Chronic Pain Therapy Grounded in Neuroplasticity
One useful method for dealing with the brain problem is based on neuroplasticity, which can undo the takeover of the brain by pain. Neuroplasticity refers to the brain’s ability to change by creating new neural pathways and eliminating neural pathways that are no longer needed, such as neural pathways devoted to chronic pain. Norman Doidge, M.D., eloquently writes about two people’s success in chapter 1 of his new book “The Brain’s Way of Healing: Remarkable Discoveries and Recoveries from the Frontiers of Neuroplasticity.”
This book brings retaining the brain away from pain into the mainstream. It was on the New York Times Bestseller list in 2015 and on Amazon it was the number 1 best seller in neurology in 2016. Over a million copies have been sold.
How to overcome chronic pain with visualization, a type of Guided Mental Imagery
The first story in Dr. Doidge’s book is about Michael Moskowitz, M.D.,who, together with Marla Golden, D.O., runs a great website on the topic: neuroplastix.com. There, for example, you can see therapeutic animations showing the progression from acute (nociceptive) pain to chronic pain and back. This is the core of the Visualization Method: visualizing the yellow areas of brain activity associated with chronic pain decreasing in size (see the brain image on the workbook cover below).
This workbook by Michael Moskowitz, MD and Marla Golden, DO, is available at neuroplastix.com, is a wonderful resource for retraining your brain away from pain either by yourself or together with a professional practitioner.
Dr. Michael Moskowitz’s breakthroughs came not only from his retraining and experience as a professional pain practitioner, but also from his personal history of chronic pain. His story is told in wonderful detail in chapter one of Dr. Doidge’s book, which I highly recommend that you read. In outline, a water-skiing accident started 13 years of chronic pain, with average pain of 5/10 (self rating of 5 on a 0 to 10 scale) going as high as 8/10 on bad days and still 3/10 on good days. After he retrained his brain using visualization exercises based on the chronic pain slides now available on neuroplastix.com, he started to get results within a month and in a year was almost always pain free, 0/10! Success for a friend of mine came even quicker, within a few weeks!
Beyond the story of Dr. Michael Moskowitz’s recovery, Dr. Doidge’s chapter is a wonderful background resource and I would highly encourage anyone interested in diminishing his or her chronic pain to read it. It contains many of the key insights that will be discussed below in detail. For example, pain is not simply the brain reporting a painful event from somewhere in the body. In general, the experience of pain is created in the brain when neural pain circuits in the brain become active and the neurons begin firing action potentials, stimulating other neurons in the neural pain circuits to fire. It can become like a chain reaction. The brain can get very good at creating the experience of pain which can run with a life of its own.
A common saying among neuroscientist is: neurons that fire together, wire together. This means that as neurons fire together in producing the experience of pain, they strengthen their connections and can do a better and better job of producing the experience of pain. Repetition of a task like riding a bike or learning vocabulary makes that task easier for the brain. Unfortunately the same is true for producing the experience of pain. If, however, you are able to give the brain a break from having neurons fire together to produce the experience of pain and instead give your brain a different task, such as visualizing the areas of pain in the brain shrinking, the brain will gradually become better at doing those tasks and less good at producing the experience of pain.
The unconscious brain decides whether or not to activate the neural pain circuits. Unfortunately the unconscious brain decides to activate the neural pain circuits in chronic pain even though it is not helpful. Neuroplastic therapy for chronic pain is focused on retraining the (unconscious) brain to learn that it is not helpful to experience chronic pain. Thus, successfully retraining the brain in this way diminishes or eliminates chronic pain.
The second story in Dr. Doidge’s book is also highly informative. In outline, a registered nurse heard the sound of a rubber band snapping and felt something inside of her break, as the full weight of a 280 pound patient damaged all five of her low back discs. She became disabled, in chronic pain. “I was depressed and suicidal, and it didn’t matter what drugs the doctors gave me—the pain never went away. I couldn’t even watch TV or read because, on top of the pain, the drugs I took put me in a gray zone. There was no reason to live.”
Based on his own success, Moskowitz retrained her to be relentless in visualizing the transformation of her brain into the no pain state with his three pictures of the brain [neuroplastix.com]. By the fourth week she experienced pain-free periods of 15 to 30 minutes and thought, “This is going to go away.” She was right. After some more work the pain did go away and never came back.
A friend I have known since college–I’ll call her Susan–wrote about her chronic pain from Piriformis syndrome, which involves compression of the sciatic nerve by the piriformis muscle. Her chronic pain was a major factor in her life. I started sending her the information I found on chronic pain and the possibility of dramatically reducing or even eliminating the pain by retraining the brain away from pain.
Within a few weeks she wrote:
I’m finding this really incredible – and while I’m a bit reluctant to even say anything in case it jinxes the effects – and because it all seems so preposterous – I have to tell you that I looked at the Chronic Pain slides, the neuroplastix.com site, glanced at pieces of online videos and google references and now find myself quite suddenly pain free (or at least pain so diminished as to not be problematic). Wow! I still get small twinges and pain grabs but they are incredibly diminished. I seem to have a pain in my neck and arm, but just thinking about the pain maps in my brain – visualizing the slides, seems to be enormously helpful. This is really encouraging and quite crazy — extraordinary really! I still feel a bit foolish – as if I have swallowed the Kool Aid and thrown away my crutches. The truth about that? Who cares! I am walking and bending with relative ease … Hallelujah.