Unpacking: The Nervous System's Role

Megan: 00:00:00

Every pain you have ever had has either been sent by, communicated through or interpreted by your nervous system. So your nervous system is really your body's command center. And that's sometimes why you'll hear the phrase no brain, no pain.

Because if I didn't have my brain to interpret the sensations, then I wouldn't have the pain experience.

Intro: 00:00:30

Welcome to Unpacking Pain, a podcast dedicated to understanding the complexities of chronic pain, what causes it, how it affects our lives and what we can do about it.

Join doctor of physical therapy and pain science researcher Dr. Megan Steele and me, Holly Osborne, a chronic pain sufferer as together we explore the biological, psychological and and social aspects of chronic pain and create community and understanding in the process.

Holly: 00:01:05

Hi, everybody. Welcome back to the Unpacking pain podcast. Hey, Dr. Megan.

Megan: 00:01:10

Hi, Holly. Nice to see you.

Holly: 00:01:13

Great to see you too. We're excited about today's episode because it's very learning based. I love being in learning mode and I've got some nerdy questions to ask.

Dr. Dr. Megan and I think we're all going to learn a lot today.

Megan: 00:01:27

I'm excited too. This is a great topic and I feel like we're taking a step back and remembering that, you know, we may, I may sometimes use a lot of buzzwords.

We talk about the nervous system, but what really is the nervous system? What's its function and how does it do its work and how can we understand it better so that we can understand our pain?

Holly: 00:01:49

Yeah, I, I'm ready with a pen on this one. Even though we're recording, I'm still an old fashioned note taker. So, you know, that's.

I think I'd like to start with understanding a phrase that we hear a lot. And this is fight or flight as opposed to rest and digest. Of course. And you know, when we think about why sometimes pain kicks up sometimes. Right.

We've got a pain spike or a rough go and we've talked in the past about that sometimes being related to a detection of threat, you know, that the system has, has felt some threat coming on and so, you know, perhaps aura is triggered in some way and so pain shows up. And I'd love to just understand that a little deeper. And are we talking about the nervous system in that case?

When we say, you know, there's that threat detection can spike up pain, is that threat detection coming from the nervous system and maybe even before that. Exactly. Just remind us how the nervous system works. What is it actually doing? How is it involved in the pain experience? Sure.

Megan: 00:02:59

That's a great Question. So, first and foremost, every pain you have ever had has either been sent by, communicated through, or interpreted by your nervous system.

So your nervous system is really your body's command center. And that's sometimes really why you'll hear the phrase no brain, no pain.

Because if I didn't have my brain to interpret the sensations, then I wouldn't have the pain experience, which. That's a bit of an oversimplification. And we can talk a bit more about that if we want to.

But really, our nervous system is the boss of our body, essentially, and it's divided into central nervous system, which is our brain, and spinal cord, and peripheral nervous system. And those are important distinctions because pathologies that affect the central nervous system cause lifelong changes.

So things like a stroke or a spinal cord injury don't change because those parts of our nervous system do not regenerate.

And this is opposed to our peripheral nervous system, which is everything that branches off from there so that everything that connects to your organs, your muscles, your skin, your fascia, everything else that is not your brain and spinal cord. And then your peripheral nervous system is divided again.

So if we're thinking about it like a tree or a family tree, now, we've got two branches off of pretty peripheral that are voluntary and involuntary. And sometimes you'll hear people say these or term these as somatic and autonomic. Okay.

Holly: 00:04:52

And again, those are in the peripheral system. The peripheral system.

Megan: 00:04:56

Correct. So your autonomic nervous system is the one where you're talking about that takes us into fight orf flight, or rest and digest.

It's not something that you say necessarily to your body, oh, it's time for fight or flight. Right. Let's get that motion going and proceed with the fight or flight.

You can cause yourself to go into a heightened nervous system response and run, but you're using your somatic or your voluntary nervous system to do that.

So your voluntary nervous system is when you take a signal from your brain to your muscle, you say to that muscle, move and help me to run, help me to do whatever it is I need to do in that moment.

Holly: 00:05:45

Does all of this even. Even the peripheral parts? Because I'm. I imagine a body with all these nerves going all the way out to the extremities and fingertips.

