EP.294/ Your Brain, Pain and the vagus nerve
Today I have an exciting episode for you! I’m still full of covid or flu, on top of preparing for my course Live and Thrive with Endo 2.0 which begins on Monday, and packing to take our rescue kitten back to the UK - today!
So, there’s a lot going on - no wonder I got sick!
So, instead of doing a replay episode, I thought I’d give you a peak into what I’m woking on in my course, and so today, I am sharing one of my lessons which is all about the science of how pain works and how it can be influenced by the vagus nerve and our nervous system (which are pretty much one and the same, as you’ll come to learn!).
This is a great episode to provide you with overall pain education and here’s an interesting fact - pain education actually helps to treat and reduce pain! So that’s a huge benefit of this episode, and the bonus is, if you’re wondering about the course and whether it’s for you, this gives you a little taster as to what’s in store (and remember - there’s a 14 day return policy too).
If you’re curious about the course and want to learn more, doors close tomorrow Sunday, April 15th, 11:55pm BST and late bird pricing has just kicked in, dropping the course back down to Super Early Bird pricing of £100 upfront or with a payment plan of £35 per month for three months.
You can learn more at www.theendobellycoach.com/live-thrive-with-endo or just go to the link in my show notes here.
Your Nervous System
The sympathetic nervous system is the system in the body known for the ‘flight or fight’ response which is our stress response. When we’re ill, stressed, injured, threatened in any way whether it’s from an underlying infection or condition or just too many emails, this is the response that’s triggered. This is our survival response which pumps out adrenaline and cortisol, and directs blood, oxygen and glucose to the brain, heart and lungs so we can prepare to run or fight.
In contrast, the parasympathetic nervous system is the system in the body known for the ‘rest and digest’ response. It is the system that activates when we’re asleep or resting, when we feel safe and calm and is responsible for digestion and repair in the body. Because the flight or fight response is essential to our survival, when this is on, the ‘rest and digest response’ is turned off.
How Does Pain Work?
Now we understand the stress response, let’s dive into how pain works.
Firstly, I know we all have a lot of pain around fear, and I appreciate that. As someone who has experienced extensive car accident injuries, endometriosis and chronic bladder pain, I know that it can be not just hard, but infuriating to be told to relax more about our pain. So this isn’t that. This is about understanding our pain, because research has actually shown that when chronic pain patients are more able to understand their pain, they experience reduced pain and increased wellbeing!
So let’s start here. Pain is not inherently a bad thing. In fact, pain is integral to survival. Pain is essential for keeping us alive and preventing further damage to tissues, organs, etc. by letting us know that we need to remove ourselves from danger or treat an injury so we can survive. Essentially, it is a part of our survival stress response.
So in that sense, think of pain like we think of inflammation. A natural part of keeping us alive, but certain triggers can turn it into a chronic state and then we begin to have problems.
Your pain is real, absolutely. But pain is made in the brain. That doesn’t mean you’re imagining the pain, that’s just how pain works for every single one of us.
Nerves in the body send danger signals to the brain when there is an injury or a perceived injury to the body. The brain then responds with pain, so we pay attention and resolve the problem.
So for example, imagine you’re slicing an orange.
If you cut your finger, the pain you’re feeling isn’t made in your finger. Instead, the nerves in your finger send danger signals to your brain, and the brain then decides how to respond based on multiple factors, which we’ll discuss in a moment. If attention is needed to help you survive (or in this case, just stop a little of the bleeding), then pain is produced.
So I really loved this diagram as a way to show you what’s happening when you cut your finger.
The pain essentially is the signal that your body needs to move your finger, drop the hot handle on the frying pan, etc.
It’s also worth noting here that your nerves aren’t firing off these danger signals all the time - usually. They actually have a threshold and danger signals are only sent when the danger risk exceeds a certain level and triggers a response from the nerves.
However, as you’ll come to learn, this doesn’t always mean there is harm happening to the body, but actually that the threshold may have lowered in some of us because the nerves are highly sensitised, and the brain is feeling unsafe. You’ll come to learn why this is so important shortly.
