Hi everyone. Welcome back to the EMDR Doctor podcast. I'm Dr. Caroline Lloyd, and today we're going to talk about pain. This is a fun one. Can't quite remember if I've done an episode on pain before, so today I will be talking about two aspects of pain, firstly about when pain comes up within the EMDR session and then I will be diving in to exploring the topic of chronic pain for a bit.
Firstly within the EMDR session. I've been working with a few people recently who have had a lot of physical sensation come up within EMDR memory processing and there's a lot of confusion about body sensations and what that means when people are processing a memory. So I'll give you a bit of an idea of what I'm talking about, first of all. So just imagine that we might be processing a memory. Let’s go with a classic example of a car accident.
And we are processing through the memory and we are processing the visual aspect, the image of the headlights coming towards them and then the moment of impact and the memory may have a lot of noise associated with it. Like they may say, yeah, I'm just hearing the dreadful screeching of the tires and the metal crushing.
And then they might start, say for example, rubbing their shoulder and saying yeah, it was really bad. I got trapped between the seat and the door, for example. And they're rubbing their shoulder and I'm saying, are you feeling that, in your shoulder?
And they'll say, yes. Yeah, it's crazy. I can actually feel the pain of that moment. It was 3 years ago and I’m feeling it like it’s happening now. And this is a really common thing. Memories exist with all of the senses attached - they exist as the visual representation and the auditory representation, the sounds that you heard at the time, when that event was taking place.
You might have smells that are associated with that memory, so there might be a smell of petrol or a smell of burned rubber or something to do with that car accident. And of course the emotions and the thoughts. So the emotions might be fear and distress, and the thoughts might be, I'm gonna die, I'm not safe.
Might be the beliefs - I'm stupid for getting in the car on a rainy day, something like that. And also there's the body sensations, like the sore shoulder. So people often notice that when they say, oh yeah, that anxiety is making me feel sick. Now anxiety can cause nausea, as a result of the stress hormones on the gastro-intestinal tract, but it might not actually be the anxiety to do with that particular memory, it might be a body memory of nausea at the time. So say for example, with our motor car accident example, there might be pain, there might be nausea there might be dizziness, and all of these are body sensations attached to the actual memory. So when we light up that part of the brain that holds that memory, we are lighting up the visual, the auditory, the emotions, the beliefs, and the body sensations. So those body sensations feel like they are actually really happening in this moment right now, as that memory replays.
Last night I was doing a session with a group of women online, one of my series of the group EMDR sessions that I'm holding at the moment, and a few of them were reporting body sensations. Now, I didn't know what memory they were working on because it was in the group scenario and we have a no trauma sharing rule in that scenario, so I didn't know the memory that they were working on.
But all they needed was a little bit of an explanation that, yes, this is part of the memory. It's okay. Just notice it and keep on going with the bilateral stimulation with the EMDR and it will pass. And they were shocked and delighted to see that it did pass, that they were able to work through that memory and as the memory became more processed, as we did more work with the bilateral, with the EMDR, with the eye movements and with the tapping and so on, the memory became less emotional. The picture became more blurred. The auditory part of the memory became less intense, and the physical sensations become less intense.
So I just encourage you, if you are on your own EMDR journey right now and you're noticing some physical sensations, talk to your therapist about it and they may be able to help you with it with some particular exercises. And also just continuing on with the processing will help that physical sensation to go away.
So the other thing I want talk about today is Chronic pain. When we talk about chronic pain, a lot comes up. So I just want to give a little bit of general education about pain right now to help people with some aspects of pain. Now, pain is not my specialty. I'm not a pain physician, I'm a gp. But many of my clients in the past and currently have had chronic pain for various reasons.
And in general, I think people are a little bit unaware of some very basic facts about pain. So I just want to bust some myths and give you some information about that now. So all pain is not equal. Pain can be felt more if you are tired, if you are hungry. If you are already distressed, if your reserves are low, if you are not sleeping well, if you are agitated because you've just had a fight with someone or had a bit of a shock in some way.
If you've just got a bill for five hundred dollars from your energy company and you don’t know how to pay it, there's agitation around that. If you then stub your toe, that toe will feel worse than if you had stubbed it on a day where you were feeling happy.
When we have more reserves, we feel pain less. You probably know that if you're a parent and your kids are tired, if it's the end of a day and they've had lots of excitement and they've had too much junk food. If they fall over, they will be wailing. It won't just be a little cry and a hug will fix it, like on a normal day. They'll be feeling that pain a lot more because they've already got some layers of distress happening. And that's the same for adults.
So if you have chronic pain, then a lot of people, when they go to a chronic pain clinic, they'll be quite disappointed to hear that part of the chronic pain treatment is regular relaxation and regular physical exercise, getting good sleep.
The chronic pain clinics actually work in a very holistic way and they emphasize good health in all areas. They won't focus on the pain initially. They will focus on lifestyle changes to help give you more reserves. To help you feel more whole, more grounded, less upset, less agitated in general, and whilst this sounds a little bit Mickey Mouse, it does actually work.
There's a lot of evidence to show that if you are feeling less agitated in general, your chronic pain becomes less severe.
So that's a really good reason to do all of those things like the meditation, the relaxation, maybe self-hypnosis, which I actually find to be a much more accessible way to relax than just meditating. So if you're interested, have a look on YouTube. Find self-hypnosis for anything you like, including pain and give that a go.