So is that physically the nervous system, or it really is all in the brain? I mean, you said spinal cord, too, but. So the nervous system is in all parts of us then, is that right?

Megan: 00:06:07

Yes, absolutely. Absolutely. Your nervous system is comprised of both your central and peripheral Nervous systems.

Holly: 00:06:16

Now where does the like, intelligence of the nervous system reside?

So if I've got part of my nervous system, let's say in my hand, do I does is that an intelligent acting part of the nervous system or that's it's in the brain and then the brain tells the peripheral nervous system to do something?

Megan: 00:06:41

Well, that's quite a controversy right now in the interwebs, if you will.

I believe the Body Keeps the Score is the book that there was an article just recently written about it which was meant to kind of debunk that theory. And I don't know if you're exactly asking this question, but if you're asking, do the nerves in my hand, are they sentient?

Do they make decisions independent of my brain? The answer is no. Okay, so if my nerve from my brain to my hand was severed, my hand doesn't act independently.

Holly: 00:07:24

Got it? Right.

Megan: 00:07:25

Voluntarily. There are some things that can happen in terms of like specificity and other things. But yeah, if that nerve is no longer connected, then.

Then my hand is no longer going to do what it is meant to do or what I would ask it to do. The other piece is. So I have the motor piece of things, but I also have the sensory piece. So my nervous system goes both ways.

I have output and I say to my nerv system, do this movement using my muscles and my joints. And then my nervous system also says, well, I'm really hot or you know, it.

I'm sensing a lot of xyz, so I may or may not do that movement in the way that you would prefer.

Holly: 00:08:17

Okay, so it's a regulator kind of a. It blows the whistle and says, not today. Or more or less, depending on. Is it like constantly looking out? Is it like a lighthouse?

You know, sort of like the lights rotating around, kind of looking for ships. Like, is that kind of what it's doing?

Megan: 00:08:35

That is one way to think about it, yeah. Because our nervous system is really designed to protect us and it does that through sensory input.

So like how I'm sensing the environment, Is it like extremely hot out here? Is it extremely cold? Am I touching something that's very hot? Also integration of that sensory input. So do I have a memory? Have I seen this before?

Have I? Is this safe? And then the motor output. So if it's red and hot on the stove, I'm going to choose to withdraw my hand.

And that's kind of all the different parts of my nervous system working together.

Holly: 00:09:19

It's. It's like it's everything because I'M I'm even thinking about. Right.

So there's, there's how the nervous system is perceiving and then sending sort of command messages to the body to act voluntarily or involuntarily, but then it's also involved in our psyche or our emotions. Right. Like, what about when we say I'm a nervous wreck or, you know, I'm a nervous nel. Are we talking also about.

I mean, certainly we're, you know, we. There's another word for that, which is anxiety or stress or what, you know. Sure, but is that also coming from the nervous system detecting a threat?

And that's. So anxiety kind of runs on. This is coming from the same place as detection of like a hot stove.

Megan: 00:10:03

Well, that can be part of it. So when we think about anxiety, we think there are many different reasons why people might have anxiety.

But much like pain, there is a learned component of that.

And so people like if we use your example of the lighthouse, people who have had difficult experiences in their lives, for example, if they had adverse childhood experiences during certain phases of their life, part of their nervous system that detects threat is going to be on heightened alert, as composed as compared to someone who is. Doesn't have that didn't have those experiences that taught them be on alert all the time. Maybe my lighthouse, you know, I turn it off.

I turn off the light every so often. And that would be kind of an example of me going into rest and digest because I'm not having to constantly scan my environment.

I'm not constantly having to turn the light on and keep the light on and look for threats because my body feels safe.

Holly: 00:11:12

So if, if we're experiencing chronic pain, persistent pain, does that mean there's been some kind of a glitch in the matrix? The nervous system is glitching or holding on to something that it shouldn't. I mean, the pain is real. It's not, you know, that. It's, it's. It's.

I'm just wondering if the origin of it is because the nervous system has not learn to, to calm down or shut itself off.

Or is that just a kind of a, you know, one of these marketing ideas that, that are out there of like, bring your nervous system down, like regulate your nervous system and you'll, you know, you'll ride into the sunset every day. So what exactly is happening?

