Primary Author: Dr. M. Vijai Kumar, MD, DA – Consultant Anesthesiologist, Chennai, India
Danial Patrick Moynihan – the late Senator from New York, most famously said “Everyone is entitled to their opinions, but not to their own facts.” The famous senator was not a pain psychologist; yet, most pain psychologists today would agree with him – that pain is indeed a subjective opinion that is permeable to change.
My aunt was knitting some sort of a table cloth with 10” long stainless-steel needles and a multi colored thread. Her 5-year-old son came running from somewhere and jumped into her lap, pushing one of the needles deep down her right thigh. Seeing the portion of the needle that was outside, she started screaming in pain. Though I was hardly 12-year-old then, it fell to my lot to put her in a hand pulled rickshaw with the help of other ladies at home – to take her to a doctor’s clinic in the next street.
On arrival, the nursing help took her inside to remove the saree and drape her. To everybody’s surprise, there was no blood or even a scratch on the skin. The needle was buried deep down in the folds of the saree. The screaming stopped. This was my first encounter of “FEAR” as an important component of pain.
Pain is a protective tool to guard our body from exposure to harmful physical forces. Even in sleep, a small pin prick or an insect bite on the arm causes it to be withdrawn. It is an inbuilt reflex action to protect our body.
In deep interior Africa, there are tribes who grow with the teaching that bearing children and delivering children is a pleasurable feeling. Women are taught to sing and dance while the mid wives help to deliver the babies. Though many are converted Christians, the dictum that “Thou shall bring forth in pain”, doesn’t hold good for them.
This goes to prove that pain is what we take it to be – pleasant or otherwise, and is located in the brain. An elaborate scientific conference on chronic back pain recently, has resulted in a headline in Washington Post – “Chronic Pain is Treatable – when patients focus on the brain.”
A study was conducted at Colorado University. A group of 151 subjects with persistent back pain were randomly assigned to 3 groups. 1/3 rd of them were not given any treatment other than usual care. Another 1/3 rd were given a placebo. And the remaining 1/3 rd were given, 8 x 1hr sessions of a new treatment called PRT – “pain reprocessing therapy”, developed by Allan Gorden – director of pain psychology, psychology center, Los Angeles. This technique teaches patients to reinterpret pain as a sensation coming from the brain, than as evidence of a physical condition. As people come to view their pain as uncomfortable but non-threatening, their brains rewire the neural pathways that were generating the pain signals and pain subsides. Nearly 66% of the subjects receiving PRT were pain free, and whopping 98% had at least some improvement, and in all, these were persistent for more than a year.
When the brains are highly alert, we interpret our surroundings through a lens of danger and the new PRT aims to lower the threat level.
Another team from Harvard obtained similar impressive results finding mind body therapy course was more effective in easing persistent back pain.
This doesn’t mean that pain is imagined, or “All in the head”. It is a brain response like blushing, crying, or increased heart rate – all bodily reactions to emotional stimuli.
By changing our perceptions – gaining knowledge, altering beliefs – can dramatically reduce pain. “Pain is an opinion” and thus reliant on brain’s fallible perception of danger.
With chronic pain, our nervous system triggered by fear, gets stuck in “fight or flight” mode, switching on our body’s alarm bells in the form of physical symptoms.
Data does not support a physical injury model of back pain. 98 people who did not have back pain were screened on MRI – 66% showed disc abnormalities – sign of aging.
Fortunately, we now have better research than ever showing that chronic pain is neuroplastic and more avenues are available for successfully treating it.
Current research shows that chronic pain is real and debilitating – and since it is learnt by the brain, it is usually reversible. One of the physical manifestations of the pain is muscle spasm. When muscle spasms are alleviated, chronic pain is gradually reduced to a point where it is completely absent. JOGO Therapy (www.jogohealth.com) employs this treatment technique with its new age digital tool which provides a real-time imaging of muscular activity on a handheld device. This visual feedback is used to train the brain to selectively relax the taut muscles – this effectively helps adjust pain signaling circuits which is responsible for brain’s perception of pain. As pain signaling circuits adjust with each session of therapy, chronic pain reduces gradually and is no longer present. This proves beyond any doubt, the neuroplastic nature of chronic pain. JOGO’s easy to use device gives a much-needed treatment option to Physicians who currently don’t have anything besides symptomatic treatments with Analgesics, NSAIDS(non steroid anti-inflammatory drugs), and current Physical Therapy modalities which most often aggravate rather than alleviate chronic pain.
Chronic pain is indeed an opinion! During his time in the US Senate, Senator Moynihan changed opinions of his colleagues through skillful presentation of facts and arguments that helped usher a new perspective. Modern tools are giving therapists new abilities to present facts and change opinions about chronic pain and thereby ushering a pain-free life. And that in-of-itself is a game changing development and welcome news to hundreds of millions of patients who are severely restricted from productive pursuits due to chronic pain.