Bradley Fanestil, MD, medical director of BCH's
Center for Mind Body Medicine at Della Cava Family Medical Pavilion
We used to think that all pain was due to physical injury in the body,
and it was simply reflected in the brain. We now know that our brains
actually generate all our internal experiences, including pain.
Pain is nothing more than our brain's alarm mechanism for alerting
us to danger. If our brain thinks something should hurt, then the danger-alarm
mechanism in our brain will activate certain
neural pathways to create the experience of pain. This experience of pain can vary from
slightly annoying to excruciating, depending on how much danger the brain
perceives itself to be in.
We know the danger-alarm mechanism is more sensitive in people with a history
of traumatic childhood or other emotional events such as previous medical
trauma. The more a person has pain, and the more severe it is, the more
likely it is that the pain itself will further activate this danger-alarm
mechanism. This leads to a vicious cycle of pain leading to fear leading
to more pain. This is why chronic pain often gets worse with time, and
often begins to involve more and more areas of the body over time.
Many people with chronic pain problems are perceiving normal sensory input
from certain areas of their body as dangerous, and their brain is then
constructing the experience of pain.
My brain probably gets hundreds of sensory inputs per second. It decides–in
a split second, and without my awareness–whether the input is dangerous
or not. For instance, as I type this sentence, my brain is receiving input
from my left elbow, which is resting on the table, that there is some
pressure from the desk on the elbow. Even though the nerves in the elbow
that sensed the pressure are working just fine, I was not consciously
aware of that pressure until I typed the previous sentence.
The pressure information was indeed being sent, via the spinal cord, to
my brain. But my brain received that sensory input and made this decision:
“Thank you very much, elbow, for this information about pressure
on the elbow, but I’m in the middle of typing right now and I don’t
need to know this. So, I’m not going to allow that piece of data
to reach my conscious brain right now.”
However, another person with a history of trauma who has a very sensitive
danger-alarm mechanism might receive that same pressure-on-the-elbow information,
and their brain (again, in a split second and without their awareness)
might make the following decision: “Thanks for the info elbow, let
me just quickly review my personal history about pressure to various areas
on my body and – HOLY CRAP!! This is potentially dangerous based
on previous sensory input! I need to turn on an alarm to let John know
that we are in trouble and he needs to take action!” Boom. Neural
pain pathway activated.
The concept of neural pathways in the brain is one of the major new understandings
in neuroscience in the last decade. The more you practice a neural pathway,
the better you get at it. This can really help when you are learning to
ski, swim or ride a bike. But you really don’t want your brain practicing
pain. It is also important to realize that these neural pathways that
develop in the brain are completely outside of our conscious awareness.
When we learn to ride a bike, we do not learn to activate our right hip
muscles while stretching the left hip and flexing the ankle just so.
Just like bike riding, neural pathways form without conscious thought,
and pain neural pathways can form without conscious thought. This can
make them hard to control. But another new understanding in the last decade—and
good news for people with chronic pain or other problems that have been
hard to treat—is the concept of "neuroplasticity." This
is our understanding that these neural pathways can be turned on and off.
If you are riding a bike on asphalt, there is no way that your brain will
let you “forget” or “turn off” the complex neural
pathway that keeps you balanced on the bike, because your brain knows
that to turn off that pathway would be dangerous. But if I were to construct
a giant bike-riding room with the world’s cushiest and softest padding,
you could teach your brain to turn off or temporarily forget the bike-riding
neural pathway. Your brain would let you fall on these pads, because it
would feel safe.
In the same way, your brain will not turn off the pain pathway coming from
your back/abdomen/arm/neck/head/foot until you can convince your brain
that there is no danger coming from this area. Right now, there is some
part of your brain that continues to perceive danger from your area of
pain. Your job now is to convince your brain that the sensory input it
is receiving is not dangerous, and it can turn off the alarm.
For some people, just understanding that there is no actual tissue damage
is enough to resolve their pain. Other people need some coaching (using
specific techniques) or encouragement for their brain to really accept
that 20 years of very real pain is not actually due to a problem in the back.
Let me know when you are ready to pursue these ideas, because I am convinced
that most people with chronic pain will be able to get rid of it by educating
themselves and convincing their brain that there is nothing to fear.
The Center for Mind Body Medicine treats patients suffering from debilitating
health problems—chronic back, neck or pelvic pain, migraines and other hard-to-treat medical
conditions—that haven’t responded to traditional medical therapies. Call
303-415-8615 to schedule an appointment.