Megan: 00:11:54

Yeah, so people with chronic pain tend to have nervous systems that are different from other people's nervous systems.

And typically what we think happens with people who have chronic pain is they have an original insult that causes nociception, which is something that our sensory nerves in our body sense. So nociception is also called acute pain, and it's a response to tissue damage. And so that's what we think of when we think about acute pain.

You think about a laceration or a bruise or a broken bone. Those are all nociceptive inputs from the nervous system.

And what you're describing is something called central sensitization, where even after the initial wound has healed or the nociceptive problem has healed, the nervous system is staying on high alert. And that does happen, and that is a component of chronic pain.

For some people, much like other aspects of science, this what, this is an oversimplification, and it doesn't apply to everyone. So. So central sensitization isn't the whole reason why people have pain even after healing has happened.

It's one reason why some people might have pain even after healing has happened. And what's happened there is that learning of the nervous system, as you mentioned.

So every time I have a painful stimulus to that nerve, I fire that synapse. It goes up to my brain, and there are multiple synapses throughout my spinal cord and into my brain and things like that.

But over time, I've fired that synapse over and over and over and over again. And it takes less stimulus in order for my body to sound the pain alarm, to fire that synapse again and again and again.

And then sometimes even people can have things that they've associatively learned with that, that we've talked about in the past on this podcast of.

It's not a physical thing that I've associatively learned, but maybe some, the sound of someone's voice changing or the sight of someone that I don't deem safe that is somehow connected to this original injury that that's going to cause my body now to sound the alarm, too. So it's not just the central sensitization.

It's also the associative learning and that predictive processing, because our brains are really, really good at predicting outcomes. And so, like you say, some of that learning is. I've seen this before. I recognize this. This is a threat. I'm going to sound the alarm.

Holly: 00:14:45

And what's interesting is that I would guess that that can still last decades, could it?

and here you are, let's say,: 6150

Megan: 00:15:11

It can, it can. But if you hadn't seen that person in the intervening 50 years, I would.

It would be more likely that that synapse would die off unless you had then, you know, had a similar experience that kind of perpetuated that and continued it.

But if it was like a such a traumatic experience that really changes your brain and it can actually change the structure of your brain, and so much so that your nervous system said, hold onto this because you absolutely need this for protection, then absolutely, you could have a response decades later and your body could hold onto it for decades. And some of that is what we see with our patients experiencing chronic pain.

Holly: 00:16:02

Okay, so what about the idea of the body holding on to memories when. When we see or hear that idea, the bot. You know, the body keeps score. The body doesn't lie.

And, you know, it's a bad knee, it's a bad hip, whatever it is. Are we saying it right, really, that, I mean, it's a nice idea, the body remembers, but is it the body that's remembering or is it.

It's something in the synapse. Right. That message goes back to the brain, and because there's a groove there, because it's sort of fired a bunch of times, it can show up again.

Megan: 00:16:41

That's exactly right. So there's no tiny brains in each of your fingertips that's interpreting the sensation.

And so, yeah, the body keeps the score, taken in the literal sense is incorrect.

You don't have, you know, trauma stored in your hamstring that when I use manual therapy and manipulate your hamstring, the trauma escapes in a cloud of dust and you have a tearful emotional response. And Chada, your trauma is healed and life is joy.

And I'm being a little sarcastic here because there is so much of that misinformation on the Internet. And I think the article that recently came out about it's not the body that keeps the score, it's the brain.

Because when I touch your hamstring, that reminds your nervous system, oh, I remember when I had that injury there, and this, that and the other are connected to that. And then I'm going to have an emotional response. And a lot of times people do feel better after that.

And so these manual therapists, sometimes massage therapists, usually, they're unlicensed, unregulated people who say I'm healing trauma with my hands are really not. And it's a really dangerous thing and it needs to stop because it can really hurt people.

I say, you know, some people feel really great after a cry, and some people feel like they want to unalive themselves. And unless you feel comfortable with both of those situations, you are not treating trauma. And that's, I think, a really important distinction.

