Bonnie

Redwater

Brighton, UK

Explore the neuroscience of pain, learn practical tools, and integrate mindfulness for a transformative healing journey.

Pain Is Normal, Real And Protective

Hello. A big welcome to each of you. You've come to this course probably to make a difference to this precious life of yours. Really honourable undertaking and it takes a bit of time and energy, doesn't it? Well done. And mindfulness and pain education can provide some really powerful tools for this. So right now, let's arrive here at the course. So just whatever you are doing, whether you're sitting or lying, standing or moving around, just taking a pause. Noticing the posture of your body. If your feet are on the floor, noticing the sense of your feet connecting to the floor. Just taking three deep, relaxing breaths. Staying present to each breath the best you can. Hmm. And perhaps welcoming yourself now into the present and into this course. Our first lesson is titled, Pain is Normal, Real and Protective. So chronic pain is an enormous problem. Worldwide, around 20 to 30 percent of people have a chronic pain state, which is out of proportion to tissue healing times. Just to clarify here that tissue pertains to all the bits that make up our body. Bits of skin, muscles, tendons, ligaments, cartilage, organs, bones, nerves, discs, joints, etc. Chronic pain is most easily defined as persistent pain that lasts at least three months. And just to qualify that it's not necessarily severe. Patients do come in to GPs, in Australia at least, and say, oh my pain's really chronic. But what they mean is that it's severe. And chronic pain is not necessarily there all the time. In fact, it's rare that it's there all the time. So this part of the course is Pain Science Education or Pain Explained. And there's actually a model called Explain Pain brought to us by David Butler and Laura Mimosley from Adelaide in Australia. And this comes out of a worldwide revolution in pain sciences. This modern view of pain neuroscience is very different to what a lot of us were brought up with. There are bucket loads of evidence to support this model. In fact, Explain Pain with Movement has the best outcome for many chronic pain states. So we're not going to be focusing on the movement very much in this course, but we'll have a little play with it as well. Just a few really big key statements now. Pain is produced when the brain believes you are under threat and need protection. The modern pain neuroscience has shifted from pain as a measure of tissue damage to pain as a protective buffer. And I like the little metaphor of pain as a bubble wrap suit. So back to these big key statements. Listen to this slowly with a bit of an open mind. Pain is made by the brain 100% of the time. Now I'm not saying the pain is all in your head. What this means is that all pain, all pain, including pain from putting a hand in a fire, is actually produced by our brain. And this actually includes the whole of what we call the NEI ensemble. The whole of the neuroendocrine immune ensemble. Our whole system really. So from now on when I mention the brain, I'm often including this whole NEI ensemble. Now even this is too simplistic. Pain's just so, so complex. And we're not going to discuss here whether it's our brains or our minds that actually produce the pain. But either way, of course, we feel the pain in our bodies. And our minds, brains and our bodies are not isolated. They are all embedded in the world in relationship to living and non-living things. But this statement, pain is made by the brain 100% of the time, can be a really useful pithy one to remember. And it's okay if it takes a while to land. Just remember, it's not saying that the pain is all in your head, quite the contrary. And you can't just snap your fingers and think your way out of pain. So there's some concepts in EXPLAIN PAIN that are so important that they're called target concepts. And today we're going to discuss the first one. And that is that pain is normal, personal and always real. The pain is normal. Life can hurt. If you're at this course, you're probably well aware of that. And in Western culture particularly, there sometimes seems to be an idea that life shouldn't hurt, that life's like a Disney movie, that anything wrong that happens on the way is some kind of aberration before the happy ending. But of course, life can hurt. And everyday pains are fairly simple to understand. But pain can be much more difficult to understand. And we all know emotional pain can be even worse than physical pain. And there's quite a lot of overlap with the two. Pain is always real. Please let this sink in. Pain is always real. There is no such thing as imaginary felt pain. So how do you know you're experiencing pain? This isn't a trick question. So right now, I have a little bit of discomfort in the base of my neck from looking over my computer a bit long. That's how I know I'm experiencing mild pain. You can't have pain and not know about it. You can have a kind of vague, unpleasant feeling tone without it being fully in awareness. And we're going to discuss that in the next lesson. But pain is much more than that. Felt pain is never imaginary. If you feel it, you have it. Yes, you can imagine pain and yes, you can fake that you've got pain. But felt pain is never imaginary. If you feel it, you have it. And on that line, no health professional can tell you if you have pain or not. You can look around any group of people and you won't know who's in pain or not at any minute. And neither can health professionals know, no matter how expert they are. They may be able to tell you what an X-ray shows or the state of your tissues, but not if you have pain. Knowing you have pain is unique to you. That's the end of the first target concept. Pain is normal, personal and always real. And now we've finished this lesson. Please search the free Insight Timer app for Adele Stewart Unfocused Body Awareness Practice, which is a 15-minute meditation encouraging an introductory, non-threatening exploration of bodily sensations and allowing the body to express itself freely. Please practice this a couple of times at least before the next lesson if you can. A lot of this education is quite conceptual and this mindfulness meditation is a great way of being in the present, in our bodies instead of up in our head in the conceptual mode. I can guarantee you'll get more out of the course if you practice the meditation suggested at the end of each lesson at least a couple of times, if not more. And in our next lesson, we'll learn about perception, feeling tone and the importance of noticing the pleasant. Bye for now.

How We See Things Makes A Difference

Hello, welcome to lesson two. How we see things makes a difference. Let's just start off with that pause. Just stopping. Perhaps feeling your feet on the ground. Noticing the posture of your body. And keeping a very soft, open gaze. Have a little look around your environment. And without needing to judge, just noticing what kind of draws you to it. It's pleasant. And perhaps a bit of the opposite. Keeping that gaze really soft. And moving to the sense of hearing. Doing the same thing. Noticing sounds. No need to strive to find them. Just allow them to be received. And notice sounds that are pleasant. You enjoy listening to. And sounds that might be unpleasant. You prefer not to listen to. If you happen to be eating or drinking something, you could repeat this with the sense of smell and taste. Finally, just moving to the sense of touch. Noticing what feels pleasant against the skin. And what feels unpleasant against the skin. You need to try hard here. Just a gentle noticing. And letting that go. And today's lesson is about perception and feeling tone. So our brains make incredibly complex predictions about us and the world based on our past experience and from the data that our five senses and our thinking brings in. It's doing this constantly, all the time, at an incredible speed. Let's do a little experiment to explore this. Notice what happens in your mind's eye, in your thoughts, as I tell you this tiny story. Sam is walking to school. She's worried about the maths test. She didn't know how she could control the class. After all, it wasn't really a part of a janitor's duties. Depending on our past and context, a lot of us would have had a really similar kind of mental model going on there. Can you see how we're constantly making a predictive mental model and updating it when errors come in? For some of us, it might be, we presumed Sam was a boy. Then we presumed that she was a student and then a teacher and then, oh, a janitor. And this is, of course, necessary and really helpful. And our perception is so colored by so much, our genetics, our past experiences, our current mood state, our pain, our context, you know, where we are, who we were with. All of this, how it affects how we read any particular situation and what meanings we make of it. Even right now, if you came into this lesson from a demanding day with many frustrations compared to if you've had a really spacious, nourishing day, it'll absolutely impact how you're taking in this information right now. And how we perceive things will have a huge effect on how we react to things and experience them. This includes stress and pain and illness and all the good stuff. Even holding our perceptions just a little more lightly can give us a bit of freedom, open us up to possibilities. So, one of the basic ways that our nervous system orients us to our current experience is whether something is pleasant, unpleasant or neutral. And we can call this feeling tone. So, the human nervous system is hardwired to constantly and automatically evaluate all experience as pleasant, unpleasant or somewhere in between, which we could call neutral. This is often out of awareness and immediate. So, as a little experiment, I'm going to mention some sensory experiences. And in your mind's eye or your imagination, I want you to bring these to mind and notice your automatic reaction. It might be a, ah, or a, ew, or a, mm, or a, yeah. And this is before thought even kicks in. The first sensory experience is a delicious cake. And the second is nails on a blackboard. The third is a gorgeous natural landscape. And the fourth is a big pile of dog poo. This is like an immediate kind of thumbs up or thumbs down or neutral. Just looking around your room now and listening in your room as well. Thumbs up when you see something pleasant, thumbs down when you see something unpleasant and just keep it flat when it's neutral. No need to judge. This is being human. And now just dropping into your body and same deal. Can you notice any pleasant sensations? Maybe a mental or an actual thumbs up. Any unpleasant sensations? Thumbs down. Perhaps a little less obvious. Anything's neutral. Noticing how natural and automatic this evaluation is. This is going on constantly. And just notice how your awareness, which gets more vivid with mindfulness practice, is able to tell us what we're finding pleasant or unpleasant. And mindfulness practices really increase our capacity to notice these subtle feeling tones in our bodies and also to increase our capacity to be not so reactive to unpleasant and pleasant sensations. Normally, we immediately want to jump away from something unpleasant. And of course, that's really adaptive, like if you put your hand on a hot plate or something, real danger, right? But when we're automatically trying to get away from our body sensations or our sadness or our anger or our thoughts, then we're in trouble. They need our attention, not our reactivity. Just a little emphasis on noticing the pleasant now. And this is important. We can get so preoccupied with our mental world and what is not right, we don't even notice what's pleasurable and good. Rick Hansen says we have Velcro for the negative and Teflon for the positive. So right now, see if you can feel anything pleasant going on. It might be something visual in your space. It may be the feeling of doing this course. It might be the sense of something pleasant happening in your body. It might be even really subtle, like part of you is the right temperature. So actively noticing the pleasant moments of perhaps really subtle pleasure or ease or joy or just contentment. And particularly if we savour it or Rick Hansen says marinate in it, can be very, very helpful. It can change our perception of ourselves and our lives. It can increase our resources to manage stress, including all the stress around the pain experience, actually rewiring the brain. Between this lesson and the next, I'd like to invite you in daily life just to notice the effect of deliberately spending a little time savouring anything pleasant. A pretty bird song, a perfect cup of coffee, and pleasant tingling in the ends of the fingers, some good news. And perhaps noticing the effect on your perception. Also, I ask you to search the free Insight Timer app for Adele Stewart, Yes, There Is Pain And, which is a short practice of noticing the pleasant even when there is unpleasant. And also encourage you to keep going with the unfocused body awareness practice. Remember, you can bookmark these and save them in a named folder. And in our next lesson, we're going to learn about danger sensors and why there are no such things as pain sensors. See you then.

There Are Danger Sensors Not Pain Sensors

Hello, welcome to lesson three, there are danger senses not pain senses. So let's just start with a little grounding, that pause, noticing where you are right now, maybe having a little look around your environment, what you can hear, what you can feel in contact with the surface that you're resting on, clothes against the body, what you're noticing inside, no need to try and get rid of this to to get calm or anything like that, just simply noticing and perhaps having a sense that the surface you're on can hold you, whether it be a chair or a floor or the earth outside, you might even want to take a couple of breaths and consciously relax a little bit into being held by this earth. So this lesson introduces the second explain pain target concept, there are danger senses not pain senses. The old idea of pain is that there are pain senses in our tissues, they get hurt and tell the brain we're in pain, but this isn't actually true. So throughout all the tissues, all through the body, skin, muscle, joints, organs, etc. There are danger senses. These can perceive pressure, temperature and chemical changes. They're specialized little nerve endings and I like to think of them like little alarm bells at the end of nerves. Now these danger senses are called nociceptors, n-o-c-i-c-e-p-t-o-r-s. Nociception is from the same Latin root as noxious. So nociception is the nervous system's response to something that harms us or even might harm us. So this statement now is super important one. Nociception is an input, pain is an output. Say that again, you might even want to write it down somewhere to contemplate this week. Nociception is an input, pain is an output. So there's actually no such thing as pain detectors or pain sensors. There are only danger detectors or danger sensors or the medical term for that is nociceptors. Okay, so sometimes it can be a bit helpful to have an actual example. A nice simple one would be stubbing your toe. So if you were asked to think about it you'd probably go well that's really easy, you stub your toe and the pain endings in the toe send a pain message that travels up pain pathways to your brain. But no, there's lots of these nociceptors, these nerve endings in the toe that send danger messages up to your brain to tell it that there's been too much stubbing and then it's the brain that judges if a good dose of pain might help you. So think of staggering to the fridge in the middle of the night for a midnight snack and stubbing your toe on the fridge, ouch, versus running across a busy freeway, perhaps you've got flip-flops on and you hit your toe on a brick in the middle of the road, exactly the same injury but there's no pain because the brain's judging, it's more important to get across that freeway right now, exactly the same injury but very different pain. You'll probably have a really sore toe once you stop at the other side to remind you to tend to it. So there are no pain endings, there are no pain fibres, there are no pain pathways and there are no pain signals. It's true and if you can really take it on it kind of changes everything. Okay, so let's talk a bit more about these nociceptors or danger detectors and what they actually detect. So they're detecting things like stretching, pressure, so in our stubbed toe it would be the stubbing's a kind of pressure, temperature, lots of chemicals, things like adrenaline, inflammation, chemicals, lactic acid. So for instance, if you've been doing a fair bit of sitting down, you might even take your attention into your body right now and notice any sensations from sitting for a little while, perhaps in the neck, the upper and lower back, the buttocks. Even for those of us with no chronic pain, it's completely normal to feel a bit achy after sitting still for a while. Immobility will cause a temporary lactic acid build-up and this chemical change will send danger messages up to the brain and the brain will often produce a mild pain experience to encourage us to flush out the acid by moving. Actually, let's do that right now. Perhaps you want to have a bit of a stretch or a forward fold or even a little jiggle if it's, if you're somewhere where that's possible and flush a bit of that acid out right now. Ah, that's better. Okay, so we're talking about these danger detectors or nociceptors. Because our bodies, our systems are adaptable and complicated, over time these nociceptors can change and become sensitive. The thing is when the nociceptors are sensitized, they get more sensitive to everything. Doesn't matter what initially caused the damage, they'll now be sensitive to pressure, temperature and chemicals. When they become sensitized, this, the function of this is to increase the protective buffer. Remember in our first lesson, we talked about how pain is protecting you from damage with this buffer. So when these nociceptors become sensitized, it might be like, I use the metaphor of the bubble wrap suit, that gets thicker. They're protecting you even more. Better to be safe than sorry. And danger sensors, nociceptors, have adjustable sensitivity. So some like this metaphor, you could think of the nociceptors as being like security guards at a club watching for danger. Sometimes they get really excited, like they've all been given some red bull. Suddenly every person in the queue is looking dangerous and they're throwing people out of the line all the time. Yeah, makes sense. So you might be ready for some good news about now. The really hopeful news is that these nociceptors only live a really short time, just a day or two, like butterflies. And they're actually constantly dying or being made. So this is very good news. Your system might be really sensitive, but it can also change really quickly. So just one more concept to introduce today, and we'll talk about this more later. The concept of the brain as a prediction machine. And this concept is really big in neuroscience these days, predictive processing. We touched in on this when we were talking about perception. So along with the input from perhaps over-sensitive nociceptors, the brain also considers a whole lot of other things. In fact, the brain is constantly balancing up the danger and safety level in our system and making incredibly complex predictions based on our past experience and our sensory input. It's taking in like a symphony of data every nanosecond. The things like context, stress levels, fear of our pain, poor explanations from doctors about our pain. So many other things are taken in and processed. And unfortunately, the brain errs on the side of being overprotective. And then there's often a vicious cycle. The more pain and stress we have, the more likely it is that pain will be produced. We're going to go into this much more in the next few lessons. Alan Gordon, who's a wonderful psychologist in the pain field, says our brains have extraordinary power to affect where, when, and how much pain we have. And this is also good news because as our mindfulness practice gets stronger, it gives us the space and time to begin to explore our brain's predictions and see if they're actually true. This can open up freedom. It can open up other possibilities. Okay, so until the next lesson, you're invited to consolidate the learning from the last lesson, actually. Searching for the meditation, Adele Stewart, Feeling Tone with Tension and Relaxation in the free Insight Timer app to closely observe sensations as they arise beyond evaluations or thoughts. I really encourage you to do this two or three times. It's a 20-minute practice. And our next lesson is, I think it's quite an exciting one, called The Pain Signature. So, bye for now.

