When I was about 17 years old, I remember getting sunburned on my face. I particularly hurt on the skin around and under my eyes, but being out with family at the pool in the complex where my grandmother lived, I needed to hang out for a bit longer. I was reading a book – Toni Morrison’s Beloved, as I recall – and was having a hell of a time concentrating on it. But lying face down on a beach chair, I began a chant inside my head. It doesn’t hurt, I kept thinking. It doesn’t hurt, it doesn’t hurt, it doesn’t hurt.
I remember my astonishment when I realized, a few minutes later, that in fact it didn’t. I returned to my reading and, as I recall, the pain did not return.
People have been using the expression “mind over matter” for ages, but research is coming around more and more to the idea that this process is quite literal. A recent article in the Daily Mail sensationalizes it somewhat (it is, after all, in the Daily Mail), but the implications are clear: with practice, we can rewire our brains to ignore pain, so that it does not become or stay chronic.
One of the basic principles of neuroplasticity, as the ability of the brain to change and adapt is called, is that neurons that fire together, wire together. It is by this mechanism – the brain making associations, sometimes between seemingly unrelated things – that habits form, thought patterns become ingrained, some sexual proclivities develop, and trauma keeps hold of us over time.
With pain, the grooves in the brain can become very deep. “The role of acute pain is to alert us to injury or disease by sending a signal to the brain,” says Dr. Norman Doidge in the article. “But sometimes an injury affects the body and the nerve cells (neurons) in the brain. As acute pain continues, these neurons become hypersensitive, firing more easily with less stimulation.” Opioid drugs like morphine and oxycodone can increase this effect over time, driving the neurological grooves deeper until even a small stimulus can trigger pain, even in areas of the body that weren’t directly affected by the injury.
Another doctor who studied this phenomenon after his own severe injury, pain specialist Michael Moskowitz, “realised that many of the areas in the brain that fire in chronic pain also process thoughts, sensations, images, memories, movements, emotions, and beliefs – when they are not processing pain, that is.
This explains why, when we’re in pain, we can’t concentrate, tolerate certain sounds or light, or control our emotions well, because areas that regulate these activities have been hijacked to process the pain signal.
Working from the knowledge that two parts of the brain process both pain signals and visual signals, he developed a way of using visualization to overcome the pain when it arose. Focusing on an image of his own brain in pain, he then imagined the areas of pain getting smaller and smaller. By repeatedly telling the brain to process this visual image rather than focusing on the pain itself, he achieved a reduction of pain in 3 weeks, a major reduction in 6, and a near-pain-free existence after a year.
These findings, which he has begun putting into practice for patients for several years with surprising success, dovetail with the work that Synergists and other bodymind therapists have been doing for some time. Because awareness is the first key to change, getting clients to focus on different parts of their bodies, on their pain, on their emotion, or on whatever is happening inside them and describe it in detail can help the client regain some control over bodily responses to stimuli. By observing our state in detail, we can then take action to change that state.
I’m again remembering a certain demo session that Ilana Rubenfeld ran in our training, with a classmate who had been in a serious car accident more than 20 years ago, and sometimes still had pain from it. In that session, she helped him rewrite the memory: starting the process of rewiring the part of his brain that had built a groove around that event, a groove that kept saying remember, and helping him to remember it differently, to tell the brain that in fact it had been a near miss, to let those pain signals stop firing at last. It doesn’t hurt. It doesn’t hurt. It doesn’t hurt.
I’m looking forward to learning more.
Power In Your Hands 
(nods)
Somewhat digressive anecdote follows… I experimented with this a lot after my stroke — hey, I was lying in a hospital bed for hours and hours a day with a broken brain, I had a lot of time on my hands — and I found there were two routes I could take to manage pain.
The first, and most effective, was similar in some ways to what you describe… paying close attention to what was going on… which included the pain, but only as one thing among many. In my case it wasn’t so much “it doesn’t hurt” as it was treating the pain as information, just like everything else. The result was that there was still pain, but I didn’t suffer. It was just pain.
