Pain and the brain

By Noralyn Dudt

PAIN is not  imagined, but your brain plays a role.  A large number of the population suffers from chronic pain which is defined as pain experienced most days to some, or every day to the unfortunate others. Conditions include migraines, sciatica and gastrointestinal disorders, as well as shoulder, knee and elbow pain. Back and neck pain have been experienced by a lot of people at some point in their lives.

The medical community has traditionally regarded chronic pain in one or two ways. Doctors either consider it a structural problem caused by tissue damage—muscle strain, ruptured disks, an inflamed or torn tendon; or they shrug, saying they cannot find anything wrong and suggest painkillers,  physical therapy,  rest, or a different diet or lifestyle. In too many cases, surgery is performed,  despite dismal success rates of around 25 per cent. 

The view that chronic pain originates in the brain—that it is fundamentally a psychological phenomenon,  and can be eliminated by altering thoughts, beliefs and feelings rather than by changing something in the body or flooding the body with chemicals—has long been controversial and is still largely dismissed as “New Age nonsense” or “offensive victim-blaming”. But what started out as a hunch by health-care practitioners on the fringe is finally being proved true by science. It's increasingly clear that chronic pain is often “neuroplastic”—generated by the brain in a misbegotten effort to protect us from danger.  And that's good news, because we are discovering that what the brain learns,  It. Can. Unlearn.

Neuroplasticity—or brain plasticity—is the ability of the brain to modify its connections or re-wire itself.  Without this ability, any brain would be unable to develop from infancy to adulthood.  Additionally,  neuroplasticity allows the neurons (nerve cells) in the brain to compensate for injury and disease, and to adjust their activities in response to new situations or to changes in the environment. Neuroplasticity enables the brain to adapt, master new skills, store memories and information and even recover after a traumatic brain injury.

The latest research by a team of Harvard-affiliated researchers found that a mind-body therapy course was significantly more effective in easing persistent back pain than either a more general stress-reduction program or usual cure. This new research is the latest to validate Dr. John Sarno's theory that much chronic pain is not structural but is a mind-body phenomenon,  and that changing our perceptions—gaining knowledge, altering beliefs, thinking and feeling differently—can dramatically reduce the pain.

This does not mean the pain is imagined or “all in the head”.  It's a brain response, like blushing,  crying or elevated heart rate—all bodily reactions to emotional stimuli. “Pain is an opinion,” neuroscientists often say. They do not suggest  that pain isn't factually present but that all pain is generated by our brains, and is thus reliant on the brain's fallible perception of danger.

Warning us of danger is, of course, the proper role of pain. When you accidentally step on a rusty nail, you do not  remain oblivious. You feel pain and your pain alerts you of danger.  But there are times when our brains misinterpret threats and overreact by causing or prolonging pain when no danger is present. With chronic pain,  our nervous system,  triggered by fear, gets stuck in the fight-or-flight mode, switching on our body's alarm bells in the form of physical symptoms.

A large body of literature shows that exposure to stress or adversity, such as trauma, childhood difficulties or job dissatisfaction, predicts chronic symptoms,  including back pain, fibromyalgia and irritable bowel syndrome, better than any physical measure.  It has long been known that expectations and beliefs about pain can affect how and whether it is experienced, with sham surgeries and other placebos able to trick people into feeling relief, and simulated injuries able to produce pain when  people think they are being harmed. If emotional and experiential factors predict chronic pain, that suggests the culprit is not physical as  does the fact that legions of people have resolved their symptoms using psychological interventions alone.

Imaging technology had advanced tremendously that it can validate that psychological and emotional factors spur chronic pain. One specialist who heads a neuroscience pain laboratory at Northwestern University predicted with 85% accuracy which subjects would develop chronic pain by looking not at their backs but at their brains. His team found that, when pain shifts from acute to chronic, it actually moves to different regions of the brain,  regions that are also involved in controlling emotion, memory,  and learning. The team now views chronic pain as a brain-learning phenomenon linked to "emotion-related" circuitry. Clinicians usually want to treat the site of the pain. But it has become  clear that  that might not be the right thing to do. That's not where the pain is coming from. Pain researchers find that more than 90% of people with lower- back pain recover in just days or weeks. Chronic pain,  by contrast, is a whole different thing, and it appears that it's "born" in the brain.

One of the hardest parts of having chronic pain is the sense that one's experience or feelings are not valid.  People who suffer from chronic pain have long been dismissed as neurotic. In addition to their pain, they also suffer from the stigma that their pain is "just in the head."

It would be a tragic misreading if the evidence on neuroplastic  pain were misunderstood as an argument that chronic pain is imagined or the fault of the sufferer. The research shows the opposite. Chronic pain is real and debilitating—and since it is learned by the brain, it is usually reversible. The brain is flexible—it can "unlearn" chronic pain.

 

Noralyn Onto Dudt has been retired for two years but still in contact with her former students who performed medical/scientific experiments and who are currently working  as clinicians in university hospitals and in private clinics. She finds the Case Studies they send her to review, very interesting and informative.