Holly: 00:18:31

I'm so glad you brought this up. Have you seen the videos? I'm not trying to pick on anybody here, but have you seen the LeAnn Rimes videos? I think it's. Where do we begin?

It's overwhelming because I think people see themselves in these videos. We've all got things that we're desperate to get out of our system.

That horrible memory that, you know, in her case, terrible divorce drug, you know, there was a rough patch, you can tell there's some lived trauma there.

And then it's like giving hope to these hundreds of thousands or millions of people who are watching this and saying, oh, if only if I could just subject myself to someone who's basically going to pull my jaw apart and unhinge my jaw, I could get over my painful divorce or I could get over that trauma. And it's been really fascinating to watch.

Is there any part of that that's worth holding onto and walking into the office of a licensed therapist and saying, here's what I think. Is there anything good to retain out of that or is it just all wackadoodle? No.

Megan: 00:19:42

Yeah, there are things to hold from that. And interestingly enough, the majority of my referrals from other clinicians are now coming from talk therapists.

And so some talk therapists do somatic work, which is the way that they refer to work pertaining to the body. It's kind of a psychology term, somatics.

It has been co opted by some members of the wellness industry, unfortunately, although it is a protected term. So you're not supposed to say you're a somatic practitioner unless you have gone through the training and are licensed and things like that.

But so the majority of my, my people that I see now also see a talk therapist. And so I tend to work with them in such a way that I work with their bodies. Sometimes things come up.

I tend to work in a way that stimulates some subconscious movement, a subconscious manual therapy that then sometimes things that they had maybe suppressed or not thought about or not remembered come up. And then we talk about how this should be discussed with your talk therapist. And so again, I'm not claiming to treat trauma.

I'm not claiming to release trauma from the body. People often do have emotional responses in my office.

And if I sense that someone has a lot going on, history wise, or if they've shared with me some of their past history and it feels like there's a lot to unpack, I won't work with them until they have a talk therapist on board because it's not safe for me and it's not safe for them. Okay.

Holly: 00:21:38

I think that's a really important distinction because you're not necessarily saying throw the whole thing out the door. I never want you to see someone who lays hands, you know, like a somatic therapist could be appropriate.

But I think what we have to hear from Dr. Megan right now is that it takes more than one practitioner to peel back the layers of if there's trauma there, particularly, you know, the longer that it's been riding with you in your life, that we're seeing a moment in time on Instagram, we're seeing a moment in time on TikTok. And what we're not seeing is the wider, the wider reality, which is Leanne Rimes for, you know, again, I'm not here to pick on her.

She's likely, you know, it probably is in talk therapy. She is also likely maybe has a psychiatrist. She's done this, she's done that. Right.

So I think the message that's, that's kind of scary is that this is like a one and done thing that you can find this practitioner and, and have this like exorcism, right, and walk out a different person. Is that what you're seeing? Is that, is that how we're meant to be interpreting this when we see these videos? Dr. Megan?

Megan: 00:22:47

I think there are some people that are marketing in that way.

And I've seen a particular massage therapy practice who now is doing trainings to train other massage therapists to do these sort of exorcism type treatments. And you know, of course they have a celebrity spokesperson who tells you it's the best massage she's ever had and yada yada.

And so it is, it's very scary and challenging and kind of the wild west out there.

And it's, it's makes me afraid because, you know, what could happen to these patients when they're unprotected, when they don't have someone to help them integrate what happened or unpack some of the complexities that are happening. It can be very dangerous. And I had a patient that I was seeing and she had a resolution of her Symptoms.

But then she was going to go and see someone for. To help her progress in her dating life. She wanted to kind of get over some of maybe the blocks that she had about dating.

And she was seeing a talk therapist, but thought, you know, this friend of mine said, he changed my life.

And, you know, so this person, and, and part of it too is the reason I get referrals from talk therapy is because they don't have a license to touch with hands. They don't touch their patients.

And so that times can be, you know, it's easier for people to stay in their heads when they're not being physically touched because then that directs my nervous system to focus on certain areas.

But she went to this practitioner that I believe had a massage therapist license, and he proceeded to whip her back and forth in a seated position and dig his hands really deeply into her pelvis and her hips and shout at her to let go, let go, let go. And it, it turned out to be a really traumatic experience for her. And then she had to come back and see me. Oh, God. To work through what had happened.

