I will have a migraine”. There’s always something that clients associate with being the cause of their pain. So I have clients make a list of all of their learned associations and I type it up in a Google doc for them. Then we try to understand all of their avoidant behaviors. We try to understand everything they do to avoid their pain. That can be anything from Tylenol, to a heat pack, going to the chiropractor, stretching, exercising to distract yourself, and so many other things. It’s not about making sure we stop all avoidant behaviors. It’s about being aware of these behaviors and trying a mindfulness exercise before using an avoidant behavior. I’m introducing this idea of soothing your nervous system first.

What is your advice for healthcare professionals on how to treat chronic pain?

Dr. Schubiner, a physician that we consult with, has something called the “rule in rule out phase”. We try to “rule in” for neuroplastic pain and rule out for structural pain. An important question to ask each client is, “Does your doctor know of neuroplastic pain?” If they don’t know about neuroplastic pain, they don’t know to consider it for a diagnosis. People are just now becoming more aware of neuroplastic pain because everyone assumed chronic pain was caused by a structural problem for such a long time.

I want physicians to be open to the idea that their patients may be experiencing something that they’re not familiar with. Physicians get so burnt out with chronic pain patients, it’s almost easier to just give them a structural diagnosis and then send them on their way for treatment and medication. This is how they are trained to treat chronic pain, but I want to encourage them to see chronic pain clients differently.

A lot of doctors only have 15-30 minutes to spend with each patient so it’s a challenge to treat these patients. It’s hard for a doctor to communicate in this time frame that the pain they’re experiencing may be neuroplastic pain. Some people get offended by this because it feels like they’re once again being told that the pain is just in their head.

We’re still learning. We have come a long way, but we still have a long way to go. People are finding us through various avenues because our work is becoming more and more acknowledged and seen as valid.

 How do you recommend having these conversations without offending people? Without implying that they are imagining their pain?

I like to get clients and physicians to understand that we have all experienced neuroplastic symptoms. I encourage physicians to ask their clients, “Have you ever felt a sensation in your body that just popped up and made you feel uncomfortable and you didn’t know how to respond to it? Maybe you felt nervous for a job interview and suddenly felt like you were going to have diarrhea? Maybe you get really nervous and you start to feel a flutter in your chest.” It’s because your brain is recognizing that you’re preparing for something that is turning on your nervous system. Your brain responds to this by sending you a sensation. It’s about getting to recognize that this is just your brain working very well.

It’s important to know how to deliver this information in advance so that it makes sense when you do it. Neuroplasticity is so simple, but people tend to believe that their pain is more complex than that because they have been in pain for so long.

I like to tell doctors, “Be mindful that if someone can’t receive this information yet, that you didn’t necessarily do anything wrong. You’re just planting that seed. And as much as that person might be frustrated with that seed being planted, the goal is for them to consider it”. That’s why we have resources. That’s why we have the book.

The person receiving this information just wants to be heard and validated. Find what works for you on how to communicate with chronic pain clients. Be educated on this topic so you feel more confident talking about it.

Can you tell me about any success stories that you have had with clients?

I can read one to you. I got a message recently from one of my clients. This individual worked with me short term which is rare. I usually have people that want to stick around in therapy for a while. This client was really dedicated to getting back to her life. I saw her for some pretty significant back pain problems that came up and nothing had come up in their life that was major and would lead to chronic pain.

This person didn’t have any childhood trauma. They actually had a really good childhood. We came to realize that she had almost experienced no adversity throughout their life and lived so peacefully that when someone of the pressures of life, parenthood, and their job started to come up, they didn’t know how to cope with it. She became hyperfixated on her body and symptoms because it wasn’t fitting into the mold of what her life was supposed to look like.

We had eight sessions and in each session she was getting better and better. This was just with psychoeducation, learning to lean into the sensations of pain, recognizing some of her perfectionist tendencies, recognizing her preoccupation with the pain.