So in helping chronic pain, the plan is to make sure you get enough sleep, make sure you're eating healthy foods, make sure relaxation is a daily practice. And that brings me to exercise - I can virtually hear everyone groaning. The idea of me saying. If you have chronic pain, you need to exercise. Everybody needs to exercise. That is just the rule. Everyone benefits from exercise.
There's lots of evidence to show that it improves mood. It improves sleep.
Exercise helps keep your weight at a stable level. It helps to regulate appetite, it actually helps you be more in touch with hunger signals and satiety signals, so it helps regulate weight in more than just expending calories.
Exercise keeps you strong so it actually prevents further injury.
The other benefits that exercise brings you is social contact. It gets you out of the house, might give you more time with the dog. Say for example, you might meet your neighbors on a walk or you might make some friends at the gym or make some connections or say hello to the people at the Pilates class, whatever it is that you choose to do.
So it increases social connectivity.
And I'll just mention here that I am aware that for some people, exercise is not possible. But if a little bit of exercise is at all possible, then it's a very good idea to do it.
And another really important point to make is that it exercise is actually a catalyst for brain plasticity. Exercise increases neuroplasticity, and what I mean by that is that it makes the brain more adaptable. It enhances neural connections between certain neural pathways. And if that's the pathway of I'm exercising, I'm moving my body, this feels good, I feel capable my body is working well and strong, then it's enhancing those neural networks.
And as a result, it's actually degrading the neural networks that are saying, my body is broken. I'm in pain. This hurts. I'm in danger. I need to stop. I'm hurting myself. So the more we can do exercise to enhance neuroplasticity around the positive neural networks and create better neural networks that reinforce- my body is strong, I’m doing a good job, I'm safe doing this exercise or this movement. Then the less we have those very ingrained pain neural networks. So it's a kind of a competitive stimulation, a little bit like EMDR. Yeah, so exercise is really great for enhancing neuroplasticity and creating new neural networks that are more healthy and more adaptive and more supportive of health than the old chronic pain neural networks.
So I'll just transition here a little bit and talk about beliefs.
There's a big influence on pain from our beliefs, and I'll dive into that in a little bit more detail. So if we believe that our pain means that we are in danger, that we are helpless, that we are incompetent, or that we should give up, I. Then that is actually gonna make the pain worse. So if we experience pain and we have strong beliefs about our capacity and our ability to cope, then that pain has less of an effect on us.
Chronic pain is more often found in people who have traumatic histories - maybe the acute pain or sensation is interpreted through the lens of the beliefs that came about because of the trauma - I am broken, I can’t trust anyone, I’m in danger, I am going to die. If we develop these beliefs about ourselves in childhood, form trauma, then adverse events, like a broken ankle, can set up in the brain the expectation of harm, so the pain from the ankle becomes entrenched and chronic pain. What may happen here is the concept of Central Sensitisation. This is a concept of how the brain gets ‘re-wired’ to expect pain and suffering even when the initial injury has healed. In other words, pain has ceased to be a symptom and has become the disease. So in the case of an ankle fracture, once it is healed, usually the pain disappears, but in someone who has a history of trauma and their brain is on red alert to danger, then even the sensation of pressure in the ankle with walking, may be interpreted by the over-agitated, sensitised brain, to be dangerous and painful. Persistent pain is a case of neuroplasticity – re-wiring - gone wrong and our brain has become hypersensitive.
But if we can enhance our beliefs about ourselves and help ourselves feel more strong, more capable, more whole, we can believe that we have more ability to cope, then the pain will affect us less. So beliefs do influence how we experience pain. And even if we are currently in a chronic pain cycle, the more we can work on our beliefs, the sooner we can get out of that chronic pain cycle or alleviate it in some way.
So I hope that makes sense. As always, I just want to say that what I’m talking about now does not constitute individual medical advice. I'm speaking generally in themes and in ideas. And if you want to explore these more with your medical provider, your gp, your pain specialist, exercise physiologist or your psychologist, then that's probably a really good idea to have that conversation with them.
And how does this relate to EMDR? So in working on pain using EMDR, we can work on several levels - we can work on the incident that caused the pain in the first place. To take some of the distress out of that, that can actually help alleviate how we experience pain. We can work around the beliefs about the pain. We can work around the current day experience of the pain and take some of the distress out of how pain is experienced right now. This can break out of that negative feedback loop of pain creating agitation, which magnifies the experience of pain.
We can work on some of the avoidance around the pain and and help to dismantle some of the barriers to doing more in your. and just like we can work on pain, we can work on other body sensations, we can work on tinnitus even, and dizziness and definitely nausea. That's something that I've worked on a lot with people.
So I hope this has been helpful to you. If you'd like to give me any feedback, please do comment on on Spotify or on Apple Podcasts or feel free to get in touch with me via my website, emdr doctor.com au. Just before I finish, I will mention that my membership is now open, very exciting, for people that I have worked with in the past who want to continue their work with me in a very low cost accessible way in an online group for EMDR, if you go to emdrdoctor.com.au and look on the membership page, you will find all the details. I have a discount coupon for June and July to join for half price, which will last for the whole life of your membership. Which is kind of an unbeatable bargain!
So I hope you all have a great week. I look forward to talking to you again soon. In the meantime, take good care. Bye for now.
