Many chronic pain patients (myself included at the start of my journey) are surprised to learn that ‘chronic’ does not mean that your pain has to last forever. There are ways that you can train your brain away from chronic pain, reduce your symptoms and reclaim your life. Let’s take a look at how this is possible, and how you can get started.
Understanding The Science Behind Chronic Pain
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.
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).
Treatments To Retrain Your Brain
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 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 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.
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.
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.
Self-Management Techniques Which Can Help
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.
How To Get Started
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.
Be consistent but patient
It’s important to be consistent: keep up with your treatments, attend all of your appointments, do any ‘homework’ they give you and continue to practice what you’ve learnt in your own time. Retraining your brain is not easy. It requires dedicated, hard work, and persistence. Patience is also key: if you don’t see results straight away, remember that this is a long term process. It’s a journey, and it can take time to start seeing the benefits of your work.
Aside from professional treatments, it’s incredibly helpful to have support on your journey. Where you get support will be an individual choice. It may be talking to loved ones and asking them to encourage you, to take you to appointments or to accompany you while you exercise. It may be finding a support group of other people who understand what you’re going through and can keep you motivated. It could even be finding support online through social media from others who are fighting chronic pain just like you.
Sometimes hearing the science can be all well and good, but you end up wondering if anyone has actually had success in training their brain away from pain. We’ve got some examples of recovery stories to help you see how the science translates into real people improving their lives.
Dr Micheal Moskowitz is perhaps the most well known example of the power of neuroplasticity. Dr Moskowitz is a psychiatrist who became a pain specialist. He became a world leader in his field after his own chronic pain recovery journey.
In 1994, Dr Moskowitz was water skiing with his daughters. Unfortunately he fell and hit the water with his neck bent backwards, causing extreme pain. This pain became chronic, lasting 13 years and having a severe detrimental impact on his life. Dr Moskowitz tried all of the treatments he could find. This article on his journey explains that, “Morphine and other heavy-duty painkillers, and all the known treatments – physical therapy, traction (stretching the neck), massage, self-hypnosis, heat, ice, rest, anti-inflammatory drugs – barely touched it.”
When he was 57, he hit rock bottom, but would soon begin his recovery journey as he began researching neuroplasticity. He read over 15,000 pages of neuroscience, learning all he could about the science behind chronic pain! From then on, he was completely dedicated to starting his own journey and overcoming his pain.
He began to use visualisation to retrain his brain. After months of hard work and persistence, despite all the odds, he began to have pain free days! Within a year, he was completely pain free! If he had setbacks, he would simply return to his neuroplasticity exercises and visualizations. From then on he set out to help his patients recover using the same techniques, and to spread the word about neuroplasticity!
Sandip, the Pathways Founder
The founder of the Pathways, Sandip Sekhon, had his own journey with chronic hand and arm pain (diagnosed as Repetitive Strain Injury (RSI)). Not knowing much about the pain he was experiencing, he continued to try and push through the pain, but quickly ended up severely disabled.
In the years that followed Sandip tried every type of pain treatment he could find, including two invasive surgeries! Unfortunately these treatments didn’t bring him relief. One of the many doctors he saw told him that the pain wasn’t stemming from any physical damage, and that his brain had learnt to continue producing pain. Determined to reclaim his life, he began to do his own research.
Sandip discovered Dr Moskowitz and began to use visualization to retrain his brain: he began to find the relief he had been searching for for years. He was completely pain free within a few months! Now he has dedicated his life to trying to help other chronic pain patients who, like him, may not be aware of the cause of their pain or how to recover from it (read his full RSI recovery story here).
Ann-Marie D’Arcy-Sharpe (that’s me!)
I am still on my recovery journey and while I am not completely pain free, I have come so far that sometimes I can hardly believe it. I was diagnosed with fibromyalgia and arthritis a few years ago now. When I was first diagnosed, I could barely walk across the room without searing pain. I couldn’t work and I was using a mobility scooter to get around. I remember feeling completely hopeless a lot of the time, feeling that I was always going to be in this much pain and that my plans for the future were destroyed.
