Thursday, 5 September 2013

Pain and the Brain - what can we learn to help ME recovery?

In Lorimer Mosely's book 'Painful Yarns' he demonstrates his experiences of people's pain and how the brain relays pain to the body. He is an Australian physio therapist who has specialised in back pain. His many stories are entertaining and amazing, but the key information they demonstrate is that pain is something the brain uses to tell a person there is something wrong, it is a construct of the brain. People can no longer have something wrong with them - for example an amputated limb - but their brain can still be telling their bodies to feel pain. Or conversely people may have something wrong with them, but because of the context or their personality their brain doesn't tell their bodies to feel pain - for example a man with a nail through his foot walking two miles barefoot to the hospital and being absolutely fine, then banging his knee on a bench and screaming out in agony! One example from his book.

Mosely is not saying these people don't feel pain, he's not saying they are not in pain, what he's doing is holding up a mirror to the fact that pain is something in essence created by the brain, and that the brain can also choose or be taught not to tell us about that pain. This is very different from saying a person with an amputated leg doesn't feel pain it is in their head. It isn't in their head, their brains are creating that pain in the same way as your brain will create pain if you stick a knife in your leg, both are real, both are valid. But if people's brains can also, for whatever reason, not inform someone they are in pain what can we learn from that, and how can that information be used to help people who experience chronic rather than acute pain?

How could this knowledge be applied to ME? Could it be something has switched our brains on to pain, symptoms etc and is it possible to switch that information off? I don't have the answer to that last one, I don't think there is a magic bullet, but I do think it's possible that by unavoidably being aware of our illnesses we are reinforcing the message from our brain that there is something wrong and we need to experience it. Again, like Mosely, this is not in anyway the same as saying it is in our minds, it is as real as putting the knife in your leg, it's just that perhaps we don't actually need to be told we have a knife in our leg anymore, perhaps we need to find a way of convincing our brains to tell us different things. Perhaps this is how we can get stuck and need help to get unstuck. We are ill, it is real, but how we think can affect how we experience our illness and we need to find the most useful ways to think to aid recovery.

This fits with something I heard on Radio 4 recently about surgery to electrically stimulate the brain to help various conditions, including enduring untreatable depression and Parkinsons. One man has chronic and constant pain in his arm, so bad that he has considered chopping his own arm off, only the doctor told him it wouldn't make any difference, the pain is not in his arm, it would still be there because the pain is a message to the brain that has gone wrong. By stimulating the right part of the brain they can change his experience of this pain. It's not that the pain isn't real, it's not that the doctors don't believe his experience - they do enough to do an expensive operation - it's that his brain or the neural pathways are stuck on the PAIN ON mode and by stimulating the brain they can either turn these off, or as one patient put it 'It's not that the pain has gone, it's that the pain doesn't matter anymore!'

All Food for Thought.

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