A study: Rewiring the Brain
In the past 3 issues of fixnews, we have been chatting about pain and how it is a response of the brain. We've started to explore the amazing way in which pain is our body's way of protecting itself and that the brain is capable of constantly weighing up all information in each and every moment of time to produce a pain experience, or not. We can start to visualise all of that grey matter with its trillions of nerve connections, pulsing, surging and deciding. The brain is very busy indeed.
Through education and a better understanding of these processes (and I have only really just begun!), we can actually change the brain's nerve connections and wiring to bypass pain experiences that may be entrenched within its grey matter. We've started to explore the plasticity (or ability to change and adapt) of the human nervous system and we can increasingly see with real time scanning, this adaptation before our eyes.
This is all very promising news and should give new hope to sufferers of persistent or chronic pain. Same can be said for suffered of chronic fatigue, mental illness and other afflictions.
Today I'm going to share with you the findings of a study by Dr Lorimer Mosely, a physiotherapist and Doctor of Pain Management. He has researched pain extensively and has published many papers. He is interested in the interface between physiotherapy, psychology and physiology in those that suffer from chronic pain.
This simple study published in 2005 demonstrates amazing well the role of education and the immediate effect it has on the brain wiring. As physiotherapists, we see every day that pain beliefs, attitudes and physiology can alter movement performance. Pain can change what muscles we activate, movement control, good movement patterns or habits and postural support. The best example here is the 'switching off' of the deep abdominal muscles that support the spine when amidst a painful lower back episode.
In this single subject study, the 36 year old woman had a 5 year history of lower back pain (LBP) after a fall at work. She had not returned to work because of the injury and was reliant on pain medication for relief. She underwent real time 'functional MRI' (fMRI) scans at 3 occasions to see brain activity for her particular 'pain movie' or wiring in the brain for pain.
The woman was taught to contract her deep abdominal muscle and scanned while performing these contractions. She was sent away to practice her abdominal exercise for a week and rescanned again performing the contraction one week later. She then underwent a 2.5 hour highly detailed education session with a physiotherapist talking about the physiology of the nervous system, the brain and pain physiology. Diagrams were drawn, metaphors used and pictures looked at to help with the information delivery. She was scanned for a final time once again performing the same abdominal exercise to compare activation patterns in the brain to her earlier scans.
The scans showed that brain areas that were activated when performing the abdominal exercise reflected this woman's 'pain movie' and involved multiple areas of her brain, including some that are known areas involved in human pain. The first 2 scans reflected a very similar activation pattern or 'movie'. However the third scan immediately following the education session showed significantly reduced brain activity when performing the same abdominal contraction.
It seems likely that the reduced brain activity in this woman at this final scan reflected a change in her beliefs or attitudes to her pain after hearing about how pain works in the body. Perhaps the new information had allowed for her to feel less threatened or anxious about her pain and the abdominal exercises that she had been asked to perform? Perhaps in some way she had begun to overcome the fear of her own pain, the barrier which she possessed that was preventing her from getting better? Could this education session be a catalyst to 'unravel' her 'pain movie', reduce her pain levels to allow for exercise, to gain strength and better support for her spine?
Perhaps she has turned the corner in her pain levels and function? New hope.