The Pain Signature

Hello, welcome to lesson four, the pain signature. So today let's start with some very easy movements that allow us to experience some of the kinds of sensations our body speaks in. We're starting off just by rubbing your hands together gently. You notice the warmth of rubbing your hands. This is heat and often people might describe their pain as as a burning or heat. Just noticing warmth as a sensation here and then stopping rubbing your hands and maybe feeling them cooling down or there might be some obvious coolness somewhere else in your body. Let's check out weight now. Lifting your arms out to the side, maybe up around shoulder height and just holding them there a moment. Noticing the weight caused by gravity and then if you like you might like to bring your arms across the body and wrap yourself in a hug. Maybe squeeze and notice the sensations of pressure. Again some people might describe their pain with a word like pressure or sometimes the pressure feels nice and safe and cozy. Then relaxing those arms down. Perhaps you might even notice that they feel a bit lighter now that they're being up at your sides and now by your sides. Now raising your shoulders towards the ears if that's okay for your body. Holding there for a moment. Feel how it brings this sensation of tightness, density and then releasing. Noticing the softening often brings a more diffuse, open kind of feeling. People often describe their pain in terms of tightness or density. And now let's notice the sensation of movement or stillness. Perhaps noticing if the feet and toes are quite still, how that feels and then giving them a little scrunch with your toes. I didn't want to do this your hands and fingers as well and notice any tingling or throbbing sensations that come with this. Again another term that people will sometimes describe their pain with either a throbbing or perhaps a kind of deadly stillness. So we're going to go into another practice of actually exploring our pain signature. Being really curious about the sensations, how they feel. We're taking this little practice that we did into this next experiment. We all know pain, almost by definition, is pretty unpleasant most of the time. And of course we have that immediate wanting to move away from it feeling that is wired in. But right now we're going to do something a bit different. We're going to do an experiment of getting more intimate with a pain sensation and investigating this with kindness and with the mind of a scientist. You'll need an actual piece of paper here or your journal but a paper and pen is going to be easier than using an electronic journal here. I'm going to explore what pain is made up of, what elements it's made up of as an experiment. Bringing curiosity to it rather than aversion. Or perhaps we can bring it alongside our aversion. So starting with writing down at the top of a piece of paper the word intensity. And now checking out, have you got any little patch of unpleasant sensation you could practice on? Probably most of us will. Centering your attention there. Noticing where it is in the body and for this moment allowing it to be exactly as it is. And writing down under the word intensity the amount of distress it's causing you right now out of ten where zero is no distress whatsoever and ten is a lot of distress. Good. I'm going to ask you some questions about this patch of unpleasant sensations and see if you can bring the mind of a scientist to this exploration. Quite a kind or at least neutral approach. No need to judge or react. So going back to your piece of paper and writing underneath where you've noticed your intensity or distress level. On the left hand side of the page the word still and on the right hand side of the page the word moving with a horizontal line joining them. On the far left of this horizontal line is a zero for extremely still and on the far right of the horizontal line is a ten for extremely moving. Now moving sensations could be throbbing, pulsing, tingling, shifting and still is where none of this is going on. But checking out your sensation now. Still or moving? A deadly still might be a zero, a strongly moving might be a ten or five might be neutral. Neither very still nor moving a lot. Write your number down. Good. And now the second element we're going to explore is the sense of heaviness or lightness. So underneath what you've just done writing the word light on the left hand side of the page and heavy on the far right side of the page with a horizontal line joining them. So on the far left of this horizontal line is zero for extremely light and on the far right of the horizontal line is a ten for extremely heavy. So on a scale of zero to ten is this sensation really heavy? Maybe a ten? We all know what that feels like. Or more light? Maybe a zero or a one or two? So checking out your sensation out now. And a five might be neither light nor heavy. Writing your number down. Good. The third one is the sense of density. A little bit more unusual. So you know how when we lifted our shoulders before or if you clench a fist it feels very defined and dense and tight. And when you relax your hand or your shoulders it feels more kind of diffuse or vague. So writing underneath what you've done so far the word diffuse on the left side of the page and the word dense on the far right side of the page with that horizontal line joining them. So on the far left of this horizontal line is zero for extremely diffuse and on the far right of the horizontal line is a ten for extremely dense. So just checking out whether this patch of unpleasant sensation is more dense, defined, tight towards a ten. Or perhaps quite vague and diffuse and more almost like a gaseous texture more towards a zero. Or a five might be neither dense nor diffuse, more neutral. Writing your number down. Good. And our last element is temperature. The sense of heat or coolness. We all know these feelings in our bodies. So writing underneath what you've done so far the word cold on the left hand side of the page and hot on the far right side of the page with a horizontal line joining them. So on the far left of this horizontal line is zero for extremely cold and on the far right of the horizontal line is a ten for extremely hot. So right now check out whether this patch of unpleasant sensation is more towards warm or even hot. Maybe a seven, six, seven, eight, nine or even ten. Or cooler, more towards a zero, one or two. Or maybe neutral, a five. Write your number down. Good. So now we have some data direct from our experience. This is the pain signature of that unpleasant sensation. And now for a short period, just a minute or so, I want you to see if you can bring the mind of a kind curious scientist to these sensations again but with even more kindness. Recognizing them just as they are. All humans experience these kinds of sensations. Allowing your excellent capacities for noticing to be here and being with this sensation. Examining the qualities with a real sense of kindness. Even imagining you're putting out the welcome mat. Opening your heart to this pain. It's just for 60 seconds. Can you be really kind? You're more than halfway through. Maybe notice is there any change, even a tiny shift. Being with these sensations that are impermanent and also impersonal. Any human would feel them in this way if they'd been through what you've been through. Seeing if you can stay with that curious kind scientist type mind. No need to judge or react. If you go off on a thought stream, bring yourself back to the actual experience. And now let's collect our data once more and see where we are now. We're just going through moving or still. Strongly moving a 10, very still a zero or somewhere in between. Write that number down, perhaps with after in brackets afterwards. And the sense of heaviness or lightness on a scale of one to 10. Is it one, very light or 10, extremely heavy or somewhere in between? And write it down, the after number. Then the density. Check out, is it really dense and defined towards a 10 or quite vague and diffuse towards a zero or somewhere in the middle? Write that number down as the after number. And checking out the temperature, is it more hot or warm towards a 10 or neutral, maybe a five or cooler, more towards a zero? Writing that number down with an after. And lastly, what's the intensity now, the level of distress now? Find your number and write it down with the after. Okay, so well done if you managed to follow it. It's not that easy with audio. And now that you've done it, you might like to practice it again if you've got a little bit more clarity around it. But everyone will experience that a bit differently every time. And sometimes you'll find it difficult, sometimes easier. Often sensations change, but sometimes they stay the same. They often improve, but sometimes they get worse. Just noticing, how did you respond to that? You might like to make a note in your journal. How did you respond to any change? Was there a familiarity in this? Was there something new in this? What else did you notice? Making a note in your journal and feeling free to post about this. Be interesting for everybody. So for your home practice, you're invited to keep practicing exploring the pain signature in daily life. It only takes not much more than a minute, noticing the intensity of pain and the four elements. And just for 60 seconds, really welcoming those sensations with as much kindness as you can and noticing any change. And do that two or three times a day, you'll really notice a difference. And it could be very helpful to keep practicing either the Feeling Tone with Tension Relaxation or the Unfocused Body Awareness practice from the free Insight Timer app under my name Adele Stewart. And look forward to doing the next lesson, which is Hurt Not Harm, how tissue damage and pain are much less related to each other than you might think. Goodbye.

Hurt Not Harm

Hello and welcome to Lesson 5 Hurt Not Harm. Just noticing your posture right now. Noticing the effect of gravity. Contact of the body with the surface it's standing or sitting or lying on. The imprint your body is making on the earth. Ever so gently taking your attention to your breathing. No need to change the breath or manipulate it in any way. Just noticing it. Noticing the felt sense of the breath in the body. No need to analyze it or visualize it, imagine it. Simply noticing it. In-breath, the out-breath. The in-breath and the out-breath. Knowing it's completely normal for the mind to wander. This happens to everybody. No need to criticize yourself, give yourself a hard time. A smile when you notice the mind has wandered. Gently direct the attention back to the breath. Letting go of attention to the breath now. Know that this lesson introduces the third target concept of explained pain. Pain and tissue damage are poorly related. Just a quick summary before we head into this. In our first few lessons on the pain science, we've learnt that pain is a protective buffer, that pain is produced by the brain or NEI ensemble, neuroendocrine immune ensemble, 100% of the time. That nociception or danger detection is an input and that pain is an output. The pain or hurt and tissue damage or harm are two very different things and they are poorly related. The tissue damage harm piece is only one part of the amazing pain experience. At one end of the spectrum, we can have absolutely no pain, even though we've got harm or damaged tissues and danger sensors working. And at the other end of the spectrum, pain can occur even when the danger sensors aren't involved and there's absolutely no harm or tissue damage. I'm going to tell you the true tale of the two nails to show the extreme ends of this spectrum. The first nail tale is a famous case study of a 29-year-old construction worker who had a scary fall at work and was brought into the emergency department in the UK with a boot on, with a seven-inch nail right through it and he was in horrendous pain, was given high-dose morphine, the boot was very carefully removed and there wasn't a mark on the skin. The nail had gone right between his toes. The brain doesn't always get it right when it decides how much pain is needed to protect us. In this case, normal signals from the feet were misinterpreted by the brain as danger signals, most likely due to his brain having sized things up, mostly the visual of the nail sticking out of his shoe, but also knowing it was a dangerous work environment, his co-workers' horrified faces, his own fear and panic. This all set off a cascade of biological and neurochemical processes. His brain, synthesising the sum total of this information, decided he was in danger so it made pain to protect him. Real pain was generated by the brain entirely as a result of factors having nothing to do with actual tissue damage. Yet was as intense as if he'd been stabbed. In this case, a complete false alarm. On the flip side, the second nail tail, another construction worker, dangerous job that, was using a nail gun, when it unexpectedly discharged backwards, clocking him in the face. Other than a mild toothache and a bruise under his jaw, he thought he was fine. Six days later, six days of eating, sleeping and working, he thought he'd better go to the dentist to check out his mild toothache. Much to his surprise, an x-ray revealed a four-inch nail embedded in his head. The nail had actually pierced his brain. So here the brain had anticipated the nail going forward and there was no fear. The brain wasn't on alert. So almost no pain was produced despite actual bodily harm, an urgent need for medical intervention and no doubt gnosis centres sending massive danger messages. So these are extreme examples, but really useful, eh? And one more pretty amazing example, phantom limb pain. Most of us have heard of this. So extreme, there's no limb, no tissue, certainly no nociceptors, but there can still be pain. Pain is such a powerful protector that it can happen in a body part that no longer exists. So let's talk a little bit more about what happens after the initial injury or damage. So in the early stage of any initial injury, in the first few days or perhaps weeks, then sure, tissue damage and inflammation will be a really big contributor to the pain. But after some days or weeks of healing, the pain associated with the tissues gets less and less and less and the pain associated with the brain and nervous system and endocrine and immune system becomes more and more of a contributor. This applies to really serious injuries as well, which may take longer to heal. Things like fractures that might take six weeks, ligaments and discs which have a lower blood supply might take a few months and damaged nerves can take even longer. But even so, by let's say 12 months at the most, injured tissues will have been through the normal healing process. Tissues may still be unhealthy, they may be sensitive, they may be unfit, crying out for movement. There may even be some scar tissue, but they are healed. Now some of you will have had diagnosed conditions that do have an element of stuff happening in the tissues. But again, the longer it's been there, the less the stuff in the tissues is likely to be related to the pain. So understanding this normal tissue healing process can really help anxious parts of us who might feel that we just can't stop seeking medical answers, which might be unnecessary or can be even worse. I just want to talk a little bit about the problems with scans in Western medicine. And chronic back pains are a really good demonstration of what can go wrong in the way current medical practice in Australia and the US and I'm sure a lot of other countries often works with investigations to try and diagnose things. So if you suffer from chronic back pain, you may have had a version of this conversation. You. I've had back pain for months, it hurts constantly no matter what I do. The doctor. Hmm, let's do an MRI. Oh dear, your MRI shows you have a 4mm disc herniation at L2-3 with partial nerve root compression. You. Ah! And doesn't it sound like your poor defective spine has an enormous disc jutting out and crushing a nerve? The image is terrifying, but also somehow appealing, right? There's pain, there's a reason. Surely there's a fix. Well no, here's the reality. Our bodies are in no ways like cars and a mechanic. There is lots of research to show that back surgery really relieves pain. That two-thirds of people with no back pain, I will say that again, two-thirds of people with no back pain have disc bulges, degenerative disc disease, disc protrusions and disc herniations. In fact, the only people who have perfectly unblemished spines are babies. Imaging, MRIs, CAT scans, X-ray findings have little or no relationship to patient's back pain. So chronic back pain is 100% real, but it's rarely caused by any structural damage in the spine. Patients want scans and doctors and physios and osteopaths like ordering them. It's quick and keeps the patient happy in the short term. But it's incredibly rare that they're useful. And what's super important is we now know they can actually worsen pain by increasing the threat level in our system. And look, it's also important to say here that sometimes the reverse is true also. Maybe you've had lots of tests and imaging and nothing showing up, but the pain persists. And this can be annoying and perplexing and puts people in a spin, continually searching for a reason. But we also know that there are many things scans don't show, like what's happening in the nervous system. If it's in an overprotective state, how stressed you are, how much tension you're holding in your muscles, how and when you're moving your body, inflammation processes. So perhaps you're coming to realize for many chronic pain conditions, just like with back pain, to effectively treat chronic back pain, we need to target the brain, the neuroendocrine immune ensemble, not just the back or the neck, the knee, or wherever it is you're experiencing the pain. Okay, so that was a lot of talking. You might like to just close your eyes and go inward for a moment, just for a little mindfulness experiment. See if you can really notice the effect of my words on your whole system. Maybe noticing facial expression, body posture, feelings of tightness, contraction, or the opposite. So I'm wondering, how does your system react right now when I talk about tissue damage, when I talk about disc bulges, degenerative disc disease, disc protrusions and herniations, spondylolisthesis, osteophytes? I do this talk all the time, but every time I do it, I feel a slight tension in my belly. And then noticing, does your system respond any differently when I speak about the wonderful plump discs and perfect joints in babies? Or when I say that it's quite natural in an adult human to be a bit bumpy, lumpy, and happily worn inside like a comfy old armchair, that we're just showing the kisses of time, or perhaps we have grey hair and wrinkles on the inside. I feel a softening as I say those words. So how might this change your pain if you hear or use non-threatening language, perhaps a little more relaxed and accepting of natural changes in the body? Perhaps you might even want to make a note in your journal about what came up with this. And you can pause the audio if necessary, if you need more time. But otherwise, while you're with your journal, you might like to reflect on if the pain science that you're learning about is true, this stuff about sensitive nociceptors or this lesson about pain and tissue damage being poorly related. How might this change your understanding of your body, your pain, your life? Perhaps a change in thinking that even if you have natural degeneration or whatnot in the joints, it's probably not causing the pain if it's chronic. Or perhaps other things come to mind. I've had an operation to remove the disc, but I still have back pain. Or the scans don't show much, or the scans show tons, but not necessarily in the area that I hurt. Or maybe you're aware that even watching someone make a certain movement causes pain in you. Or that really light touch hurts. And again, pausing if you need more time. But otherwise, this final question, if hurt doesn't necessarily equal harm, what might you want to change in your activity as an experiment? Okay. So the home practice is to keep reflecting on these questions. And also notice the impact of the hurt not harm concept on your pain experience while practicing some gentle movement. Search Adele Stewart, gentle standing mindful movement on the free Insight Timer app. It's a 20 minute practice, very gentle. And just see how that goes with an open mind. Really keep this concept hurt not harm in your awareness until the next lesson, perhaps for the rest of your life. Very useful. Okay, and next lesson will be the power of emotions, exploring our emotional systems and how understanding those can help us with our pain. Goodbye. Thank you.