And so those are some of the things that can happen in these situations.

When you're dealing with people who have, you know, that Dunning, Kruger, they have a little bit of knowledge and they kind of run with it and they don't really see the whole picture because they say, oh, I've seen this work online, or this worked with that one person that I saw. And so now I'm going to sort of apply the same framework to everyone.

Holly: 00:25:26

What would you advise to anyone listening who either is a pain sufferer who suspects that there could be some unearthed trauma, you know, something that they want to just get out?

Megan: 00:25:40

Right.

Holly: 00:25:41

Or a practitioner who's listening, who has a patient saying, oh, I want to go do this, would you. What, what's the sort of best practice here?

Do you think that before starting any kind of a treatment like this that they should at least check it either with their primary care doctor, their physical therapist, if they have one, or their talk therapist. It's like one of those three should be the one to help you make this decision? Or what do you think is the right approach?

Megan: 00:26:09

That that's an approach that can be helpful if you have a practitioner on board that you trust their opinion. Think it's also fair to ask for a phone consultation with this person? How do you treat people? Where did you go to school? What are your credentials?

What have you seen? You know, what's the best case scenario here? What's the Worst case scenario here.

I mean, I have patients call me all the time and say, so what are you all about here? You know, like. And I welcome that. I'm happy to chat about it and, and see if we're a good fit. Right.

You tell me a little bit about what's going on for you. I'll tell you a little bit about my background and my training and we decide if we're a good fit for each other.

I'll tell you about what I think maybe are the first places we might want to go to start to peel away some of this and you decide if that sounds okay to you or not.

And oftentimes those are the situations when I'll ask somebody if they do have somebody on board in terms of a mental health provider because of my policy of not. Not unpacking things when it's. When there's so much. So much going on.

Holly: 00:27:24

Yeah, yeah, that's. That's really good advice. I think that initial conversation is sometimes just.

We skip over it because we see a credential, you know, or we see a follower count. It's like, well, they have 200,000 followers. How could you know? Or, well, they were treating this singer, so. Right.

So I think, I think what you're saying, Dr. Megan, is, is simple enough that we, everybody should be able to do it. I think we just have to kind of pause and, you know, just have a healthy. Just have a little healthy skepticism, maybe.

Megan: 00:27:56

Right? Yeah. And the gold standard for referrals still to this day is word of mouth.

And so oftentimes we trust our friends, our family members who have seen this practitioner, but we have to remember that we are completely different people from them.

And what helped them and the type of treatment and the type of practitioner that helped them isn't necessarily going to be the same thing that's going to help me. So even though they, like, saved her friend's marriage, you know, this person was way too aggressive for her.

Just a completely wrong fit and frankly, an unsafe situation. Yeah.

Holly: 00:28:38

Could have been a really serious setback if she didn't have you. I think the right person to go to following that. Okay. While we're unpacking some myths or some, you know, things that the interwebs tells us.

What about, okay, someone who's dealing with chronic pain, who is not necessarily looking for the biggest release, the, you know, something dramatic to expel from the body, but is. But is thinking that they need to calm their nervous system down in order to improve their chronic pain. And I've thought this before too.

And I've said it to friends like, oh, my system's just on high alert. And so I just need to regulate my system. And then I'll grab scraps of information like, oh, meditation, that's system regulation, right?

Or slow walking, mindful walking and mindfulness, any of these things. And I have this idea that it's somehow calming my nervous system or regulating it. Let's take a minute there. Is that real?

Is that what's actually happening?

Megan: 00:29:50

Sure, yeah. That's a great place to start. So a regulated nervous system is kind of a misnomer. There's like, technically that's sort of like a made up term.

But when people are referring to a regulated nervous system, what I think they're really talking about is a flexible nervous system. Because what we find with people who have chronic stress and chronic pain is that they have an inflexible nervous system.

And we know this because we can measure the flexibility of someone's nervous system through something called HRV or heart rate variability.

And this is a component of my research where we hook people up to a heart rate variability machine while they're being given a stimulus and we see how their nervous system responds.

