Neuroplastix

Change the Brain; Relieve the Pain; Transform the Person

Pain Gone Wild


Wiring New Connections


Substance-P: The “P” in Pain


Substance-P is the main pain neurotransmitter. It has five basic functions in the body. They are pain, inflammation, anxiety, depression and nausea. Even though these seem like negative experiences, they are important for survival. Problems arise with excessive production and release of Substance-P. Look at the graphic on page 36 of the Neuroplastic Transformation workbook. It depicts a nerve injury causing a massive release of Substance-P, up to 5 times greater than in acute pain. This diffuses out to three to five times more local area. This is a major way that the pain map expands in persistent pain and keeps the pain going. It is also involved in maintaining the inflammatory brain-body loop, when much of the excess Substance-P is sent back down nerve axons diffuses backwards through synapses and is released from pain receptors into injured tissues.

Traumatic experiences throughout life, often starting in childhood and overlooked, set the stage for excessive release of Substance-P later in life and prime individuals for the development of persistent pain states. All aspects of a person’s traumatic life experience need to be addressed in order for the treatment of persistent pain disorders to have lasting effects. Literally we have to help people replace the release of Substance-P, with soothing neurotransmitters and anti-inflammatory and healing molecules.

Look at the graphic on page 35 of the Neuroplastic Transformation workbook. It shows the limbic cortex in the brain activated with stress, anxiety, depression, and/or pain. Deeper serotonin and norepinephrine rich regions of the brain oppose this. These areas can send molecules to the limbic cortex and calm the effects of too much Substance-P release. Learning self-soothing techniques can be very helpful in controlling these problems. Because emotional circuits and pain circuits share brain regions and nerve cells there is a great overlap of pain disorders and mood disturbances. Reining the release of Substance-P can go a long way to controlling pain and mood disturbances.

Fighting Off Anxiety and Depression


Pain is often accompanied by anxiety and depression. Although this makes sense from a standpoint of pain’s persistence provoking these feelings, there are very real changes happening in the brain that promote a sense of fear and hopelessness. Mood problems occur because of how pain stimulates and steals nerve cells and depletes neurotransmitters that allow us to self soothe, be calm and be happy. Look at and read the text on page 35 of the Neuroplastic Transformation workbook. This explains the interplay of pain and mood problems, but also reveals the extensive types of brain changes that lock pain, anxiety and depression in with each other.

To change this situation mood problems should be dealt with as a neuroplastic puzzle to be solved. The same idea of letting the symptom itself become the signal to do something to counter it needs to be employed until it is mastered. Self-soothing activities used to fight pain work just as well for anxiety and depression.

The following list of things to do can be helpful:


Passive to Active


Pain starts out as a warning signal to protect us from injury. Persistent pain tricks us into becoming less and less active. People start to believe that normal activity will damage them. They restrict their activity to prevent the pain and become deconditioned as a result. Deconditioning can lead to more pain due to muscle weakness, loss of strength and balance, and inappropriate beliefs. They withdraw and become socially isolated. Passivity begins to dominate active life planning. Pain avoidance becomes the number one priority and takes over the person’s identity.

Look at page 35 of the workbook. Read the last column. Step back into your life.

Expanding the Pain Map


The brain learns pain the same way it learns anything else. As we master new tasks, signals are sent with increasing frequency back and forth from body and brain. We make new synapses to wire in these activities and, at the same time, break less used synapses. Because the brain has to budget its allotted supply of energy and a great deal of energy is devoted to making new synapses and maintaining old ones, we cannot make the new without breaking the old. Other processes occur simultaneously, including expansion of the actual brain territory devoted to this new learning, increased strength of nerve firing, increased frequency of nerve firing, rebalancing of brain and body responses via electrical circuits and molecular signaling and establishment of a new equilibrium in both brain and body to maintain this new learning.

When the wiring is happening because of persistent pain signals, the same processes form new synapses dedicated to pain, while breaking other less active synapses in brain areas that process pain. Read the text on page 36 of the Neuroplastic Transformation workbook. The expanded pain map causes more pain and loss of other functions processed in these pain processing regions.

Look at the “Pain Makes Pain” graphic on page 36 of the Neuroplastic Transformation workbook. Picture the Substance-P being released pulling back into the nerve cell, instead of spreading out to more regions.

