Chronic Pain: Retrain Your Brain

I recently read The Brain’s Way of Healing by Dr. Norman Doidge and learned about a fascinating way to retrain how chronic pain is processed in the brain. The approach, developed by pain specialist Dr. Michael Moskowitz, is used with people who have been in pain for an extended period of time and whose brains have essentially become oversensitive, heightening their experience of pain.

To understand how Moskowitz’s method works, you must first understand how and why you feel pain.

3 Types of Chronic Pain

There are three types of pain that you can experience.

1. Nociceptive Pain: Nociceptive pain occurs when nerve endings called nociceptors (pain receptors) sense that damage is being done or is about to be done to your physical body. So when you cut your finger, step on a nail, or twist your ankle, you feel nociceptive pain.
2. Neuropathic Pain: Neuropathic pain occurs when structural damage is done to your nervous system: your brain, spinal cord, or peripheral nerves. This type of pain can result from an injury, autoimmune disorder, genetic condition, degenerative disease, stroke, vitamin deficiency, infection, toxins, diabetes, or alcoholism.
3. Neuroplastic Pain: You can experience neuroplastic pain when changes occur in your nervous system that affect how you process and experience the sensation of pain. When you’ve been in nociceptive pain or neuropathic pain for a long time, your nervous system adapts in a very unfortunate way—so that you experience more and more pain as time goes on. Pain receptors become more sensitive, the spinal cord becomes more responsive to pain signals, and more neurons in the brain are recruited to respond to pain signals. This is the type of pain for which Dr. Moskowitz’s approach has proved to be very effective.

Different Types of Chronic Pain Respond to Different Strategies

If you are experiencing nociceptive pain as a result of damage to your body (a broken bone, a pulled muscle), the damage must be allowed to heal in order for the pain to go away. Clinical Somatics is the most effective way to relieve your pain if your nociceptive pain is caused by chronic muscle tension, nerve compression, body use, or postural misalignment. And if your pain is neuropathic, you should work with a health professional to address the underlying cause.

But if you believe that most or all of your pain is caused by adaptive changes in your nervous system that have caused you to experience an increasing amount of pain, then Dr. Moskowitz’s approach could be exactly what you need.

Enter Dr. Moskowitz and Neuroplasticity

When Dr. Moskowitz was in his 40s, he went water-skiing with his daughters. While being pulled along at 40 mph in an inner tube, he flipped over and hit the water with his head bent backward, injuring his neck. He tried prescription painkillers, physical therapy, stretching, massage, self-hypnosis, heat, ice, rest, and anti-inflammatory drugs, but the pain only got worse as time went on. Thirteen years later, he was in extreme pain and decided to start researching the relatively new discovery that neuroplasticity (adaptive changes in the nervous system) could cause chronic pain.

You may have heard the phrase “neurons that fire together, wire together.” This means that when we repeat an action over and over, the neurons that control the action build stronger connections with each other. New neurons can even get recruited to help control the action. So if you throw a baseball repeatedly, your throw will become more efficient and accurate over time because more neurons are helping to control the movement, and the neurons are continually building stronger connections with each other.

Neuroplasticity and Involuntary Actions

It turns out that it isn’t just voluntary actions like throwing a baseball that result in this type of neuroplasticity. Our brain adapts to repeated sensory experiences—like pain—in the same way.

So when the sensory parts of your brain continually receive pain signals, those parts of the brain strengthen and grow. Neurons that receive and process pain sensation develop stronger connections and relay information more efficiently, making you hypersensitive to pain. And, neurons in nearby areas of the brain become involved in processing the pain signals.

As the areas that process pain expand into nearby brain areas, you can start to feel pain in larger areas of your body. For example, a wrist injury that results in chronic wrist pain can over time lead to pain in the hand, arm, and shoulder, as the “receptive field” for pain expands in the brain.

Moskowitz realized he was caught in a vicious cycle that would inevitably get worse unless he intervened. He read fifteen thousand pages of neuroscience text and research to fully understand how neuroplasticity worked. He found his answer. While neurons that fire together wire together, the opposite is also true: Neurons that fire apart wire apart.

Chronic Pain and the Brain

There isn’t unlimited space in the brain, so there is an ongoing competition for real estate, and the brain will allocate space based on demand. The activities or input that occur most often will gain neurons, taking them away from areas that are used less often. Brain areas that are used less often will weaken and shrink over time. The principle of “use it or lose it” is at work constantly in our brains.

Moskowitz theorized that if he could stop activating the pain-processing neurons in his brain, the area of his brain that was processing pain would start to shrink and the neural pathways would weaken.

