Pain is in the brain – part 2

In part one we were introduced to the work of Dr Michael Moskowitz from the Department of Anaesthesiology and Pain Medicine from the University of California, who has identified eight section of the brain responsible for up regulating the pain sensation in people with chronic pain; posterior cingulate, amygdala, insular, supplementary motor, prefrontal, anterior cingulata, somatosensory and posterior parietal. In Part 1 we had a cursory look at the first four. In the second party we will be addressing prefrontal, anterior cingulate, somatosensory and posterior parental regions involved in pain modulation.

The prefrontal cortex covers the front part of the frontal lobe and is thought to be responsible for executive functions or top down control of behaviour and memory, mimicry and mirror behaviours (Goldman-Rakic, Cools, & Srivastava, 1996).

The role of this part of the brain is of great significant, as this part of the brain appears to be responsible for mapping the connections and controlling behaviour. It remembers what caused pain in the past and it seems to be the part of the brain that provides the expectation that pain will return if the same behaviour is enacted. It is why I ask my clients to walk without stopping for a minimum of 15 minutes and to walk through the pain and as naturally as they can. Eventually this part of the brain will change its focus to other memories and the counter productive muscle guarding patterns and the pain can completely disappear is some instances.

Anterior cingulate is a part of the frontal cortex that wraps like a collar around corpus callous, a central bundle of white matter (like a bundle of electrical wires) dividing the hemispheres of the brain. Important in the autonomic control of blood pressure and heart rate, that increase during episodes of pain, it also plays a part in reward or penalty anticipation and impulse control along with the prefrontal cortex. Learning new activities can be rewarding here.

Located along the post central gyrus of the brain, the somatosensory cortex is responsible for perception of sensory inputs from the body. Home of the sensory homunculus or sensory body map of tactile perceptions, neuroplasticity in this region can cause areas of pain to expand due to the increased sensations being produced there. So the region of the homunculus responsible for the perception of stimuli from a painful knee may increase, while synapses responsible for thigh or calf tactile information may be sheared away. As a consequence providing pain free or pleasurable stimuli to those  regions around the painful site such as the calf or thigh may help reduce the central sensitisation of chronic pain.

Finally the posterior periatal region of the brain is thought to have significant responsibility for planned movements, spatial reason and attention. We can distract this section of the brain by learning a new activity – any activity. A new sport, a new craft or skill. For example learning how to ‘juggle’ can effect the perception of pain in a profound way and for clients open to new experiences,  juggling could be a positive boon.

This blog is in no way comprehensive or heavily researched – it is a grab bag of ideas to inspire and entertain people suffering chronic pain and offer them some hope. People suffering with long term pain should seek help with skilled professional and via your local pain clinic.

Thanks for reading – Laurence

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