I’ve been writing about some heavy stuff recently, so I thought it would be a good time to share something that makes me feel really hopeful:
Christopher deCharms is a neuroscientist and entrepreneur who, along with other prominent researchers such as Dr. Sean Mackey, is paving the way towards using brain imaging to study and treat chronic pain.
deCharms founded a company, Omneuron, which has developed something called rtfMRI, or “real-time functional MRI.”
In studies of chronic pain patients, this new technology allows researchers to see exactly which area’s of a patient’s brain are the most active, and how this activity can change from moment to moment, depending on what the patient is instructed to do.
We know that the brains and nervous systems of chronic pain sufferers function differently from people who aren’t in pain– now this technology allows us to see how.
deCharms explains,
There have (historically) been three ways to try to impact the brain:the therapist’s couch, pills and the knife.This is a fourth alternative that you are soon going to have.
We all know that as we form thoughts, they form deep channels in our minds and in our brains.Chronic pain is an example. If you burn yourself, you pull your hand away.But if you’re still in pain in six months’ or six years’ time,it’s because these circuits are producing pain that’s no longer helping you.
If we can look at the activation in the brain that’s producing the pain,we can form 3D models and watch in real time the brain process information,and then we can select the areas that produce the pain.
Just as there are parts of the brain which can produce the experience of pain, there are also parts of the brain which can “turn down the volume” on pain, so to speak.
There are a few mechanisms by which the brain can inhibit pain signals. One powerful way is through the production of our own endogenous opiates– chemicals which our own brain produces to block pain. (These chemicals are what opiate medications such as Percoset and Oxycontin are trying to mimic).
Omneuron is researching ways which patients can learn to “turn up the volume” on the parts of their brain which inhibit the sending of pain signals.
There is a built-in dial in the brain, that, when you turn it up… pain goes away. So we hope that when we can teach people to control these systems, to control this dial in the brain, they can make the brain go down.
He explains that many of his patients report feeling empowered simply by seeing images of the pain activity in their brains on the screen. For so long, they had felt as though the people in their lives didn’t believe them about how much pain they were in, and there, on the screen, was proof.
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I really find this topic to be so fascinating, not to mention inspiring.
If you’d like to know more, I actually have a whole section within my “Resources” page on how fMRI is being used to study and treat chronic pain. (I have links to a bunch more articles, as well as some interesting talks by other prominent researchers).
My friend C. once wrote that vulnerability does not always have to mean a state of weakness:
In order to function in my everyday life, I have to be vulnerable and explain why my body “doesn’t show up” when it needs to and that sometimes exposes me to feelings of powerlessness. At the same time, it exposes me to my own courage, resiliency, and even to these words.
Think about that. Isn’t that something radical and beautiful? Being vulnerable is a state that I am placed into because of my body but it is also a position of boldness. It is the same condition that allows you to love, explore and seek out meaning in your life, and relate to each other’s humanity. That’s not weakness; rather, that’s power.
Can being forced to rely on others actually be a good thing– something that forces you to connect?
This question struck a chord within me, after a lot of the things that have happened in the past few years.
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You may have noticed that I say much more about science than personal stuff on this blog. Partly, of course, that’s because it’s public, and to say too much about my life would be terrifying.
But at the same time– despite how complicated it is, and how many classes I had to take to get to this point– the science is actually much simpler to me, compared to trying to manage relationships when you have chronic pain.
Looking back now, I realize that it probably wasn’t just because of my physical issues. It probably would have happened anyway–my health problems were just the catalyst.
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I was 25 when I first developed these problems. I have written elsewhere about how terrified I was; how confused. I had just gotten answers for my chronic pain problem, and now, all of a sudden, I had this pinching sensation in my low back and I could barely walk.
For a while, everything went out the window. I couldn’t climb stairs; it hurt to climb into the shower. At times, my physical appearance slipped.
I went to meet friends for coffee in sweatpants. On Saturdays, I had to wait until the very end of the day to use my gym pool, because it was filled with swim lessons the whole rest of the day. This meant I’d show up at social events late, sometimes with my hair wet.
I had to plan ahead. Sometimes it hurt so much to drive that I preferred to take public transportation. I wasn’t always the easiest person to coordinate with; I admit it.
Some of my friends were happy to stand by me, and our relationships were unchanged. Yet, with others, it seemed I could no longer keep up, and I stopped getting invited to things.
The most painful part of this that it wasn’t just my casual friendships that slipped away.
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Instead, some of my most cherished friendships turned into a scenario where instead of a friend, I started to feel like an unpaid therapist. I’d be available to listen for hours, when the other person needed someone to talk to about her problems on a Sunday afternoon, or a weekday evening. On Friday or Saturday night, I wouldn’t actually be invited out. But sooner or later, I knew that next phone call for help would be coming.
To an extent, I think it comes down to the amount of strength people have to offer. As the saying goes, “People cannot give you something they don’t have themselves.”
I noticed it’s the people who were the most unhappy in their own lives, the ones who felt they were under the most pressure to conform and live up to superficial standards, that were the most likely to let our friendships be affected.
