Mind Your Body

When Pain Gets Worse: Allostatic Load, Nervous System Dysregulation, and Expanding Your Window of Tolerance

Dr. Zev Nevo recounts a 90-minute visit with Emma, 26, who has had chronic pain since childhood but recently developed severe sensory overwhelm, brain fog, dissociation, and functional decline despite largely unchanged imaging after seeing 10 specialists. He reframes her worsening as reduced coping capacity and increased nervous system reactivity, explaining allostatic load, high-functioning freeze, psychophysiological coherence, and the window of tolerance, and noting traits like being a highly sensitive person. He emphasizes a “both/and” approach: structural findings (e.g., hypermobility, possible craniocervical instability) can coexist with nervous system dysregulation, and surgery can act as major stress/trauma. The plan includes validation, psychoeducation, HRV assessment/HeartMath, Safe and Sound Protocol, gentle manual therapy, coordinated care, and homework (battery check-ins, interoception, self-compassion, boundaries, and an anger journal).

00:00 Grocery Store Breakdown

00:24 Meet Emma’s Story

02:24 Why Now Despite Scans

03:48 Capacity Not Symptoms

04:28 Allostatic Load Explained

06:02 Phone Battery Analogy

06:58 High Functioning Freeze

08:54 Window of Tolerance

10:25 Inside the Clinic Visit

16:18 Tools and Treatment Plan

18:15 Anger as a Signal

19:33 Both And Pain Model

22:18 Surgery as Stressor

23:22 What We Did for Emma

25:42 Key Takeaways Recap

26:57 Science of Safety

28:28 HSP and Sensory Sensitivity

29:54 Healing Takes a Team

31:15 Three Practices to Start

33:21 Final Encouragement

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LINKS:

• Body and Mind Pain Center
• Mind Body Rehabilitation
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When Grief Meets Pain, Episode 3: A Five-Step Healing Sequence

Dr. Zev Nevo presents episode three of “When Grief Meets Pain,” describing how major loss can rapidly worsen chronic pain by shifting the nervous system (including increased IL-6 inflammation, HPA-axis dysregulation, disrupted sleep, nucleus accumbens craving, and identity loss). He argues grief-informed pain care is essential and offers a five-step sequence: (1) stabilize the nervous system (coherence breathing, Safe and Sound Protocol, gentle somatic movement, grief-adapted sleep support) until feelings can be observed without total overwhelm; (2) name and witness all layers of loss with a safe other to support regulation; (3) process grief with body-based tools such as Pennebaker expressive writing, grief-specific therapies for complicated/prolonged grief, and a “stenographer” observing practice; (4) reprocess pain with grief-informed PRT and somatic tracking while rebuilding a future self; and (5) reconnect through community, meaning, service, and ritual. He notes when to seek professional help (prolonged grief disorder, suicidal ideation, escalating pain, severe isolation), shares his own losses, and ends with a one-breath, one-loss practice.

00:00 Welcome and Series Recap

00:49 When Loss Amplifies Pain

02:29 Grief Biology Explained

04:43 Why Grief Informed Care

05:10 Five Step Sequence Overview

05:31 Step One Stabilize

08:15 Step Two Name Losses

10:26 Step Three Process Grief

13:28 Step Four Reprocess Pain

16:07 Step Five Reconnect Meaning

17:58 Ritual and Relearning

20:34 When to Get Help

23:13 Personal Closing Story

27:01 Final Practice and Goodbye

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LINKS:

• Body and Mind Pain Center
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Chronic Pain as Unnamed Grief: Invisible Loss, Ambiguous Loss, and the Selves It Changes

Dr. Zev Nevo argues that chronic pain is an often-unrecognized grief experience, especially when losses are unnamed, unmourned, and unsupported by cultural rituals. Citing a 2026 paper, he outlines four “epistemic barriers” that cause chronic-pain grief to be missed: grief is assumed to be only about death, the loss is invisible, it lacks a clear start date, and it is often misread as depression (distinguishing depression’s hopelessness from grief’s missing what was real). He describes five layered losses chronic pain can create: the physical, relational, professional, future, and spontaneous selves. Drawing on Pauline Boss’s concept of ambiguous loss, he explains how chronic pain’s lack of closure can keep the stress response activated, and notes a 2023 review linking unresolved grief to chronic illness, somatic distress, and insomnia. He shares his own recent losses and previews episode three’s step-by-step approach to treating grief-amplified pain.

