The parasympathetic nervous system and chronic pain
Alright, this is the Chronic Insights podcast, today we're going to learn some cool facts about the nervous system which are really relevant for anyone with chronic pain: the para-sympathetic nervous system. It's a really amazing thing, and we're going to see how it works, and more importantly, learn how we can activate it to make us feel more relaxed, and maybe – to help chronic pain. So, that's really exciting, and – we'll even do a quick meditation, to help us practice what we've learned. I'll do that right at the end. As always, there's a link to a transcript of the show in the show notes.
I'm James Allen, I have chronic pain and I'm so glad you're here because, just to be able to connect with other chronic illness warriors, spoonies, however you identify – it just feels so comfortable and I feel like I'm at home with my best friends when I know that you're there listening.
I'm having a good day today, can you tell? Do you ever have random good days which just come out of nowhere? I don't think my joints are physically aching any less, I don't think the fatigue I physically have in my body is really less, like, my disease, my axial spondyloarthritis is more or less the same today as it usually is, but – I just feel okay with it today. I dunno. Do you ever get that? I think sometimes I've just spent so much time feeling sore and achey and tired, and kind of get a bit down, and just feel like I can't manage this, becausae I'm so desperate to succeed at life, at something, I just want to win, I put all this pressure on myself to do achieve all these goals, and when I feel like my disease is just like this anchor around my waist which is slowing me down, stopping me from winning, making me miss out – it's just so much pressure and anxiety that I'm not doing what I'm supposed to be doing. That's kind of how I feel a lot of the time. Just, crushed under all that weight.
But sometimes, I realise that I'm just putting way too much pressure on myself, and if I just stop doing that, and just try to enjoy now for what it is, just be happy with this moment, and not worry so much about tomorrow or the day after, and just take all that weight off – I suddenly feel like I can move forward. Instead of trying to reach higher and higher to these lofty goals that eveyone else seems to be going after, just – forget that, and reset to absolute zero. Reset my baseline to – okay, I'm alive. That's a start. Everything else that happens, all the rest, is a bonus. Drinking this cup of coffee, reading this book, for me – this is now winning. This is all I need to make myself smile and be grateful. I think that's where I'm at today. I just hope it lasts for a few days. Because I know at some point I'll just revert back to – eugh, this sucks. Maybe I need to try meditating again, so I can get to this state more often. I'm rubbish at meditating, I never seem to stick with it. It's one of my many flaws.
Not much to say about the Chronic Insights app today – I've been working to fix that bug with the 3D pain recording I mentioned last week, for boring reasons beyond my control it's just taken a lot longer to do that – I've basically had to wait for someone at another company to just press a button for me, and it took them 5 days to do it, which was kind of annoying, but I get it. So let's just get straight to the science
Audio snippet: Yeah, science!
Alright, so last week we ended by talking a bit about the sympathetic nervous system, which is called sympathetic because it involves a lot of different parts of the nervous system working as one, at the same time, in sympathy. It's the process that kicks in when we're threatened and scared, usually called the fight or flight response. And, it kicks in when we're in pain. Because the body naturally thinks that, if we're in pain, we must be under threat somehow.
So, one of the things I really struggle with, with my AS (which is axial spondyloarthritis – it's an autoimmune disease which causes chronic pain in my spine, my hips, shoulders, neck, ribs and so on), one thing that I've really noticed with my AS is the fact that when my joint pain is high, it puts me on edge, I feel anxious and tense - and this actually makes my pain worse. It's like a feedback loop. If you have chronic pain, you probably know what I mean, you almost certainly have the same problem.
And it's because of our sympathetic nervous system being stimulated by pain. And as we've said, it involves a lot of different parts of the nervous system which do all sorts of different things, so it's actually amazing the range of different things that happen when we get into this fight or flight state - breathing becomes shallow and short, so we take more, smaller breaths, it creates tension in muscles, it causes blood vessels to tighten and the heart rate to rise, all of the things we associate with being on edge. It even causes digestion and peristalsis to reduce – peristalsis is what our digestive system does to move food along our gut and digest our food. And these are all useful things if we're actually being threatened, because they make us more ready to fight something that's attacking us, or running away from something that's attacking us. But in chronic pain, and this is a common theme that we keep seeing – in chronic illness, this is no longer useful to us, because – we're not being attacked, there isn't a tiger about to jump out of the trees, but our body thinks there is. All the time. So it becomes actually the opposite of useful. In scientific terms it becomes maladaptive.
But this is the good news. This is the part that I find really fascinating, and I want to learn more about. Like many things in nature, there is an equal and opposite part of our nervous system to balance it out - we call it the para-sympathetic nervous system. Para from the ancient Greek for 'beside, or against or opposite to', like 'paranormal' which means 'opposite of normal', or 'paralegal' which is someone who works alongside a lawyer. There's also a latin origin of the word 'parare' meaning to 'prepare for or defend against something', which is where we get 'parachute': para to defend against, and 'chute' from the French 'chute' meaning to fall, so a parachute is to defend against a fall. I love words.
So anyway, the para-sympathetic nervous system works in the opposite direction of the sympathetic nervous system - it relaxes you, it causes blood vessels to open and the heart rate lowers. It causes our breathing to slow. It causes relaxes us. peristalsis increases, digestion increases. Which is why it's often called the rest and digest state.