Over time I came to realize it wasn’t a reflection on me. Yes, maybe there were a few things I could have done differently to be easier to make plans with, but my real friends took it in stride. They stood by me, and were still willing to be seen in public with me, even if (God forbid) I was wearing flats and I wasn’t wearing makeup.
Now I understand that these things just happen. If a friendship couldn’t withstand my having physical limitations, it wasn’t meant to be. What it really means is that person, at that moment in time, did not feel secure with her own life, and did not feel she was in a position to have anything to give.
As my friends and I hit our late 20’s, there was just something about the age of 30 approaching. We all felt the pressure looming over us: the end of our free, hippiesh 20’s. The growing pressure to find a career we were going to stick to for the rest of our lives. Find a husband. Settle down. Have kids.
As one friend put it, it was almost as though 28 and 29 were the age we realized for the first time that, in fact, someday we were going to die. We’d always known it in the abstract, but now we were beginning to understand that we weren’t special; we were just like everyone else. (Looking back now, I know this sounds a little absurd. But somehow it was a truth that hit us all, at the same time).
In the face of this growing pressure, people changed. I think it’s worse for women. In fact, I know it’s worse for women.
So I don’t take it as a rejection; I take it as a sign that my friends weren’t okay with where their own lives were at. When you’re able to be there for someone else, and put your own needs aside, it means you’re strong. And I am grateful that, despite everything– despite my ever having dared to create the spectacle of showing up in public without makeup– I am still the kind of person who has the strength and security to be there for other people.
Ultimately, I am the one who chose to walk away from these relationships, although it’s not like I really felt I had much of a choice.
It just got to the point where the dissolution of the friendship seemed inevitable. I saw the writing on the wall and decided to focus my efforts on the people who were there for me; the people who had something to give.
With my extra free time, I reached out to people I’d been meaning to get to know better, but had always been too busy.
I discovered that acquaintances I’d known for years were actually amazing people, and some of them became my new best friends.
Honestly, I was sad for a long time, and it didn’t all come together overnight.
It took a while for my new friendships to solidify. I had to wade through a period of loneliness first; it took time to reach out to new people and build new relationships.
And sometimes I wanted to run back. But I didn’t. There was no going back.
Over time things came together. I can honestly say now that for everything and everyone that I’ve lost, I ultimately found something new, and something that fit me better for this stage of my life.
But It took time.
I still have the positive memories of my old friendships. I’ll always be grateful.
Now, I understand that life isn’t perfect, and people will usually hurt you in an attempt to heal themselves. It’s because they feel like something is missing, and they don’t know what to do to find that missing piece. It isn’t personal.
But it is okay.
I will always have the good memories. I can still love the people I loved, even if I had to walk away in order to make room for something new.
We normally think of stress in as the chronic, ongoing stress that continues for weeks on end, taking a toll on our body in the process. However, there are ways in which acute stress– that is, stress that only occurs during a short period of time, and then comes to an end– can actually benefit our bodies.
Neil writes,
If you want to make a muscle stronger, use it more. If you want to grow more tolerant of an irritating or bothersome sensation or experience, step up to it. Face it. In time, it will bother you less.
Try playing a string instrument for the first time, and feel the intense pain from pushing down strings with your fingertips. Keep doing it and your body will adapt, even creating a callous as a protective response, just like woodworkers and carpenters have on their hands and dancers have on their feet. In other words, when you stress your body, typically it responds by being better able to tolerate that stress next time.
We are built to survive. If there’s anything I learned in my health and science classes, it’s that our bodies are built to adapt specifically in response to the stresses we experience. If we continually perform a certain movement, the muscles that perform that movement will become stronger and better suited to the task.
If we perform a new task repeatedly, we will get better at it, until it becomes second nature. Our nervous systems will change, and our mental map of this task will become more developed.
Our bodies crave the kind of challenge that we can rise to. As Neil says, “acute stress is adaptive. This makes sense. When we exercise – challenging our physical abilities – we are not just improving our bodies physically; we are also making changes in our nervous systems.”
So. How can people with chronic pain and health issues use acute stress to our advantage?
Neil suggests that we harness our body’s ability to grow and change in ways that can benefit us. By teaching our bodies to do new things, we can give our nervous systems something to process other than pain, and try to jump-start that healthy, adaptive response.
If pain has been preventing you from exercising, Neil suggests:
Create acute stress while limiting the chronic stress of a flare-up: Make a daily plan to try an activity (or part of an activity) you want to do, but do it while you do your very best to keep your breathing even, your body tension low (only use as much as you need for the activity), and your stress level as low as possible.
So basically: we stress our bodies– our nervous systems, in particular, but also our muscles– in new ways. But we make sure we are in the right place, mentally and physiologically, while we do it, by proactively taking steps to keep our nervous systems from going into fight or flight mode.
There’s even more in Neil’s article. He talks about some of the positive effects of stress and exercise on the brain– how chronic pain can dim these effects, but how the techniques he suggest might present a way around that. Definitely check it out!
***
All this talk about the positive aspects of stress reminds me of health psychologist Kelly McGonigal’s excellent TED talk on “How to Make Stress Your Friend.” I’ve posted about it on my blog before, because it’s just really so great.
