Is pain a habit? A great and challenging question. For people with chronic pain, life can be hard. ... But pain IS more within our control than many people think. Switching bad habits for good ones can help ease the pain and improve—and potentially prolong—your life. It's never too late to reverse your bad habits or adopt some new, healthy ones. SO EASY, right. Just switch this for that and Voila!!!

Traditional research tells us it takes 21 days to create a new habit. Research also tells us it takes 21 days to break a bad one and replace it with a desired one and that may be true, but I’m thinking there is more to it that just voila. What has been learned in the last decade, about how habits form neurologically is that every habit has three components. 1) the cue 2) routine and 3) reward.

The cue, which is a trigger for the behavior to start unfolding, A routine, which is the habit itself, the behavior, the automatic sort of doing what you do when you do a habit. And then at the end, there’s a reward. And the reward is how our neurology learns to translate this pattern for the future. Most people, when they think about habits, they focus on the behavior or the routine. But Harvard led research says it’s the cue and the reward that really determine why a habit unfolds.

As a behavior becomes a habit, as it becomes automatic, it moves from the prefrontal cortex (where volitional thought occurs) into the basal ganglia, which is one of the oldest structures in our brain and it’s near the center of our skull. And when things happen in the basal ganglia, it doesn’t feel like thought. That’s why a habit feels automatic, is because it’s happening in this part of your brain that for all intents and purposes, from what we think of as thinking, is completely exempt from that process.

Movement is no different. The primary motor cortex, or M1, is one of the principal brain areas involved in motor function. M1 is located in the frontal lobe of the brain, along a bump called the precentral gyrus. The role of the primary motor cortex is to generate neural impulses that control the execution of movement.

Muscle memory encoding. The neuroanatomy of memory is widespread throughout the brain; however, the pathways important to motor memory are separate from the medial temporal lobe pathways associated with declarative memory. ... The main area involved in motor learning is the cerebellum. Every athlete, musician, surgeon—or anyone who regularly performs a motor skill that becomes fine-tuned with practice—knows that through repetition and practice motor skills become automatic. Everyday activities like typing on a keyboard, driving a car, or tying your shoelaces become automatic over time for anyone without a neurological disorder.

This is no different for someone who experiences pain.  They will try to avoid pain at all costs and a new movement (accessory or compensated) is created. Do this long enough and the ‘new’ movement becomes habit – the new normal. It is now hardwired into the system.

And that’s why it’s harder to change your habits, because making a conscious decision occurs in the prefrontal cortex of the frontal lobe and the habit exists in the basal ganglia of the cerebellum. In order to influence the basal ganglia, you have to target these cues and these rewards.

Identify the cue: Every cue falls into usually one of five categories. 1) a time of day, 2) a certain place, 3) the presence of certain other people, 4) a particular emotion, 5) or kind of a set of behaviors that’s become ritualized.

Identify the reward: (not so simple) The reward is actually the most important part. That’s the craving that creates the habit in the first place. Trust me the reward is not “cause the cookie tastes good” – too easy. Is it the taste, the sugar boost, the break from the work, or the socialization and interaction you get from walking into the break room to get the cookie? Once you figure this out you can then get the same reward with a new habit.

Wait there’s more:

Keystone Habits: In both people’s lives as well as within companies, there are these things known as keystone habits. Some habits seem to have a disproportionate influence. When a keystone habit starts changing, it seems to set off a chain reaction that changes other habits.
And in a lot of people’s lives a keystone habit is exercise (movement). When they start exercising, they start using their credit cards less. They start eating better and losing weight. Their blood scans improve and have decreased blood pressure and increased energy. They start procrastinating less and being more productive. They do their dishes earlier. Something about movement and exercise makes other habits more malleable.

We talk often about company culture here at IPT and lets step back to think of how this can apply to a patients’ constitution. A chronic pain patient who has developed a habit or several habits due to their pain has created a cascading effect on all other parts of their lives. If we can help guide a chronic pain client to make a change (notice I did not say change for them) in one of the keystone habits (movement or exercise) the client can potentially create a cascading effect in the other direction with further guidance in how to address their mental preparation, emotional control, awareness and intuition and eventually and unconquerable spirit within them.

See, now wasn’t that easy??? Voila!!!