Rewiring the Chronic Pain Brain
Friday, May 29, 2015
by: Robert Kachko, ND, LAc

Section: Healthy Aging

About Dr. Robert Kachko

Robert Kachko, ND, LAc is a Naturopathic Doctor and Licensed Acupuncturist at InnerSource Health in New York City. He proudly serves on the Board of Directors of the American Association of Naturopathic Physicians (AANP) and takes an active role in the New York Association of Naturopathic Physicians (NYANP). He graduated Summa Cum Laude with a Doctoral Degree in Naturopathic Medicine and a Masters Degree in Acupuncture from the University of Bridgeport College of Naturopathic Medicine and Acupuncture Institute. He has completed an additional 2 year course of study in Classical Homeopathy at the New England School of Homeopathy. He completed his pre-medical studies with a Bachelor's Degree with honors at the University of Wisconsin, Madison.

Dr. Kachko believes in the importance of expanding access to Naturopathic Medicine and Acupuncture for all patients. At the College of Naturopathic Medicine, he was founding President of the expanded local chapter of the Naturopathic Medical Student Association (NMSA) and received the prestigious award for Outstanding Service to the Profession.

To learn more about Dr. Kachko, please visit him on Facebook and
Pain can be unlearned. It is meant to serve a crucial but temporary role in our lives: to alert us of danger and to influence appropriate action. This is certainly the case when we place our hand on a hot stove: pain signals immediately shoot to our brain and initiate a muscle reflex to remove our hand from the flame before we even become conscious of the source of pain itself. This mechanism evolved to optimize our chances for survival.
Pain can be unlearned. It is meant to serve a crucial but temporary role in our lives: to alert us of danger and to influence appropriate action....

In the case of chronic pain which cannot be explained though, there is no such adaptive advantage. Instead, chronic pain exists in large part because our brains (specifically our “sensory cortex”) have been rewired to perceive danger even when it ceases to exist. To take that idea a step further, the area where we would feel “hand pain” actually grows in size at the expense of other crucial neurological functions. This concept is well aligned with the relatively novel idea of neuroplasticity: new connections can be made as our brain has new experiences and processes new data. While this can be beneficial in the recovery of function after traumatic brain injury or stroke, it can have a negative impact as well: we can program ourselves to experience a continual cycle of discomfort with no known cause.

The Role of Neuroplasticity
In his book “The Brain’s Way of Healing”[i], Norman Doidge, MD discusses the work of psychiatrist-turned-pain-specialist Michael Moskowitz, MD who is using this concept to help his patients rid themselves of chronic pain. Based on the concept of “competitive plasticity”, he discusses how we can retrain our brains to experience less chronic pain by allotting more mental capacity to competing neurological tasks. For example, one of the main areas of the brain which processes pain also processes mental visualization. Similarly, our emotions and beliefs are intricately connected to other aspects of our physiology, and they can be utilized in concert to quite literally reshape the lens through which we experience the material world.

An important factor in our ability to do this is the understanding that our expectations, if negative, have the capacity to stifle progress and healing. In the case of chronic pain, our brain is not the enemy. Rather, it is an ally which must be utilized in a comprehensive approach to pain management. For many of us, every time we feel pain the trauma of its initial cause is relived, which serves to perpetuate the chronicity and false despair of the situation. By empowering ourselves with the knowledge that we have the capacity to literally change our brains with our thoughts, the initial trauma can be properly assimilated and dealt with. Pain can be unlearned.

How You Can Break the Cycle
Despite all of the advances we’ve made in modern medicine, our toolkit for treating chronic pain is rather limited. As long as there is no structural abnormality which needs to be addressed, most patients in chronic pain are prescribed opioid medications (in the same class as morphine). While these can be very useful, they have strong addictive capacity as our brains eventually grow resistant to them (by creating more pain-related “receptors”) and we require higher doses for the same effect. Relevant to the concepts of competitive plasticity and “learned pain”, the long-term use of these medications actually increases the sensitivity of our brains to pain stimuli because of the increased volume of those receptors. We become more susceptible to very same dangerous stimuli we’ve learned to avoid.

Pillars of Health
If long-term relief is the goal, we must learn to break this self-perpetuating cycle. The earlier one gets started, the better, as the longer we experience chronic pain the more difficult it becomes to rewire those parts of our brain. The first step in doing so is to establish a foundation for optimal wellness with a health promoting lifestyle. This means individualized improvements to diet, stress reduction, restful sleep, and appropriate therapeutic exercise among many other things. If our diet promotes bodily inflammation, any painful stimulus will be magnified regardless of the other factors at play. Stress is a major activator of our sympathetic nervous system, and stress reduction helps to “calm” our nerves. Ensuring restful sleep is necessary as the deep stages of sleep are our most crucial opportunity for repair and healing. A sedentary lifestyle and excessive physical exertion can both predispose us to structural abnormalities which prolong the cycle of pain. In working with a Naturopathic Physician, an individualized care plan can be formulated for your unique needs.

To specifically break the pain cycle, visualization, biofeedback or guided imagery under the care of a qualified health care practitioner are very useful tools. Though there are many specific approaches in this realm of therapy, one technique to try involves visualizing pain centers being activated in the brain and gradually shrinking them with intention.

When one experiences pain, they can imagine a large red area light up on the side of the brain opposite where the pain is felt (left arm pain, right side of brain), and over the course of a few minutes gradually imagine that area shrinking until it has disappeared. The goal here is not immediate and lasting pain relief, but rather retraining our pain centers to activate in a different way. If practiced over the course of several weeks, as one part of a comprehensive approach to addressing chronic pain, this and similar techniques can set the stage for long-term relief.
Change your Brain, Change your Life
Chronic pain is extremely common in our society, and we must begin assessing new approaches to therapy if we are to serve the needs of our patients. Research is helping to elucidate the relatively new concept of neuroplasticity: recovery from damage to our brains is gradual but feasible with the correct approach. As medicine is often slow and unreliable in embracing new ideas in practice, the time to initiate these safe, gentle, and effective therapies for patients is now.

[i] Doidge, N. The Brain’s Way of Healing. New York, NY: Penguin Group;2015
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