In this talk, McGonigal explains more about how stress can actually be a healthy motivator, seeking us to reach out to others and form social supports, and also spurring us on to create meaning in our lives. She also suggests that when we learn to view stress as a potentially positive factor, it can actually limit some of the negative effects we normally assume stress will have on us.
There’s so much more to say, but for now, I think I’ll let you check these two resources out! Happy reading/Youtubing– let me know what you think!
Tonight, I’m going to try out a type of post I’ve been wanting to write for a while: taking a scientific journal article on central sensitization, and translating it into plain English for my readers.
I got the idea from Paul Ingraham of PainScience.com. He has a fantastic “jargon-to-English” article on central sensitization on his site (a translation of a paper by renowned pain researcher Clifford Woolf), which I really love.
There is no reason why you, as a patient and chronic pain sufferer, should not be able to know a little bit about the scientific research being done on your condition. You are going to need to be able to advocate for yourself, stand up for yourself, and remember there is a legitimate explanation for your pain, even if other people don’t always see it that way. Knowing there is research to back you up helps.
Ever since I first learned of the term “central sensitization” back in 2011, I found so much comfort in reading these articles. Even if I didn’t understand every word, just knowing there were people out there who would believe me about my pain, if I met them, provided me with the sense that I wasn’t alone.
These changes to our nervous systems are real, even if some of the people in our lives don’t always understand.
The article discusses central sensitization, which is the name of the process through which our nervous systems learn to become more sensitive to pain.
Let’s look at it in bits and pieces:
“Central sensitization represents an enhancement in the function of neurons and circuits in nociceptive pathways caused by increases in membrane excitability and synaptic efficacy as well as to reduced inhibition…”
This basically means that the parts of the nervous system responsible for sending pain signals become more active than they were before.
“Increases in membrane excitability” means that it will take less stimulation for nerves to send a pain signal.
An increase in “synaptic efficacy” means that the nerve is going to learn to be more efficient with the neurotransmitters that it has. So, even though the nervous system still has the same chemicals floating around in it, it is going to learn to start sending stronger and stronger pain signals with those same chemicals.
Reduced inhibition. Your body has many intricate systems of checks and balances within it. It is how our bodies maintain control over our internal environment.
One way our body maintains control is by “inhibiting” some of the signals our nervous system sends. This serves a really practical purpose– we do not need to be bombarded with reminders that our socks are a little bit itchy at all times. Your nervous system chooses to block out certain signals when they are not useful, or in emergency situations (which is why people can feel no pain when they are in shock).
But in the case of central sensitization, our body’s ability to “block out” or “turn the volume down” on pain signals is reduced, meaning we ultimately experience more pain.
“Central sensitization is responsible for many of the temporal, spatial, and threshold changes in pain sensibility…”.
There are several ways in which these changes to our nervous systems manifest themselves.
We may find that, when something happens that we find painful, we end up experiencing it as painful in a larger part of our body than we might have otherwise.
I’ve really found this to be true with back pain. When my back pain was at its absolute worst (before I discovered pain neurophysiology education) one tight muscle or muscle knot could make my entire back hurt.
“Because central sensitization results from changes in the properties of neurons in the central nervous system, the pain is no longer coupled, as acute nociceptive pain is, to the presence, intensity, or duration of noxious peripheral stimuli.”
This means that, in a sensitized nervous system, pain is no longer an accurate measure of the presence of an injury, or the degree to which our tissues may have been damaged by an injury. The central nervous system is now doing its own thing, and you can’t really go by the pain to know what’s wrong.
“Instead, central sensitization produces pain hypersensitivity by changing the sensory response elicited by normal inputs, including those that usually evoke innocuous sensations.”
This means that we now start to feel pain in response to things that are not harmful, and which would have felt painful to us before.
To give you an example, I once knew someone who also suffered from chronic pain, and she said there were days she simply could not bear the feeling of clothing against her skin. Just the feeling of a lightweight sweater against the skin of her chest made it burn and throb.
This person wasn’t crazy. She knew her clothes weren’t “hurting” her. But her nervous system was reacting as though those clothes were somehow damaging her skin. There was a disconnect between her rational mind, which knew it was only clothing, and the parts of her nervous system which were contributing to her pain hypersensitivity.
(So… lest I end the post on a gloomy note, not to worry. That’s where pain neurophysiology education comes in, to try to fix this disconnect).
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Phew. Okay. That was not quite as easy as I thought it would be, all the times I thought about writing this post. But hopefully you made it through!
Everything I write on this subject is meant to be a trial, of sorts. I’m experimenting with what types of stories and explanations make the most sense, because I really have it in my heart of hearts to develop a set of educational materials on these nervous system changes.
So I want to see what works– what makes sense, what resonates. (And what doesn’t).
I suffered for so long, thinking I was crazy, when the whole time there were answers out there. And there was no good reason for it, except that most people (including many medical professionals) still do not know anything about central sensitization.
So I, and my blog, and my future potential physical therapy practice, are hopefully going to be doing something about that.
Please let me know if you have any questions, or any feedback on what sorts of things would be helpful in the future! I do take requests!
