There really is no spoon - Part II

The starting point is of course our minds.
The mind is our way of interacting with the outside world - and also with our bodies. Being the artist that I am I postulate that there really is no difference between the two: our bodies (yes - even the one you feel you inhabit) - are the same as the outside world.

For me - in terms of the "Theory of Everything" - our bodies and the outside world are one and the same thing. Why? Because our bodies don't have fixed boundaries. Our body schema is flexible - enabling us to incorporate tools, peripersonal space and other things.
And once something is incorporated into our body schema we show the same stress response as if our real body were in danger.

And yes - you even can swap bodies or faces in a few minutes if you want to.

I don't think this happened "on purpose" - but is simply a happy/serendipitous effect of us being able to use tools. It's just one of the mechanisms we can exploit if we want to.

However - I also wonder about the effects it has on us - even if we are not consciously attending to them. As we have shown the brain is remarkably plastic - it changes all the time. And since the mind is a product of the brain it also changes with it.

So if our body schema is changed by tool use - what happens to our minds? For those who want to rant about the Internet - remember that language is an invention and a tool also - albeit without an external power source.

The Alphabet is a tool any of us uses on a daily basis - and yet we don't think about it that way. But it has to have an effect on us - as we can see when scientists compare peoples way of thinking that are from different cultural backgrounds.



"You" are changed by where you were born and where you live and what language you use. Twins raised apart show strikingly similar behavioral patterns - I wonder what would happen if you compared twins that were raised apart - one in the US and the other one in China for example. My guess is that only then could you clearly show how much genetics (really) influences a persons behavior.

Our brains use a lot of tricks, shortcuts and even lies to present a coherent world to our minds - and we can exploit those weaknesses almost at will. That's very useful in treating chronic pain syndromes as shown by mirror therapy.

But what about all the drawbacks this haphazard way of creating the world has?
What effect on the mind has sitting in a chair all day long? I'm not talking about back trouble here - but by not moving we are changing our cortical maps. And the mind is based on those maps. So what happens to the mind - your way of thinking - when you sit for long periods of time?

I know from my own experience that I can't do any serious work when sitting in my otherwise excellent Stokke Gravity. It is the best piece of furniture I have seen in my entire life - comfortable, well made, sturdy, gorgeous to look at - but I can't think when in the sitting position.

For me pacing around is the best way to come up with new ideas.

This folks is the riddle of the embodied mind. Our minds are based on our brains and bodies - and what you do with one of them has an effect on the other. Which one has which - well - that's for you to find out.

The only thing that seems pretty clear to me so far is this: as you exercise your body - you also have to exercise your mind.

And I'm not talking Sudoku here - but "deeper stuff" like focusing attention, meditation and the like. As one improves - so will the other. Attention in itself seems to be the most important part - but that requires a whole series of postings on itself.

There is no spoon - Part I

A while ago I did a series of postings about pain and about mirror therapy for phantom limb pain and other chronic pain syndromes.

The good news is that all of the information contained in that series of articles is still as accurate as when I wrote it - and is a good starting point for most laypersons, therapists and those who suffer from chronic pain and want to try a new form of treatment.

From the feedback that I got it is clear to me that I did a good job of explaining the very often difficult science behind it and made it accessible and understandable for everyone.

However - as an Artist and Visionary (I took a test that said that I am both) ;-) my brain refuses to stop thinking about that stuff.
And that's what I have been up to for the last year or so.

In order to go even farther - to develop even better and faster ways to treat pain we have to construct a "Theory of Everything" as I like to call it - because only then will we be able to see how we can exploit the weaknesses of the brain even more to our advantage.

The good news: there is enough experimental data available from a lot of different fields that we can start to construct such a theory. The bad news: it's a lot of different disciplines from which I have to "borrow" from and try to integrate them into one comprehensive overview. And new stuff keeps cropping up all the time which makes it hard to keep up with all the new input.

In the past I've made a few pretty wild guesses (based on the data available at the time) - and most of them were shown to be true. See for example my description of how to treat chronic pain in paraplegics (Yahoo Group Supertraining, Message 29357).
My idea of using visual feedback in treating chronic low back pain by showing the patient an image ofhis back on a monitor is now undergoing trials in Australia.

So I want to start this series with a few questions that are on my mind right now and that show where my "Theory of Everything" is heading at the moment.
And - since I am an Artist - I don't recognize authorities or self-made boundaries I'm going to sound pretty weird at times. ;-)

Here we go:

- We are still accustomed to thinking in terms of influencing the real body when treating patients. However research on Phantom limb pain has shown that there is a virtual body which our brain constructs. The simple solution to phantom limb pain turned out to be not to treat the real body - but the virtual one.