00:00 Welcome Back Setup

00:23 Unnamed Grief In Pain

01:54 Four Barriers Overview

02:28 Grief Beyond Death

04:02 Invisible Losses

05:29 No Start Date

07:00 Grief Or Depression

08:46 Five Layers Of Loss

09:02 Physical Self Loss

10:16 Relational Self Shifts

11:30 Work Identity Grief

12:38 Future Self Taken

13:38 Spontaneity And Calculation

15:27 Ambiguous Loss Framework

16:40 Nervous System Impact

17:53 When Bereavement Meets Pain

19:24 Personal Closing And Next

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This essential pre-roll message serves as a clear disclaimer, stating that the podcast provides pain and trauma-informed psychoeducation for informational and entertainment purposes only, and does not constitute medical advice. Listeners are reminded to always consult a qualified healthcare professional for specific medical conditions or symptoms.

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LINKS:

• Body and Mind Pain Center
• Mind Body Rehabilitation
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Grief and Chronic Pain: Why Loss Amplifies Pain and What to Do About It

Dr. Zev Nevo introduces a three-part series on grief and chronic pain, describing a patient whose longstanding low back pain sharply worsened after her husband’s sudden death despite unchanged imaging, framing it as nervous system grief rather than bodily damage. He explains how grief disrupts the HPA axis and cortisol rhythm, increases inflammatory signaling (including a 2022 study of 111 bereaved spouses showing higher stress-related IL-6 rise in those with high grief symptoms), and activates reward circuitry (UCLA fMRI work showing nucleus accumbens activation), linking grief to craving and reduced endogenous opioid regulation that normally dampens pain. He uses allostatic load to show how grief overwhelms an already taxed chronic pain system and highlights shared identity disruption and “relearning the world.” He offers three practices: stabilize the nervous system (coherence breathing, gentle movement, grief-adapted sleep support), use a “stenographer” observing practice for grief sensations, and seek witnessing/co-regulation through safe people or communities. He shares recent personal losses and previews episode two on invisible losses from chronic pain.

00:00 Grief Makes Pain Louder

01:26 Why Loss Amplifies Pain

02:03 Stress Hormones Go Offbeat

02:53 Inflammation Turns Up Pain

03:57 Grief Is Craving

06:11 Allostatic Load Explained

08:05 Identity After Pain And Loss

10:29 Three Practices To Try

10:50 Practice One Stabilize

13:20 Practice Two Observe Waves

14:31 Practice Three Be Witnessed

16:03 Personal Loss And Next Episode

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This essential pre-roll message serves as a clear disclaimer, stating that the podcast provides pain and trauma-informed psychoeducation for informational and entertainment purposes only, and does not constitute medical advice. Listeners are reminded to always consult a qualified healthcare professional for specific medical conditions or symptoms.

About Dr. Nevo
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LINKS:

• Body and Mind Pain Center
• Mind Body Rehabilitation
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Episode 25: Waking Up

Dr. Zev Nevo explores awareness and alertness as the key to “waking up” in the context of pain and healing, arguing that awareness is the most important thing because nothing has experiential value without it. He explains that pain requires alertness and can diminish with distraction, and that suffering reflects both sensation and our interpretation of threat, shaped by limbic sensitivity, past experiences, and cumulative stress/trauma. The nervous system’s survival responses (fight, flight, cry for help, freeze, shut down) are framed as protective rather than adversarial, and a flashlight metaphor illustrates how attention can narrow reality to pain. Nevo emphasizes reconnecting to self-worth and values—what one is fighting for—so alertness has meaning, warning against identity becoming centered on pain, and offering the formula: aware plus alert equals awake.

00:00 The Big Question

01:32 Why Awareness Matters

03:05 Pain Needs Alertness

04:36 Meaning Makes Suffering

10:02 Flashlight Metaphor

11:49 What Are You Fighting For

12:59 Self Worth And Belonging

14:44 Stuck In Survival Mode

17:41 Aware Plus Alert Awake

20:22 Practice And Hope

24:44 Reflection Questions

26:12 Closing Encouragement

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This essential pre-roll message serves as a clear disclaimer, stating that the podcast provides pain and trauma-informed psychoeducation for informational and entertainment purposes only, and does not constitute medical advice. Listeners are reminded to always consult a qualified healthcare professional for specific medical conditions or symptoms.

