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Pain Take 3: Safety, Compassion and Pain Reduction

What would you do/ be in the world if you felt truly safe?

I have been thinking so much lately about safety.

How our own sense of safety informs not only our felt sensations, the function of our nervous system, the capacity for us to be creative in our thought. But also how our own sense of safety can determine the way we broadly inhabit the world.

When I read articles about people scrambling for vaccines ahead of priority populations, it makes me wish we had a national discourse about safety and how to support our own. I can hear how people are desperately trying to find more safety for themselves- and in those attempts inadvertently oppressing the safety of others.

Two truths that I know about safety:

1) We can work with out sense of safety and danger by working with our thoughts and beliefs

2) Safety is interdependent. Our physical safety is reliant on the safety of our neighbors, the trees, indeed the whole of our planet. In addition, the safer we feel, the more we can enhance safety in others.

I was first introduced to the trippy connections between safety and pain when I was a PT student, doing lab classes in neurologic rehab at famous Rancho Los Amigos in greater LA.

Pain is a common experience for people who have had central (and of course peripheral) nerve damage. I recall reading a research article that measured pain levels of individuals with spinal cord injury, who used wheel chairs for mobility and who experienced high pain on a chronic basis.

During the course of the study, researchers created an optical illusion- they put a mirror at the level of the participants head, so that his (the study was conducted on males) head could be clearly imaged. And they used a screen to project an image of a person walking. The effect was to create a visual of the participant walking with ease.

Very broadly, pain levels were reduced across the subjects who participated.

Flash forward to today. Pain is still largely misunderstood. The general consensus that comes out of western medicine is that pain is related to injury/ damaged tissue (a biomedical model). We know- like we know, like we know- that this model is only half of the story.

If this were true, how are neurologic pain conditions explained (thalamic pain syndrome, phantom limb pain)?

Also, how do we account for people whose tissue- ligament, bone, tendon, muscle- is healed but who present with persistent pain?

The pure biomedical model also falls short to explain how people who have broken limbs can override trauma to get themselves (or loved ones) out of danger. There are much more complex neurologic/ hormonal signaling going on in pain production than the biomedical model can account for.

In the early days of my career, I was lucky enough to have attended a course taught by the folks at the NeuroOrthopedic Institute (NOI). I know I have mentioned them before- but their work in the field of pain (for lay people and clinicians) is unsurpassed.

They give voice to both the biomedical and psychosocial models by combining them to create the verbose- biopsychosocial model. This model can be broken down most simply in this way: pain manifests when there are sufficient incoming danger signals.

Sit with that concept for just a moment.

In the case of the men with spinal cord injuries, if they perceived their physical limitation as being a source of danger, then the image of them walking would be a safety signal.

I have described the 7 categories of safety/ danger as broken down by the NOI in my blog post pain take 2 (if you are interested in working with these concepts, please take a read here).

What if your tissues are healed, your danger messaging is low and you are still having pain?

I have not, in my 13 years of clinical work, encountered anyone in this position. Outside of one or two patients, no one has had any awareness of danger/ safety signaling. (And those two clients had the easiest rehabilitation process, as we only had to address biomedical issues).

In my personal experience (please take this with a grain of salt as we have an n= 1), I have noticed that the danger and safety balance has worked for me 100% of the time.

When I first started practicing, I was having debilitating 10/10 sciatic flares (which would last for several hours like a migraine), about once every 3 months. They would happen when I was bike riding, when I was backpacking, trail running, at weddings, driving- when I was doing things that I loved but conditions were such that my danger outweighed my safety.

It could be related to cold, or the anxiety levels in the people I was outdoors with. Unfortunately, no form of medication would touch these pain flare ups, and I would be in agonizing pain until my endorphins flushed through my system and I could eventually fall asleep.

In desperation, I slowly began to work with safety messaging. I used ice/ heat when I would feel any danger signaling escalating. I took rest in my favorite pjs and put the kettle on for my favorite tea after a fender bender. I took long diaphragmatic breaths during difficult exchanges in the clinic.

I began to practice what I had learned and slowly over time, I began to build more successes in my physical body. I could hike longer, ride longer, be exposed to more anxiety before I would start to have sciatic pain.

I tried everything, and there was not a physical movement or practice that could have healed my system as effectively as enhancing safety messaging.

And then a really interesting thing happened. As I began to feel safer and safer, I was able to expose myself more to conditions/ people/ activities that previously caused me flare ups. I was also able to see others’ suffering with more compassion. I was even able (despite my student loan debt) to give some of my income to charities that I felt the most compelled to support. My sciatic flares became less and less frequent. As I write this post, I have not had one for over 2 years.

In essence, this project, which started as a self-compassion and safety project grew to change the fundamental way that I felt in my body and how I saw myself in the world.

I can see now, how unusual it is to have the conditions that I have. To have access to healthcare. To have clean water to drink. To have fresh food to eat when I am hungry. To have access to the internet to connect with my friends. To make a decent wage that I can live off of. And I can better support the pursuit of those basic rights for others.

Noticing safety has been very different from a gratitude practice. It is an actual account of all of the ways I am safe, and it clearly reduces my anxiety.

For a very basic safety practice, please come up with an item for each of the seven fields from Pain Take 2:

) Things you hear, taste, touch and smell

2) Things you do

3) Things you say

4) Things you think and believe

5) Places you go

6) People in your life

7) Things happening in your body

Notice how much your physical safety is enhanced by these conditions.

And what I think we're really talking about here is compassion.

How much compassion can you extend yourself? And can you enhance your self compassion to enhance compassion of others.

Kristin Neff, leading researcher in self compassion writes:

“Compassion is, by definition, relational. Compassion literally means 'to suffer with,' which implies a basic mutuality in the experience of suffering. The emotion of compassion springs from the recognition that the human experience is imperfect.”

The next step in this process, and this is crucial, is to extend the desire for that safety/ those conditions to all living beings. How might your striving for safety/ security be affecting others? Is it really necessary for your well-being in the world? How might you help others enhance their sense of safety in the world?

I will graciously bow out now, because at this point, we are teetering on tonglen and compassion practices, and I defer to the many fantastic buddhist teachers in the world to explore that further.

But I think you get the gist of my point- enhance your own safety+ enhance the safety of others = change the world away from fear and insecurity.

May you all be safe, may you all know ease, may you all be healthy, may you all be happy,


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