How the Brain Shapes Pain

By - karengray
05.20.19 01:49 PM

So much of our work here at the hypnosis office is about empowering people just like you and me to use these incredibly powerful and intricate machines we call our minds. We help people to move away from the thinking that they are at the mercy of their automatic behaviors, and teach them to harness the ability to program their minds to work for them instead.

 

This week Iā€™d like to share with you a story  that aired this morning on Morning Edition from NPR. This is an excellent example of how we integrate the signals in our brain to create a habitual response, and how we can use simple and easy-to-learn techniques to interrupt those signals and experience less pain.

 

How The Brain Shapes Pain And Links Ouch With Emotion

Heard on Morning Edition May 20, 2019

By Jon Hamilton

 

When Sterling Witt was a teenager in Missouri, he was diagnosed with scoliosis. Before long, the curvature of his spine started causing chronic pain.

 

It was "this low-grade kind of menacing pain that ran through my spine and mostly my lower back and my upper right shoulder blade and then even into my neck a little bit," Witt says.

 

The pain was bad. But the feeling of helplessness it produced in him was even worse.

 

"I felt like I was being attacked by this invisible enemy," Witt says. "It was nothing that I asked for, and I didn't even know how to battle it."

 

So he channeled his frustration into music and art that depicted his pain. It was "a way I could express myself," he says. "It was liberating."

 

Witt's experience is typical of how an unpleasant sensation can become something much more complicated, scientists say.

 

"At its core, pain is just something that hurts or makes you say ouch," says Karen Davis, a senior scientist at the Krembil Brain Institute in Toronto. "Everything else is the outcome of the pain, how it then impacts your emotions, your feelings, your behaviors."

 

The ouch part of pain begins when something ā€” heat, certain chemicals or a mechanical force ā€” activates special nerve endings called nociceptors.

 

"Once they are activated, they trigger a whole cascade of events with kind of a representation of that signal going through your nerves and into your spinal cord and then all the way up to your brain," Davis says.

 

And that's when things get really complex.

 

Pain signals interact with many different brain areas, including those involved in physical sensation, thinking and emotion.

 

"There's quite a pattern of activity that permeates through the brain that leads to all the complexities of what we feel associated with that initial hurt," Davis says.

 

All that processing can have benefits, she says, like sometimes allowing us to ignore pain signals.

 

Say you're playing hockey and you just got slammed into the boards, Davis says. "If you're concentrating on that, you're not going to be able to keep skating. So you need to be able to tune out the pain and deal with it later."

 

Witt learned that he could tune out pain when he immersed himself in composing songs or painting.

 

"When I'm making art and music, I feel less pain," says Witt, who is 40 now and makes his living as an artist and musician in the Kansas City area. "While I'm doing those things I'm so distracted from my pain that it's almost like I don't have it."

 

But as a younger man, Witt still struggled with the emotional fallout from his back pain. He was depressed and felt like a social outcast.

 

Why does the brain link pain with emotions?

 

One of the scientists trying to answer that question is Robyn Crook, a biologist and brain researcher at San Francisco State University.

 

Crook studies the evolution of pain, and her lab compares the pain system found in mammals with its counterpart in squids and octopuses.

 

The most obvious evolutionary reason for pain, she says, is to prevent or minimize damage to the body. Touch a hot stove and pain tells you to move your hand away. Fast.

 

But evolution didn't stop there, Crook says.

 

"In some animals with more complex brains there's also an emotional or a suffering component to the experience," she says.

 

In dogs, for example, pain appears to cause emotional distress much the same way it does in people. And there must be a reason for that, Crook says.

 

One possibility, she says, involves memory.

 

"Having that emotional component linked to the sensory experience really is a great enhancer of memory," she says. "And so humans, for example, can remember a single painful experience sometimes for their entire lives."

 

So they never touch that hot stove again.

 

And there may be another reason that people and other highly social animals have brains that connect pain and emotion, Crook says.

 

"Experiencing pain yourself produces empathy for other group members or other family members that are in pain," she says. As a result, if one of them is injured "you will offer help to them because of the empathetic response or the emotional response to pain."

 

That response has obvious benefits for animals that live in groups, Crook says. But an octopus is a solitary animal with no obvious need for empathy. So Crook's lab is trying to figure out whether pain has the same links to emotion in these marine animals.

 

For people, the link between pain and emotion is a good thing. But sometimes it can also be destructive, says Beth Darnall, a psychologist at Stanford University.

 

"Mental health disorders amplify pain," she says. "They engage regions of the brain that associate with pain processing. And they can also facilitate rumination and fearful focus on the pain."

