Puppy Training, or Why Visualisation Works: Neuroplastic Brain Hacking for Chronic Pain Day 17

What’s so special about visualisation? There are many things that we can focus our minds on instead of pain. Listen to music. Daydream. Do exercise. Develop software. Play. Go for a walk. Have coffee dates. Go to parties. Travel. Trust me, I’ve tried all of the above and more. The list of things is as long as our society’s bewilderingly long list of entertainments. It even goes beyond entertainment: meditation (focus on breathing), yoga, psychotherapy. Then there’s painkillers, ice-packs, massage… Why choose to visualise, out of all these possibilities? How is it any different?

On some level, it’s not different at all. All these things — visualisation included — remove the pain from our consciousness. The difference is, that most items from the above list don’t stop the pain programme from running subconsciously. They push the pain out of our awareness, but that just means the pain signals are received and processed in our brains on autopilot, while our backs are turned if you like. They run unopposed. It is in this exact environment that the pain maps are enlarged through “neuroplasticity gone bad”, until they are running at up to five times the level of sensitivity than is usual for non-persistent “acute” pain.

Visualisation is different because in order to visualise at all, we must engage the very brain regions that are hyper-involved — fivefold — in persistent pain processing. We are not distracting ourselves or ignoring the pain. We are challenging it directly.

Say you have an over-eager puppy at the park. Your puppy is running up to kids and jumping at their face, eating their sandwiches, crapping in front of their mums (bear with me here). She’s generally just acting as she pleases.

You have several choices on how to improve things. You could scold her and tell her how bad she is, give her a smack every time she nears another person. That will get her behaving, but she’ll be scared of you, scared of other people, and eventually the relationship you have with this puppy won’t contain the love and companionship you’re both aiming for. You could take her home and never to the park again, but that would have a similar effect.

You could also take her running around and around the park, to all the trees and the river and back to the playground and around the park again, distracting her until she’s so exhausted that the idea of eating a kid’s sandwich never even enters her mind. Good luck with that. Most puppies have more energy and can run much longer than you can. And as this puppy matures, all you’re going to get is one very fit and healthy animal that can outrun you all day and still jumps up at children, still eats their sandwiches and craps on their picnic blankets (sometimes it might even mix those actions up a little!)

Another option is to put your puppy on a leash, and train it up with little doggy-snacks to come when it’s called, so that eventually you can drop the leash.

In our analogy, the pain is the puppy. Maybe you’ve tried scolding yourself to get rid of the pain, or maybe you haven’t. Chances are though, if you’re in persistent pain, then you’ve tried the distraction tactic — giving your mind so much to focus on that it “can’t” process the pain. Now you’ve got a very strong, fit and healthy network of neurons that you’ve unwittingly trained to outrun and outpace every distraction you throw at it.

Time to get serious and take those neurons to puppy school! Continuing our analogy, the visualisation is the leash. By visualising, we give those neurons something else to do instead of pain processing, just like with the leash we can guide the puppy to stay on the path. When the puppy is on a leash, she can’t run quite so riot. We are not distracting her temporarily, nor punishing. We are training her to do a different job.

Training means being relentless. We train our neural architecture just like the puppy. We even have temporary pain relief that functions like a little snack as an incentive.

Of course, at times puppy will still get ideas about eating duck poo or chasing cats. But because you have not just indulged her with temporary distractions, because you have invested time in teaching her a different job, you can call on that training. Call her back to neutral. And she will stray less and less. Eventually you won’t even need a leash or the snacks.

Your puppy will be trained.

Fatigue and Cellular Support: Neuroplastic Brain Hacking for Persistent Pain Day 16

I never sleep well on a full moon. Energy levels are an ally in this neuroplastic technique, when they’re high; a huge hurdle when they’re not. Unless you’ve lived with pain for years, it’s hard to appreciate that your fellow humans won’t have deep reserves of endurance to draw on in these situations. Already worn thing by putting up with pain for a number of years — a kind of emotional and metabolic “death by a thousand cuts” — on top of that the neuroplastic technique itself saps energy. The temporary relief one may gain does give a temporary boost at times, but in general we are intensively rewiring a large multiplicity of neurons here, in regions all across the brain.

It is well established that in periods of high usage the brain can be responsible for up to twenty percent of ATP (cellular energy) drain in the body [1]. That’s a huge amount for something so small!