She emailed me recently and said, “Hi Vanessa, I hope you are well. I just listened to The Below (a recording exercise that I had sent her) for the first time in a while. I do every now and then when my back plays tricks on me. Every time it hurts, I use the techniques and thought patterns that you taught me and the pain goes away like magic. My life is completely different than when I first met you. I am pretty much pain free. I play golf every single week. I have started my own business with no tension flare ups or stress. I have more fun and I am able to do more things with my kids than I was able to do before. I know it was a while ago that we spoke, but I wanted you to know that I am forever grateful for your guidance and helping me get to this place. I wanted you to feel appreciated for making such a huge difference in my life”.

I’ve worked with a lot of people who are now completely pain free or mostly pain free and they still see me for one-on-one therapy because we hold such a good relationship. The goal is to get these people to a place where they know what it feels like to feel safe.

Is there anything else that you would like to talk about?

I just really want people to know that your pain is not just stuck in your head and being made up. It’s really there. When I was in pain, I looked like I was fine because I’m such a perfectionist, but I really wasn’t. Getting people to understand that was so hard and so invalidating that I felt as if I wasn’t allowed to not be okay. It put this message in my head that it’s not okay to not be okay. I want my clients to know that it’s okay to not be okay. That it’s not in their head. Their pain is very real, but all pain comes from the brain.

I want people to learn to take a moment to just sit with their pain and explore the sensation. Be an observer and try not to judge the sensation. We can get to a point where we can approach the sensations in our bodies with a sense of ease and lightness.

I encourage people to try it when they’re hot or cold. If you’re hot, instead of trying to adjust the temperature, can you just sit there for 30 seconds and ask yourself, “Where am I hot? My arms, legs, hands?” and just untense your muscles. Then feel free to change the temperature. This is a good exercise for people when they are just getting started with mindfulness exercises.

Takeaways:

Go to The Pain Psychology Center. They are incredibly successful at treating chronic pain.

Learn about neuroplasticity and mindfulness.

Starting learning to sit with and lean into your pain rather than running away from it.

Learn about Pain Reprocessing Therapy.

Chronic pain can be cured.

I am in absolute awe of Vanessa Blackstone and The Pain Psychology Center. They are truly curing chronic pain. I highly recommend checking The Pain Psychology Center out. Huge thank you to Vanessa Blackstone for doing this incredible interview with me. This was my first in person interview and the most detailed one I have ever done. I hope all of my readers read this interview because there is so much to learn.

mentioned that you fit the criteria for the personality type that tends to develop chronic pain. Are you saying there is a certain personality type that puts people at a higher risk for developing chronic pain?

I would say that, but it’s not based on outwardly personalities that are more obvious. We tend to think of these crazy high achievers that are doing a ton of things at once. You can also be that person who is so nervous and anxious about speaking up for themselves that they kind of implode. I see a variety of people. I see the lawyer who specializes in four different practices of law, who has never stopped working since they were sixteen. Now they are in their 70s and they have been in chronic pain for ten years. 

I have seen the person who is a stay at home mom and hasn’t quite learned how to tell people that their feelings have been hurt or learned they are allowed to say anything for themselves because of internalized messages they learned growing up. They are type A, but in a way that are constantly defaulting to a state of people pleasing because that looks perfect. It all really comes down to this type A personality. That is the most common personality type that we see. The type A personality comes with a lot of strengths and a lot of downsides. I try to see it as a superpower or something to lean into.

7. I read that you specialize in mindfulness and guided meditations. Can you explain what these are?

I like to describe mindfulness as just observing in a non-judgemental way. Like if you’re at an aquarium and you’re watching a fish, you’re not judging the fish. You’re not thinking, “That fish is ugly. That fish doesn’t look right.”. That’s how I like to describe mindfulness. You’re in a state of observing without judgment. Guided meditation is an opportunity to have someone that you feel safe with get you into space that you struggle with getting into without any stimulation. The point is to lead someone into this observing mentality and now they have that resource. They know what I would say and they know what to relate it to. 