So how does it do all of this? Well one part of it is a bunch of nerves which come directly from the brain down the spinal cord into the rest of the body, called cranial nerves – cranial because they come out of the skull, the cranium. There are 12 pairs of these cranial nerves, pairs because there's one that goes down the left side of your body, and one down the right. They're labelled 1 to 12, and they go to different parts of the body to do different things – so, cranial nerve 1 is mainly concerned with smell, 2 is for vision, it's also called the optic nerve, the one that connects to your eye, 3, 4 and 6 are all to do with eye movement, which just shows how important vision is in the human body, 5 and 7 are mainly for facial expression and touch sensation in the face and for jaw movement, 8 is for hearing and balance, 9 is for taste and mouthfeel, 10 is called the vagus nerve: vagus from the latin for 'wandering', which is also where we get the word vague, and it's called that because the vagus nerve – it's kind of difficult to pinpoint an exact function for the vagus nerve, because it goes to so many different places: the throat, the heart, the lungs, the stomach, the liver, the kidneys, which is why there's a lot of research and debate into it's function, because there seems to be some evidence that it has a profound affect on a lot of things like stress, fatigue, anxiety, all sorts of things. I'll definitely do a whole episode some day, maybe more than one, just on the vagus nerve. 11 is for lifting the shoulder and turning the head, and 12 is for tongue movement.
So when the brain decides that, okay I'm not under attack, it's time to relax, to rest and digest, it sends signals to lots of areas of the body through at least 4 of these cranial nerves, including the vagus nerve, to plexuses, from latin 'plexus' to 'braid or intertwine', which is where nerves branch out to different places, and ganglia, which are bundles of nerves like little junction boxes, and end up in the lungs, to slow our breathing, in our stomach to stimulate digestion, and so on.
This is really powerful knowledge to have, especially if you have chronic pain. Because we can use this knowledge as a tool, we know that we can have a real, physical effect on our bodies, to counteract this maladaptive runaway feedback loop of stress and pain triggering our fight or flight response, by doing everything we can to instead stimilate our para-sympathetic nervous system, which will help to break that loop.
So how do we do that? Well you probably already know, right? It's the kind of things that calm us down. And the great things is that some of these things are really simple.
Like taking deep, slow breaths, even for just a minute – that's probably my favourite. I like to put my hand to my heart, so I can feel my heartbeat, which is often – quite high, especially when my pain is high – and I just – take a really deep breath in, hold it for a second, and just try to relax on the outbreath, just try to enjoy that feeling of letting go of tension. And I can usually feel my heartbeat slow down a bit, which for me actually adds a really good kind of feedback loop, like I feel more relaxed when I feel my heart slow, and feeling more relaxed makes it slow even more.
And so the parasympathetic nervous system can slow down our breathing, it can have that effect, but by purposefully, by consciously slowing our breathing down ourselves, by actually doing that action, we're sort of feeding back into the parasympathetic nervous system and stimulating it, it's kind of a two way thing you see. So, that's how we can use our breathing as a tool to actually change how our nervous system is acting.
Mindfulness and meditation do similar things. That's another whole episode I've got planned: the science behind meditation, the evidence and the mechanisms for how it works.
And the parasympathetic is also really involved in sexual arousal, so touch, sex, massage, these are all things that can activate this calmer state.
So as I say, these are not new ideas, and I know – first hand – that when you have chronic pain and fatigue, it can be hard to – relax, to breathe, to meditate, and it doesn't always help. Sometimes the pain can just feel too great. But for me – it's different when you know why these things can help, it's different when you actually understand the mechanisms of the nervous system, to know that you can really change some things that are happening in your body – I think that makes a huge difference to my psychology, to my wellbeing, to have that extra bit of – control, and – self empowerment.
One of my favourite quotes is from Marie Curie: “Nothing in life is to be feared, it is only to be understood. Now is the time to understand more, so that we may fear less.” And for me that's just a beautiful way of saying how empowering knowledge can be, especially when we are unwell and our bodies are rebelling against us.
And it's that time again, when I feel like – my sympathetic nervous system is being stimulated, because I've been sitting here for too long in one place and my arthritis is starting to get angry at me – so it's time to slow down, to switch off, to relax. I'll leave you with a short, very short, meditation – to help stimulate the parasympathetic and get us all into a better state of being. It's based on a meditation you can find in my symptom diary app, Chronic Insights. If you haven't seen it, just search the app store and you'll find it. So just, try to get comfortable, close your eyes, let go of the day, your attachment to it, and all your worries and thoughts and things that are rattling around in your head. Just give yourself over to this next two minutes, gift your body – just this two minutes, to switch off. And relax.
And start with some deep breaths, in your own time. A nice deep breath in through your nose, just hold very briefly at the top, and breathe out of your mouth, sighing as you let go.
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And just let your breathing return to normal.
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Feel your breathing. Feel your chest rising and falling. Are your breathing into the top of your chest? What would it feel like to breathe into your belly instead?
Can you feel the air – is it warm, or cool?
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And when thoughts intrude – as they always do – just observe them without getting caught up in them. And then – let them go. And return to here. Return to now.
Feel the ground underneath you. Feel where it presses into your body. Where do you feel it most? Is it symmetrical? Or is one side uneven? If you were sitting or lying on sand, what kind of imprint would it leave?
What can you hear?
What can you smell?
And return to your breath. Just feel it breathing in, breathing out. A human being, this wonderful, complex, flawed, amazing human body, in its environment, at this place, here and now.
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Enjoy the rest of your day. I hope you're well, and if not – you're not alone. I'll see you next week spoonies. Love you. Bye bye.