(OK, some of us have bigger brains than others [2]).

Regardless of one’s individual brain size, one can expect to feel drained when undertaking this kind of relentless brain training. I’ve personally made a deliberate effort to increase calories and essential brain nutrients like tryptophan and carnitine through nourishing foods (plenty of that!) and supplements. It’s also worth investing in a quality form of CoQ10 that can help boost production of ATP throughout your body including your brain (plus there are anti-ageing benefits to such a high-strength antioxidant that anyone can appreciate).

When choosing a CoQ10 supplement, avoid the standard off-the-shelf pharmacy brands — they’re not worth throwing your money at. You will literally excrete them unchanged. You want it in ubiquinol form, a bit more pricey but at least it is bioavailable to your system [4]. Or if you’re feeling particularly Bank, the MitoQ developed at Dunedin University is “mitochondrially targetted”, meaning that 850 times the CoQ10 actually reaches your mitochondria where it’s needed for ATP production. I have taken a bottle dose of their standard supplement for the last month. I noticed a subtle but significant feeling of energy and endurance that I’d not had for a long time within five days of taking it. I kept taking it for a month before talking about it, afraid that the effects would wane. But they haven’t. I now credit MitoQ with stabilising a downward spiral of fatigue and making it even conceivable for me to begin the neuroplastic training regimen. My second bottle just arrived and well worth the $85 per month that it’s costing me [3].

(BTW I’m not getting any kickbacks for suggesting these things, just sharing what I’ve tried that works for me!)

Back to the full moon. That plus the collision of several worlds ended with me not getting even two hours sleep last night, plus currently at a stalemate vs the seasonal headcold and you could say I’m not a big dynamo of energy right now. I’m having a corresponding setback in pain today. Rather than individual pain spikes that I can neatly nip in the bud with a bit of visualising, I’m getting these non-distinct waves of pain. They change location but I couldn’t really say there has been a time at all today where the pain wasn’t intruding on consciousness. The technique which has been giving me no little amount of relief for the past week is in disarray. I struggle with focus when sleep deprived (I’m sure you do too!).

I’m not really doing anything today. Concentration is low enough that it’s not an option to visualise with closed eyes like yesterday, so I’ll feel pain and be forced to stop a task only to become distracted and lurch back into activity before realising that the visualisation wasn’t complete, at which point I’ll stop again and try finish what I was doing. As I noted back on day 11, the level of pain itself has an inversely proportional relationship to concentration levels, which is not exactly helping the situation today.

I know this will change though. I know it’ll get better. I’m just in a trough between two breaking waves. Many more will come, just as the glimpses of freedom, the vista and freshness at each crest, also come and go, only to come again. It would be so easy to give up now. A relief, to turn and run. But the relief is a trap — there’s nowhere to run except pain. So again, I find myself falling back on the Litany against Fear:

“I must not fear. Fear is the mind-killer. Fear is the little-death that brings total obliteration. I will face my fear. I will permit it to pass over me and through me. And when it has gone past I will turn the inner eye to see its path. Where the fear has gone there will be nothing. Only I will remain.”

When the fear has gone there will be nothing. These troughs, they resolve like a line drawn in water. Utterly ephemeral. But what we do during them, just like plowing the soil in winter, cultivates our habits for the coming thaw.

[1] Why Does the Brain Need So Much Power? Scientific American. http://www.scientificamerican.com/article/why-does-the-brain-need-s/
[2] Ask a Neuroscientist: Does a bigger brain make you smarter? Stanford Neurosciences Institute https://neuroscience.stanford.edu/news/ask-neuroscientist-does-bigger-brain-make-you-smarter
[3] There are many well-established studies proving the effectiveness of ubiquinol and MitoQ at assisting cellular metabolism and ATP production. For purchasing MitoQ, see http://www.mitoq.com/nz/mitoq-5mg-capsules-60.html.
[4] If you’re in NZ, BioBalance is a good source of ubiquinol, available at many online pharmacies such as HealthPost.

