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I’m a Chronic Pain Expert, Here’s Everything You Need to Know

08.17.2020 — Christie Uipi

Hi there! I’m Christie Uipi. I’m a psychotherapist specializing in the treatment of chronic pain and anxiety disorders.  I have a private practice where I see patients and am part of a multidisciplinary research team exploring the mind-body treatment of chronic pain through UnitedHealth Group.  My focus is on both chronic pain and anxiety because these two things are intimately linked—a concept that feels particularly relevant this year, as so many of us are working harder than ever to preserve our physical and mental wellness.

It’s also worth mentioning that I’m a recovered chronic pain patient myself, and I’ve had pretty much every symptom in the book: neck pain, wrist pain, knee pain, stomachaches, headaches, vertigo… you name it, I’ve felt it.  Chronic pain is a uniquely lonely, depressing, and invisible experience.  It makes you feel small and weak and weighed down.  Over the past few years, I’ve developed an entirely new relationship with my body, one that is full of movement and compassion and free from chronic pain.  I experienced healing through mind-body medicine, which is rooted in the understanding that our brains affect our bodies and our physical health.  The healing process was so profoundly transformational for my own quality of life that I decided to dedicate my career to supporting others through their recoveries.

While my journey to wellness was difficult and the contributing factors to my pain were complex, I can explain my recovery quite simply: I did not need to fix my body, I needed to re-train my brain.

There are three things I want you to know about pain.

All pain comes from the brain. 

Even when you feel pain sharply in your body, it comes from the brain.  Take stubbing your toe as an example.  Let’s think about what actually happens when you stub your toe.  Nerves in your skin communicate to your brain; your brain then processes the experience and generates the sensation of pain as a result.  It’s your brain that is responsible for sending a pain signal down to your toe. In other words, your brain creates the pain, and then your body feels it.

Pain is a danger signal.

It’s designed to protect you.  If you put your hand on a hot stove, your brain generates pain as a warning to move your hand and avoid injury.  If you break your leg, your brain generates pain as a warning to rest and recover.  Put simply, there is a reason why pain hurts: It warns us of danger quickly and effectively, helping to keep us safe.

The brain can generate pain when it perceives a threat of any kind.

This can be physical, psychological, or emotional.  Mainstream medicine is accustomed to recognizing pain as an indicator of potential physical damage to our bodies, like when pain from a broken leg warns you to rest and recover.  Mainstream medicine, however, is only beginning to recognize the ability of the brain to warn us of psychological or emotional danger.  In the emerging field of mind-body medicine, we are still learning the ways that pain manifests itself in the absence of injury to the body.  We call pain that is not caused by or related to physical damage to the body “neural circuit pain,” and it is incredibly common.  

About one in five people in the United States suffer from chronic pain, and many of them have neural circuit pain.  Unfortunately, neural circuit pain is often misdiagnosed and improperly treated.  If you don’t have neural circuit pain yourself, you probably know someone who does… and chances are, they don’t even know it!

What’s Fear Got To Do With It?

Neural circuit pain may sound foreign, but everyday examples of it are quite common.  A headache before a big exam, shoulder tension during a stressful conversation at work, and even butterflies in your stomach before a first date are all everyday examples of neural circuit pain.  In each of these examples, the brain is alerting us to perceived threats that, in all likelihood, have nothing do with physical damage to our bodies. 

For most people, it’s not a big leap to accept that acute headaches or stomach aches can be caused by stress.  But recent studies indicate that many chronic symptoms are often caused by the same neural circuit processes, including chronic back and neck pain, migraines, fibromyalgia symptoms, fatigue, pelvic pain, and repetitive stress injuries.  Chronic neural circuit pain is 100% real pain and can be devastating or debilitating to those suffering from it.  However, while neural circuit pain is felt in the body, its cure happens in the brain.

Quick tip: If you are wondering whether you may be suffering from neural circuit pain, it is important to consult with a physician to rule out a clear structural or pathological cause of your pain. If no damage to your body has been indicated, ask yourself the following questions:  Are you lacking a clear diagnosis for your pain?  Did your pain begin or worsen during a time of stress? Do you have, or have you had, pain in multiple areas of your body?  Has your pain continued long after an injury “should have” healed?  Has your pain changed or “spread out” over time?  Does your pain come and go?  Have “traditional” medical treatments and interventions failed to provide relief? Do you have a history of anxiety or depression, and/or do you tend to put a lot of pressure on yourself?  This list is not exhaustive, but the more questions to which you can answer “yes,” the more likely it is that you may be experiencing neural circuit pain.

Our natural human reaction to pain is to be afraid of it.  However, if pain is a danger signal, fear is the gasoline that sets this message on fire.  Fear can create, intensify, and prolong our pain experience.  The treatment of neural circuit pain focuses on regulating the fear center of the brain.  Recovery includes teaching the brain to process sensations in the body through a lens of safety and working to lower overall levels of anxiety.  

