Our Sensory system brings in information about our current local area and the state of our body in this moment. Some of that may trigger a pain response, which then triggers various actions. Chronic pain and sensory over reaction are awful life experiences, which often are biologically driven and neurologically processed. Sensory and Pain Therapy are methods to address pain and over sensory sensitivity.

Three Phases of Sensory Perception

Sensory perception seems very fast, but from sensing something to acting on it is actually a multiple layered process. Often we just use our default automatic system due to speed and efficiency, but when we are in pain, or we are reacting poorly to some kind of sensory situation, it is helpful to start to break it down to make changes.

Here we will break the Sensory Perception into 3 different phases.

Layer 1 – Sensory Input and Output

Our bodies have around 5 billion sensory inputs that can send a signal to our brain. If we “listened” (paid attention to) each of those, it would be overwhelming. There are a few strategies that our bodies use to manage this. By necessity, this is simplified and is more about understanding approximately how it works rather than deep diving into any particular process.

We have nerves traversing most of our body, which are each able to report to our brain. Technically, the nerves are the same kind of cell that our brains are made out of – a kind of neuron. There is the peripheral nerve system, which reports to the central nervous system, which is effectively a specialised extension of our brain. The Central Nervous System (often shortened to CNS) reports to the cerebellum (at the top of your spine), which then talks to the rest of your brain.

Each cell of your body is trying to stay optimally healthy. When it is damaged, it will send a signal out to indicate the kind of damage it has experienced, which often triggers the sensation of itch, but also may trigger a different kind of nerve response. If a sufficient number of cells release the messenger chemicals, the nearby nerve will pick up that something is going on and will then pass on a signal to the CNS.

The five most common sensory pick ups are:

• Sharp – for a local sensation
• Blunt – an area effect sensation
• Hot – from body temperature up to a certain threshold
  • Warmth is between 34° to 42° C
  • Painfully hot is 41° to 50° C
  • After 50° C, the damage is severe enough to not send signals
• Cold – from body temperature down to a certain threshold
  • Cool is 14° to 30° C
  • Painful cold is from 0° to 12° C
• Itch
  • Detecting chemical damage
  • Detecting light touch such as insects

The nerves concentrate in specific areas and incorporate more complex types of sensory perceptions. For example, your hands have more sensory pick ups than the rest of your arms, and adds in mehcanoreceptors (mechanical receptors). Mechanorecpetors detect types of touch, pressure, vibration, and cutaneous tension, which allow us to detect many different types of material and their properties when we receive signals from 1 or more of the mechanoreceptors (Meissner’s corpuscles, Pacinian corpuscles, Merkel’s disks, and Ruffini’s corpuscles).

The peripheral nerves will do some level of signal processing, and may:

• A “No signal”
  • As the signal strength was not strong enough
  • The signal has not changed sufficiently (habituation)
  • Another signal from somewhere nearby is stronger
• Simplify the signal information
  • Smooth, rough, prickly etc rather than the specific information that built towards making that. This is similar to how the screen you are reading this on is only emitting 3 types of light, but you think you are seeing far more than that. You don’t care whether the colour is a real frequency on the spectrum or made of two or three bands of light that simulate that frequency – orange.
  • Send specific urgent information (often painful)

The decision by the peripheral nervous system is then sent to the Central Nervous System.

The “No signal”

The “No signal” is actually a signal in and of itself. Effectively the signal is “no concern” rather than silence. When the nerve cannot send a “no concern” signal, the body wants to find out why and will try to amplify or stimulate the nerves nearby (why you rub at certain spots). It can then attempt to amplify the signal in case the signal strength is compromised and important information is being lost. The problem here is that noise can be amplified and mistaken as an important signal – that’s phantom pain. Tinnitus is a form of phantom pain.

Layer 2 – Reactive Neurology

The signal from our sensory inputs (other than sight) goes to our peripheral nervous system and is then channelled through our Central Nervous System. Our CNS does some additional decision making and can prompt a physical reaction that leads to a change at around the same time that your brain receive the signal that there is a problem. This is why you will often lift your foot as you become aware of the problem (lego, glass etc).

• Foot steps on a bad thing
• Cells send a signal, peripheral nerves detect a problem
• CNS receives the alert
  • Sends a reaction sequence to raise the foot and
  • Sends a message to the brain
• At the same time
  • Foot lifts
  • Brain receive alert

If we had to become aware of the problem in our brain, to then send a signal to the CNS to send a signal to the peripheral motor nerves to then lift the foot, we would get far more damaged by accidents as that would take far too long.