A lot of people now are doing this with a whoop band or an aura ring or even their Apple watches, which have less reliability but still give some information about how someone's nervous system is functioning.

And when I say a flexible nervous system, what I mean is, do you have the ability to switch back and forth between fight or flight and rest and digest?

Because what we found in people who have chronic pain is that they tend to stay on one end of the nervous system and they don't have the ability to toggle back and forth as easily. So a lot of times they are on the fight or flight side. But that's not always the case.

There's something on the other side of rest and digest, which is like a hypoactive or underactive nervous system. And sometimes you'll see this with people with depression, whereas on the other side we talk about fight or flight.

And that hyper vigilance or hyperactive nervous system is more often associated with anxiety.

Holly: 00:31:44

Okay, and so would. All right, I'm going to expose myself on something here, but I bet some listeners will identify with this.

When I'm driving and I'm listening to a happy song, I can be like, you know, brown Eyed Girl, blah, blah, blah, happy. And then something pulls, a horrible move, total cut off, you know, jerk driver. And all of a sudden I'm like, you Jerk.

And then five minutes later, I'm like, you know, da da, da banana, you know, singing again. And it's like, am I psycho or not?

Actually an example of a flexible sort of nervous system or maybe a metaphor for what we want to see as the flexible nervous system is like, yeah, you might get a little tweaked out, but your body was able to bring yourself back down. Yes. And get excited about the next song on the radio.

Megan: 00:32:37

Right. And that's probably in part because the music is helping you to be in a rest and digest state.

And that's one way, like, certain sounds are great signals to our subconscious mind that we're safe. And if I'm just driving to Brown Eyed Girl, my body's saying, like, we're doing great. We're like, having a great time here.

And yeah, somebody cut me off and fu. And all the things. Right. And then I could get back into the music. As long as it doesn't turn off or I don't turn it off, then.

Then there's kind of a possibility of coming back down. So that is kind of a great example of what that might look like. Another.

Another example of what that might look like is I am already chronically stressed because my work is really stressful and my kids are really stressful, and I'm worried about my housing situation, and I stubbed my toe. And normally it would just be something I would just kind of move on from and whatever.

But because I have all those other stressors on top of this, this has now become a much bigger issue. And I'm limping and it's swelling and I can't put my shoe on because it's so sensitized to the pain.

That would be an example of somebody that didn't come back down from that heightened state because they probably started at a little bit of a higher situation.

Holly: 00:34:14

Okay. So this is interesting. It's helping that it's coming full circle.

And I think I'm understanding that similar to the way that if we're living in this heightened state of fight or flight, you know, is always. Or high beta or, you know, whatever we want to call that, that that may make us more susceptible or potentially more vulnerable to experiencing pain.

Is that fair to say?

Megan: 00:34:46

I would say you're more vulnerable to chronic pain to the. Yeah, I mean, we all have pretty similar. Unless you're out there doing contact sports, then you certainly have a higher predisposition to pain, but.

Or to injury or to nociception tissue damage, but you're more likely to Move through it. Right.

And similar with somebody who's really hypoactive, who's kind of stuck in that low functioning of the nervous system is if, if I'm stuck there and I have an injury and I feel like, oh, this is just going to perpetuate my depression and my immobility and things are just going to spiral. And you know, like I say, your, your nervous system in split second runs it through. Have I seen this before? Is this safe? Can I let go of this?

Or do I need to hold onto it because it's important for my survival? Okay.

Holly: 00:35:46

And, and if our nervous system has been tracking this chronic pain for however long, it's sort of like you were describing earlier, where it's got that well worn groove, right? That it's better at anticipating, it may even more quickly or more aggressively anticipate.

Megan: 00:36:07

Yeah, absolutely.

And also if, you know, I oftentimes hear people say things like even a cold, my spouse or my kids will get over a cold very quickly or easily, but it's stays with me for so much longer and I get so much sicker. You know, your body is dedicating resources to whatever you're experiencing. So if you are in a great deal of pain, that takes up energy.

If you're not able to sleep, that causes you to perceive pain higher.

You know, so these things, if you can also think about it like a dialogue, like if I didn't sleep well, I'm not eating very well, I'm stressed, my dial is turned up a bit and now I'm going to perceive things as more intense.

