Kate has suffered from chronic sciatica pain for over 10 years. Her syndrome began as right-sided throbbing in her legs, but the aches later expanded to also include her lower back, neck, and arms. Over the years, Kate has visited numerous doctors, chiropractors, and acupuncturists to relieve her persistent pains, but to no avail. So far, the medical professionals haven't uncovered any apparent reason for the pain and none of the treatments they have recommended have worked. Resigned, Kate has learned to live with her condition and uses various methods to cope, including exercise and support groups.
As Kate can attest, the feeling of pain is always real, even when doctors are unable to locate a bodily cause for it. But is it possible that sometimes the pain we feel is the result of our thoughts (1)? Does the way our brain processes pain impact how we feel? And if this is the case, can we potentially lessen or eliminate our pain by learning to think differently about it?
These are bold assertions but important to consider given recent studies that have supported them and how devastating chronic pain can be on one's physical and mental well-being. Here, we will explore if and how chronic pain is sometimes the result of learned neural pathways in the brain (referred to as centralized pain) instead of a structural problem in the body. We'll also take a look at various psychological treatments, including Pain Reprocessing Therapy (PRT) (2) and Pain Neuroscience Education (PNE) (3), to see how they - and other mind-body treatment principles - can possibly help us reduce or stop our chronic pain.
What is Chronic Pain?
Whereas acute pain is usually short in duration and generally related to a soft-tissue injury, chronic pain lasts much longer, can be constant or intermittent, and isn't always the result of an actual trauma to the body. In many cases, no identifiable cause of the chronic pain can be found at all.
Over time chronic pain can actually affect not just the body, but also the brain. It can alter the brain's structure by strengthening certain neural pathways, essentially teaching the brain a familiar sensation of pain. This, in turn, leads people like Kate and others to experience what is called centralized pain, which is caused by changes in the neural pathways of the brain and NOT by a problem in our bodies.
Psychological Treatments That May Help
This is where PRT, PNE, and other mind-body treatments come in. Let’s start by examining PRT. Developed by Alan Gordon, LCSW, this centralized pain therapy aims to break the cycle of chronic pain by retraining the brain so it responds to signals from the body properly. To do this, doctors first need to determine that your chronic pain is centralized (meaning that the pain is due to the brain not processing pain signals correctly). A clinician can confirm this by ruling out all structural (i.e., bodily) causes of pain and by running appropriate medical tests and procedures. Next, you should consider the various indicators of centralized pain to see how many apply to you. Some signs that you may be suffering from centralized pain include:
- A lack of a physical injury.
- Pain symptoms that are frequently triggered by stress.
- Pain that is inconsistent and shifts around the body in terms of both location and intensity.
- A tendency to be hypervigilant and anxious by nature.
- An experience of childhood trauma (4).
If you are experiencing centralized pain, you can move forward with PRT and start the process of re-teaching your brain that certain sensations that it previously deemed dangerous are actually safe. Instead of allowing yourself to be fearful when thinking about pain, PRT teaches that you should first be mindful of the pain in a non-judgmental way, tell yourself that it isn't legitimate because there's no bodily harm, and then focus on generating positive emotions about the situation. This will create and strengthen new brain associations between the activity that used to cause pain and feelings of positivity.
Similarly, PNE uses stories and metaphors to recharacterize pain. This educational strategy typically involves a conversational, one-on-one interaction between the patient and clinician where pictures, analogies, etc., are used to explain what the patient might encounter and/or feel throughout the entire process of pain. This deeper understanding of what to expect when it comes to the pain experience can, in many cases, lessen the fear that has been found to correlate with pain (5). Again, changing the way the brain looks at or understands pain can potentially change how we experience it.
Beyond the psychological treatments that can help to combat centralized pain, there are also other mind-body approaches we can incorporate into our lives that may reduce some of the pain we feel. Consider, for example, taking steps to reduce stress and fear in your everyday life. Deciding to move on from a highly stressful career, for instance, might result in you feeling calmer, happier, and more pain-free. Meditation, yoga, and progressive muscle relaxation might also be beneficial (6). In addition, taking care of yourself by getting enough sleep can also strengthen both your mind and body.
The idea behind PRT, PNE, and other centralized pain therapies is that we can teach our brain not to view pain as a danger or threat by changing the way we consciously think about it. Making these changes to our thoughts, and integrating other mind-body approaches into our lives, can potentially result in less pain or even eliminate it altogether. Perhaps someone like Kate can overcome her chronic sciatica pain after all by modifying her thought patterns, if indeed her pain is centralized. And keep in mind that when pain is centralized (i.e., brain-driven), these techniques can drive transformative healing very quickly. Learning that your pain is only the result of your brain’s processing may be the most hopeful diagnosis out there!
If you have been struggling to treat your pain and have only considered the body and not the mind-body connections that might be causing it, it could be worthwhile to revisit the source of your condition. At Lin, we make sure to get to the root problem of your pain by connecting you with best-in-class clinicians who determine if you have a structural issue. If you do, we will work with you on getting your body as healthy as possible. But if it turns out you have centralized pain issues instead, then our health coaches can implement effective alternative pain management options (including PRT-based care plans) to help tone down your pain.