How I Visualise Part 2: Neuroplastic Brain Hacking Day 15

So it’s Day 15 of this “pain map visualisation” trial. I’ve been practising to shrink those virtual maps in my minds eye but keeping my actual eyes open. I’m now able to do that more often than not. Visualising with your eyes open might sound weird, but it’s something we do all the time without thinking — e.g., when we review our upcoming route while driving. What makes it possible is familiarity — of the route and the act of driving, or in this case, of the visualisation and whatever task I might be performing.

A big advantage of this is that the practice can become more integrated in daily life. The visualisations can be more long-running. Instead of dropping everything to bring the images to mind, I can have them playing back throughout the day, although I do of course drop them and focus when necessary, e.g., when speaking about something complex.

In general, it’s helping to make things more integrated, so the practice is finally becoming a bit less intrusive on my daily life. But I still stop mid-walk periodically, in response to a pain spike and appearing struck dumb to an outside observer I suppose, while I run through the visuals. And I still struggle with mornings. The imagery is a lot more vague and broken up when I first waken. I’m evolving the visualisation each day as well, to keep the interest level high. For both those reasons, I continue to sit quietly with eyes closed each morning, thus evolving the animation and also overcoming the morning struggle early on.

When I first started practising there wasn’t much detail or sophistication to the visualisation — just three or four red blobs in random locations, getting smaller. That was enough though. But over a few days I started to include a particular sense of whereabouts in my skull they were located (interestingly, I’ve since discovered upon receiving Moskowitz’s book[1] that two of those locations were bang smack in the middle of the two most active regions highlighted).

Soon after that, I added different colours — red fading through orange to yellow, green, blue, the whole spectrum to black and just empty, quiet, blessedly pain-free space inside my head. These were inspired by MRI images but not trying to hold true to any scientific accuracy. Unexpectedly it seems that the more movement and shifting I put into the shapes the more powerful the temporary relief is. I guess because it requires more engagement from the relevant systems.

Last few days I’ve begun to experiment with each region being a three-dimensional structure, red in the centre, surrounded by orange, yellow, green, blue corona. As each central blob shrinks, it drags the other colours with it until the whole thing shrinks to a violet shimmer and eventually fades or stutters out. and all I’m left with is a baseline of little colour sparks surrounded by quiet, calm blackness.

This is what works for me. Changing the visualisation a bit each day makes it harder to run the visualisation while doing other things, because I lose familiarity with each change. But it’s more fun to keep it challenging.

The Moskowitz book has dozens of examples of imagery that has worked for others, and it’s clear that there’s no need to try and reproduce anything in particular. As long as it’s engaging enough to focus the mind and keep it from running the pain programme unopposed, then it’s good enough.

[1] Moskowitz, Michael MD and Golden, Marla DePolo. Neuroplastic Transformation Workbook. https://www.amazon.com/Neuroplastic-Transformation-Workbook-Michael-Moskowitz/dp/0615814654

Neuroplastic Brain Hacking for Persistent Pain: Two Weeks

Two weeks down!

Today I have done more visualising than ever because I have a head cold. That means I have persistent aches from the virus on top of the persistent aches from the pain syndrome. (I’m resisting saying that the latter aches are caused by whiplash injury. While that may have been the case originally, it’s now morphed — literally — into a disease all of its own, known as “chronic pain” or “neuropathic pain” or as Moskowitz calls it, “persistent pain”).

I’m right tired now, so will make this entry short.

While it was an interesting exercise to try and sort out the different pain spikes into “virus related” or “needs visualisation”, eventually I realised that the virus-related pain presented just as much of an opportunity to practice as did the pain syndrome symptoms. So what that’s ultimately meant is that today I’ve done visualising for virus-related pain as well, which has meant that I’ve done more visualising than ever.

Virus as a motivator for wellness, how cool is that?

How I Visualise — Pursuing a Cure for Persistent Pain

Nearly two weeks ago I began practising a form of “neuroplastic brain training” designed for people suffering persistent pain. This was in an attempt to resolve neck, head and at times whole-body pain that I’ve been experiencing since being hit from behind by a bus while driving in 2012 (there were two subsequent cases of whiplash and a concussion after that, which have likely contributed to the pain getting worse and not better).

Today I’ll try and explain how I practice the technique every day. Hopefully you’ll see that, despite the seemingly complex theory behind it all, the visualisation is actually quite simple, and even rather beautiful if you use the suggestions in here. There is also plenty of freedom to engage your own creativity when coming up with your own visualisation — in fact, that’s encouraged!

