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

Pain is 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.