Resource Review: “The Way Out: A Revolutionary, Scientifically Proven Approach to Healing Chronic Pain” by Alan Gordon

Hi everyone,

I hope you’re having a restful summer. I’ve been having an awesome time checking out Toronto’s farmer’s markets, taking my dog to the beach, exploring the Toronto Islands by kayak, and biking around the city. I also enjoyed a beautiful trip to Vancouver, where I hiked a mountain and am sending to the universe a proclamation that I’ve got to spend more time out west!

I’ve also been reading a lot this summer, and I wanted to share some of my favorite resources with you. My hope is that my Tuesday book review series inspires you to pick up these resources, or you can review my summaries in hopes you’ll find the information useful to your wellbeing.

For my first review, I’ve chosen to summarize a book about chronic pain that has significantly expanded my understanding on the brain/body connection.

Across many years working with folks with PTSD, depression, and anxiety, I have always been curious about the relationship between mental health and physical pain. Reading this book has been particularly useful as it has provided me with concrete studies, strategies, and ways of framing chronic pain that I’ve found helpful to share with my clients.

About the author:

Alan Gordon is a Licensed Clinical Social Worker (LCSW) and founder of the Pain Psychology Center in Los Angeles.

In 2022, Gordon and his colleagues published the Boulder Back Pain Study, which found that psychological treatment that focused on changing the relationship to chronic back pain may provide substantial pain relief.

The take-home message of this book is that actual felt pain in the body can originate in the brain, and that psychological treatment can be a tool to reduce pain felt in the body.

Here are some case examples that demonstrate how the suggestion of pain in the brain can cause actual felt pain in the body:

A nail in the boot:

The book features a case study published in the British Medical Journal in 1995 of a 29-year old construction worker who jumped on a 6-inch nail, which pierced through his boot and emerged out the other side. Reeling from terrible pain, the construction worker went to the hospital where the nail was extracted.

Once sedated, ER doctors removed his boot to discover that he nail had miraculously passed between his toes without penetrating his skin.

There was no damage at all to his foot. However, despite the absence of physical injury, his pain was generated by the brain and was indeed very real.

Hot probes and pain suggestions:

A study at the university of Pittsburgh conducted by Dr. Stuart Derbyshire placed subjects into an FMRI machine and touched participants with a hot probe to elicit pain.

Subjects were then hypnotized and it was suggested to them that they were being touched with the hot probe, while the probe came nowhere near them.

The findings showed that the same areas of the brain lit up when pain was actually elicited by the touching of a hot probe or the subjects were given the suggestion that they were being touched by a hot probe.

Whiplash and a placebo car crash:

Gordon’s book also describes fascinating research on participants in a German study who were placed in a car and put in the situation of a “placebo” rear-end situation - the car was moved forward with pullies and sensory information was used to simulate a car crash.

Three days after the fake collision, 20% of the participants had neck pain and four weeks later, 10% of participants continued to have symptoms.

This real pain came from the belief that the pain (and rear-ending) were “real”.

I was also fascinated to learn about the notion of chronic whiplash as a potentially psychological disorder. I learned that in Lithuania, chronic whiplash doesn’t exist because, culturally, there is the expectation that symptoms of acute whiplash will subside in a short amount of time.

This suggests that the expectation of a symptom’s prevalence can actually have an impact on whether the symptom subsides or intensifies.

I just want to pause here and have you consider if you are as flabbergasted by this information as I first was when I came across it.

The implications for this research are huge. It also aligns well with what I’m studying in clinical hypnosis - that the power of suggesting what may happen can actually influence the outcome. More on clinical hypnosis in another post, though!

Neuroplastic pain:

Enter the concept of neuroplastic pain. But first, let’s learn about the reason why we experience pain to begin with.

Pain has a central function - it acts as a danger signal generated by the brain to alert us to bodily threats.

So, for example, if you roll your ankle while running, your body will send a signal to your brain that your ankle is experiencing pain. This helps you ensure that you stay off that ankle for a while as it recovers.

However, imagining or thinking that pain originates in the body can actually have the brain create pain in that part of the body. Examples of this can include the belief that the body is structurally damaged due to a bulging disc, a nerve issue, curved spine, inflammation, scar tissue, muscle weakness, etc. The idea is that if you believe “something in my body is damaged, and this is dangerous”, the body will respond with pain.

