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Can Neuroplasticity Techniques Help Alleviate Chronic Pain?

Humans have the capacity for lifelong learning. This ability can lead to a huge variety of enriching hobbies, skills, and information acquisition. It can also lead to anxiety, PTSD and chronic pain or symptoms. Learning occurs when novel neural pathways are developed over time.  Psychology Dictionary defines neural pathway as “any route which is followed by a nerve impulse which travels through either the central or peripheral nerve fibres….This can be a simple reflex or neuron arc or alternatively something a lot more complex.”1


What is Neuroplasticity?


In simpler terms, neural pathways are how we communicate from our brains to our bodies and our bodies to our brains. As we develop from infancy to adulthood, our neural pathways get more defined, easier to replicate, faster, and they require less energy. Because of the increase in efficiency adults are able to function safely in the world by being able to quickly determine what is worth their attention, what appropriate behavior is in different social settings, how to tie their shoelaces and on and on. However, adults still have neuroplasticity which Verywell Mind states“... is the brain's ability to change and adapt due to experience. It is an umbrella term referring to the brain's ability to change, reorganize, or grow neural networks. This can involve functional changes due to brain damage or structural changes due to learning.”2 


How does Neuroplasticity benefit us?


Let's imagine that I am teaching you salsa. I show you the basic footwork very slowly. Left foot forward, right foot in place, left foot meets right, right foot back, left foot in place, right foot meets left, and repeat. At first when you try it, it feels foreign in your body. Like you have two left feet or are a baby learning to walk. You try again and again and within a few minutes you can do it, not well, but you can place your feet where I told you to. It feels good because you are doing something new and exciting but you also have moments of frustration because it’s harder than you thought it would be. Now I tell you that we need to do these steps to a specific timing: quick, quick, slow. As you attempt this timing you start messing up the basic footwork that you thought you had down. The more information I share, the more mistakes you will make until your neural pathways get stronger and they don’t have to work so hard to communicate to your body. The next week when you come back, you practiced a couple of times and you have the basic step down! I am able to teach you a couple of new steps, which trip you up, but the quick, quick, slow timing is getting a little easier to maintain (because of your new neural pathways). The third week you start to feel like you are really getting the hang of things. At that point I start talking a little bit about hip action- the technique that makes salsa look like a Latin dance. This really throws you off, as trying to move your hips at the same time that you move your feet is really challenging and not something you have ever done before. It takes months before you start to understand how to do the hip action. In the meantime your footwork gets better and you learn more steps. All of this is an example of new neural pathways being formed and engrained. 



The impact of the negativity bias on learning


Now when it comes to pain, it gets a little more complicated. As humans we have a cognitive bias called the negativity bias. Something that hurts us, makes us scared, and/or threatens our sense of self, causes greater activation of the brain than a positive experience or emotion. Evolutionarily this has served our species well, helping us to avoid being eaten by a lion, helping us remember which berries made us sick, etc. If you have ever gotten food poisoning, you may have experienced the same phenomenon. You eat takeout from your favorite restaurant, spend the next two days sick as a dog, and when you recover, even simply thinking about that restaurant can make you queasy.3 It probably took many times eating the food to decide it was your favorite restaurant and after only one negative experience you have a completely opposing reaction.


The negative impact of neuroplasticity on pain


Let’s imagine a scenario where a runner starts experiencing knee pain. He gets it checked out, and his doctor informs him that he has osteoarthritis. This triggers frustration and helplessness in him as he was training for the Boston marathon. Weirdly, after getting the news that he has osteoarthritis, his pain gets worse even though he stopped running. He is hyper focused on the pain, and experiences a lot of fearful thoughts about his future. He tries PT and although he experiences temporary relief, the pain always returns within hours to days. Eventually he decides to have surgery. He is told that 6 weeks post surgery he should be healed and have very little pain if any. During the waiting period he has “what ifs” running through his mind regularly. What if I never get back to my best racing times? What if this pain never goes away? What if I fail? What if I lose my running friends/community? He constantly monitors his pain and fears the worst case scenario. So the six weeks pass by and he is still in tons of pain. He goes to his doctor and the doctor takes an MRI and tells him that the results from the procedure look good but maybe he just needs some more PT in order to fully regain mobility and strength after the surgery. He continues going to the PT but doesn’t seem to be getting much better. His fearful thoughts become scarier and he starts thinking he might never get the life he wants, might never run again, might lose his ability to walk etc. His nervous system is ramped up and he jumps at loud noises, he has trouble sleeping and he feels anxious all of the time. His brain is on high alert, sending pain signals and perceiving almost all sensations as threatening. 



This is an example of neuroplasticity working against someone's well being in an attempt to protect them. Because of this evolutionarily beneficial negativity bias, he is inadvertently reinforcing the pain and fear neural pathways.




Sensations felt in the body often originate in the brain


Everyone experiences pain and other VERY REAL sensations caused by the brain and emotions. Some examples are:

-getting nauseous before public speaking

-a tension headache halfway through a long and frustrating day

-throat constriction when anxious

-a rapid heartbeat before doing something thrilling

-a stomach ache and inability to eat after heartbreak

-feeling achy flu like symptoms during early stages of grief


There are a myriad of socially accepted ways that we as a society acknowledge the existence of mind-body symptoms. Regrettably, many other symptoms that are caused by the brain, never get the type of support that actually helps the person experiencing them to recover. 