The Power Of Emotions

Hello, welcome to lesson six, the power of emotions. Let's start with a standing grounding practice today. Taking a stance with your feet about hip width apart, your knees off lock. Really notice the four corners of your feet contacting the floor. Allow them to press down, feeling the solidity of the earth beneath you. Maybe even as though you've got roots growing down from the soles of your feet right into the earth. And at the same time, feeling into the whole length of you. Taking a little reach through the spine. Notice how it is to be both grounded, connected and standing in a dignified way. And just for another moment, just notice what thoughts are passing through right now and what emotional tones are present. Maybe you're feeling a bit stressed or calm or irritated, curious, just simply noticing. And as you continue to ground your feet into the floor, into the earth, you might like to move a little, sway a little. Knowing it's possible to sway and also come back into groundedness. Hmm, letting that go now. Taking any comfortable position that you'd like. I'd like to share a little something of how our minds and bodies work, including our emotions that are very strongly relevant to physical pain. Put very simply, emotions are motivators. We discussed how humans and all mammals, in fact, have this constant, automatic, wide-in feeling tone of things, often sensory things, being pleasant, unpleasant or neutral. And often the next step are full-blown emotions. And feeling tone and the emotions that come out of this motivate us to move towards or away from things in our world. Understanding emotions as a natural part of being human can de-shame them, can help us with ways of soothing them and can stop the kind of layering effect of one emotion leading to another, leading to another. So Paul Gilbert, who's a psychologist in the self-compassion field, has this beautiful model that divides emotions into three emotional systems, all designed to help us survive. They're biologically based and every human baby is hardwired to be able to use these emotional systems. Might be helpful to have a paper and pen here. And draw three circles on a page. And in these three circles, in the first one, put down drive. So this is the drive system for getting things done, getting resources that we need. In the second circle, write threat. So this is the threat system for self-protection, the fight, flies, freeze reaction. And then in the third circle, write soothing. So this is the soothing system for affiliation and connecting with ourselves and others. So let's start off and talk a little bit about the drive system. This incredibly important system motivates us to get things done and make things happen. It gets us seeking, getting, consuming, achieving, competing. And there can be really pleasant emotions associated with this drive and the release of dopamine, which most of us have heard of these days. So that little bit of satisfaction, maybe excitement, competency, get up and go determination kind of feelings. It's involved in even the motivation to get out of bed in the morning, to do some gardening. It gives you the energy and purposefulness it took to actually choose to do this course. And when it's thwarted, it can be very hard on us humans. And this can commonly happen in chronic pain. We may not be able to make the things happen that we want to happen. We might be unemployed. We may not be able to be as competent a parent as we want or a partner. And this can give rise to a sense of helplessness and distress. The other issue with our drive system is that a lot of us are in it a lot of the time on a kind of autopilot, and we can be really driven to push past our limits, blocking our need for rest or soothing. And it can lead to quite rigid black and white definitions of success or failure. This kind of ideal how I have to be as the perfect partner or the perfect person at work, the perfect parent. It's also worth knowing that in the drive system, we don't just get that pleasant feeling from doing things. We get that kind of buzz from anticipating these things, which is fine. And problems can arise when these things really start to consume us. Paul Gilbert talks about the unrelenting pursuit of goals that might not really matter. The higher stress of perfectionism, or even worse, if we fail, if we or our children aren't the best, the most beautiful, the richest, the cleverest, or even that we're in pain, we can feel shame and unworthiness. And then we may swing back to the threat system. So just for now, perhaps making some notes on how this drive system shows up in your life. You've got room in your circle, you could write that there or underneath it. If you need more time, feel free to pause and spend a little bit more time on this. We're going to move to the threat system now. So the threat or self-protection system is all about detecting and responding to actual or potential threats. When it comes down to it, our brain's main job is to protect us, to keep us safe and alive. So we have this negativity bias. So we're on alert for danger. And I mean, this can be, again, extremely important. And if we put our hand accidentally on a hot plate, we have this immediate action without having to think about it. So when something bad happens, our sympathetic nervous system will kick in with a very quick reaction. We can go into fight, flight, or freeze with all the associated unpleasant body sensations and thoughts and emotions that comes with that. Our heart rate and our breathing can go up. We can sweat. We can have lots of muscle tension. Our minds can go blank or we can go into very rigid thinking or worrying or ruminating or self-criticism. And of course, we feel all those unpleasant emotions, mostly related to fear. And if we're into fight, flight, freeze, a lot of the time, this can cause a lot of chronic health problems, right? It's also really hard to be kind to ourselves or anyone else when in this state. And if it's all too much, we might really just shut down or freeze. So taking a few moments with pen and paper again, maybe just noticing what's going on as how the threat system shows up in your life. It might be when you feel a twinge of pain, might be nothing to do with your pain. Okay, again, pause if you need a bit more time. Otherwise, let's talk about the soothing system. So when animals, including human animals, have enough food and shelter and don't feel threatened, a spontaneous feeling of connection, contentment, safety and calm arises. And this comes from the parasympathetic nervous system, sometimes called the rest and digest system. A lot of you will have heard about the vagus nerve being associated with this. Perhaps you've had it already in this course from the meditation. And this is really different to the dopamine drive kind of pleasure feeling. It's a different pleasure, the pleasure of slowing down and being present. For a lot of people, it can arise in nature. And because of our very fast overstimulating world, ironically, we need to put a bit of effort into being into this state. Otherwise, we can get really stuck in the drive and threat states. And mindfulness and compassion training really helps activate the soothing system. We can give ourselves attention, acceptance, care, soothing, kindness, almost like re-parenting ourselves. Oxytocin, endorphins and natural opiates are released. Human beings are also hardwired for empathy. That sense of knowing how others feel. It can be really powerful to respond to being in our threat system or our drive system with active steps to bring us into our soothing system. And we can do this by activating our empathy and compassion for ourselves. So take a few more moments with pen and paper again to notice when does your soothing system show up in your life? Look, it's difficult if you've got chronic pain. It's difficult for people who have any physical or mental health problems because our system understandably sees this as a threat. But perhaps you can think of a time when you were younger, or when you're in nature, when you're with your pet, maybe having coffee with a good friend. Notice if your threat or drive system kicks in while you're trying to write this down. Okay, again, so you can pause and keep going here. So there's no need to take being in drive or threat and the emotions that arise from these personally, they're just natural for all mammals, actually. And for many of us, threat and drive are going to be more dominant. We can be almost constantly swinging back and forth. But our mindfulness practice can really help us get into the soothing system. And then we have more access to wise choice making and not be acting on autopilot. It's not going to happen instantly. You do need to practice this. So let's practice a little one now, just to get a bit of a sense of this. Maybe having a bit of a stretch before we move into this exercise. Okay, so what would happen if we could bring some of the soothing system to some of our difficult emotions? Even if we turn just a little towards our emotions, rather than manage them by trying to suppress them or distract from them or block them out. What if we treated them as something that's not really there? Something that actually needs our care? So let's try a little experiment if you're up for it. What I'd like you to do is bring to mind and body one of the stressful things that you brought to this course to deal with. It might be your pain, might be that the anger or despair that might come from this. It might be a completely different difficult situation in your life. Fleshing it out in your experience just enough so that you can have the sense of it. The thoughts that go with it, the body sensations that go with it, the emotions, the impulses, maybe to cry, to rage, to vent, to stay under the blankets in bed. And imagine now that that painful stress could be put into your fists. So actually make a fist with one hand in a way that captures that intensity. And now with the other hand, see if you can try and make that fist release. Try and pry open the fingers while the fist stays as tight as it can. The threat system particularly is there for a reason and usually doesn't like to release unless it feels some safety. So now keeping that tight fist, bringing your other hand now as a soft open hand underneath the fist and without making any demands to this fist, simply allow the fist to rest in this hand. Just giving it that kind of support that it needs. Just some tenderness, no demands. Just holding gently. Notice what's happening. It's happening in the fist. It's happening in your breath. What's happening in the rest of your body? And letting the practice go. So not for everyone, but for a lot of people, what happens when they try and make the fist release, it actually gets tighter and more uncomfortable. And when they just support that fist with that kindness and soothing, the fist relax. I'd love to hear what happened for you if you want to post about it. And just perhaps going away with the thought that this is what our mindfulness and compassion can offer our stressed moments, our stressed parts. So for the home practice today, search the free Insight Timer app for Adele Stewart, Difficult Emotions. And this will bring up about 10 or so short meditations, mostly about 10 minutes. I would suggest you just use your intuition and choose two or three and see how they go. All different ways of using mindfulness and self-compassion with emotions. We need to actually show our brains that these emotions are completely safe by firstly, feeling and experiencing the emotions as they occur. Secondly, not judging ourself for feeling the emotions. And finally, not getting stuck in the story behind the emotions. Our next lesson, we're going to explore this danger and safety aspect even more with the target concept that pain depends on the balance between danger and safety signals. Bye for now.

Pain Depends On The Balance Between Danger And Safety Signals

Hello. Welcome to Lesson 7, Pain as a Balance of Danger and Safety Signals. I thought I'd start off with a little kind of safety grounding exercise. And if you're in the position where you've got just a pillow or a cushion somewhere, which we usually got somewhere close by in the house, if you're in the house, just taking that now and feeling what it's like to kind of wrap your arms around it. Notice your body meeting the pillow. Kind of gentle pressure against maybe your chest or your belly, your arms. Really allow yourself to sink into that sense of touch. You might even try rocking a little bit with it. You might notice the effect of the breath in the belly and chest as it perhaps presses against the surface of the pillow. Shifting the shape of the pillow slightly. How is it to allow yourself to receive this comfort? It's okay. You're allowed to do this. That's just noticing the effect on your system. Is there any little bit of softening or tenderness in your chest or heart space? And you can either keep holding the pillow or put it down now. And if your eyes are closed, allowing them to open, but very gently, keeping a very soft, wide gaze to the space that you're in. Deliberately invite the tiny muscles around the eyes to soften, release a little bit. No need to dart the eyes around, just keeping this wide, soft gaze and taking in some of your space. Textures. Three dimensionality of objects. Different shapes. You might even notice some colours. And you might even allow your eyes to linger a little on objects that are just kind of nice or feel safe, a sense of comfort or beauty. Letting that go now. And we're going to just go through a little summary of the explain pain target concepts we've done so far. But the first target concept was that pain is normal, personal and very real. We talked about nociceptors or danger detectors on the ends of nerves, like little alarm bells that send danger messages, not pain messages, as electrical impulses up to the brain when they perceive danger in the tissues. We talked about nociception is an input and pain is an output. We talked about having pain without tissue damage or tissue damage without pain. And all these target concepts can also apply to other outputs that we don't consider as chronic pain, things like irritable bowel syndrome, chronic fatigue, chronic itch, chronic tinnitus, chronic vertigo, chronic nausea or digestive problems. So we're going to turn to the fourth target concept now, and this is that pain is a balance of danger and safety signals. So the brain makes that decision as to where that balance is at any instant, where the pain is needed. This includes emotional pain as well as physical pain. Remember the brain's constantly making predictions on how much danger we're in. Remember that predictive processing? It's taking in a crazy amount of data every millisecond to decide, is pain needed right now? The computations the brain makes around what is our level of danger safety at any moment is unfathomable. And this concept's a big leap for lots of people, because we're now going into this concept of modern pain neuroscience, that pain is more about the brain rather than the part of our body that might be damaged or that we feel the pain in. And you might have got from last lesson that our emotional pain also is more about our brain and nervous systems than actually whatever the upsetting situation is. So let's talk about the huge variety of danger and safety signals our brain might be processing at any moment. You'll need a paper and pen for this, and an A4 sheet of paper would be ideal. So pause if necessary and go off and get yourself some A4 paper and a pen. And we're going to come up with a danger and safety signal chart, a kind of category of different danger and safety signals in our lives. I'm going to get you to start by making three columns and eight rows on this page. So in the far left column, we're going to leave the first row blank. And in the other seven rows, we're going to write the seven categories of danger and safety signals. So the first one we're going to write is things we sense. Second row, things we do. Third row, things we say. Fourth row on the far left, things we think and believe. Fifth row, places we go. Sixth row, people in our life. Seventh row, things in our body and biology. And when you look down these seven categories, notice it covers a great deal of our life experience. Now EXPLAIN PAIN uses an acronym for danger and safety experiences, or you could say danger in me and safety in me, or D.I.M.S.I.M.S. So in the heading of the second column, we're going to write D.I.M.S. And in the heading of the third column, we're going to write S.I.M.S. So let's start with danger experiences or D.I.M.S. So D.I.M.S. are things in life that are worrying, that are a threat to our body tissues, our life, our lifestyle, our job, our happiness, or a threat to our day-to-day function, perhaps even a threat to who we are as a person. Think of things like shame or embarrassment. And these D.I.M.S., these danger signals or danger experiences are usually associated with fight, flight, freeze, feelings of fear, or feelings that are under the fear umbrella. This includes anger and despair, irritation, frustration, disappointment, resentment. So I'll ask you to look down the D.I.M.S. column now, and we're going to come up with some of our own examples. They might be directly connected to your pain, but they may not be, but they're still relevant because the brain is assessing the overall risk. So I'll start with some examples. So in the things you sense, it could be as minor as smelling a bad smell or seeing a scary looking x-ray of your spine. Things we do, perhaps staying home all the time, never going out. Things we say. I know one of mine is, I'm shattered. It's a bit of a danger message. Things we think and believe. Maybe you believe that you can't manage pain without opioids. Places we go. Perhaps the hospital feels quite a threatening, unsafe place to be. People in our life. One of my patients worked out that his mother-in-law was his major danger signal. Things in our body and biology. Maybe depression or anxiety or hypermobility. I'll give you a few moments to see if you can just come up with a couple of your own D.I.M.S. examples. I know when I first did this, I couldn't think much at all, but over the next few days, I thought of lots and lots. Okay, so let's move to our safety experiences or our C.I.M.S. in the far right-hand column. And these C.I.M.S. are anything in life that makes you soothed, stronger, better, healthier, surer, more certain, and of course, safe. And it won't surprise you that they tend to be associated with feelings of happiness, of curiosity, contentment, joy, kindness, compassion, peace, relaxation. So just looking down that C.I.M.S. column now, and again, I'll give you a few examples. Things you sense. Maybe that first cup of delicious coffee in the morning or the pretty sound of a bird. Things we do. For me, gentle yoga is a major C.I.M.S. Things we say. Maybe you've heard the expression, motion is lotion. Ah, such a, such a safety message. Things we think and believe. And maybe you're starting to believe that your pain can reduce. Places we go. So maybe the hospital's a really safe place for you. So this is a good point to notice that these dim C.I.M.S. are interpretations actually, not just facts. Notice that it's danger in me or safety in me. This can remind us that the danger's not outside us, but as part of the brain interpreting things. So the hospital's a good example of that. Or my example of the dim of a, of a scary looking scan, that might even be a C.I.M.S. for some, because there might be a real relief that there's actually something there. And this can apply to all these categories. So moving on, we've got people in our life, perhaps working with a great pain physio, and things in our body and biology. Maybe you have a few, good night's sleep. How amazing is sleep? What a difference it can make to pain, right? And I'll give you a few moments again to see if you can just come up with a couple of your own C.I.M.S. examples. Again, they might be directly connected to your pain, or maybe not. Okay, and of course, you could pause here if you want some more time. But otherwise, what I'd suggest is that you maybe keep this chart somewhere, and just spend some time between now and the next lesson noticing dims and C.I.M.S. in your life. And I'd love you to post some of your discoveries on the course if you feel like it. It can be really inspiring for others. And the other suggested home practice that I'm hoping will be a C.I.M.S. for most of you is searching the free Insight Timer app for the 20-minute meditation, Adele Stewart Gentle Lying Movement. Give it a go. Give it a go at least once, maybe, maybe more. And really looking forward to the next lesson, which leads on from this talk about dim C.I.M.S. into the pain-fear cycle. Bye for now.