So once the nerves fire off a danger signal, and the then brain uses information from memories, the current situation, your emotional state, learnt behaviours and more to make a decision about whether you’re at risk and whether it needs to make pain so you can protect yourself.
So for example, your brain has learnt that cutting your finger can be dangerous and that you generally need to stop blood flow and put on a plaster. This is a pretty obvious scenario where there’s nothing stopping the brain from deciding to make pain.
In contrast, there are times where the brain will decide now is not the time for pain signals. So trigger warning, just skip this is you’d rather not hear me talk about my car accident, but it’s a very clear example.
When I was in my car accident, I broke my spine, hips, pelvis, pubic bone and a few other things but the key here is this pelvic area. When I woke up, my friend next to me was halfway through a window with a lamppost across her body and she wasn’t moving. The paramedics wanted to get to her, and I needed to move, so even though I actually couldn’t really get my legs to work, I didn’t feel any pain and with the help of friends I managed to get out of the car. I was held up for a long time, but I was standing on all of these broken bones, as the main priority was cutting my friend out of the car. Then, when the paramedics got to me and put me on the stretcher and they realised how serious my injuries were, then my pain kicked in, then my brain allowed me to feel it because at that point my friend was alive and safe. In that initial moment, my brain took in the information around it and observed that I needed to move out of the way for my friend to survive and so I didn’t feel pain and was able to get out of the car.
The same would happen if for example you tripped in the road. Your stress response would not tell you to check your knee you just banged; it would instead motivate you to get out of the road. Then, once you’re safe on the pavement, you would feel the pain from your bleeding knee.
Now, this is really important for us - because if the brain doesn’t feel safe, then it’s going to create stronger pain signals to get our attention as it believes we’re really in danger.
For example:
Your endo pain may be affected by whether you’re already feeling anxious, scared or stressed. I know many, many of you have told me your endo worsened after a period of stress in your life, which we’ll explore more shortly, but all of these feelings are essentially telling your brain one thing - we’re not safe. It triggers the stress response and puts your nervous system on high alert, causing that threshold to lower and the brain to create strong pain signals.
Your endo pain may also be affected by whether you already have negative memories around it. So for example, if you frequently end up in A&E, your brain will now use that memory to judge whether this scenario is dangerous and given that your endo has resulted in A&E trips frequently, it’s likely to respond with increased pain.
Now in the normal healthy scenario, once the initial threat has been removed your stress response will calm down and the nerves will go back to a normal let’s call it ‘resting’ state. The pain subsides as healing occurs so that you still stay aware of the injury, in case an infection occurs, or something goes array with the healing process, and once healing is complete, the pain should then go.
In research, healing has been shown to be complete within 3-6 months depending on your injury - as long as of course, the injury is capable of healing. Essentially with endo, we sort of have open wounds all over our pelvic cavity. But you could for example look at this from the perspective of a laparoscopy, you’re healing from that should be finalised within 3-6 months. As long as you’ve healed correctly and haven’t gotten an infection, any pain remaining after that time will not be from the active healing process, but will be down to nerve sensitivity, pelvic floor dysfunction, remaining endo lesions, inflammation, etc.
Chronic Pain
Okay now let’s look at what happens in the case of chronic pain, in particular, with endo.
So as I just explained, your nervous system should once again calm down once the initial danger or threat has gone, and healing is taking place. This allows that threshold to be restored, with the nerves only firing off danger signals when that threshold is exceeded.
However, for some people, the nervous system cannot fully relax and instead, stays vigilant and on high alert. The nervous system then becomes easily triggered by everyday activities and minor stressors because it’s in a state of low-level chronic stress, so it doesn’t take much to switch on the flight or fight response and danger signals.
With endometriosis, the brain and body may constantly feel at threat and stressed, causing nerves to become extra sensitive because of the inflammatory scenario happening locally wherever the lesions are found. Interestingly, nerves have been found inside the endometriosis lesions, in varying levels depending on the location and type.