Something similar happens in CRPS - the symptoms we see in the real body are just that - symptoms. The real disease is in the brain - in the representation of the affected limb - a software error so to speak. And treatment that tries to correct that software error leads to automatic changes in the body. We simply have to tell the brain what we want it to do and it does all the things necessary - like increasing blood flow and so on.

In the talks I give I always try to teach my students to shift their perspective from a hardware based model to a software based one.

Now - what if we took this idea even further? What if we applied this model to all forms of pain? What if instead of: "When I want to move my arm I tell my boy to do it." we were to say "If I want to move my arm I move my virtual body - which then sends out a signal to the real body to replicate the movement."?

This might not sound like a big difference - but in terms of rethinking movement and movement control it's huge. Remember that the virtual body can be quite different from the real one!

What happens when a distorted virtual body is simulating a movement that the real body can't replicate because there is a limb missing? Phantom pain is the answer.

Now take chronic low back pain - and you can see the same mechanism at work - the cortical field of the low back is enlarged - and yet the real lower back stays the same. Pain is the result.

Giving up the idea of treating/working with/even having a real body is difficult - one of the drawbacks of having an embodied mind - but I think it's crucial for us to "just let go" if we want to develop new ideas and treatments.



- Placebo. Placebo is a fact. There are enough studies out there showing that it works - and works really well.
And yet - the mechanism of action is as yet unknown. Really?
Again - think about the difference between a virtual and the real body. What if the placebo (be it a procedure or a pill) - is simply becoming a "piece of software" - and the brain tries to simulate it's effects on the virtual body - thereby changing the real body.

The brain has to represent the outside worlds so our minds have something to act upon. This is where the mirror neuron system comes in. So while the brain simulates the interaction with the placebo it accidentally changes the real body in response - setting free endorphins and the like.

This of course is just a rough idea at the moment - but what if placebos manage to - once again - fool the brain by using this "trapdoor"? The mirror system wasn't "meant" to be there for placebos - but for understanding others/empathy and so on - for all the stuff you need to be able to do when living in groups. It seems to me that placebos exploit this weakness of our brains quite efficiently.

- Environment changes behavior. Lasting behavior change is difficult. We are after all creatures of habit. But again - what study after study shows is that the environment we find ourselves in actually determines some of our behavioral responses.

We are not "in charge" - but are influenced by what and who is around us. And yet - our brains still hold up the illusion that "we" are in charge and give us the feeling that we wanted to do this or that. The short story is this: if you have identified a behavior that you want to change - don't try to change it directly - but try to change the environment in which it manifests itself.
Remove the "cues" if you will that "make your brain do things automatically" - and you will succeed far more quickly and it will last.

As I've written before - starting an exercise regime is often quite difficult - because there really is no spare time left in a day. By identifying "empty time" - time that is spent doing meaningless tasks you create time in which to exercise.

And just to make clear that it works really really well: I've been going to the Gym for a year now - doing 3 sessions each week (1 hour each) - and have lost 45 pounds. Just as I said I would. And I'm not going to stop there ;-) - because by now it's turned into a habit - like brushing my teeth.

- "Me". Our brains create the illusion of "I" in order to .......? What is a feeling of "Me" good for? Based on the fact that our environment changes our behavior quite dramatically I think we should take a closer look at the concept of "I".

What if we really are like worker bees - mindless robots following a few simple rules in order for the queen to survive? Would it make us less happier? Look at the people around you: seems to me that most of them are unhappy anyway.

Since this feeling of "I" is so strong I think it's pretty much impossible to try to imagine a theory without it - the drawback of an embodied mind again. But if you look at the Hardware/Software approach I think it's one well worth pursuing. What if "we" are really just cogs in the machine being made to think we actually have a say in the matters of what the bigger machine does?!

One of the first steps in this direction is the Biopsychosocial Model. It recognizes that we as people are a part of different environments and groups - and looks at what influences us.



- Another trapdoor of our minds. Here is more evidence for my hunch that "we" don't really exist: you can be made to swap your body within a few minutes. One can - by visual trickery and exploiting our sensory system - be made to experience another body as one's own.

We can also include objects into our body schema quite easily. "We" don't really have fixed boundaries. What we think of as our body is really just a constantly changing "sphere of influence". This helps us in using tools.