Holly: 00:36:59

So would, would the goal be if, as a chronic pain sufferer, should, should someone potentially think about the goal of achieving a more flexible nervous system? Is that a good goal to have?

Megan: 00:37:14

Absolutely, yeah. And there are a couple reasons why that's important.

One, being chronic stress or living in a chronic state of fight or flight puts more stress on your tissues, puts more stress on certain systems of your body, certainly, certainly your cardiovascular system and your metabolic system. And this is why we see higher incidence of chronic disease in people who have prolonged or chronic stress like heart disease and diabetes.

We also see more hormonal dysfunction in people who have chronic stress. Because when I'm in fight or flight, I'm dedicating a lot of resources to perceiving the sensations that are going on in my body.

Kind of like that lighthouse again, I'm dedicating resources to shunting blood to my musculoskeletal system in case I need to fight or run. And therefore I have fewer resources to work on my cardiovascular system, my digestive system, my hormonal system, my endocrine system.

So those systems are all working at a lesser capacity. Doesn't mean they shut down completely. That would not be real life. But they're not working at it as. Because it's on a spectrum. Right.

So we're never all in fight or flight and we're never all in rest and digest. Okay. Yeah, but you're somewhere on that spectrum and you want to be able to toggle back and forth from one side to the other.

Holly: 00:38:50

Is there if, how, how would we go about doing that? Is there?

And is that a lifelong pursuit for, for any of us, even if we're not suffering from chronic pain, is, you know, kind of getting to that, that middle chair and the Goldilocks like where. Bringing the system to the point where like it can kind of handle. Yeah. Is that just a lifelong thing and nobody ever really gets there.

Megan: 00:39:16

I think of kind of like the regulated nervous system as the Goldilocks chair. You're never gonna just be in like smack dab in the middle feeling great. It's kind of like the pursuit of happiness. Right.

So like we're all sort of pursuing this happiness through our different avenues. And then, you know, you, you find some happiness, you recognize it, hopefully you're grateful for it, hopefully.

And, and then you go back into whatever it is. Right.

So a flexible nervous system says, yeah, I can go into fight or flight because sometimes I need to rush and I need to get to work and I need to get my kids shoes on and I need to brush their teeth and we need to get out of the house in the next five minutes or somebody swerves into my lane and I need to be able to react very quickly to protect myself. I need to go into fight or flight. I need to run from a bear if you know, you're hurling yourself up a mountain again.

Holly: 00:40:16

As a callback last week early, I remember that.

Megan: 00:40:21

Yeah. So that's necessary. And it's also necessary to be able to come back down from that. So what we find is people tend to stay stuck on that side.

And part of that has to do with our western society, which is go, go, go, do do, do.

Rest is for the weak or the wicked or the lazy or, you know, it's kind of what we've determined or what we've decided about non productive time in some cases. And so for a lot of us, it will be a lifelong pursuit.

I mean, I will raise my hand as a guilty party Here that I have to actively work every day and say, what can I do today to bring my nervous system down? Because I'm looking at the list and I'm coming back and I'm looking at the list and I'm coming back, you know, and you know.

Holly: 00:41:19

Absolutely, yeah.

Megan: 00:41:20

For me, it is sometimes as simple as a five minute meditation.

If I can feel my heart beating in my throat, if I recognize I haven't eaten today, it can be as simple as sitting down, putting devices away from me and eating in such a way that allows my body to do the work of digestion. Because again, if I'm in fight or flight and I'm putting food into my system, my body's saying, oh, that's nice.

I'm not going to do the work of digesting this right now, so good luck with that.

It's going to sit here and move slower through your system and maybe ferment and cause gas and bloating and discomfort as opposed to can I take the time and sit down, take five deep breaths, eat my food mindfully, and then give myself five minutes or ten before I jump right back into the next patient? For some people, it's the walk in nature that brings the nervous system back down.

And then again, for some people, I'm on that hypoactive side of the nervous system. So I need to ramp up my system a little bit more. I need to do some exercise.

