Neuroplastix

Change the Brain; Relieve the Pain; Transform the Person

Soothing


Wiring New Connections


Pleasure or Pain


Pleasure and pain appear to be completely opposite concepts. There are times when seemingly painful experiences can give us great pleasure. On the other hand pleasurable experiences can have painful aspects. If something is painful, yet valuable than the pain is acceptable. An example would be the pain of a good workout yielding to the pleasure of attaining a goal of being fit. Childbirth is one of the most painful experiences that anyone can have, yet the reward of having a child is well worth the pain. When that very child leaves for college it is often a bittersweet moment, leading to painful experience of loss and emptiness.

The person with persistent pain, due to no conscious decision of their own, suffers in vein. The choice wasn’t theirs and the pain feels completely negative. This pain takes over a person’s life and robs people of pleasurable experience. Under these circumstances pleasure and pain do not exist simultaneously. We have choices to either reframe persistent pain differently to find something valuable from the experience or to replace pain with pleasurable experiences to rewire the brain away from persistent pain. Triumphing over that pain can be strengthening, defining, fortifying and transformational.

Look at the Graphic on page 43 of the Neuroplastic Transformation workbook. It shows the Orbital Frontal Cortex and many of it’s important functions. This is the area located above the eyes and is most highly developed in human beings. We use it to relate to other people with empathy and understanding, because it is here that we evaluate whether an experience is pleasurable or not. The primary directive of survival is to avoid pain and pursue pleasure and it is the two way circuit between the Orbital Frontal Cortex and the Amygdala and Hippocampus that allows us to do so.

Empathy, Understanding and Attunement


Review pages 43 and 44 of the Neuroplastic Transformation workbook. The circuits responsible for our sense of empathy, understanding and attunement are described. It is our mirror neurons in the insula connecting with the neurons in the orbital frontal cortex that process this input. This circuit allows us to make connections with other people. People with persistent pain often become withdrawn. Their suffering demoralizes and terrorizes them. Their entire sense of self becomes determined by their pain experience. Relating to others becomes more difficult. It is hard enough to understand why this pain does not go away. Trying to explain it to others is frustrating and fraught with reminders of the suffering. Struggling to complete the necessities of living doesn’t leave a lot of time for the richness of life. Mirror neurons turn inward and reflect a person’s own loss, sorrow, resentment and loneliness.

It is just as important to counter-stimulate this experience as it is the pain itself. The mirror neurons are designed to reflect to us what others are going through. Life is enriched by relating to other people and trying to understand what they are experiencing. We are drawn out of ourselves and extend beyond our own limitations. Reaching out to help others stimulates the insula to perform its other functions of reducing the emotional impact of pain, quieting fear, encouraging self-soothing and restoring pleasure.

Soothing Island of the Brain


The experience of unrelenting pain, constantly present and frighteningly familiar, can be used as a signal to self-soothe. This type of pain is characteristic of persistent pain and is clearly abnormal. The terror that attends this pain goes beyond rational experience. It relates to the genuine fear that it will never leave and will disrupt and potentially destroy one’s life. This type of pain causes a sense of being trapped. The fear, anxiety, panic and pain are processed in the same areas of the brain. They become intimately entwined. These extreme emotions wrack the entire body with powerful electrical and chemical responses.

Look at the graphic on page 44 of the Neuroplastic Transformation workbook and read over the text describing the functions of the insula. This part of the brain modifies the intense emotional input from the amygdala, the fight-flight center of the brain and steps down this intensity to make emotions more tolerable. It is highly involved in self-soothing activities. The fear caused by persistent pain can be used as a signal to self-soothe. Remember what is soothing, and practice this when pain intrudes. Listen to soothing music. Rub a smooth stone or gently rub your skin. Apply a soothing lotion and pay attention to how that feels. What would soothe the area of your body where you feel pain? Try gentle self massage. Try to calm and soothe the emotions that accompany your pain. Use hope , courage, joy, pleasure, love and kindness to counter fear, anxiety, sadness, frustration and anger. If pain makes you feel isolated, reach out for family and friends. Come up with simple, soothing phrases, such as “calmly relax,” or “it will be ok.” Breathe slowly and relax your muscles. Appeal directly to your brain to shut off the pain. It serves no purpose.

