Re-Wiring Chronic Pain, National Pain Week 2022
National Pain Week 2022
This week marks National Pain Week 2022. Chronic Pain affects over 3.6 million Australians and is the leading cause of disability. Chronic pain is often poorly understood and many people are surprised that we now now that pain is ‘100% of the time produced by the brain.’ With this in mind here are some resources to help people with chronic pain “re-train’ their brain:
BIOFEEDBACK
Pain influences your nervous system, and your nervous system influences your pain.
This power of bi-directional influence can be thought of as a really busy two-way street. There is a brain body connection that wanders all the way through you. Biofeedback training teaches you how to rebalance your body and brain by showing you how your own nervous system is working. Biofeedback technology has been developed over more than 60 years. Over this time research has shown that Biofeedback can help people with chronic pain.
CURABLE
Identifying the missing pieces.
Curable is an online programme and app designed to help people with chronic pain. Curable helps people with pain identify and address the ‘missing pieces’ that can be excluded from treatment plans, including the role of the brain and the nervous system. The Curable programme guides users through engaging lessons about modern pain science and teaches them how to apply a wide range of science-backed techniques to reduce their symptoms.
GUIDED IMAGERY
Your imagination is as powerful an influence on your brain as reality.
Your thoughts can transform your experience of anything. While it is difficult to quantify just how much, there is a vast quantity of evidence that verifies that mindfulness meditation decreases pain and increases quality of life. Dr Rachael Coakley is a Paediatric Psychologist in the Pain Treatment Service at Boston Children’s Hospital and assistant professor at Harvard Medical School. Dr Coakley has developed three specific visualisation exercises that can relieve pain, create warmth and relaxation, and soothe muscle tension. Specifically visualising the colour, shape, and size of our pain experience can help take an abstract thing we have going on in our brains and give us a way of having some control over and then changing this experience.
MINDFULNESS COACH
Mindfulness training for everyone, not just the military.
Complex and cumulative traumatic experiences can change the way your brain tries to protect you from the world and from pain. By recognising the layered benefits of using both specific interventions for pain and underlying stress and depression you can then have a positive impact on the lived experience of PTSD as well. Mindfulness Coach was created by The US Department of Veterans Affairs National Centre for PTSD to help Veterans, Service members, and others learn how to practice mindfulness. The app provides a gradual, self-guided training program designed to help you understand and adopt a simple mindfulness practice. Mindfulness Coach also offers a library of information about mindfulness, 12 audio-guided mindfulness exercises, a growing catalogue of additional exercises available for free download, goal setting and tracking, a mindfulness mastery assessment to help you track your progress over time, customisable reminders, and access to other support and crisis resources.
MINDSPOT
There is an overlap when it comes to physical and emotional pain.
You feel it with a broken heart or when something is gut wrenching. Physical and emotional pain are woven together, in part, because some of the same brain areas are responsible for both pain experiences and emotions. This is some of how pain can feel like it impacts all aspects of your daily life and your emotional wellbeing. MINDSPOT is a government-funded non-for-profit mental health service with a team of experienced mental health professionals, including clinical psychologists, psychiatrists, and mental health nurses. The MINDSPOT 8 week Chronic Pain course recognises that chronic pain can impact not just your physical but your emotional wellbeing.
NEUROFEEDBACK
Changing your brain.
How your brain behaves when it comes to pain is not stuck or fixed, it is plastic - which means it works by changing all the time. Your brain is changing now because of what you are reading. It is changing with everything you think, feel, and do every moment of every day. Neurofeedback Therapy, also known as EEG Biofeedback, is a brain-based treatment that uses a sophisticated brain-computer interface to ‘strengthen’ or ‘rewire’ the brain, by training brainwaves, the tiny electrical signals produced by the brain. Neurofeedback Therapy is widely known as a treatment for ADHD however research also shows it can help people with chronic pain. Targeted, specific and personalised Neurofeedback Therapy is guided by special brain scans known as QEEG (Quantitative Electro-Encephalogram).
NEUROPLASTIX
What fires together wires together, what fires apart wires apart.
Brains really work hard to make connections between neurons stronger and faster especially if it feels, somehow, it might protect you, be helpful or make things easier. With chronic pain experiences, sometimes, this ‘wiring together’ can go a bit wild or become what neuroscience terms ‘maladaptive’ and this can be really unhelpful. Dr Michael Moskowitz is a Psychiatrist who has dedicated his practice to the neuroplastic treatment of persistent pain. His clinic operates under the name Neuroplastix and is located on the west coast of the USA. The programs he, and his colleague Dr Marla Golden, have developed started with his own lived experiences with debilitating chronic/persistent pain. Their detailed educational programs provide a new neuroscientific approach to transform individual pain experiences right down to neuron-to-neuron connection and communication, so instead of wiring together neurons can helpfully wire apart.
NOI
Pain is an output not an input.
The pain you may be experiencing is NOT directly related to your injury or physical damage. It’s not a simple ‘this then that’ situation at all. The pain you are experiencing is a highly complex multi-input system - where all the inputs are interpreted by your brain, and the output is what your brain believes is best to protect you from a perceived threat, and that output may be pain. Our beliefs about pain being ‘just a physical thing’ may take time to change, but they need to move with the science of our time, just like we do. The Neuro Orthopaedic Institute (noi) researches this phenomenon with a diverse approach - even recently exploring the fascinating field of pain and perception. Their Graded Motor Imagery (GMI) program is a structured, evidence-based, 3-stage rehabilitation program that uses targeted brain-based exercises to help ‘re-wire’ the brain that can help to reduce pain and movement problems, and is based on the latest science and clinical trials.
tDCS
Non-Invasive Brain Stimulation.
tDCS is a non-invasive brain-based treatment that delivers a very weak current to the brain. tDCS is best known as a treatment for depression, but research also shows it can help other problems including chronic pain. tDCS increases the excitability, plasticity and potential for positive change in the brain. Treatment is safe, with most people simply feeling a mild “tingling” or “itching” sensation during the session. People often perform specific activities or exercises, like those we have detailed in the article, during and after each treatment session when their brains are experiencing an increased potential for change to drive it in the most positive direction possible.
THIS WAY UP
Rebooting. It takes a team. Don’t go it alone.
When it comes to chronic pain, you may already be starting to see, that right now we have more access to helpful, targeted, well researched online resources than we ever have before. When these programs are available with additional support from skilled professionals in the field the team approach to caring for those living with chronic pain is not lost, in fact it can really connect communities of like-minded people and the helpfulness can ripple out. This Way Up (TWU) provide a range of self-paced online courses that teach clinically proven strategies to help improve the way you feel. TWU is run by clinical psychologists, psychiatrists, researchers, and web technicians based at the Clinical Research Unit for Anxiety and Depression (CRUfAD) – a joint facility of St Vincent’s Hospital and the University of New South Wales. The Chronic Pain course they offer is based on the ReBoot education and self-management developed and researched by Sunshine Coast and North Queensland persistent pain management services.
All of this knowledge, and a great deal more, has helped to build a range of practical treatments to improve pain by working with your brain. The skilled Clinicians at Perth Brain Centre are equipped to teach you how these brain exercises for pain work and how to incorporate them into your daily life, to reclaim your brain and your life from chronic or persistent pain experiences. There are three easy steps to help get you started today.
About the author - Ms. Emily Goss (Occupational Therapist, Senior Clinician, The Perth Brain Centre).
