Summary, References and Acknowledgements

Summary and Action Plan

A useful metaphor is: Once you have consulted with computer experts and decided on an appropriate level of virus protection for your computer, then you want to turn off annoying and useless pop-ups that arrive on your computer screen interrupting you with, “It’s time to upgrade your virus protection to Platinum or you are in serious danger!” You believe that it is possible to prevent the pop-ups by changing “settings,” but for now you just X them out individually. Chronic pain is like those annoying pop-ups. We’d like to figure out how to change our brain’s settings so chronic pain does not even come into our awareness, but until we find how to reset the settings, we can X them out individually.
If you are at the stage of X-ing them out individually, there are proven methods you can employ.
1) Meditate with a goal of refocusing your attention on one thing (focused awareness) or many things (open awareness), but not pain. See if it helps decrease the negative emotions normally associated with pain, if not the pain intensity.
2) Try TENS, perhaps enhanced with the idea that you are choosing to use TENS, or any other temporary relief method, as a way of retraining your brain that it is not important to pay attention to the chronic pain. You do just fine, in fact probably better, without the “benefit” of the pain so why choose to pay attention to the pain?
3) Use a sling or other way to stop doing anything that ignites pain, at least temporarily, until any tissue inflammation has had time to go away or the body has healed itself in some other way.
4) Start any activity where you can lose yourself like walking in nature, looking around actively, music, sex, watching movies, video games, virtual reality, intense tastes, sudoku, golf, painting, dancing. The key is that the stimulation from the activity needs to be great enough to be more interesting to the brain than the pain. If you find yourself still mostly focused on your chronic pain during the activity, perhaps try something else.
5) Use prescribed drugs to enable beginning helpful, safe activities that would not be possible otherwise.
If you become really committed to “resetting the settings” then it is time to come up with your own action plan to deal with your chronic pain in a way that can cure it, not just relieve it temporarily. A sample action plan is:
1) Read and reread Dr. Sarno’s books and/or watch videos about his approach until you have a breakthrough of using your brain to stop pain. You can also find lots of useful information about his approach and find practitioners at www.tmswiki.org.
2) Resume normal and gentle activities. You can start gradually with Graded Mental Imagery from Neuro Orthopaedic Institute if you are afraid of moving. When you are ready, Qigong and Tai Chi can really help!
3) Practice warming your hands to 95 degrees F. three times a day.
4) Visit the neuroplastix.com website and learn, for example, to visualize pain centers in the brain decreasing in size. Consider purchasing the excellent workbook available on the website.

Soon, I hope and believe, the idea of retraining the brain away from pain will be well enough accepted that more grant proposals will be funded, more scientific papers will be written, and more pain specialists will become specialists in retraining the brain. Then there can be expert consensus panels and increasing knowledge about optimum methods for specific situations and personalities. But what can you do until this happens?
You can follow the example of the thousands of people who have already become proactive, developed their own action plan and overcame their chronic pain. I want to encourage you. You can do it too and overcome your chronic pain.

Useful YouTube Videos

Allan Basbaum – Pain and the Brain – Wonderful overview of pain from a leading expert at UCSF.

Christopher deCharms Ted Talks – A look into the brain using fMRI for chronic pain patients Has wonderful images of the brain experiencing pain and describes using fMRI as a feedback device for retraining the brain.

Daniel J. Clauw M.D. Chronic Pain – Is it All in Their Head? Wonderful material about the downward spiral of pain/(inactivity, lack of sleep, stress) and its reversal starting 1:14 after a great discussion about the differences between chronic “brain pain” and acute (nociceptive) pain.

Elliot Krane M.D. The mystery of chronic pain. This video has a wonderfully informative story about sensitization and its reversal in a young woman.

Lorimer Moseley M.D. Body in mind – the role of the brain in chronic pain. This has a great story about how meaning affects the experience of pain starting at 2:00, but I recommend watching the whole thing for some of the first research studies that are relevant to retraining the brain.

John E Sarno M.D. – 20/20 Segment. This short video and his books helped me overcome my chronic pain by convincing me that the source of my pain had become my brain.

John E. Sarno M.D. On The Howard Stern Show. Documents how retraining your brain can dramatically improve your quality of life.

Neuro Orthopaedic Institute NOI – What is Graded Motor Imagery?

