Chronic Pain and the Hijacked Brain
Knowledge Is Power In Order To Rescue The Hijacked Brain
In order to achieve the best quality of life and level of functioning, people living with chronic pain must learn as much as they can about the subject of pain and what constitutes effective pain management. We know that pain is a signal that tells us there is damage or something wrong with our system. However, with some chronic pain conditions the system (including the brain) gets altered. The pain system gets turned on and cannot be turned off. I call this the “hijacked” brain or what is often referred to as Neuroplasticity (also called brain plasticity, cortical plasticity or cortical re-mapping).
A surprising consequence of neuroplasticity is that the brain activity associated with a given function can move to a different location as a consequence of normal experience or brain damage/recovery. In the case of chronic pain this can mean that pain signals keep occurring despite lack of a trigger or tissue damage.
Opioid Use Can Also Hijack The Brain
According to research published in Annals of the New York Academy of Sciences titled Spinal Cord Neuroplasticity following Repeated Opioid Exposure and Its Relation to Pathological Pain; states that convincing evidence has accumulated that indicates there are neuroplastic changes within the spinal cord in response to repeated exposure to opioids. Such neuroplastic changes occur at both cellular and intracellular levels. Unfortunately, most pain conditions in this country are treated with opiates – research indicates that as high as 90 percent of people undergoing pain management are prescribed opiates. With so many people living with chronic pain and using opiates, these neuroplastic changes need to be better understood.
I like to use simple language and metaphors or visual images when educating my patients. Many of the people I have worked with would not understand the term Neuroplasticity so I use the metaphor of the hijacked brain. I tell them the reality or neuroplasticity science are much more complex but in essence what is happening is that the brain forms pathways (called neuro-networks) that eventually become super highways—in other words the new neuro-network becomes more complex and elaborate.
Building Better Highways
What I believe needs to happen in chronic pain management is developing new pathways or highways to replace self-defeating pain behaviors or suffering that can lead to a reduction or elimination of pain. My Mentor and colleague Terence T. Gorski uses the example of living in a rural area with an outhouse over a hundred yards from the back door. Between the back door and the outhouse is a field of heavy vegetation that is very hard to walk through. On the first trip it takes a long time and is very difficult but some of the vegetation is getting tramped down just a little so the trip back is not quite as hard. After several trips it gets much easier.
I expand this metaphor by saying treatment is like gaining access to landscaping equipment that will assist you in putting in a paved path to your goal—effective pain management. It is crucial to develop new ways of thinking, more effective methods of managing painful emotions and new ways of behaving that will improve pain management and quality of life. To do this, new neuro-pathways need to be generated and used over and over until the highway is built. Unfortunately, there are many obstacles that can get in the way and detour people back to the old highways and people need a strategic integrated plan to stay on the new highway.
Utilizing Addiction-Free Pain Management®
To assist keeping people on the new highway, I started developing The Addiction Free Pain Management® (APM) Manualized Treatment System in 1996. The APM™ System is a comprehensive method of addressing the four quadrants of suffering: biological (psychical), psychological, social, and spiritual. This system was first utilized by me in my own quest to find chronic pain relief without reliance on opioid medication and to stop suffering with my pain.
The APM™ Treatment System is based in part on the Gorski-CENAPS® Developmental model of recovery. It also includes the best practice standards reported by the National Institute on Drug Abuse (NIDA), the American Society of Addiction Medicine (ASAM) and the Substance Abuse and Mental Health Services Administration (SAMHSA) along with the leading evidence-based chronic pain management best practice standards.
To request the remainder of this article, please connect with me at drgrinstead@yahoo.com.
Strategic Empowerment Pain Journaling Made Easy
I would like to share with you a valuable tool that I have developed and used with many of my chronic pain patients, as well as using it myself, over the past several years. In the remainder of this article I’m presenting the same education information and actual worksheets that I use with my patients.
