Training the brain out of pain
Curious about chronic pain? Lauren Cannell speaks about taking control of chronic pain and getting your life back after traumatic events. Lauren has been a Tasmanian police officer for more than 20 years and participated in endurance sporting events such as Ironman races and ultra-marathons. After having a brain haemorrhage, followed by an accident where she was hit by a motor vehicle, Lauren experienced ongoing chronic pain long after her injuries healed. This led her on a journey of understanding pain, how it works and how to recover. You can watch and read her speech below!
Laurens Tedx Talk
I am not here today because I stand out or because I am unique. In fact, for several years, I was just one of the millions of Australians who experience persistent pain, also known as chronic pain which is commonly defined as pain lasting longer than 3 months or past normal healing time. I’m here because I became curious about my pain, and it sent me on a journey that changed my understanding and experience of pain, and also changed my life. I’m here in the hope that by hearing my story you too will become curious about pain. Aside from my lived experience of pain, I’m also a wife, a mother, a police officer, and a runner. I was not naturally gifted at running and only started in my 30’s and I became irritatingly passionate about it and eventually started running marathons, ultra-marathons, and ironman events. The quote that says that ‘running a marathon is a journey of 1000 kilometres, the race is just the last 42’ is accurate, because the hard work happens in the training, that’s where you build the mind and body strength to succeed.
For me there were 3 key elements to my approach: education, planning and training. Education is learning about your body’s needs and capabilities as they relate to your event or goal. To plan, you often need the expertise of a running coaches to help you devise a training plan to meet that event or goal. Then came the training, which was all up to me. A coach can provide expert advice, but they don’t do the running for you. I loved every aspect of running however, like most runners, I picked up some injuries along the way.
Most of you here would have had a minor injury or niggle in your body at some time. You probably went to a Dr who provided advice on management. Imagine then, you follow that advice, but your discomfort grows, and you’re experiencing pain that doesn’t feel ‘normal’. You go back to the Dr, get medication, get a scan done. The results are a little inconclusive and so you start reaching out to other health care providers, a physio or chiro, and yes, it’s always worth trying some acupuncture and massage. But the pain is only growing, in fact it’s worse than when it started. You try out cortisone injections, opioids, even nerve blocks. Before you know it, you’re meeting with a surgeon and having exploratory surgery and… it doesn’t help.
It’s been months and the pain is moving and growing, it’s now in both sides of your body, it hurts to sit, it hurts to stand, it burns and prickles and radiates through you. You stop going to work and social events, and your world becomes smaller and scarier. You start having panic attacks and become obsessed with your pain. You’re constantly googling your symptoms, self-diagnosing that this must be some terrible illness and you turn to your Dr desperately asking them to find out what is wrong, and to make it stop. But they can’t. And you have no answers, and no relief.
That was my reality only a few years ago. From the development of a minor knee injury, I went from running marathons to feeling unable to walk to my front gate without pain in a matter of months. This spiralled into several years of depression, medication and medical treatments.
That’s when I became curious about my pain. I read and watched and listened to every reliable source I could about pain, notably those from the Pain Revolution and Pain Australia, until I discovered what was wrong, which was… Nothing, well nothing in the sense I had no longer had physical injuries. My pain was very real, but there was no damage to my body.
Now there are some great Ted Talks by pain experts that explain how persistent pain works in a clinical sense, but from my perspective: my brain had developed the opinion that I was in danger and was sending me warning messages in the form of pain. Normally these messages are a good thing, it’s a evolutionary protection system designed to keep you alive but the brain can get over-protective and keep sending you pain when you no longer need it. Usually, we think of pain as a symptom of an injury or illness, but that’s not always the case.
Psychological and social factors can play a part in the development and intensity of pain, meaning the amount of pain we feel can depend on the context in which it occurs and our beliefs about pain. Our brains store information about everything we see, hear, do, and the way we experience the world. This psycho/social information is used by the brain to form opinions about many things, like our favourite colour or music style, and whether we are in danger. If the brain forms an opinion we are in some form of danger it may send a warning message to the body which could be the hair standing up on your arms, or it could be recurring pain. Fear, stress and depression can feed and amplify those messages. Understanding that my pain was no longer related to a physical injury was the first of two breakthrough moments in my recovery.
