It’s All In Your Head? Controlling Pain Through the Mind-Body Connection

(Editor’s note: This article from a past issue of Brain World magazineIf you enjoy this article, consider a print or digital subscription!)


Calming a frantic person, whether he or she is dealing with worries, sadness or even chronic pain, is a pretty tall order. About one in three Americans — more than 116 million people — lives with long-lasting pain that never seems to go away.

Here’s the thing: When pain becomes persistent, even after a person’s underlying problem has been treated or the catalytic injury has healed, it is considered chronic. Doctors and researchers are finding that even after a patient’s injury is no longer present, there are significant changes in the brain and spinal cord that cause pain to become amplified and ongoing. Further research is investigating the response of pain-control systems in the brain that regulate and modify how much pain we feel. As it turns out, simply believing that a pill or medication will relieve pain is often enough to cause the brain to release its own natural painkillers to bring about relief. Neuroscience is proving that the placebo effect is actually quite powerful.

So, the question begs, if modern neuroscience is showing us that our brains can regulate how pain is experienced, is it possible to manipulate the mind enough to endure an unbelievable amount of pain without feeling an unbearable amount of suffering? Can we truly fake it until we make it?

Pain has always served an evolutionary purpose. Its essential function is to warn us that something isn’t quite right in the body, but when we’re talking about chronic pain, it’s a different story. The only function it serves is to keep us in constant aching agony. Without a root cause, this sort of pain is thought to be a disease of the central nervous system that results when there’s a malfunction in the brain and spinal cord.

Perhaps the complexity of aches and pains is seeded in the fact that there is no single pain center in the brain to target. Instead, neuroimaging has shown that pain is represented in a network of about 10 areas in the brain, which transmit information back and forth. These areas form a pain-processing neuromatrix. It is centered on the parts of the brain related to our sense of touch, which is what creates the actual feeling and sensation of pain.

Additionally, this network is thought to be divided into two systems that communicate with each other: One perceives pain, and one regulates or modulates pain. Research suggests that when pain occurs, it’s the result of either an overactive pain-perception system or an underactive pain-regulation system. But here’s the fascinating part: Both of these systems can be activated by stress, as well as belief. The brain will eliminate the sensation of pain — via its own pain-fighting endorphins — if it believes it is being given relief, even when it isn’t. This phenomenon is what is commonly known as the placebo effect.

In a recently published study led by Dr. Jon-Kar Zubieta at the University of Michigan Medical School, 14 participants had a stinging saltwater solution injected into their jaws, after which they underwent brain positron emission tomography (PET) scans. They were then each given placebo painkillers and told that they would positively relieve their aches. The men immediately felt better. Their scans showed that this was indeed true, because parts of the brain that release endogenous opiates lit up. In other words, belief became reality.

“We looked at the response of pain-control systems in the brain,” Zubieta said. “We observed that a placebo that was believed to be an agonistic agent was able to enhance the release of these anti-pain endogenous opioids.” Additionally, “there was more relief in response to this inactive medication as a function of belief,” he stated. “In fact, in some areas of the brain, the release was related to how much they believed the drug was going to be effective.”

Conversely, thinking about pain and stress actually creates it; real-time functional neuroimaging seems to be proving this phenomenon as well. To test this, researchers at Stanford University allowed subjects to watch their own brain activity as they were experiencing pain. The idea was to have them attempt to change it or take control of what they were feeling.

Dr. Sean Mackey, head researcher and director of Stanford’s Neuroscience and Pain Lab, explained that, in the study, participants could learn to control the activation and regulation of what they felt by interacting with the brain itself.

The first phase of the study looked at 12 subjects with chronic pain and 36 healthy subjects. The healthy participants were given a painful heat stimulus in the scanner, during which they tried to modulate their responses. The chronic-pain participants, however, simply worked to reduce their own agony. Those suffering from chronic pain who underwent neuroimaging training reported an average of 64 percent relief by the end of the study. “The purpose of this study is to show patients their mind matters,” said Mackey. “It’s reverse learned helplessness.”

Similarly, researcher Irene Tracey of Oxford University has shown that asking subjects who experience chronic pain to think about their aches will increase activation in their pain-perception circuits. Distraction, however, turned out to be a great analgesic. When Tracey’s volunteers were asked to engage in a complicated counting task while being subjected to a painful heat stimulus, she could watch the pain-perception matrix activity decrease while cognitive parts of the brain involved in counting lit up the screen.

Furthermore — and this is the main point — these techniques may offer a particular advantage over drug therapy, especially given the fact that it’s very difficult to design drugs targeted for fixing a problem in a specific region of the brain. For instance, opiate receptors are generally located in multiple networks and areas throughout the brain, which is partly why drugs almost always have side effects. Imagine that your car is in need of oil, so instead of opening up the oil spout, you lift the hood of the car and start throwing oil over the entire engine. Some of it will get to where it needs to go, but the rest will affect parts of the car that don’t need it. Neuroimaging therapy teaches patients how to control the activity within a targeted and localized brain region, and really focus on that specific area for a desired outcome.

“The technique gives people a tool they didn’t know they had — cognitive control over neuroplasticity,” Mackey said. “We don’t fully understand how this feedback mechanism is working, but it provides tangible evidence that people can change something in their own brains, which can be very empowering. It takes Buddhist monks 30 years of sitting on a mountain learning to control their brains through meditation — we’re trying to jump-start that process.”


So, while neuroimaging therapy has been proved to treat pain, its potential to rewire the brain remains an area to be explored. In the meantime, remember that the mind and body are in fact connected, since the body achieves what the mind believes.

(Editor’s note: This article from a past issue of Brain World magazineIf you enjoy this article, consider a print or digital subscription!)

 

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