In chronic pain research, scientists often distinguish between structural and neural pain. Structural pain – whether acute or chronic – has a physical cause that can be identified and potentially treated. Neural pain is pain that is not traceable to a particular cause but that persists. Essentially, the brain experiences pain and creates a memory of that pain. This memory of pain becomes embedded in the brain and may result in acute pain becoming chronic. But can we “unlearn” chronic pain? Recent research says yes.
Chronic pain and cell memory
While many chronic pain sufferers understandably bristle when anyone insinuates that chronic pain is “all in their head,” new research from King’s College London has found evidence that cell memory may be more responsible for pain than previously thought.
Researchers looked at the nervous systems of mice and found that injury or acute pain left epigenetic marks that determined which genes were expressed. These marks may or may not affect the functioning of the cell. Those mice suffering from chronic pain had hundreds of epigenetic marks that may have changed the function of the cells, indicating a cell “memory” of pain.
Dr. Franziska Denk, first author of the study, from the Wolfson Centre for Age Related Diseases at the Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King’s College London, said the goal of the study was to determine why some pain turns from acute to chronic, noting:
“We are ultimately trying to reveal why pain can turn into a chronic condition. We already knew that chronic pain patients have nerves that are more active, and we think this is probably due to various proteins and channels in those nerves having different properties. However, it is unclear why these nerves should remain in this overactive, highly sensitive state, even when the initial injury or disease has gone: the back pain from two years ago that never quite went away or the joints that are still painful despite your rheumatoid arthritis being in remission.”
All pain is real
All pain is real, and all pain is in the head. Chronic pain patients may continually hear that their pain is “made up” and only in their head. At least half of that statement is true. But, chronic pain is not made up or imaginary. Patients who suffer feel it physically in a way that can be debilitating and impact their daily lives. However, pain that has no identifiable cause can often be traced back to one source: the brain.
Our neural pathways can serve protective functions with regard to pain. They teach us not to touch hot things or tell us when we have injured another part of our body. When these pathways become overstimulated and grooved, our pain signals become overactive and hypersensitive. If this pattern continues, chronic pain may result.
When an acute injury is healed and pain becomes chronic, the neural pathways of the brain begin to change in a way that is similar to addiction or a habit. Once changed, neural grooves are difficult (but not impossible) to reverse. This occurs without any effort or knowledge of it happening.
New chronic pain research
A study from the CNRS Institut des Neurosciences Cellulaires et Intégratives in Strasbourg, Francehas found a “command center” in the brain that may be key in explaining why pain becomes chronic. Thirty neurons located in the hypothalamus seem to control the release of oxytocin, a chemical which controls how the body responds to pain. If this group of neurons is not functioning properly or is overstimulated, this could affect how the body responds to pain, both in the short- and long-term.
New research is looking at another method for helping the brain to “unlearn” chronic pain. This method retriggers the old injury and then effectively erases the memory of that injury from the brain. Yves De Koninck, a professor of neuroscience at Université Laval in Canada, injected capsaicin into the paws of mice to trigger hypersensitivity, then repeated that same injection but with anisomycin, an antibiotic. The mice experienced the same neural activity that created hypersensitivity, but the anisomycin stopped the spinal cord from producing additional pain receptors. It is these additional receptors that may cause pain to become chronic in people.
New treatments based on this research are a long way off, but anything that may provide new options to solve the mystery of why pain becomes chronic is a welcome discovery.
How to start unlearning chronic pain
The brain is an incredibly elastic organ that has the capability to learn for the entire human lifespan. The reverse of this is also true: chronic pain can be “unlearned.” There are a few therapeutic approaches that can be used in conjunction with traditional treatments to address the mind-body connection of chronic pain.
One of the ways in which chronic pain can be unlearned is by attending to it just as it is when it occurs without projecting, exaggerating, or catastrophizing. This type of attention is called mindfulness. Mindfulness (and mindfulness meditation) is truly the process of changing your mind. When pain hits, instead of worrying about it or thinking about what might happen, mindfulness asks the practitioner to think about what is happening at the exact moment it occurs, breathing and allowing the sensations to be present.
While this seems like a simplistic approach, there is evidence that practicing mindfulness works to help chronic pain patients cope with their pain. A study in 2009 found that just three 20-minutes of mindfulness meditation helped reduce pain measurably. Another meta-analysis of studies found that mindfulness meditation helped to “turn down the volume” of chronic pain.
Sarno method (ACT and CBT)
A more controversial approach to unlearning chronic pain combines acceptance and commitment therapy with cognitive behavior therapy to get chronic pain patients moving back into their life. Barring structural causes of pain, the Sarno method counsels patients to tell their body that they are going to move, regardless of pain. According to this method, a patient suffering from chronic back pain with no cause should not allow pain to stop them from doing what they would do normally. This includes leisure activities as well as any physical therapy and rehabilitation recommended.
Many people, doctors and chronic pain patients alike, struggle with this type of treatment, but anecdotal evidence supports its effectiveness for some. If pain is largely a learned behavior, then changing the ingrained pattern of this learning may change (or eliminate) pain altogether.
Do you believe the brain is responsible for chronic pain?