Pain is perceived in the brain – part 1

According to the work of Dr Michael Moskowitz from the Department of Anaesthesiology and Pain Medicine from the University of California, brain scans indicates that pain is perceived in eight section of the brain; posterior cingulate, amygdala, insular, supplementary motor, prefrontal, anterior cingulata, somatosensory and posterior parietal.

In part 1 – I do a relatively brief investigation of the first four regions of the brain involved in pain and postulate how neurones involved in chronic pain might be able to be stolen back.

Each of these regions is responsible for a number of things other than just pain and by encouraging people to engage these other actions and perceptions chronic pain can be down regulated; or as Dr Moskowitz puts it – we can steal back our neurones.

So lets break them down these regions of the brain and start a discussion on how we can help people free themselves from persistent pain.

1. Anterior cingulate has been referred to as the default mode network of the brain, it is most active when we are daydreaming or in a state of wakeful rest. It is involved in episodic memory retrieval and pain perception (Buckner, Andrews-Hanna, & Schacter, 2008)

Could we daydream our way to a pain free state? Is this section of the brain utilised in meditation? Certainly thinking happy thoughts fits the bill. Not such an easy thing to do when you are in chronic pain.

2. Amygdala is a distinct part of the anterior temporal lobe and a vital part of the limbic system, and is active in memory, decision making and emotional reactions. Larger in men than women, and it is hypothesised it is a critical in evaluating the environment for potential dangers (Amaral, 2006).

As a consequence if we could provide people with a change of environment we might be able to change the focus of the amygdala from pain perception to other risk assessments.

3. The insular cortex is part of the cerebral cortex involved in a wide range of functions from emotional state to homeostasis; these include motor control, self-awareness, cognition, perception and interpersonal interactions, and it is theorised that it is responsible for offering a sense of spiritual certainty; removing all fear of uncertainty (Gschwind & Picard, 2016).

Perhaps this part of the brain could explain why people stubbornly hold onto the belief that the pain is in the tissues that have long since healed?

So many options for treatment here. Interpersonal interaction – changing your friends or how your friends talk to you, learn a new activity, catch your negative self talk, practice positive affirmations, even find religion?

4. Supplementary motor is a part of the cerebral cortex involved in the control of movement and it neurones project directly into the spinal cord. It has been hypothesised that it is involved in control of movement including postural stabilisation, bilateral coordination and sequential movements – and the perception of pain (Graziano & Aflalo, 2007).

This section of the brain is thought to initiate movement independent of external stimuli, and consequently could be a good place to reduce central sensitisation. There are a any number of balance related exercises from simply stating on one leg to standing on a board on a roller. A complex and repeated pattern of these could steal back some vital pathways. Again remember I’m only hypothesising here – all of the management ideas are experimental.