8. How exactly are mindfulness and guided meditation stopping pain in its tracks?

Chronic pain gets us preoccupied in this state of being preoccupied about whether or not this is a structural problem; Being preoccupied about how you’re going to problem solve the pain, being preoccupied about how you use to feel, wondering if this pain is going to be forever. You’re in this constant state of preoccupation with chronic pain. We feel frustrated, we feel intensity with every slight sensation. Whenever we start to feel the sensation of pain we start to think “Ugh I have this dinner tonight. I can’t be dealing with this right now”. With that sensation you’re automatically in a state of preoccupation. You’re already predicting what’s going to happen eight hours from now.

Your brain only goes off of the messages that you tell it. Mindfulness and that type of work really impact the nervous system. When you’re in a state of pain, your nervous system is turned up. The goal of mindfulness is to turn down your nervous system and get you to a place that feels authentically safe. You need to prioritize that message of “I don’t have to respond to this chaotic sensation of pain with more chaos. I can notice when I’m having this sensation and be okay and teach myself to respond differently”. By doing that we reduce the urgency of the nervous system. We soothe the nervous system in a primitive way and when we do that your soothing the part of your brain that is sending pain signals. If we soothe the nervous system we can change the way that we respond to pain. This helps us reduce pain long term overall. That creates a foundation.

You’re thinking about fixing your pain all the time, but that doesn’t help you long term. We need to create a foundation of how you respond to pain.

9. Can you explain what cognitive behavioral therapy and psychodynamic therapies are?

Cognitive behavioral therapy involves working on the cognitive approach which is our thoughts. It’s a lot of thought work and calling out the thoughts like “Oh I shouldn’t have gone out last night because now I have pain today”. We do this black and white thinking of “I am in pain now. I’m going to be in pain forever”. These thoughts turn up the nervous system. In cognitive behavioral therapy, we are calling out those thoughts and recognizing that they are false.

Psychodynamic work is working on things we have learned throughout our life that we are not fully aware of. We develop these internalized messages. We develop toxic positivity. I am helping clients dismantle and unpackage that. That’s a psychodynamic approach. I help people understand where they learned these internalized messages. People like to say, “My pain could be worse today” or “At least it’s not cancer”. Toxic masculinity is also something that needs to be addressed. Even systemic racism and things we grew up learning from our families about how we are supposed to act. We learn internalized messages from society as well. If you’re in your 30s and you develop chronic pain, society says, “You’re old and there’s something wrong with you”. Psychodynamic therapy is about unpacking these internalized messages that are getting reinforced over and over again.

Cognitive behavioral therapy is thought work and psychodynamic therapy is addressing messages that we are not aware of.

10. I’ve heard a lot about trauma impacting the way we experience pain, specifically childhood trauma. How are chronic pain and childhood trauma related?

If someone experienced childhood trauma and a lack of safety, they learned as a child to be hyper attuned to their needs. There is someone or something that didn’t protect them so the child realizes “I have to protect myself”. They develop an unclear message of what it’s like to be truly safe. When a child protects themself, they do it through hyper attunement and hypervigilance. It all comes down to a lack of safety and this leads to chronic pain and other symptoms.

If I have a patient who tells me they have been screamed at their whole lives, they learn that is normalized. Yet their brain still processes being screamed at as unsafe. They grow up and get married and the person they marry may start yelling at them. They think they’re happy in this relationship, but they are having symptoms of chronic pain. This is confusing and it makes them feel as if there is something wrong with their body. They don’t realize that their childhood is being repeated and that they’re going into a place of fight or flight.

11. Something I’ve noticed with my chronic pain research is that there are so many resources out there. The problem is that these resources are not affordable or accessible to a lot of people. How can people who do not have a lot of financial resources pursue all these different treatments and therapies?

One on one support is really tough because a lot of therapists don’t accept insurance and the process can be really messy. The good news is there are a lot of free resources through technology. The internet makes these resources way more accessible. There are also apps that people can use. Curable is a good one. We have a healing platform that is being created on our end. We have TMSwiki which is our 21-day program online. There are podcasts and social media that provide information and support. At the Pain Psychology Center, we try to make it available for clients who really need the lowest rate possible. We have really well trained interns that we hire every year that can provide therapy at lower rates.

