Chronic pain is an intractable problem affecting up to a third of the U.S. population. It costs the U.S. more than 600 billion dollars in medical interventions and lost work time, has fueled and cost the lives of far too may souls from the opioid epidemic and impacts the health and welfare of everyone it touches. Too often, chronic pain results after the initial injury resolves, leading to the persistent release of chemicals and creation of neural pathways that feed into the pain cycle. Where this occurs in the brain has actually been mapped. By retraining how the brain responds to those chemicals and shutting down pathways through techniques that either distract or compete for the same neuronal signals, pain can be significantly lessened.
There are three types of chronic pain.
- Nociceptive, which occurs from tissue injury.
- Neuropathic, which occurs from nerve injury.
- Nociplastic, which occurs without a clear-cut physical cause as a response to a sensitized central nervous system and abdominal pain processing issue.
A new and exciting program, pain reprocessing therapy, teaches techniques to retrain the brain into interpreting and responding to these bodily signals more appropriately. It helps patients understand that the origins of their pain come from improper signals, not a structural cause, that then causes a pain-fear cycle, and how it can be decreased.
Two thirds of chronic back pain sufferers were pain free or nearly pain free for up to a year after treatment. The results weren’t just subjective, participants also showed significant improvement in the brains pain center activity on pre and post scans.
Over 85% of patients with chronic back pain have no underlying source to explain their persistent pain. Degenerative changes, even bulging and herniated discs are not considered structural changes that explain persistent long-term pain. More and more studies suggest misfiring neural pathways could be the culprit for many underlying, persistent chronic diseases such as migraines, digestive and gastrointestinal complaints, fibromyalgia, and more. Functional MRIs show there’s activation in different areas of the brain, depending on whether the pain is chronic vs. acute. Including those associated with reward and fear. As pain persists, these neural networks become sensitized and react to even minimal stimuli. It’s as though the switch required to notify us of injury or harm got stuck in the on position. Without relief we develop expectations and learn behaviors that no longer help the situation, but perpetuate it.
Pain reprocessing therapy can help to change how we see our pain. Understanding it no longer comes from a threatening source we can alter the pathways it follows in the brain and neutralize it. This does not mean the pain is not real. Quite the opposite. Pain causing signals are clearly being generated by the brain. We’ve seen them on scans. Before and after treatment with pain reprocessing therapy showed incredible MRI imaging improvement. Even opioids only show moderate MRI changes and perceived short-term relief. Almost 66% showed activity in the brain regions that process chronic pain- the neural and anterior midcingulate regions – had significantly quieted.
The brain interprets incoming data all the time:
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Just as predictive visual processing automatically transforms a 7 into a T because it expects a T, predictive sensory expectations of pain generate pain.
The biggest hurdle is not just understanding there’s no longer a structural source for the pain, but believing it. Most of us are too focused on looking for a reason for our pain and then finding a way “to fix” the problem causing our pain.
“It has to be there. No one is really listening. I’m not crazy, it’s too painful to walk, sit, bend…live my life.”
I get it.
I have been there.
For years I told myself I have a private medical practice and raised a little girl on my own, so I wasn’t slacking or giving into the pain! I just needed someone to fix it.
That final hurdle, after ruling out every imaginable acute concern, was the hardest to overcome- pivoting from,
“Fix me,”
To
“How do I live with this pain” was overwhelming.
It meant accepting it was a part of my life, my existence, forever.
But once I did, the pain became manageable. It didn’t magically go away. It became a part of who I am. I learned ways to accept it and live with it.
Pain reprocessing therapy can help to assess the emotions, especially fears behind the pain and retrain the brain pathways that generate signals long after the inciting event has resolved.
For me it meant getting past the fear I’d have pain with any movement, as I did when I had true structural damage that necessitated surgery. Understanding I was no longer dealing with an acute injury I could finally deal with my pain and slowly and safely learn ways to get past the fear of causing more damage.
In others there’s no physiological event causing the pain, just an insidious onset that persists or worsens with time. The more we do, the more we hurt, so the less we do. Until, like the mime in the box, we have nowhere to go. Understanding that moving normally- simply walking, sitting, standing rarely causes catastrophic pan. Once structural damage is ruled out (e.g. fracture, tumor, infection, acutely ruptured discs impacting a specific nerve root), getting past the fear these activities cause is the goal.
This is the hardest part of my job.
Helping people move on after months, years, of evaluations and interventions that result in no culpable finding.
Reaffirming they are not crazy. Helping them to understand the persistent pain has caused them to learn responses that have created neural pathways that keep generating pain. If the loop isn’t interrupted, nothing can help.
-https://www.colorado.edu/today/2021/09/29/how-therapy-not-pills-can-nix-chronic-pain-and-change-brain
-https://www.medscape.com/viewarticle/960370?ecd=ppc_google_rlsa-traf_mscp_news-perspectives-hdle-cohort_md_us&gbraid=0AAAAADoSQiXyGekFfgJP7oaviRJD6Y9lx&gclid=Cj0KCQjw9rSoBhCiARIsAFOiplkqBXpuK8vL8UHQWnqPk3McjFsC_ztSYTbARFNiwsUz-JWTEAl_UegaAumoEALw_wcB
-https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2784694/
-https://www.nih.gov/news-events/nih-research-matters/retraining-brain-treat-chronic-pain
-https://www.thismighthurtfilm.com/pain-reprocessing-therapy-prt
-https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2784694?guestAccessKey=3e677261-f26b-4244-858c-8d319ea5b2f4&utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_content=tfl&utm_term=092921
-https://www.everydayhealth.com/chronic-pain/pain-reprocessing-therapy/