In fact, HPA axis dysfunction (low or excessive cortisol output) from chronic stress (whatever the source of the stress, whether pain related or not) has been shown to trigger the onset of some chronic pain conditions and worsen existing chronic pain. Low cortisol output is particularly associated with nearly all chronic pain conditions, especially pelvic pain conditions, endometriosis and fibromyalgia. This is thought to because the anti-inflammatory and pain-relieving properties of cortisol that allow us to power through acute stress (so we can run with an injury for example) are now lowered.
For those of you who just thought “wait - isn’t stress inflammatory?!”, the relationship between cortisol, inflammation and stress is fairly complex (at least, it is in my opinion!). The acute short-term stress response does originally release inflammation to address any potential injuries that may occur from the perceived threat, but cortisol itself is anti-inflammatory and pain relieving to allow us to survive and ignore injury whilst we escape from danger. Cortisol is released 15 minutes after this immediate stress response to ‘clean up’ inflammation and continue to power us through the stressful situation, once the immediate danger has gone.
However, with chronic stress, the damage done to tissues from high cortisol levels causes inflammation and it’s also thought that to counteract the immune supressing anti-inflammatory effects of cortisol, the body releases inflammatory chemicals (as we of course need some inflammation to fight off bacteria, viruses, etc.). There are also other mechanisms and malfunctions that occur during chronic stress that elevate inflammation with prolonged stress exposure, so whether or not your cortisol levels are elevated or low, the likeliness is, chronic stress will heighten pain and inflammation.
Additionally, people with endometriosis-associated pain (rather than people with endo but no pain) and people with endo and general heightened pain sensitivity (not related to the pelvis) have heightened activity in parts of the brain that process pain and a dysfunction of the nervous system.
So whether it’s from the pain from endo itself, or from a previous injury, people who do experience pain with endo have hyperalgesia (heightened pain response) and this in general (in anyone) can be caused from injury. So you may have had no endo pain, then went through a period of acute stress which upregulated your nervous system and then suddenly you began experiencing endo pain, or you may have had an injury that caused this heightened pain sensitivity in the brain, after which, you started developing endo pain. Of course, you may not have experienced either of these, but what the research is now pointing to is that people who do experience pain with endo, seem to have altered pain and nervous system responses, whether that’s from living with chronic endo pain or from having an injury or trauma that altered the pain response originally.
So let’s look at some of the reasons that your brain may feel unsafe, leading to a heighted nervous system response:
· Persistent swelling, inflammation and bleeding from lesions.
· History of feeling ‘let down’ by medical professionals.
· Anxiety around trying to live with a chronic condition.
· Relationship strains.
· Financial strains due to healthcare costs, work, etc.
So what these stressful situations can do is create a cycle of worsening pain where you begin getting a heightened pain response from the same stimulus. For example, scarring from endo may have once not caused you pain, where it now does, or you never had bladder pain before, but you now do, even though your bladder is healthy and free of endo.
As a result, a cycle begins. Your nervous system creates a feedback loop where your brain is feeling constantly at threat, which stresses the body, increasing inflammation and pain signals, which then just reinforces the need to feel threatened and worsens the pain signals.
Now over time, other nerves can get involved. If we are unable to calm down the pain response and resolve the issue, more nerves, organs and areas become involved in an attempt to get our attention. Inflammation spreads and surrounding nerves become more sensitive, firing off even more danger signals to the brain.
This is like the equivalent of a house alarm going off in the street at night. If the owners don’t turn it off, eventually, the neighbours start turning on their lights, poking their heads out of the window, etc.
And then as the pain continues, your brain stops releasing its natural pain-relieving chemicals like dopamine because it wants us to feel and respond to the pain and this means we become even more sensitive.
What Can We Do About It?
So what can we do about it? The answer is thankfully - lots!
Calming down the pain response is absolutely possible. It normally involves addressing inflammation as you know, resolving structural issues as you’ll come to learn and calming the nervous system for people with endometriosis.
Stress is always going to happen in life, the key here is that instead of just allowing the danger signals to rule, we want to reassure the brain it’s safe so the nervous system can calm down. We need to crowd out the danger signals with safety signals.
