Vagus Nerve Resets for Pain Management


Recent developments in pain science involve the Vagus nerve and the autonomic nervous system, the part of the nervous system you do not have conscious control of. The autonomic nervous system consists of the sympathetic nervous system known as "fight or flight" which is a response to DANGER and the parasympathetic nervous system known as "rest and digest" in response to SAFETY. There is another component of the parasympathetic nervous system that has recently gained attention known as "freeze or fawn" that is triggered when you have a LIFE THREAT as described by the Polyvagal Theory by Stephen Porges. The Vagus nerve divides into two segments as it exits the brain, the ventral and dorsal branches. The ventral is in front of (anterior) and the dorsal is behind (posterior). The body's physiological response is different depending on whether you sense danger, life threat or safety. The ventral vagal creates a sense of safety and calm while the dorsal vagal creates a sense of immobilization and shut down. It is important to understand that both are NORMAL and vital to keep you in a state of SAFETY. It is also important to know that the response is physiological and not psychological; in other words, what happens is a normal response to the environment you are in so your brain can do its job of keeping you alive.


To further understand the physiological response, it is important to know that 90% of the brain is subconscious and only 10% is conscious. Much of what you feel in your body does not come to your consciousness, unless you are aware that it is happening. This is why it is essential to be mindful to map your nervous system and bring the other 10% of our brain into consciousness. There are 12 cranial nerves (numbered I through XII) that originate from the brain stem; all other peripheral nerves that supply the arms and legs and rest of the body come from the spinal cord. Only one cranial nerve, the vagus nerve X, goes below the diaphragm to supply the organs. This is part of what we call the "gut feeling" from the enteric nervous system, or gut brain. It is also why what you eat matters since there are more neurons going to the brain than from the brain. Take for example an inflammatory diet such as the Standard American Diet (SAD) that is nutritionally poor and full of seed oils and other artificial ingredients that the body doesn't recognize. If the gut is inflamed, the nerve signals going to the brain are altered and can cause inflammation in the brain that we sense as irritability, anxiety, depression, etc. A healthy mind needs a healthy gut. Another example is an injury or trauma to the abdomen or pelvis such as during a fall or contact sports. The brain automatically protects the organs and tightens the fascia which signals to the brain something has happened and it should protect the area further. This is part of muscle memory and why someone might have pelvic pain, poor digestion, menstrual cramping and/or muscle dysfunction. If you further guard and protect the abdominal area due to pain, it creates a feedback loop, keeping muscles clenched and organs lacking normal motility (think constipation). Receiving safe touch through hands-on manipulation of the surface or deep fascia through a technique we use called visceral mobilization gives positive feedback to the brain, bringing to consciousness a sense of safety and bringing the nervous system back into balance. The Vagus nerve is 80% sensory, receiving most of the information going to it from the senses such as touch. You can go from one state to another by overriding the subconscious and becoming more mindful, which is known as nerve mapping. Additionally, stimulating nerves in the face and head (above the diaphragm) is very powerful and can change the brain quickly due to the myelinated sheath that is part of the ventral vagal system. This will be covered more in Part 2 of this blog.


Another example is breathing. You are breathing automatically without telling your brain to do so thankfully because the messages come from the primitive part of the brain known as the brain stem. You might be unaware that you are holding your breath or taking shallow breaths. This is where mindfulness comes in. You can override shallow breathing or a rapid heart rate by taking three DEEP and purposeful breaths. This will stimulate the Vagus Nerve and calm your nervous system down which lowers the respiration rate and heart rate. Now let's say you have a life threat, whether real or perceived. This can spike your nervous system rapidly into the primitive part of the Vagus Nerve known as dorsal vagal, similar to what mammals do to "play dead". The graphic above demonstrates this. This is a normal and expected reaction. What is not normal is that the nervous system can get stuck. This can happen with emotional or physical trauma, such as from sports or injuries, and is critical in understanding pain and muscle memory.