All Roads lead to Unpleasantness


Everything about pain is an unpleasant experience. When a pain signal reaches the brain, it generates changes in hormones, the state of arousal, the excitatory automatic processes, sensory and motor centers and emotional centers of the brain. The graphic on page 37 of the Neuroplastic Transformation workbook depicts this. When we cannot escape pain because it keeps returning, people lose the expectation of relief and a growing sense of anxiety begins. When the pain is a constant companion, most people experience hopelessness and depression. The overall experience of persistent pain is that of pain unpleasantness, persistence and constancy, mingled with depression and anxiety. This tends to lock in the trauma experienced during the injury, its treatment and recovery. The pain generates overwhelming anxiety, stimulating anatomical pain and emotional centers, releasing excitatory neurotransmitters, activating perpetual nerve firing, releasing more inflammatory substances and placing the peripheral body in a constant state of “red alert.” In a sense the pump is primed for fight and flight and the experience of destabilizing terror is just another increased pain episode away.

Be willing to experience the pain to try to gain an understanding of what can be done about it. Once the fear of your pain is brought under control, this becomes a much easier task. Fear is a huge part of what makes pain so intolerable and that fear is built into the experience of pain unpleasantness. Understand that the unpleasantness of your pain is really the combination of a number of events happening in your brain and your peripheral body. Try to tease apart pain from other sensations, but also from your emotions. See if you can determine what you are experiencing in its individual pieces rather than as overwhelming unpleasantness. See if you can bring reason to your emotional responses and calm them down. Try different physical activities and see what hurts and what helps. Avoid anything that hurts until you can work with someone who can tell you if it is all right to move through that pain. Otherwise, see the pain as a way for your body to communicate to you what you should and should not do. Keep looking for ways to get around it, ways to be functional or to restore function. Keep pushing the limits in reasonable increments, while listening to your body for new directions in what to do. Keep trying new ideas that help you take greater control of your pain and your life. Look for things that you can do in the moment, that don’t require any more than minimal equipment and are not invasive in nature. Be as relentless as your pain in finding new activities that reduce it.

The Survival Response: The Amygdala Rules


Unrelenting pain, never healing and constantly present, frequently leads to a derailment of a person’s life that should be seen as the slow motion part of the injury. We all expect pain to leave once we are stabilized, but persistent pain does not behave this way. As it becomes clear the pain is not leaving, a sense of disbelief sets in. The pain is disabling and the person gradually loses contact with friends and co-workers, work-related identity, social context and family. Fear takes hold. Medical tests and treatments that lead to more pain and partial or poor outcomes augment this fear. As the intensity of the pain increases so does the intensity of the fear. People experience their pain in the survival center of the brain called the Amygdala. Soothing from others has little impact as the unrelenting pain isolates the person’s experience from that of everyone else. Hope of recovery leaves when the person is told that there is nothing further that can be done. Hope and motivation fade. The physical and emotional trauma merge. People live in an anxious state of pain and emotional upset. Interrupted sleep, fatigue and unrelenting pain make it even more difficult to cope. Instinctual terror and panic are triggered. Pain takes over reasoning, problem solving, emotional regulation and breaks the spirit. The pain becomes an enemy from within that attacks randomly. The person becomes emotionally and physically overwhelmed.

Look at the graphic and read the text on page 38 of the Neuroplastic Transformation workbook. Remembering that we are not defined by our pain turns on higher brain function and allows a person to put their pain and emotional response into perspective.

Recognizing the Response


Look at page 39 of the Neuroplastic Transformation workbook. Read throughout the text. The graphic and accompanying text explains the resonance that occurs between the amygdala and the hippocampus, locking in traumatic memory. Persistent pain causes us to become stuck in the loop between the amygdala and the hippocampus. This prevents the higher functioning parts of the brain from modifying the pain. It traps a person in their wild amygdala. The emotions here are extreme, and we tend to relive events in their extreme, when caught in this region of the brain. Higher language centers do not work and without words it becomes impossible to integrate this experience into your life story, known as your personal narrative. Putting words on the emotions and events can be helpful. Just recognizing that you are stuck in your amygdala, begins to activate effective problem solving, language, emotional regulation and planning centers in your brain to modify the raw and reactive experience of being in your amygdala. The treatment itself and the failure of that treatment can cause the same result. The person experiencing this feels traumatized and the stress is never integrated into the personal narrative.