He began drawing pictures of the brain as they would appear on brain scans. Moskowitz saw that the areas that tended to be overtaken by pain processing should normally be processing visual and sensory information, thoughts, memories, movements, and emotions. He now understood why it was difficult to concentrate, think, and regulate emotions when we were in pain. The areas that should be controlling those functions are being used to process pain signals.

Reprogramming the Brain

Moskowitz came up with a plan to take back those areas of the brain that had been hijacked to process pain and return them to their original functions. His approach was simple: Whenever he felt pain, instead of allowing himself to focus on the pain, he would provide counterstimulation to his brain. So instead of allowing his brain to process the pain, he would force it to process something else. In theory, the more he activated the hijacked brain areas to do their intended activities, the less they could be used for pain.

He decided to use visual information as his counterstimulation. He started by visualizing the map of the brain he had drawn, showing all of the areas that were active when he was in chronic pain. Then he visualized those areas shrinking and shrinking until the map looked like the brain when there was no pain information being processed. He committed to doing this visualization or some other mental activity every single time he felt a spike in pain.

After six weeks of dedicated practice, Moskowitz had successfully eliminated the pain in his shoulders, and it never returned. After four months of practice, he was having pain-free periods in his neck.

At the one-year mark, he was virtually pain-free.

He observed that the pattern in which his pain disappeared was the reverse of how it had originally expanded. The pain had begun in the left side of his neck after his injury, expanded to the right side of his neck, and then down to his shoulders and midback. As his pain gradually disappeared, the midback and shoulder pain went away first, then the right side of his neck, and finally the left side of his neck.

Sharing Moskowitz’s Method

Moskowitz soon taught his method of visualization to one of his clients, a woman who had been in extreme chronic pain and on heavy-duty painkillers for 10 years. He taught her the principles of neuroplasticity so that she would understand what was happening in her brain. Then he trained her to use his visualization techniques and told her to be relentless in her practice. After four weeks of consistent practice, she was experiencing pain-free periods of 15 to 30 minutes at a time, and she began going off her medications. Today she is completely pain-free and does not take any medications.

MIRROR: Defining the Method

Moskowitz set about to systematize his approach and came up with the acronym MIRROR, which stands for Motivation, Intention, Relentlessness, Reliability, Opportunity, Restoration.

• Motivation: The patient must take control and responsibility for their healing process, rather than relying on someone else.

• Intention: The intention must be to refocus the mind, not on immediately getting rid of the pain. So, the patient should not focus on the reward or end result of getting out of pain. They must simply refocus their mind so as to use the mind for visualization instead of pain processing.
• Relentlessness: The patient must be relentless! Every time they feel pain, they must use all of their mental energy on refocusing the brain using visualization.
• Reliability: The patient must know that they can rely on their brain to regain normal function.
• Opportunity: The patient should treat every episode of pain as an opportunity to repair their pain processing system.
• Restoration: The patient’s goal isn’t to simply mask their pain or reduce it, but to restore normal functioning of their pain processing system.

A Cure for Chronic Pain?

After using his method with many of his patients, Moskowitz said that he does not believe in pain management anymore—he believes in trying to cure chronic pain. He has successfully helped patients relieve pain from nerve injury, inflammation, cancer, diabetic neuropathy, spinal degeneration and trauma, arthritis, irritable bowel, trigeminal neuralgia, multiple sclerosis, and more. The key in his patients’ recovery is their commitment to doing the relentless mental work required to retrain their brains.

In 2008, Moskowitz met Marla Golden, a physician specializing in chronic pain and trained in osteopathy. Golden uses touch, sound, and vibration in the same way that Moskowitz uses visualization: to provide counterstimulation to pain sensation. The two teamed up to form Neuroplastix.

If you want to learn more about Moskowitz’s method, you can purchase his workbook and look through the videos on his Vimeo channel.

If you want to learn more about neuroplasticity, I recommend Dr. Norman Doidge’s books The Brain’s Way of Healing and The Brain That Changes Itself.

How to Practice Retraining Your Brain

• Retraining your brain is not a quick or easy fix. As described above, it requires relentless commitment to refocus your brain every time you experience pain. It also requires patience, because you will likely not begin to feel improvements for at least a few weeks, maybe more, with the method.
• If your muscles are chronically tight, nerves are compressed, or posture is misaligned, choosing to only retrain your brain’s pain processing system is not the appropriate solution. You must release your chronic muscle tension, relieve nerve compression, and restore natural alignment by using Clinical Somatics exercises. As your pain is relieved with Clinical Somatics exercises and fewer pain signals are sent to your brain, the area of your brain being used to process pain will naturally shrink (if it had expanded).
• If you feel that neuroplastic pain is contributing to your nociceptive or neuropathic pain, then Moskowitz’s method may be an effective adjunct therapy to Clinical Somatics or other treatment that you are pursuing.