About Dr. Nevo
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LINKS:

• Body and Mind Pain Center
• Mind Body Rehabilitation
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Episode 24: High Definition Pain

Highly Sensitive Nervous Systems and Chronic Pain: Sensory Processing Sensitivity, Allostatic Load, and What Actually Helps

Dr. Zev Nevo explains how highly sensitive persons (HSPs)—a neurobiological trait affecting about 20–33% of people—may experience chronic pain differently due to heightened sensory processing and insula activity, leading to vivid pain descriptions often misread as catastrophizing. He describes “bidirectional sensitization,” where sensory sensitivity amplifies pain and chronic pain further sensitizes the nervous system, shaped by central sensitization, autonomic dysregulation, and allostatic load. The episode introduces the validated 27-item Highly Sensitive Person Scale (HSPS) and outlines six sensitivity patterns (introverted, extroverted, empathic, sensory, intuitive, creative). It addresses misconceptions and offers strategies: patience, titrated “microdosed” exposure, interoceptive reframing to reduce hypervigilance, addressing allostatic load, pivoting to regulation during stress, and using objective data like HRV. Guidance is included for self-advocacy, provider practice, and cultural, gender, and lifespan factors.

00:00 Vivid Pain Dismissal

01:43 HSP Pain Link

03:24 Two Patients Contrast

06:40 Bidirectional Sensitization

09:03 Allostatic Load Bucket

12:42 HSPS Assessment Tool

16:59 Interoception Trap

21:42 Six Sensitivity Faces

28:49 HSP Pain Myths

33:27 Six Core Strategies

37:19 Balanced Sensation Tracking

37:45 Reduce Allostatic Load

39:21 Pivot Toward Neutral

40:34 Objective Data Trust

42:15 Self Advocacy Scripts

47:09 Patient Recovery Story

49:57 HSP Pain Neuroscience

54:39 Provider Clinical Framework

01:00:30 Culture Gender Lifespan

01:04:35 Final Healing Roadmap

01:08:39 Closing Thanks Share

REFERENCES & RESOURCES:

Sensory Processing Sensitivity & High Sensitivity

Morese R, Palermo S, Defedele M, et al. Sensory processing sensitivity and social pain: a hypothesis and theory. Front Hum Neurosci. 2023;17:1122849. doi:10.3389/fnhum.2023.1122849 [PMC]

Lionetti F, Aron A, Aron EN, et al. Dandelions, tulips and orchids: evidence for the existence of low-sensitive, medium-sensitive and high-sensitive individuals. Transl Psychiatry. 2018;8(1):24. doi:10.1038/s41398-017-0090-6

Hochreuter J, Wehrli S, Locher C, et al. Painfully sensitive: how sensory processing sensitivity affects healthy adolescents' perception of pain. J Pain Res. 2025;18:719-733. doi:10.2147/JPR.S473575 [PubMed]

Aron EN, Aron A, Jagiellowicz J. Sensory processing sensitivity: a review in the light of the evolution of biological responsivity. Pers Soc Psychol Rev. 2012;16(3):262-282. doi:10.1177/1088868311434213 [PubMed]

Allostatic Load & Stress

Ruiz-Robledillo N, Costa-López B, Moreno O, et al. Sensory processing sensitivity as a predictor of health-related quality of life outcomes via stress and sleep quality. Sci Rep. 2024;14(1):22707. doi:10.1038/s41598-024-72657-9 [PMC]

Polyvagal Theory & Window of Tolerance

Porges SW. The polyvagal theory: neurophysiological foundations of emotions, attachment, communication, and self-regulation. WW Norton & Company; 2011. [PMC]

Siegel DJ. The developing mind: toward a neurobiology of interpersonal experience. Guilford Press; 1999.

Autonomic Dysfunction & Chronic Pain

Kolacz J, Porges SW. Chronic diffuse pain and functional gastrointestinal disorders after traumatic stress: pathophysiology through a polyvagal perspective. Front Med (Lausanne). 2018;5:145. doi:10.3389/fmed.2018.00145 [PMC]

Pain Reprocessing Therapy

Ashar YK, Gordon A, Schubiner H, et al. Effect of pain reprocessing therapy vs placebo and usual care&

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This essential pre-roll message serves as a clear disclaimer, stating that the podcast provides pain and trauma-informed psychoeducation for informational and entertainment purposes only, and does not constitute medical advice. Listeners are reminded to always consult a qualified healthcare professional for specific medical conditions or symptoms.

About Dr. Nevo
Read what patients are saying...

LINKS:

• Body and Mind Pain Center
• Mind Body Rehabilitation
• Substack

Episode 23: The Parts That Hurt - When Protection Becomes Pain

Episode Description

Ever feel like you're at war with yourself when dealing with chronic pain? One part of you wants to push through while another screams "stop!" In this episode, Dr. Zev Nevo explores Internal Family Systems (IFS) and how understanding the different "parts" of yourself can transform your pain experience. Learn why these internal conflicts keep your nervous system in threat mode—and what you can do about it.

