Role Of The Brain in Pain Control

In order to protect yourself from more pain, the only obstacle worse than the pain itself to not participate in activities you enjoy. Our culture has been conditioned to directly correlate pain to physical injury. This is not entirely the case with chronic or persistent pain states and perhaps even other types of problems such as acute low-back pain. There is now edifying research that the underlying problem, of certain types of pain, lies within the nervous system itself— above the neck, not so much in a physical structure, such as bulging spinal discs, worn-out joints, or tendons. It is well established that MRI research has shown a poor correlation between physical injury and the types of pain a patient may feel. People who have minor structural abnormalities may suffer severe disability and people with severe anatomical defects may be free from pain. A team of researchers at Stanford devised a way for chronic pain patients to view video MRI images of how pain is represented inside their brains (DeCharms, R.C. 2005). The patients were taught mental skills in how to gain some control over their pain while watching videos of their brain activity. By gaining these mental skills, a visceral understanding of how pain works, and in particular how pain is generated inside the brain, these chronic-pain patients experienced an overall 64% decrease of pain. The scientific rationale supporting these ideas is being disclosed in the neuroscience and psychological literature and is very exciting. The first 10 years of this century were known as the Decade of Pain Control and Research and I believe this is only the beginning of interventions that will help ease pain. Future advances will change the way doctors and physical therapists help people, with chronic pain, restore normal movement ability. From a physical therapist perspective, movement is essential to a healthy body and brain. It is awe-inspiring to glimpse how the key to unlock neural patterns that have gone awry (i.e. pain) must begin within our own understanding.

Anna Kotula, DPT

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