Rewire your brain to reduce your pain: three approaches to changing your pain

There are many theories about the pain perception process. The video below explains how we think it happens (as quickly as I can).

If, like me you’d prefer to read than to watch, what I explain is that acute pain has administrative levels with lots of components. It starts locally with the pin scratching the hand which activates the sensitising soup. These are the chemicals that spread the word that the body is under threat and needs healing. (They are macrophages, mast cells, prostaglandins, histamine, nerve growth factor and bradykinins). In response to this soup nociceptors (pain messengers) release neurotransmitters (such as substance P, CGRP, Glutamate and Brain Derived Nerve Growth Factor) to see if things can be resolved locally without going further up the chain. However, once the presence of all of these molecules hits a threshold these primary afferents/ first order neurons send for reinforcements and travel to the spinal cord. Here there is an interaction between the inhibitory interneurons trying to sort it all out with chemicals that reduce cell firing, and neurons that trigger the production of some of our bodies own analgesics. (These are our natural opioids, serotonin, noradrenalin and endorphins). If the messages keep firing then second order neurons will send pain messages to the brain stem. Our brain stem is our brain’s gate keeper and it is BUSY it receives billions of pieces of information per second. It might respond automatically and trigger more analgesic chemicals, (our natural opioids, endorphins, serotonin and dopamine) to dampen the pain. If the pain registers as dangerous however, then third order neurons will project this message to the pain matrix. This is a map of areas within the brain that interpret the level of threat from a sensory, cognitive and emotional standpoint. This is what I'm trying to illustrate in the picture below.

The frustrating thing about chronic pain is that it bypasses each of these levels. The nervous system has got so used to sending pain messages that the connections have grown thicker; the threshold for sending the message up the chain has reduced; and neurons that used to register sensations such as touch have now changed to register pain as well. At the spinal cord and brain stem, pain inhibition down regulates and pain messaging jumps straight to the brain. Here cortical restructuring has happened. This is a picture of a brain with chronic pain and one without. It shows how the pain map has spread.

Repeated connections linking pain with inflammation, stress, emotions, memories, images and situations creates a world filled with pain triggers. Combine this with the brain’s tendency to create efficient systems of fast, autopilot processing and we have an entrenched pain habit. To undo this requires deliberate, effortful attention and clever ways of bypassing our existing neural pathways. To start with these new paths will be mere goat tracks but with repeated practice they will get stronger.

The first step to overwriting our autopilot pain pathway is to:

Pay Attention

The easiest way to pay attention to your pain is to notice when you feel pain and breathe. This is called mindful breathing. When you feel your pain imagine breathing into it and imagine that your painful area can breathe. This recording guides you through how to do this.

The other thing to practice is mindful movement. This is movement that requires all of your attention. I encourage you to circle the area that feels pain and while you do this pay attention to where it feels comfortable or uncomfortable. Pay attention to the size of the pain, the shape of it, notice how it changes with movement. Update and correct the information that is travelling to your brain about your pain. Finish by massaging the area. Perhaps rub some deep heat/ liniment into the area too.

The next step is to

Experience Pain Free Movement

The picture above shows that brain areas involved with movement activate when observing and imagining the movement too. By mentally rehearsing a painful movement you activate your motor cortex and create a pain free pathway for this movement. If you can visualise sights sounds and smells associated with the movement then the sensory cortex will also be activated.

While you are using imagery training you can also practice changing your pain. This recording is an example of how to do this

The next step after imagery training is graded exercise therapy, which finds ways to move without pain. Every pain free movement we do becomes recognised as safe and retrains the brain. To do this we need to break movements up into their parts, we need to do them slowly and not at full range.

This image shows that your exercise prescription will depend on many elements

The third approach is to try to:

Bypass Current Wiring

To unwire old habits and patterns of movement you need to try something new. An example is a Tai Chi class. By asking your brain to connect movements that you have never joined before, the sensorimotor system, and the primary motor cortex must process new input.

Alternatively we can get creative with our own movement routines. By reconfiguring what we already do, we can create new pathways for a movement. For example when walking on the spot we can imagine that we are composed entirely of water, concrete or air. While doing balance exercises we can bring focus only to our elbows, we can try to move in slow motion, move like an animal or figure out what this Victorian woman was up to.

And that is how to get moving despite the pain. Get creative, use imagery and pay attention.

Good luck

xx