Internal Mirrors


For most of us our mothers were the first source of soothing. Touch, taste, sustenance, thought, problem solving, social interaction, sound, sight, smell, warmth, relief, pleasure all come from these interactions. The actual shape and flexibility of our DNA is profoundly affected by these early experiences. The infant cries and someone responds. When that response is soothing, the brain and body make new connections and set up a memory of being soothed. The link of crying and being soothed is established. Over time, the child is rewarded for more pleasing behaviors, like smiling back at someone. As sounds are made by the child, they are often responded to with other pleasing sounds. Body language and facial expressions are read, interpreted and addressed even before any negative or positive value is assigned. In this way the child’s needs are attended to and anticipated, before they become anxious and fearful. Mirror neurons between mother and child are firing back and forth to make this preverbal connection that ushers the child into a world of increasing comfort, experience and pleasure. Mirror neurons look no different then the other nearby nerve cells, but their function is dedicated to read what is happening in others and to link that to our own experience. Long before rational thought is even possible, the most sophisticated part of our body, the connection between ourselves and others, is being stimulated. Literally, the infant is learning to connect to another and communicate what it needs, have those needs met and regulate their internal electrochemical environment. Thus, the association between soothing and relationship with another is established.

Self Portrait


Look at the graphic on page 45 of the Neuroplastic Transformation workbook. The homunculus is a representation of how the brain perceives the body based on the sensory information it receives. The brain sends out responses as a result of these stimuli. There are actually four input homunculi and one output homunculus. Even the simplest and most ordinary responses require extraordinarily complex coordination of events in the brain. The brain varies its response based upon the type and intensity of the sensation experienced. Under normal circumstances, moderation and balance are the rule. When the input is that of unrelenting pain, balanced brain responses yield to more extreme output. Over time this increasingly stresses the defensive and buffering systems of the body and leads to breakdown of normal function. At the same time, the brain’s accuracy in perceiving pain fails and the perception of pain expands to non-injured areas of the body. Restoring balance is essential. Paying attention to painful input and looking for other sensations being hidden by the pain is one way of accomplishing this. As the input to the brain is more accurately experienced, restoration of balance in the body leads to reduced physical stress, improved function and improved quality of life. Refer to page 45 in the Neuroplastic Transformation Workbook for a more detailed description of this process.

Wired by Senses


In the hierarchy of the sensation, pain demands the greatest level of consciousness and consideration. Its very unpleasantness is there as a danger signal, instantly invoking central and peripheral survival mechanisms. Although all of our senses are critical to our survival, pain is the alarm that indicates danger is high. The amygdala turns on, shuts off the higher associative regions of the brain, sends out the warning to the motor cortex, fires peripheral nerves, releases adrenalin, tenses muscles. We become ready to fight or flee. In persistent pain, the alarm does not predict current or impending damage to the place where the pain is located. Instead it reflects the damage inflicted by the pain itself to the body.

Emotion, sensation, memory and cognition are all integrated in the Associational Cortices. If pain is the overwhelming input, then everything is perceived as painful. It is in these areas where pain consumes us. We can start pulling out the negative thoughts, beliefs, emotions and sensations about pain, counter-stimulating with soothing and pleasurable experience. The input to the associational cortices is changed. This modifies the output from these highest functioning areas of the brain, decreasing the consumptive power of pain.

