Pain Debugging Protocol #

Foundational skills for debugging pain.

This page is about giving you a structure for debugging pain. Debugging pain is not unlike other forms of debugging¹. Although there are generally helpful rules of thumb, there is no perfect recipe that works for everyone. You will need to understand the architecture of the system. You will need to tinker, sometimes randomly, and pay close attention to how the system responds.

This protocol brings together a few high leverage principles that have been helpful in our own experience and our experience in helping others. It distills principles common to many techniques that aim to address pain and thus ‘sits atop’ them. We encourage you to view this as a meta-protocol that informs how you go about trying more specific practices, whether that be Pain Reprocessing Therapy or Qigong.

Rule out structural damage before you begin #

Prior to beginning this protocol, it’s important to consider whether your condition might be closely linked to tissue damage. Although the majority of chronic pain is not directly linked to tissue damage, you may be in the minority of cases where a structural intervention is the most helpful (for instance, inflammatory pain associated with a cancerous tumor). It is very valuable to consider the doctor’s assessment in light of your own hypothesis. You can combine this with the assessment criteria used in Pain Reprocessing Therapy.

Nevertheless, even for people who have clearly associated tissue damage, this protocol should be helpful in association with other forms of treatment.

In our experience, pain recovery can be split into seven capacities. If you are able to get to the seventh stage, you will have been able to resolve your pain — though it is not strictly necessary. Many people after just the first or second stages are able to resolve their pain.

Our approach is built on three stages: Understanding, Processing, and Integrating.

The 7 steps of this linear model fit neatly inside each pillar. Here’s the model:

Understanding #

1. Intellectual Understanding: This is propositional knowledge about the complexity of pain. You may be able to explain it intellectually, but there’s no felt shift in perspective.

2. Internalization: You realize that “pain is not from damage” is not just some fact, but very concretely about you in your body, right now.

Processing #

3. Settling the Nervous System: Coming to recognize internal peace, even when there may be remaining pain or sensation.

4. Sensing the Fluid Component of Pain: Becoming more familiar and comfortable with the experience of pain.

5. Unburdening: Finding residual obstacles to feeling pain. Noticing emotional responses and allowing them to be felt.

Integrating #

6. Fluidity through Gentle Movement: Encouraging movement that feels easeful and nourishing.

7. Expansive Physical Activity: Rebuilding confidence and joy in movement.

What is the actual protocol?

0. Set up your environment #

This is about preparing a space for the work to happen. It includes both your internal environment (your mindset) as well as your physical environment (your workspace) and your habits.

For your mindset:

• You are the solution architect. Your life is in your hands. You cannot rely on a magical device, technique, or healer. Bring your utmost care and creative problem solving ability to this and you will be richly rewarded.

• Progress is often nonlinear. While our muscles and tendons can be understood with linear mechanics, our brains and nervous systems cannot. This means that results can be highly nonlinear. For some people, complete resolution can happen in days. For others, it can take much longer. Be open to either, while also accepting that day to day progress can vary significantly.

• Be kind to yourself. Many people experiencing chronic pain have strong perfectionist tendencies. Self-criticism tends to be associated with an activated sympathetic nervous system and reinforce the pain catastrophizing feedback loop. Accepting and forgiving yourself is very helpful. More on this in Process Your Patterns below.

For your physical environment and habits:

• Make a calm space, free of distractions. Somewhere you won’t be bothered by pets or other people. Lighting a candle can serve as a helpful symbol that you are going to begin.

• Make your work less stressful. If you take this process seriously, it will be your most important part-time job. Rearrange your work around this, not vice-versa. It is hard to make meaningful progress if you go to sleep dreaming of that project you should have finished by now.

• Dedicate >30mins at a consistent time each day. Ideally first thing in the morning.

• Stabilize diet, sleep, and exercise. Not much more than the obvious.