When I first started this technique thirteen days ago I didn’t have a lot of material about it. I had read of the benefits and some pretty useful discussions about attitude in Doidge’s book [2]. But there were no actual images of what to be picturing in my mind. Instead, for visual specifics, all I really had to go on was a single paragraph:

“[Moskowitz] visualised the very brain maps he had drawn, to remind himself that the brain can really change, so he’d stay motivated. First he would vbisualise his picture of the brain in chronic pain — and observed how much the map in chronic pain had expanded neuroplastically. Then he would imagine the areas shrinking, so that they looked like the brain when there was no pain.” [4]

Not willingly idle while awaiting Moskowitz’s book from Amazon USA, I went ahead anyway and did it kiwi style, as the first ever entry in this Chronic Pain diary explains. [1]

I figured, “well, I’ve seen pictures of fMRI scans online. I’ll just Google some of those and play around with them visually.”

I knew from Norman Doidge’s book [2] that it doesn’t matter at all what you visualise. The whole point is, that by visualising anything — anything at all — we engage brain regions that are involved in both pain processing and visual imagination. By bigging up the visual imagery, we dampen down the pain, goes the logic. Eventually, through thought stimulation, we rebuild the anatomy in those regions (hello, neuroplasticity) to focus less on pain. Eventually, we can leave out the visualising altogether and go on about our lives, only occasionally making recourse to the technique whenever pain spikes recur (but that apparently becomes a rare event — bring that shit on).

So far, nearly two weeks in, I’ve found all the information I could have needed in Doidge’s book, by reading the relevant chapter a few times and relying on my own imagination when coming up with the visual images. Moskowitz’s book is definitely worth having too, and although pricey, you can’t fault the shipping which had it to my door from the US within a week!

Moskowitz, the creator of the technique, suggests to visualise brain maps shrinking, because it probably helps with motivation to relate it directly to the intended goal, but if I was feeling facetious I’d suggest it’s also because he’s spent a lot of time looking at such things in his professional life. From what I understand you could just as well be visualising Tibetan deities (an interesting thought, considering how important that practice is within the Tibetan tradition). There could well be advantages to coming up with your own imagery, as this will engage more regions of your brainware than just memorising the images that Moskowitz uses.

Having said that, I went with the “brain maps” idea, and I’ve found it solid.

Whenever a pain spike intrudes on consciousness, I gotta say my first instinct is to ignore it, and hope it’ll go away. Next tactic is, to rearrange my body — to “twitch” it into a shape where the pain is lessened. I’m a slow learner.

Eventually, I remember that I’m doing that other thing now, that visualisation stuff. I don’t have to live with this persistent pain shit any longer. For real! OK, wake up from distraction.

Feel the pain. Recognise it. And then I do my best to get motivated by remembering that the pain isn’t actually in my neck — not really. Pain is only experienced when neural signals are interpreted at “the thinking parts of [my] brain” [5]. I remember that once acute pain develops into persistent pain, the number of neurons dedicated to processing it increase five-fold [6].

Set the Intention: to return the brain to its original pain processing configuration, freeing up those neurons to do other jobs, and freeing my mind from the constant bracing against discomfort.

After all that talk, the visualisation is actually a simple three-step process:

  1. Establish mentally that the location of pain is actually inside my head, not in my body.
  2. Visualise the pain as glowing “starburst” regions — it doesn’t, in fact, matter at all where one puts them or how they’re shaped. I find that there are certain locations in my imaginary skull cavity that my mind naturally puts them, so I just go with it.
  3. Shrink them, using whatever imagery comes to mind — but I make it quite a long animation. Not just two frames, I shrink them progressively. I think about colour, and I change the colour of the regions as they shrink, cycling through all the rainbow (remember Roy G. Biv?).

Using Moskowitz’s “pain maps” suggestion a) helps remind me that the pain only exists if I allow my brain to reinforce those neural pain pathways. But b) it’s also my understanding that associating the visualisation with a particular location in my body engages the “posterior parietal lobe”, which, as well as being a pain-processing region, can be targeted neuroplastically by generating an “internal location of stimuli” [5].

I continually remind myself to visualise the shapes inside my actual skull where it is sitting now, not in some imaginary simulation of my skull out in front of or beside my actual body.

