This section is based on a talk by Randolph Sparks, a psychologist specialising in chronic pain and a guest lecturer at the School of Psychology at the Australian National University.

Approaches to pain have changed a lot over the last few years in response to new scientific evidence on the body’s responses to injury. These new conceptualisations of pain look at the effects of pain on the nervous system, in which pain messages are interpreted as danger signals. When pain becomes chronic, danger signals are continually pumped into the body, and the operation of the nervous system is fundamentally changed. Chronic pain therefore “rewires” the nervous system.

“To me, being a pain psychologist for quite a few years already, this particular model has really filled in some missing pieces of the puzzle, and it’s doing so for my own clients as well.”

This gives rise to a new approach in managing chronic pain. Just as pain can “rewire” the nervous system, you can attempt and succeed in “rewiring” your nervous system to better manage pain. The strategies to manage chronic pain themselves are not new, but how we understand the processes and how we implement the strategies is changing.

This new approach is based around three practical interventions you can take to start “rewiring” your nervous system and thus learn to manage your pain more effectively. These are movement, relaxation and pacing.

Chronic pain is partly a dysfunction of the immune system. The role of the immune system is to immobilise the body when injured, sick or in danger. For example, when a person has the flu, they become more sensitive to pain, their mood deteriorates and they experience stiffness, fatigue and changes in temperature. This is an immune response to the flu. The immune system has immobilised the body to aid healing and allow it to safely increase the body’s temperature to deal with the virus.

Similarly, after an acute injury the body responds with pain, a deteriorated mood, stiffness and fatigue. There may also be slight changes in temperature. We also immobilise the injured body part. This is an appropriate and helpful response to a short term injury. However, we also tend to respond in a similar way when an injury becomes chronic.

Are you immobilising when you don’t need to?

People with chronic pain often immobilise the areas that are giving them pain and are often not even aware they are doing it. Movement is painful and therefore dangerous – and the painful part of the body needs to be immobilised. For acute pain, immobilisation is necessary, but for chronic pain, it is not.

If you are already immobilising part of the body, you are already enacting the beginning of an immunological response, which means the full-blown response is primed and ready to kick in at any time.

“If you have chronic and constant pain, observe how you move to see if you’re not already immobilising parts of your body. It can be very subtle.”

1. The first practical intervention is to start moving

This new approach to chronic pain employs feedback loops to start “rewiring” the body to better deal with pain. For people with chronic pain, the feedback loop is simple. You immobilise because you are in pain, but immobilisation, in turn, tells your body you are in pain. This is an automatic immunological response. You need to consciously and deliberately “rewire” the body to reduce your suffering.

You need to start moving. If immobilisation demonstrates that pain is necessary, then movement demonstrates that pain is unnecessary. Movement is key to the functioning of our nervous system. While stretches and exercises are good, you need to start moving in a conscious and deliberate way, to start “rewiring” the nervous system. “Nerves that fire together, wire together”. Once nerves fire together in a particular direction, they keep firing together in that direction.

“For someone like me with 20 years of lower back pain, my pain experience has changed completely since I’ve started using these techniques.”

Do you fear movement?

Many people with chronic pain fear movement, as movement has caused them pain, and pain is perceived as dangerous. Therefore a person can increasingly limit movement and cease activities requiring it. These activities can include exercise, social activities and work, and can result in the person experiencing a significant reduction in quality of life.

So fear of movement can have severe effects on quality of life in many areas, and produce or increase anxiety and depression, as well as having a direct effect on the nervous system.

You need to do two things when it comes to movement. You need to:

  1. Normalise movement: Immobilisation rarely relieves chronic pain, and we believe, in fact, that immobilisation actually contributes to pain. If you move normally, this demonstrates to the body that pain is unnecessary and you will start to “rewire” your body and your nervous system.
  2. Increase movement: While too much movement will cause pain, too little movement will also do the same. When you start moving, do not move too much or too little. You need to activate the nervous system in an adaptive way – “wiggle and jiggle”.

“I remind myself that my back is there, my back is moving and that it’s okay. I actually say out loud to myself, “Yep, my back is here, my back is moving, and it’s okay”. In as many ways as you can, you need to start “rewiring” your body.”

2. The second practical intervention is to relax

The danger reaction is the natural “fight or flight” reaction when a person is facing imminent danger. This is the sympathetic nervous response: adrenaline kicks in, breathing goes to the upper chest, blood flows out to the extremities, the digestive system stops working, heart rate increases. This is great for immediate danger, but not so good if it goes on for a long time.