Not all of our reactions occur at our CNS. Many of them occur in our cerebellum and basal ganglia, some are from our frontal lobe (motor cortex) behind our prefrontal cortex. This is part of our muscle memory reaction sets, which are much faster than our conscious movements.

A more complex reaction series can be triggered from our Amygdala, which ties into the limbic system (hypothalamus and thalamus). Our limbic system stores information where we can recognise problems and retrieve solutions. The Amygdala also connects to our endocrine system, regulating our heart rate, breathing and blood chemistry – it can trigger our freeze / fawn / fight / flight emergency response, or calm that down.

None of this is conscious choice – this is all reactions to what we have sensed.

Layer 3 – Cognitive Reinforcement

Learning is a fundamental property to being human. We learn from the past, making changes and improve until we get a good enough result. Sometimes we go further and optimise. Anything that we do repeatedly tends to optimise to the least energy cost for the least pain and most benefit, so long as it doesn’t hit a boundary. Generally, this is an automatic process, with the basics for that outline in the section just above.

Cognitive Reinforcement comprises of two main parts – mood and meaning.

Mood

When we experience something, our middle brain gives us a feeling to try to define if the experience is fundamentally safe or not safe. What we show to others our emotions -generally emoting that feeling, however, we don’t always show others’ what we feel. When a feeling is persistent for a while, it is our mood.

If we have a certain feeling prior to the event, it can change how we perceive that event. For example, if you have just watched a horror film, and you hear an unexpected sound in your kitchen, your brain is more likely to fear something horrible is there. If you had just watched a comedy, you are more likely to think that someone has just knocked something over. Our expectations flavour our experience, and this is also true for our sensory system.

If we expect that we are going to be in pain and we fear that feeling, we are more acutely aware of pain signals, which means that the received pain is likely to be interpreted as worse than if we were expecting to feel some mild discomfort pain and that it would be okay.

Meaning

We attribute meaning to events as a part of trying to predict the future. Our sensory system is trying to inform us about what is going on in the world right now, trying to inform us about that event. While the meaning that we attribute can be flavoured by the mood we had prior to the sensation, our past experience and our current expectation also has a strong influencing effect on the meaning that we attribute to the what our sensory system is informing us.

Reinforcement

There are two kinds of Reinforcement – memory / perception and cycling escalation.

Memory / perception has been covered briefly above, but will be explored more fully in the below section on Retraining Sensitivity. This is an important understanding for Reinforcement at this point in the process of understanding how our sensory perception works and is influenced by the past. In brief, what meaning we have for the event that we interpret from our sensory inputs, how we solved that in the past, and how we felt about that process, will strongly influence how you interpret your sensations now.

For the rest of this section, we will look at how Mood and Meaning can reinforce each other, leading to an exacerbation of the sensation in a cyclic escalation.

Let us say that you realise that your arm has a mild itch. In the absence of some concerning cause, this is likely to be just an annoying experience easily solved with rubbing your arm.

If you were using chemicals earlier, it might mean that you are having a reaction to the chemicals because you didn’t wash that arm properly – or perhaps you did and it is just that random annoying itch. If it is just a mild irritant, a quick rub may be enough to reset the nerve system, while if it is a reaction to chemicals, you may be needing to take a more complex action. While you are dithering about what the itch means – a nuisance or a reaction to chemicals – the feeling of the itch is likely to intensify, especially if you cannot wash your arm soon, even when it wasn’t caused by a harmful chemical splash.

Just the possibility of worsening harm is enough to exacerbate the interpretation of that itch signal, which might then affect your mood, in this case, causing worry. Your worry mood can affect your interpretation of the sensation signal, and also increases the interpretation of meaning – what if the chemical is really harmful? What if this is the first sign of poison? The added threat meaning cycles back to your mood pushing worry in to anxiety, and further into panic. With the expectation of symptoms of poison, any signal that aligns with what might indicate a poison is amplified, creating a confirmation bias, which reinforces that this is going to be very bad.

Sensory and Pain Therapy

Treating Sensory and Pain issues is generally a two part process, Biology and Cognitive. Biological problems need biological solutions, and often that is a medical intervention. Cognitive problems require talking and skills therapy.

Medical Interventions

Looking at how our sensory system works, we can see that a large part of this process is biological signaling (Layer 1) and base level neurological interpretation (Layer 2). If the majority of the problem that you are experiencing with sensations is in these two layers, it is a biological problem and generally that means a biological solutions aka Medical Intervention. Also see our section on Chronic Pain.

