Not many people realise that only around 20% of chronic pain sufferers actually get relief from current treatments, which is not different to placebo, and that this leaves around 3 million Australians experiencing pain pretty much on a daily basis.
If you’re one of those 3 million, the following 7 pictures will not only explain why, but will show why a new treatment strategy is so effective.
Picture Number 1 Shows Us It’s Often NOT about the Damage
Whether looking at x-rays, or looking at MRIs, we find there is no correlation between apparent “damage” and the existence of pain. Teams of specialists, looking at a range of results from “normal” to “abnormal” spines, are spectacularly unable to predict which person will have pain and which will not.
So if chronic back pain is not actually related to damage or wear and tear, what on earth is going on? Read on ….
Picture 2 Will Begin to Explain Why Pain Treatments Haven\’t Worked
In the diagram above we see an accurate representation of CHRONIC pain as a BRAIN FUNCTION. This is very different to fMRIs of people experiencing ACUTE pain. On fMRI, chronic pain looks almost identical to emotional pain, and that figures, since it’s actually being modulated by the amygdala region, just like emotional pain is.
Note! This does not mean that the pain is “all in your head”. The pain is real. It’s just that it’s a very different beast to acute pain, and therefore MUST BE TREATED DIFFERENTLY. No wonder current treatments, working as if chronic and acute were the same, are failing so many people.
Picture 3 Helps to Show that Chronic Pain is CONDITIONED Behaviour of the Nervous System
Over a hundred years ago, a scientist called Pavlov did some pretty amazing experiments with dogs. He was measuring salivation rates in dogs, and to get them to salivate he brought them food. Make sense?
Pavlov noticed that very quickly the dogs started to salivate before the food arrive, in fact as soon as they heard the staff member’s feet coming toward them! So Pavlov decided to see what else he could make the dog salivate about. So when it was time to bring out the food, one of the staff would ring a tuning tine (which made a distinctive sound), so that the sound became associated with the food.
Very soon, even with no food, the dogs would salivate at the sound.
This is called a conditioned response and shortly I’ll show you how your pain is like that too.
Picture 4 Shows How Conditioned Responses Get Set Up
Basically this can be represented as:
Food = salivation
Food plus noise = salivation
Noise alone = salivation
Now let’s look at how your nervous system can get hooked into giving you certain feelings, including pain ….
Picture 5 Shows How Complex this “Learned Behaviour” of the Nervous System Can Be
When people first start smoking, they don’t actually like it, but over time a couple of things happen. For some people there’s an actual physical addiction because of the nicotine receptors in the brain (some, not all!). But for pretty much everyone, their nervous system begins to ASSOCIATE the act of smoking with things they commonly do when they smoke, and these become TRIGGERS to the desire to smoke.
Examples of commonly-recognised triggers are:
- Smelling cigarette smoke
- Having a cup of coffee
- Having a beer or wine
- Leaving the office
- Feeling stressed
However triggers can be anything:
- Opening a newspaper
- Getting up in the morning
- Going to bed at night
Quite literally, the trigger to the urge to smoke can be absolutely ANYTHING you were doing or thinking about while having a cigarette, even your own self talk. Your chronic pain is most likely just like that.
Picture 6 is All about Your Chronic Pain – How Once There Was a Cause, But Now There May or May Not Be
In fact all “healing with central plasticity” can be categorised as “chronic pain” of the type we’re dealing with here. It is pain that doesn’t have adequate explanatory pathology, although once that pathology may have been present.
Your particular experience of chronic pain may not have arisen from an actual injury as such, but could be from some other insult or trauma, such as an illness, a virus, or a traumatic event.
Notice that most people recover from such situation and go back to normal life. However in the case of chronic pain, the pain becomes associated to whatever was happening at the time, even the weather, even your own self talk, and your own thoughts about the pain. And now when you have pain, that ongoing pain is further associated to whatever is happening or whatever you are experiencing, even being associated to your very PERCEPTION of the pain.
The pain can in fact increase rather than getting better, and can spread far and beyond the original site, including some really wild and wacky symptoms!
Please note that I am most certainly not blaming you for your pain, or trying to tell you that your pain is “in your head”, because that is absolutely not the case. Your pain is unfortunately very real, generated not by any damage or injury, but by your nervous system, all by itself.
If all you had to do was force yourself to think differently, or to somehow “change your attitude” to the pain, then CBT would work, and the fact is that CBT has the same impact as placebo, and can’t be described as “working”. CBT has no impact at all on pain levels.
So your pain is being generated as a conditioned response, or as a set of conditioned responses, and that’s what we need to deal with. We need to actually shut off those conditioned responses ….
Picture 7 is My Favourite and I’ve Saved It Till Last – It Shows How Quickly We can Eliminate Conditioned Responses and Shut Off Your Pain
As Pavlov discovered over 100 years ago, we can eliminate a conditioned response (this is called “extinction” of the conditioned response) when we stop reinforcing the response. In lab animals this theory works just fine. With little kids, works pretty well. With complex adults, it really does not work very well at all. Thankfully modern scientists have taken this a step further and they say:
When we DISRUPT the reconsolidation of the conditioned response, we get IMMEDIATE extinction of the response.
This means we no longer have to struggle with difficult inhibition/exposure strategies that risk actually making the problem worse. Instead we can identify the conditioned feelings, thoughts, and behaviours that comprise the problem and simply eliminate them. This is exactly what we teach colleagues to do using SDR Therapy.
Reference Re Non-correlation of Pain
Haig AJ, Tong HC, Yamakawa KS, et al. Spinal stenosis, back pain, or no symptoms at all? A masked study comparing radiologic and electrodiagnostic diagnoses to the clinical impression. Archives of Physical Medicine & Rehabilitation. 2006 Jul;87(7):897–903. PubMed #16813774.