Learn about Pain
Howard Schubiner, M.D.
The role of the mind has been largely overlooked in chronic pain treatment. However, there is strong evidence that the mind can change the pain experience to a large degree. In fact, the conscious experience of pain is only possible because the human brain can interpret signals from our bodies to create the sensation of pain. From this point of view, the saying “All pain is in the brain” is an actual fact. Our brains have specialized areas that can both increase or decrease the feeling of pain. How we perceive pain is affected by many factors. For example, a study by Henry Knowles Beecher found that only 32% of recently wounded soldiers in WWII reported experiencing pain. And think of the boy who doesn’t cry after skinning his knee until he sees his mother running toward him.
Chronic pain is much more complex than acute pain and the mind plays a large role in how this pain is experienced. However, most current treatment methods still rely on biotechnological treatments such as medications, injections, ablations and surgery. Unfortunately, research has shown that these methods are not particularly useful in reducing chronic pain. Most providers assume that chronic pain is simply caused by tissue damage in the body. Without addressing the role of the brain, attempts to fully resolve the pain are usually not successful. This standard approach leaves most patients with little hope of becoming pain-free.
Recently, researchers have shown that pain can be caused by "nerve pathways" even when there is no sign of tissue damage. A nerve pathway is a collection of nerve cells in the brain that triggers a certain action or response in the body. A nerve pathway is created when a group of nerve cells are used over and over until eventually they learn to fire automatically creating pain. Pain caused by nerve pathways is every bit as real and severe as pain caused by actual tissue damage. The discovery that our brain can learn to cause pain has led to the development of new brain-based therapies. Recent research has shown that people with migraine and tension headaches, neck and back pain, fibromyalgia, abdominal and pelvic pain syndromes and many other disorders can “unlearn” pain. It's possible to dramatically reduce or completely get rid of symptoms in a relatively short time period.
Therefore, it is important for people with chronic pain to be evaluated carefully. Providers who are not familiar with the concept of pain caused by nerve pathways are likely to assume that small changes on a patient's X-rays or MRI exams must point to the reason for the pain. This may not only be wrong, but may prevent patients and their providers from finding more effective treatment. Once it becomes clear if an individual has nerve pathway pain, tissue damage pain, or a combination, a more effective treatment plan can be developed.
David A. Hanscom, M.D.
Scientists had long thought that a person was born with a certain number of neurons (nerve cells) and would slowly lose them over a lifetime that the cells would not change or grow. Although the brain is more active during the first few years of life, it has been clearly shown that the brain can change at any age—for better or worse.
The word “neuroplasticity” describes the ability of the brain to adapt and change.
Depending on the stimulation, the changes can be either helpful or harmful.
The brain can change in a number of ways:
- Growth of new neurons
- Shrinking of unused neurons
- Increasing or decreasing the number of connections per neuron
- Building up or losing layers of the insulation around nerves (myelin). This layer improves the speed of nerve conduction.
- A healthy area of the brain can take over some of the work of an injured part of the brain and develop new capacities.
The bottom line is that your brain is constantly changing depending on how much it is stimulated—or not stimulated.
- There is great improvement potential because the nervous system is able to continue to change in a helpful way, but it must be kept active.
- On the other hand if your brain changes negatively, cells shrink or wither, it is harder to undo. It is still a solvable problem but you need help and tools.
With modern brain scans that can actually measure brain size and activity we are able to see these changes. Some changes can happen quickly. A recent study showed that certain parts of medical students’ brains enlarged within a few months after starting school. (1)
It has also been shown that the brains of patients in chronic pain shrink, however, the brain also re-expands with successful resolution of pain.
Why would your brain shrink in the presence of chronic pain? One way of thinking about it is to view the pain nervous system as an energy drain that steals energy away from healthy creative parts of your brain. The brain areas that allow us to enjoy friends, entertainment, community, creativity etc. gradually shrink. There is a huge amount of neuron activity generated by these regular enjoyable pastimes that does not occur in the presence of unrelenting pain.
Once a pain pathway is created in your brain it is essentially permanent. It may become less active but it is not going to disappear. So what is the answer? There is only one and that is what the STOMP project is all about. You must build new pathways or detours around the problem pathways. Once you learn the tools and choose the ones that are the best fit for you, it is remarkable how consistently the pain will lessen or even disappear.
Welcome to a big adventure and the start of your new brain. It will not be easy but it is also not difficult. You will do the brain building. Use the STOMP project as your resource. Choose just the tools that seem a good fit for you and make it an enjoyable experience. The aim of the STOMP team is to assist you in regaining a rich and full life.