Purpose Of Journaling About Pain
When I explain this process to my patients I start with the following directions: You are about to embark on a very personal and exciting journey. The Following information contains guidance for completing your personalized empowerment pain journal which will give you the power to begin making peace with your pain, allowing you to come to understand yourself on an intimate and powerful level. Believe that you have the ability to make your pain your friend! You have the power to utilize your pain as a loving guide that will direct you on your path of happiness and peace.
Your pain wants to teach and guide you! Your pain can show you how to nurture yourself, how to recognize unhealthy situations, to give you the insight to create a life of love and meaning. This journal will allow you the means to gain awareness and insights into the hidden messages your pain wants to communicate. As you uncover the hidden communication within your own personal pain cycles, you will gain a new sense of freedom and empowerment.
Goal Of Journaling About Pain
Uncovering your pain’s secret communication is of great importance. You will identify and personally connect with your pain’s triggers, patterns, and themes. You will discover your pain has a personality. You will learn it may like certain people better than others. It may prefer special foods, liquids, and exercise. It may like specific weather conditions, hot and dry or yearn for cold and damp. It might be a big fan of acupuncture or massage. It may lead you into a great relationship with people of similar struggles.
Your pain may be a morning person or an evening person or one that likes to chat all through the night. It might have a favorite season of the year, a favorite holiday! Your pain is the first warning sign that lets you know when your negative thinking has gone too far. It may do many obnoxious things to get your attention. It may even put you on bed rest! Your pain is always the first one to let you know when it does not prefer something as well as when it is happy and at peace with your choices. When you choose to listen and communicate with your pain it will direct you on your path towards success and healing.
What Is Your Pain Telling You?
This question often puzzles and at times frustrates many of my patients. This is where I need to do a little education about pain and the difference between acute and chronic pain. I believe that whenever you experience pain, it’s helpful to ask: What is my pain trying to tell me? Pain is the signal that says something is wrong and you need to find out what is it; you then need to learn how to manage it. Sometimes it can be difficult if not impossible to pinpoint the pain generator, and as human beings we want to know why something is happening and we want to know “right now.” But when we are in pain the more important question is: What can I do right now to manage my pain in a healthy way that supports me physically, emotionally and spiritually? The answer will be different for each person.
Exploring the Difference Between Pain and Suffering
But what if you can’t answer that question because your chronic pain has become unmanageable, no matter what you try? This brings us to a discussion of pain versus suffering. The psychological meaning that you assign to a physical pain signal will determine whether you simply feel pain (Ouch, this hurts!) or experience suffering (This pain is awful and will just keep getting worse; this is terrible and why is it happening to me!). Although pain and suffering are often used interchangeably, there is an important distinction that needs to be made. Pain is a physical sensation, a warning signal telling you that something is going on in your body. Suffering results from the meaning or interpretation your brain assigns to the pain signal.
Many people believe that: I shouldn’t have pain! Or because I have pain and I’m having trouble managing my pain, there must be something wrong with me. A big step toward effective chronic pain management occurs when you can reduce your level of suffering by identifying and changing your thinking and beliefs about your pain, which in turn can decrease your stress and overall suffering. Because of the two parts—pain and suffering—chronic pain management must also have two components: physical and psychological. The way you sense or experience pain—its intensity and duration—will affect how well you are able to manage it. Thus the need to learn what your pain is telling you!
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The Role of Spirituality in Chronic Pain Management Is Crucial
Chronic pain is often misunderstood and undertreated. In addition to the biopsychosocial impact a chronic pain condition frequently has on a person, a spiritual crisis often accompanies the situation as well. Long-term chronic pain is a body-mind-spiritual problem that requires a multifaceted solution. I believe that complementary spiritual practices are necessary components of any effective chronic pain management plan.
Many people have found spiritual interventions like the traditions of prayer and meditation to contribute to the reduction of the sense of suffering. Unfortunately, in our fast-paced world and the secular treatment modality, adding a spiritual component to chronic pain management does not get enough attention.
The concept of spiritual pain requires healthcare providers to go beyond the bounds of traditional clinical treatments and be prepared to devote the time required to give supportive and understanding care. It is crucial to explore spirituality and its impact on a person’s pain in a multidimensional assessment.
