Chronic pain is greedy. It spills over into adjacent areas of my brain, which is why on bad days I can't think clearly. If Bill asks me an either/or question, my brain comes to a halt and I am left hopelessly vacant. One idea is OK but two diverging paths is beyond my processing. Which is why when the pain ramps up, I try to occupy the adjacent areas before they are hijacked. I start inhaling visual information fast, looking around, concentrating on details, busy work for my eyes, so their real estate isn't conscripted into a pain machine.
The pain path up my spine is conveniently shared by nerves from my digestive tract, which is why when my stomach is out, which as a celiac it often is, my back is much worse.
Even trickier, stress travels the same route. So, having had a lot of external stress in my life, including as a very young child, the pathway was hypersensitive even before my back pain set in. As a physio told me, my nervous system is hypervigilant.
Now, I read that social exclusion activates one of the same circuits (the insula and anterior cingulate) as physical pain. So loneliness and pain will dance with each other, one egging the other on. Of course, having chronic pain is likely to increase isolation, because with the best will in the world there are many things that either I can't do or where I would be a drag. A further discovery: that social isolation increases inflammation!
So, pain signals run up my spine, along tracks greased by both digestive disease and severe stress. On arrival in my brain, the anterior cingulate and the insula interpret the signals as rejection which fans inflammation. As a result, renewed pain signals are sent up to the brain – and the vicious cycle begins again.
What I have discovered is that taking acetaminophen turns off these feelings of exclusion. I am on a daily extended-release pain killer (tramadol). Reading up on it, I learnt that it is works more effectively if it is combined with acetaminophen. My break-through medication is Tramacet (a combination of tramadol and acetaminophen). I wonder, I thought to myself, whether taking a 325 mg Tylenol twice a day would make my tramadol more effective.
When I read How the Body Knows it's Mind by Sian Beilock a light bulb went off in my head. She traced the loneliness-rejection-pain circuit and I realized that the intrusive, picky voice in my head which constantly presented clear cut vignettes of past hurts and mistakes is now silent. For how long? Since I started the acetaminophen!
This changed how I see myself. No longer someone outside, who didn't fit the group. That isn't me; it's pain poisoning my sense of self. As pain throbs through my back, it also lights the neural circuits of exclusion, which were probably already over eager from my lonely childhood.
As a child whose brother was institutionalized at age 7, I was terrified of being different or wrong, of being banished like him. So stress and fear of exclusion had sensitized pathways ready for pain, which flowed easily – all pain gates open. And that same pain then fuelled the neurocircuits of rejection, like an endless chorus playing in my head.
Two acetaminophen a day turned it off. It didn't banish the physical pain in my back, but the loneliness circuit has been taken out of the loop. I hope it has been quieted long enough that my brain will learn a different way of being.
Looking back, I can also see that my pain became more manageable and my life took an upward turn precisely when we move into a village townhouse, where it was easier for me to see friends and be part of a community. Ten acres in the country had become a prison as my back deteriorated.
So, what I am saying is that it is possible to turn the pain cycle round. Just as biology conspired to spiral me down into pain, it has been possble to climb the steep staircase back up – not to complete freedom from pain. There's too much physical damage for that, but to an enjoyable connected life.
Tips to Trick Pain:
Take pain meds before the pain sets in, so that the pain circuit doesn't get a hold
Keep your brain active, so pain can't steal real estate from your visual cortex nearby. Look, name, concentrate on detail
Take care of your digestion
Try to avoid stress: much is self-induced. Decide not to react or ruminate
Move as if you are not in pain to send a message back to your brain that you are moving well
If pain leads to melancholy thoughts, take a low level of acetaminophen (I take 325 mg twice a day) to calm the social isolation circuit and reduce inflammation
How the Body Knows it's Mind by Sian Beilock
Social isolation in childhood – link
Acetaminophen and social pain – link