The Vagal Brake

The Vagus nerve is mostly parasympathetic, acting as a brake to the sympathetic nervous system, to down regulate the "fight or flight" response. In individuals who have experienced trauma or chronic pain, the Vagus nerve may not be functioning properly due to low vagal tone. The good news is you can improve vagal tone rapidly by stimulating the ventral vagal pathway working above the diaphragm in the face and head due to the myelinated nerves or by stimulating the dorsal vagal pathway working below the diaphragm into the abdomen and pelvis with safe tough and massage. According to Stephen Porges, "when we are social and are engaged, we are reducing metabolic demands to facilitate health, growth and restoration." Having the Vagus nerve working optimally is critical to your health and potential for healing.


Triggers and Glimmers

Deb Dana in her book, The Polyvagal Theory in Therapy, explains triggers and glimmers. A trigger is anything that the brain perceives as unsafe. A glimmer is the opposite, creating an optimal state in the nervous system where the Vagus nerve is stimulated and "social engagement" occurs. Some examples of glimmers are: petting a dog, going to a concert, relaxing at the beach, spending time in nature, exercising under optimal conditions (in the absence of pain or excessive temperature), getting a massage, getting hands-on therapy (what we do at Healthy Core), and spending time with others who you are in a healthy relationship with. Family members can be a "trigger" and sometimes it is best to have "healthy boundaries" to keep your nervous system from getting triggered. Here's an important concept that we have learned; you need to intentionally seek glimmers, especially if you know you might be triggered in certain environments or with certain individuals AND to do this BEFORE the triggering event. Take for example firefighters like my husband. There are multiple triggers on the job, including the tones that ring when there is an emergency call. Before he starts his 7 am shift, we go through some of the cranial nerve resets mentioned below while ensuring he has a good night's sleep and proper nutrition. Cortisol levels are highest in the morning and can be a trigger in and of itself. I know he will have several triggers in his 24-hour shift so we now intentionally include some "glimmers" before his shift. We intuitively have known this and did some of this throughout his 30-year career without understanding the science or reason behind it. Another example is intimacy. If you are stressed and not in ventral vagal, you will have poor libido or will not be able to become aroused. By adding some glimmers before intimacy, you can quickly regulate the nervous system and become present and in the moment. Our advice for someone who has a history of pain with sex is to breathe deeply from the abdomen, pull on the ears, play relaxing music and anything that promotes an optimal nervous system. Look for a future blog on this.


Vagus Nerve Resets

Changing your body's physiological response to your environment is possible through the stimulation of the Vagus nerve and other cranial nerves that share space in the brainstem or are in close circuitry to the the Vagus nerve. We will cover more specifics in Part 2 of this blog to learn how to simulate the trigeminal nerve (V), facial nerve (VII), glossophyaryngeal nerve (IX), spinal accessory nerve (XI). It is easier than you might think and highly effective!


My experience with chronic pain for myself and for my patients has evolved exponentially since learning about and incorporating the Polyvagal Theory. I do not view pain the same and I now make more time to include intentional glimmers. Knowing that pain and dysfunction is a NORMAL reaction and knowing you can change your body's physiological response is empowering in the healing journey. My hope is you will embrace this information and be able to incorporate it to prevent and reduce your pain. If you need help getting started, call our office to schedule a physical therapy evaluation with one of our experts. Healthy Core therapists are trained to treat and teach you about pain science and healing from chronic pain. You deserve a pain-free lifestyle to be the best version of yourself!


Written by Janine Laughlin - September 2022


References:


Reference Materials and Class Notes from Vagus Nerve Mojo Workshop by Perry Nickelston. January 2022.


Porges, Stephen. The Pocket Guide to the Polyvagal Theory. W. W. Norton & Co. 2017.


Dana, Deb. The Polyvagal Theory in Therapy. W. W. Norton & Co. 2018.



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