The Predictive Brain and Chronic Pain, Part 2: Rewiring the Brain to Alleviate Pain
Welcome back to our deep dive into the world of chronic pain, exploring how our brains play a pivotal role in this complex condition. In Part 1, we unravelled the traditional perspectives on pain, discovering that chronic pain conditions often elude clear medical explanations; a HUGE percentage of individuals with these conditions don’t have any clear source of injury in the body. This all suggests that when it comes to generating pain, our brains play a much more central role than scientists of yore previously realized. (Did you miss Part 1? Never fear, you can read it here!)
We explored how chronic pain, rather than being a reaction to tissue damage, might instead be a case of the brain’s predictive nature gone awry. The brain relies on past experiences to forecast potential threats, which can lead to the activation of pain responses even when our body is completely free from harm.
In Part 2, our focus will shift towards groundbreaking new therapies that are a radical departure from conventional treatments like surgeries, injections, medications, or spinal adjustments. Understanding that pain can become an automatic learned response — a false alarm where the brain mistakenly predicts danger — has opened the door for a new generation of chronic pain therapies that are much more effective that traditional approaches because they work toward adjusting the brain’s neural connections rather than trying to fix damage in the body that isn’t actually there. I mean, would you ever try to turn off a false alarm by trying to extinguish the fire that isn’t there?
Chronic Pain and Trauma
Before we dive into specific brain-based therapies for chronic pain, it is important to have a sense of how they work. While they may seem like magic, the truth it, these new therapies are just as biological as a back surgery — they just target a different part of our nervous system. Rather than trying to repair physical damage from an injury, brain-based pain therapies are trying to repair maladaptive neural pathways that were created in response to previous trauma.
People often assume that in order to have a lasting impact, trauma must come in the form of a huge, life-altering event (mental health professionals often refer to these type of trauma as a “big-T trauma”, but since I have the benefit of writing this article rather than speaking it, I’ll just call it Trauma). These types of Traumas might include things like living in a war-torn or highly dangerous environment, various forms of abuse, difficult family breakups, or the death of someone who we are close to. They can often (but not always) result in a serious condition called Post-Traumatic Stress Disorder (PTSD). If they occur during our childhood, they are often referred to as Adverse Childhood Events (or ACEs). These types of Trauma have strong connections to many different chronic health conditions, and chronic pain is no different. People who have suffered Trauma are significantly more likely to experience a chronic pain condition in their lifetime than people who have not suffered from Trauma.
What is more recently coming to light is that it isn’t just the big Trauma that affects our health; consistent exposure to more subtle traumas also have a significant impact on the likelihood of someone developing chronic pain.
Ironically, for practitioners specializing in nociception (the specialized nerve response that triggers pain when the body is damaged), it is well-understood that damage isn’t exclusion to big, severe injuries. Conventional medicine has long understood the impact of “microtraumas” — small, consistent injuries that persist over time to create serious physical damage. Our brain works very similarly. People who face a constant barrage of stressors every day — financial stress, a toxic workplace, microaggressions from the people around us — also experience higher rates of chronic pain than the general population. In fact, we have even given a name to these “little-t traumas”; they’re called Social Determinants of Health (SDoH), and they play a part in a whole bunch of chronic health conditions (but today we are just going to stay in our pain lane).
SDoH and microaggressions, as well as big Trauma, all activate the amygdala. You may remember from Part 1 that when the amygdala gets involved, it works alongside your hippocampus (where your memories are formed) to start associating all the sensory data going on around you with a sense of danger, so you can better predict and avoid similar threats in the future. In chronic pain conditions, these sensory data activate an anticipatory pain response when you encounter them, usually in such an automatic way that you don’t even notice or realize it. You just suddenly feel pain. That pain generates more fear, further reinforcing your sensory cues as dangerous. This creates a feedback loop that leads to chronic pain that can persist for years, or even decades.
Breaking the Cycle with Neuroscience-Informed Therapies
So if chronic pain is the result of an automatic misfiring in the brain as a result of trauma, how can it be fixed? As awesome as it might be, you can’t just eliminate all of the stress from your life to help calm down your amygdala to stop it from activating a predictive pain response. Luckily, there are several different therapies out there that have found ways to rewire the automatic neural connections that cause chronic pain.
Pain Reprocessing Therapy (PRT)
Pain Reprocessing Therapy (PRT) represents a cutting-edge approach to chronic pain treatment that aims to recalibrate the brain’s pain processing system, teaching it to reinterpret harmless signals as non-threatening. The core of PRT involves cognitive techniques and guided exposure to help patients reassess their pain-related beliefs, specifically targeting the ingrained notion that pain must be a sign of bodily harm. Through a series of sessions, patients are guided to understand that their pain signals are often false alarms and not indicators of real injury. This cognitive shift is supported by exposure-based practices, where patients gradually and safely engage with activities they might have avoided due to pain, reinforcing the new understanding that these activities are not actually harmful. The ultimate goal of PRT is to decrease the brain’s pain response by altering how it interprets sensory information, effectively “rewiring” the brain’s neural connections between the somatosensory cortex and the amygdala. Clinical studies have shown that PRT can lead to significant reductions in pain, and in some cases, complete remission. In a randomized controlled trial with patients who had long-term chronic low back pain, 66 percent of subjects assigned to PRT were pain-free after four weeks, and were still pain-free a year later. These results make it a promising option for those suffering from persistent pain conditions, although it is fairly new, so research is so far limited.
