The Foot Pain Was So Bad, Shoes Were Unthinkable

“The pain can be agonizing, to the point that patients will do anything to relieve it,” he adds. A common practice is to plunge the feet and hands into ice. He discourages that because “it can lead to frostbite.”

Davis has seen people become reclusive, avoiding outdoor walks and public places — especially if the locations are hot, such as stores, restaurants and gyms. “Some people end up in wheelchairs or even quit their jobs,” he says.

Haller’s treatment plan at the Mayo Clinic involved a multidisciplinary approach, including cognitive behavioral – or talk – therapy. She also had daily physical therapy, occupational therapy and group behavioral therapy, as well as meditation, mindfulness, yoga and gentle movement exercises. The doctors there also X-rayed her feet and built custom orthotics for additional foot support.

But it was a novel technique employed by Mayo’s Pain Rehabilitation Center “that made all the difference in the world,” she says.

The pain-relieving approach

The technique the center used, known as titration, relies on the brain’s neuroplasticity — its ability to learn and adapt — to alter a patient’s perception of pain. The process involves gradually increasing or decreasing an individual’s exposure to stimuli that trigger the nervous system to produce pain signals — in Haller’s case, the sight and wearing of shoes and socks.

The treatment doesn’t always eliminate the pain, but enables patients to cope more effectively. It teaches them “how to live a better life with the pain,” Davis says.

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For Haller, it meant desensitizing her response by slowly lengthening the time she spent wearing shoes and socks. Avoiding them, compounded by mounting stress over her disorder, caused her nervous system to produce increasing foot pain, says Matt E. Schumann, a psychologist with Mayo’s pain center who treated her.

“The nervous system sees certain situations as potentially threatening and damaging, which exacerbates the symptoms,” Schumann says. “Wearing socks is not inherently damaging, it’s the nervous system’s perception of … what would happen when you put them on that promotes the onset of pain,” he says.

The goal was to slowly expose her to the perceived threat in a safe context — the clinic — to build confidence, Schumann says. For some people the pain disappears, he says. Others feel less pain and, as a result, can function better.

Haller wore shoes and socks off and on for a few minutes every hour, gradually increasing the time until she wore them continuously for 10 hours on the final day of the three-week program, which “felt so good,” she says.

The brain shapes experience

Haller’s story “is yet another example of the remarkable power the brain has in shaping our experience of pain,” Marco L. Loggia, professor of radiology at Harvard Medical School and codirector of its Center for Integrative Pain NeuroImaging, wrote in an email.

“Think of a soldier in a life-or-death situation who momentarily forgets his or her injuries in order to reach safety, or of someone whose pain genuinely improves after taking a sugar pill they believe to be a powerful analgesic,” added Loggia, who was not involved in Haller’s case. “These are not tricks or exaggerations,” he says. “Harnessing this power for therapeutic purposes could be truly transformative.”

Haller’s is “a great example of what we call the plasticity of the brain,” says Dr. Scott Fishman, director of the Center for Advancing Pain Relief at the University of California, Davis, who uses the approach in his own practice. “The idea that pain can be modified by experiences such as the titration treatment is mind-boggling.”

The pain system “can go both ways,” adds Fishman, who also was not involved in Haller’s case. “We increase our sensitivity to pain to protect ourselves, but … we have the ability to desensitize ourselves to pain by teaching the brain to respond differently to stimuli. Many people see this as some trick that isn’t real — but it is.”

Although brain retraining and titration have long been recognized as valuable tools for pain management, the approach still may not be in widespread use, Schumann says.

“These interventions were not created at Mayo Clinic but have been a critical component of interdisciplinary pain care at Mayo Clinic since the 1970s,” he says.

Back to the trails

It’s been more than a year since Haller went through the three-week Mayo program. Her pain isn’t entirely gone, but she’s able to manage it and has returned to the activities she loves, including long hikes. In March she walked the trails at Picture Canyon in Flagstaff, Arizona. The following month, she hiked in the Glen Canyon recreation area surrounding Lake Powell on the Arizona/Utah border.

“I walked for three hours on the trails at Picture Canyon with little pain,” she says. “I can sleep without pain, and that makes each day better. I feel so happy. I still have pain in my feet sometimes, especially when it is hot or I carry heavy things, but I know how to push on. Walking more actually makes my feet feel better these days, which is amazing.”

The treatment “changed my life by helping me change my brain,” she says. “I ... feel reborn.”