And that’s it! I repeat three times for strong pain, or until the pain diminishes, whatever is sooner. Whenever I feel pain.

It takes patience to interrupt what I’m doing and visualise, especially when I’m pressed for time. That’s probably the most challenging (and crucially important) aspect of the whole technique. R for Relentlessness.

But other than that, the visualisation itself is rather simple and even quite pretty, if you go for the colourful approach.

[1] Here in NZ, there is a bit of mythology around “making do” without necessarily having access to all the latest tools or materials. Number 8 wire and some tape will repair most things. That kind of thing. http://give.kiwi/2016/07/visualization-for-chronic-pain/
[2] Doidge, Norman. The Brain’s Way of Healing, Penguin Books. www.normandoidge.com/?page_id=1042
[3] ibid. pp19
[4] ibid. pp15
[5] ibid. pp14
[6] Moskowitz, Michael, MD. Neuroplastic Transformation Workbook pp4, https://www.amazon.com/Neuroplastic-Transformation-Workbook-Michael-Moskowitz/dp/0615814654
[7] ibid. pp10

Neuroplastic Brain Hacking for Chronic Pain: Day 12

I was going to write a bit much more in depth update, but then Saturday night happened.

Oh, but this arrived! I ordered it on Amazon only a few days ago, astonished to see it on my doorstep.

Much Excite.
Much Excite.

Psychological Responses to Neuroplastic Visualisations for Chronic Pain: Day 11

Intensity of pain relates directly (and negatively) to level of concentration. When the pain is just moderate (5/10, most days for me), the visualisation itself is easier to focus on and I’m less likely to get pulled into distraction. The imagery is more vivid and less broken up. I’m working on a theory that this equates to the early stages of vipassana insight.

But when the pain is more severe — 7 or 8/10, like the day before yesterday — then I’ve noticed that the visualisation suffers. Despite repeatedly trying, the visualisation regions just won’t engage for any length of time. My stream of consciousness goes something like: images of red blobs … pain … distraction into some other conundrum. Wait while spinning in distraction for a few breaths, then repeat. Additionally there is a sense of desperation that goes along with that — as though the visualisation will spare me pain if only I can get it “perfect”. This feeling doesn’t occur on days when the pain is only 4-5/10. On those days, I’m far more laissez-faire about how the visualisation unfolds — almost preferring it to be asymmetrical, random. Messy, chaotic, wild and arty. Intuitive, like life. The desperation, perfectionism, rigidity around the visualisation being “good enough” the intensity to “get it right” are strictly phenomena from the realms of 7/10 and above.

Those thoughts do crop up even on days of moderate pain, but they’re easily laughed off, soothed with feelings of balance, and intuition that (in the words of the Desiderata) “no doubt the Universe is unfolding as it should”. Executive function and intuition, from the prefrontal area, the final brain region to mature in our early twenties. The adult shrug at misfortune that is frequently the only thing we have left to teach our teenage offspring.

Being swamped by that striving for perfection, that rigid feeling of the visualisation not being good enough, seems distinctly an artifact of strong pain.

“Damn it, I wasn’t seeing a whole half of that pain map, I forgot to transition through blue and violet, FML!” That kind of desperation arises because of seeking relief from the pain. This is ironic because, as Moskowitz writes “If focus is merely on immediate pain control, positive results will be fleeting and frustrating. Immediate pain control is definitely part of the program, but the real reward is to disconnect excessively wired pain networks and restore more balanced brain function in these pain processing regions of the brain.” [1]

Desperation to perfect the visualisation, out of fear of pain continuing, then turns that very fear into reality, creating what’s often termed a “self-fulfilling prophecy”. The act of predicting a result creates the result. I wonder how many irrational thought patterns, these kind of self-fulfilling prophecies, are frequently side effects of chronic pain flare ups in many people, both diagnosed and otherwise?

How does neural sensitivity (in physically compressed brain stem, hypersensitised pain circuits) relate to mental health and anxiety? And what other brain regions aside from pain processing may be involved in similar fashion with the manifestation of anxiety, obsessive-compulsive disorder, learning disabilities… ?

Further research required on my part, as I’m sure there are much more learned minds than my own who have thought of this already and pursued it beyond a mere thought experiment.

