Chronic pain and Neuroplasticity

March 9, 2016 Gordon A. Irving, MD

Why do you continue to have pain long after whatever caused the pain is gone? The answer is that the pain has changed parts of your brain. These altered parts continue to send messages, prolonging the agony. And some parts of your brain, such as the hypothalamus, may have shrunk and no longer work as well.

We used to believe that after childhood, the brain began a long period of decline and steadily lost neurons, or nerve cells. According to this theory, the decline would accelerate if you suffered something such as chronic pain. Now we know that brain neurons are changeable, or “plastic.” No matter how old you are, your brain has neuroplasticity. In the case of pain, that means shrunken areas can be encouraged to expand and change again, this time in positive ways, thereby reducing your pain.

Your pain is all in your head

Have you ever heard this? Perhaps all of your pain tests have come back normal. Your surgeon believes he or she has done a great job and there is nothing else that can be fixed. Yet your back, neck, leg or whatever is still in agony. Those pain sensations from your skin, bones, joints or muscles send messages to your brain, and it’s how those sensations are perceived by the brain that makes you suffer.

If you suffer from chronic pain, you may have noticed that the intensity can change with your mood, perception of past experiences or how serious you think your condition is. Pain medication research has shown that a sugar pill, or “placebo,” can decrease pain significantly in up to 40 percent of patients. These effects are real and we can see them occur with special brain scans.

Why don’t medications stop pain?

Medication may decrease chronic pain, and it can play a role in improving quality of life. But it doesn’t eliminate chronic pain. Medication tends to change the perception of pain by altering how some nerves and neurons fire, but generally medication does not affect neuroplasticity or create positive changes in the brain. If you suffer chronic pain, the areas of your brain that have shrunk remain small and some medications, such as narcotics, may even shrink the brain further.

How can we change the brain to decrease or stop chronic pain?

Regular exercise, eating healthy, stopping smoking, keeping your mind active, relaxation and mindfulness meditation techniques all can decrease chronic pain, and now we are learning why. They affect neuroplasticity and can create positive change in a brain that feels chronic pain. I will go deeper into reasons and specifics in future blog posts, but a good place to start learning more is to read the booklet STOMP (Structure Your Own Management of Pain). This Swedish program is designed to help people with chronic pain take charge of their care.

Think of MIRROR

As you try to understand and reduce your pain, use MIRROR for maximum results and to maintain a positive outlook:

Motivation: Stay motivated to change the brain; it will take time.
Intention: Focus on changing the brain to change the pain.
Relentlessness: Don’t let a pain spike go by without trying to ease it, without medication.
Reliability: Count on the brain to make positive changes.
Opportunity: Change pain from a symptom to a signal that can be interpreted differently.
Restoration: Expect the brain to return to normal function.

If you need more guidance on managing pain, we can help. Visit Swedish Pain Services to learn how to schedule a consultation at one of our convenient locations.

Suggested Reading

  • An Introduction to Mind Body Medicine, by Howard Schubiner, M.D.
  • “They Can't Find Anything Wrong! 7 Keys to Understanding, Treating, and Healing Stress Illness," by David D. Clarke, M.D. Dr. Clarke is a specialist in gastroenterology and this book describes how stress can cause severe, unexplained pain. Dr. Clarke discusses how to understand and treat this pain.
  • "Unlearn your pain," by H. Schubiner, M.D. This book explains the neuroplasticity of the brain. It includes a one-month instructional program to calm the hyper-excited brain and a CD for relaxation.
  • Back in Control: A Spine Surgeon’s Roadmap Out of Chronic Pain,” by David Hanscom, M.D. Dr. Hanscom discusses how to quiet a turbocharged central nervous system and make a full recovery. His patient stories, as well as his own, show that you can take charge of your care and set yourself on the road to a healthy, rich and full life.


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