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Chronic Pain Hope – Brain Changes can be Reversed

an abnormal brain.

Chronic pain isn’t just an injury that won’t get better. Remember: damage doesn’t really ’cause’ pain.

In fact, chronic pain is often defined as pain that lasts longer than the expected time of healing.

One of the reasons pain persists is that the brain re-wires itself to change pain perception. This is known as ‘Central Sensitization’. The changes are actually significant enough that they can be detected through brain imaging! 1

It’s almost like a ‘pain memory’ 2. Like an over-reaction of your brains job to protect you from danger by giving you pain. It can make safely moving in a certain way cause pain, because your brain remembers that being a painful movement before.

But don’t let this worry you. Fascinating (and exciting) new research has shown that not only is this pain treatable, but these changes in the brain can actually be reversed!


Central Sensitization?

The idea of a pain memory can sound scary. You might wonder “how are we supposed to erase a memory?” Well, that’s not exactly what we are trying to do. It’s more like trying to help you forget something!

This sounds easy! After all, I forget things all the time! Important things!

Maybe that’s why Homer don’t have chronic pain after all his ridiculous injuries.

But the thing about chronic pain is that the things that remind you of pain are really hard to avoid. If you have chronic low back pain, the things that set off that ‘alarm’ in your brain could be every-day activities. Simple things like bending over to look in the fridge, doing laundry, or sitting for a long time (like driving to work). Speaking of driving, people with chronic neck pain from a car accident (whiplash) can get pain simply from sitting in a car! Even weird things like being in a certain environment (like one where you were hurt before) can set off the alarm and cause pain.

These things just increase the fear and stress associated with pain, which can make it worse. Pain will also cause you to avoid normal activities, which can decrease your physical functioning.

All of these little ‘pain reminders’ keep making your brain re-wire itself to be more sensitive to pain. The biology of a ‘pain memory’ is quite complex 3, so we won’t get into the details here. All you need to know is that it happens. Now, we can figure out how to deal with it.

Like G.I. Joe says: “Knowing is half the battle!”


So what do we do?

First, we have to treat the pain.

This could include manual (hands-on) therapy from a Physical Therapist, Massage Therapist, etc. It could also include proper medications. Movement therapy in the form of safe exercises (like graded exposure) that don’t ‘set off the alarm’ are very helpful.

Furthermore, we have to address those so-called ‘psycho-social’ factors. Pain physiology education, so you can understand pain, can decrease fear and stress associated with pain, decreasing avoidance 4. Anything that relieves stress is very helpful.

Clearly, treating pain involves many factors, and each is important. You should try it all, and a good therapist should know this!


The brain CAN change back!

Here’s the cool part:

If we can consistently treat pain effectively, the brain will eventually reverse the changes that made it more sensitive. That’s right, we can ‘desensitize’ the brain.

brains are awesome.

In 2010, a study was performed on patients who had chronic hip pain due to osteoarthritis 5. Before hip surgery, their brains were scanned and compared to ‘normal’ people. The people with hip pain had significantly reduced grey matter in the Thalamus. But about nine months after surgery, the grey matter had returned to normal!

But do these positive changes correlate with pain relief too?

Another study in 2011 studied people with low back pain 6. This time the people with chronic pain had decreased cortical thickness in a few areas: the left dorsolateral prefrontal cortex (DLPFC), the primary motor cortex, and the right anterior insula. These changes were correlated with pain and physical disability. Plus, these people performed poorly on an ‘attention-demanding cognitive task’.

The pain patients were treated with either ‘spine surgery’ or ‘facet joint injections’. About six months later, the same brain areas were similar to ‘normal’ people, their pain and disability decreased, and they performed normally on the cognitive task.

Awesome.


Hope for People with Chronic Pain

This is good news for people who used to think: “well <insert pain treatment here> only works temporarily and then the pain comes back, so what’s the point?” There is a point! It can eventually become permanent relief.

The message is this: hang in there. The worlds scientists are hard at work figuring out the brain. People are beginning to appreciate pain and it’s complexity.

For now, do whatever you find helpful for your pain.

Don’t be afraid of pain. Keep moving stay active. Reduce stress and anxiety in any way you can. Don’t let pain be the first thing on your mind. Enjoy your life.

Be consistent, and don’t give up.

Good luck!

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    7 Responses to Chronic Pain Hope – Brain Changes can be Reversed

    1. Tony Ingram says:

      References:

      1. Seifert F, Maihöfner C. Functional and structural imaging of pain-induced neuroplasticity. Curr Opin Anaesthesiol. 2011 Oct;24(5):515-23. Review. PubMed PMID: 21822136.

      2. Yi M, Zhang H. Nociceptive memory in the brain: cortical mechanisms of chronic pain. J Neurosci. 2011 Sep 21;31(38):13343-5. PubMed PMID: 21940428.

      3. Louw A, Diener I, Butler DS, Puentedura EJ. The effect of neuroscience education on pain, disability, anxiety, and stress in chronic musculoskeletal pain. Arch Phys Med Rehabil. 2011 Dec;92(12):2041-56. Review. PubMed PMID: 22133255.

