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Flare-ups, shooting pain, cramps, and spasms are daily events for chronic pain sufferers. With random increases in pain, making plans for the week becomes nearly impossible. Wouldn’t it be great to have better control over how and when pain shows up? Well, there is a way we can do this—with the help of neuroscience.
We usually think of pain as information that comes from nerve endings traveling to the brain. For example, if you poke yourself with a straight pin, you imagine an “ouch” signal traveling up to your brain telling you that your finger is hurt. With 43 miles of peripheral nerves running throughout our body, our brain is constantly analyzing the “data” they send.
Cognitive science refers to this definition of pain perception as a “bottom-up” approach, meaning data travels up to the brain from the body, alerting the brain as to what is happening. However, this concept of pain perception is becoming outdated and is rapidly being replaced by the Bayesian Model; this new theory suggests that pain results from the brain’s prediction that something should hurt based on past experience, contextual cues, and sensory input.
How the brain predicts either pain or comfort
The probability theory known as Bayes’ rules has led to a radical new view of how the brain produces pain and brings with it great potential for helping chronic pain sufferers find relief.
Here’s how it works: The brain creates a hypothesis about what it expects the world to be like. This hypothesis helps to frame how the brain interprets what is happening in real time. If there is a mismatch between what the brain is expecting and what information it is actually receiving, then the brain will change its hypothesis.
To better understand this model, consider this example—anytime you have been startled by a piece of fuzz that you first thought was a spider illustrates how your brain already had a hypothesis in place. Now, not everyone would react to a piece of fuzz by jumping, but if your brain is more vigilant of a spider threat, it will see one, especially if the stimulus is ambiguous. The implication here is obvious—our world is largely made up of what we think it should be, not what it truly is.
How the brain views the body
The brain is not only making predictions about potential spider encounters in our external environment, but it is also making assumptions about what is happening within the body as well. As you recall, we have a host of sensory data rushing to the brain from every part of the body at all times.
When you watch TV for an hour, your brain receives information about your body. This includes the following: poor blood flow to lower half of your body, the strain in your eyes, stiffness, muscle tension, soreness, variations in your breathing and heart rate, your neck position, poor posture, blood sugar levels, and variations in your skin temperature.
The real question is, what does all this data mean for your cognizant experience?
When your brain’s current hypothesis is that you are healthy, there is no basis for concern, and this ambiguous, mildly suspicious sensory data will not be interpreted as a threat. In other words, your attention will be focused on the TV, and not on your physical experience watching it.
This positive expectation is the same reason why a placebo often brings relief. The person taking a sugar pill holds the belief that it will help, and as such, will “feel it working.” As it turns out, this feeling is partly true! The brain, treating the normal flow of sensory input as a sign of recovery, actually helps real healing to take place, in some cases.
Relief for chronic pain
Chronic pain and pain flare-ups may be more similar to the effects of a nocebo. The nocebo effect occurs when a person takes a sugar pill with the expectation of negative side effects. If a person expects pain, discomfort, hives, cramping, tiredness, dizziness, and/or brain fog when taking a sugar pill, then that is what they will be more likely to experience. The ambiguous signals of the peripheral nervous system are now framed within a threat by the brain’s hypothesis that something is wrong; the brain’s prediction that there will be a problem puts the entire body into preparatory action for the threat and consequently, it will produce pain in an effort to protect us.
If the Bayesian theory of pain perception is correct, it means that pain relief does not only come from improving a person’s physical health, but also from helping the brain view what is happening from a different perspective. Changing the framework matters.
I work with patients to find the right message that makes the most individual sense. For example, one message that I always start with is, “Pain does not equal harm.” To elaborate, this means that just because pain occurs when a person starts a gentle exercise program—like the one prescribed by a physical therapist, for example—it does not mean damage is actually being done. Pain does not mean damage is occurring, but more so, that the brain wants to protect us. Another positive message is, “I am okay, and I am getting better.” Speaking to your brain in this framework helps to remind you that you are a healthy person with a strong body full of courage and hope.
Be mindful of your expectations—our body is constantly preparing us for what it assumes will happen in the future. By speaking messages of safety, health, enjoyment, and a meaningful life to yourself, you will begin to create a positive framework for growth and healing.
