“...is it not rather narrow-minded to limit one’s interest to those disturbances of function which are based on anatomic abnormalities?”
- Francis Peabody, MD (1927, Harvard Medical School)
This past week I had the pleasure of attending the Psychophysiologic Disorders Associations Annual Conference in Boulder, CO. The PPDAs mission is "to end the chronic pain epidemic and opioid crisis by advancing the awareness, diagnosis and treatment of neuroplastic symptoms (PPD) that affect millions worldwide."
PPDs occur when the brain creates real pain and symptoms in the absence of any physical injury. These occur when past or current stress put the brain in a state of high alert. The good news is effective treatments are available that target these pathways in the brain.
The conference was a who's who of mind-body healing practitioners from physicians, psychotherapists, and coaches. It felt electric getting to converse with many passionate, caring practitioners on how we can better treat and promote awareness of PPDs.
The best part was the enlightening presentations on the current research and treatment guidelines around PPDs, from wonderful speakers including Dr. Howard Shubiner, Dr. David Clarke, Yoni Ashar, Nichole Sachs, Christie Uipi, and Charlie Merril. Below are some of my key takeaways from the presentations.
Takeaways
Effective treatments for PPDs reduce emotional repression and fear of symptoms.
40% of people who go to their primary care doctor are experiencing a PPD. Emotional Awareness & Expression and Pain Reprocessing Therapy are two treatments that show dramatic improvements in PDDs. Both help reduce the dialed-up threat response within the brain by creating a greater sense of safety with sensory experiences. These are the frameworks I use with my clients as well.
PRT changes the brain, but we still don't fully understand why.
Brain scans pre and post-PRT treatment show changes in grey matter volume and activity in the brain areas related to pain perception but more research is needed on exactly why these changes occur.
Movement is a critical part of the healing process.
With neuroplastic pain, we don't hurt because of movement, we hurt because the pain perceives a certain movement or position as dangerous. Physical changes like stiffness are typically the result of being in pain rather than the cause. A key part in the healing process for people with restricted movement is gradually reintroducing movement. Movement in itself helps to reverse the brain changes that keep neuroplastic symptoms alive.
Obsessive-compulsive personality is common amongst people with PPDs.
Many people with PPD have an obsessive personality (OCP) structure, which requires specific considerations for treatment. Doubt and issues with control are common features among OCPs. Doubting whether there could still be a physical cause after getting cleared medically, doubting if psychological treatments could work, and the endless "buts" and "what ifs" can perpetuate symptoms by keeping the brain on high alert. This session pretty much described me to a tee at height of my own PPD.
Long Covid is a PPD
Research is further reinforcing the evidence that Long Covid is a PPD/neuroplastic and psychophysiologic treatments are proving effective. Large studies (Taquet et al, Wang et al.) showed that a history of mental health disorders greatly increases the likelihood of developing Long Covid. Two factors that are protective against developing Long Covid are Psychosis and Dementia, likely because people with these conditions do not have awareness of the fearful messaging.
We need to break down the siloes between physical and mental health
Patients who are suffering in the intersection with mind-body conditions are often falling through the cracks and become susceptible to being taken advantage of the multi-billion dollar industry of placebo treatments. We need better awareness and collaboration between doctors, psychologists, and other practitioners to help patients with neuroplastic conditions get the care they need.
As much as this week was a call to action, it was also incredibly inspiring and hopeful to see where this field is headed. I look forward to a future where PPDs are well understood, not stigmatized, and effective treatments are readily available for all.
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