00:00 Introduction to Chronic Pain and Internal Conflict

01:21 Understanding Internal Family Systems (IFS)

01:39 Real-Life Examples of Internal Conflict

05:03 The Neuroscience Behind Pain and Internal Conflict

16:31 Practical Steps to Work with Your Parts

31:29 Common Questions and Answers

34:27 Final Thoughts and Encouragement

What You'll Learn

• Why you have conflicting voices about your pain (and why that's completely normal)
• How Internal Family Systems helps you understand your internal "family" of parts
• The neuroscience behind why internal conflict amplifies pain signals
• Four practical techniques to work with your parts starting today
• How accessing "Self" can shift your nervous system from threat to safety
• Real patient stories of transformation through parts work

Key Concepts Covered

Internal Family Systems (IFS)

• Protector parts: The voices trying to keep you safe
• Exiled parts: Emotional pain that needs to be seen and healed
• The Critic: The harsh voice that's actually trying to motivate you
• Self: The calm, compassionate center underneath all the parts

The Neuroscience Connection

• Fear avoidance model of chronic pain
• How threat detection amplifies pain (amygdala & anterior cingulate cortex)
• Polyvagal theory and nervous system states
• Heart rate variability and pain regulation
• The bio-psychosocial model of pain

Four Practices You Can Start Today

1. Parts Mapping - Notice and name which parts show up during pain
2. Get Curious - Interview your parts to understand their positive intentions
3. Thank & Reassure - Acknowledge parts for trying to help, then update them
4. Unblend - Create distance when a part takes over completely

Research Discussed

• Yoni Ashar's 2022 JAMA Psychiatry study on Pain Reprocessing Therapy
• Tracy et al. (2016) on heart rate variability and chronic pain
• Lumley et al. (2017) on Emotional Awareness and Expression Therapy
• Dr. Stephen Porges' polyvagal theory

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This essential pre-roll message serves as a clear disclaimer, stating that the podcast provides pain and trauma-informed psychoeducation for informational and entertainment purposes only, and does not constitute medical advice. Listeners are reminded to always consult a qualified healthcare professional for specific medical conditions or symptoms.

About Dr. Nevo
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LINKS:

• Body and Mind Pain Center
• Mind Body Rehabilitation
• Substack

Expanding Gratitude Amidst Chronic Pain: Transforming Your Mind-Body Connection

In this Thanksgiving special episode, we explore the complex relationship between gratitude and chronic pain. We examine the neuroscience behind gratitude practices, Polyvagal Theory, the Window of Tolerance, how gratitude affects pain perception and emotional regulation, co-regulation in relationships, and practical ways to cultivate authentic gratitude while living with persistent pain—without falling into toxic positivity. Includes a guided 2-minute gratitude practice.

Episode Length: 41 minutes

KEY CONCEPTS DISCUSSED

• Gratitude as nervous system regulation, not positive thinking
• Emotional complexity: holding pain and gratitude simultaneously
• The neuroscience of gratitude (medial prefrontal cortex, reward circuitry, anterior cingulate cortex, default mode network)
• Polyvagal Theory and the three states of the autonomic nervous system (ventral vagal, sympathetic, dorsal vagal)
• Window of Tolerance and expanding capacity for distress
• Broaden-and-Build Theory of positive emotions
• Pain acceptance vs. resignation
• Co-regulation in relationships and interpersonal neurobiology
• Micro-gratitude practices for chronic pain
• Self-compassionate gratitude
• Managing pain flares and grief
• Seasonal challenges during holidays
• Seven actionable steps for practicing gratitude with chronic pain

KEY RESEARCH REFERENCES

• Gratitude & Outcomes: Davis et al. (2016) - Meta-analysis; Emmons & McCullough (2003) - Well-being; Ng & Wong (2013) - Chronic pain; Sirois & Wood (2017) - Depression; Wood et al. (2009) - Sleep.
• Neurobiology: Fox et al. (2015) - Neural correlates; Kral et al. (2018) - Amygdala reactivity; Huffman et al. (2016) - Inflammation biomarkers; Jackowska et al. (2016) - Vagal tone & sleep; Kok et al. (2013) - Vagal tone; Porges (2011) - Polyvagal Theory; Siegel (1999) - Window of Tolerance.
• Regulation & Resilience: Fredrickson et al. (2008) - Broaden-and-Build Theory; Kashdan & Rottenberg (2010) - Psychological flexibility.
• Relationships & Pain: Algoe et al. (2008, 2016) - Relationships; Cano et al. (2004) - Relationship quality & pain; Gordon et al. (2011) - Couples; Martire et al. (2002) - Caregiver burden.
• Coping Strategies: Kratz et al. (2007) - Pain acceptance; McCracken & Vowles (2014) - ACT for chronic pain; Sturgeon & Zautra (2016) - Coping; Vowles et al. (2007) - Pain flares & self-compassion; Harris et al. (2003) - Grief & pain; Seligman et al. (2005) - Brief practices.