Language barriers are an issue as well. Not all of the apps and books are translated. The field is advancing but there are still barriers. For now, I recommend reading the books, listening to the podcasts, and using the online resources.

12. When I was first diagnosed with chronic pain, I went to the Facebook support groups and I found people who had been in constant pain for 20-30 years. These people were talking about how chronic pain is this incurable life sentence. What are your thoughts on social media groups like this?

I have clients who ask me if they should stay with these groups and I like to ask if there are resources or content that is actually beneficial. It’s important to recognize what is soothing your nervous system and what is not. Look for things that soothe your nervous system and be as particular as possible.

13. You mentioned that some people are pursuing physician assisted suicide due to their chronic pain. Can you expand on that?

I have had a few clients tell me that if this doesn’t work, they plan on suicide. That tells you a lot about the desperation that people go through. I’ve worked with clients in different countries that have physician assisted suicide as an option. Being able to have a person make sense of their pain before you start the healing process makes a difference. You can already see it working. It’s like having a place to finally put their stuff when there hasn’t been a place for a long time. It’s powerful when someone actually cares about what you have to say.

14. How often are you seeing suicidal patients and when do you see them transition out of that?

This may sound kind of morbid, but whenever I have a client that expresses to me that they’re suicidal, I try to normalize it as much as possible. I say things like, “It makes sense. I don’t blame you. You’re tired of it and I don’t blame you at all”. I’m very direct with my clients. It is safe for clients to speak with me about those thoughts. They’re allowed to talk to me about the dark thoughts that come up when they wake up each morning in pain. They have been spending so much time trying to fix themselves and their thoughts, sometimes it’s better to just pause and say what you’re feeling out loud. This way we can work through those thoughts. It’s important for them to be heard and that can be so helpful. Before I know it, someone’s urgency around their suicidal thoughts diminishes and goes away without them even noticing. This happens because we’re talking about those thoughts and we’re no longer afraid of them. I’m not afraid to talk with clients about their thoughts and that makes them feel safe. A lot of people are afraid of sharing these thoughts because they don’t want to scare anyone or they’re thinking, “Is someone going to 5150 me?” We all want to have an escape route and that’s how a lot of chronic pain clients end up thinking about suicide.

As a therapist, I have to protect my clients to the best of my abilities and make sure that there is a plan in place

I listen to this podcast called The Happiness Lab and there is this one episode called “Don’t Think About the White Bear”. The head of psychology at Yale is who runs this podcast. The episode is about this idea that you can tell yourself not to think about something and it will go away. We know that this does not work. In the episode she interviews a professional golfer and they talk about the “yips”. The “yips” are something that happens where someone has so much pressure to do something perfectly (like hitting a golf ball), that the pressure comes up, keeping us from focusing, and we push that pressure aside and develop an involuntary nerve twitch causing us to screw up that thing we were trying to do so perfectly. Those are the “yips”. We actually need to allow some of that pressure in so that we don’t mess up.

She also interviewed a researcher who did some research with Holocaust survivors who never shared their experiences with anyone. After speaking with this researcher about their experiences, they started going to doctor’s appointments less often because they were having less health problems. There is a power in being able to verbalize the dark things that we fear and experience and having someone contain that for you and being able to say those things without scaring people. I’m big on getting clients to say those dark thoughts, no matter how scary it is to say them. I want to expose them to the thing that is inducing fear.

15. I’m sure you see a large variety of chronic pain clients. There are clients who have been in pain for one years and clients who have been in pain for 30 years. Do you treat patients differently based on how long they have been in pain or does everyone get treated the same?

They are treated the same and I really like to stress that because a client who is coming in with 30 years of pain is terrified that they are going to be so much harder to treat. Experiencing chronic pain almost makes you look for ways in which you are the outlier. I like to say “chronically unique”. I have clients saying, “I’m going to be different. I’m going to be really hard to treat”. Whenever someone says that to me, I say “I’ve heard this story a lot. I can promise you that I have heard this story five times this week already”. I want to get them out of this idea that they are chronically unique or that they think they’re the one person who is not going to be able to get out of pain.