So why had my brain developed this opinion that I was in danger? In the 5 years prior to this injury, I had experienced two painful, traumatic, and life-threatening incidents, a brain haemorrhage and an accident where I was struck by a vehicle while cycling . I had been a police officer for twenty years which can be a stressful role with exposure to trauma. If you haven’t already guessed, I am a Type-A personality with high self-expectations. Add to that, the stress of being unable to exercise and fear of the pain, and it’s little wonder my brain formed this opinion. Once I understood this, I needed to learn how to fix it. Just because you understand pain, doesn’t mean it goes away and I’ve done the homework for you, there is no magic pill or instant cure. Medication may have a place to help with symptoms, but it doesn’t address the cause.
The brain is an adaptive bit of kit. Like any new skill, the more you practice something the better your brain adapts to perform the task, and I had spent a lot of time practicing fear and pain. However, just as you can train your brain to wind up the pain, you can also consciously train your brain to wind it back, using a process the experts, like our first speaker, call neuroplasticity. Luckily for me, training is something I know a lot about. Instead of training my body to run long distances, I now needed to train my brain to reduce my pain. This was the second breakthrough moment in my recovery, where I made a conscious and deliberate decision to actively change approach to pain. Instead of seeing my body as broken or dysfunctional, I became grateful for this amazing organ in my head that was just trying way too hard to protect me.
To start winding back that pain, I returned to a process I had relied on many times before: Education, Planning and Training. I had the education part down, but I needed a coach - a pain informed expert to help me develop a plan. This can be a doctor, physio, psychologist, local pain educator, occupational therapist, it can depend on who you have access to – but they must be well informed about contemporary understandings of pain. For me that person was initially a exercise physiologist. But, like a run coach, that pain coach, wont do the training for you, you are the active participant in your recovery.
And just like running, your plan is a personal thing so everyone’s looks different. Some people may wish to get back to running marathons, some want to get back to work, others may just want to get out of bed. My plan involved what I dubbed the MASS approach – Movement, Acknowledgement, Self-Talk and Support:
Movement is medicine and returning to movement in a safe, gradual way, restores confidence while reassuring your brain that you are not in danger. Physical activity is great for your brain health, as are general wellbeing factors like nutrition, sleep, and social connection. Pacing your return to movement helps avoid the boom and bust outcomes and puts in place contingencies if you have a pain flare up.
Acknowledgement is an acceptance that psycho/social factors can be drivers of pain and may need some expert attention such as therapy mindfulness or other methods specific to you.
Self-talk is critical to reversing those pain messages. For me that meant sending simple repetitive reminders to my brain reassuring myself that I was safe. For example, I would say to my brain ‘hey buddy, thanks for the pain message, I know you’re looking out for me, but I don’t need you today’.
Support in the form of family, friends and work colleagues who understand your journey and are there to cheer you on.
Like training for a marathon, training your brain to overcome persistent pain doesn’t happen overnight. In my typical style I wanted to recover faster and better than anyone else! But it was more like running a long mountain range. There are ups and downs, self-doubt, and setbacks, but also wonderful milestones and triumph. Every month, my pain lessened, and I got a little bit of my life back as my brain adapted and trusted that I was safe. Several years have now passed since I first became curious about my pain and I’m back running marathons. I still get pain that is unrelated to injury - usually when I’m under stress - and I notice those familiar symptoms returning. But I know why it’s happening, I don’t fear it, and instead of running mountains to wind it back, it’s often just a bit of a jog.
It was confronting to think that the origin of my persistent pain was literally in my head, but this was not a new medical breakthrough. The brain/pain connection has been documented for decades in cases like phantom limb pain or sympathy labour pain. What astounded me was that for the dozens of health professionals I had seen, very few investigated these psycho/social drivers of pain in me. They were busy treating my already healed body but not exploring what was happening in my brain. There are missed opportunities in the medical model of pain where these factors are not always considered and people like me spend years of their life in pain because they are not educated or empowered to actively change their experience.
As I said at the start, I’m not here because this story is unique, I’m here because it’s not. It’s estimated that one in five Australians experience persistent pain, and it’s a leading cause of workplace absenteeism, premature retirement, disability and poor mental health. How many people do you know that have pain that limits what they do, like back pain, migraines, arthritis, and knee pain? Maybe that person is you. I’m curious how many people can reduce or eliminate their pain just by having access to the right education and resources. There's also opportunity for those with acute injury or illness to lessen their pain experience or prevent the development of persistent pain by receiving the right information at the right time. I’m not saying this approach is the answer for everyone in pain, of course it’s not, but if you experience persistent pain, then I invite you to become curious about why. Being curious about your pain could change your life too.