Pain Trivia Learned from Neuroplastic Brain Hacking for Persistent Pain

Unlike a simple sense impression such as taste or smell, pain seems to be a fully-fledged, mind-body experience. We don’t just feel pain — we are gripped by it almost like an emotion or mood. How does that happen? Does pain always correlate with injury in the body? I’ll try and keep this short, and as jargon-free as possible!

Fancy a warm day at an idyllic beach. Wading towards the shore after a long leisurely swim, gazing around at the sunlight on the waves, you unexpectedly stub your toe on a submerged rock. Let’s use that example to analyze what’s going on as you suddenly find yourself dealing with a flurry of unpleasant feelings.

Nociception

I know, you’re like noci… wha?? Jargon straight up! Don’t stress — I never heard this word until a couple months ago either. But this is the only jargon for the whole article, ok? Bear with me …

Roughly speaking, nociception is the name for the pain signal before it reaches the brain. Interestingly enough, nociception itself does not cause much of a reaction in the area where the injury happens.

In the case of your accident at the beach, it is not until your brain receives a signal from the toe, that any kind of response begins to take place.

Nociception vs Pain

When we get a signal that “something hurts”, how does that expand into such a rich experience that all or most of our concentration and our emotions are suddenly turned towards it?

Well, as soon as your brain receives the nociception signal it does some trickery to figure out how bad the damage is (if you just scratched yourself or if you cut yourself deeply). It also looks into where the signal is coming from and how easily damaged that area tends to be (if you stub your toe it hurts more than if you hit your arm).

You’re already starting to feel things in a context that is more than just simple nociception. Next up perhaps memories will crop up of the last time you stubbed your toe, you’ll lift your foot out of the water and examine it closely. Your eyes and visual parts of your brain will be processing all those images. If you’re like me you’ll be wondering if anyone has noticed and if you perhaps look a trifle silly standing on one leg in the water with your other foot held up in front of you. You’ll be trying not to topple over.

Our mind has gone from soaking up the summery day, to a more active state. After the initial fast signals, the toe is now sending slow throbbing nociception signals to our brain, and every time a new throb reaches our brain, it goes through that whole activation state again. It returns our focus to our foot from whatever else might be going on. Now we are experiencing pain.

What’s interesting is that nociception and pain can be experienced separately. While normally of course, nociception does lead directly to an experience of pain, in some cases it is possible to experience great amounts of nociception but to be in an entirely pain-free state. This is sometimes noticed in cases of “massive trauma” [2] by paramedics in victims at the site of a car crash.

The opposite is also possible, for example when “individuals with functional pain syndromes report considerable anguish in spite of having [no measurable -nociceptive activity]”. [2]

Pain as a Perception

These understandings and many more led Ronald Melzack, a Canadian who studied phantom limbs and pain, to refer to pain as an “output of the central nervous system”. (Ok, a tad more jargon. “Central nervous system” is a medical term for the brain and spinal cord.)

What Melzack is saying here is that although pain does start starts in the site of injury, it is not until it is taken into the central nervous system and evaluated as being important enough to warrant attention, that the pain begins to intrude on our thoughts and emotions. This is more like a perception, where we are not just receiving sensory input but thinking about it and evaluating it.

Although this may seem quite obvious, you can see that rolling all of this together and calling it “pain” turns pain from being a simple realisation that “something hurts” to being the full mind-body response to an incident of nociception, and not just the nociception itself. Linking it all together like this is the only way to explain complex pain syndromes like those outlined above, or in the case of a phantom limb causing pain, where the pain persists in the brain long after the nociception has ceased.

The particular brain regions that are involved in taking up the call of pain, on behalf of the nociception from the site of injury, in order to generate this “output” are many. Moskowitz identifies no fewer than sixteen different brain regions! [3] and [4] Many of these are connected with our emotions and our thinking patterns, and others are connected with our body’s most basic self-monitoring and survival systems.

This explains why pain can be such a distressing experience, and why we sometimes shrink away even from the thought of hurting ourselves. The emotional centres of our brain are anticipating our potential distress and creating aversive reactions before the pain has even happened, by simulating the pain independently of receiving any actual nociception.

Conclusion

I’ve found this knowledge to be the start of a whole investigation into the nature of pain. Knowing that pain is partly to do with how I evaluate it, and not just a result of being told “something hurts” by my body, has been quite an eye-opener for me.

I hope you’ve found it interesting too. If so be sure to like my Facebook page or follow my blog for more updates. I write about wellbeing and mindfulness, with a few creative pieces thrown in from time to time.

Further Reading

Here are some useful links I’ve found while reading about pain theory.

How do our brains process pain? contains a good introduction with some diagrams.

And there’s way more to be learned from this How Pain Works at HowStuffWorks.