Medical Interventions can be surgery, injections and medication. Before those occur, a proper investigation needs to be done to determine what is going wrong. Often that starts with scans, such as X-ray, ultrasound, MRI or CT scan. Each of these can “see” through the body in different ways to look at different parts of how your biology works and identify if anything is out of the ordinary. Sometimes further tests are required to determine if there is a direct physical cause for the problematic sensations that you are experiencing, such as nerve conduction tests, EEG, ECG and many, many more.

Another very informative test is a blood test. There are certain nutritional deficits (eg low iron aka ferritin, vitamin B6, vitamin B12, vitamin D, low magnesium etc ) that can cause erroneous sensory signalling and can be addressed. Thyroid dysfunction (hypothyroidism and hyperthyroidism), hormones (oestrogen, progesteron, testosterone and cortisol), rheumatoid factor and so on can be tested depending on the nature of your sensory discomfort. For example, one of my clients had consistent joint pain and often low thyroid function but not technically medical hypothyroidism. On trialling some thyroid medication, they found a significant reduction in joint pain.

There are some medications to help balance the neurotransmitters that manage pain. Some of these happen to be the same medications given for some mental health conditions, which can lead to people thinking that the doctor thinks you have a mental condition rather than a neurological condition. While this may be true, often the medication can treat more than one condition, and pain or other sensory discomforts can be the target for those medications.

Finally, we should also address simple mitigating interventions. For example, photosensitivity can often be manage with shaded glasses, audio hypersensitivity can be managed with headphones or insert dampeners, hand touch sensitivity can sometimes be mitigated by gloves and so on. Not all people can use these devices, for example someone who is photosensitive (bright lights cause pain and headaches) may not be able to wear sunglasses due to hyper sensory touch face sensitivity.

Retraining Sensitivity

Sensory Reframing

We talked earlier about how our experiences can be affected by mood, meaning and reinforcement and that most of that is an automatic process. What we can modify is the mood we deliberately bring into the experience, how we manually choose to interpret the signals, reviewing our actions & choosing better options for next time and practicing better response methods.

• Phase 1 : Where possible, prior to a known trigger event
  • We can frame our mind for an interpretation of what we are about to experience
  • We can attempt to adjust our mood prior to the event, such as feeling empowered because we are choosing this experience
• Phase 2 : During the event
  • We can push out of the automatic reaction space and notice the sensations separately to our feeling and assumption of meaning [this isn’t easy]
    • Often the first step in accomplishing this is to not act (unless in clear danger) and instead try to get curious and thoughtful about the sensation
    • Common step two is to notice how the sensation creates or strongly suggests a mood feeling, and become curious about if this feeling is accurate to the sensation in both type and strength; often the error is a feeling of extra urgency that doesn’t match the situation
    • We can also look at how we attribute meaning to the sensation and the feeling it evokes. This is a good time to seek alternative explanations for meaning
      • For example: while this hurts, and I don’t like it, I’m not actually in danger despite the feeling of danger, so this is my body overreacting to the pain and being really enthusiastic about warning me. Instead of the suggested action of [run, fight, etc], I’m going to calmly [do something about it, read / chat because it is necessary etc] – because I am in charge of me, not my automatic system!
  • We can also practice various grades of the stimuli that triggers our sensory system, learning to downgrade the point of sensitivity, or increasing our ability to discern harmless from harmful [also not easy, often requires set up]
• Phase 3 : After the event
  • We can gather some additional information and review how things went
    • If we don’t like how it went
      • We can try to image a better response to that situation
      • Review what warning signs may have indicated that situation was going to happen, and what actions can either change the situation or prepare better for the sensation
    • If we do like how it went, we can affirm to ourselves that we did well

Sensory Practice / desensitisation

In Phase 2, I referenced that often playing with the source of the sensation takes set up. If the thing is unexpected and over quickly, you may not have the opportunity to experiment, while if it takes a while then you can.

It can be worth setting up a similar situation to practice various coping methods or learning how much of the stimuli and sensation you can handle before you start to lose your choices and just react or meltdown. With practice, you will get better at this.

This skill is similar to desensitisation, except that some things you don’t desensitise to, you just get better at handling. It is also important to recognise that some things are just managed rather than handled (for example, headphones help to manage).

Desensitisation is all about starting small and working your way up. This works well when the problem is a feeling or cognitive reaction you want to train yourself out of, but not very good if it is the type of signal you get from that stimuli. For example, you can’t desensitise to photosensitivity – trying to do so only trains you to endure pain, which while a good skill for brief amounts of time, is not what desensitisation is about.