[1] Michael Moskowitz, Neuroplastic Transformation Workbook, https://www.amazon.com/Neuroplastic-Transformation-Workbook-Michael-Moskowitz/dp/0615814654

The MIRROR Acronym for Neuroplastic Visualisations

Moskowitz[1] uses the MIRROR acronym to describe six qualities of a successful neuroplastic intervention.

Here is a brief run down of what these letters stand for:

M — motivation. The motivation part refers to being motivated to change the pain pattern. Active visualisation, an active role in our own treatment, in the face of inevitable setbacks.
I — intention. The intention is to not necessarily to remove pain (which is not the experience for the first week or so). The intention is “focus the mind to rewire the brain”. More on this below.
R — relentlessness. Again, more on this below. Briefly: we must be utterly ruthless with our visualisation and be more relentless than the pain.
R — reliability. Cultivating a reminder that the brain is not an enemy, and it is doing something it has evolved over millions of years to do. In most cases, the very mechanism at play in chronic pain is the same mechanism that we can use to unwind it.
O — opportunity. Somewhat pathologically optimistic this one, but it’s good to get in the habit of trying to see each pain spike not as a threatening event but an opportunity to learn new ways to untangle ourselves from these eruptions. Mentally re-framing our experience like this reduces the panic of each spike onset.
R — restoration. We are not trying to mask the pain but to restore normal brain function.

Today I’m a bit confused about two of these qualities — ‘I’ for Intention and ‘R’ for Relentlessness. So what are these concepts all about anyway?

Intention

The Intention aspect is a reminder of why we are doing the technique. Surprisingly, this “is not to get rid of pain — it is to focus the mind”.[2] By focusing on the visualisation, we are engaging a part of our brain that would otherwise be processing pain and encouraging it (Relentlessly) to process visual imagery. If we instead focus on pain, or on getting rid of it, we engage other thinking regions of our brain that are not involved in the pain cycle, and so the results will be different.

Relentlessness

Relentlessness is all about intensity of focus. Any pain “intruding into consciousness is the signal to push back. When the pain is just beginning to act up, (we) may think perhaps it will be enough to tolerate the pain or distract (ourselves) … casual distraction must be resisted, because it allows the pain to run unopposed … Relentlessness means, every time pain is detected, push back, with full focus and the Intention to rewire the brain back to what it was before the chronic pain began. No exceptions. No negotiations with pain.”[2]

Question

My question is, what about long-running stubborn pain, i.e., that lingers for minutes or hours even with visualisation? These two aspects seem to be in conflict then.

Example

Say I drive to the supermarket nearby. Halfway there I feel a spreading pain and tightness from the base of my head into my shoulders and down my arms. This is a classic repeat symptom for me, so I pull over and run through the pain maps in my mind. No relief. All good, I’ll run through it again. No relief.

According to Doidge, a helpful internal dialogue at this point would go “I got a pain attack and used it as an opportunity to exercise mental effort and develop new connections in my brain, which will help me in the long run.”[2]

But that runs counter to the aspect of Relentlessness, which says to push back every time pain “intrudes on consciousness”.

Resolution

Until I learn otherwise, I’ve set myself an arbitrary maximum of three times through the visualisation. That way I’m not falling short of strong focus (after all, Three Is a Magic Number). But in keeping with the Intention, I am also not trying to calculate whether the pain has relinquished its hold. If the pain melts away in less than three iterations, then I will smilingly carry on my way to the supie. Freedom is its own reward, to paraphrase Ghandi.

[1] http://www.neuroplastix.com/styled-2/page1/styled-23/mirror.html
[2] Doidge, Norman. The Brain’s Way of Healing, Penguin Books. pp19-20.

Neuroplastic Visualisations for Chronic Pain: Day 9

Today I’m doing the best I can. That’s about all I can say of it.

What is Neuroplastic Visualisation for Chronic Pain?

Today I’m going to try and describe the theory behind this neuroplastic technique in my own words (mostly)* in the hopes that someone finds it interesting. Hopefully, nobody finds it useful! Because although that would mean my writing was not in vain, one more person with chronic pain is one too many.

The visualisation I’m doing involves imagining the boundaries of the brain regions that process pain and then making them shrink in your “mind’s eye”. But what are these regions? And how does that help?