Quick tip: Humans are designed to move away from discomfort: If you suspect you are experiencing neural circuit pain, your natural human reaction is likely to avoid or ignore it.   But avoidance actually increases our anxiety levels, which can increase our pain levels!  Instead, can you practice a few seconds of moving towards this sensation in your body, instead of away from it?  Close your eyes, take a deep breath, and gently notice the pain or tension.  Notice the sensation like you would notice clouds passing in the sky—without judgment or rush.  When you’re ready, open your eyes and repeat to yourself, “I am safe and my body is safe.”

Creating Inner Calm Amid Global Chaos

Whether you have or haven’t ever experienced chronic pain, anxiety is an experience we can all relate to—especially in the uncertainty and grief of 2020.  It’s more important than ever that we prioritize our mental health, especially when we acknowledge the undeniable connection our stress levels have on our immune system and physical wellbeing.

As someone who has dealt with anxiety for many years and recovered from chronic neural circuit pain, I am taking great care to replenish my mental and emotional reserves.  It’s very easy for me to feel overstimulated, so I’ve developed a basic day-to-day flow to keep me regulated.  Mornings begin with movement.  I’m moving my body in ways that feel good and are accessible to me, without any pressure or specific goals.  This often looks like taking walks outdoors with my husband and daughter (and leaving my phone at home!).  I do not take a “working lunch,” and never eat in my office.  Mealtime is for slowing down and connecting back with myself.  When I’ve finished appointments with my patients for the day, I meditate on my own before transitioning into the evening “downtime.”  Nighttime is for stillness.  I use my daughter’s bedtime routine as a time to remind myself that her day was magical and joy-filled and that even in the solitude and stress of a pandemic, her life is enough for her.  

As simple as these habits may be, they prevent me from arriving at a place where I feel “flooded,” or overwhelmed by an accumulation of anxiety.  I’m working to set boundaries without feeling pressure to justify them and to honor these daily rituals as my medicine and energy source.

Quick tip: If you’re experiencing a rush of anxiety, you may notice that your thoughts sound irrational or catastrophic.  Oftentimes, we try to combat these irrational thoughts by pointing out all the reasons they are distorted or inaccurate… only to have an even more irrational thought five seconds later, and feel totally hopeless.  That’s because anxiety actually alters our ability to access the part of our brain responsible for logic and decision making—essentially setting you up for feelings of failure or frustration!  Try calming down your body instead of your thoughts. 

Practice box breathing: Inhale to the count of four, hold your breath to the count of four at the top of the inhale, exhale to the count of four, and then hold your breath to the count of four at the bottom of the exhale.  Repeat to yourself, “In, two, three, four.  Hold, two, three, four.  Out, two, three, four.  Hold, two, three, four.”  I like to put my hand on my chest to allow myself to notice the sensation of my chest rising, holding, and falling as I breathe.  Once you feel a bit more regulated, you can resume engaging with your thoughts.  By this time, your logical brain might be “back online!”

Take This With You

While pain and anxiety may cause uncomfortable feelings, these experiences are designed to protect you. I encourage you to try and see increases in pain or anxiety as warning lights directing your attention back to your wellbeing.  The next time your chest starts to tighten or your neck starts to tense, try asking yourself, “What do I need right now?”  You may find yourself grateful to learn what your body is trying to teach you!  

Recommendations and Further Resources

Books:

Podcasts:

  • Tell Me About Your Pain: A fantastic series aimed at helping listeners overcome obstacles to healing through evidence-based techniques (hosted by Alan Gordon and Alon Ziv)
  • Like Mind, Like Body: A collection of interviews from researchers, authors, and providers in the field of mind-body medicine (hosted by Laura Seago)
  • The Mind and Fitness Podcast: An exploration of physical and mental wellbeing from the perspective of both patients and providers (hosted by Eddy Lindenstein)

Apps:

  • Curable: A pain psychology-based self-care program filled with healing techniques and recovery tools
  • Calm: A collection of meditations and relaxation exercises to help with anxiety, sleep, and mental fitness

THE FRENSHE FIVE

What’s something toxic you’re trying to get rid of in your life? Nonreciprocal relationships.

How do you keep yourself balanced? My job is very stationary and cognitive, so I use the weekends to move my body as much as possible.  Walking, hiking and kickboxing are my favorites.

One health or beauty trend you’ll never do again? Fad or restrictive diets.  I’m vegan, and it works for me.

Top 3 favorite skin products?

  1.  Beautycounter Counter+ All Bright C Serum
  2. Mario Badescu Facial Spray with Aloe, Herbs & Rosewater
  3. Puracy Organic Hand  & Body Lotion

Quote you live by? “Sometimes to bring the light, you must feel the burning.”

Christie Uipi