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Chronic Pain - The Way Out




Pain is an output of the brain. When we injure ourselves, the brain assesses signals from the body and decides if outputting pain is required as a "danger signal" to prevent us from doing further harm. Neuroplastic pain is when the brain continues to output pain signals even when the original injury has resolved. When this occurs, pain becomes chronic.


The book by Alan Gordon, "The Way Out," explains why neuroplastic pain occurs and details a method to enable you to rewire your neural circuits and turn off 'stuck' pain signals.


His Pain Reprocessing Therapy (PRT) has excellent research from the University of Colorado Boulder that outperforms any other therapy or surgery for lower back pain. You can read the study here.


Our brains sometimes make mistakes, our bodies can send normal safe signals, but our brains can process these signals as pain. When our brain outputs pain repeatedly, the neurons associated with this pain grow a stronger connection. Unfortunately, if the brain gets too good at associating these neural connections when an injury has resolved, the brain may still output pain. In essence, this is neuroplastic pain. FMRI research has shown that pain from an injury causes usual pain circuits to light up in the brain. Different brain areas are active with chronic pain, notably circuits associated with learning and memory. The brain has learned to predict pain from similar past experiences and outputs pain as a precaution.


Fear is what we feel when we think we are in danger, and fear is what Gordon attributes to a feedback loop that can further strengthen neural pathways that create chronic pain. He calls it the pain-fear cycle; You fell off your bike three months ago and had a sore back for two weeks afterward. You still get some twinges of pain now and again, but you would love to get back to biking. On the other hand, you are fearful that being on the bike will exasperate the back pain. The association of the bike accident, coupled with the fear of re-injury, causes your brain to be on high alert and output pain to your back when you start to cycle. You consequently give up biking for the day, and the brain assumes it was correct in outputting the pain. This avoidance creates a feedback loop that strengthens the neural connections that generate pain when you get on a bike. The association with the bicycle and subsequent pain is called a conditioned response.


What I like about Alan Gordons' book is that it has clear step-by-step instructions on how to reverse the process of neurogenic pain. I'm a big believer in the mind-body connection to chronic pain (read my blog post here), but not everyone wants to spend time with a psychotherapist etc. resolving past stressors. Alan's approach focuses more on the "how to resolve" and less on the "why you got to this state of chronic pain."


His method shows chronic pain sufferers how to gently bring themselves into situations where their brain outputs neuroplastic pain in a safe/controlled way to change the brain's association of the activity from a threat to a normal safe response.


The other important part of his approach is that he permits people to have off days (setbacks), explains that recovery is a two-step forward, one-step back process, and if your pain does get intense, then it's time to do whatever you need to bring the pain back down. Meaning avoidance behaviors are ok, hot baths, ice packs, massages, etc. In short, whatever makes you feel good enough to get you out of the setback state.


I don't administer Pain Reprocessing Therapy. I'm the creator of a manual therapy called SensoriMotor Repatterning (SMR); in the context of Pain Reprocessing Therapy, SMR looks for sensory inputs going to the brain that are misinterpreted as threats. These sensory inputs are typically at the sites of injuries or surgeries. SMR uses acupoints to repattern the nervous system's response from fear (outputting pain) to one of safety. Further, SMR tests for similar reactions in functional positions (for example, on a bike or in a squat) and corrects these conditioned responses.


SMR can often completely resolve chronic pain in three sessions, check out vanSMR.ca for more info.


You can book an SMR appointment with me here




References/Resources:


https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2784694?guestAccessKey=3e677261-f26b-4244-858c-8d319ea5b2f4&utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_content=tfl&utm_term=092921


https://www.painpsychologycenter.com/the-way-out.html



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