The brain (and nervous system) create all pain

It’s important to begin by understanding that the brain and nervous system create all pain. Our body is constantly sending messages to the brain, and some of these messages are danger messages.

The brain interprets these danger messages, and decides whether or not to create pain in response to keep us safe. The brain takes hundreds of factors into account when creating pain in fractions of a second. It’s a fascinating process, and one that we can influence.

Acute pain versus chronic pain

When there is an outside threat (such as if we touch something too hot) or we injure ourselves, our brain sends out pain messages to let us know that there’s something wrong. This allows us to act and try to avoid or repair any damage. In our example this would be pulling our hand away from something hot to prevent burning ourselves, or seeking medical help for an injury. Acute pain is useful, whereas in chronic pain, this protective behaviour loses its protective benefit.

At Pathways, we often refer to the analogy of chronic pain as a faulty alarm system. The brain is still sending out pain messages, even when there is no outside threat. You may hear the term central sensitization, meaning the nervous system has become overactive. This can stem from an injury not healing properly, or even persist after an injury has healed. It can even happen when there’s no injury at all! So why is the brain still sending out pain messages when there’s no threat? The answer lies in neuroplasticity.

Neuroplasticity

Our brain is neuroplastic, which means that it learns and physically adapts from what happens as we go through our lives. As it adapts, neural pathways within our brain change accordingly. The more an experience is repeated, the stronger these neural pathways get. This article aptly describes the process: “Think of a river carving out a channel. The more water that flows through that channel the slicker and deeper it becomes.”

Chronic pain changes our brain and nervous system over time. It learns to continue producing pain messages and changes it’s neural pathways to do so, even when these pain messages are no longer serving a purpose. Essentially, your brain becomes increasingly more skilled at producing the pain you’re feeling (known as ‘maladaptive neuroplasticity’).

The good news here is, just as our brain has learnt to produce these pain messages, it can learn to stop producing them! This post from Dr Moskowitz’s website explains that, “it is by understanding and exploiting neuroplasticity that these changes can be reversed.”

Pain creating behaviours

When you live with chronic pain there are some behaviours which, while completely understandable, actually contribute to the cycle of chronic pain. Changing these behaviours can play a significant part in retraining your brain and overcoming your symptoms.

These pain creating behaviours include:

• Hypervigilance: You may become very focused on your pain and are constantly aware of it. You might start thinking about it in regard to every action throughout your day and looking for potential ‘threats’: this is known as hypervigilance. When you’re constantly in this state of high alert, you’re actually feeding back to your brain that there is danger, making you more likely to feel pain. 
• Pain catastrophizing: Worrying about your pain constantly and thinking about the worst case scenarios is known as pain catastrophizing. Just like hypervigilance, this can feed back to your brain that there is danger, and that pain is the necessary protective response.
• Fear avoidance: Hypervigilance and catastrophizing can lead to fear avoidance. This means that you become fearful of your pain and begin to avoid anything you feel may worsen it, such as exercise. Unfortunately this can actually make your pain worse by feeding into the stress and pain cycle, and leading to deconditioning (weakening of the body due to lack of use).

So how can we teach our brain to stop producing pain messages and break the pain cycle? Most of us will need help and guidance to start our recovery journey. Thankfully, there are scientifically proven treatments available which can help you.

The steps you take to retrain your brain will vary depending on the therapy you receive and the methods used, but all fundamentally have the same theories and goals. You will first learn about pain neuroscience. Once you have that basis of education to work from, you will be guided through tackling negative pain perceptions and pain creating behaviours, and replacing them with positive coping strategies. 

You will gradually ‘teach’ your brain that specific movements and activities do not require pain messages to be sent out, and that there is no threat present. As your brain learns this, it will ‘rewire’ itself so that you can start feeling relief from your symptoms. Let’s take a look at some of the treatments which can help you to retrain your brain.

Cognitive Behavioural Therapy (CBT)

CBT is a psychological therapy which focuses on changing negative thoughts and behaviour patterns which may be perpetuating the chronic pain cycle. CBT teaches you to replace these negative patterns with positive thoughts and perceptions about pain, and aids you in implementing positive coping behaviors. This means that through CBT, you can actively tackle the pain creating behaviours we mentioned earlier.

This detailed study on using CBT as a method to ‘unlearn’ chronic pain found that CBT was successful in changing neural pathways in those who participated. The study concluded, “CBT intervention results in measurable alterations in intrinsic functional connectivity (iFC) within and between networks previously implicated in chronic pain, including motor, perceptual, affective, default mode and striatal circuits.”

Acceptance and Commitment Therapy (ACT)

Instead of focusing on changing your thoughts, ACT works to help you accept your thoughts and to understand that they don’t need to lead to behaviours. Essentially ACT teaches you that you can allow negative thoughts to pass you by, and commit to using positive coping strategies to deal with your pain. 

ACT tackles pain creating behaviours and promotes patients taking control over their own recovery journey. This article from the Integrative Pain Science Institute states that CBT and ACT can help chronic pain patients end the chronic pain cycle

Graded Exposure Therapy

Graded exposure therapy helps patients to tackle fear avoidance by gradually and gently introducing them to the situations they fear, starting with the least worrying. Each situation is broken down into bite-sized manageable pieces. As patients start to see that the situations weren’t as bad as they expected, their confidence grows and their fear lessens.