There are (at least) sixteen brain regions involved in processing pain

According to Michael Moskowitz, quoted in Norman Doidge’s book, there are many different regions involved in processing a single incident of pain. Without having done my own research to verify these, I won’t go into specifics of which areas he mentions (they all have funny names like ‘hippocampus’). But what is worth knowing is that pain is processed in many parts of the brain.

When not processing pain, these regions do other stuff

When an acute (new and intense) pain signal is generated somewhere in our bodies, those sixteen brain regions light up on brain scans. But in fact, even before the pain signal, those regions are not dormant. They do other stuff too. They just light up even more once the pain signal arrives. Before the interruption, these sub-networks do things like (quoting from Doidge again) “sense pressure, position, vibrations. [They] detect conflict … solve problems [that are presented to them], plan movement sequences, process and retrieve emotional memories. [They] connect emotion with bodily sensations, empathise with others, retrieve autobiographical memories” [1]

And finally, the posterior parietal lobe “processes visual perception [and] internal location of stimuli”. The prefrontal area is involved in “executive function, creativity, intuition, emotional balance”. And the posterior cingulate processes “visuospatial cognition”. [1]

Those last three are where the visualisation comes in.

Chronic pain is neuroplasticity gone wild

When those regions process acute pain, only about five percent of the neurons in each area are dedicated to processing the pain signal, leaving about ninety-five percent to carry out the other important tasks they are involved with.

What Doidge reports is that Moskowitz discovered that in chronic pain, the number of neurons processing pain has grown to between fifteen and twenty-five percent. This leaves a shortfall in the number of neurons that can carry out other jobs.

Essentially, the constant ongoing signals of alarm and damage have rewired the brains of people (like me!) with chronic pain, so that the neural networks no longer function like they used to. That is neuroplasticity — but not in a good way.

Incidentally, to me this seems to explain why those of us with chronic pain can seem to lack concentration or struggle to form sentences, solve problems or recall facts. We may have trouble empathising with others or controlling emotion. Our own brain is being appropriated by excessive signals from our peripheral nerves.

Our posture comes to reflect a defensiveness that is nothing to do with how we feel about the world, but has everything to do with how much finesse and fidelity has been lost in our actual cognitive experience.

Disconnecting is harder than connecting

Making new connections between things in our minds is relatively easy — just repeat it a few times and soon you’ll have no trouble remembering the way to a friend’s house, or how to tie a shoe. But have you ever tried to unlearn something? That’s not so easy. Many of us have nights we’d rather forget 😉 But how many of us have managed to intentionally ditch those unpleasant scenes? Or once we hear a song that we detest and it’s going round in our head, how do you stop it?

That’s essentially what we’re doing with the visualisation technique. We focus our mind and use thoughts themselves (visual images) to literally force our brains into using the neurons for their original purpose — visual perception, internal location of stimuli, creativity, intuition, visuospatial cognition. Visualisation involves all these functions and more. By doing this, we are unlearning a pattern of neural behaviour that has become so ingrained that we were until now unable to break free in any meaningful way, as the neurons became more and more tightly connected. That is why we need to bring such seemingly unreasonable levels of conscious determination to the situation. Relentlessness, as Moskowitz calls it. We must be more relentless than the pain, or else we stand no chance of disconnecting a network that has become progressively more deeply wired over time.

A final point

Eventually, the goal is to use the mind to return our brains largely to the same state they were in before they began producing the experience of chronic pain. When that has been achieved, the visualisation is no longer necessary and we can go about our lives with more normal pain-processing neurology.

We will still receive normal pain signals. The five percent of neurons that are dedicated pain processors will still do their jobs. And the injuries or limitations in our bodies will remain — they will need to be treated in their own way.

An as-yet unanswered question

Although there are sixteen brain regions responsible for processing pain, Moskowitz’s technique only targets three of them. Despite this, anecdotally it seems to have had remarkable success. Why is this? Are these three more central to the experience of pain?

[1] Doidge, Norman. The Brain’s Way of Healing. Penguin Books 2015. pp13-14

  • Note that this is not a systematic scholarly review of the latest research. My list of sources is minuscule. There may well be errors or mistakes compared to the latest neuroscience. I’m just trying to present the basic gist of what I’m doing so people can do their own reading about it if they choose.