It was never "meant" to be more than that - but this is the beauty of the brain: you can use all these mechanisms that evolved over time and do some crazy stuff with them. As you can see our bodies aren't real in any way - you can change them, make them bigger or smaller, give them extra arms - even swap bodies completely.

What if the same goes for our minds? What if our mind is just a tiny part of a bigger (hive) mind? After all - culture looks to have a mind of it's own sometime. The culture you grow up in shapes you and your brain - and you become part of it by reinforcing the same behaviors and cultural norms. You become part of it. And that becoming part of it is manifest in your brain.

And since your brain creates your mind it changes you. If you grew up in a different culture you would be different and have different ways of thinking and acting. But you'd still feel as if "you" were in charge - which you are quite clearly not. I wonder what would happen if you got rid of the "Me" module in your brain and would start to experience yourself as part of something bigger - a hive mind.

I sometimes get the feeling that there are people who either have achieved this or are close to it: people who are driven by the need to do something to benefit humanity as a whole. (or it's just the endorphins released by doing something good which you can get hooked on too). Either way - I guess this approach would give us some pretty far-reaching insights.

As I've said - these are the questions that keep me up at night at the moment. ;-)
The difficulty in making progress is that the feeling of "I" is so strong that you can't run a simulation in your head without the "I" part being central to it.

We'll see where it leads as more evidence is produced in labs around the world.
The following postings will show different aspects as the relate to my development of the "Theory of Everything" and present proof that most of my crazy ideas are based on science and solid facts.
Have fun! (It's just a ride)

Relax

Regular Readers of this blog will have noticed the absence of new posts during the past couple of weeks.

Well - the blog was never intended to be updated regularly.
I always wanted to create some kind of "database" for interested therapists and patients alike. So you can always go back to the archives and start exploring. ;-)

There are a lot more topics I'm working on - but between "regular" work and photography there is just too little time left at the moment to ensure that new articles would adhere to the standards I have set for myself.

To make it official: I'm taking a break from blogging. I guess I should "be back" in a few more weeks.

If you find yourself a bit overwhelmed too - just look at this picture for a few minutes and you'll be relaxed like never before: ;-)

Interview with Diane Jacobs - Part III

Part I is here.
Part II here.

Matthias:
"Gandevia and others have shown that by displacing skin - for example at the fingers - gives the patient the illusion that the finger has moved. The same thing happens when you vibrate tendons - depending on the context people think their limbs start moving. It seems from this line of research that our brain constructs a Virtual Reality Simulation of the body - a virtual body as it is often called. Do you think that the brain regards the virtual body being real and that problems in the real body (only) arise because of discrepancies between the virtual and the real body? What I mean by this is: the brain tries to adjust the real body so that it fits the virtual body?"

Diane:
That is a good testable treatment construct, I think. Butler has been thinking along these lines as well.

Matthias:
"What can patients do on their own to keep their virtual body flexible and healthy? What are some of the things you yourself do in everyday life to keep it fit?"

Diane:
Well, everyone knows that pain can arise when the real body gets impacted, jolted, injured as in a car accident, etc. Most people do not realize pain can arise through ordinary daily habits. I usually ask patients what their "default" positions are, the positions they adopt while being sedentary.

These positions often leave lasting impressions on the nervous system. For example, most people relax in the evening, sit with a leg crossed over the other. Many people always cross the same leg, have for years, never the other. Or they will pick a corner of the couch to watch TV from, and tuck their legs up to the side - always the same direction. Or lean on one elbow - always the same elbow.

I once treated a woman who had an enormous dint in the side of her leg from her other knee pressing in. You can learn to spot the sedentary habits from the impressions they leave on the actual body! But think what this must also do to their virtual bodies after awhile.

I make people aware of the need to observe themselves at home, become aware of their default positions, change them. I explain it simply - let them know that nerves need fed evenly from all sides or eventually they'll set up a distress call.

I don't teach "exercise" anymore, instead I teach sensory awareness, i.e., anything that will change sensory discriminative input into the neuromatrix. Change the relationship to gravity - lie down on the floor. Attend to breathing. Stay focused on the breathing and lengthen out an arm along the floor, see how it feels.

Do telescoping movements instead of stretching. Shorten and lengthen. Breathe. Feel what parts are trying to help and which ones feel as though they don't help, or resist. And don't worry about trying to make them do anything they can't seem to. Stop trying to override everything, just notice things, let them be, let them change by themselves, but keep checking on them periodically.