Safety As A Way Out Of The Pain-Fear Cycle

Hello. Welcome to lesson eight. Safety as a way out of the pain fear cycle. So let's start off with another nice safety practice. If you're up for it we might do a standing one today. So placing your feet about hip width apart, have your knees just off lock, really feel the whole of your feet connected to the floor. Have a sense of dropping your energy down through your pelvis into your thighs, the strong muscles there. At the same time feel the spine rise up tall, alert but relaxed. See if you can notice the solidity and support of the earth and the relaxed dignity of your stance. Noticing the breath. Noticing how safe you feel in this stance right now. And if it doesn't feel that safe, can you modify it? Can you make it a bit safer? One idea is to give yourself a self-hug. Wrapping your arms across your body, might squeeze your shoulders gently, and tuck your chin in a little. Maybe even starting to squeeze gently around the neck, the tops of the shoulders, and down the upper arms. A kind of reassuring, hey I'm here for you, you're okay. You might even want to gently squeeze the the collarbones, the ribcage, might move your hands around a bit, around your belly. Where you can reach in your back. Maybe your face. Maybe going back to that self-hug and just checking out how does this feel in your body, your system? How's your breathing? What do you notice in your heart space? Any change to the pace of thoughts? Spending a moment longer with your feet on the ground. Allowing the belly to be a little soft, the eyes to soften. We're going to talk about the pain-fear cycle today. And last lesson was all about the balance of danger and safety experiences. The dim sims, danger and me, or safety and me. Now this pain-fear cycle, you're probably well aware of this actually in your own experience. Just a note first, we do need fear. It's really important. The brain and the whole of the NEI ensemble, the neuroendocrine immune ensemble, their main job is to keep us safe and alive. So it's totally normal. All humans experience both these nervous system reactions, a fight freeze and emotions. Remember we talked about emotions under the fear umbrella. So anger, disappointment, despair, irritation, resentment, frustration. We experience these in subtle ways, numerous times per day. Do you just think back on the day? Being a little bit late, somebody toots when they shouldn't, when they're driving, your child frowns. You see a text just flash up on your phone and you think you know who it's from. Sometimes even waking up in the morning, right? So as I said, one of the ways our brain and NEI ensemble keeps us safe and alive is by activating our threat system and fight, flight, freeze and fear. And another way of course is giving us pain as a not always accurate motivator to basically to inhibit movement and activity. That's what pain's really doing. And it's entirely human and normal for us to fear our pain. It's also a threat. It's also a danger experience, a dim, right? And if we have appendicitis or something like that, then pain and fear are really helpful, perhaps even life-saving. But when it's chronic pain, not so much. And that's where we get stuck in this pain-fear cycle, this feedback loop, where pain is triggering feelings of fear. Fear puts the brain on high alert, which produces more pain, which leads to more fear, which leads to more pain. So the more afraid or anxious we are of our pain, the more likely the pain is to get stuck and stay stuck in this pain-fear cycle. And pain-fear cycle is just a general term. We could call it a pain-despair cycle. Going into a spiral of despair can absolutely keep us in this. Or maybe you're someone who gets more angry and grits your teeth and says, I'm not going to let this pain beat me. I'm going to soldier through it. Well, that can keep us in the same kind of cycle, maybe a pain-anger cycle. So there are three ways we can help kind of loosen this pain-fear cycle or even get out of it. And the first is this messages that you're starting to take on, hopefully, that our persistent pain isn't caused by tissue damage and isn't causing tissue damage. Hurt, not harm. This is such a powerful safety message, a powerful sim that can help us get out of the cycle. The second is the soothing, both the pain and the fear with compassion. Remember the fist exercise from a couple of lessons ago? We had our pain and difficult emotion in that fist and we brought that soft, soothing, just simple kindness, no demands, another powerful safety, powerful sim. And then we've got mindfulness. So we did some work on the pain signature where we were actually like a kind scientist and took in the data from our bodies and minds to start to update our system. And we're going to learn about another powerful mindfulness exercise called somatic tracking, brought to us by Alan Gordon. So I'd like to read a poem by the monk Thich Nhat Hanh here. This is a reminder of what mindfulness and compassion can do for this pain-fear cycle. He says, the function of mindfulness is first to recognize the suffering and then to take care of the suffering. A mother taking care of a crying baby naturally will take the child into her arms without suppressing, judging it or ignoring the crying. Mindfulness is like that mother. The practice is not to fight or suppress the feeling, but rather to cradle it with a lot of tenderness. When a mother embraces her child, that energy of tenderness begins to penetrate the body of the child. Even if the mother doesn't understand at first why the child is suffering and she needs some time to find out what the difficulty is, just the act of taking the child into her arms with tenderness can already bring relief. Just a little bit of time for you to have a bit of a reflection. We're getting your journal or some paper and pen, a little reflection on the danger and safety signals, the dim sims and the pain-fear cycle. So if we accept that our pain is coming out of our balance of danger and safety and that the fear of pain can put us in a vicious cycle, how have you gone by noticing your dims and sims? Sometimes just noticing them can strengthen sims and help dims lose their power. So have a little think about this week. How could you actively work to somehow decrease some of your dims? Maybe just softly challenge them or soothe them. Perhaps the dim could be the fist and just holding them with some of that softness and acceptance is a good start. Or perhaps there's something much more practical that you could do. Feel free to pause if you want a little bit of more time here. The other part of the practice this week is how could you actively work to increase or amplify some of your sims, your safety experiences? Perhaps that might be deliberately choosing activities that you know make you feel better. Perhaps it might be drinking your first cup of tea mindfully. Even if you can just come up with one little example that will be helpful. Occasionally we can even turn danger into safety signals, dims into sims. And all this, all this work on dim sims and pain fear cycle really gives us the resources to increase the safety in our system. Your brain and overprotective pain system generates pain even when there's no real threat. So between now and next lesson, I invite you to keep exploring the pain fear cycle. Or maybe for you it's the pain irritation cycle or the pain disappointment cycle. Notice the danger signals, the dims, the safety signals, the sims in your life. And on the free Insight Timer app, search for Adele Stewart self-compassion break for pain. This is quite a short practice which can be a really wonderful safety signal for some. And next lesson we're going to do an incredibly important practice called somatic tracking. A really powerful mind-body practice that teaches us to observe and allow body sensations through a strong lens of safety. Bye for now.

Safe In My System - Somatic Tracking

Hi there, welcome to lesson nine, Safe in my system. We're going to learn about a very important practice in the pain and mindfulness field. This is brought to us by Alan Gordon through pain reprocessing therapy called somatic tracking. So somatic tracking is learning how to be with and allow different feelings and sensations in the body through a very strong lens of safety. And because you're up to lesson nine of the course, you're most likely ready to do this because we're learning that all pain is produced by the brain or the NEI ensemble, the neuroendocrine immune ensemble. And it's felt in our bodies. And that pain in our bodies doesn't necessarily mean and probably doesn't mean in chronic pain that there is tissue damage contributing to the pain. This is really important mind-body work. We're learning to reinterpret sensations through the brain and mind. So a few important points before we get going. Firstly, we really do have to have the intention that what's happening here is okay. It's safe. We are not under threat or in danger. We need to be pretty convinced that it's not disease damaged body tissues that are causing this pain anymore. That it's pretty much coming from our brain and nervous system. And if we know it's safe, we can just allow it to be. We want to let whatever happening in our body happen freely, really allowing, opening to, being at peace with, maybe even putting the welcome mat out. We're wanting to give our body permission to express itself fully, maybe even speak to us. When we can do this, we'll notice that sensations will shift and change and move. And finally, a big one and a real paradox. We need to be in this practice, not trying to make the pain go away. Of course, we want it to go away. But in this practice, just for the time of the practice, we need to freely let it be there, do its thing. Because if we try and make it go away, we're not really accepting it. And that resistance or struggle will just be seen as a threat and make things worse. So your body, heart and mind knows how to deal with this. If you can just get the brain to be less on high alert, get the thinking part of the brain to back off a bit. Remember, a lot of body functions do really well on their own without having to think about them. Breathing, our heart beating, our blood flowing, the digestion. So bringing this mindfulness, this allowing, accepting attitude towards feelings in the body while not feeling under threat, hopefully feeling safe, perhaps even relaxed, can be very powerful. So finding yourself any comfortable posture, eyes open or closed, reminding yourself that what you're going to do is really safe, really healing, can allow our body, our heart and our mind to be soothed. Starting off by bringing awareness to the whole body from top to toe. Bit like in our unfocused awareness at the start of the course, noticing what's happening in a broad way. Noticing sensations and feelings, both pleasant, unpleasant or neutral. Try to keep descriptive mental words, descriptive rather than emotive. And no need to really immerse yourself in any sensations. Just allow a part of you that observes, observes the sensations in a little distance. For some, being a passenger in a car can be a good metaphor. You're not driving, you're just noticing the scenery going past. For others, the metaphor of snorkeling or scuba diving can be helpful. A sort of relaxed, floating, simply observing all the interesting fish and coral and seaweed in a friendly, curious way. Perhaps even with a bit of lightness or even humour. That pain in the knee is like a snapping turtle. But keeping that broad awareness. No need to delve in too deep. Just allowing whatever is happening right now to happen. No need to interfere or change anything. Just allowing. And that includes thoughts and emotions and sensations in the body. You do drift off into thoughts, that's so fine. Every time you bring your attention back to the body, you're strengthening the mindfulness part of the brain. Rewiring it, healing it. Can you be with and allow whatever body sensations or feelings you notice? Even pretty intense ones. Letting your body speak. Letting your body express itself. Reminding yourself if there are intense sensations, it's just an alarm from your brain. You are safe. Your body tissues are safe. And you just step back, swim back if you're doing the snorkeling metaphor. And allow your body to do its thing. It's fine to breathe around or through intense body sensations or an inviter softening. You're just not trying to get rid of them. Just staying curious. And noticing, is there any changes, any subtle shifts in sensations? In where they are, how intense they are, the quality, the texture. Can you simply allow this to shift and change, perhaps like the shifting underwater landscape? What's happening? Can you allow whatever is unfolding to simply unfold? And perhaps there is a lot of resistance or struggle to whatever it is. You bring some curious allowing to this. Just let it be there. It'll play out in its own time. And gently remind any struggle or resistance, you are perfectly safe. This practice is really healing, really therapeutic. Amazing neuroplastic work. Teaching your brain and system to interpret symptoms as okay signals, not danger signals. By keeping soft and relaxed and open to all sensations, you can remind your brain, these are just sensations. Thanks brain for all your hard work keeping me safe. But I don't need them to feel unpleasant anymore. I'm okay. I am safe. Giving your body total permission to express itself any way it wants. Maybe you feel emotions in the body. Is it possible to allow sadness or anger, confusion, fear, disappointment? They won't stay forever. You allow them to flow, they won't last long. Being like a kind, curious scientist, stepping back, allowing your body to do its thing. And as we're coming towards the end, noticing your body. Can you be okay with what's happening right now? Can you trust your system to know how to process this stuff? And finally, just noticing any difference at all from the start to the finish. Even the tiniest subtle change. This helps the brain with its predictive error, helps the neuroplasticity. Perhaps giving yourself a little appreciation for spending this time doing this super important mind-body healing. Allowing your body to stretch, move a little, do what needs to be done. You can find two full versions of this practice by searching for the 20-minute practice Adele Stewart Somatic Tracking with Safety or the 15-minute practice Adele Stewart Somatic Tracking for Persistent Pain in the free Insight Timer app. You're really encouraged to get quite familiar with this amazing transformative practice. It can be practiced formally, and I encourage you to do that, but also whenever you think to do it informally. When you're unloading the dishwasher, in a queue at the supermarket, any time you notice pain. Our next lesson will be on pain as a complex system. We explore how pain is a process, not a fixed thing, emerging from the dynamic interplay of the brain, body and environment. And the good news about this means there's lots of ways in to change pain. Goodbye for now.

Pain As A Complex Emergent System - Untangling The Pain Knot

Hello, welcome to lesson 10. Pain as a complex system, untangling the pain knot. Let's start today just with three nice deep relaxing breaths, really noticing the in-breath and allowing the out-breath to relax you a little. We're about halfway through the course now and just a little summary. We've talked so far about pain is real, it's often not related to tissue damage, it's generated in the brain and NEI ensemble, neuroendocrine immune ensemble, as a protection in response to what it perceives as danger or safety from inside us and outside us. So this lesson is based on the explain pain target concept, pain involves distributed brain activity. What does that mean? So basically, there's no single pain center in the brain, multiple areas are involved. With the experience of pain, the brain lights up a bit like a Christmas tree. There's not just one little brain bit lighting up for one pain. So pain is a process of the brain and body and the outside world, it's not a solid thing. We'll get into this a bit more, but firstly, let's expand a bit on brain bits. There's actually billions of neurons, which is another name for nerve cells, in the brain, in the nervous system, each making thousands of connections. And this all creates any experience we're having. So think of your grandma, if you're having a memory of your grandma, perhaps in your life, perhaps not now in your life, perhaps actually never in your life. But there still will be hundreds of brain bits involved. This means that in order to think of her, many parts of your brain and nervous system activate. This might depend on whether you're remembering the way she looks, the taste of the pie she used to make, the smell of her perfume, the feeling of hugging her, maybe even sometimes being irritated by her. Or maybe memories from what you've been told. And this example of hundreds of brain bits involved is similar to how the experience of pain gets generated. So clarifying that, this means that pain is created by many different things, including our danger and safety experiences that we've been investigating quite a lot in the last few lessons. So I want to introduce this concept now of complex systems that have these two properties, self-organization and emergence. And complex systems are actually everywhere in life. It's not just about pain. So emergence is the opposite to something linear. This is what makes something more of a process than a set thing. I quite like the example of a snowflake as an emergent phenomenon. There's no boss or leader or plan giving instructions to how this amazing snowflake comes into being. There's lots of different bits involved. There's water molecules. There's outside conditions like wind and humidity conditions. And all of these bits are random and unpredictable. But somehow they emerge and self-organize into these amazing, unique snowflakes. And then they melt away. So what has this got to do with pain? Well, like a snowflake, a person is also a process, not a thing. The mind is also a process, not a set thing. And pain is a process, not a set thing. It's created by the mind and body interacting with the outside world. Now, this next part of the lesson is from the wonderful Dan Siegel, who's a psychiatrist from the US. And he says that the mind, beyond subjective experience and beyond conscious and non-conscious information processing, the mind can be seen as a self-organizing, emergent process of a complex system. And that system is both within us and between us and others. And he goes on to say that a complex system is characterized by these three features. Firstly, it is non-linear, i.e. emergent. Small inputs can lead to large and unpredictable results. It's open, so it's influenced by things from outside of its own system. Think of this body-mind and all the things that influence it. And it is erratic or chaos-capable, which means it can function in unpredictable ways at times. So does this kind of sound familiar in your life and your pain? And sometimes going to the gym feels great and other days not so much. Tiny little memory can change our whole day, perhaps our pain experience. So if our own lives meet these three criteria, emergent, open, chaos-capable, then we ourselves are complex systems. A traffic jam is another nice example and sometimes can be a little easier to get our heads around. Have you ever been stuck in a traffic jam, crawling along at snail's pace and looking ahead for the cause? But eventually the traffic just melts away and you're moving again and there didn't seem to be any specific cause, no accident, no ambulances. So you can't look for the cause of the traffic jam in any one event, any one car. It is an emergent pattern created by multiple moving parts. There are also road conditions, people's moods, road rage, different brands of cars, different qualities of cars, the weather, good drivers, bad drivers, pedestrians. And similarly, we can't look for the cause of pain in one place, example, one part of the body. So just like you can't understand a traffic jam by looking at one car or one car's steering wheel, you can't understand pain by just looking at a muscle or a nerve or a disc or a bone or even the brain. Our best bet of getting real understanding in a way that helps it change, understanding pain is by thinking emergently. The whole human, the brain, mind, body, nervous system, endocrine system, immune system, thoughts, beliefs and everything that's happening outside of us too, other people's actions, conversations we have and all those other categories of danger and safety experiences or dim sims, all creating this emergent experience of pain in this moment. So your emergent pain experience is the result of the brain's best guess as to your system's most helpful protective output. The emergent experience is not just more than the sum of its parts but very different from the sum of its parts. And this applies to all pain. It applies to acute pain, pain from spraining your ankle. It's just that when it comes to chronic pain, this concept is even more important. So if you're seeking a single cause for a pain experience, giving it a linear explanation, for instance, oh, it's hypermobility or a bulging disc or the surgeon stuffed up, as an explanation for years of chronic pain, you won't have access to the power of all the actual things you can do about it in the present moment. And I get it. It's easier for all of us to grab onto a linear version of pain around how a broken bone heals or what a disc does when it's bulging. But it can be so much harder to understand and accept that, for example, say my partner's ill health might have a lot to do with my sore back right now. Another metaphor for how our brains and bodies work is like an orchestra. This is a wonderful example of a complex system with emergence. All the thousands of tunes that an orchestra can produce, with each tune having possible different tempos, different keys, different instruments, different players, all with different moods. And we'll talk in another lesson about the orchestra getting stuck playing the pain tune over and over. And one more metaphor, pain as a tangled knot is another metaphor for pain being a complex emergent system. And the good news about the tangledness, the complexity of pain is that there's lots of ways in to impact the pain. So our home practice between now and the next lesson is going to be exploring a practice that helps untangle the pain knot, helps us with separating emotions and thoughts and body sensations. And this practice is on the free Insight Timer app if you search Adele Stewart, Untangling the Pain Knot. And of course, we're also tending to our emotions differently in this course, where we're learning to respond with compassion and kindness to ourselves. And in the second half of the course, we'll get familiar with how our thoughts create rigid beliefs, risking conversations that matter, the language we use to speak and think about our pain, our lives and our lifestyle, what we eat, sleep issues, alcohol, other medication choices. We can really open up to this wonderful repertoire of powerful tools that we can bring in to attend to our pain experience, creating new tunes in the orchestra. So don't hurry on to the next lesson. You may like to re-listen to this lesson. There's a lot in this. And when we do get to the next lesson, we're going to be exploring the pain story, which is reflecting on the nature of thoughts, including our personal pain story, recognising its impact and exploring how mindfulness can help loosen the grip of these narratives. Bye for now.

