Treatment of Chronic Pain ~ A Neuroplastic Approach
Apr 12, 2011
Which lifestyle changes have the most influential effect on lifespan? Some people will answer lower blood pressure, reduce cholesterol, exercise, no smoking or even healthy weight. The right answer is: positive attitude. In fact, positive attitude increases lifespan almost twice as much as any of these other factors stated the U.S department of health and human services.
Although a positive attitude may help to increase life span, it’s not always enough to improve quality of life as many older adults suffer from chronic pain. With the incidence of chronic pain increasing with age, an estimated 50-80% of adults over age 65 suffer from chronic pain lasting more than three months, stated the U.S department of health and human services in the report “Health, United states, 2006.”
The key to helping these patients is the brain. Research in the field of psychoneuroimmunology has helped us to better understand how the mind directly affects the nervous and immune systems. For example, positive attitude causes positive alterations in hormone production, thus improving vitality.
Many health and wellness retreats include programs such as yoga, meditation, qi gong, counseling and lifestyle changes which all help to regulate the nervous and immune systems. In particular, meditation has been shown to actually change the physical structure of the brain.
Harvard University neuroscientist Sara Lazar found increased thickness of the grey matter of the brains of monks who practiced meditation on a regular basis. This increased thickness is due to increased neural connections resulting in increased mind-body control. These monks have the ability to consciously moderate activity in their autonomic nervous systems including reduction of blood pressure. This ability of the brain to adapt is called Neuroplasticity. Neuroplasticity is the changing of neurons, the organization of their networks and their function via new experiences according to the U.S department of health and human services.
As a child learns how to walk or how to talk, the brain develops neuronal networks which, with practice, enable the child to eventually walk or talk effortlessly. When we learn a new skill such as playing an instrument or driving a car, the amount of effort required to perform the skill decreases with practice, as the brain’s pathways become ingrained.
Years ago, it was believed that damage to an area of the brain resulted in deficits based upon the specific region of the brain damaged. If the patient was able to overcome the deficit, it was thought the brain must have healed. Nowadays, we know that the specific area of the brain does not need to heal but, rather, other areas of the brain are capable of learning to take over these functions.
Just as the brain is able to continually learn new skills, the brain also may learn bad habits. It will result in unfavorable automatic responses such as the inability to move a limb properly or the perception of chronic pain. The brains of patients in chronic pain have adapted in order to process perpetual sensory input. Functional MRI studies show changes in the prefrontal cortex of the brain in patients with chronic pain. When a patient experiences pain, intense or prolonged, there is increased neuronal firing in the brain to process this sensory input. Sometimes the system changes such that the neuronal firing persists even if the original cause of the pain has been removed. The brain adapts to more efficiently process the pain. It is akin to a computer virus. Unless you re-wire the system to remove the virus, it will continue to impair the function of the computer. This is an example of how neuroplasticity can have a negative affect on a person’s life.
The good news is, just as the brain re-wired itself to perpetuate the chronic pain, it can un-do the damage. In order to do this, treatment must focus on re-wiring the faulty neural pathways developed.
Rather than focusing on long term pharmaceutical management and teaching how to live with pain, pain management programs must also include treatment geared towards rewiring the system to un-do the faulty neural pathways responsible for chronic pain. One way to accomplish this is to access the memory of sensation prior to the onset of pain.
According to Harvard University Professor Ellen Langer in “The Counterclockwise Study,” a group of elderly men spent a week living immersed in an environment recreated to be as life 20years prior they were younger and not limited in activity due to pain from arthritis. During this week, all men became more active, less dependent upon assistive devices and healthier as described by several measures. One man who had been using a cane stopped using the cane and was able to play touch football by the end of the week.
Other techniques include mindful meditation, guided imagery and mirror box training.
According to a report published by the International Association for the Study of Pain,
There is an urgent need for better professional education programs, further dedicated research to help guide clinical practice and better pain management strategies who specifically target the special needs of the older persons in our community.
A strong understanding of how the brain changes in response to pain gives us insight as to how to more effectively treat chronic pain. Treatment focused on brain training may be the most effective method known today for reversing these changes brought about by pain.
Key components utilized in a neuroplastic approach to the treatment of chronic pain include:
- Stress management and relaxation techniques
- Patient education
- Re-training the body to move without eliciting pain
With such a high incidence of chronic pain, health retreats focused on a neuroplastic approach for the treatment of chronic pain are critically needed and may help decrease the burden of the high cost of managing these patients.
About the Author
Lori Rubenstein founded Mosaic Physical Therapy in 2003, a multidisciplinary healthcare organization dedicated to providing quality health care. Lori graduated from Boston University in 1987 with a Bachelor of Science in Physical Therapy. In 1998 Lori completed an Advanced Master's Degree in Manipulative Therapy from the University of South Australia where she studied under the direction of world renowned physical therapists. Lori completed her Master's thesis on "Backpacks and Schoolchildren" and was an invited guest on "Good Morning America" to discuss her findings as one of the first healthcare professionals to address this evident and ever growing problem. She received her Yoga Teacher Certification from Samata International Yoga and Health Institute in Los Angeles and advance training in Yoga Therapy from Larry Payne Ph.D. She is also certified in Pilates by Retrofit and teaches continuing education courses on advanced manual therapy techniques, management of chronic pain and Yoga Therapy.
In 2009, Lori received her Doctor of Physical Therapy Degree from Massachusetts General Institute of Health Professions. Lori has been recognized in publications across the country and has authored articles in several professional journals. She was one of the few elite physical therapists qualified to be a Fellow in the American Academy of Orthopedic Manual Physical Therapists from 1999 through 2009. Lori is a member of the American Physical Therapy Association, California Private Practice Special Interest Group and the International Association of Yoga Therapists.
An advocate for civil rights and peace, Lori completed the New Leaders' Project in Los Angeles in 1998 and The Glass Leadership Institute with the Anti-Defamation League in 2009.
Lori teaches in the Doctoral Program of Physical Therapy at Mount St. Mary's College in Los Angeles and is also a senior instructor on staff for the Yoga Therapy Rx certification program at Loyola Marymount University.