The word pain has its roots in the Latin word meaning punishment. Fitting, right?
But pain isn’t just your body’s way of playing some sadistic trick on you. Pain is actually an injured body’s reward and penalty system telling the person not to do something that might cause further damage and rewarding them with relief when they comply. At the most basic level, pain is simply your body sending some electrical signals which your brain interprets as pain.
The Gate Theory Of Pain
In his book The Brain’s Way of Healing: Remarkable Discoveries and Recoveries from the Frontiers of Neuroplasticity, Norman Doidge tells of the work of neuroscientists Ronald Melzack and Patrick Wall who disproved the conventional thinking that pain nerves send a one-way signal to the brain with the intensity of the pain correlating to the seriousness of the injury back in 1965. Melzack and Wall proposed the “gate theory of pain” where pain messages sent from hurt tissue have to pass through several “gates” in the nervous system before reaching the brain. Each gate decides if the signal is important enough to give it permission to pass, and if permission is granted, the gate opens causing certain neurons to turn on and transmit their signals increasing and escalating the pain.
But the good news is: The system also works in reverse. Doidge explains:
…the brain can also close a gate and block the pain signal by releasing endorphins, the narcotics made by our bodies to quell pain.
Chronic Pain is Brain Plasticity Gone Wild
Your brain is neuroplastic, meaning it physically changes form and function based on your repeated experiences, mental and physical. Neurons that fire together wire together strengthening and increasing their connections, firing faster, and becoming more efficient. The opposite is also true, and connections are weakened and lost over time when neurons are not activated together. Neuroplasticity is both a blessing and a curse and chronic pain is brain plasticity gone wild. Acute pain is your body’s way of getting you to immediately attend to injury or disease. Chronic pain is acute pain’s uglier, stronger ghost.
Signals from parts of the body are processed in the brain with adjacent body areas usually represented beside each other in the brain. When pain receptors in one body area’s pain map fire repeatedly, they can undergo neuroplastic change, becoming stronger and more sensitive and even enlarging the brain map (meaning the pain is experienced over a larger area of the body), and continue firing after the original cause of the pain is gone. Pain signals can even “spill” onto other brain maps causing what’s known as “referred pain” in completely different parts of the body.
When this happens, the pain isn’t in the body anymore. It’s is in the brain. A vicious cycle of the pain reinforcing itself has taken hold and the body’s alarm system in the brain is stuck on.
Acute pain is the brain interpreting sensations originating from the bottom up. Chronic pain is a more complex, top-down process. Studies have shown that when determining our subjective experience of pain perception, our brain factors in its expectations for whether action can be taken to diminish the pain which greatly influences the level of pain felt.
Plasticity Is Both The Problem And Answer
In his book, Doidge tells the story of Michael Moskowitz M.D., a psychiatrist, who became a pain specialist because he wanted to alleviate his own chronic pain resulting from a falling accident. After pouring over thousands of pages of neuroscience research, Moskowitz came up with a plan to reverse his pain.
Because of plasticity, there is always a battle in your brain for cortical real estate. You have a use or lose it brain meaning that activities performed regularly take up more space in the brain and “steal” resources from other areas, a concept known as competitive plasticity. Moskowitz noticed that the areas of the brain that actively process chronic pain also process thoughts, sensations, images, memories, movements, emotions and beliefs when they aren’t being hijacked by pain.
Moskowitz decided that when he was in pain, he would take these areas of his brain back and force them to work on other activities rather than processing the pain signals. When he felt an attack of pain, he immediately visualized the areas in his brain processing pain shrinking until it looked like a pain-free brain. Doidge quotes Maskowitz and writes:
‘I had to be relentless – even more relentless than the pain signal itself,’ he said. He greeted every twinge of pain with an image of his pain map shrinking, knowing that he was forcing his posterior cingulate and posterior parietal lobes to process a visual image.
It worked. In the first three weeks, he noticed a slight decrease in the pain. By six weeks, some of his expanding pain had started to disappear. By four months, he was having his first totally pain free periods in thirteen years, and within a year, he was almost always pain free. If he did have pain, usually from doing something to cause it, he responded with his visualization method and could make it go away in minutes most of the time.
Moskowitz started teaching his method to his patients with amazingly successful results. He coined the acronym MIRROR to detail the steps of the process:
- Motivation – The chronic pain sufferer has to take an active role in their healing. Instead of taking a pill or turning to doctors to solve their pain, they must understand the physical process causing their pain and understand how and believe that their brain can reverse it.
- Intention – Contrary to what you might think, the immediate intention is not to get rid of the pain. It’s to focus the mind and visualize the pain brain map shrinking. The long term reward is pain relief.
- Relentlessness – Every time pain breaks through the consciousness threshold, it must be met with the visualizations. Self-directed neuroplasticity requires intense focus to happen.
- Reliability – The person needs to know that they can rely on their own brain to heal and function normally. The brain always seeks a stable state, which in this case, is chronic pain. So, its unconscious preference for stability has to be consciously overridden until pain free becomes the stable state.
- Opportunity – The person needs to view each pain episode becomes a chance to repair a faulty system.
- Restoration – The goal of the process is not to mask the pain or deal with the symptoms as medication or anesthetics would, but it is to restore normal brain function.
Plasticity – Not Placebo Or Pills
The end to the pain is not likely to be a placebo effect because the results are lasting (in Maskowtiz’s case 30 years and years for his patients), and placebos generally work rapidly with persons relapsing pretty quickly. Patients using the MIRROR method can show no response for weeks, then gradually have diminishing pain as the brain changes until they only have to do the intervention for occasional pain breakthroughs. This pattern is consistent with people who have used neuroplastic techniques to cure learning disorders and recover after stroke or brain injury. However, because results were not immediate or dramatic at first, not everyone was able to sustain the level of commitment and dedication required to successfully implement MIRROR.
I used my own experience-dependent neuroplasticity exercises to recover from a brain injury. Neuroplasticity does take time, commitment, and effort, but it CAN work. Doidge writes:
What Moskowitz has added to our understanding of this ability of the mind to eliminate a particular pain is that constant mental practice is necessary to strengthen this ability and change the firing of the brain in a way that can be sustained. Unlike medication or placebo, the neuroplastic technique allows patients to reduce use over time, once their networks have rewired.
One of the most important insights coming from Maskowitz’ work is the revelation that opioid narcotics, popular for treating pain, actually make pain problems WORSE because of neuroplasticity. Over time, a pain sufferer’s brain adapts to the opioids becoming less sensitive to them and more sensitive to the pain causing the patient to become more dependent on the drugs. Maskowitz successfully weaned many of his patients off their opioids by lowering their doses gradually giving their brains time to make neuroplastic changes with the visualizations.