Changing the Meaning

What do we define as good and what do we define as bad?

Pain is usually bad, however, there are times where it can be good. For example, after doing some heavy lifting, our muscles may be sore where we have broken some muscle fibre. Our body responds to this by repairing the muscle and adding some extra fibres, and we become stronger – pain isn’t always bad.

Sometimes the avoidance of pain can be a problem. If you have an injured back, you may be over tightening certain muscles, leading to fatigue, poor posture and increased sensitivity to certain movements, creating hypersensitivity to actual pain, pre-triggering the pain response and acting on that before actual pain has been sent by the cells or nerves. Talk to a competent Physio Therapist about how to change this if this may be something that is happening to you.

Sometimes our state of mind can make a big difference. For example, if you are doing some exercises and stretches to remedy some back pain (from the above example), focusing on how much an exercise hurts will risk priming the pain response, elevating the level of perceived pain. So once you have got comfortable with how the exercise is done and what the exercise feels like when it is done well, put a comedy on to distract you from expecting pain. The comedy will help boost endorphins, shifting your mind to enjoyment and your body to better relaxation.

This is not mind over matter. This is using your mind to add to an effect, or to soften an effect, by tweaking either your mood or your definition of what things mean.

Re-sensitising Sensory Perception

Sometimes the problem is not that the sensory perception and reaction is too big, it is that it is too small. This commonly happens for people who have had some peripheral nerve damage, but can also be a problem where people have low awareness of things due to inattention or poor interoception.

Interoception

Interoception is the ability to be aware of what signals your body is sending to you, evaluating that signal and then consciously or unconsciously choosing a response. For example, knowing you are hot, cold, hungry, need to go to the toilet, that your foot is itchy, that your tired, what you emotionally feel, that your blood sugar is low, that you forgot to take your medication, that the floor is not a zero degree angle and many more.

A part of your brain runs through a cycle of checking various parts of your body, some get polled more often, others less often.

There are three major problems that Interoception can have.

Low or Absent Signal

We covered earlier the part of the peripheral nervous system where the “nothing to report” signal may be absent, causing phantom pains. This was a simplification to try to bypass the very complex nature of what causes this problem. When your brain polls a part of the body that it can no longer reach, the response it gets is absence rather than “okay”. Your brain then amplifies the signal in case it just didn’t hear it properly. If you’ve ever turned the volume up to the maximum when there is a silent part of a recording, you’ll hear hissing and popping as the noise in near silence is now turned into a sound. The same thing happens to the signal that should be coming from a body part that isn’t responding, and your brain interprets that noise as a signal of some kind. That can be tingling, pain, ringing or in rare cases pleasure. The problem is, it doesn’t stop.

There are a few things you can do to help this.

• Fooling the brain:
  • Sensitise the area around the missing bit. Your brain will often average out the signals and think that the middle part also sent something, and will assume the signal from the other parts is the same.
  • Mirror therapy for phantom pain uses a mirror to create an illusion that the missing limb is present and moving, helping to reduce pain and other symptoms. Places your healthy limb in front of a mirror in such a way that it looks like both limbs are present. You then tense and relax both the phantom appendage and the mirror image present one, while looking at the reflection in the mirror illusion that shows that your phantom limb is present.
• Retraining the brain
  • Occasionally rubbing the edges of the nerve damaged area will trigger semi functioning nerve system signals to your brain. While rubbing the periphery, note the bits that feel like normal, and the bits that feel faint. Practice noticing the fainter signals, which helps your brain recalibrates that weaker signal as a better strength signal (amplifying the received signal). If the nerve damage is total in some spots, there will be a limit to how much you can retrain the damaged area.

Poor Polling

While not exclusive to Autistic People and ADHDers, not noticing that your body is sending is generally due to not polling very well. Effectively, your brain is not listening and isn’t aware that you need to do something in response to the signal (pain, hunger, toilet), or due to the circumstance, the signal fails to trigger a change in action (finishing this thing feels more urgent than going to the toilet).

Occupational Therapists are the people who primarily help with retraining improved awareness of body needs, Mental Health Therapists are fairly good at this too.

Since our emotional feelings are tied in with our physical body feelings, poor polling can also often lead to a poor perception of how your emotional state is. Part of that can also be in the next section, where you may have learned to ignore the emotional feelings because those feelings are confusing, so ignored. For that you want a mental health therapist.

Confused Meaning for the Signals

A good Mental Health Therapist can help you uncover the meaning from your body signals.