1. Dragananski, et al. Temporal and spatial dynamics of brain structure changes during extensive learning. The Journal of Neuroscience 2006; 26: 6314-6317.
2. Apkarian AV, Sosa Y, Sonty S. Chronic Back Pain is associated with decreased prefrontal and thalamic gray matter density. Journal of Neuroscience 2004; 24: 10410 -10415.
Gordon Irving, M.D.
Determining the Validity of Online Resources
There are hundreds of websites and it may be hard to know which ones offer useful information and which probably do not, or are trying to sell you something. You should ask some simple questions before using a website for the first time so you know if you can trust it.
- Who runs and pays for the site?
- Does it list any credentials?
- Does it represent an organization that is well-known and respected?
- What is the purpose of the site and who is it for?
- Is the site selling or promoting something?
- Where does the information come from?
- Is the information based on facts or only on someone's "testimonial" and feelings?
- How current is the information?
- Does the site show when it was last updated?
- How are links you can follow from the site chosen or more helpful tips view the fact sheet "Evaluating Online Sources of Health Information” which can be found at the website: http://cancer.gov (search for “internet”).
Below are some recommended resources. Resources for additional topics can be found at the end of each section throughout the book.
Books and Websites
General Pain Information
• Pain Tamers by Helen M. Dearman
• The Pain Survival Guide: How to Reclaim Your Life by Dennis C. Turk
• Cognitive Therapy for Chronic Pain: A Step-by-Step Guide by Beverly E. Thorn, Ph.D.
• Managing Chronic Pain: A Cognitive-Behavioral Therapy Approach by John D. Otis, Ph.D
• Back in Control by David Hanscom, M.D.
• The Feeling Good Handbook by David D. Burns, M.D.
• Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain and Illness by Jon Kabat-Zinn
• Managing Pain Before It Manages You by Margaret A Caudill, M.D., Ph.D., MPH
• Mind Over Mood: Change How You Feel by Changing the Way You Think by Dennis Greenberger and Christine Padesky
• Unlearn Your Pain by Howard Schubiner, M.D. with Michael Betzold
• The War on Pain by Scott Fishman & Lisa Berger
• Heal Your Headache: The 1-2-3 Program for Taking Charge of Your Pain by David Buchholz
• The Chronic Pain Solution: Your Personal Path to Pain Relief by James N. Dillard and Leigh Ann Hirschman
• The Trigger Point Therapy Workbook by Clair Davies, Amber Davies and David G. Simons
• Pain Connection, www.painconnection.com
• American Chronic Pain Association, www.theacpa.org
• painACTION, www.painaction.com
• U.S. Pain Foundation, www.ctpainfoundation.org
• CreakyJoints, www.creakyjoints.org
• Let’s Talk Pain, www.letstalkpain.org
• The American Academy of Pain Medicine, http://www.painmed.org/patient/facts.html
• P.U.R.E. H.O.P.E., www.pure-hope.org
• American Headache Society Committee for Headache Education, www.achenet.org
• CancerCare, www.cancercare.org
• National Council on Aging, www.ncoa.org
• National Council on Aging Center for Healthy Aging, www.healthyagingprograms.org
• Chicken Soup for the Volunteer's Soul by Jack Canfield, Mark Victor Hansen, Arline Oberst, John Boal, Tom Lagana and Laura Lagana
• Staying Sane: When You Care for Someone with a Chronic Illness by Melvin Pohl and J. Kay Deniston
• The Fibromyalgia Relief Handbook by Chet Cunningham
• Fibromyalgia and Chronic Myofascial Pain: A Survival Manual Devin J. Starlyn and Mary Ellen Copeland
• Fibromyalgia Information Foundation, www.myalgia.com
• FibroCenter, www.fibrocenter.com
• Fibromyalgia Network, www.fmnetnews.com
• National Fibromyalgia Association, www.fmaware.org
• Living With it Daily: Meditations for People with Chronic Pain by Patricia D. Nielsen
• Mindfulness with Jon Kabat-Zinn, http://goo.gl/4aAd
• Cognitive Neuroscience of Mindfulness Meditation, http://goo.gl/Idnw
• I AM heart, www.applied-meditation.org
• Wildmind, www.wildmind.org
• Meditation CDs, http://carolynmcmanus.com/
• Prescription for Dietary Wellness: Using foods to heal by Phyllis A. Balch
• Turn Off the Fat Genes: The Revolutionary Guide to Losing Weight by Neal Barnard
• USDA Center for Nutrition Policy and Promotion, www.cnpp.usda.gov
• American Foundation for Suicide Prevention, www.afsp.org
Temporomandibular Joint Problems
• The TMJ Association, Ltd., www.tmj.org