The Pain Story

Hello, welcome to lesson 11, The Pain Story. Let's start by just taking a pause. Eyes can be open or closed, but just stopping for a moment and noticing. What's going on? No need to judge or change anything. Just noticing. What am I thinking? What am I feeling? Both emotionally and sensations in the body. Taking three breaths now, as mindfully as you can, really following each breath. Fully on the in-breath and fully on the out-breath. Noticing any difference from this brief pause. And taking a comfortable position to explore the pain story. And you will need a journal or pen and paper for this lesson. So, our brain is constantly rehashing the past or rehearsing the future. Well, I hope that's not just me. Have you ever felt like your mind is a mind of its own? Welcome to the human brain. And of course, the truth is that the past is gone and the future isn't here yet. And of course, we want to learn from the past and plan for the future. That's important, but not constantly. And as we learned about in the danger and safety signals lesson, the dims and sims, thoughts and beliefs, especially ruminating or worrying, can be danger signals, dims. And mindfulness can be a powerful safety signal, a sim, to help take us back to the present moment so that we aren't helplessly taken on a ride, sometimes even bullied by our thoughts. When we're in pain, and especially when the pain has been there for a good while, we not only experience the pain present in this moment, but also immediately feel what happened around the pain in the past and what might happen in the future. So each pain story has two parts, the story of the past and the story of the future. The story of the past is about how this pain came about, what was or wasn't done, what mistakes we or others made, what oversights happened, and so on and on. The story of the future often has two aspects, the anticipation of the immediate future, how will I get ready for the task I've got to do right now or get through today, or worry about the broader future, what might happen if the pain doesn't get better or even gets worse. Carrying these pain stories can be a bit like wearing a heavy backpack all the time, even when it's not necessary. So how can we learn to put this backpack down, even for a little while? First, and this is mindfulness, we need to become aware of it, we can only change what we can notice. Then we can make a conscious choice to put the backpack down. So getting your electronic journal or your actual journal or paper and pen, I want you to consider your past pain story here a little bit. Might like to write a heading, past pain story. Perhaps just making some rough notes of common thoughts that come up around the past. Not try to change the thoughts, just noticing them. It might involve how the pain started, or the mistakes that were made, or the things that went wrong, or what you wish didn't happen, and also what emotions come up around this. A little bit of time to just make some rough notes on what you usually think about in regards to the past and your pain. So feeling free to pause the audio if you need more time here, but otherwise putting your pen or your journal down, just taking two or three breaths, and letting go of this past pain story. Now you might like to write the future pain story, and this has two parts, so you might like a subheading of the immediate future pain story. What is it that happens on a daily basis about the near future, the fears and worries that might come up about perhaps doing something or not doing it, perhaps about what others will think of you, avoiding things, pushing yourself through things. What do you think of yourself? Taking some time here to make some rough notes about the immediate pain story, what we think about regarding the immediate future, maybe even what you're going to do right after you finish this lesson. So again, pausing if you need a little bit more time, otherwise putting your pen and your journal down, taking two or three breaths, just letting go of the immediate future pain story. And now you might like to write one more subheading, the more distant future pain story, just reflecting what kind of thoughts come up commonly around this. Perhaps it will be to do with what will happen if the pain gets worse or doesn't go away. It's totally human nature, right? This is, this is our systems looking after us. What thoughts come up around how pain might interfere with our dreams and aspirations, around interests and recreation, around work, around parenting, around how am I going to do it, how am I going to cope? Just a little bit of time here. And again, pause the audio if you need a bit more time, otherwise putting your pen and your journal down. Perhaps feeling your feet on the floor, noticing that you are in the present. Notice the effect of the writing, journaling exercise. Did it feel relieving? Is there more anxiety? No judgment required, just noticing the effect. Can you leave the pain story there in your journal and bring the attention to an anchor? The soles of your feet can be particularly useful because they're a long way away from your head where you think. For you, maybe it's the sense of gravity on your body, or your breath. Maybe the sensations in your hands. Just give you a last few moments for anything else that might have just emerged that feels like it needs to be written down. A metaphor that I find helpful that was mentioned in the last lesson is that pain can be like a tangled knot, and that knot includes not just the sensations of pain, but our thoughts, our emotions about the pain, our pain story, and it can even include urges and behaviours. The thoughts are perhaps the trickiest area, so noticing our thoughts is so helpful to kind of loosen this tangled knot a little bit. We may even be able to realise that thoughts are not actually facts, they're mental events. Yeah, they might be helpful or unhelpful, but they are representations. If you look at a photo of a flower or a tree or something on your phone, you think of that, oh, that's a flower, that's a tree, but it's actually a photo, it's a representation. It's not like an actual living, growing, perhaps dying flower or tree outside our window. So between this lesson and the next, and perhaps continuing this, because this can be a lifelong practice, it's so helpful simply to notice our pain stories. No need to judge ourselves harshly for this totally human capacity. And sometimes the pain story helps, so that's fine. But perhaps sometimes the pain story is not so helpful, or you've thought it a million times, or perhaps you even know it makes the pain worse. And in that case, can you try dropping the story, which is a bit like putting down that heavy backpack? Or if you like the metaphor of the pain knot, can you loosen the story a little bit? This is like untangling the knot a little bit. The other practice that you're invited to do is, the invitation is to return to either the untangling the pain knot meditation that we introduced last lesson, or return to the somatic tracking meditation. And hopefully you've been bookmarking these and saving them into a folder so they're easy to find on the free Insight Timer app. And next lesson, we're going to discuss metaphors, including warmongering metaphors for pain, and how this is a big cultural dim, big cultural danger experience that has a huge impact on pain. Goodbye for now.

Warmongering Metaphors Of Pain

Hello, welcome to Lesson 12 Warmongering Metaphors. Let's just start with that pause. Check in. Just noticing, noticing what posture you're in right now. How you feel in your body. And your emotions. And what thoughts are happening right now. Doing anything that you need to help so that you can pay attention for the next little while. Maybe you need something practical like a glass of water. Or a few breaths. Feeling your feet connecting with the floor. Maybe even a hand on the heart. Offering yourself that little bit of kindness. So have you ever considered that these thoughts that you've just been noticing can make electricity and chemicals at the end of nerves? Just like the danger message from something like getting a nail in our foot. So let's move to spend a little time on a type of thought or belief that's very, very common. This is metaphors for our pain and our body. We think, believe and speak of the body and our pain in metaphors or figures of speech a lot. More than you're probably aware of. And metaphors can be danger signals, dims, and they can be safety signals, sims. So just going to read a random bunch of metaphors that we might use around our body. Face facts. Shoulder the blame. Put the bill. Head a team. Keep someone on their toes. Rule of thumb. Knee jerk reaction. Give someone a tongue lashing. Can you hear how common they are in our language? And we also use metaphors for pain constantly. It's really the easiest way to describe pain usually. Burning pain. Gnawing pain. I'm shattered. I feel like I've been run over by a bus. And if we're going about our day imagining things like our bone-on-bone or our ripped tendon or our pinched nerves, these type of metaphors can become a little persistent network of nerve impulses. And now you're probably thinking, well, those aren't metaphors. But it's really important to know they are. With arthritis, you've never literally got bone-on-bone. Tendons are not literally ripped. They're more frayed. Nerves are incredibly rarely actually pinched. Laura Mimosi's got a great example of a client that he saw who introduced himself as Roman. He then said that that wasn't his actual name, but everyone had always called him Roman since 20 years ago when the doctor had told him that his back looked like the Roman ruins. And he had a postcard of the Roman ruins in his wallet. Now, can you imagine what a powerful little persistent network of nerve impulses that would be, the effect on his system of perceiving that his back was like the Roman ruins? So, more specifically, from about the 17th century to the present day, we've all tended and tend to use a lot of what we might call warmongering language, which, when you think about it, it's very much in the old view of tissue damage equals pain. And, of course, we're learning that this is not the case. So, in this warmongering language, diseases are thought of as the enemy that can be destroyed, battled, attacked, and such. So, can you see that warmongering metaphors could really encourage that the pain means tissue damage belief if we use metaphors like pinched, burning, pins and needles, trigger finger, attacks of pain, stabbing pain, the horror of pain, even painkillers? Can you hear the problem with these metaphors and language? They're so common in our language that it can actually take some time to really get that these are metaphors and they are very negative metaphors. So, the problem with this language is it firstly keeps this ongoing such deeply ingrained belief that pain is due to tissue damage. And this is a very powerful danger signal. When we think of pain in the context of war, suffering, chaos, fear, and despair, you can imagine that that's a danger signal as well. War zones are not exactly a healing place. We can be almost constantly in fight, flight, freeze, or shutdown. The other trouble with this language is it keeps us thinking in a really linear, not emergent way when we think about treatment of pain. So, things like painkillers kind of imply that tablets are the only answer. And pain becomes very black and white, lacking the gray, a sort of, we must eradicate the pain. And in this course, we're developing mindfulness, curiosity, even playfulness and a little bit of humor that helps us explore this pain, this normal part of being human with such a different attitude. And the metaphors we use to talk about our bodies are important too. Weak knees, butterflies in the tummy, a broken heart. Well, how about heel spur? Such a common term, you probably don't even think of it as a metaphor. Now, a heel spur is actually just a little bit of hardening where the soft tissue inserts into the bony part of the heel. Very common and can be in a multitude of people with no pain whatsoever. But perhaps just noticing if you bring the term heel spur to mind, you might even close your eyes and say it internally or imagine it internally. What comes to mind? What thought associations are there? Are there any subtle shifts in your posture or facial expression? Maybe even subtle emotions or body sensations as you bring the metaphor heel spur to mind. Now, another term that's used for heel pain is plantar fasciitis, which is also a bit of a dim, a bit of a danger sounding medical term, right? And there's a push from pain educated podiatrists to just call it persistent heel pain. It sounds and feels safer, doesn't it? And this is a bit of a by the by, but the modern view is that this persistent heel pain is caused by the sensitized nociceptors and backfiring nerve messages rather than anything actually coming from tissue in the heels. Okay, so I always notice by this point in talking about dim, danger kind of metaphors, my system is starting to tense up. So time to talk about some metaphors as safety signals. So the explain pain target concepts themselves are powerful slogans, safety signals in themselves. Things like pain is normal, personal and very real. Pain depends on a balance of danger and safety signals. And here's a few other metaphors as safety signals. And so again, perhaps noticing any subtle shifts in your posture or facial expressions or feelings of perhaps softness or warmth or opening or soothing as I read these. How about the purpose of pain is protection, uses the power of three and alliteration. One we've used before, motion is lotion. The lovely rhyming, the soothing sound, eh? Your next position is your best position. A repeat is always helpful. I'm sore but safe. Maybe compare that to, I'm having a flare up. Now this is a very commonly used term and I still use it because that's what people understand. But be aware it is a metaphor and it's got an element of danger in it, flare up. And how about there is a glimmer of hope. Another comment here. This is not just positive thinking, which can be a little forced and unhelpful at times. The push to just think positively can encourage us to avoid our emotions and our sensations and sometimes stop us being with and being then able to soothe our painful emotions of sadness and anger and distress. And if we start with noticing, picking up the metaphors we think or say and perhaps getting a bit creative and playful in choosing different ones, this can be really helpful in improving safety messages to our brain. The scientific evidence on the effects of the neuroimmune system, which we'll talk about in another lesson. So our home practice between now and next lesson is to notice metaphors of pain and the body that we use. Notice it with kindness, with a smile even, and then get creative. What other ways could you describe it? This would be a lovely one to share in the course and post because it inspires people to read others' ideas of where they've changed their metaphors. Keep taking a note of any other danger and safety signals, remembering pain as a complex system. And also keep going with hurt not harm, which is actually another metaphor, but a helpful metaphor. Noticing moments of pain and seeing how saying hurt not harm might change your experience. So for our formal practice between now and next lesson, please search on the free Insight Timer app for Adele Stewart, Kindness Body Scan for Pain. And next lesson, we're going to talk about the importance of context in pain. And then the lesson after that, the particular and sometimes painful context of interactions with other people. Bye for now.

The Importance Of Context In The Pain Experience

Hello, welcome to lesson number 13, the importance of context. Just for a moment, taking a note of how you feel right now, just pausing and checking. Are you a bit tired or energized? Are you feeling a little lonely or well-connected? Are you hungry, thirsty or comfortable? Are you irritated, angry, disappointed or perhaps peaceful and content? Believe it or not, there's no need to change any of these. Of course, attend to something that's easily attended to. Go off and have a hug with a person or a pet, have a glass of water or a snack. But particularly with emotions that are not so easily changed. Remember that fist that we talked about and the power of emotions, that fist representing a difficult emotion and that soft open hand. We can just rest that fist in, no demands, no stress. Let's talk a little bit more about this context piece. One of the target concepts from Explain Pain is pain relies on context. Four tiny words, but a huge, huge thing. This is pointing to the biopsychosocial model of pain. And it applies to all pain, both at the time of injury, if that's applicable, as well as chronic pain. Remember early on, we talked about those extreme cases of the construction workers and the nails and their pain experience. That was heavily a result of context. And you may have been noticing this in the past little while as you've been doing this course, that your experience of pain and symptoms can be easily changed by different contexts. There's quite a lot of research around this. Did you know that a simple injury can hurt more during a negative event, like doing an unpleasant chore or even smelling a yucky odor, than sustaining exactly the same injury doing an enjoyable activity, like playing a favorite sport? The pain neural networks can be really easily changed by different contexts. Yet more danger and safety signals, dims and sims. And one piece of good news context is we kind of have a drug cabinet in our brain that's open 24 7. It has us release our own pain relieving chemicals, endorphins and serotonin and whatnot, even natural opioids that trickle down the spinal cord. And this example might not mean much to the American listeners, but in Australia, there's a Rabbitohs football player who played the whole final with a broken cheekbone and no pain. And this is likely because he was playing the final and it was really important, not because he ignored the pain. And for those of us who aren't elite sports people, things like getting lost in a good movie or wonderful music or just playing a community sports game can have the same effect. Bob Marley sings, when the music hits, I feel no pain. There's a cool little study that shows that a painful stimulus given at the same time as a red light is on, hurts more than exactly the same stimulus given when there's a blue light on. To do with our system associating red with fear and alert. There's another study on headaches that show that coloured capsules work better than white tablets with exactly the same active ingredient. And what about the visit to the dentist or the doctor and the tooth pain or the body pain disappearing when you get there? It doesn't always happen, but as a GP, I see it happen quite a lot. The brain is probably assessing it's safe enough not to have pain now since you've actually taken action. And sure, this is simplistic, right? There's some research that shows women who have breast pain after being treated for breast cancer will have worse pain if they're worried it's due to the cancer returning than those who think it's due to something else. And this is with exactly the same changes seen in the breast tissues. So let's do a little reflection on ourselves here. Might like to get your journal out. Just considering, when does your context change your pain? Most pains alter with movements and activities, but does your pain change with your level of stress? Whether you're doing something you love or hate? Where you are? Who you are with? Whether you're understood by others or dismissed by others, including health professionals? And your general state? In the 12-step program, there's an acronym they use called HALT. Hungry, angry, lonely, tired. Most of us will notice that these change our pain. And it's context, right? Or perhaps you've noticed in the lesson on the pain story or the metaphors that they can change your pain experience. A few more moments to make some notes, if you like, and another really useful one to post in the course, because reading about others' experience can be very helpful. So pausing the audio if you want a little bit more time. But perhaps you consider that you always get pain when you move a certain way or do a certain activity. You perhaps have a fixed belief that that's what will happen. So useful to keep an open mind here. Does it really happen every time? And if not, what might be different when it doesn't happen? This noticing pain being less than expected can help our brain that's constantly making predictions to receive what's called a prediction error. So between now and next lesson, can you pay extra attention, use extra mindfulness in moments when you don't feel pain or you have much less pain? Especially when that's unexpected. Really notice the context and savour the good feelings, creating these prediction errors, which helps the brain be more accurate and less overreactive. For our formal practice from the free Insight Timer app, search for Adele Stewart Mindful Self Compassion Break for Pain. And when you do this short practice, it's about 10 minutes, you might notice how this shift in attitude towards your pain can change the context and the pain itself. In our next lesson, we're going to explore the context of difficult interpersonal interactions, the pain of disconnection. So until then, please check out how your mood and pain might change as you interact with others. Getting curious, noting without judgment, particularly in any difficult interactions with others, either in person or by phone or even by text or emailing. Bye for now.