Emotional Awareness and Expression Therapy (EAET)
Emotional Awareness and Expression Therapy (EAET) is a therapeutic approach specifically designed to address chronic pain and other somatic symptoms that may have emotional underpinnings. The core principle of EAET is that suppressing emotional experiences, particularly negative emotions related to trauma or interpersonal conflicts, can contribute to physical symptoms, including chronic pain. This therapy encourages patients to identify, explore, and express these emotions, which are often deeply buried or unacknowledged. During EAET sessions, therapists guide patients through processes that help them confront unresolved emotional issues, such as past trauma, anger, or grief. By facilitating a safe environment for expression, EAET aims to break the cycle of emotional suppression and somatic symptoms. The process not only involves emotional expression but also includes techniques to develop greater emotional awareness, helping patients recognize the links between their emotions and physical sensations. The therapeutic goal of EAET is to alleviate physical symptoms by resolving the psychological stressors that may exacerbate them. Research indicates that by addressing the emotional dimensions of pain, EAET can significantly reduce the intensity of chronic pain, improve emotional regulation, and enhance overall quality of life for patients. It has shown particular promise for patients with fibromyalgia, irritable bowel syndrome, pelvic pain, and medically unexplained symptoms.
Pain Exposure Physical Therapy (PEPT)
Pain Exposure Physical Therapy (PEPT) is an innovative therapeutic approach tailored for people suffering from conditions like chronic back pain, complex regional pain syndrome (CRPS), or fibromyalgia. PEPT is grounded in the understanding that avoidance behaviors, often exacerbated by fear of pain, can worsen pain symptoms and contribute to a decline in physical function. This therapy challenges the avoidance by systematically exposing patients to physical activities they fear, within a controlled and therapeutic setting. The methodology of PEPT hinges on the gradual desensitization of the patient to the feared activities through repeated exposure, coupled with cognitive interventions that help reframe thoughts related to pain and activity. The therapy progresses through carefully structured stages, starting from low-intensity exposure and incrementally increasing to more challenging tasks, based on the patient’s tolerance and response. This controlled exposure helps to dismantle the fear-avoidance cycle commonly observed in chronic pain conditions. The aim of PEPT is not only to reduce pain perceptions but also to restore functionality and improve quality of life. By retraining the brain to process pain differently and decreasing the emotional response associated with pain, PEPT has shown efficacy in reducing pain intensity and enhancing patient mobility. Its effectiveness underscores the importance of integrating psychological and physical approaches in the treatment of chronic pain syndromes.
Bringing It All Together
In this deep dive into chronic pain, we explored how our brains often misinterpret signals related to trauma (both big and small), leading to feelings of pain without physical injury. In fact, it seems that most chronic pain doesn’t come from the body itself but from neural circuits creating a predictive pain response in anticipation of perceived danger. This shift in understanding paves the way for innovative, neuroscience-informed therapies that offer hope beyond traditional pain management strategies. Three of these novel approaches — Pain Reprocessing Therapy (PRT), Emotional Awareness and Expression Therapy (EAET), and Pain Exposure Physical Therapy (PEPT) — focus not on the symptoms, but on the source: the brain’s learned responses. By retraining the brain, these therapies aim to break the vicious cycle of pain and fear, offering patients a chance at a life free from chronic pain.
Diving Deeper
For those eager to delve further into understanding and managing chronic pain through innovative methods, The Way Out by Alan Gordon provides an enlightening read. Gordon, a pioneer in pain psychology, offers a step-by-step guide on how to overcome chronic pain using the principles of neuroplasticity showcased in Pain Reprocessing Theerapy. His work provides not only a practical framework for individuals suffering from chronic pain but also a deeper understanding of why the brain creates pain and how it can be retrained. Accompanying this, exploring articles in journals such as Frontiers in Pain Research can complement your knowledge with cutting-edge scientific research.
Call to Action
If you or someone you know is struggling with chronic pain, consider exploring these therapies as potential options. Engage with professionals who specialize in neuroscience-informed treatments, and advocate for a comprehensive approach to pain that addresses the root causes, not just the symptoms. Share your stories and experiences to foster understanding and support. Let’s push the boundaries of what’s possible in pain treatment together, armed with knowledge and a new perspective on healing. Join the conversation on social media, share this article to spread awareness, and stay tuned for more empowering insights at the intersection of neuroscience and everyday health!