Do not cause more pain.
Practice moving without pain, practice what you can inside the comfort zone - there's lots to work on without trying to push the boundaries. Wait. Do small amounts frequently. Think of this work as feeding the nervous system.

Like a very young and cranky baby, it cannot absorb very much at a time. It needs your help and caregiving and attentiveness and feeding, but it needs small amounts frequently to turn itself around and thrive. A big "meal" once a day would be counterproductive, to say the least.

I use the example of learning to ride a bike - here's a complex motor skill that requires about three days to learn. All that's required is repeated exposure to the task, practice. Nothing is going to happen until that exposure has made its way all through every part it needs to go.
Patience and repeated exposure is all that is required.

Suddenly, on about day three or four, the task is accomplished - suddenly, the brain has figured out how to help your body achieve balance and coordination sufficient to ride a bike, and it's without effort. It's the same for learning to move without pain.

Matthias:
Diane – thank you very much for sharing these fascinating insights!

I hope more people will be inspired by your example.

Interview with Diane Jacobs - Part II

The first part of the interview is here.

Diane:

From that point on I became an ectodermalist. I deliberately gave up worrying about muscle function, joint alignment, posture, all that stuff. I became mainly interested in helping people downregulate pain, manually, but since then I've focused my efforts on learning all I can about that first layer that is contacted in manual therapy, about how it reads contact from another nervous system.

This has taken me into learning about the brain faster than anything ever did previously. I've read all I can lay hands on about pain, how the brain works, how it evolved, how it produces movement, pain, and perception as output, how it "feels" its environment, how it constructs strategies for its own survival and for that of its "organism". As fast as I can learn, more info is being produced. Is it possible to ever know enough?

I've learned about the cutis-subcutis layer, how it regulates homeostasis, about the importance of the cutaneous nervous system in this regard, how although it doesn't innervate "muscle" it is still "motor" in that it has autonomic efferent function as well as afferent sensory function.

I've done a dissection of the arm, to learn how the underlying cutaneous nerves (which run parallel to the skin) send off many mechanosensitive disseminating twigs that embed into skin from below, via tubular skin ligaments. I was allowed to photograph this work, about which I'm currently writing an article.

All this sensitivity built into skin is adaptive, and can be construed as the brain's own sensors, feelers, into the environment. Touch skin in a therapeutic context and it is as if you are touching someone's brain, on many levels. Knowing the levels and knowing how to help them downregulate themselves properly is the whole knowledge base that helps manual therapy make more sense.

I'm involved in a study to determine the effects of a completely nervous system based form of treatment, which I have called "dermoneuromodulation", on pain. It considers the cutaneous nervous system closely, tries to move it carefully according to the principles of neurodynamics.

I am still in the process of de-programming myself from all the mesodermalist learning I took on, but have made a lot of progress. Instead of viewing manual therapy as something I do "to" someone's body, I see it now as interaction "with" someone's nervous system.

Matthias:
"From what we heard so far - it seems that your approach could be described as helping people heal/help themselves - pointing their brain in the right direction. It seems to me that this dermoneuromodulation is different from other treatment methods because you emphasize downregulating much more than others which are more about adding strength here, increasing mobility there and so on and so forth. Your treatment is more about removing obstacles so that the brain/body can heal itself. Would you agree with this assessment?"

Diane:
I would agree with you in general, especially the part about obstacle removal. But I wouldn't say my treatment does this - when the brain is ready to change its output, it does. That's all.
The whole illusion that I, the therapist, create change in someone else's nervous system, is fantasy. I like to think of my work as pointing out possibilities to the patient's brain.

I feel like I just hold up a flashlight while the patient's brain gets busy fixing the "problem". :) I think my presence is necessary so the nervous system can get a good "read" or "fix" on some body part, but it does all the heavy lifting - my role is to feel the changes as they occur.

Matthias:
"It sounds to me that by using skin and it's cutaneous nerve system you are in a way talking directly with the patients brain - trying to establish “first contact” so to speak. What role does the patient play during this treatment process? What are your instructions to them? Should they try to move the part of their body that is being treated? Should they just observe?"

Diane:
The patient plays an observing role, but it's a lot bigger than it sounds: I ask them to let me know immediately if they experience any discomfort. Most people willingly take this task on - it not only gives them a tiny, manageable, focused task to do, it reminds them that they have charge of that all important "locus of control" - they become treatment manager/gate keeper, in a way.



Several other important objectives are met. They immediately realize they must be engaged in the process, mentally. They came in thinking it was I who would do all the work and they would just lay there, but now they realize it's about them focusing, breathing, staying in the process. All this from just one simple instruction - "I can't 'feel" your body the same way you can.

