The Way Out is a must-read for anyone experiencing chronic pain.  It’s written by the same people who hosted the podcast “Tell Me About Your Pain” and who are involved in the Curable app, both wonderful resources.  As someone who has coached people with chronic pain, this book packaged many key concepts and put names to things that I’ve seen to be beneficial to clients.  It is a great starting point for anyone who is open to brain retraining and who thinks their pain may be at least partially related to neuroplastic changes rather than structural issues (spoiler: the vast majority of pain has some neuroplastic component that may be receptive to these techniques….because, after all, the experience of pain changes the brain, even if the cause was structural).  And if you are not sure, the appendix provides a handy questionnaire on page 163 to help identify if your pain is at least partially neuroplastic.  

The book introduces a technique called Pain Reprocessing Therapy (PRT) which includes several techniques to help the brain unlearn pain and, in particular, to address what the authors call the “fuel” of neuroplastic pain: fear (page 31).  Perfectionism and living in a high pressure culture contribute to this state of high alert that many people with chronic pain find themselves in unknowingly (page 37).  

Here are a few concepts that I find to be particularly helpful.  

Look for exceptions to your pain.  These are cases when you would expect pain (if the pain was purely structural), which are often mediated by changes in emotional states or environment.  The example given in the book is sitting through an exciting basketball game and not noticing back pain that is typically triggered by sitting because you are so caught up in the game (page 59).  Awareness of these exceptions are like seeds that can be built upon to help the brain “unlearn” pain.  

Create corrective experiences.  This occurs when an exposure to a typical trigger or fear becomes a safe experience.  These often need to be engineered and reinforced with healthy thought patterns (“This is temporary,”  “My body is safe,” etc).  However, anytime fear and pain behaviors become reinforced, a “setback” can occur, as it reinforces the pain-fear cycle in the brain.  Thus, although “avoidance” gets a bad connotation, the authors emphasize that this is actually a healthy strategy when pain levels are high so that the pain is not reinforced.

The trick is graded exposure….incremental small changes that the brain can make healthy adaptations too.  This reminds me of any kind of physical training where you are loading the body to make small adaptations over time to get stronger (doing too much exercise can be counterproductive)....same is true with pain brain retraining.  The authors provide many strategies for making your brain feel safe, including practicing somatic tracking (similar to mindfulness…observing pain sensations with curiosity and without judgment), sending safety messages, avoiding feeling trapped, embracing positivity, catching fears and many others (page 149).  

One other thing that resonated with me was this idea of non-attachment to the outcome and focus on the process….this takes pressure off the goal and, paradoxically, tends to be much more effective.  The book is short, concise and packed with a wealth of information.  My biggest advice for someone reading the book is to open your heart and mind to the concepts and experiment with the techniques without a goal in mind.  As I’ve seen this play out with my own pain and my client’s pain, my caution is to not make this an intellectual activity (reading the book and thinking about the theory), but make it a practice.  And think of any gains as gravy.  For many, the gravy can be life changing.

​