It won’t be any harder to treat someone who has been in pain for 30 years. Those neural pathways have been ingrained for 30 years, but it’s not going to take 30 years to get them out of that. It’s the same process of prioritizing messages of safety and getting them to that exploratory stage. It comes down to where this person is at with their pain and how to unlearn these messages of lack of safety.

16. What is your advice for someone who is newly diagnosed with chronic pain?

I’m biased. I’d tell them to just come to the Pain Psychology Center. We get a lot of people who have been in pain for a long time and they start turning to Google for answers. They usually stumble across the Pain Psychology Center website.

If someone is new to chronic pain, I like to help my clients understand their relationship with pain and fear. I want them to ask themselves, “How is the fear that I am currently experiencing inducing pain?” I want them to have a basic understanding of what being in high alert is and how they define their state of high alert. I want them to understand the role pain is playing in their life and how they are responding to it so that I can make some connections for them.

I’m teaching clients that all pain comes from the brain while empowering them to know that their pain is real. They’re not imagining the pain. I let clients know, “You’re not making this up”. 

I’ve had a physician tell me that they think it is problematic to tell someone that their pain is coming from their brain. I told this physician, “I feel the same way about you. You’re telling the client that there is something wrong with their body and that is scary”. 

The way we consciously and unconsciously respond to pain is fueling the pain.

17. Do you find that a lot of people with chronic pain have unhealthy habits that are fueling the pain?

When I train the interns, I encourage them to get to know their clients’ behaviors, learned associations, and avoidant behaviors. Learned associations are “When I do this, this will happen”. For example, “When I go for a run, my back starts to hurt”. I want to know if they experience pain when they walk or stand too much. Are they thinking, “If I spend too much time on the computer, I will have a migraine”. There’s always something that clients associate with being the cause of their pain. So I have clients make a list of all of their learned associations and I type it up in a Google doc for them. Then we try to understand all of their avoidant behaviors. We try to understand everything they do to avoid their pain. That can be anything from Tylenol, to a heat pack, going to the chiropractor, stretching, exercising to distract yourself, and so many other things. It’s not about making sure we stop all avoidant behaviors. It’s about being aware of these behaviors and trying a mindfulness exercise before using an avoidant behavior. I’m introducing this idea of soothing your nervous system first.

18. What is your advice for healthcare professionals on how to treat chronic pain?

Dr. Schubiner, a physician that we consult with, has something called the “rule in rule out phase”. We try to “rule in” for neuroplastic pain and rule out for structural pain. An important question to ask each client is, “Does your doctor know of neuroplastic pain?” If they don’t know about neuroplastic pain, they don’t know to consider it for a diagnosis. People are just now becoming more aware of neuroplastic pain because everyone assumed chronic pain was caused by a structural problem for such a long time.

I want physicians to be open to the idea that their patients may be experiencing something that they’re not familiar with. Physicians get so burnt out with chronic pain patients, it’s almost easier to just give them a structural diagnosis and then send them on their way for treatment and medication. This is how they are trained to treat chronic pain, but I want to encourage them to see chronic pain clients differently.

A lot of doctors only have 15-30 minutes to spend with each patient so it’s a challenge to treat these patients. It’s hard for a doctor to communicate in this time frame that the pain they’re experiencing may be neuroplastic pain. Some people get offended by this because it feels like they’re once again being told that the pain is just in their head.

We’re still learning. We have come a long way, but we still have a long way to go. People are finding us through various avenues because our work is becoming more and more acknowledged and seen as valid.

19. How do you recommend having these conversations without offending people? Without implying that they are imagining their pain?

I like to get clients and physicians to understand that we have all experienced neuroplastic symptoms. I encourage physicians to ask their clients, “Have you ever felt a sensation in your body that just popped up and made you feel uncomfortable and you didn’t know how to respond to it? Maybe you felt nervous for a job interview and suddenly felt like you were going to have diarrhea? Maybe you get really nervous and you start to feel a flutter in your chest.” It’s because your brain is recognizing that you’re preparing for something that is turning on your nervous system. Your brain responds to this by sending you a sensation. It’s about getting to recognize that this is just your brain working very well.

