What is an Extinction Burst?
When Pain Returns
Imagine you've been experiencing persistent pain for months, perhaps years.
Recently, things have started to change.
You may be moving more comfortably, doing things you hadn't done for some time, or noticing moments when the pain simply isn't there.
Perhaps you're beginning to feel excited about what might be possible.
Then, unexpectedly, the pain returns.
What do you make of that?
You might have an explanation immediately. You might be puzzled. Perhaps it doesn't particularly surprise you.
One term you may have encountered when exploring persistent pain recovery is an extinction burst.
It's an interesting term, borrowed from behavioural psychology. But what does it actually mean, and how might it relate to pain?
What Is an Extinction Burst?
In behavioural psychology, an extinction burst describes a temporary increase in a previously reinforced behaviour when the reinforcement is removed.
Imagine pressing a button on a machine that usually gives you something you want.
One day, you press it and nothing happens.
You might press it again, perhaps harder or more frequently, before eventually stopping.
That temporary increase in the behaviour is an example of an extinction burst.
The term is sometimes used in persistent pain recovery to describe a flare that occurs when someone begins changing familiar behaviours or responses associated with pain.
But there's an important distinction.
Pain is an experience, not simply a behaviour waiting to be extinguished.
An increase in pain doesn't establish that an extinction burst is taking place. Nor does it demonstrate that recovery is progressing or failing.
The concept may help us consider aspects of learned behaviour, but it isn't a complete explanation of persistent pain.
And perhaps we don't need it to be.
The Influences We Don't Always Notice
Pain is a real experience, influenced by processes occurring throughout our bodies and nervous systems.
Tissue injury and disease can contribute to pain, but the relationship between tissue condition and pain experience isn't always straightforward.
Our experiences, expectations, emotions, movements, memories and circumstances can also influence what we feel.
Some of these influences are obvious. Others may be less apparent.
Imagine someone who's been experiencing pain for years.
They notice a period of improvement and become excited about what they might be able to do again.
Then their pain increases.
Did their excitement contribute? Was there a change in activity, sleep, health, expectation or something else?
Possibly.
Perhaps several influences were involved.
Perhaps we simply don't know.
We can recognise that the nervous system responds to many different sources of information without claiming to know precisely why an individual experienced a particular change.
The absence of an explanation doesn't make the experience any less real.
And finding an explanation isn't always a prerequisite for experiencing something different.
When Familiar Patterns Change
We're remarkably good at learning.
We develop habits, expectations and familiar ways of responding to the world.
Some develop deliberately. Others emerge through repeated experiences without much conscious thought.
Persistent pain can influence how we move, rest, exercise, work, socialise and respond to sensations.
These behaviours develop within the circumstances of our lives.
They may have served us well. They may have presented challenges. Sometimes both.
And here's something I think is particularly important.
Recognising an opportunity to change a behaviour doesn't mean that behaviour caused the pain in the first place.
Perhaps you've developed a particular way of moving because you experienced pain.
Perhaps you've become accustomed to anticipating discomfort in certain situations.
Or perhaps you've discovered that you can do more than you previously expected.
What if some of these patterns are open to change?
What if doing something differently allows you to have an experience you hadn't anticipated?
For someone who's spent years believing persistent pain must always indicate continuing tissue damage, this introduces another possibility.
It doesn't deny that injury or disease may have played a part, or may still be relevant.
It simply adds learning, behaviour, expectations and experience to the conversation.
And sometimes, another possibility is all we need to begin exploring.
That's My Space!
Imagine you've parked your car in the same space at work for months.
Nobody has officially allocated it to you, but you've started to think of it as your spot.
Then one morning you arrive and someone else has parked there.
You might notice a little reaction.
Hang on, that's where I park!
Perhaps you're irritated. Perhaps you laugh. Maybe you don't care at all.
Nothing has necessarily been taken from you, yet something has happened differently from how you expected.
What happens the following morning?
Do you arrive earlier to claim your space? Find somewhere else? Stop thinking about it altogether?
There are several possibilities.
Our expectations and responses can change through experience, sometimes without us deliberately trying to change them.
That doesn't mean parking spaces explain persistent pain!
But the example offers us a familiar glimpse into how habits and expectations develop, and how a different experience may open up another response.
It makes me wonder what other familiar patterns might be open to change.
Does a Flare Mean You're Going Backwards?
If pain returns after a period of improvement, what does that tell us?
Perhaps something has changed physically and warrants attention. New, unusual or concerning symptoms may need medical assessment.
But the presence or intensity of pain alone doesn't tell us everything about tissue condition.
And it doesn't prove that an extinction burst is occurring.
We can recognise the pain without immediately deciding what it means.
You may have moved comfortably yesterday and experienced pain doing something similar today.
Both experiences happened.
One doesn't erase the other.
Perhaps there's something useful in that observation.
You may choose to explore what was different, or you may simply continue with your day.
There isn't a particular interpretation you have to adopt.
Change Without Erasing the Past
Our lives include physical and emotional experiences that can leave lasting impressions.
Injury, illness, grief, loss, relationships and significant life events can change us.
Some changes are welcome. Others are not. Some experiences contain elements of both.
There are emotional states that we may find challenging, and moments of sadness, fear, anger or grief are inevitable parts of life.
Recovery doesn't require us to deny those experiences or pretend they didn't happen.
We can remember an injury without continuing to experience the same pain.
We can carry the memory of a loss while discovering that our emotional experience changes over time.
The history remains. Its meaning and its influence on our present experience may change.
And sometimes persistent physical or emotional pain can resolve, even when the events associated with it cannot be undone.
That possibility doesn't guarantee an outcome for everyone. But it is a possibility worth recognising.
Life after recovery might look very different from life before pain began.
It may have different priorities, relationships, activities or meaning.
Different doesn't have to mean better or worse.
It can simply be different.
And perhaps that life no longer includes pain that once seemed certain to persist.
An Opportunity to Explore
So where does that leave us with extinction bursts?
The term describes a particular phenomenon in behavioural learning. Its application to pain requires care, and we don't need to identify every flare as an extinction burst.
But the broader understanding of learning and behaviour offers something valuable.
Our previous experiences and responses needn't determine every future experience.
You might choose to change a familiar movement, approach an activity differently, experiment with a routine or notice a response that surprises you.
Perhaps you brush your teeth with your other hand, park somewhere different, or revisit an activity you've been anticipating with pain.
Perhaps your exploration is a small one.
Perhaps it's something much more adventurous.
What happens next?
You might notice a difference. You might not. You may discover something you want to explore further.
It isn't necessary to prove a theory, achieve a particular result or interpret every sensation.
And there's no requirement to abandon an explanation that's useful to you simply because another possibility has been introduced.
Different people will find value in different approaches at different times.
What interests me is that behaviour change can offer an opportunity to influence our experience without making our previous behaviour responsible for the onset of persistent pain.
Our history is part of our story.
It doesn't have to be the final chapter.
Perhaps something you've read here has made sense. Perhaps you've questioned it. Perhaps something entirely different has caught your attention.
That's interesting.
And perhaps that's enough for now.
Keep Exploring
If you've enjoyed exploring these ideas, I share further observations, stories and questions about persistent pain through The Pain Habit emails.
They're an opportunity to consider different perspectives and see what, if anything, you notice.
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