I maybe need to listen to some more like engaging heavy metal type music or something that really can kind of ramp up my system. So, you know, we're, we're not trying to find that Goldilocks moment in the middle, but we want to be able to kind of go back and forth.

Ideally, you want to be spending a fair amount of your day in rest and digest because we need to digest ideally three times a day. You need to be able to rest when you lay your head on your pillow at night.

But you also need to be able to respond when your nervous system calls for a fight or flight response.

Holly: 00:43:12

I think that's actually a positive. I'm really glad you said that because I don't know if anyone listening has done this like I have, but I have turned fight or flight into a negative.

And it's not hearing what you're saying. Dr. Megan, we need to be able to, I mean, thank God for fight or flight, right? Like that car is coming at you.

You had better thank God that you've got a nervous system that goes, you know, cranks that wheel and respawns get your child out of danger. Right. So absolutely.

Megan: 00:43:44

Yeah. And we have kind of villainized Fight or flight. And it's not a villain. It's not ideal to live there. Right.

Because then you can't sleep and you can't digest and you make. You may not heal sugar and all the things. Yeah. Your hormones are a little off, but yeah, it's necessary and it's a part of life.

Holly: 00:44:10

Okay. This is. Yeah, that.

That itself is just a really important takeaway, I think, particularly because we sometimes are looking for the reasons that we're causing something. What am I doing wrong? What am I. You know? And Fight or flight being a natural part of it is.

It's just kind of affirming, Megan, to hear that it's okay to have these moments that you're not some frazzled, out of control person if you spike up. It's more about what happens to bring yourself back down and move through it.

Megan: 00:44:43

Right.

Holly: 00:44:43

Which is now why I want to pay even more attention to breathing exercises and things like that. Because I honestly did not know before this conversation that you needed to be in a calm state to actually digest.

I thought your digestion could just started happening no matter what. And was this, you know, relatively the same process kind of. That it goes through? And what I think I'm hearing is that it's.

It's disrupted or it's going to be slowed down or it's going to be a much more challenging proposition in. When you're in that state.

Megan: 00:45:16

In a lot of cases that is true. You know, there are some people that have that iron stomach and they. Yeah, yeah. Are lucky enough to say, yeah, eat whatever I want.

And I don't have any issues.

But there is quite a high correlation with people who have chronic pain and digestive issues, people who have chronic pain and trouble with hormone regulation, people who have chronic pain and cardiovascular issues over time. So it's not a coincidence and it's not that your system is completely shutting down, but it's not functioning at its optimal level. Yeah.

Holly: 00:45:54

Okay.

Well, I think this has been enormously informative and hopefully as we continue this season, we're going to be help giving people more and more pathways to achieve that healthy swing back.

Megan: 00:46:09

Right.

Holly: 00:46:10

The ways to sort of bring yourself back down. In fact, next week we're going to be talking to a pair of guests who will be addressing two ways to really bring your nervousness.

I won't say regulate, but you know, who that might really.

That actually science is proving has done a lot to help us create a more flexible system, the practice of qigong, you guys might be familiar with tai chi. So it's, it's similar to that and we'll learn the difference as well as acupuncture and you know, last episode about nature.

You know, next coming qigong and acupuncture. And we'll also be talking to a stress science therapist later this season.

And so I think we're really trying to fill our toolkit here, fill our listeners toolkits with knowledge like today. Dr. Megan, thanks so much for the education and also for the hope.

Like we, you know, we want you to be educated, then we want you to have the tools to be able to go out and, you know, do something about it.

Megan: 00:47:10

Absolutely. And not everything is going to work for everyone.

And so we'll give different options about, you know, forest bathing or qigong or listening to nature sounds or stress management. And yeah, you can, hopefully you can create a list and then you can pick like smorgasbord style and yeah, really help. Help yourself.

Holly: 00:47:36

Yeah, just not an exorcism. Maybe don't sign up for that.

Megan: 00:47:40

Please don't. Yep. Please do not tell your friends. Yeah.

Holly: 00:47:46

Awesome.

Well, as always, thank you so much for the learning and for really breaking things down in a way that is accessible and gives us the power to advocate for ourselves and to move forward. Because, you know, like we like to say on here, if you're still breathing, you can change your pain.

Outro: 00:48:12

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