So just like we explored a minute ago, danger signals are basically stressors, they could include:
· Feeling unsupported by loved ones or your medical team.
· Inflammatory triggers to the body i.e. lack of sleep, food sensitivities, dysregulated blood sugar.
· Unresolved trauma
· Work stress
· Depression and anxiety
· Endless to-do lists
· Pain and inflammation
· Pelvic floor dysfunction and adhesions
Now of course, dealing with some of these can feel too much to take on at the beginning and may stress us further, so start small with little moments of safety until we feel better able to cope with everyday stressors before taking on the bigger ones. If we can boost a healthy and robust stress response, then we can better equip ourselves to deal with these bigger changes in the future.
So, safety signals include stress relieving strategies that calm the nervous system, such as:
· Breathwork
· Meditation
· Walking in nature
· Yoga
· Mindfulness
· Finding a support network (a positive support network, a support group which solely focuses on pain and symptoms may not actually be helpful)
· Laughter
· Hugging and human contact
· Joy in whatever form that takes for you - reading great fiction, good music, baking, sex, etc.
· Exercise that feels energising and restorative
· Brisk walking for 15-20 minutes (reference: Why Pelvic Pain Hurts)
· Good sleep. One of the tactics Dr Jessica Drummond taught us was taking a sleep vacation which I thought was amazing! Basically, you spend 12 hours a night sleeping for three days, or at least 12 hours in bed resting (not watching TV!) with low lighting, books, etc.
· Active self-care and rest which is intentional. So not just vegging out watching Netflix, but taking baths, doing gentle yoga, taking time for meditation, etc.
I also wanted to mention Acceptance and Commitment Therapy that can help us think about pain differently. Acceptance and Commitment therapy is a type of behavioural therapy which helps us to experience less distress, panic, anxiety and depression around pain.
It won’t reduce pain, but it can help our brains to feel safe, which may in time lower pain signals and encourage HPA axis regulation.
In the handout, I’ve linked to an online programme you can take and work through alone, as well as a directory for practitioners.
Now I’d like to move on to a therapy called Emotional Freedom Tecnique.
EFT or ‘tapping’ is a method where you tap on specific acupressure points in the body, whilst repeating certain statements about how you’re feeling or your situation. The practice interupst the stress response and helps you to move into ‘rest and digest’ and done repeatedly, it can strengthen those pathways, meaning you’re less likely to move straight into flight or fight as your automatic response.
The research behind EFT is pretty remarkable. It’s been shown in numerous studies to be effective for trauma releif.
· It’s been shown to significantly reduce cortisol, ranging from 43% to 24%.
· It’s also been shown to reduce depression by 41% and even totally eradicate anxiety.
So two key tips to keep in mind as you go on this journey:
· Don’t add so many practices in that you stress yourself out. Instead, start slowly and put these in your diary so you actually do them and so you can realistically see how much you can fit in.
· If you have PTSD or unresolved trauma, appreciate it may take some time and therapy to calm down the nervous system. Addressing some of these can feel distressing, so find the safety signals that feel good to you first and lean into those whilst you go through the more intensive work, and only take those on when you feel strong enough and ready to do so.
I’ve provided some mental health support services and resources in the handout.
The Vagus Nerve
Okay, so now related to this subject, let’s talk about the vagus nerve.
The vagus nerve is a large nerve that travels from your brain all the way down to the base of your spine, to your colon. It controls multiple functions and is responsible for your ‘rest and digest’ reponse, otherwise known as your parasympathetic nervous system.
The vagus nerve can be damaged from injuries to the spine and head. It actually doesn’t have to be a severe injury, even just a bang on the head when playing as a child or falling on your spine can cause some damage to the nerve. The vagus nerve can also be affected or impaired by trauma or chronic stress, inflammation, hypothyroidism, diabetes and other infections, diseases and conditions.