The Pain Of Disconnection

Hello, welcome to lesson 14, the pain of disconnection. Just taking that pause and perhaps feeling how you can be connected to the floor that you're on, the surface that you might be sitting on or lying on. If your feet are on the floor, perhaps even sensing roots coming out of the bottom of your feet, passing through the earth, that really strong connection, that being held by the earth. And you can come into connection with yourself by just noticing what's present right now, what thoughts, emotions, body sensations, perhaps offering them a little bit of kindness, maybe a hand on the heart, maybe reminding yourself that what you're feeling, it's part of being human. And letting that go now. And so today we're going to explore context and pain a bit more, in particular, how we relate to others and how our personality traits might be involved. There's research to show that certain personality traits are linked to the development of chronic pain. I think it's quite interesting because they keep us in drive or threat. So these personality traits can be danger experiences, dims. The first classic one is the warrior with an O, not an A. This worrying, sometimes habitual, thinking about what might happen in the future and coming up with ways to control it. Like all these things has its good side, but it can absolutely keep us on alert in a threat state. And it might not even be about your pain. Notice if you resonate with this. I like the little saying from Winnie the Pooh where Piglet and Winnie the Pooh are up a tree and Piglet says, supposing a tree fell down, Pooh, when we're in it. And Pooh says, supposing it didn't. I have to confess, I'm naturally more of a Piglet than a Pooh. The other personality trait that can be linked to a higher likelihood of chronic pain is the high achiever, often a perfectionist tendency. So unfortunately, this being human means almost by definition that perfection is actually impossible. So being a perfectionist can keep us constantly driving to be better and then swinging into that threat system where we can never quite achieve the impossible. The third personality trait is the strong self-critic. That voice that beats you up for every decision or action. Most of you will probably be familiar with this. For some, it'd be very clearly a voice. For others, it's more of a feeling, a kind of sinking feeling. And this is pretty obviously a danger experience. The very metaphor, beat myself up, right? We know that people with this set of personality traits in particular will often have a tendency to be people pleasers, put everyone else before themselves, sometimes ignoring their own body's cues and needs. And that in itself can be a danger experience for some. That it's not safe to be my authentic self. It's not safe to have needs when with others. And it's okay to have these personality traits. We're learning how we can be with difficult thoughts, difficult emotions, with kindness. However, interacting with others can be tricky when we have these personality traits. And let's face it, it can be pretty tricky at the best of times, everyone with all their different personality traits. It's amazing that any of us get on at all. And adding pain into the dynamic can take that to a whole new level. Pain's mostly invisible. We often hide it. We don't want to be a person who identifies with chronic pain. And other people in our life may mean well, but it's human to make ignorant, invalidating, and sometimes outright hurtful remarks. They can imply that somehow they know better than you and that what you're doing or feeling is wrong. And the remarks can add up like a thousand paper cuts and add on this extra layer of pain of disconnection, of not being got, not being understood, not being seen or heard. And of course, we do this to others also. Very human. So I'm just going to lead a quick reflection now, and this would be good for you to have your electronic or paper journal. Starting off by thinking of some kind of interaction with someone else this week. It can be quite minor. It might have been a hurtful remark, a moment of tension, a disagreement at home or work, an awkward email. It could be related to your pain, but it may not be. Feel free to pause if you need a little bit of time to consider what interaction to use. We don't want the worst one in the world, but we want something that's enough that you can reflect on. What was happening? What was said? And particularly, what were your feelings, your body sensations, your thoughts when this was happening? What were you wanting in this? And did you get it? Letting that go now, maybe with a breath or two. What was the other person wanting? And did they get it? Just want to say here, this is not about always empathising with the other person. This is not about being treated like a doormat. This is just noticing, even if the person's behaviour wasn't the best, what were they wanting and did they get it? And is there any familiar dynamic or pattern in this interaction? Sometimes it could even help if you've got paper and pen to do some doodles. Was one person much bigger than the other or much higher than the other? So perhaps you can get a sense from this of how when we feel disconnected in our social relationships, this can be a danger experience, a dim, or you could even call it social danger or social dim, and how it could play a role in our pain experience. And of course, sometimes this social danger could be very real, right? Of course, we can't control everything about others. And sometimes they are a danger. People who are toxic or abusive to us, medical gaslighting. And other times, it's perhaps not so real. It's more of a perception. But our system won't necessarily differentiate with that. If we perceive that something is a social danger, we will be in flight, fight, freeze or shut down. But it can be valuable to consider our own tendencies in interacting with others. Do we tend towards people pleasing? Do we tend to put on a mask or a happy face when we were going to be interacting with others? Do we allow boundaries to be crossed? Do we avoid important conversations? Do we not speak up when we should? Or do we speak up too much when perhaps stopping and listening might be more helpful? Be careful not to make this yet another dim. Be careful to be not too judgmental. Just know that these are very, very human tendencies and be as kind as you can as you consider these. Just as important, what about the flip side? Let's consider social sims, things people say or do or ways of relating that bring about safety. So, perhaps just having a few moments to consider what really helps you. What's a real social sim for you? Perhaps it's a hug from a specific person. Someone cooking you a meal. Your partner telling you that they love you. An offer of help. Someone listening without jumping in to fix things. So, making a note in your journal now of some of, some things that come to mind that are social sims. Do you get the sense of how that will put our system into safety mode and impact our pain positively? Feel free to pause the audio if you'd like a little bit more time to consider this. But between now and next lesson, I really urge you to explore social danger and safety signals. Social dims and sims, especially relating to interaction with others. And the formal meditation for this lesson can be found by searching the free Insight Timer app for the 15-minute practice, Adele Stewart, Pain of Disconnection, Dealing with Hurtful Remarks. Our next lesson will be a meditation, kindness for self and others. Really boosting those social sims. Bye for now.

Kindness For Self And Others

Hello, welcome to lesson 15, Kindness for Self and Others. This practice is primarily a meditation, so you might like to find yourself a comfortable posture somewhere, get yourself settled in. And the intention of this practice is to generate some feelings of kindness and love towards ourself and others. This healing journey can be a tough one and we can feel quite alone. It's so easy to get discouraged. There's research to show that actually practicing kindness and love can change our inner experience, easing our sense of threat and increasing our safety. Perhaps just thinking of this as planting some seeds and just seeing what grows or doesn't. Finding your seat or lying down on the floor perhaps, so you can have a sense of support and some stability. Connecting with a sense of your whole body here, being as present as you can be. And if it feels supportive, it can help to place your hands somewhere on your body to support this opening towards warmth and caring for yourself, towards tenderness for yourself, kindness and friendliness towards yourself. You might try a hand on the heart or perhaps both hands cupping your cheeks. And yeah, this kindness thing can feel a little strange, even uncomfortable. Especially if we're used to offering ourselves unkindness, criticism and rejection. Through this practice, as best you can, just allowing for that complexity, making space for it. And looking after yourself, coming back home to breath and body regularly. If that's good for you. If necessary, you can even allow yourself to open your eyes, look around the room, settle and ground yourself. Right now, if it feels okay, just noticing any feelings of pain, either physical or emotional. There's no need to be specific. In a broad sense, think about what you are carrying with this pain, with this condition. See if you can acknowledge how difficult it is to experience this pain, to have this pain, to take care of this pain. Again, a hand perhaps on your heart for extra support can be really helpful. And if it feels right, you might even say to yourself, this is hard or so tough to feel this way. Use words that you would find helpful to hear from a close person. A close friend who really understands what you're going through. Practice softly repeating these words a few times and actually really listen to yourself saying them. Check out, do you mean them? Does it feel good to hear these words? Or do you notice that you have a hard time hearing them? Whatever your experience, it's okay. There's no right way or wrong way. Letting yourself honor the unique gifts and strengths that lie within you. Knowing there are gifts and strengths that are already realized and those that are still seeds of potential. Like in every human life, there are wonderful moments of strength, courage, humor, creativity, generosity and tenderness. Your heart, like all human hearts, is capable of more love and kindness than you ever dreamed possible. You might allow a slight smile on the lips as you practice meeting what's here with kindness, tenderness and acceptance. Knowing that these things will change over time as you practice. Becoming aware of your breathing now, settling into the rise and fall of this natural breath. Riding the waves of each breath and allowing the rising and falling to offer some softening and presence to arrive. You might even allow the breathing to help support the quality of kindness. You might like to imagine the breath being imbued in the quality of kindness. This might be a word or a light or a color or a fullness or warmth. Breathing in acceptance, warmth, tenderness, friendliness. Breathing in these qualities of kindness. Opening to and making space with each breath. No need to force anything, no need to try hard. Allowing this practice to unfold, to emerge. Making space for whatever arises is also an act of kindness. And now using some words to offer this intention of kindness as a wish if you like. Wishing yourself tenderness. Wishing yourself acceptance and deep care. Wishing yourself courage and the strength to live life with more compassion. Wishing yourself ease and peace in your body, your heart and your mind. Notice whatever is arising as you practice in this way. Noticing if there is any sense of constriction or tension or unkind thoughts or ambivalent feelings. It's okay, just opening to sensations in the body, to all thoughts and feelings as best you can, just as they are. Making a soft space to allow whatever arises. This wellspring of natural responsiveness and care is what we're cultivating in this practice. You may even like to make these wishes a more formal offering using the words may I. Try them out, try offering yourself these phrases. May I be safe from inner and outer harm. May I find peace. May I be well in my body and mind. May I be free. Perhaps you can even imagine you're whispering these words into your own ear. Using a soft kind voice. May I be safe. May I be peaceful. May I be well. May I be free. Wishing yourself kindness in the best way that only you know how. Allowing whatever comes up. Grounding using the soles of the feet or the breath as an anchor if needed. Opening to receive these wishes. Just as much as you can. And knowing that this will shift and change over time, no need to struggle with it. And now letting go of this and returning your attention to the whole body resting here breathing. And maybe opening up to all the others in the world who are suffering just like you. Many millions of people on this same journey learning how to shift and transform their safety and danger experiences. This careful and caring work of investigation and transformation. Knowing you are not alone. In your mind's eye perhaps you might even invite all these people into your awareness. Maybe as a small gathering of people, maybe a huge group. To stand with you in solidarity in some way. Maybe they have your back, maybe they come out from your sides or maybe they're in a big circle around you. Sending their messages, their wishes. May you be safe from inner and outer harm. May you find peace. May you be well in body and mind. May you be free. Radiating out a sense of kindness to the world. No need to push it out. Perhaps see if you can be like the sun which just sits there and radiates it. May we be safe. May we find peace. May we be well. May we be free. Keep breathing, keep softening. Keep radiating out a sense of kindness to the world if that makes sense to you. May all beings be safe. May all beings find peace. May all beings be well. May all beings be free. When you're ready, bringing this kindness practice to a close. And knowing you have this capacity at any moment of your day to pause, to notice what is happening. To connect to the common feeling we all experience. And offer yourself and others kindness, compassion and understanding. And now becoming present to whatever is here now. Letting the practice be just as it is. And for you to be just as you are. And for home practice you may like to repeat this meditation. Or you can search the free Insight Timer app for Adele Stewart, You are not alone for pain. And next lesson we're going to be talking about how pain is only one of many protective outputs. We'll speak about some of the other protective outputs including the motor system. And an antidote to the fight flight sympathetic nervous system which we call rest and digest. Bye for now.

Pain Is One Of Many Protective Outputs

Hello. Welcome to lesson 16. Pain is one of many protective outputs. So pain's kind of like the end game. It really forces us to take action. But there's lots of other systems that are constantly helping us. Our thinking, creative thinking, planning, problem solving, feelings and emotions, anxiety and fear that motivates us to avoid things, people and places and protect our body. Our respiratory system, our breathing helps us be able to cry, scream, talk, calm down. Our language, we can call for help, explain ourselves, be involved in our treatment. And then there's a number of protective outputs that are constantly protecting us in the background. There's our motor system, activates muscles to make you move, cry, avoid, brace, limp, pray, scream. We've talked a lot about the sympathetic nervous system and the endocrine system, the threat system, increasing alertness, improving our hearing and vision, sending bloods to muscles, increasing our heart rate, closing down systems we don't need in emergencies like healing, growth, reproduction, digestion, and fires up essential systems, energy production, muscle action, respiration. And then we've got the immune system that kind of knows who we are, looks out for threats, sends protective molecules to injured areas, makes micro-inflammation, makes fever, helps you learn, sensitise nerves. And we're going to talk more about that immune system next lesson. We're going to talk specifically about the motor system today, but before we go there, I want to talk a little bit about if our protective systems get turned up and edgy, how they can affect us because the danger level will go up in our system. So, let's start with thoughts. If we have an edgy protective system, our thoughts can lead to frequent worrying, negativity, hopelessness, a loss of creative thinking, just focusing on scraping through the next minute, the next hour. And our emotions, we can have excessive anxiety, and fear, reduced confidence, and lots of avoiding, avoiding activity, avoiding other people, sometimes really withdrawing from life. If our language is affected, we can have lots of silence, lots of swearing, repeating yourself, being unable to express your pain. As I'm going through, obviously, just notice if anything resonates with you. If our respiratory system is turned up and edgy, we can have shallow breathing, lightheadedness, our voice can be affected, and we can have chronic shortness of breath. Our body perception can be affected. We can have a body part feeling bigger or smaller. We can have a loss of left-right perception. We can sometimes hate a body part or feel a body part doesn't belong to us, or have a really sensitive space around the body. Please post something if this one in particular resonates with you. It's important. Then we've got the endocrine system and the sympathetic nervous system, and these can affect so many things. Sweating changes, blood flow changes, weight loss, weight gain, feeling anxious and edgy, difficulty sleeping, restlessness, increased blood pressure, change in our skin and fingernails, panic attacks, loss of sex drive, poor digestion, increased flatulence, constipation, slow tissue healing, affected memory, unable to learn, depression. An edgy immune system can cause depression, antisocial behaviour, increased infections and colds, being tired all the time, having more aches and pains, and an affected edgy motor system can cause tight muscles, new muscle aches, rigid or jerky movements, groaning, grimacing, tensing up, and difficulty learning new movements. So sometimes it helps to know that we're not a complete mess, right? All these symptoms that we might have and resonate with are related to our systems being in overprotective mode, turned up, edgy, and of course, a lot of these are danger experiences, dims, so they'll often worsen or sometimes even cause pain. And meanwhile, that pain buffer, that bubble wrap suit might get thicker and thicker so that we do less and less before we get pain. So let's talk a bit about the motor system. When our motor or movement system is working well, yeah, it helps us move, limp, cry out. If there's a threat, it can be very helpful getting our long muscles like our quads and hamstrings and biceps primed to run away or fight. And in short-term acute pain, tightening to brace or splinting area can be very helpful. Of course, with persistent pain, we can have chronically tight muscles, which is not helpful. Very common in back pain to have a spasm in the back muscles. The vaginal muscles can tighten and cause problems in pelvic pain. The scalp muscles can tighten in chronic headache. They also contribute to holding emotional tension in common places like the jaw muscles, the temples, the base of the skull, the shoulders, and I mentioned the pelvic muscles. And if the system overprotects us, we can have muscle spasm in these places, chronic tension, even difficulty learning new movements. So imagine if you were constantly stalked by a scary animal like a lion for many months. The long muscles in your body like the quads and hamstrings and biceps would always be turned on ready to fight. You wouldn't waste energy on short muscles, just used for things like posture, like in your neck or the front of your tummy so they'd weaken. And have a think of the lion as a metaphor that the lion could be your dims stalking you. Perhaps work issues, personal stress, creaky knees, fears. A good pain educated health professional like a physio for instance can help you relax the long muscles, strengthen the short ones that tend to be stabling like the core. And just as importantly and more in my area, you may be able to identify the threats, the dims, the lions that have been stalking you and causing all of this. Putting the lions to sleep. Now I do want to mention just a little bit about complex trauma, a bit of a trigger warning here, just hearing it talked about can be difficult for some. And this is a huge complicated area affecting so many people. Events in childhood, particularly ongoing abuse or betrayal by a caregiver are turned complex trauma. And there's studies to show that they can affect our physical and mental health many years, even decades later, including pain and pain conditions of course. And I'm going to use the backpack metaphor again, but this time having had complex trauma could be seen like we're carrying an invisible backpack accumulating more and more over the years. And what might the backpack of a trauma impacted adult contain? So many things. Inflammation, micro-inflammation, sensitized nociceptors, neuro-immune effects, stress hormones, troubled emotions and relationships, avoidant behaviors. So many dims. There's really good important news here. Trauma can be helped with things like trauma-informed meditation and mindfulness, trauma-informed therapy, even things which you mightn't think of like self-defense classes, rock climbing, dancing and theater. The brain can change and go into that more towards the end of the course. Just finishing off this lesson with rest and digest, which is activating the parasympathetic nervous system, which is a great soothing antidote to the sympathetic nervous system, stress, the fight-flight response in general. And these include things like improved sleep, meditation, yoga, tai chi, qigong, yoga nidra, even just looking at something calming in nature like the ocean, lazing in a hammock. And of course, mindfulness and self-compassion, which can be confronting, right? Not always relaxing, but for many there is a lovely rest and digest kind of response. There's also the practice progressive muscular relaxation, which comes from way back in the 70s, but it's still really effective. So this is your formal home practice this week. Go to the free Insight Timer app and search Adele Stewart progressive muscular relaxation and give it a go. Next lesson, the whole lesson is going to be about one of our super important protective systems, the neuroimmune system and how to balance it. Bye for now.