Doctors didn’t offer me much in the way of help other than telling me to ‘stay positive’ and essentially leaving me with no hope for improvement. I’ve always been a determined person and decided I wasn’t going to accept that. I began to do my own research and found pain management techniques I could use to try and improve my quality of life. One of the most significant things I learnt which really started to turn things around for me, was that the pain itself wasn’t going to damage me, and that I didn’t need to fear it!
From then on I began pacing my activity; facing my fears; gradually starting to exercise; getting back to work; building my confidence; using CBT techniques to challenge negative thoughts and utilizing mindfulness. Over time, my activity levels increased, and to my amazement my pain levels dropped! I started hiking and very gradually, began to be able to walk one mile, then two, then more!
Last year I did a sponsored 9 mile hike and now go hiking almost every night with my husband and my dogs. I never thought I’d be able to say that going out exercising is my happy place! I have days where I am completely pain free, and when I do have pain or other symptoms, it’s much less severe and much more manageable.
I’m working full time doing a job I love, and living an active, happy life. It’s hard work and it takes constant management. When I have flares in symptoms, I have to remember that I’m still learning and that recovery doesn’t have to be perfect: I’m still doing well! I’m determined to continue on my chronic pain journey and I sincerely want to help other people with chronic pain regain their hope and reclaim their lives. It truly is possible.
Jan Sandin was Dr Moskowitz’s first neuroplastic patient. She was a nurse and had severely damaged five of the discs in her lower back, leaving her in a lot of pain. Jan’s pain ended up persisting for a decade! Thankfully she found Dr Moskowitz and with his neuroplastic technique, she too became pain-free! In this article Jan is quoted, saying “I wondered, ‘Is it a placebo?’ But the pain still hasn’t come back. It has never come back.”
In 2019 Hannah Milington wrote an article for The Guardian detailing her recovery journey from chronic pain. After graduating university she started an office job and like Sandip, developed RSI. After being told her pain was chronic, she became very distressed because her dream was to write.
Hannah didn’t give up on her dream and instead turned into a warrior! She did her own research and learnt about the mind and body connection. She realised that if she used this mind body connection to start tackling her chronic pain, reducing stress and letting go of negativity, she could start to regain her level of functioning. After eight months of debilitating pain, Hannah states that she is almost completely recovered, and she’s now writing! She ends her article with a wonderful, apt statement, explaining that if we begin to further understand the mind body connection, “the prize would be that many chronic pain patients might start to feel a little less lost and, hopefully, find the tools they need to begin to heal.”
Retired Navy Senior Chief Petty Officer Jim Wilt
In this 2019 article on the Military Health System’s website, Jim Wilt tells the story of how he retrained his brain away from pain. After a training accident, he was left with chronic pain. Initially on the guidance of his doctors he tried to manage his pain with prescription medications, but understandably this failed to solve his problem. After Jim retired, he had an operation on his spine and began to do research into how he could retrain his brain.
He began to use mindful movement, meditation, exercise, physical therapy, pacing and other natural approaches to reduce his pain, and tapered off his medication under the guidance of his doctor. Jim isn’t pain free, but he’s come a long way and has learnt how to manage and reduce his pain. He’s still on his recovery journey. He states in his article that despite not being pain free, “I feel better overall now that I no longer take prescription pain medications. I’ve regained the ability to feel real, authentic emotions.”
Bec shares her story in this powerful, emotionally written blog post, which is well worth a read. For a number of reasons (including a horse riding accident, degenerative disc disease and hypermobility in her joints), Bec had been suffering with chronic pain for years. Yet she loved exercise and refused to give up on her passion of staying active!
After years of tests and a variety of treatments, Bec started to learn about the science behind chronic pain and realised that pacing and gradually increasing her activity level was part of retraining her brain. She explains that, like me, she came to an understanding that, “even if it hurt, it wasn’t going to physically harm me”. She began to see improvements, but life got in the way, and stress took over. Her quality of life reduced, but Bec never gave up!
She saw a new doctor and started a new treatment programme including exercise, manual therapy and graded motor imagery (GMI). Bec’s life started to improve, her activity levels increased and she could see light through the darkness once again. She began to run! She completed a 5k, then a 10k, then a half marathon! She wasn’t pain free, but she was fighting her pain amazingly!