You can unlearn your pain and build new neuropathways


It is unfortunate that, as in the example of the runner, doctors don’t recommend treatments like pain reprocessing therapy, and education about pain. It is disappointing that doctors don’t share that many adults have osteoarthritis without any pain and that surgery often has no positive impact. In one study at Baylor College of Medicine by Moseley, J. B., O'Malley, K., Petersen, N. J.,4 Surgeons had three groups of patients with osteoarthritis in their knees. They provided two different surgeries for two of the groups and for the third group had a placebo procedure where they only made cuts in their knees so it appeared as though they had been operated on. At both one and two years post real or placebo surgery there was no difference in the level of pain reduction nor the level of functionality and mobility between any of the three groups. The placebo surgery was just as effective as either procedure. 


The placebo effect works when the cause of pain originates in the brain, not the tissues. In our dualistic medical system which tends to fully separate the mind and body, the well studied and substantiated fact that most chronic pain is caused by neural pathways not tissue issues, is overlooked and many unnecessary and ineffective treatments and procedures are performed. In this 5 back study performed in Boulder, Colorado they treated three groups over 8 weeks, one was treated with pain reprocessing therapy, one with conventional back pain treatments, and one with placebo treatments. On average each of the 151 patients in this study had suffered with chronic back pain for 8.9 years. The results were as follows: Conventional treatments: 10% efficacy rate, placebo: 20% efficacy, pain reprocessing therapy: 66% efficacy (no or almost no pain) and 98% of patients had a reduction in pain. 


Our brains are neuroplastic throughout our lives which is why we can learn both salsa and pain. But it is also why we can unlearn pain. For many people, the idea that their brain is causing their pain can feel incredibly invalidating. This is understandable considering that most westerners have been inculcated into the dualistic medical system where hearing something like “it’s all in your head” is like a gut punch. But as neuroscience is advancing and becoming more mainstream, people can start to understand that all perception is created in nervous systems. That even tissue based pain is created in our brains. If someone with a compound fracture went to a doctor and she said “the pain is being caused by your brain” she would be correct despite the bone sticking out of their arm. Pain medicine works because it adjusts how the brain processes pain. Just because your pain might be caused by neural pathways rather than tissue damage does not make it ANY less real or valid. It only means that the most effective treatment for you is to unlearn your pain. It means that after years or decades, you can finally be empowered to be in the driver's seat and learn new neural pathways. 


I personally floundered for years trying to figure out every possible treatment and supplement and feeling completely out of control in my own body. I was terrified to my core. One day I came across the app Curable6 which is where I discovered that I had the power to change my trajectory and get out of pain. I was no longer destined to decades more of pain but could be completely free of chronic pain/symptoms. If you have been stuck in pain, you deserve to be free again. I hope you will give neuroplastic pain treatments a try and see if you can finally break out of the prison pain can trap you in.  I know it can be hard to hope, especially if your hope has been crushed over and over, so until you can hope for your future, I’ll hold hope for you. You deserve freedom, safety in your body, and joy. And it’s yours to take. 


Resources


Check this list for conditions that are often Neuroplastic in origin. 

*It is important that serious medical conditions are ruled out before beginning treatment.

Chronic back pain

Chronic abdominal and pelvic pain syndromes Chronic fatigue syndrome

Chronic hives

Chronic tendonitis

Dizziness 

Fibromyalgia

Foot pain syndrome

Gastrointestinal issues

Insomnia

Interstitial cystitis (irritable bladder syndrome) Irritable bowel syndrome

Migraines

Myofascial pain syndrome

Neck pain

Paresthesia (numbness, tingling, burning) 

Plantar fasciitis

Postural orthostatic tachycardia syndrome

Repetitive strain injury

Sciatic pain syndrome Temporomandibular joint (TMJ) syndrome

Tension headaches

Tinnitus

Vaginismus 

Vulvodynia

Whiplash



For more on the fear-pain cycle give this episode of Tell Me About Your Pain a listen: https://open.spotify.com/episode/0kluwKfkcnqvqqhwFqfEoU?si=5Rp88pX_TfuPHvBiEiAAfw


Citations



Cherry, K. (2022, October 20). What is brain plasticity? Verywell Mind. https://www.verywellmind.com/what-is-brain-plasticity-2794886


Goleman, D. (2003, June). Our brain's negative bias. Psychology Today. https://www.psychologytoday.com/us/articles/200306/our-brains-negative-bias


Moseley, J. B., O'Malley, K., Petersen, N. J., et al. (2002). A controlled trial of arthroscopic surgery for osteoarthritis of the knee. The New England Journal of Medicine, 347(2), 81-88. https://doi.org/10.1056/NEJMoa013259 


Ashar, Y. K., Gordon, A., Schubiner, H., Uipi, C., Knight, K., Anderson, Z., Carlisle, J., Polisky, L., Geuter, S., Flood, T. F., Kragel, P. A., Dimidjian, S., Lumley, M. A., & Wager, T. D. (2022). Effect of Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain: A Randomized Clinical Trial. JAMA psychiatry, 79(1), 13–23. https://doi.org/10.1001/jamapsychiatry.2021.2669


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