I want you to tell me if you experience any discomfort, because there is no point in reinforcing any pain pathways - that would be completely counterproductive - and besides, if you are experiencing discomfort it will be harder for you to relax and let your nervous system change itself."

Then I ask them to feel their breath go past their nose, on the way in, and on the way out. If I have a rapid or shallow breather to deal with, I ask them to breathe out for twice as long as they breathe in. That's about all.

It's like learning to meditate. The outward mechanics are rather simple, but a lot of processing goes on. I let them figure out how to do that themselves. Our connection is through the skin, and they've been instructed to tell me about any discomfort they might feel. Some people go for complete silence immediately. Others like to stay in more verbal contact.

I let them decide what level of engagement with the process they want - it's up to them, and I realize they need to establish rapport with me in their own time. As long as they can process something, dip in and out of the process even, it will be fine. Lots of people give me a running commentary of what they are sensing.

A useful metaphor is skin diving. Skin diving is the process. On one level it looks like I'm the one "doing" the skin diving, but in reality, I'm the one left on the boat managing the lines, staying alert to danger, and the patient is the one doing the dive, for the first time perhaps, diving right into their own processes, sometimes scary, sometimes wonderful, but it is they who have to do the "work", exploring, bringing up the sunken treasure - which turns out to be a fleeting realization that they can in fact move some part without pain, if they like.

They realize they have an option. It's a lot like mirror therapy I think. Instead of accessing a visual part of the cortex to convince the motor map that movement is possible, the kinesthetic sensing part of the cortex (or perhaps subcortical maps as well) are accessed somehow. And most patients will choose freedom to move over pain.

A space opens up, an opportunity to move without pain, and the patient accepts the possibility as their new reality. This decision-making is done well back of their "ordinary" decision-making capacities - it's quite automatic, although they get to be aware of it in the moment.

Certainly they are free to move in the moment if they would like, but usually I ask them to sit up periodically to move, see if they can move more easily. Most of the "movement" during treatment is palpable to me - it feels like physiology - little pulses start up then fade away, elongations occur, muscles twitch or feel as though they gently writhe,... small things that signal something rather large and non-conscious is happening below the surface.

Interview with Diane Jacobs - Part I

Some of you might already be familiar with Diane Jacobs from her blog Humanantigravitysuit or from the Teamblog Neurotonics where we share our views on certain topics.

I asked Diane a while ago if she would like to do an interview – and I’m happy to say she agreed.

She has over 35 years of hands-on experience, reads everything she can get her hands on and is a devoted student of the human body and it’s inner workings.

She has developed her own approach to treating pain and movement dysfunction – called Dermoneuromodulation.

By showing how she developed her style and treatment over the years I hope others will find some inspiration.

Here’s Part one:

Matthias:
Diane, glad you agreed to do this interview.

Please tell us how you came into the profession and what factors shaped your career:

Diane:

I entered PT school (a diploma program at U. of S.) in 1968, at age 17. I entered into the program hoping to be taught how to use my hands to help people rid themselves of pain. Three years later, I was a graduate with a license, and lots more growing to do. The hands were trained for a lot of things, but helping to relieve pain somehow had escaped inclusion in the curriculum.

The first decade out of school was mostly about growing up, learning to be independent. I worked in hospitals, took university classes frequently, figured my adult self out. I played by the rules and enjoyed life. I still wanted to learn to use my hands to help relieve pain, but hope was fading that I'd ever learn to do this within the profession of PT.

Around 1983 I went to a workshop taught by an osteopathic physician. There, I learned techniques for handling spinal dysfunction and other kinds of pain, muscle energy technique and positional release. I thought I was the luckiest person on the planet, bumping into this teacher.

Based on this single workshop, I pulled up my life in Saskatchewan, moved to BC, to be closer to the manual therapy school he taught at. For the next 20 years, on and off, I attended his school and became very good at using the techniques taught there. I began attending orthopaedic training workshops taught within the PT community, but dropped out, having lost interest - they were about learning to manipulate joints, and I was decidedly uninterested in pursuing that direction. The osteopathic techniques were more clinically interactive and very helpful to people.

By now I had my own practice, successfully treating all manner of patients with these gentle techniques. There was still something missing however - the treatment constructs were very biomechanical, and I was ready for more understanding.