 

And when pain doesn't go away, Darnall says, it can cause disabling changes in the brain.

 

"Pain is really a danger signal," she says. "But once pain becomes chronic, once it's ongoing, these pain signals no longer serve a useful purpose."

 

Over time, these signals can lead to problems like depression, anxiety and stress.

 

That's what happened to Witt in his teens and 20s. His pain led to negative thoughts and depression, which made the pain even worse.

 

But it's often possible to break that cycle, Darnall says, by learning techniques that help pain patients gain some control of the way their brain is processing pain signals.

 

For example, she has a system for teaching pain patients how to slow their breathing and relax their muscles.

 

"This state of relaxation is an antidote to the hard-wired pain responses that are automatically triggered by the experience of pain," she says.

 

For some patients, techniques like these can provide an alternative to pain drugs, including opioids. And for pain patients who rely on medications, she says, psychological therapies can often help the drugs work better.

 

But patients are rarely offered psychological treatments for pain, Darnall says.

 

"We have overemphasized pain as being a biomedical phenomenon that requires a biomedical intervention," she says.

 

Witt, the artist and musician, agrees. He has lived with back pain for more than two decades.

 

But he doesn't create songs or paintings about pain anymore. And he chooses not to take pain medication.

 

Instead, Witt says he stretches and exercises, watches his diet and works hard at staying optimistic.

 

"I'm actually not convinced that I have to live with this for the rest of my life," he says. "I very well may. But at the same time I live in that state of mind all the time that there's hope."


You can listen to the program on NPR here:

https://www.npr.org/sections/health-shots/2019/05/20/724136568/how-the-brain-shapes-pain-and-links-ouch-with-emotion#

 

The Impact of Pain

In 2016, the Institute of Medicine estimated that up to one-third of the US population lives with ongoing pain. Chronic pain, the main cause of disability, is more prevalent than diabetes or heart disease. It costs the US economy up to $630 billion every year in health care and lost productivity, and lowers the quality of too many lives. Although precise numbers are hard to come by, National Institute of Health spending breakdowns show that the agency committed just over $500 million in 2017 to broad pain research. Finding better ways of treating pain is surely worth a greater investment.

 

Consider this crucial question: what is the first treatment you should give a person for chronic pain, or even many acute injuries? Most clinicians now agree that the answer should not be opioids. Fewer recognize that the question is not which pill to use instead, but what system of interventions, including medication, and monitoring to implement.

 

Too often, pain is treated as a purely physical problem. It is a biopsychosocial condition. Psychological treatments can be combined with medication to equip people with the tools to better control their pain experience. Psychological therapies, such as hypnosis, EFT, and others, can also lower risks such as addiction, because the emphasis is on engaging patients in managing their daily actions to help themselves to feel better in the long run, rather than relying solely on passive medications. And despite this, a common medical practice is to recommend such psychosocial strategies for pain only after all medications have failed.

 

The Role of Hypnosis

Hypnosis is a complementary therapy that works well with traditional medical care. Clinical research has provided a large amount of evidence that hypnosis is a recommended first-line treatment for many types of pain. The integrative use of hypnosis provides pain relief, stress management, relief from depression and anxiety, and provides the client with a sense of real control over their bodies.

 

Hypnosis, when used for the treatment of chronic pain,  generally involves a hypnotic induction with suggestions for relaxation and comfort. Posthypnotic suggestions are usually given that the client will experience reduced pain. These suggestions can continue to be effective long after the session, and can be integrated so that the client can quickly and easily create a state of comfort using an anchor, such as a finger press or a deep breath.

 

Effective hypnosis treatment of chronic pain also often involves teaching the client self-hypnosis or providing recordings of hypnosis sessions that can be used to reduce pain on a daily basis outside the sessions. In our experience, many clients experience an immediate reduction in pain severity following hypnosis treatment, whereas others can obtain reduction in pain with repeated  hypnosis sessions or by practicing self-hypnosis.

 

Clinical studies on the effectiveness of hypnosis in pain management can be found here:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2752362/

 

If you have questions about using hypnosis as a part of improving your health, or maintaining your healthy lifestyle, send us an email or give us a call. We are happy to talk with patients and healthcare providers about the benefits of hypnosis.ā¬›

 

Karen Gray is a Certified Hypnotist, a Registered Nurse, and the Director of Green Mountain Hypnosis. For more information on how you can use hypnosis to change your life, contact Karen at karengray@greenmountainhypnosis.com, or (802) 566-0464.

karengray