With each situation that is tackled, the brain is actively being retrained away from pain as it learns that this situation isn’t a threat and therefore doesn’t require pain messages to be created. This 2019 study is one of many which shows positive outcomes for pain patients from graded exposure therapy. The study concluded that, “Based on an empirically validated theoretical model with rigorous experimental evidence graded in-vivo exposure has emerged as a promising treatment for patients struggling with chronic pain and fear avoidance.”

Graded Motor Imagery (GMI)

Graded motor imagery (GMI) uses the brain’s neuroplasticity along with mirror neurons to retrain the brain. Mirror neurons make up a quarter of our brain. They fire when we’re watching other people do an activity or are imagining doing that activity. GMI uses imagery to help the patient visualize doing specific movements while being pain free, utilizing mirror neurons to teach the brain that these movements don’t need to cause pain. 

As GMI progresses, the patient can gradually build up to performing the movements physically. This study on the use of GMI for those with chronic pain concluded that, “Pain intensity decreased over the course of GMI, and relief was maintained at follow-up.”

Biofeedback

Biofeedback uses monitors to make you aware of the processes within your body, such as your heart rate and breathing rate. With the guidance of a therapist, patients learn to recognise the relationship between these processes and levels of stress, muscle tension and emotions. The therapist will then guide you through learning to calm and regulate these processes.

With increased control and relaxation techniques, patients are able to reduce chronic pain symptoms going forward. This article from Practical Pain Management explains the promising research behind biofeedback for chronic pain patients, and states that, “The beneficial effects may last for 10 years or more—provided they continue to apply the physiological awareness skills they have acquired through this treatment.”

Mindfulness

Mindfulness can be guided or done independently. Mindfulness is all about being present in the moment, in a calm grounded state. Through regular mindfulness practices, you can learn to reduce stress (breaking the stress and pain cycle), increase emotional control and relieve chronic pain symptoms, among many other benefits. Visualization through mindfulness can play a part in helping to retrain your brain, just as with GMI.

Physiotherapy

It’s not just psychological therapies which can help you to retrain your brain. Some manual therapies play an important part in the process, physiotherapy being one of them. You may also hear physiotherapy referred to as physical therapy. Physiotherapy helps the patient to build strength and flexibility. By helping patients to move their body in a gradual, safe way, they can reduce pain and teach the brain that these movements don’t need to cause pain.

Hydrotherapy

In a similar way to physiotherapy, hydrotherapy allows patients to learn to move and strengthen their body in a safe environment. Hydrotherapy refers to exercises done in a pool of water, which is usually heated. The water takes weight off the joints and the heat eases pain, making movements less painful.

As well as therapies which can retrain the brain, there are also pain self-management techniques you can use which can help on your recovery journey. 

Exercise

Not only is exercise great for general health, for those with chronic pain it helps to fight fear avoidance and deconditioning, boosts mental health, strengthens muscles, reduces stress, and more! When exercise is built up gradually, it can be a powerful aid in training the brain away from pain. 

For me, exercise was (and still is) absolutely pivotal in regaining my level of functioning and reducing my symptoms. It can be worrisome at first, and you may feel it’s counterproductive, but as you learn more about the science behind chronic pain you can come to understand the amazing ability exercise has to help you fight your pain.

Pacing your activity

A really important self-management technique is pacing your activity. This means not trying to do everything at once even on days when you’re in little or no pain: it’s important to still take rests. It also means continuing to function on days when you’re in pain. This prevents the boom bust cycle, which means you cause a flare because you’re pushing your body too far. It’s all about finding that balance! 

With pacing you can set goals and gradually work up to them from a baseline, actively teaching your brain that these activities do not need to cause pain, and allowing you to build up your level of functioning. This article from Pain Health explains that pacing, “helps you to stay active, doing the things you care about and want or need to do, and helps you to avoid pain flares.”

Finding purpose and setting goals

Having purpose and setting goals for the future keeps you motivated. You need that motivation to fight chronic pain and put the hard work required into retraining your brain. Whether this purpose is related to work, a hobby, a place you want to visit or another personal goal, it’s vital in maintaining focus.

Practicing self care

Self care becomes even more vital when you’re trying to fight chronic pain and tackle pain creating behaviours. It’s important to keep up with treatments; eat well; practice good hygiene; maintain social connections; make time to rest and more. Self-care is any act you do which takes care of your physical and mental health.

You might be thinking that this all makes sense, but be lost as to where to get started! It can feel a bit overwhelming, but don’t worry you don’t have to do this alone. Let’s go over how you can get started on your journey.

Educate yourself about pain science

You’re already getting involved in the first step! It’s important to educate yourself about the science behind pain so that you can understand how retraining your brain works. When you first hear about the concept, it can sound a bit ‘out there’ or ‘too good to be true’, but once you understand the science, it all makes so much sense!

You can gather information by reading articles and blog posts, watching videos, reading books, and even reading personal stories! Ensure you use reputable resources and take your time so you don’t feel overwhelmed. This article on the topic states that, “Educating yourself is the best way to find a treatment method that works for you. Learning about pain will help to dampen an overly sensitive nervous system.”

Seek effective treatment

Once you’re ready, you can seek treatment! Professional treatments like we’ve discussed are fantastic because you’ll be guided through the process step by step. You’ll have the support and encouragement you need to work towards your goals. 

You can access the treatments we’ve mentioned by talking to your doctor and asking for a referral; seeking treatment privately; or finding treatment online with a pain management program like ours. At Pathways, our program is built on the principle that we are able to naturally train our brain and body away from pain.