Anger, anxiety and excitement are three quite different emotional feelings that have adrenaline at their neurological neurotransmitter chemical base. There is a bit of a subtle different in some of the other neurotransmitters and the location of neuronal activity between the three, but it is not uncommon to mistake the feelings for each other and in that mistake, confuse the meaning for why you are feeling heightened adrenaline. Once that mistake has occurred, we can then make unwise decisions. For example, if I mistake my feeling for the upcoming vacation as anxiety instead of excitement, I may cancel my vacation.

Often our body tries to inform us of the various states and needs of our body with various physical and emotional feelings. Unfortunately, we often are not taught well what these feelings mean, so we either learn to ignore these feelings, or do the wrong thing about them because of that mistaken meaning. If we do the wrong thing for the feeling, we may feel worse, or only temporarily better. This can lead to eating disorders, behaviour disorders or self neglect.

I know what red looks like to me, and I know what a pear tastes like to me, but I don’t know what red looks like to you, or what a pear tastes like to you. I can point at an item that I call red and say “this is red” and you can learn the name for that, but I don’t know what red feels like to you. After all, what we see as red is a thing that your brain is making up to explain the signal it receives from a particular set of cones in your retina – there is no red in that signal. The same is true for a pear. Try to explain to someone what a pear tastes like without saying “it tastes like a pear”. People often use the words “sweet” and “crunchy”, but not all sweet and crunchy things taste like pear.

Each child feels hunger a bit differently. When I try to explain what hunger feels like for me, it may not make sense to someone else. When a child doesn’t recognise the hunger feeling and tie that to “I should eat”, then they may not seek food when they are running low on blood sugar and other nutrients. Have you ever had a craving for a particular food? What did it feel like? How did you know what food to go and get? How did your body tell you that you needed something in that food that you crave? How can you explain to someone else what the craving for apple feels like?

Many of my clients do not know what their body signals mean. They recognise that something is wrong and that they feel weird. Generally, when they have described these feelings to people, they have not been understood. Without meeting the body need, their system starts to break down in some fairly predictable ways – cognitive thinking becomes muddled (brain fog, faulty conclusions), emotional feelings become erroneous (anxiety, depression, anger etc that don’t match the situation) and their behaviour is poor to the circumstance (flight, fight when stay and talk is better).

It doesn’t take long to start interpreting that signal as “I’m crazy”, since that is what often follows.

Sometimes I can work out what their description of the signal means, but often I’m not sure either. When I do know, I tie the sensory sensation to a corrected meaning and then tie that to a useful action for self care. When I don’t, I run people through the Weird Mood or Thoughts – Top 6 Causes.

1. Medication – Did you miss your last dose?
2. Food – Do you need to eat something, or did you eat something that is bad for you?
3. Fatigue – Did you get enough sleep? Do you need to take a break?
4. Hormones – Where are you in your menstrual cycle, is your thyroid okay, are you having an adrenaline reaction to something?
5. Sensory load – Do you need to adjust the sensory stimuli (light, sound, touch, temperature) up or down?
6. Threat – are you in active danger from something?

These are ordered from most likely to least likely. Once you cognitively run through this list and work out which is most likely wrong:

• Try to remember what this felt like compared to other odd feelings. Try to find something distinctive and write that down.
• Go and address that need and see if you feel better. Write down your result.
• If you don’t feel better (in up to 30 minutes), then try the above step with the next most likely thing that is out.next most likely one on the list.

A similar system can be used to attune to your emotional feelings. The above Top 6 is used when your feelings are extreme and you notice that cognition or mood regulation is out. When you aren’t that far out, but want to know what your mood is, take a look at your activity.

1. Correlating Behaviour to Feelings
   • If you were watching someone else behave the way you are right now, compared to how you on average behaviour, what emotion do you estimate that they would be feeling?
   • If you aren’t sure, ask a trusted nearby person (if available) what they think you are feeling based on how you are behaving (if your behaviour is a bit different to normal).
   • After a while, you will start to recognise the way your behaviours
2. Feeling Behaviours
   • Once you have correlated a kind of behaviour difference to a probably emotional feeling, when you next catch yourself acting in that way, pause and look in:
     • At how you are physically feeling – muscle tenseness, breathing, heart rate, kinds of movements, impulsive desires
     • At how you are thinking about things currently – optimistically or passivistically, wanting to be near people or away from people, wanting to try something new or wanting to keep things consistent etc
   • After a while, when you start to feel that inner physical and thinking state, you will recognise the feeling that means