Enter David Butler in 1998. He spoke a new fresh (to me) language - suddenly I was hearing all about physiology and brain and peripheral nerves. Peripheral nerves? They can "hurt"? This new layer of information and the emphasis on careful handling compared very favorably with the techniques I'd been using - I realized that all along, they had been "neurodynamically" friendly without the originators' ever having known the first thing about neurodynamics or any other concept about the physicality or structure or preferences or sensitivities of nerves in the body.

The techniques had simply been developed in concert with patients with treatment constructs tacked on after the fact, treatment constructs that didn't make any real sense because they were (archaic to me now) bio-mechanical, joint-based, structure-based (e.g., bones, fascia) - if they involved consideration of the nervous system at all it was a convoluted construct involving some sort of influence of treatment on muscle innervation, as if skin didn't exist at all.

Matthias:

Please explain why skin is so important in the approach you developed?:

Diane:

I realized no one seemed to care about skin. No one cared about the fact that all manual techniques are applied through skin. That the cutaneous system reads every kind of handling first. That the brain reads every kind of handling first. Practitioners only seem to care about what is underneath skin. This suddenly seemed ludicrous to me.

Then something else clunked into place, cognitively - a lot of detailed study of embryology. I remembered that skin came from ectoderm and so did the brain. At the manual therapy school all this embryology was taught, yet the techniques themselves were taught from a mesodermal or structural perspective, not from a nervous system perspective.

For me, cutaneous innervation became the transition; it is still structure, but helped me bridge the techniques I loved to do into a context that made much more sense as to why on earth they seemed so helpful. I realized they were brain-friendly - that when performed expertly, with attention in the moment to every detail in the moment, not in any zombie-like or mechanical fashion, but slowly, with feeling, they helped the brain down-regulate pain.

Matthias:

I hear you!

The focus – at least here in Germany – is still very much tissue based.
Neuroscience isn’t mainstream yet.
I want to point out to all the therapists out there who read this that they don’t have to give up their favorite techniques – just that they have to look at what they are doing based on the bigger picture.

If you are manually mobilizing a joint – you have to touch the patient – there is no other way to do it. This fact is sadly overlooked in most approaches.
By thinking in terms of altering nervous system input you can achieve miracles since the brain takes care of the rest.

Again: use what you have learned – but change your thinking about why you apply it and how!

Play As If Your Life Depends On It

That's the title of a book I bought recently. I haven't read it yet - but the title alone is worth it's weight in gold. ;-)

I don't know if there is a proper definition of play and playful out there - but here is mine:
"Play is the joyful exploration of oneself and one's surroundings/environment" (this also includes interaction with said environment).

I want to stress the joyful aspect of it here. If you are doing things because you love to do them - then that's one of the strongest and best motivators out there. And motivation means that the sky's the limit. ;-)
(Fear by the way is an equally strong motivator - unfortunately accompanied by a lot of detrimental side effects).

Why are babies and children able to learn so much so quickly?
Because they are motivated, hardwired to learn and have fun exploring everything around them.

If they are interested they focus intensely on one thing - and one thing only. They have no problem whatsoever trying hundreds (?) of different ways to interact with objects in their environment. They are exploring things from perspectives we - as adults - would never think about.

Who would voluntarily go inside a closet and pull the door closed behind them?
Who would sit under a table and declare it to be a cave?
Who would insist on wanting to lie in the trunk of the car on the way home? (I did once - and my wish was granted) ;-)

By not doing things like that - even simply lying on the floor reading a book for example - we forgo certain experiences. Our interaction with the environment becomes "dulled down" and repetitive.

Once you try a couple of new things you suddenly realize how "liberating" and refreshing they actually can be.

Give it a try - lie down on the floor and read a book down there. Or draw something - anything.
Compare that to your favorite spot on the couch or in your favorite chair and see how much more feedback the floor provides.

I'm not saying that this particular exercise is joyful - in most cases it even hurts a little because you are simply no longer accustomed to it.
But it's one of the best ways to get quick feedback from your body.

Now think of you going to the gym every week - doing the same exercises over and over again.
Not really inspiring isn't it?

Try to adopt a playful attitude here too: do the exercises differently - with your eyes closed for example. You'd be surprised how different things can become when you change them even a little bit.

There are restaurants now that have no lights. The staff are blind and the food is served - and eaten - in total darkness.

Since taste is integrated with our sense of vision the food tastes completely different.
Shake things up to keep them interesting and fresh. Brains like novelty!

As for chronic pain: in order to re-wire the brain you need attention and motivation. Those two ingredients are the best recipe for quick changes.

So find movements that you like, ways to do things that you like - set the mood - and go play!