When the brain misinterprets a situation as being threatening, a person can feel pain as if it were actually coming from the body. Imagine, then, that once your ankle heals after a running injury, you hyper-focus on that ankle. You may interpret even normal sensation in the ankle as a sign of damage, which can actually lead the body to create pain in that area in order to keep you off that ankle and safe.

A similar phenomenon can happen around, let’s say, PMS symptoms. Experiencing discomfort around a menstrual cycle is an expected experience. However, if the brain experiences these symptoms as dangerous (e.g. thinking ‘I have stomach cancer’ when there is slight discomfort) it can create a situation in which the brain sends pain signals to the stomach, creating a feedback loop of fear and pain.

Gordon highlights several factors that may flag whether pain is originating in the body or the pain is originating in the brain, which is known as neuroplastic pain:

·        Pain originating without injury

·        Pain originating during a time of stress

·        Pain that is inconsistent (eg, back hurts while standing but not while running)

·        Pain that spreads or moves around the body

·        History of a wide range of symptoms (eg, stomach pain, migraine, knee pain, etc.)

·        Childhood adversity or trauma history

·        Personality tendencies towards anxiety, hypervigilance, and perfectionism

Breaking the pain/fear cycle:  

In order to respond to neuroplastic pain, it is important to learn to experience pain or discomfort without attaching fear, judgement, or criticism to the pain.

Instead of experiencing the pain as dangerous,  it can be a practice to be curious about the physical sensations – to name the sensations, put language to the experience, and notice whether the sensations stay the same or shift at all.

Through the experience of lessening fear/anxiety around physical symptoms, those symptoms can actually subside as the brain no longer interprets them as dangerous (a process known as safety re-appraisal).

My FAVOURITE metaphor – symptoms and the Wizard of Oz:

One of my favorite takeaways from this book is a metaphor used to describe how looking at pain symptoms with curiosity can serve to actually reduce physical pain. I’ve found it useful to expand this notion to help clients respond to anxious thoughts, as well.

Let’s revisit the story of the Wizard of Oz. When Dorothy, the Lion, Scarecrow, and the Tinman visit the Wizard, they are terrified of him, and rightfully so - he is, after all, a giant floating head surrounded by blasts of fire.

However, it’s Toto who pulls back the curtain to reveal that the Wizard isn’t all powerful and terrifying after all. He’s just a little old man using gizmos to appear great and powerful. There’s nothing to be afraid of, even if he appeared intimidating at first.

Pain and mental health symptoms can be like the Wizard.

Sometimes we have a thought, sensation, or engage in a behavior that we feel is terrifying. It is the experience of that symptom as terrifying that can actually contribute to physical pain and the continued experience of symptoms.

But when we look at something with curiosity – in the way that only the playful, curious, non-judgmental Toto could do, we strip that symptom of it’s power.

Facing pain and fear in therapy:

We know that the treatment for anxiety is exposure therapy – that is, exposing yourself to the things you’re afraid of: heights, public speaking, conflict, and scary thoughts. Gordon’s book puts forward the idea that we can also practice exposure therapy to physical pain.

By becoming mindful of what it is that you’re afraid of or what’s causing you distress, you can learn to deal with the challenges and lessen anxiety around symptoms. In the case of anxiety, you may put the fears into words and practice gently exposing yourself to those fears. In the case of chronic pain, you can work with a practitioner to begin to focus on the sensations of pain, name them, and become curious about the sensations without experiencing fear around them.

I’m sure you can by now see that although this book was written to address symptoms of chronic pain, so many of the concepts can be borrowed to treat other mental health challenges.

This book has reinforced the importance of therapy to bring attention to symptoms in a way that John Kabbat Zin would define as mindfully “paying attention, on purpose, in the prevent moment, without judgement”.

When you pay attention mindfully, you pay attention without fear, and that can serve to reduce mental health and physical symptoms.

I hope you’ve found this information as useful as I have, and that if you’re struggling with pain or anxiety, these concepts  can provide a road map by which to begin to heal.

Until next week,

Jenn