It’s Time To Think Outside The Box
Spirituality is vital aspect of being human which is difficult to fully understand or measure using scientific methods; yet convincing evidence in medical literature supports its beneficial role in the practice of medicine. It will take many more years of study to understand exactly which aspects of spirituality hold the most benefit for health and well-being.
Many of the world's great wisdom traditions suggest that some of the most important aspects of spirituality lie in the sense of connection, inner strength, comfort, love and peace that individuals derive from their relationship with self, others, nature and the transcendent.
I believe that spiritual healing is an important component of a multifaceted chronic pain treatment plan. One goal of spiritual healing is to help patients improve their well-being and quality of life, rather than to cure specific diseases or in this case eliminate pain. Spirituality as part of a treatment plan may include encouraging patients to use visualization, prayer and positive thinking.
The Difference Between Religion and Spirituality
Over the years I have found it important to have a discussion with my patients regarding spirituality and effective pain management, as a common understanding of terminology is essential as is an understanding of what their beliefs are.
One concept that rang true was the simple saying: “Religion prepares people for the next life while spirituality helps them live this life to their fullest potential.” Many of my colleagues also recommend clarifying the difference between the terms “spirituality” and “religion.” They advocate developing a broad-based definition of spirituality that encompasses religious and nonreligious perspectives.
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Moving Beyond Anticipatory Pain for Effective Pain Management
If you’re living with a chronic pain condition like I am you may have noticed that sometimes you are so fearful about doing even the most basic tasks of daily living, that you become immobilized. It can also manifest as overwhelming anxiety, so much so, that a phenomenon gets triggered which amplifies your perception of pain. I call this Anticipatory Pain.
Because you believe you are going to hurt by doing a certain activity, you can activate the physical pain system. Just by thinking about doing something that you believe will cause you to hurt, you will start to feel pain. This can happen before you even do whatever it is you already believe will cause physical pain. All you have to do is to start thinking about doing that thing.
Once the physical pain system is activated, the anticipatory pain reaction can make your perception of chronic pain symptoms worse.
Whenever you feel the pain, you interpret it in a way that makes it feel worse, and you think about it in a way that actually does make it worse. You tell yourself that “this pain is awful and terrible,” and “I can’t handle it.” You convince yourself that “it’s hopeless, I’ll always hurt, and there’s nothing I can do about it.”
This way of thinking contributes to the development of emotional reactions that further intensify or amplify the pain response. The increased perception of pain causes you to keep changing your behavior in ways that create even more unnecessary limitations and mounting emotional discomfort. These reactions can make you believe you are trapped in a progressive cycle of disability.
Coping and Moving Beyond Anticipatory Pain
One of the most requested articles I wrote was titled “Coping with Anticipatory Pain. I believe it’s vital for us to support people to not just cope with anticipatory pain, but to move beyond it.
I learned a long time ago that what we expect is usually what we get which can sometimes be both helpful and harmful. When it comes to feeling pain and developing an effective chronic pain management plan, it’s crucial to understand the role of anticipatory pain. It has both biological and psychological components.
On the biological side, the cascade of effects from a pain sensation occurs on many levels and involves a variety of different areas within the nervous system. As a result, a wide variety of nervous system chemicals are produced and dumped into the blood while other brain chemicals are rapidly absorbed or depleted. Pain doesn’t just hurt — it changes the most basic neurophysiologic processes in the human body.
On the psychological side, anticipation of an expected pain level can influence the degree to which you experience your pain. In some cases, when your anticipatory level of pain expectation is lowered, your brain responds by influencing special neurons. This renders your brain less responsive to an incoming pain signal and your sensation of pain decreases. In any event, both ascending (pain signals coming from the point of injury to the brain) and descending nerve pathways (signals from the brain to the point of injury) will influence or modify the effects on your body.
To request the remainder of this article, please connect with me at drgrinstead@yahoo.com.