It’s important to know how to deliver this information in advance so that it makes sense when you do it. Neuroplasticity is so simple, but people tend to believe that their pain is more complex than that because they have been in pain for so long.

I like to tell doctors, “Be mindful that if someone can’t receive this information yet, that you didn’t necessarily do anything wrong. You’re just planting that seed. And as much as that person might be frustrated with that seed being planted, the goal is for them to consider it”. That’s why we have resources. That’s why we have the book.

The person receiving this information just wants to be heard and validated. Find what works for you on how to communicate with chronic pain clients. Be educated on this topic so you feel more confident talking about it.

20. Can you tell me about any success stories that you have had with clients?

I can read one to you. I got a message recently from one of my clients. This individual worked with me short term which is rare. I usually have people that want to stick around in therapy for a while. This client was really dedicated to getting back to her life. I saw her for some pretty significant back pain problems that came up and nothing had come up in their life that was major and would lead to chronic pain.

This person didn’t have any childhood trauma. They actually had a really good childhood. We came to realize that she had almost experienced no adversity throughout their life and lived so peacefully that when someone of the pressures of life, parenthood, and their job started to come up, they didn’t know how to cope with it. She became hyperfixated on her body and symptoms because it wasn’t fitting into the mold of what her life was supposed to look like.

We had eight sessions and in each session she was getting better and better. This was just with psychoeducation, learning to lean into the sensations of pain, recognizing some of her perfectionist tendencies, recognizing her preoccupation with the pain.

She emailed me recently and said, “Hi Vanessa, I hope you are well. I just listened to The Below (a recording exercise that I had sent her) for the first time in a while. I do every now and then when my back plays tricks on me. Every time it hurts, I use the techniques and thought patterns that you taught me and the pain goes away like magic. My life is completely different than when I first met you. I am pretty much pain free. I play golf every single week. I have started my own business with no tension flare ups or stress. I have more fun and I am able to do more things with my kids than I was able to do before. I know it was a while ago that we spoke, but I wanted you to know that I am forever grateful for your guidance and helping me get to this place. I wanted you to feel appreciated for making such a huge difference in my life”.

I’ve worked with a lot of people who are now completely pain free or mostly pain free and they still see me for one-on-one therapy because we hold such a good relationship. The goal is to get these people to a place where they know what it feels like to feel safe.

21. Is there anything else that you would like to talk about?

I just really want people to know that your pain is not just stuck in your head and being made up. It’s really there. When I was in pain, I looked like I was fine because I’m such a perfectionist, but I really wasn’t. Getting people to understand that was so hard and so invalidating that I felt as if I wasn’t allowed to not be okay. It put this message in my head that it’s not okay to not be okay. I want my clients to know that it’s okay to not be okay. That it’s not in their head. Their pain is very real, but all pain comes from the brain.

I want people to learn to take a moment to just sit with their pain and explore the sensation. Be an observer and try not to judge the sensation. We can get to a point where we can approach the sensations in our bodies with a sense of ease and lightness.

I encourage people to try it when they’re hot or cold. If you’re hot, instead of trying to adjust the temperature, can you just sit there for 30 seconds and ask yourself, “Where am I hot? My arms, legs, hands?” and just untense your muscles. Then feel free to change the temperature. This is a good exercise for people when they are just getting started with mindfulness exercises.

Takeaways:

• Go to The Pain Psychology Center. They are incredibly successful at treating chronic pain.

• Learn about neuroplasticity and mindfulness.

• Starting learning to sit with and lean into your pain rather than running away from it.

• Learn about Pain Reprocessing Therapy.

• Chronic pain can be cured.

I am in absolute awe of Vanessa Blackstone and The Pain Psychology Center. They are truly curing chronic pain. I highly recommend checking The Pain Psychology Center out. Huge thank you to Vanessa Blackstone for doing this incredible interview with me. This was my first in person interview and the most detailed one I have ever done. I hope all of my readers read this interview because there is so much to learn.