1. Understand Pain #

As we’ve discussed, pain is partly made of thoughts. How we understand pain greatly affects how we perceive it. During a workout, we might willingly put ourselves through significant pain. We intuitively understand that this pain is safe, and so it isn’t a problem even when we wake up bruised and sore the next day. We want to internalize something similar when it comes to chronic pain. At first the understanding may be purely conceptual but you should deepen this understanding until it feels clear that the pain is not due to damage and that you know how to work with the pain.

Prompts:

• Start logging: Start a pain doc that gathers the evidence about pain in your context and start keeping track of what you have attempted. Be empirical about it: write down what you think is happening with your pain, perform little experiments, and refine your hypothesis.
• Gather intel: See the evidence page and explore, following your curiosity. Use this to inform your hypothesis of what’s going on.
• Rubber ducking: Articulate what you think is going on with your pain. What parts are you less sure about? Keep refining until it feels clear in light of the evidence we’ve presented
• Find your ‘proof of concept’: there are thousands of testimonials from different types of people with different conditions. Once you find someone who has recovered who you can relate to, recovery becomes more real.

2. Process Your Patterns #

The patterns that generate pain are often rooted in the past. These are forms of technical debt that were once but no longer useful.

It may have been once helpful to suppress anger to avoid fights in middle school, but at the workplace anger suppression may be directly linked with chronic muscle tension. Processing past patterns is often very helpful for addressing chronic pain.

Processing the past includes many different sub-skills

• Relaxing the nervous system. Just as a strange shadow is far more terrifying right after a scary movie, your bodily sensations are more painful when your sympathetic nervous system is constantly activated. Similar to developer mode on an operating system, relaxing the nervous system allows you to experiment and problem solve in a way that you usually cannot. You may have to experiment to find the practice that works well for you. Breathwork, Progressive Relaxation, and even Tapping have been helpful for people.

• Improving interoception. Interoception is the ability to notice internal sensations. Getting better at interoception allows us to update our internalized beliefs about the pain. A very powerful practice for this is Somatic Tracking [cite: as developed and described in Pain Reprocessing Therapy], in which you gently inquire into the pain sensations. If you are able to notice the sensation aspect of the pain in a nonjudgemental way, the fear-catastrophizing loop is interrupted, and the pain

• Feeling emotions. As we’ve mentioned, pain has a cognitive, an emotional, and a sensation component. The emotional component of chronic pain is often highly charged when emotions are repressed for a long period of time. Unfortunately, most of the time it is very difficult to know to what extent you are inhibiting your emotions. One very helpful set of practices involves stopping resistance to unpleasant emotions. This can be done through targeted writing prompts², guided awareness exercises, or just sitting there and feeling. You might also consider working with a skilled therapist or coach³.

3. Learning to move #

Understanding and processing are best done in a controlled environment. If you want this to extend to your daily life, it will be helpful to bring in aspects of the world. Including the factors that trigger the pain-generating feedback loop in the first place. This should be done with care, once you have capacity to do so. In our experience, it is very helpful to begin with gentle movement, then include smaller versions of the actions you wanted to perform, before finally integrating it wholly into your work life.

You do not need all of these skills to resolve pain. Many people find significant resolution from education alone (people have reported resolution from just reading reviews of a book). But in our experience gaining facility in all these skills significantly increases agency in life and often coincides with the resolution of pain [For those looking for a base rate, the closest thing we will point to is Pain Reprocessing Therapy, which found 2/3 people with long lasting moderate back pain find lasting relief after following their program for four weeks. Our protocol is closely inspired by theirs, but there is no study on how effective it is if you follow it yourself].

For those who’d enjoy more structure

We’ve put together a set of free self-guided practices. They walk you through the different stages of the protocol and give you much room to improvise and create your own version. Just check the box in the form here.

We also run monthly cohorts of small groups to come together and debug their pain. You’ll get an email for the next cohort if you sign up here

Additional resources

There are many guides to pain and many different practices for resolving pain. We have experimented with many of these and referred to what we feel are the most compelling for a wide range of people. We invite you also to explore and let us know what you find!

• Physiotherapist Greg Lehman has a free pain guidebook.
• The Pain Management Workbook
• Pain Reprocessing Therapy’s The Way Out
• Shinzen Young’s Break Through Pain