Silje Endersen Reme Pain, Is it all in your mind? This TED talk supports Dr. Sarno’s idea that underlying psychological issues can be a major factor in back pain

Useful Books

Doidge, Norman. The Brain’s Way of Healing: remarkable discoveries and recoveries from the frontiers of neuroplasticity. Penguin Books, 2016.

Morowitz, Michael and Golden, Marla, Neuroplastic Transformation Workbook, available at Neuroplastix.com

Moseley, G. Lorimer. The graded motor imagery handbook. Noigroup publications, 2012.

Sarno, John E. Healing back pain: The mind-body connection. Grand Central Publishing, 2001. Sarno, John E. The mindbody prescription: Healing the body, healing the pain. Grand Central Publishing, 2001.
Sarno, John E. The divided mind. Harper Collins, 2009.

Useful Websites

This is the website with the images that Susan used for her breakthrough: Neuroplastix.com

A great website for Dr. Sarno’s approach that includes a link to medical evidence: tmswiki.org/ppd/An_Introduction_to_Tension_Myositis_Syndrome_(TMS)

There is lots of information about Graded Motor Imagery at gradedmotorimagery.com/ and evidence-based multimedia resources and courses for the treatment of pain at noigroup.com/.

All Care Visiting Nurse Association and Hospice has a wonderful web document on the modern theory of pain. allcare.org/CancerPain-and-SymptomManagement/comfort/cfm2/cfm2_cont.htm#5e

[NIH MedlinePlus] nlm.nih.gov/medlineplus/magazine/issues/spring11/articles/spring11pg5-6.html
This National Institutes of Health MedlinePlus web page gives the definition of chronic pain used here and states: “Self-management of chronic pain holds great promise as a treatment approach.”

Scientific Publications

Ambrose, Kirsten R., and Yvonne M. Golightly. “Physical exercise as non-pharmacological treatment of chronic pain: Why and when.” Best Practice & Research Clinical Rheumatology 29.1 (2015): 120-130.

Baliki, Marwan N., et al. “Chronic pain and the emotional brain: specific brain activity associated with spontaneous fluctuations of intensity of chronic back pain.” The Journal of Neuroscience 26.47 (2006): 12165-12173.
Baliki, M.N., Geha, P.Y., Fields, H.L. and Apkarian, A.V., 2010. Predicting value of pain and analgesia: nucleus accumbens response to noxious stimuli changes in the presence of chronic pain. Neuron, 66(1), pp.149-160.

Baliki, M.N., Mansour, A.R., Baria, A.T. and Apkarian, A.V., 2014. Functional reorganization of the default mode network across chronic pain conditions. PloS one, 9(9), p.e106133.

Bowering, K. Jane, Neil E. O’Connell, Abby Tabor, Mark J. Catley, Hayley B. Leake, G. Lorimer Moseley, and Tasha R. Stanton. “The effects of graded motor imagery and its components on chronic pain: a systematic review and meta-analysis.” The Journal of Pain 14, no. 1 (2013): 3-13.
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Acknowledgements

Pamela Benham,my wife, (figures and ideas and support and love), Drs. Hal Kopeikin, Ken Pfeiffer, Michael Bordofski, Robert Hines, Larry Brilliant, Brian Kopeikin, Michael Moskowitz, Ken Kosik and John Sarno for advice and encouragement,  Daniel Bridges, Morgane Audouard, Carolina Camargo, Jiwon Jang, and Ken Kosik (figures, ideas and editing), Ray Enslow and Zachary Vaillancourt (editing), Katiana O’Dowd (editing and figure), Lad Handelman, Miranda Kolias, Dylan Cummings, Peter Burks, Alex Proctor, Matt Harris, and Ryan Candy of Active Life Scientific for helping me refine the ideas (feedback) and Chancellor Yang and his wife Dilling of UCSB for their encouragement.

And, especially, the chronic pain sufferers who helped me refine the ideas from basic science into practical strategies for overcoming chronic pain by letting me see what worked for them!  It has now been 6 weeks since the library talk.   Since then, I have worked with a few people with the ideas on this website.  Two people have partially overcome their chronic pain, two have decided that this is not the right treatment at the right time for them and three have totally overcome their chronic pain.