Full citations list located in episode transcript.

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This essential pre-roll message serves as a clear disclaimer, stating that the podcast provides pain and trauma-informed psychoeducation for informational and entertainment purposes only, and does not constitute medical advice. Listeners are reminded to always consult a qualified healthcare professional for specific medical conditions or symptoms.

About Dr. Nevo
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LINKS:

• Body and Mind Pain Center
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Compassion with Boundaries: Sustainable Support in Caregiving

In the final episode of the 'Partners in Pain' series, Dr. Zev Nevo explores the transformative concept of 'compassion with boundaries' as essential for sustainable caregiving. This episode highlights the role of empathy, the necessity of boundaries, and the impact of co-regulation in relationships affected by chronic pain. Dr. Nevo revisits the key points from earlier episodes, emphasizing the importance of self-care, concrete support actions, and maintaining partnership and intimacy despite the challenges of chronic pain. Practical strategies for both caregivers and chronic pain sufferers are outlined to foster connection, communication, and mutual support.

00:00 Introduction: Compassion and Boundaries

00:35 Recap of Previous Episodes

01:36 The Framework for Sustainable Support

02:28 Understanding Compassion and Boundaries

03:10 The Science Behind Boundaries

05:47 Practical Strategies for Caregivers

07:19 Empathy Misses and Effective Communication

18:49 Self-Compassion and Setting Boundaries

25:14 Support for Caregivers

30:46 Guilt and Honest Communication

31:44 Cultural Influences on Emotional Expression

32:10 The Cage of Traditional Masculinity

33:59 Boundaries and Sustainable Caregiving

36:15 Power Dynamics in Relationships

41:00 Talking to Children About Pain

46:02 Concrete Practices for Pain Management

50:18 The Power of Connection and Empathy

52:12 Final Thoughts and Takeaways

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This essential pre-roll message serves as a clear disclaimer, stating that the podcast provides pain and trauma-informed psychoeducation for informational and entertainment purposes only, and does not constitute medical advice. Listeners are reminded to always consult a qualified healthcare professional for specific medical conditions or symptoms.

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LINKS:

• Body and Mind Pain Center
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Mastering Empathy to Support Partners in Chronic Pain

In this episode of Mind Your Body, Dr. Zev Nevo delves into the practice of empathy as a learnable skill, not just an inherent trait, particularly in the context of supporting partners suffering from chronic pain. Dr. Nevo outlines Brene Brown’s four attributes of empathy: perspective taking, staying out of judgment, recognizing emotion, and communicating understanding. He contrasts cognitive empathy, which promotes sustainable compassion and genuine connection, with affective empathy that may lead to burnout and enmeshment. He also discusses practical strategies for caregivers, emphasizing the importance of regulating one's own nervous system to effectively co-regulate their partner's. The episode provides actionable advice on maintaining balanced compassion without drowning in empathy fatigue, setting the stage for the upcoming part three on Compassion Plus Boundaries.

00:00 Introduction: Empathy as a Learnable Skill

00:40 Recap of Part One: The Invisible Burden

01:24 Understanding Empathy: Brene Brown's Framework

03:36 Attribute 1: Perspective Taking

04:32 Attribute 2: Staying Out of Judgment

05:35 Attribute 3: Recognizing Emotion

06:57 Attribute 4: Communicating Understanding

09:40 The Critical Distinction: Cognitive Empathy vs. Enmeshment

12:48 Polyvagal Theory: Co-Regulation and Emotional Intuition

15:31 Practical Strategies for Partners

21:33 Conclusion: Sustaining Empathy Long-Term

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This essential pre-roll message serves as a clear disclaimer, stating that the podcast provides pain and trauma-informed psychoeducation for informational and entertainment purposes only, and does not constitute medical advice. Listeners are reminded to always consult a qualified healthcare professional for specific medical conditions or symptoms.

About Dr. Nevo
Read what patients are saying...

LINKS:

• Body and Mind Pain Center
• Mind Body Rehabilitation
• Substack