If the vagus nerve function is impaired, we’ll struggle to move into rest and digest and will often find that we generally live in a stressed state or feel stressed quickly, because as I mentioned, the vagus nerve actually controls the rest and digest response, so if it’s not working adequately, nor will our rest and digest response.
As a result, we may struggle with:
· Digestion/gut health
· Chronic pain
· Immunity/autoimmune conditions
· Depression/anxiety/overwhelm and have difficulty regulating our emotions
· Sleep difficulties/chronic fatigue
I also want to just share that this symptom list is from Jessica Maguire’s Vagus Nerve Masterclass.
There’s a multitude of things you can do to support the vagus nerve and I’ve provided some further reading in the handout, but here are some examples:
· Yoga
· Qigong
· Tai Chi
· Meditation
· Deep breathing exercises
· Singing/chanting
· Gargling
· Alternate nostril breathing
· Body work - by which I mean therapies on the body like massage, acupuncture, etc.
Now, a little bit of breathing and meditation is not really enough for those of us who really have lived with a lot of chronic stress and anxiety and whose vagus nerve is not working too well, and from my experience as a coach, I think that’s a number of us with endo. So, these can certainly help, for sure, but you might need some more intensive forms of vagus nerve support.
For now, just adding in some of these practices into our week, can help.
Now lastly, let’s look at advanced vagus nerve support.
So, as I mentioned previously, for those with chronic pain conditions, chronic gut conditions (especially SIBO) and a history of trauma and/or long-term exposure to stress, we often need more extensive vagus nerve support because the nervous system is so dysregulated.
There are likely a number of options out there, but of course I haven’t tried them all, so my recommendation is The Vagus Nerve Program by Jessica Maguire - and just to be clear, I’m not an affiliate and this isn’t an ad! I really love Jessica’s work and am also taking her course at present, which I paid for myself, it wasn’t gifted!
But anyway, this course is designed for people with
· Chronic pain
· Fibromyalgia
· Chronic fatigue
· Gut health problems
· Depression/anxiety
· Autoimmune/inflammatory conditions
· Trauma/chronic stress exposure (which arguably is pretty much all of us living with endo, given how stressful the condition can be)
Whilst the previous vagus nerve strategies may well be enough for you, if you find that you get a few months down the line or further, your symptoms are still resisting or you know you could feel better despite current improvements, this could be your next step. It’s not something I would necessarily add in right now, because it does require time to watch it and to complete the practices, but once you’ve added in the previous protocols and you’re feeling settled and have space, you could move into this.
The course will take you through education and practices that deep dive into the nervous system and vagus nerve and will rewire your brain and nervous system so that you have a healthy stress response and a resilient nervous system.
The Key Takeaway
A heightened stress response plays a lead role in how much pain we feel by telling our brain we’re unsafe, so addressing how we feel about stress and how we respond to it is one of the best forms of pain management we can take on.
Add in some kind of safety signal at least once a day, even if all you start with is a minute of meditation.
Need more help or want to learn how to work with me?
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This course offers you a customisable roadmap and it identifies the most important changes to begin with first, fast tracking you out of overwhelm and into symptom relief.
Learn more or sign up here.
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Can you help me save Jelly the kitten? We are currently travelling, working remotely, and within 24 hours of arriving in Montenegro, we met Jelly. He was extremely thin, with a distended stomach and a little lollypop head and bulging eyes. We took him to the vets where he was put on an IV drip for dehydration, and treated with antibiotics and anti-inflammatories for a bacterial infection that has spread into his bloodstream from his intestines. His intestines are damaged due to excessive worms, which has caused him to become malnourished.
The vets have given us a very stark picture of the reality. If Jelly goes back on the streets, his condition will deteriorate and he will suffer until he eventually passes away. We have been told to find him a home where he can continue getting care or put him to sleep.
We have found him a foster home and a forever home in the UK, but the total cost is over £1200. We have already spent hundreds on vet visits getting him to this point, and need your help, if you can.
If you are able to and want to support, you can donate and read Jelly’s full story on our Go Fund Me page. I truly cannot express how much your support means to me, thank you from the bottom of my heart.
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Produced by Chris Robson