As soon as people start mixing words like pain and behavior or pain and the mind, etc. we all think they are telling us the pain is in our heads. Then of course our eyes glaze over and we stop listening. If someone tries to tell me that decreasing my stress will cure my migraines…well let’s not go there. But this recent article published in Neurological Sciences is different. This article is one of my favorites I’ve ever read. It actually discusses the anatomical link between pain and emotion in our brains. Then it talks about using these physical, anatomical facts to intervene and improve our own pain.
Believe it or not, altering the manner in which we think about and respond to pain actually alters the brain itself; this then changes our actual pain experience. As pain patients, this gives us more power over pain.
A painful stimulus activates two separate pathways. One is the lateral pathway which allows us to be aware of the physical sensation and type of pain including the location of the pain stimulus. The second pathway is the medial pain pathway which mitigates our emotional experience of pain and the extent of arousal. The two pathways work through separate areas of the brain but they both converge in the anterior cingulate cortex and insular cortices. It is here that our personal subjective interpretations of pain are created and our personal coping mechanisms are generated.
Interestingly, it has been shown that the physical changes that occur in the brain when migraines change from episodic to chronic mostly occur in the areas associated with emotional factors. One could interpret this to mean that intervening on the emotional/behavioral level could alter the physical changes caused by our pain syndrome and improve our pain. It is believed that pain “perpetuates itself” by causing changes to the areas of the brain related to emotional response.
The best thing about this research is that there is evidence that if we change our thought processes about our pain we can alter the brain itself, thus improving our pain. Approaches that have been used to accomplish this include: cognitive behavioral therapy (CBT), yoga, meditation, and biofeedback. One study showed an increase in gray matter volume in areas associated with pain in patients with a variety of chronic pain conditions after an 11 week CBT program. This change was associated with a decrease in pain catastrophizing. The authors note that this could be a particularly important finding for patients with chronic #migraines since these areas of the brain have been found to have reduced gray matter in migraineurs. The fact is that maintaining control of the emotional factors related to one’s pain reduces the perception of pain.
So, in summary, behavioral interventions that help us control our emotional response to pain can help us improve our pain syndrome in the short term and over time. This is hard for those of us who feel like a tractor is perpetually running over our heads. But with discipline, this is one of the steps we can take to come out from under that tractor.
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