      4. Gwilym SE, Filippini N, Douaud G, Carr AJ, Tracey I. Thalamic atrophy associated with painful osteoarthritis of the hip is reversible after arthroplasty: a longitudinal voxel-based morphometric study. Arthritis Rheum. 2010 Oct;62(10):2930-40. PubMed PMID: 20518076.

      5. Seminowicz DA, Wideman TH, Naso L, Hatami-Khoroushahi Z, Fallatah S, Ware MA, Jarzem P, Bushnell MC, Shir Y, Ouellet JA, Stone LS. Effective treatment of chronic low back pain in humans reverses abnormal brain anatomy and function. J Neurosci. 2011 May 18;31(20):7540-50. PubMed PMID: 21593339.

    2. Hillard says:

      Hi Tony,
      Your article on how the mind can control your pain is both timely and accurate. Sometimes people need help. I myself have experienced 9 surgical procedures in the past 9 years. My colon erupted (3), (3) separate shoulder surgeries, a total Hip replacement (1), a torn labrum in my knee (1) and my esophagus stretched (1). I am 57 years old with two boys, one 8 and one 23. My wife is 16 years younger than myself. I have never let any of these surgeries and lots of pain get in my way of accomplishing everything I do. I am a Financial Advisor and my wife is an English teacher. We both also run a Children’s clothing web site/Facebook business with over 12,000 fans. It’s called Posh Little People. If I allowed the pain to get in my way we would never be able to do what the two of us do all by ourselves. I must admit I had a little help getting through the pain prior to having my hip operated on. I came across this device called Calmare Pain Scrambler. It’s a non-invasive procedure which is FDA cleared and being used at many of our countries VA Hospitals. The Mayo clinic has done and continues to do clinical studies along with the Massey Cancer Clinic and the University of Wisconsin Medical Center. There are also Pain clinics opened up around the country helping hundreds of people in pain. The Therapy “Retrains your brain to Feel no Pain”. If you GOOGLE Calmare Pain Therapy you can get all the info you need to convince yourself that this medical breakthrough works. If not just follow Tony’s advice and do it on your own. Retraining your brain without any Therapy. Either way as the NIKE commercial says “JUST DO IT”.
      Thanks Tony for your valuable insite and great writing on this topic.

    3. Kate says:

      Hello,
      Interesting! I’m a chronic headache sufferer (constant for 2 years). Is it really possible to retrain the brain? If it was, then why are there so many millions of people still suffering? I’m looking for some hope!
      Kate

      • Tony Ingram says:

        Hi Kate!

        Good questions! First of all, really sorry to hear about your pain. I hope this info, and more soon to come (not from me, but from researchers all over the world) will help you with your pain. There are many reasons people are still suffering. There is no “cure” for persistent pain, but our understanding and treatments are getting better – that’s why I write articles like this. Furthermore, much of the world – even healthcare – isn’t aware of this new science. Myths persist, and people are not looking in the right places.

        You’re right, it’s not as simple as “re-training” the brain. Pain is never straightforward. Still, it’s important to understand the involvement of the brain to explore better options than constantly searching for some injury or disease that needs to be “fixed”. It seems targeting the brain is an important idea. Here’s an example of a treatment that targets brain changes involved in persistent pain: graded imagery – I’m not sure if it’s specific for headaches, but it might help you get started.

        Other than trying treatments that target the brain, you should also take into account all the other things that could contribute to pain. This definitely involves stress and anxiety relief, relaxation and breathing, pacing and exercise, responsible use of medication, creating friendly and enjoyable environments for yourself, and more. Also, if I were you, I’d also look for a chronic pain specialist of some sort, someone who understands all of this new science.

        I wish I could give you a straight answer, a cure of some sort. I can certainly help you figure things out, and point you in helpful directions as best as I can. Pop me an e-mail if you like!
        I really wish you the best. Thanks for commenting!

        Tony

    4. Moe says:

      I’ve seen much research on this & other Brain related study’s top do with chronic pain. Its certainly where I think a great percentage of research dollars are and should be spent. CBT also brain related is another amazing approach, all this non medication based treatment cannot happen quick enough for me. Please hurry!

    5. schnauzer mom says:

      My mother had pain that was “CAUSED” by Prilosec! And many others have had the same using this medication and other PPIs. For 3 years she was taking this drug not knowing that it was the drug causing the pain not her back or knee replacement (had to have a knee replacement of a faulty 6 yo knee replacement. We were almost at de-nervation until we found forum of people trying and getting off of PPIs. In 2.5 weeks of a 4 week wean down of the drug she went from one day having pain and the next day no pain and that “no pain” has continued this past year! There is nothing that can stop this kind of pain.

      My suggestion – get off or DON’T use PPIs and statins and really – ANY kind of pharmacuticals if at all. Unless absolutely necessary. They totally screwed up my mom and she is paying the price now with Dementia symptoms that we are trying to find out if they can be reversed or are permanent.

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