Integrating Pain into Thought and Action


The Associational cortices are the highest functioning part of our brains. Look at the graphic on page 46 of the Neuroplastic Transformation workbook. The Primary Association Cortices are made up of three other regions of the brain, the frontal cortex, the limbic cortex and the parietal cortex. Their function is described on the graphic and in the text. They have the ability to modify and override all other brain function and account for a great deal of the sophisticated decision making that adds up to the day to day experience of being human. Creativity, empathy, executive function, problem solving, planning, pleasure, logic, associational memory, conflict detection and resolution, emotional regulation, emotional perception, salience, trust, pleasure, disgust, pain perception and pain invoked emotion all take place in these areas. As such, the role of the Primary Associational Cortices is one of the highest sophistication, requiring a tremendous amount of energy. The Primary Somatosensory and Motor Cortices are a reliable parts of the brain. They process sensory input and motor output with little modification from the Associational Cortices. The Primary Associational Cortices can control and coordinate sensation and movement, but often do not interfere with the assessment of sensation, planning of motor action and execution of motor activity. The Primary Associational Cortices can be invoked purposefully to override the sensorimotor process. This is what allows us to intervene in the runaway belief, thought and action response associated with persistent pain.

Vetoing Pain


In reality, people with pain are the only ones who can truly help themselves. They are the only ones who know what they feel. They are the only ones who can determine which treatments work. For pain care to be effective, it must be self-directed and self-regulated, with a team of professionals and non-professionals. Positive outcome is measured by improved pain control, improved function and improved quality of life. Ultimately, the person with pain has to become the leader of their treatment team. They assess the situation, determine needs, set goals, find help and pursue appropriate strategies. They must reach out and connect with friends and family, reject self-isolation and fear-based limitations, reconnect to the pleasurable aspects of life and re-establish the rhythm and harmony of social existence.

Thoughts become beliefs and beliefs becomes reality. The brain perceives thoughts and mingles them with sensory experience, memories and emotions. This becomes reality. We can harness beliefs and redirect efforts and energy to change situations. Remembering always that the brain and body are one thing and that each has a profound effect upon the other, we can begin to imagine the possibility that things can change. As change occurs the beliefs about being able to overcome pain are reinforced. We begin to understand the endless potential and power within. People accomplish things that are thought to be impossible. There are countless numbers of inspirational stories about people who defied the odds, overcame their impairments and triumphed over what were thought to be insurmountable obstacles.

People with pain are told every day that there is nothing more that can be done for them. Living with persistent pain often requires an heroic attitude, unimaginable to those who have not experienced it. People who have pain must refuse to accept their current fate and be willing to harness their own power to begin the process of change that will overcome their pain and suffering. This will require not only belief, but determination, persistence, courage and endurance. There will be times when the validity of the effort will come into question. Setbacks will occur. It is important to understand during these times that the route to success is one of taking small steps every day and of changing in small increments. Relentless pursuit of pain relief, while surrounded by an assembled team of helping professionals and loved ones, remaining fully involved a vibrant life, will help push through these difficult times.

Sniffing Out Pain Relief


Peppermint shows significant evidence of efficacy for pain control. Peppermint molecules are effective as both anti-nausea and analgesic agents. There is excellent pharmacologic evidence that peppermint blocks Substance-P, the main pain neurotransmitter in the nervous system. Aside from pain, Substance-P is also involved in nausea, anxiety, depression and inflammation. Peppermint has been used to treat post-herpetic neuralgia, trigeminal neuralgia, chronic low back pain, neck pain, migraine and chronic daily headache, inflammatory pain, nerve pain and irritable bowel pain. One of peppermint’s main components is menthol, a soothing substance when placed on the skin. It is used in various rubs and ointments to activate cold temperature receptors on the skin and reduce musculoskeletal pain. Additionally, peppermint evokes a feeling of well being and has a positive effect on mood.

There is good evidence that lemon scent improves mood. Lemon has the highest concentration of a substance common to all citrus, limonene. There is no evidence that lemon reduces acute pain, but it appears to have the ability to bolster the immune system and reduce chronic inflammation.