Bec is still on her recovery journey and is working to overcome flares and live a full life. What an amazing woman! She ends her article with a beautiful, inspiring statement: “It is possible to overcome chronic pain. You do not have to learn to live with it, or manage it. You can treat it and change it. No matter how out of reach this may seem, know that it is true.”
Things To Keep In Mind
Recovery means different things for everyone
It’s important to remember that recovery is very much a personal, individual process. For some people, recovery from chronic pain may mean a reduction in symptoms and an improvement in quality of life. For others, it may mean that they are pain free.
Although of course being pain free would be the ultimate goal, if your recovery means you are experiencing less pain and are better able to live your life, that’s still a great success. It’s important not to compare ourselves to others, and to celebrate each success we make on our journey.
Setbacks don’t equal failure
Very few recovery journeys start from one point and continue to progress in a positive direction until they reach their goal. Recovery is all about learning and growing. We’re all human, so inevitably we may make mistakes, or we may have setbacks. These setbacks do not equal failure. They do not take away from the progress you’ve made. They do not mean that you cannot achieve your goal.
Progression can take time
If you don’t see progress right away, or even a few months into your journey, this doesn’t mean you won’t get there! If your progress is mild or seems to be taking a long time, know that you’re heading in the right direction. Progression truly can take time with retraining your brain. Don’t give up!
You must believe in yourself
If you’ve dedicated yourself to retraining your brain, you must of course understand the science and believe that it’s possible. However it’s also vital you believe in yourself! Build yourself up. Encourage yourself. Believe that you are capable and you can succeed.
Hope lies ahead
If you’re in doubt or are feeling that you are not going to be successful, remind yourself of the science. Look back over the evidence. Read personal success stories. Remember that retraining your brain is possible. There is hope in the future for your own success story. And don’t forget, we’re here to help you on your recovery journey. Download our app for chronic pain (links below).
- Cort Johnson, (2019), “Rewiring the Brain to Get Out of Pain: the Moskowitz Approach”. Health Rising.”
- Michael Moskowitz, Marla Golden, (2015), “Education”. Neuroplastix.
- Marina Shpaner, Clare Kelly, Greg Lieberman, et al, (2014), “Unlearning chronic pain: A randomized controlled trial to investigate changes in intrinsic brain connectivity following Cognitive Behavioral Therapy”. NeuroImage: Clinical Volume 5, 2014, Pages 365-376
- Integrative Pain Science Institute, (2018), “How CBT affects the brains of patients with pain”.
- Laura E.Simons, Lauren E.Harrison, Shannon F.O’Brien, (2019), “Graded exposure treatment for adolescents with chronic pain (GET Living): Protocol for a randomized controlled trial enhanced with single case experimental design”. Contemporary Clinical Trials Communications, Volume 16, December 2019, 100448
- Walz, Andrea D. MSc; Usichenko, Taras MD; Moseley, G. Lorimer PhD; Lotze, Martin MD, (2013), “Graded Motor Imagery and the Impact on Pain Processing in a Case of CRPS”. The Clinical Journal of Pain: March 2013 – Volume 29 – Issue 3 – p 276-279
- Gabriel Tan, PhD, Richard Sherman, PhD, Bilal F. Shanti, MD, (2012), “Biofeedback Pain Interventions”. Practical Pain Management, Volume 3, Issue 3.
- painHEALTH, (2020), “Pacing and Goal Setting”
- Integrative Pain Science Institute, (2018), “How chronic pain rewires the brian and 5 proven ways to reverse it.”
- Norman Doidge, (2015), “Training the brain to beat pain”. Weekend Australian Magazine.
- Michael Moskowitz, Marla Golden, (2015), “Neuroplastix”.
- Hannah Millington, (2019), “To cure my chronic pain, I had to learn about the links between mind and body”. The Guardian.
- Retired Navy Senior Chief Petty Officer Jim Wilt, (2019), “I learned how to retrain my brain to manage chronic pain”. Health.mil
- Bec, (2015), “Bec’s Story – overcoming chronic pain”. Specialist Pain Physio Clinics.
Please note: This article is made available for educational purposes only, not to provide personal medical advice.