Remember the circumstance surrounding your pain. Recall the emotions and the sense of fear, anger, loss, disappointment and sorrow. What are the feelings that come up for you when you let yourself think about what has happened? Can you think of ways you have had to defend your pain and have felt under attack by others. Instead of doing that, tell your pain and the accompanying feelings that it is time to move on to forgive the people you have to forgive, let the trauma of all of this shift from center stage in your life to a part of your life story. Acknowledge what you have lost, but recognize this as part of moving through life for all of us and that your losses open you up to new opportunities and experiences. Reclaim the pleasure of the things you used to be able to do, by thinking about them actively and remembering them fondly. Look at pictures of yourself before the persistent pain problem. If regret or sorrow arise, replace these feelings with gratitude that you were able to enjoy that part of your life and a sense of hope and optimism that you will increasingly enjoy the rest of it. Pledge to engage in more activity with friends and family. Volunteer your time and talents for a group or activity that means something to you. If you are going through a medical legal process, do not let it color everything that you do. Do not stake your entire future on the outcome, because that is almost always fraught with disappointment and anger. Try to emphasize the positive and reject bitterness, resentment and isolation.

Taming the Amygdala


If the emotions that either accompany or worsen your pain are too frightening to face, ask why this is so? Do not give into the fear. Ask yourself what is so frightening about what you are feeling? What is so terrifying about the pain? Is it the fear that you will not be able to do what you have planned? Is it that you will have hours or days to pay for some perceived excessive activity? Is it that the things you have learned to diffuse your pain will not work and that you will have no defense against it? Is it that the pain will never leave you and that this will make you miserable for the rest of your life? Question the validity of these ideas and feelings. Pain always varies in intensity. If it doesn’t feel like it does vary, then assume that your emotional conflicts are playing a role in the experience you are having about your pain. Attack the pain from that end. Start examining what you are feeling emotionally and question why this has such a grip on you. Are these emotions completely unique to your pain or do you have them under other circumstances, as well? If they are unique, try to figure out why your pain has brought up these feelings. In a sense, loosen them from the grip of your pain and examine them in the light of your own understanding. If the emotions do feel familiar to you, something you have experienced under other circumstances, try to determine what is common about that experience and the experience of your pain. It may be that there is an unconscious link between this trauma/pain and another in your life. Do the emotions seem magnified or out of proportion to your pain? Again, this may be a clue that the pain is compromising your emotional life and your emotions are helping to perpetuate the pain. Break this cycle by calming and soothing yourself during pain episodes, while treating them with interest and curiosity to try to find out the link between your pain and your emotional state.

Connection, Integration and Perspective


Some treatments themselves can be painful. It is important to be comfortable with being a little uncomfortable. It is often helpful to try some things that cause you to relive the trauma. If this is tolerable, try to continue, as this may be what you need to work through it. It is imperative to release any negative or upsetting emotions associated with the traumatic incident. Healing must occur throughout your body. Emotional release often occurs in conjunction with reconnecting to our bodies through manual therapy, sound or music therapy, movement or exercise. Be patient with yourself and your body. Injuries can happen in an instant, but healing may take months or years. Nurture yourself during the process. Tend to yourself. Eat well to give your body the building blocks it needs to heal. Be sure to rest. The body needs rest and time to heal. This doesn’t mean spending the day in bed, but instead should punctuate periods of activity with periods of rest, pacing the day and advancing activity. Restorative rest is essential. Sleep may be difficult either constitutionally or from the pain or both. Explore as many non-medication approaches to enhance restorative sleep, as possible. These can include relaxation exercises, muscle tension and relaxation, soothing thoughts and images, soothing sounds, white noise and meditation.

All of these approaches allow you to have a different relationship with your persistent pain. Our bodies hold pain, emotions and memory. Working on this with the idea of releasing or freeing your body is an excellent way to stimulate the emotionally locked in parts of your brain. Once you stop fearing the pain and stop looking at it as if it is an acute warning of an immediate danger, the pain can actually help you understand what you have to change in your life to be done with it. Just the very act of thinking of your pain in this way decreases your suffering and starts you on the road to recovery. When you stop dealing with the persistent pain in the fight/flight, survival regions of your brain and start integrating it into your personal narrative, the pain becomes another problem to be solved and its place in your life fades from the central experience through which everything is filtered to a peripheral issue to be dealt with like all others.