
Episode 29: Running on 18%
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 Send us Fan Mail 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
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