Various scents stimulate pleasure circuits, and are helpful in counteracting pain. This active stimulation of pleasure circuits is a very powerful strategy and can ultimately become a direct replacement for abnormal pain. Pain and pleasure circuits are located in the same are of the brain. They each have their respective neurotransmitters. When the neurotransmitters of a stimulated pleasure circuit are released, pain neurotransmitters are suppressed.

Accessibility and Connectivity of the Scent Circuit


Scent is of great interest in trying to deal with pain because of the scent circuit’s connection to the amygdala and it’s tracing of the subsequent pain circuit. Review the graphic on page 48 of the Neuroplastic Transformation workbook and note the strong overlap of scent and pain circuits. Scent receptors are buried in the upper 1/3 of the mucous membrane in the nose designed to pick up odors and mingle these with taste receptors to come up with the array of scents that people are capable of distinguishing from each other. These include 300 to 400 specific scent receptors in nasal mucus membranes, that when combined allow for a vast array of scent discrimination.

Nerve endings for the scent receptors that start in the nose move through a series of small holes at the top of the nose and the base of the skull. The multiple nerve endings move from there to the first synapses in the olfactory bulb. The second synapse in the scent circuit is in the amygdala, the wild area of the brain responsible for such things as survival, raw emotional perception, emotional memory encoding and retrieval, as well as pain perception. The amygdala is the area where transition from automatic brain to thinking and perceiving brain occurs. It is here where we first perceive pain. Extreme emotions mix with the perception of pain danger, activating fight flight mechanisms. Reactive brain function selectively shuts off the higher brain’s ability to down regulate the emotional impact from the amygdala and sift through that input for problem solving and planning. Literally the amygdala takes over the rest of the thinking brain

Scent, Memory and Emotion


The amygdala receives first signals of scent, and a second scent signal, once it is processed by the scent circuit. It then assigns it a positive or negative meaning. This allows for a second chance to mount a fight flight response. Some of the most highly charged emotional memories are evoked by scent. The hippocampus, where memory is stored, also takes a direct connection from the olfactory bulb, linking scent to powerful memories. Furthermore the connections between the hippocampus and the amygdala are numerous and account for the emotional coloring of scent memories.

Scent and emotion are also highly interconnected. Look at the text on page 47 of the Neuroplastic Transformation workbook. Several scents evoke pleasant memory and pleasurable experience to counteract pain. Lavender, rose, spruce, peppermint, spearmint, wintergreen, orange, grapefruit, tangerine and lemon can be used to stimulate brain pleasure centers. Moreover, during periods of traumatic memory and excessive pain processing, these scents can be used to interfere with the stimulation of the circuit between the amygdala and the hippocampus. This can block the fight-flight response accompanying persistent pain

Belief Processed in Sensory Cortex


Look at graphic on page 49 of the Neuroplastic Transformation workbook. Belief is located in the sensory processing area of the brain. When we are born with our abundant, but sparsely connected set of nerve cells, we are truly helpless and dependent upon others. We wire by the sensory experiences of life and this wiring forms basic connections of the sensory and motor functions of our bodies. We begin to connect our nerve cells via our sense of touch, movement, position, pain, vibration, pleasure, temperature, physical comfort, sound, taste, scent, sight. It is by believing these experiences that we begin to reliably predict reality. The sensory experience of our bodies is sent to the sensory portions of the brains in the posterior parietal cortex, the primary somatosensory area and the secondary somatosensory area. These are major brain areas where we perceive pain, but other senses, as well. Our increasing sense of predictability, reliability and truth is intertwined with our sensory experience long before we have developed the ability to reason and think. Literally, what our senses teach us to believe is the basis of how we begin to define the world we live in. Our introduction into the bright, cold, painful, loud world, while being removed from the dark, warm, quiet, gestational comfort of the womb is our first brush with pain unpleasantness, and we greet it with a cry as we breathe in air for the first time. Our consciousness awakens into a riot of sensations, and new experiences come fast and furiously. From the very beginning the experiences of our senses lead to our beliefs and our beliefs will always have their underpinning in believing what we sense.

