Authored by Dr. David Alter

In the last entry we introduced the idea of pain as a faulty memory signal; a state-dependent signal that can be activated by many triggers.  We emphasized the importance of learning memory-modifying steps you can take to put you back in charge and learn to have the remembered past – the pain signal that keeps on firing – pass right on by.  By recognizing that The Pain, its Plain, Stems Mainly from the Brain, here are six suggestions to consider that help free the brain from old pain memory patterns, and allow it to express different nerve firing patterns that modify your experience of pain.

1.    Shifting the focus of attention from what can be done for you to what you are able to do for yourself.  This shift in focus orients the brain to how and where you can exercise control, which disrupts old patterns of helplessness in the face of failed efforts to obtain relief.

2.    Develop a toolbox of safe and simple movements.  The body is designed for movement.  The body needs movement the way it needs food and sleep.  Whether the safe movement involves simple stretches, a walk to the mailbox several times per day, or involvement in a yoga class, develop a movement routine you maintain.  It disrupts the memory circuits that say movement is dangerous and painful.

3.    Restoring restful sleep. While we sleep, the brain filters our experience from the past.  Sleep revises, discards or strengths aspects of past experience.  Without adequate sleep, our ability to restore energy reserves, rebound from the past experience, and feel prepared for the future is hobbled.  Explore proven methods for re-establishing restorative sleep so you give the brain the energy it needs to construct new habits of functioning during the day.

4.    Learn focused awareness skills.  When pain is present, it can be like a magnet that draws attention to it.  Pain-focused attention almost always makes the perception of pain worse!  A number of methods for developing the capacity to direct attention away from pain, or toward perceiving sensations in the body in new ways can be very useful.  Meditation, breath awareness, guided imagery and self-hypnosis are examples of focused awareness skills you can learn.

5.    Become a “sensualist”.  We are blessed with five senses.  Pain tends to make us aware of only one of them.  If pain becomes the dominant sensation that people experience, awareness of other sensations dulls.  It is important to involve yourself with activities that bring alive other sensations – taste, sight, sound, smell, taste and touch.  In addition, there is good evidence that laughter and humor release molecules that flood the brain and body with strong pain dampening effects!

6.    Letting go of what’s past (passed).  People with persistent pain tend to have much higher rates of depression, anxiety and even high rates of histories that include past traumas of various sorts.  Of course, having persistent pain can be depressing, anxiety provoking and traumatizing!  Still, past trauma tends to keep the doors to pain in your present life wide open.  Therefore, it is important to learn methods of resolving the on-going influence of past trauma on your daily life.  Doing so powerfully rewires the brain and frees up the mind to experience life anew.

Authored by Dr. David Alter

In the movie musical My Fair Lady made famous by Audrey Hepburn, she sings a song whose words begin, “The Rain in Spain Falls Mainly in the Plain.”  Her song signals her growing ability to achieve her full but untapped potential.  Every day, millions of people struggle to overcome the limitations imposed by their personal histories.  These are individuals who face the misery and despair that all too often arises with chronic pain.

Chronic pain has bedeviled healers for thousands of years.  Invisible, untouchable, and yet so many are touched by it – more than 70 million Americans per year!  A key aspect of chronic pain that makes its successful management so challenging is its disconnection from obvious tissue injury.  Typically, as the physical body heals, the process of healing turns off the nerve signals that generated the pain sensations in response to the original injury. 

What is difficult to understand is that over time pain signals become disconnected from actual tissue damage.  This involves a modification to the body’s pain signaling process.  Pain is an experience that is encoded in the brain in through state dependent learning experiences.  In other words, the experience we call pain is a type of memory that is encoded into the neural circuits of the brain, ready to be reactivated when any of the other elements that were present at the time of the original injury are once again present.  For example, when my young adult son was injured playing his favorite sport he needed stitches that were sown into his mouth without sufficient anesthetic.  When he began to anticipate going to have the stitches removed, he began to hurt again.  The hurt he felt involved reactivation of the state dependent learning that linked together the memory of stitches with the memory of pain.  The anticipation of going to have stitches removed reactivated pain!  The original emotional state (scared), the physical context (doctor’s office), the sensory cues (white coat, hospital smell, overhead paging, etc.) also served to reactive the pain because they were encoded as part of the original state dependent pain experience.

While this example involves an acute pain experience, you can appreciate the relevance to chronic pain conditions, where the encoded emotional, contextual, sensory, and cognitive cues linked to pain are more common and have been reactivated so much more powerfully over a longer period of time.  Still, the implication is clear: As hard as it is to accept, the fact of the matter is that chronic pain really is “in your head!”  It is wired into the brain’s network of nerves, ready to “fire” in response to so many different triggers. 

That the pain is in the head makes it no less real!  In fact, it allows a whole new approach to managing it: learning ways to re-program pain program wired into the brain.  To return to our theme, the key to management of chronic pain involves learning to change the “remembered pain,” the memory pattern that gets established in the brain and which is responsible for the activation, maintenance and exacerbations of chronic pain conditions.  If Audrey Hepburn were to star in a pain management movie, perhaps she would sing, “The Pain, its Plain, Stems Mainly from the Brain!”

There are a number of ways to modify chronic pain memories: the pain-maintaining signaling patterns that are at the core of chronic pain conditions.  In the next entry to this blog, six suggestions for modifying pain maintaining memory circuits will be introduced to you.  Each of the pattern-modifying techniques is useful precisely because of its proven capacity to alter the ways in which remembered pain signals are generated.