My biggest problem was that this took a lot of concentration, and I often didn’t have the ability to concentrate in the first place. I can definitely see how developing this technique as a practice, a habit, or a ritual, would be totally worth doing.
The second was to focus on anything other than the pain. Singing was good. This was much easier but didn’t work nearly as well.
It is interesting, isn’t it? Focusing *not* on the pain didn’t work, but recontextualizing it was more effective. I’m very interested in general in how much work *attention* does, and how ineffective it is, in most circumstances, to pretend something isn’t happening; the body just intensifies it.
(nods) Among other things, if I’m not paying attention to an injury I’m probably doing all kinds of things to further exacerbate it. But avoidance is even worse, because I’m probably causing extra tension around that injury.
And, yeah, attention is awesome.
When I started seeing a therapist, she was fond of asking me to keep logs of various things, and for a long time I thought she wanted them as data. Eventually I noticed that she didn’t actually want the logs at all. At one point I reported that X and Y were happening a bunch and I was going to log them but I mostly figured the important thing was that I was paying attention to them, and the log was just a ritual to focus my attention, and she laughed and said “You figured out my secret!”
Nice! 🙂
I should probably also add that I spent a lot of time during this period kind of pretending that I was managing the pain, but in fact simply being stoic about suffering. I really don’t recommend this. Somewhat embarrassingly, it wasn’t always clear to me which one I was doing at any given moment.
I wouldn’t expect such things to be clear in any condition, let alone in the months post-stroke.
Hmm, it’s funny — I have a lot of feelings and thoughts on this stuff because migraine pain.
My absolute most reliable pain reducer is Ira Glass. I listen to This American Life, or another similar podcast, and my pain often calms down a lot. I’ve thought a lot about the relationship between distraction and pain, and I think it actually isn’t the distraction that helps me so much as the relaxation. I get so caught up in the thought cycle of “oh god, it’s a migraine, this will hurt so much, I’m angry I get these and frustrated I can’t feel better and I can’t do the things I want to do right now, and scared at how much this will hurt” that the stress spikes the pain up something fierce. Unwinding that tends to help calm things down, even if it usually doesn’t make it “all better.” I guess for that reason it’s almost impossible for me to imagine actually thinking about the pain being a path to pain-freedom, but at this point, I’d try anything!
*nods* This seems like a really astute observation – that it’s not so much distraction as relaxation. The role of pain in the body is generally to alert the person to a problem, but as the article suggests, this can be bypassed. Shock is a great example of this, as I think happened to the doctor mentioned early in the article: when the injury is bad enough, the brain’s like, “no, we don’t really need pain for this, it’s pretty clear that something’s gone really wrong.” With chronic pain, though, it can sometimes seem like the body behaves like a toddler. We talked about this quite a bit in the training: imagine the pain as a little kid who keeps going “Mom. Mom. Mom. MOM. MOOOOM!” until the mother finally goes “WHAT” and the kid’s like, “Look at my drawing.” We spend a lot of time trying to ignore small discomforts or habitual positions or little stressors, and the result is generally that they get louder and louder until we have to pay attention, at which point things have escalated.
Another extension of this metaphor is when a parent responds to a child’s emotion by getting spun up and escalating the emotional situation instead of calming it down, leaving the kid in fear and anxiety. I thought of this in relation to your fear cycle: “oh god, it’s a migraine, this will hurt so much, I’m angry I get these and frustrated I can’t feel better and I can’t do the things I want to do right now, and scared at how much this will hurt.” It sounds like letting the pain be there, but relaxing some of your own responses to the pain, helps the pain to ease. And yes, having another focus – as the article talks about – is critical: making your brain do something other than amplify the pain signal is a way of training your brain to respond differently.
And yeah, it’s not easy.
What a beautiful post, Kamela. You are an amazing writer and educator! I’m proud to know you 🙂
Janet