Chronic pain changes every aspect of our lives. Both physically and emotionally. Through its lens we focus and define what we can and cannot do. Over time we become hypersensitive. Any stimuli, no matter how benign- walking, sitting, standing, lying in bed-is suspect. Pain, the body’s mechanism meant to protect us from harm becomes the very thing that keeps us trapped and in agony. Here, the brain turns into our worst nightmare, generating pain in the absence of continued physical damage.
Retraining the brain to stop interpreting safe messages as dangerous is key.
Pain reprocessing therapy does just that. It helps our brains to accurately distinguish, interpret and respond to signals so that false signals can be ignored, and the never-ending cycle is broken.
The most common type of chronic pain comes from the back. Yet, in 85% of cases, no physical cause can be found. This is a perfect example for unexplained pain thought to be due to the way the brain perceives signals coming from the back, even after the damage heals. In one study, 33 of 50 participants with chronic back pain (66%) were pain free or nearly pain free just 4 weeks after therapy, 73% maintained these results 1 year later. And 98% reported some improvement.
Pain reprocessing therapy targets nociplastic pain that occurs when there’s no clear evidence of actual or threatened tissue damage, evidence of disease or lesions in the somatosensory system but peripheral nociceptors are still activated.
It shifts perceptions about these type of threats by acknowledging it’s a brain generated phenomenon not indicative of pathology. It builds on all the modalities already discussed:
Cognitive behavioral
Decreasing catastrophizing
Improving coping skills
Promoting engaging in life activities
They all share a common message – the pain isn’t causing injury. But unlike other modalities that may try to interpret and attribute pain to other causes- this is a guided exposure and reappraisal process.
You’re not crazy, the pain is very real it’s just not coming from a specific source any longer. Say you’re in a car accident and get slammed into the air bag. There’s no question serious neck, chest, back, or head pain can result. In the following weeks and months, the brain begins to adapt to the injury and associates pain with certain movements and actions. Initially it’s a healing mechanism telling us not to turn too quickly or lift too much, we’re not ready yet. But a year later, after the injury is healed, if the sensation of pain still persists it’s because the brain is telling that person it exists- even when the exam is normal.
Pain reprocessing therapy can retrain the brain so that it no longer connects pain from the injury to current normal tissue. It helps patients to see and understand pain from moving the neck is coming from old perceptions of the trauma that no longer apply post healing. This understanding can often resolve the pain entirely or substantially reduce it.
Sound too good to be true?
Brain scans proved the results. Participants in the above study underwent fMRI scans before and after treatment, revealing marked reductions in brain scan activity in several regions of the brain associated with pain processing. Mounting research attribute chronic pain to misfiring neural pathways. As opposed to acute pain, different brain regions are activated and become sensitized to even mild stimuli. By thinking about the pain as safe, not threatening, we can alter the brain networks reinforcing the pain, and neutralize it.
At its core, pain reprocessing therapy teaches patients to re-examine the way they think about their pain and do everything possible to see it for what it is- an aberrant signal from the brain that’s no longer needed. Therapists encourage mobilizing and performing activities that hurt, giving participants the chance to reassess what they are feeling, physically and emotionally.
- Does waking in the park really cause damage, pain so debilitating we can’t continue? Or is this my brain remembering the car accident from a year ago and trying to prevent a pain so my body will heal, long after it has?
- Am I just reacting to the fear and anxiety pain used to trigger, causing more pain and anxiety? Worsening the cycle until no action is tolerated? Distinguishing where it’s coming from and shutting down the fear before it takes hold is the first step.
- Is the memory of how awful I felt after an injury still restricting my life? By retraining how pain signals are interpreted we can overcome them. We regain the power and refuse to give up control. Certain restrictions may continue, not lifting, participating in certain sports… but that doesn’t diminish all the other possibilities that open up.
No one is suggesting our pain isn’t real. But if there’s any impact from misinformation coming from the brain, who wouldn’t want to stop it? Differentiating life threatening, acute injury, from learned, adaptive behavior is critical in helping us to live more fulling lives.
-https://www.nih.gov/news-events/nih-research-matters/retraining-brain-treat-chronic-pain
-https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2784694?_ga=2.153539388.567498472.1713532282-825394919.1713532282