Balancing The Neuroimmune System

Hello. Welcome to lesson 17, Balancing the Neuroimmune System. So we talked last lesson about all the other protective systems that look after us, especially the ones that are constantly protecting us in the background, the sympathetic nervous system and endocrine system and our motor system, and also our immune system, which we're going to go into today. And we talked about pain is like the end game, really forces us to take action. And that our protective systems are just that, they're protective, but if they're switched on and turned up for extended periods, they can get edgy and overprotective and will sometimes worsen or sometimes even cause pain. Before we go into talking about the immune system, let's have a little grounding. It's taking that pause right now. Perhaps feel your feet, the soles of your feet connecting to the surface beneath you. It's noticing the breath. Nothing special, no need to change or manipulate the breath. Spending a little time noticing the felt sense of the breath. Perhaps even having a sense of coming home to this breath. In breath. The out breath. The in breath. The out breath. The in breath. The out breath. Knowing that whenever we use an anchor like the breath, it's completely normal for the mind to drift. That's what humans' brains and minds do. No need to drag your attention back to the breath. Just gently noticing where the mind's gone. Perhaps even having a little smile at that and gently, gently come back to the breath. Strengthening the attention part of our brain and mind. Letting that go now and let's talk about the magnificent immune system. We now know that the brain and immune system are far more connected than we used to think. Hence, we talk about the neuroimmune system. It goes two ways. The immune system can affect the brain and the brain can affect the immune system. So, an example of the immune system affecting the brain might be a vaccine. A vaccine can cause immune cells to be affected, which can travel to the brain and directly cause changes in the brain to produce fatigue and brain fog and affect our behaviour. And some of you with chronic pain might be thinking, hmm, that describes me. Because when you have persistent pain and an edgy, overactive immune system, you might be suffering frequently with fatigue and brain fog. It's the immune system trying to look after us, but being overprotective. You might also be suffering from loss of appetite, anxiety or depression, withdrawal from life, generalised aches and pains where perhaps the pain started off localised, headaches, sweating, dizziness, reduced libido, reduced motivation. So, you're not going crazy if you're suffering a lot of this a lot of the time. This is our neuroimmune system in overprotective mode. So, the immune system can affect the brain and the brain can affect the immune system. There's a lovely study that shows that someone very experienced in mindful meditation doing some specialised breathing techniques were able to voluntarily reduce the inflammatory response to introduce bacteria into the system, right into the bloodstream. So, the immune system plays an enormous role in chronic pain. The immune system doesn't just react to things that we would expect it to, like viruses and bacteria. It also reacts to tissue damage like muscle tears and fractures, nerve damage, burns, things like poisons, even prescription opioids. And it also reacts to our thoughts and beliefs. Yes, our thoughts and beliefs, just like viruses, can produce micro-inflammation in our system and cause the immune system to release inflammatory chemicals that sensitise those nociceptors. This is a little bit mind-blowing, isn't it? The good news is we can do things to balance our neuroimmune system. We don't want it too edgy and overreactive and make our pain worse or sometimes even cause our pain. And we don't want it to be too sluggish or underactive and have us get infections more easily. We want it to do its thing in a balanced way. So, we can identify and reduce danger experiences and increase and power up our safety experiences. Small changes matter. And we're doing great immune system balancing with our mindfulness meditation. The more we practice, the more effect it will have. We're also doing some lovely immune buffering with the pain knowledge and the education. What we've been doing during this course, this is helping your immune system. Getting to know what stresses us helps buffer the immune system. Movement and exercise and pacing, so important. And exercise doesn't have to mean beating yourself up at the gym. Any movement is helpful. Tim Cox, who was with the NOI group, says, perhaps what is important in regard to exercise, it's good for everything, is not so much the idea of getting strong or fit, but rather the beneficial neural endocrine and immune effects of exercise. And there's some other cool research revealing we should probably consider the muscle as another endocrine organ. It produces so many different hormones and chemicals. Activating our muscles, even with things like heel raises or sitting and standing from a chair, helps many body systems, including our immune system. Other things that can have an effect on our immune system are perceptions about our health. Perhaps yours are changing during this course, and that will be helping your immune system. Good social support, our loved ones, our friends, good medical support, the health professionals that are there for you. And as I introduced earlier this lesson, our belief systems and how we think do affect our immune system. So if we can question some of our beliefs, if we can see our thoughts as mental events, not facts, we can put down that pain story for a little while, or at least loosen it. This helps. Humor, laughing can be a lovely immune buffer. So next time you watch a funny cat or dog video, you're actually helping your immune system. Developing coping skills, perhaps in a therapy context, absolutely helps. And then there's what we eat. There's a lot in this, and I'm just going to mention a few factors here. The gut biome, important. There's research benefits on fasting for the neuroimmune system. Antioxidants called polyphenols that are in blue and purple foods, veggies and berries can be helpful for chronic pain. And reducing processed foods, or at least very processed foods, is helpful. All the other lifestyle factors also influence the immune system. We've talked about what we eat and moving exercise, but also stopping smoking, limiting alcohol, and our sleep hygiene. This is super important. A very, very common problem in chronic pain. And the good news is just like chronic pain's complex, so is sleep. So again, there's lots of ways in. And contact with nature. It sounds like a bit of a cliche, but you know, we are meant to be in contact with nature. Perhaps just as simple as lying in the grass or sitting against a tree, being near the ocean. These are helpful. They help our immune system. And there's research to show that having a spiritual faith can benefit your immunology. How's that, eh? Here's a powerful quote from Mark Hutchison. He says that making changes in things like movement, changing our thoughts and beliefs, improving our sleep is like molecular neurosurgery, eh? Molecular neurosurgery. Actually making structural changes at the level of the brain and spinal cord. So much more nuanced and emergent than the more linear neurosurgery we might have on a disc. We're going to move to a little contemplation now, and I'd like to start this with a beautiful poem by Mary Oliver, The Summer Day. Who made the world? Who made the swan and the black bear? Who made the grasshopper? This grasshopper, I mean. The one who has flung herself out of the grass. The one who is eating sugar out of my hand. Who is moving her jaws back and forth instead of up and down. Who is gazing around with her enormous and complicated eyes. Now she lifts her pale forearms and thoroughly washes her face. Now she snaps her wings open and floats away. I don't know exactly what a prayer is. I do know how to pay attention. How to fall down into the grass. How to kneel down in the grass. How to be idle and blessed. How to stroll through the fields, which is what I've been doing all day. Tell me, what else should I have done? Doesn't everything die at last and too soon? Tell me, what is it you plan to do with your one wild and precious life? So going into a contemplation now to purposely bring in an immune balancer for this one wild and precious life. So closing your eyes, bringing your attention to your life at the moment, reflecting on what you might want to stand for in this perhaps very difficult time in your life. What really matters deep in your heart? If you looked back to this time in 10 years, what sort of attitude would you like to have now so that you would feel proud of yourself in the future? So bringing attention to one area in your life that's emerging as something you'd like to attend to more, take better care of. It might be to do with the care of the body, eating, movement or exercise, relationships, meditating, how we spend our time at work or with involvement in the community. Just choosing one now, you can do this again with another one later. Now let's explore what might be one action, one behavioral shift in this area of life that you could undertake this week. Some sort of action that will balance your immune system. It could be a really tiny thing. In fact, a tiny thing is often good and more realistic. Maybe making one phone call to connect or eating vegetables every day, making your lunch each day, putting your exercise clothes out the night before, improving sleep hygiene by committing to turn off your device at a certain time. Joining a Tai Chi class, making an overdue health appointment. What might it be like to take one small achievable action to attend differently to what matters to you in this one wild and precious life? And just a little caution here. Firstly, make it realistic. So if you're saying I will exercise every day, maybe you might say I will exercise twice a week and more if I can. And remember, we can't necessarily just snap our fingers and change our thoughts or emotions. We can only change our behaviors. So if you've chosen an action like I won't feel despairing when I'm in pain, perhaps instead your action could be when I feel despair, I will hold that gently like the fist in the open hand. Just another few moments to just modify this action so it's small and achievable and behavioral. I'd really recommend that you post this on the course. Very helpful to actually put something in writing and put it out there to reinforce our intentions. And so the home practice between now and next lesson is to see how you go with your life action. Please remember our systems can be quite threatened by changing an ingrained habit. Most of us prefer the known, the stable. You might get a little bit of pushback and urge to go back to old ways, possibly even a flare up. See if you can be kind with this and see if you can be really compassionate if it doesn't quite go the way that you hoped. For the formal home practice, please search on the free Insight Timer app, Adele Stewart Open Focus. Now this is a 40 minute meditation, but it can be very, very powerful and transforming for some. Really recommend you at least do it once. And next lesson, we're going to talk about how we're not just neuroplastic, we are bioplastic. It's not just our brains and nervous systems that can change, our whole systems can change. Goodbye for now.

We Are More Than Neuroplastic - We Are Bioplastic

Hello. Welcome to lesson 18. We are not just neuroplastic, we are bioplastic. Taking a moment to settle in. Pause. Perhaps take three mindful breaths. Perhaps even allowing a bit of an audible sigh on the out breath. Sighing can be really nice for our rest and digest that we talked about a couple of lessons ago. So the majesty of the brain. It's amazing, constantly changing and adaptable, more than we ever realised. It's alive, it's electrical, it's chemical and there are new brain cells growing every day and many, many connections between brain cells growing every day. Most of you will probably have heard the term neuroplasticity. Just a reminder here that plastic here means changeable, not artificial. But as our brain and nervous system changes, our whole system changes. So we are bioplastic. And that's both good news and bad news. In terms of pain, I just want to return to the metaphor of the brain as an orchestra that we brought up earlier when we were talking about complex systems. So the more the orchestra plays the pain tune, unfortunately, the better it gets until sometimes it gets stuck in that pain tune. And this is bioplasticity. And we are here to change that pain tune. And that is also bioplasticity. This bioplasticity is, again, there to protect us from possible future injuries or dangers. Just wanting to keep us safe. And of course, we've said that the brain does this partly by using all its memories and its constant predictive abilities. But this means that anything that puts you under threat, any dim, anything at all can increase pain. And boom, bad news, plasticity. And we've discussed over the duration of the course, so many life factors can increase danger messages being sent and pain being produced. Things we see, hear, say, feel, think, believe, people in our life, places we go, things happening in our body. All those danger categories. So again, pain and these other systems all have good intentions for us, they want to protect us. But unfortunately, the longer we have pain, the more protective the pain gradually becomes. And the more sensitized our whole system becomes. Now, I just want to clarify here, this is not you're just sensitive, okay? This is a whole system process that can happen to any human. In the orchestra metaphor, this sensitization is like turning up the pain tune. And eventually, the system can become completely overprotective. And it actually starts to prevent recovery, ironically. Now, some of you may have heard this referred to as central sensitization. This originally actually referred to a very specific sensitization process related to the spinal cord. And some feel it's been adopted a bit too widely. The term may have even become a dim danger signal to some. Other terms for this sensitization are Alan Gordon refers to it as neuroplastic pain, which kind of makes sense. The technical term is nociplastic pain, which is a bit hard to remember. And one that Laura Mimosley came up with a group of people with lived experience of pain was pain system hypersensitivity. So at the risk of laying it on a bit thick with the orchestra metaphor, remember the last lesson where we talked about the neuroimmune system and the lesson before where we talked about the protective systems in general. So it's not just the orchestra being stuck in the pain tune. It draws in the other protective systems, which also perpetuate the pain tune. So in this metaphor, the orchestra gets less creative, the trumpets take over the violins, the audiences stop coming. And in this course, we're learning to not only change the tune, but to open life up. So I'm just going to read out some very commonly heard statements in someone with a sensitized system. And as I'm saying these, you might just make a mental note if you identify with any of these. Because if you do, then it's highly likely that you have some sensitization. The pain has spread. So as the nerve endings wake up more and get sensitized, they can also wake up nerve endings on neighboring nerves and call them nosy neighbors. It's worse on Mondays. My memory is terrible since having the pain for a while. The pain's got a mind of its own. I've got lots of pain diagnoses, you name it, I've got it. It's the same pain my mother had or my grandmother had. No one seems to believe me. Medication has stopped working. It hurts even if I watch someone move a certain way. It hurts much more when it's cold, or when it's raining, or before a storm. Since my pain got worse, I'm less coordinated. The pain is so random. Yes, stress makes it worse for sure. I've had pain for years. We're just pausing a moment. Perhaps you might like to open your journal. Maybe making a note in your journal if you identify with any of these statements. And if this pain science is true, how might this knowledge of sensitization change your relationship to your pain? Feel free to pause the audio if you need a little bit longer. This pain from sensitization is very real, very understandable, and very manageable. All the things that we've been talking about during the course will help. Soothing the nervous system. Lifestyle changes that can balance the immune system. Improving how you eat, how you move, meditating, doing yoga, spending more time in nature. All can gradually decrease the sensitivity. Use the power of neuroplasticity or bioplasticity, as we know it's more than just the neuro system. And look, if we have big stuff in our past, if we've had past emotional or physical trauma, think about it. It's really understandable that our systems will be particularly overprotective. Remember, the best way to protect the body is to make it hurt. And remember when we were talking about the science behind actively changing our language to use helpful metaphors can make a difference. Something like my favorite motion is lotion. Perhaps there's light at the end of the tunnel. That's good news bioplasticity. So some more good news bioplasticity. A graded movement program devised by a well-pain-educated health professional, like a physio or an exercise physiologist, can gradually help you move with less pain. Very, very slowly and gently, and gradually desensitizing painful muscles. Here's another little good news bioplasticity nugget. Might surprise you. Without lubrication, our bodies wouldn't function. Just think how amazing it is that your eyelids slide on your eyes, that your tendons glide, that your joints are almost friction-free and don't need WD-40 squeezed in every few months. So we're self-lubricating. And much of our lubricating ability comes from a chemical, a juice called Lubricin. So how's this Lubricin related to bioplasticity? Well, we know that moving and having a well-balanced immune system improve the amount and quality of Lubricin. And we know stress makes Lubricin deteriorate. So any of those immune system balances that we've talked about, including movement, will help us lubricate our joints. David Butler says, make them gleam and glisten and glide beautifully. How's that for a bit of nice language? And nourish our cartilage. Oh, and apparently newly pressed extra virgin olive oil can help the Lubricin also. All our body parts rely on movement for health and the spinal cord's no different. It's great to flush out all its spinal neural networks. Healthy spinal movement, say like a forward fold in yoga, is bioplastic itself. It encourages blood flow to the spinal cord. It helps move the fluid around the spinal cord. Gives all the nerves in the spinal cord a good workout. Nerves are tough and flexible. They like being worked out. And even stretches the tough ligament that supports it. And it protects the flushes out some of the stagnant inflammatory stuff as well. Amazing. If you've got back pain years ago, you may have been told that bending from the waist and forward folds are not good. But we now know that that's almost always wrong advice. Let's do one now. You can stand up or if you prefer, you can do this sitting. Just nice and slowly. Really noticing the feeling of gradually folding the body forward. Starting with your neck, then your upper spine, your lower spine. Stay in this fold a short time. Remind your system this is really safe, really good for back and spinal cord. Back off a bit, of course, if there's pain. This is safe. And then mindfully, gently unfolding one vertebra at a time. Bioplasticity in action. So it was bioplasticity that got you into this mess. And bioplasticity can get you out. Yet all the protective systems can get turned up and edgy. And the wonderful news about plasticity is that they can change back through our lives. And I'm going to finish this bit with the best bioplasticity news of all. It is biologically implausible to suggest that pain can't change. Say that again. It is biologically implausible to suggest that pain can't change. So for the formal meditation practice this week, please search the free Insight Timer app for Adele Stewart Dissolving Pain. This is a beautiful practice, can be very, very helpful. It's about 20 minutes. I really recommend you try it a few times if you can. And next lesson, we're going to talk a little bit about how knowledge is power and how we are not our pain. Bye for now.

