The Dark Side of the Brain

The brain is constantly changing, thanks to neuroplasticity. These changes can be positive things such as learning to play a new game, but they can also be negative such as what happens with persistent pain. This blog post discusses the role of neuroplasticity in creating chronic pain and how to re-train the brain to reduce chronic pain.  

It was once thought that the brain was fixed after a certain point. However, the brain is always creating new connections and therefore constantly changing, a process called neuroplasticity. Because of neuroplasticity, we can do a lot of groovy things. We can learn new languages, how to play an instrument, and many other things throughout our life. 

While there are many positive benefits that we can reap from neuroplasticity, there can also be negative benefits as well. Negative benefits? Yes you read that right, and no, its not a typo. Positive and negative benefits are assigned to learning after the fact, the actual process of learning is the same. 

To understand how neuroplasticity can have “negative benefits” in relationship to pain, we need to understand what the purpose of pain is. Pain is to alert you of tissue damage or the potential for tissue damage. This means that the purpose of pain is to protect you from actual or the potential of tissue damage. There is not a malice intention of pain, in fact, it is supposed to be a benefit of you (keeping you out of harms way). 

The issue with chronic pain is that the brain has become overprotective. There are two ways that the brain can become overprotective, either by allodynia or hyperalgesia. 

Allodynia is the term used to describe when non-painful stimuli become painful. This could include movements becoming painful such as writing, lifting, walking, running, bending, twisting, etc… It could also include environments or situations such as feeling pain in the car after a bad car accident. 

Hyperalgesia is when painful stimuli cause more pain than expected. An example would be if you were to get punched in the arm and the pain is so severe that you drop to the ground. Getting punched in the arm is supposed to hurt, however, it usually isn’t enough to cause debilitating pain. 

As the pain system is triggered more and more frequently, the brain becomes better and better at creating pain thanks to neuroplasticity. More non-painful stimuli can become painful as well as the pain experienced during each stimulus can increase. This creates a black hole of pain that seems impossible to get out of. 

But thanks to neuroplasticity, there is a way out of chronic pain. Just as the brain can learn to become better at producing pain, the brain can also learn how to stop producing pain. 

One way to re-train the brain is by using mirror therapy. Mirror therapy works by providing pain-free visual feedback of the normal limb to the brain. This can help change the way the brain processes movement of the painful limb, which will decrease the pain in the painful limb. This is commonly used for hand or foot complaints. The painful limb is placed in a box and the mirror is used to reflect the non-painful limb. The non-painful limb is then moved so that it appears that the painful limb is moving. 

Another strategy is to use graded exposure. The goal of this strategy is to find a movement that isn’t painful and to slowly expose the limb to more movements without triggering the pain system. If running is painful, we might find the amount of running that can be performed without pain. We would then gradually increase the amount of time running while staying under the pain radar until we’ve reach out goal. Another example would be for someone who has pain with overhead movements. If we can change the movement so that it isn’t painful (we could try shrugging before moving, clenching our fists, etc…) we would use that movement to begin moving.

Chronic pain can be frustrating and difficult to deal with. Neuroplasticity allows the brain to produce persistent pain even after the tissues have healed. Thankfully, neuroplasticity also allows the brain to be re-trained to reduce persistent pain. Mirror therapy and graded exposure are two examples of re-training the brain to treat chronic pain. Just like learning how to play an instrument, re-training the brain can take time. Patience is required.