It is the belief that this pain can never be vanquished that strikes terror into the person who has it. The fear grows of the pain worsening and nothing working to relieve it. This pain takes over reason, problem solving, emotional regulation. It breaks the spirit. It’s very relentlessness fosters the belief that it can only be endured, at best controlled and at worst become an unbearable torment. Pleasure recedes to a distant memory and hopelessness establishes itself as a constant companion. Just as the other senses are diminished by constant pain, so thoughts themselves become focused only upon the pain and how to avoid it. Withdrawal into shrinking expectations and diminishing activity becomes the norm. Pain spikes strike randomly and often without any obvious precipitating event. The time of day, a change in the weather, extended sitting or standing, walking an extra distance all seem to be the cause of pain that not only comes, but lasts for hours, days, weeks and even months. Yet, new medical evaluations show no new damage. Pain from injuries of the past remain a constant companion and unremitting threat to predictability and comfort in the present. The longer this goes on, the more people believe that their pain is invincible and that it can only be relieved in a minimal fashion.

Patient and Provider Beliefs About Pain


Low expectation of pain control on the part of patients and providers leads to poor pain control. Settling for any improvement is not enough. Patients state clearly that they are always going to have pain, always need to be on medication and always be limited because of this pain. Providers set low expectations of pain relief. Statements are made to patients that they will have to learn to live with their pain and the best they can hope is to manage it. The provider-patient relationship is a powerful example of the social synapse, the connection between people involving mirror neurons and the highest Associational centers of the brain. As such, the words passed from provider to patient strongly determine patient beliefs. As belief centers in the sensory part of the brain become dominated by the expectation of pain, nerve cells in those belief centers are taken over by pain processing. The belief in the inevitability of pain expands the pain map in the sensory cortex where beliefs are born.

The process of healing starts by embracing the core belief that patients can be pain free. Providers need to believe that their patients can be free. They must continue to try new approaches to achieve this goal. The traditional model of care changes here. Patients become partners with their providers, rather than passive recipients of care.

Using Belief for Pain Relief


Life changes once people believe they can be pain free. An active approach to meet every pain spike with the belief that it can be stopped is the foundation for patients taking control of their lives. It may take a while to take control, but practice, repetition, relentlessness, adaptability and belief in yourself will result in pain relief. To do so, your brain and body have to work together as increasingly seamless parts of the entire whole. Pay attention to the pain and recognize it for what it truly is, a short circuit in a very useful system. Believe the brain can be rewired.

See yourself as moving through the phases of treatment. Your treatment will vary whether you are in the Rescue, Adjustment, Functionality or Transformation phase of care. The belief that medication management is all that is left for the treatment of persistent pain is flawed. Medication management and interventional treatments are methods we employ to move patients from the Rescue phase into the Adjustment phase. These are steps to being able to control pain, while they are applying neuroplastic strategies to overcome pain. Each has its place, but neither is the foundation of treatment.

Do not settle for partial pain control. Stabilizing out of control pain is essential, but so is the belief that we can end pain persistence. Remember that all beliefs require a leap of faith at some point. This is that point. This cannot be a thinly held belief, but must be unshakable. Your pain will try to shake it over and over and you must teach your brain and your body that it is the belief and experience of abnormal pain that is to be disbelieved.

Do not give into your fear. This must be actively rejected. Believe that you can rebuild your pain tolerance and increase your pain threshold. Tell your brain and peripheral body to wait until the pain becomes much worse before they recognize it is there. Break the pain down to its other components, pressure, movement, vibration, position, temperature, touch. Do not be afraid of your pain. Look at it as information provided by your body, and treat it as an opportunity to practice to overcome it.