The body is always trying to achieve homeostasis, or balance. Following a sympathetic nervous response (the danger response), the nervous system then activates the parasympathetic response (the relaxation response) and relaxes the body, and the person then often becomes tired.

This is the body’s way of restoring balance. For people with chronic pain, however, their nervous system is continually bombarded with danger signals, stimulating a constant sympathetic nervous response. They do not experience the usual parasympathetic response that follows.

“I’ve conditioned myself. So I just have to say the word, “relax, breathe”, and I get really sleepy.”

You need to learn to relax. The nervous system needs to be “rewired” back into experiencing the parasympathetic response. Relaxation techniques are essential here. Fear of movement is a conditioned response; you need to override the condition of fear of a situation that can cause you pain. You need to pair movement with a relaxation response instead. If you can trigger the nervous system to relax when you have pain, then you remove the message of danger and can avoid going into the full-blown immune response.

Breathing is key. There are other relaxation methods but learning to relax through breathing is a simple and easy technique to start practicing. The aim is to practice breathing until you can think “breathe” and you relax.

When we breathe in, we activate the sympathetic system, and when we breathe out, we activate the parasympathetic system. When facing imminent danger, breathing goes to the upper chest, taking long breaths in and short breaths out. A person in pain will often breathe like this.

You need to train your breathing to do the opposite. Breathe in for a count of one, and out for a count of two. You will activate the sympathetic system slightly, but the parasympathetic system more, and you will relax. You need to practice this technique all the time, not just when you are desperate, but when you have little to no pain at all. You need to practice until you can employ this technique automatically, calming your system and bringing you out of the danger response automatically.

How do you know when to stop when you are in pain?

For people with chronic pain, certain activities will often cause pain. For these people, pain becomes their “stop” signal. Sometimes pain can be delayed, so a person will often stop “just in case” the next time around. For people with chronic pain, pain is saying “stop” all the time. Generally, a person with chronic pain will always check their pain before undertaking an activity. They are thus restricted by a binary operating system which is pain-driven.

For people who do not experience chronic pain, “go” is normal. There is no need to check for pain. Pain has an acute function in this basic operating system; a person will stop if they are injured to allow time for their injury to heal. In general, however, pain is not important. For these people, their basic operating system is a quota system based on choice.

A choice is made when to stop, usually based on distance, time or repetitions. For example, at the gym a person may decide to do 20 push ups, and even though it may start to hurt after 5 push ups, the person will not stop. The pain is not important because they made a decision to do 20 push-ups.

But for a person in chronic pain, this system is defunct. They have lost their choice and are restricted by a binary operating system driven by pain. Pain is functional because it is in control. If you have chronic pain, you rely on pain to know when it is safe to move or not. You need to “rewire” your nervous system, remove pain from the equation and return to a system based on choice.

“It took me about 2 years to shift my nervous system and immune response. Now it works to my liking. It doesn’t mean that I don’t have pain. It doesn’t mean that I don’t get flare-ups. But my pain flare-ups have gone from 3 weeks of immobilisation to 3 or 4 days with full movement.”

3. The third practical intervention is to start pacing

  1. You need to start with time, and use an accurate stop watch.
  2. Select an activity. Choose as many as you want because the more you train, the more you can train and the more effective pacing is. For example, you might choose walking.
  3. You will have a baseline of pain. Start your activity and note the time when the pain starts or increases, not where it becomes overwhelming. For example, after 10 minutes of walking your pain begins to increase.
  4. Take a number of readings and then take the average. Reduce this time by 30%. You have effectively taken pain out of the equation. With this 30% buffer, you can do the activity with confidence and by choice. For example, you walk for 7 minutes with confidence and then you stop by choice.
  5. Continue to practice the activity with your 30% buffer until you are bored with that timeframe.
  6. Increase the timeframe by 10% and practice again until you are bored. Continue to increase by 10%.

It is a long process to “rewire” the nervous system, but if you stay with the program then your baseline of pain will eventually increase. Do not be overconfident when increasing the time frame. You can also work with repetition and distance, but always be planned and accurate.

“Chronic pain is like the dark side of neuroplasticity, but what I’m saying is this is the bright side of neuroplasticity, this is how we can rewire ourselves to live a better life. Chronic pain has already rewired your nervous system, so you are going to have to retrain it back.”

Practice, Practice, Practice

Practice is key. You need to practice normalising and increasing your movement. You need to practice your relaxation techniques. You need to practice your pacing activities. When you practice these three practical interventions, you are successfully “rewiring” your nervous system to better manage your pain and achieve a better quality of life.

If you want to read more about this approach to pain, we recommend “Pain Tracking” by Deborah Barrett and “Explain Pain” by Dr Lorimer Moseley.

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