A more in depth look at chronic pain

Pain is not only a huge problem for the sufferers, it is also a huge problem for the nation. [data from Gaskin, DJ]

What do experts say about chronic pain? “For some unfortunate persons, pain persists beyond the healing time needed for recovery from an injury, extending indefinitely because of factors that are pathogenetically and physically remote from the originating cause. Often, such pain bears little or no relationship to observable tissue damage. Pain that exists indefinitely under these conditions is chronic pain.” [Chapman and Nakamura] “Chronic pain is often defined as any pain lasting more than 12 weeks. Whereas acute pain is a normal sensation that alerts us to possible injury, chronic pain is very different. Chronic pain persists—often for months or even longer.” [NIH MedlinePlus] “Around 100 million adults in the United States are affected by chronic pain in a single year. The annual total cost of pain, including direct costs, decreased wages and lost productivity, eclipses that of any other condition” [Holmes, David].

The goal of retraining the brain away from pain is to keep helpful pain, but reduce or eliminate unhelpful pain.

Pain related to tissue damage is, of course, very useful for survival (here “tissue” refers to all the skin, bones, organs and other stuff that make up a human body). Congenital insensitivity to pain is a serious disease. “From birth, affected individuals never feel pain in any part of their body when injured. People with this condition can feel the difference between sharp and dull and hot and cold, but cannot sense, for example, that a hot beverage is burning their tongue. This lack of pain awareness often leads to an accumulation of wounds, bruises, broken bones, and other health issues that may go undetected. Young children with congenital insensitivity to pain may have mouth or finger wounds due to repeated self-biting and may also experience multiple burn-related injuries. These repeated injuries often lead to a reduced life expectancy in people with congenital insensitivity to pain.” (ghr.nlm.nih.gov/condition/congenital-insensitivity-to-pain)

Pain thus serves not only to alert us that our hand is on a burning surface and thus minimize tissue damage, but also to motivate us to let injured tissues take a break to heal. This type of “nociceptive” pain (pain due to tissue damage) is useful. Chronic pain is not useful! It has no survival value. Chronic pain is basically a brain pathology: neuroplasticity gone wrong. The whole goal of chronic pain therapy grounded in neuroplasticity is to undo the takeover of the brain by pain. Pain is a construct of the brain designed to protect you, but pain becomes useless after sensitization.

Everyone I have met with chronic pain believes that their pain is due to a body problem (or multiple body problems). But there is no way of knowing if this is the case because of the brain problem, which can create pain even after the body problem is healed or even if the body part has been removed!

For all but one person whom I have met that has dealt with the brain problem, it has turned out that there was no significant underlying body problem anymore. Their bodies had healed, but the pain had continued due to the brain problem in the same or nearby location to where it had begun, leading to the confusion. This includes cases of diagnosed long term chronic pain from shingles, from sciatica, from bursitis, and from a galaxy of “abnormalities” seen in X-rays, especially of the lower back. The one exception was from diabetic neuropathy.

Once the brain problem is solved, your chronic pain will be gone or greatly reduced. Any remaining signals coming from the body, such as from an incurable disease like diabetic neuropathy, can then be dealt with by retraining your brain to make better choices about what is in your conscious awareness (distraction) and by reducing the unpleasantness associated with the signals coming from the body with meditation and with affirmations. A very useful affirmation is: “I feel that. It’s of no importance.”

If the brain experiences enough stimulation from damaged tissue during the nociceptive phase, it learns to create the sensation of pain better and better! It gets better and better at creating and experiencing pain. It can create the sensation of pain from light touch or even in missing limbs!

Phantom limb pain clearly demonstrates that pain felt in a part of the body is actually due to mental processes in the brain that are referred to the body image in the brain. As long as the missing limb remains a part of the body image in the brain, it can still hurt! In this case it is clear that experiencing this type of pain serves no purpose. Mirror boxes, which will be discussed below, have treated phantom limb pain by successfully retraining the brain.

Dr. Moskowitz, along with Dr. John Sarno, was one of the first to call attention to the idea that understanding chronic pain required tracing it back to the brain. He delineated the anatomy, physiology and molecular biology of brain-based pain. [Moskowitz] There is evidence that as chronic pain persists, it takes over more and more of the brain. [neuroplastix.com] Daily pleasures such as having fun and being active become compromised as the brain becomes increasingly focused on chronic pain. The cure, as mentioned in Dr. Doidge’s book (based on Dr. Moskowitz’s research), is to retrain the brain away from pain.