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In Pain? Blame Your Brain

Pain comes in many varieties—mental, emotional, physical—the list is practically endless.

One of the most frustrating and debilitating forms of pain is chronic pain.

According to a 2011 report released by the Institute of Medicine of the National Academies, around 100 million Americans struggle with chronic pain. This figure tops the combined number of people who suffer from cancer, heart disease and diabetes.

Unlike acute pain, which lasts for a few hours or days, chronic pain can go on for months—even years—and may, or may not, have a physical cause. Even when the pain does have a traceable explanation (i.e. a torn ligament, or broken bone), discomfort can still persist, long after the injury has fully healed.

Because it often lacks a visible source, chronic pain can be difficult to treat, and its symptoms are often dismissed as being, "imaginary," or "all in the head."

The mind-body pain connection

All pain originates in the brain.

When you brush up against a hot stove burner, the pain center in your brain is triggered and a series of nervous system responses eventually results in the searing burn on your arm. But, it isn't your arm that hurts—it's your brain. You feel the discomfort in your arm because of the connection that was generated between your mind and your body.

Once a mind-body pain link has been created, it never really goes away and can be re-activated.

"Chronic pain is not something you imagine—it's an activation of a real mental pathway. It's as if a switch in your brain gets flipped on and the pain is there," says David Hanscom, M.D., a spinal surgeon and author of, "Back in Control: A Spine Surgeon's Roadmap Out of Chronic Pain."

Re-programming your pain circuits

The human brain is adept at adapting, meaning that the longer this switch stays flipped the harder it is to turn off. As time goes by, a nervous system that is constantly barraged by pain signals will become increasingly sensitive and reactive to pain of any kind.

Neuroplasticity is the term used to describe the brain's ability to acclimate and create new neurological pathways depending on the stimuli it is exposed to.

Whether you're a musician attempting to learn Poulenc's Flute Sonata, or a baseball pitcher trying to throw the perfect curve ball, the theory of neuroplasticity states that the more times you practice a skill, the stronger and more insulated the neurological connections having to do with that action will become.

The principal of neuroplasticity applies to chronic pain as well. The more a person dwells on their pain, the deeper and more permanent that pathway becomes. By contrast, breaking out of the cycle of discomfort will eventually cause that path to become decayed and overgrown.

Hanscom offers three essential steps for severing ties with chronic pain:

  1. Safeguard your sleep: "Sleep is the trump card," says Hanscom. "Not getting enough rest intensifies pain and makes it harder to get rid of." If you're taking care of an elderly family member, getting the recommended eight hours of shut-eye may seem like a near impossibility. But, sleep is essential, not only for banishing pain, but also when it comes to looking after your loved one.
  2. Rein in your rage: The line between anxiety and anger is so razor-thin that it's impossible to control one without first getting a handle on the other. According to Hanscom, the root of most anger lies in anxiety. "Anger is like anxiety on steroids," he says. "Anxiety causes a need for control and anger is the response that occurs when control isn't possible." The uncontrollable, unpredictable nature of caring for a senior with multiple health concerns makes caregivers prime targets for this rage-producing lack of control. Indeed, Hanscom says that one of the prime triggering events for chronic pain is dealing with a family member who is suffering from a chronic illness. A senior who is scared or in pain, is also more likely to lash out at the person caring for them. This abuse is often inadvertent, but it piles more anxiety and anger onto the caregiver. Learning how to set boundaries and disengage from unhealthy interactions is essential to maintaining your health while taking care of an aging loved one.
  3. Detach from the discomfort: Only after you've attended to the first two elements—sleep and anger management—can you begin to work on create some much-needed distance in between you and your pain. Hanscom offers three tools for doing so: writing, active meditation and visualization. These three tools can help you become more aware of your thought processes and how your feelings affect your pain pathways:
    1. A good writing exercise to start out with is to simply write down what you're thinking about (or feeling) in a given moment, and then write about the effect that the thought (or feeling) is having on your life. For example, if you're second-guessing your decision to seek respite care because your loved one just accused you of abandoning them, writing about the interaction can slow down your thoughts and help you come to the conclusion that taking care of yourself by getting a break is going to make you a better caregiver for them. This can serve the dual purpose of diminishing your stress as well as your physical pain.
    2. Meditation involves focusing your awareness on the present moment—seeing, sensing and feeling the aspects of your immediate environment. This includes any intrusive thoughts that come bubbling to the surface of your consciousness. The key is to watch these thoughts, but refuse to engage with them.
    3. Visualization is all about imagining a pain-free future for yourself. It's important to employ all of your senses—don't just see yourself walking around pain-free, feel it.
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