4. Guided Imagery and Meditation

The Neuroplastix method (the method on neuroplastix.com by Michael Moskowitz, M.D., and Marla Golden, D.O.,) involves visualizing areas of brain activity associated with chronic pain decreasing in size. It was discussed in some detail above in the section on Chronic Pain Therapy Grounded in Neuroplasticity. It involves visualizing areas of brain activity associated with chronic pain decreasing in size. It has been reported, based on fMRI imaging, that the areas involved in different sorts of pain can be different [Makin, S] [Wager, T] and that in chronic pain there is a growing involvement of areas involving emotion [Baliki, M N]. But fMRI studies of chronic pain are in their infancy.

Dr. Moskowitz wrote to me: “fMRI readings are only part of our work. Before there were fMRIs
the areas of the brain that are major pain processing and perceiving regions were mapped out,
using other scientific techniques and approaches. fMRI is very helpful, but just another tool in
refining and confirming other science in the understanding of how the brain works. Dr. Golden
and I have scoured applicable literature on Neuroplasticity and our research has taken us to an
incredible body of cross discipline work ranging from basic neuroscience to clinical science. We
covered everything from physiology to genetic science in researching and writing up our work.
This work has yielded many ideas of how to help people, and we were fortunate to have large
numbers of patients to work with us on these approaches. We did not take the route of doing
our own randomized double blind trials, because the concept is too large to control enough
variables to do these types of studies, honestly. Our goal, instead, has been to gather the
information that has already been tested in various scientific manners and to pull together these
ideas across disciplines to come up with out approaches.”

Thus, there is evidence that this method is useful because: 1) it was gathered from already
tested information, 2) Drs. Moskowitz and Golden have documented the experiences of the
many people in the “Neuroplastic Transformation Workbook,” available at neuroplastix.com , and 3) It worked (very quickly) for Susan!

There are two main types of mindfulness meditation: focused attention, most typically on the breath, and open monitoring, being receptive to whatever arises moment by moment [Wallace]. Both of these have been shown to be helpful for dealing with pain. Focused attention has been shown to significantly reduce pain intensity ratings and pain unpleasantness ratings [Zeidan, Fadel]. Open monitoring has been shown to reduce pain unpleasantness but not pain intensity ratings [Brown CA, Jones AK]. Thus both types of mindfulness meditation can reduce the unpleasantness of pain. As the Dalai Lama said, “Pain is inevitable. Suffering is optional.” I currently understand this as, “Acute pain is inevitable. Suffering is optional. Chronic pain can be overcome.”
Zeiden and Fadel conclude: “Focused attention may attenuate pain by altering the elaboration of nociceptive information into pain, whereas open monitoring promotes a non evaluative stance to a fully experienced sensory event.” This seems especially important in light of recent fMRI imaging research that concludes, “Brain activity related to the perception of back pain shifts in location from regions involved in acute pain to engage emotion circuitry as the condition persists.” [Hashmi, et al.]

A 2016 study that included Mindfulness-based stress reduction (MBSR) and Cognitive Behavioural Therapy (CBT) concluded: “Among adults with chronic low back pain, treatment with MBSR or CBT, compared with usual care, resulted in greater improvement in back pain and functional limitations at 26 weeks, with no significant differences in outcomes between MBSR and CBT. These findings suggest that MBSR may be an effective treatment option for patients with chronic low back pain.”
People have also looked at the brain activity that is enhanced by meditation. Newberg et al. found that “there is increased blood being pumped into the prefrontal cortex and the anterior cingulate gyrus after participating in the meditation practice”. Engström et. al. found that compassion meditation increased “activation in the left medial prefrontal cortex extending to the anterior cingulate gyrus.” Thus one way of looking at brain retraining is to replace undesirable mental activity, for example, generating the experience of chronic pain, with desirable mental activity, for example, generating the experience of compassion by using a practice, for example, meditation.
As currently presented in the scientific literature, meditation is seen as a treatment, not a cure for chronic pain. But the literature does clearly document that the brain can be retrained with meditation to control the experience of pain in the moment. It is not a giant leap beyond this to believe that the brain can control the experience of pain more generally.
From a neuroplastic perspective, if we keep our focused attention on something other than pain, the pain is not experienced as much of the time. And recall that neurons that fire together wire together. So not experiencing pain as much of the time will not only help keep the pain from increasing, it will actually help decrease it because it is also true that neurons that don’t fire together don’t wire together. Thus it is not really a good idea to stoically endure pain, but rather, especially once one knows that there is no benefit to experiencing the pain, to reducing the pain with drugs or rubbing (especially in the acute phase), and meditation or visualization or distraction (especially in the chronic phase).