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The Strain in Pain Lies Mainly in the Brain

Thank you Sean Mackey for the catchy title of this blog. His slides from his lecture on the neuroscience of pain can be found here

I will not be exploring the neuroscience of pain in depth - I’ll try to keep things very straightforward. The take-home message for you should be that pain might happen in our body but it is processed and perceived in the brain. And it just might be the case that we can change our pain through changing our brain.

This picture shows pain being noticed by primary nociceptors (our first of danger detectors) travelling to the spinal cord and either being passed to secondary nociceptors to travel further up the spinal cord to the brain or being stopped by messages and chemical messengers from the brain (such as serotonin, cannabinoids and norepinephrine) that help us feel safe. If the danger message carries on up to the brain it goes to the thalamus - our relay station in the brain, and then on to a whole bunch of places in the brain where sensory information interacts with cognitive and emotional processing to gauge the level of threat. This explains why cognitive and emotional variables such as attention, expectation, prior experience, mood, sense of control and religious beliefs shape a person’s pain experience.

People living with chronic pain are thought to have a lower signalling threshold in their spinal cord as well as increased sensitivity of the second order nociceptors which leads to allodynia (pain hypersensitivity) and hyperalgesia (increased pain response). They are also thought to have depressed inhibition of the safe messaging pathway that travels down from the brain. They may also have cortical reorganisation which further connects pain sensations to emotions and memory. Because there are so many variables involved in the creation of chronic pain, it makes sense that we need to try a whole lot of different things to shake it.

In the marvellous book The Brain's Way Of Healing, Norman Doidge tells the story of pain scientist Dr Moskowitz who after developing chronic pain decided to figure out how to fix himself. His personal pain strategy was simple. He used visualisation exercises to overpower his pain. He knew that two brain areas process both visual information and pain, the posterior cingulate and the posterior parietal lobe. Each time he got an attack, he began visualising his brain in chronic pain. Then he would imagine the problem areas shrinking. He greeted every twinge with an image of that area of his brain shrinking:

In the first three weeks he noticed a very small reduction in pain. After a month he never let a pain spike occur without doing visualisation. It worked. By six weeks, the pain between his shoulders in his back and near his shoulder blades had disappeared, never to return. By four months, he was having his first totally pain-free periods throughout his neck. Within a year he was almost always pain free.

Wow! Isn’t that exciting? Influenced by the study that I am doing at the moment (an Msc in Pain Management) I have been writing scripts for meditations. I am running with Dr Moskowitz’s idea and playing with some other concepts around pain. I have thought through five or so areas that are typically affected by the person living with chronic pain and written scripts that focus on themes such as dialling down the pain, creating distance from pain, having control, feeling safe and keeping relaxed.

It is possible that guided meditations may decrease nociceptor sensitivity, they may help boost descending pain inhibition, they may increase feelings of safety, they may alter the meaning of pain. I’m not entirely sure how this stuff works but mediation is free, it’s painless, it takes five to ten minutes a day - and so, it might be worth trying. Ideally, I’d like you to listen to all of my recordings (recorded on my phone in my closet) over ten days and see if they make even the slightest difference. If they do, maybe listen again for another ten days? Or. Better yet. Figure out what works for you and every time you feel a twinge - use that technique.

Here they are:

People in pain often hold their breath when they move as a protective mechanism so the first meditation is breath awareness