Emerging neuroscience research is unraveling how our brain processes pain. This research is helping us to better understand why some people develop chronic pain that just will not go away. This is exciting news for people suffering from intractable pain; pain that just will not stop and that is resistant to all current forms of pain management. How the brain processes pain is a very complex subject and in fact there are a number of identified circuits in the human brain that neuroscientists have associated with pain processing. I'll attempt to simplify this complex subject for you. To simplify things, I want to give you an analogy. We our going to compare the pain processing centers in the brain with a big screen TV. Let's say you're watching a movie about your lower back on a big screen TV with the remote control in your hand. In the very highest centers of your brain, the cerebral cortex, all conscious perception occurs. So in comparing our nervous system to a big screen TV, what you are watching and paying attention to and following on the TV represents your cerebral cortex. So consider whatever the cerebral cortex is “watching” on the TV is our reality. If you have chronic pain that just will not go away no matter what treatment you have tried, it is like watching the “pain channel.” Since you are watching the pain channel, every movie, show and broadcast is related to pain. In our analogy between the brain and a TV, just like a real TV, there are other channels available to your brain. These alternative channels deal with other sensations felt in your body, all of the sensations other than pain.
So while we are watching the pain channel on the big screen TV, in the background there is another channel devoted to warmth, one devoted to cold, another to light touch and so on and so forth. The bright idea that I want you to understand is whatever the channel that is playing, that is what is in your conscious perception. I also want you to understand that there are many other channels in your consciousness playing at the same time, but in the background.
Now you might be thinking, I do not want pain in my conscious perception all day long, why can not I switch the channel to something else other than the pain channel?
If this thought occurred to you, then I have done my job and you understand my analogy between the circuits in your brain and a big screen TV.
Current brain research suggests that patients in chronic pain may have a defect in that part of the brain that acts like the remote control on your TV. So the nervous system may try to change the channel to any channel other than the pain channel, but the remote control stops working. This keeps the conscious brain stuck watching pain related broadcasts.
So the bright idea to help alleviate chronic pain is to get the remote control working and turn off that pain channel!
Research from the field of perceptual neuroscience may have identified the brain's remote control. More importantly recent research suggests possible ways to access the remote and change the brain's perception of pain, effectively changing-the-channel on chronic pain.
Here is what the research suggests and how you may benefit from it.
There is a part of the brain known as the thalamus that scientists believe acts as the brain's remote control. Virtually all of the sensations from the body ascending to the cerebral cortex and conscious perception, must funnel through the thalamus. So which sensations are forefront and those sensations that are relegated to the background is controlled by the thalamus; exactly like a remote control on a big screen TV.
In most people, painful events or injuries cause the thalamus to switch attention to the injured or damaged body part. In essence the thalamus acts like a remote control on a television turning on the pain channel. This is important so you can recognize you have a problem and take the necessary steps to promote healing and restoration of damaged tissues. As soon as the threat or damaged tissue starts to heal the remote control spaces switching between the pain channel and all of the other channels available. In this way the thalamus acting like a remote control, returns your consciousness to normal operations.
However, in at least some patients with chronic pain syndromes the remote control gets stuck on the pain channel. Sometimes even years after an injury or illness has resolved, in patients suffering from chronic pain, the remote control simply will not let your consciousness switch off of the pain channel.
So to explain this a little further and to give you a concrete example, let's say you had a pinched nerve in your back. The thalamus switches the channels to make you aware you have nerve damage in your lower spine. You receive the necessary treatments and the nerve heals. In most patients the thalamus would release your consciousness from the pain channel and restore normal switching of signals ascending from the body. For those unharmed souls that develop chronic pain, even though the nerves have healed, the remote control will not release the pain channel.
What his means is the nerve in the back is now healthy, but the brain still perceives that your back is injured and hurting. This suggests that chronic pain is in your brain, not in your body. Even though it feels like your body hurts, the periphery is healed, but the brain is stuck on the pain channel. We call this a central pain syndrome. Meaning pain that feels like it is in the body, but is actually generated in the brain.
Central pain syndromes are very difficult to treat because treating the painful body part is not treating the origin of the pain. To treat central pain you need to direct treatment at the source of the pain which is the thalamus and the brain itself, not the body.
But is it possible to treat the brain to heal central pain and how can we do this?
To help you understand how it may be possible to use brain based therapy to treat central pain, we need to go back to our big screen TV analogy. Most big screen TVs allow you to watch a particular channel on the main screen, while simultaneously watching another channel in a small screen superimposed on the larger picture. This is sometimes this is called a picture-in-a-picture.
So let's say the main screen of our television is playing the pain channel, but there are some alternative channels playing in small boxes on the big screen. What we need to do is to switch the content of the small box and make it the subject of the main screen. In this way we can switch the pain channel into the background. This will reduce if not eliminate your perception of pain.
If your TV has the ability to play a picture-in-a-picture you know exactly what I am talking about. Press a button on the remote and the channel playing on the big screen plays in the small box and the channel that was playing in the small box is switched to the big screen.
But how does all this relate to your chronic pain and how can you use it to feel better?
Here is where things really get exciting. Neuroscientists have discovered a way to use the brain's remote control, the thalamus, to switch channels; effectively switching the pain channel into the background and bringing other non-painful channels to the forefront.
It takes advantage of the fact that just like on your TV, you can have multiple channels playing, but you can not really pay attention to more than one channel at a time. By dividing your attention between more than one channel you reduce your conscious attention to all of the channels.
I need to give you one more bit of information so you can understand how all of these works to reduce chronic pain. In the nervous system information is carried on specific pathways very much like the channels on a television, however as this information reaches the thalamus in the brain, the channels mingling and interact. We call this process “integration.” The integration of pain signals with other channels is what allows us to switch from pain to other sensations and treat chronic pain.
Some channels integrate with the pain channel more readily than others. Vision, what we see and the sounds that we hear are strongly integrated with what are called tactile channels which are what we feel.
So we can use a technique of “watching-what-we-feel” or Visual Integrated Tactile Stimulation as a therapy to switch pain into the background. We can also use a technique of “listening-to-what-we-feel” or Sound Integrated Tactile Stimulation as another therapy to switch pain into the background of our consciousness. These therapies when used together can often cause an immediate drop in a patient's chronic pain. As our understanding of the thalamus increases and more research is published, we can continue to improve our techniques of Vision and Sound Integrated Tactile therapies and that is great news for people suffering from pain that just will not go away.