I Am Not My Pain

Hello. Welcome to lesson 19, I am not my pain. But to start off today, upstanding. Have your feet about hip width apart. Notice the feet contact the ground, the floor below you. Put the knees a little off lock. Just be aware of where you are carrying tension in your body. Now some of this tension may be necessary and some of it might be a bit outdated. But the invitation is to let it go as best you can. Drop the shoulders, maybe shake the arms and hands a little bit. Maybe shake each leg and foot a little bit. Allow the torso to get a bit loosey goosey. Maybe even use what we call horsey lips with the out breath. And as you do this, observe the breathing slowing down. Perhaps becoming a bit more natural, a bit more full. This is a lovely really short practice to do many times a day. So we're getting towards the end of the course. And I'm hoping that you're getting really engaged with these pain science concepts. And maybe you might even feel a part of something bigger. A worldwide pain revolution. And the power in this lies in the hands of pain scientists, pain health professionals, and also you, also in those with lived experience of chronic pain. And this revolution is not going to happen overnight, nor will the changes in you, but they will happen. This approach is not just about managing pain, it's about reducing pain. It contains a hopeful and perhaps confronting message. Chronic pain can be slowly but surely improved. There are a vast number of people who can now say after weeks, months or years of pain that they get it. And have switched paths from a downward spiral of pain and suffering to a slow and steady road to recovery. One thing that I'm sure you're aware of if you've got this far in the course is that pain is a really complex experience. And as we're learning, ultimately the brain, the NEI ensemble is what produces the pain. And we can engage that same brain to understand chronic pain. There's a lovely little study on a patient that had years of pelvic pain. When she had a brain scan, when she was resting and pain free, there was very little brain activity. She was then given a task that was painful for her of moving her pelvis. She had another set of scans that lit up very strongly as the brain was very active processing the pain. She was then given a half an hour of neuroscience education, like what you've been learning here. And she was asked to do the task again. In this set of scans, it was lit up about half as much. She felt much less pain than she had the first time. She could also move and function slightly better. It may seem too simple, but knowledge is power. And the good news is since you're nearly through the course, the same process has already started in you. So you're already doing it. And of course, if you've had pain for a prolonged time, it will take time and patience to change your system. In the meantime, if you can see pain as a part of your experience, but not you, not defining you or reducing you. If you can know you are so much more than your pain, this can be one of the most helpful mental shifts we can have. It widens the world. It stops us feeling like we're broken or defective or unlovable. So we're going to do a little meditation called You Are Not Your Pain. Finding yourself a comfortable posture. You're seated. With your feet on the floor. Your upper body reasonably upright. Alert, but relaxed. Or lying down flat on the floor, or perhaps the bed. Noticing the contact your body's making. And ever so gently moving the attention to the breath. Noticing the rhythm of the breath. Perhaps noticing any sense of expansion or contraction in the chest or belly. And noticing if there are any unpleasant or painful sensations in the body. Notice if it's one area or several. And just choosing one area to work with today. Firstly, check in with yourself if it feels okay to start paying a little bit of kind attention to the pain in this moment. If not, perhaps you might just want to stay with the breath for a little while. And if you choose to work with the pain today, bringing a gentle sense of presence to it. You can choose how close or far away you get. You do go a little closer, noticing if there's any increase in tension or bracing. Allowing yourself to consciously relax that a little if possible. Or perhaps using the breath and letting go of tension on the exhale. The summit can be really helpful to imagine the breath is holding the pain. Maybe breathing around it or through it. Keep breathing. Keep softening. And breathing. And softening. And softening. And perhaps you're noticing some thoughts, part of the pain story or just pain, I hate this pain. And if there is, is it okay to let go of those thoughts just for a little while, just for some moments. Perhaps trying really gently to say something like, oh, this is a moment of pain. Or this is what whatever pain you're feeling right now feels like. And perhaps just gently seeing how these words land. This is not my pain. It is just the pain. Human beings experience pain. Many people are experiencing exactly this kind of pain in this moment. Keep breathing. Checking if this is okay, or if you want to stop the audio and just go back to the breath as an anchor. And if you're willing to keep exploring, the invitation is to drop this question into your system. No need to go to your head to think. Perhaps imagining dropping it into your heart or your belly. And the question is, is that which is aware of the pain also in pain? Perhaps imagining you were dropping this question like a pebble into a well, just feeling into the widening ripples instead of trying to think of an answer. Is the awareness of the pain in pain? Notice any subtle shifts, even in texture of your inner experience. Because this is not something you can think of an answer to. Finally, if you're willing to try one more question, dropping this question in like a pebble deep into a well. What is aware of this pain? What is aware of this pain? And now gently letting go of this exploration, spending a few moments in this experience as best you can without judgment, accepting your experience right now. And starting to move the body. Opening your eyes if they've been closed. Your invitation for home practice between this lesson and the next is trying out changing your spoken and internal language from something along the lines of, I'm in pain, to something along the lines of, this is a moment of pain. Notice the impact of not taking your pain so personally. And if you search the free Insight Timer app, there's a longer version, about 15 minutes of this meditation. Adele Stewart, I am not my pain. Please be gentle. This is maybe not a good practice to try with very little pain. Very, very high intensity pain. And our next lesson is our final lesson. The road less traveled. Reinforcing that active management like this course empowers you to reduce and reshape your experience of pain. And some little inspiring ideas for heading out of the course with. Bye for now.

The Road Less Travelled

Hello, welcome to our final lesson, lesson 20, The Road Less Travelled. Just taking a moment to check in. Wow, got to the last lesson. This has been a big ask, this course. Just noticing any thoughts. Perhaps there's questions, perhaps the pain story. Perhaps there's answers, insights. Noticing emotions that are present. Perhaps there's some hope, maybe excitement, maybe some peace. Perhaps there's mixed emotions, might still be some frustration. Disappointment. All of these emotions are welcome. And noticing body sensations. Unpleasant and pleasant. And just noticing what is it that you might most need right now. Perhaps it's some nice anchoring breaths. And on the heart, some soft mental words, wishes, reassurance. Perhaps simply noticing the effect of gravity. And letting that go now and know that at any moment you can pause and notice. Notice thoughts, emotions, body sensations. And what is it that you need? So for most people doing the course, you will have tried a few things for your pain. And at times you may have coped passively. Avoiding stuff that makes pain worse. Doing nothing. Waiting for something to happen, something to change. Believing someone else has the answer. You may have also tried many passive treatments. Maybe TENS machines, hot or cold packs. Getting a massage. Getting ultrasound therapy. Having a physiotherapist or an osteopath or a chiropractor move bits of you. Stretch bits of you, adjust bits of you. Perhaps you've tried medications. Cortisone injections. Nerve stimulators. So all of these passive coping mechanisms and passive treatment are understandable. But we now know that active approaches have far better outcomes than passive approaches. So with active coping, we learn about the problem, what we've been doing here. Explore ways to move. We've only done a little bit of that, right? Staying hopeful. And making plans, active plans. Active but realistic plans. So the active treatments for chronic pain. In this course, we've been exploring psychological approaches, mindfulness and meditation. We've touched on things like moving, stretching, yoga, and other physical activity. We've touched on pacing and desensitization, relaxation and breathing exercises. We've mentioned changing the way we eat. Improving the way we sleep. In this course, we have been actively exploring and nudging the edges of pain. So this whole course is an active treatment. What a gift you've given yourself. And that can be quite eye-opening for some, how much you are the active treatment, not a doctor or clinician. You at the centre, making the choices, observing, nurturing, strengthening neural pathways. And hopefully by now you're starting to have some ideas about more active steps that you want to take to bring a greater sense of agency to your health and wellbeing. Have so many more things within your control than you thought. Now this is not to say that health practitioners can't help, they absolutely can. And anyone with good going chronic pain needs a team of health practitioners. Could be doctors, physios, occupational therapists, osteopaths, chiropractors, exercise physiologists, Feldenkrais practitioners, acupuncturists, naturopaths, traditional Chinese medicine practitioners. They can all offer various helpful safety signals, sims, or perhaps even more likely they might be that sim. And of course, with any pain, we make sure that any injury or disease which requires urgent medical attention is dealt with. All ongoing pain states require a medical examination at some stage. But make sure that any prescribed help makes sense to you and to your understanding of the problem. Ask the health practitioner if there are any scientific studies supporting what is proposed. Have all your questions answered satisfactorily. Avoid total dependence on any one practitioner. You must take control. Just an interesting little one here and I guess a bit of a caution with some health practitioners. Why does getting your back cracked or popped help? It's actually research to show that these noises are probably loud, in this case literally loud, safety messages that dampen down danger messages in the spinal cord and give temporary pain relief, often hours, but for some for days. And any of the touching type therapies can be very powerful sims, especially if we have a lot of trust in that health practitioner. There's nothing wrong with this, but be very wary of a health practitioner who talks about unlocking, realigning, untwisting or releasing bits of you. These ultimately can end up being danger beliefs and are a passive treatment. When you're seeing a health practitioner, have goals that are understood by both you and them, depending on who you're seeing. They could be physical goals, social goals or work goals, which allows some quantifiable way of measuring progress. Look for clinicians with qualities like being compassionate, enthusiastic, informed, curious about new ideas. Look for clinicians who can assist you in mastering your situation. If they're only offering passive management, this is not ideal, but they can absolutely help with all the active management. Watch out for clinicians who order imaging on the body without very, very specific reasons. Watch out for clinicians who use over-medicalised or threatening language. Watch out for practitioners who recommend multiple visits for hands-on treatment. And please be careful if opioids are prescribed. Short-term, immediate release opioids can be very helpful for a few days at the most for flare-ups. But anyone who's prescribing slow-release ongoing opioids is really going very much against the modern guidelines. And we now know that opioids can cause an increase in pain because of the neuroimmune reaction, because nociceptors can get sensitised. So the journey we've been on here is absolutely the road less travelled. We have been exploring and nudging the edges of pain, not going down the no pain, no gain route, which can cause the boom-bust cycle, and not going down that let the pain be your guide route, which often causes a gradual decline in our condition. And now that this course is over, it's time to go and explore this path. Keep being curious, experiment, keep trying new things, test yourself. And on this road, a deep understanding of pain is a powerful safety signal, really decreases the threat in our system. But understand that hurt doesn't always mean harm. And of course, do your best to avoid pain flares. Don't flare up, but don't freak out if you do, is another nice metaphor. And mindfulness, self-compassion, self-kindness, whoa, what powerful safety signals. So these next bits have not been the focus of this course, but I want just to mention a few things to inspire you. Some of the things that you might start looking for in terms of extra help on this road less travelled. I think perhaps the main thing is finding someone to help with movement, to really explore pacing, which is so much easier with mindfulness. And graded desensitization usually applies to movement, but can also apply to different contexts like being at work versus being at home, being with different people and other activities. A movement practitioner who's well-versed in modern pain neuroscience can help you exercise your virtual body and your actual body. There's so much potential within visualization and imaginal movements, rated motion imagery. There's so much that can be done to alter context. We can use gravity, we can change our position, we can use music to distract while we're moving. We can vary visual inputs. We can do movements in a pool. We can do in different moods, when we're sad, when we're happy. We can do movements that are meaningful. We can do sliders, gliders, smooth out glitches in our movements. Think outside the square. And a well pain educated health practitioner can help so much with this. Of course, it's important to recognize we've only just begun here. This 20 lesson course might need to be 20 years, but I hope it's been an important beginning and piqued your curiosity to continue to explore your life with these skills. And for our final reflection, perhaps just taking your journal and making some notes. What kind of adventure has this been? I'm not going to leave a lot of space between questions, so just suggest that you pause the audio between each question. What is the course demanded of you? What have you learned? What do you most want to remember? What kind of person started this adventure? And what kind of person has emerged? Has there been any shift in the way you view your chronic pain? Perhaps even something positive has emerged. Thich Nhat Hanh talks about the lotus that emerges from the mud. And what needs to happen now in my life? When we've been suffering pain for a long time, it's human nature to just want someone or something to make the pain go away. And sometimes it's been there so long, losing the pain can be weird. You might need some support from a therapist or psychologist, if that's the case for you. So this is the end of the course, but it's time for you to get started. It's time to apply all this to your life now. The mechanisms behind pain are complex, sophisticated, and your sensitized system may have been set on high a long time, so it's not going to change overnight. But it will change. You might like to repeat the course. Go back to the meditations, they're for life. And I just want to finish off with a little story that Tara Braak talks about in her book called Trusting the Gold. This is a true story. There was a huge statue of Buddha that was made of gold and when Tibet was going to be invaded, it was covered in clay and stored in a shed. And when it was finally discovered, and when it was moved, a little bit of the clay chipped off a corner and it revealed the gold. So we are maybe learning the things that we are seeking, perhaps are within us, when we pause to look and find out. And perhaps this practice, this learning to look within, might help you find the tiny moments of gold, of joy, of pleasantness, of hope. Perhaps you might like to reflect that with all the seeking that you've done outside of yourself, that gold has been there all along. I send you so much loving kindness on this huge journey. Goodbye.

English

Welcome to Mindfulness and Pain Explained with Dr. Adele Stewart. I’ve been a GP for over 30 years and bring that experience—along with my background as a mindfulness teacher, my interest in modern pain neuroscience, and my role as Chair of the Royal Australian College of GPs Pain Group—to this course. I also have my own lived experience of chronic pain.

My hope is that this course helps you discover a transformative approach to understanding and processing pain. You’ll explore the neuroscience behind chronic pain and uncover how greater awareness can reduce its intensity and impact.

By shifting focus from a fixed “diagnosis” to a mind-body perspective—one that highly considers the level of safety and danger in our whole system—you’ll gain practical tools to navigate the pain-fear cycle. You’ll also learn how your thoughts, emotions, behaviors, and even aspects of life that may seem unrelated to pain influence your experience.

We’ll demystify complex topics like neuroplasticity, nociplastic pain, and neuroimmune interactions, making them accessible and applicable to everyday life.

Bring along a pen and paper or an electronic journal to capture your reflections as we embark on this journey of curiosity and self-discovery.

Each lesson will begin with a brief grounding practice, followed by some of the following: education, reflection, meditation and exercises. Each lesson ends with a suggested home practice, including one of my meditations from the free Insight Timer app. The names of these meditations are listed in the lesson audios and the course descriptions. Once found, they can be bookmarked and saved in a folder, which you might name Mindfulness and Pain Explained. The home practice is an important part of consolidating your learning in an experiential way.

This course is quite an ask. The lessons only average 15 minutes—some a few minutes shorter, some a bit longer. However the course represents a paradigm shift in understanding pain, challenging deeply help beliefs and requiring substantial energy to engage with. Like most things in life, the more you put in, the more you’ll get out. Be patient with yourself though, as you navigate this new perspective. Although the course is structured as daily lessons, I recommend leaving a few days to a week between lessons to allow the learning to integrate and to give you time to practice.

You’re encouraged to post in the course as much as you like. Reading others’ posts and my responses can be inspiring along the way. I will usually get back to you within 24 hours, except for once a year when I do a 14-day silent retreat and am offline.

Let’s get started!

A mind-body approach to understanding and transforming chronic pain using modern pain neuroscience and the power of mindfulness. 

Mindfulness And Pain Explained

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Hi there, welcome to Mindfulness and Pain Explained with Dr Adele Stewart. I'm Dr Adele Stewart, I've been a GP for over 30 years and I bring that experience along with my background as a certified mindfulness teacher and interest in modern pain neuroscience and being the chair of the Royal Australian College of GPs pain group to this course and I have my own lived experience of chronic pain which is much better these days. This course is an invitation to explore a transformative way of understanding and processing pain. Together we'll dive into the neuroscience behind chronic pain and discover how greater awareness can help reduce its impact on your life and improve the intensity of the pain. Rather than focusing solely on a fixed diagnosis, this course takes a mind-body perspective. As well as learning about the most up-to-date view of pain, you'll learn practical tools to navigate the pain-fear cycle and understand how your thoughts, emotions and behaviours and things in life that might seem to have nothing to do with pain can influence your experience of pain. We're going to break down big ideas like neuroplasticity, nociceptors, nociplastic pain, neuroimmune interactions into simple accessible concepts that you can apply in daily life. For this journey I encourage you to journal electronically or even have an old-fashioned pen and paper nearby to capture your reflections. Most lessons will begin with a brief grounding practice and they will contain a mixture of education, meditation, reflection and exercises. At the end of the lesson you'll receive a suggested mindfulness home practice to deepen your understanding. These are guided meditations that I've recorded on the free Insight Timer app. You'll find the names of the recommended meditations in the lesson audios and also in the course descriptions. And once searched you can bookmark and save them in a folder, you might call it Mindfulness and Pain Explained or just Pain Course. These practices are a great way to consolidate what you're learning in an experiential, practical way. You know what, the course is quite an ask. The lessons only average 15 minutes, some a few minutes shorter, some a bit longer. However, the course represents a paradigm shift in understanding pain. It can challenge deeply held beliefs and require quite a bit of energy to engage with. And like most things in life, the more you put in, the more you'll get out. Please be patient with yourself though as you navigate this new perspective. And although the course is structured as daily lessons, I recommend leaving a few days to a week between lessons to allow the learning to integrate and to give you time to practice. Please post lots. Being able to read other posts and my responses can be very inspiring along the way. I'll usually get back to you within 24 hours. With the exception of once a year, I do a 14 day silent retreat where I'm completely offline. I really look forward to embarking on this journey of curiosity and self-discovery with you. Let's get started.