The interoceptors. It sounds like the latest box set action hero series in which the heroes, the interoceptors, save the world from a terrible threat in the shape of _________. You can use your imagination to fill in the gap. Close your eyes and think of something that causes on-going suffering to millions of people.
Alas no, for the interoceptors are the actual sufferers. You may have filled the gap with an alien-shaped villain, or you may have thought of chronic pain–no surprise for regular readers.
Interoception is the term used to describe the inner sense of your body’s physiology — some reading here and here. This ties in inextricably with your sense of ‘self’, who I am. Some debate that the sense of self is an illusion and Buddhists purport the belief in non-self; just to give you some background on the subject of self, which is indeed absolutely fascinating and relevant to pain.
Another term used in the literature and sometimes in the clinic as a result, is hypervigilance. This is often paired, or followed by catastrophising. What a couple of words! Anyhow, in essence they mean that the person is readily aware of feelings and sensations in their body, in themselves that is (the two are not distinct), and then attribute these to something bad and hence provoke on-going negative thoughts and feelings. This is one of the contributing cycles to pain, as the persistent negativity affects thoughts and behaviours that impact upon the pain itself–intensity, on-going attribution, moment-to-moment choices etc.
Interoception being the very sensing of physiology from within (exteroception is without), that is apparently amplified in many cases of on-going pain, mean that people feel sensations in their body (some pain, some non-pain) and are so aware, that this completely occupies their experience in that moment–there is only one real moment, and that has just passed, as has that one, and that one; the point being that past and future are in our minds, the only real moment is the one passing..now…now etc etc. We can really only attend to a few foci at any one time and if much of our capacity is taken up with monitoring how our body, how ‘ourself’, feels and what this means, there is not much room for anything else! It is exhausting and increases perceptions of these sensations including pain. It is a habit.
Pain is all about threat. When your body systems that protect you are activated in the face of a perceived or actual threat (the former occurs more and more and in relation to non-threatening cues in chronic pain), the ensuing protection includes pain as well as a range of other responses. When the perceived threat diminishes because it goes away, heals up or we comfort ourselves for example, the pain subsides, sometimes very quickly. When we are vigilant to body signals and then over-worry about what they mean, including normal feelings that then become misinterpreted, this increases the threat, and hence the likelihood of pain.
For all these reasons then, understanding pain and the associated aspects of the pain experience are key: e.g./ attention, focus, expectation, awareness, thoughts, feelings, emotions.
The interoceptors*, in case you haven’t twigged, are people who are very aware of the feel of their bodies, logging many of the normal sensations and worrying that these feelings are problematic or part of their pain issue as well as feeling aches and pains and considering them to be signs of danger, and hence increasing the threat. Most people with persisting pain develop this habit and need guidance and experiences to change this, re-focusing their energies on the right thinking and actions.
* Just a brief note on this apparent labelling — I am not a fan of labelling, hence this note. No-one is any ‘one’ entity; we all have different and unique blends of characteristics that change according to how we are feeling, perceiving the current moment, where we are, who we are with, what our brains are predicting we may do with that person or in that environment etc).
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