[1] Melzack, Ronald. “Gate control theory: On the evolution of pain concepts.” Pain forum. Vol. 5. No. 2. Churchill Livingstone, 1996.

[2] Garland EL. Pain Processing in the Human Nervous System: A Selective Review of Nociceptive and Biobehavioral Pathways. Primary care. 2012;39(3):561-571. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3438523/

[3] Moskowitz, Michael MD and Golden, Marla. Neuroplastic Transformation Workbook. pg10-13. https://www.amazon.com/Neuroplastic-Transformation-Workbook-Michael-Moskowitz/dp/0615814654

[4] Doidge, Norman. The Brain’s Way of Healing. Penguin Books 2016. pg 13-14.

Beyond Visualisation: On To Section Two of the Neuroplastic Transformation Workbook

Section Two of Moskowitz’s book[1] goes beyond visualisation to the sense of touch. This is particularly helpful when the pain is long-running. Sometimes, I’ll do visualisation and that pain is gone by the end of it. Was it the visualisation that caused the pain to diminish? Impossible to say really. But when the pain doesn’t decrease, I’m using some of the techniques in Section Two as a way of flooding the brain with other input.

Some of the suggestions are very simple. Rub your thumb-pad with your forefinger to stimulate touch sensations in the brain that are not painful. He also advocates brushing the skin over a painful area very lightly with a finger, or a cold glass, or even things like feathers and shaving brushes! All to stimulate nerves in the area other than pain receptors. Some of these suggestions are more in the realms of traditional advice you’d receive from your friend. You have a back ache or a “crick in your neck”? Take a warm bath.

Gently rubbing an area where there has been almost constant pain is not a small deal. In fact, when I take two fingers and just rest them lightly on the skin in my left-hand-side clavicular fossa[4], I feel a high-pitched throbbing down the underside of my left arm, through my elbow into my little finger, and a circle on the top of my head and the orbit of my left eye both set up sympathetic aches. In this case, Moskowitz recommends placing your fingers just to the side of the painful area, as near as possible without firing off the nerve that is hypersensitised.

We are not taking a warm bath or rubbing a painful area to achieve temporary relief but in order to reduce the dominance of pain processing in our brain. The idea again is to approach it with the MIRROR acronym in mind:

The key is to stay Motivated. Have the Intention of changing your brain. Be Relentless in opposing any and every pain intrusion into your consciousness. Rely upon your brain’s ability to adapt and make considerable initial efforts automatic and seamless. Approach each pain intrusion as an Opportunity to hone and master this proactice and make it automatic and effortless. Expect your brain to Restore itself and work on these approaches until it does so.
Michael Moskowitz MD [2]

So we don’t need to be discouraged when the pain doesn’t go away, or returns immediately. We weren’t expecting any relief in the first place, necessarily. Just as in the visualisation we used imagery to “access” the pain centres and direct them to process other input, so now with the sense of touch we are starting to use the nerves outside of the brain and spinal cord (the peripheral nerves) to access the brain for the same purposes.

A further suggestion that Moskowitz makes is to receive regular gentle massage from a skilled therapist [3]. As a trained massage therapist myself, you’d think this would have been obvious!

[1] Moskowtiz, Michael MD and Golden, Marla. Neuroplastic Transformation Workbook.
[2] ibid, pg 1
[3] ibid, pg 21
[4] The supraclavicular fossa is roughly speaking the area where your neck joins your torso just above your collarbone.

My Visual Imagery: Neuroplastic Brain Hacking for Persistent Pain Day 30

Visualisation now is more refined again; colours fade gradually through all the colours of the rainbow including indigo, violet to black. I’ve two versions. One of these versions — we’ll call it the “full-cream” version — I use just for the more focussed sessions (when I stop what I’m doing and close my eyes). It has a lot more detail, eight different regions of colour fading through all colours of the rainbow and each colour in between to black. Whereas when I’m more active and moving around, I go for a more “lite” version. I mentally zoom in on just one of these regions and fade it through as many colours as I can before distraction sets in. Often that’s just red through orange to yellow. Or sometimes I start with violet and just let it fade from there to nothing.

I’m writing absent-mindedly at present because I’m visualising at the same time.

Another setback today, which I’m using as an opportunity to practice my visualising “in anger” as they say — in the extremity of a strong flare up of pain, after an awful gapping sensation in C3-C4 region on the left-hand side of my neck.

Was all chill, sitting before the fire, warm as, reached up with right hand to adjust my hairtie and turned my head as I did so to provide more leverage. As you do. Weird graunchy clunk that my son heard from across the room and zing, pain in the origin of my left-hand anterior scalene over Rib 1 and 2 and sudden body bracing from top of torso to bottom. Last night and all today — drop everything and visualise, constantly. Takes an hour to wash a small load of dishes because I keep pausing to hallucinate haha.

I’m not sure if it’s recommended to visualise so intensely as I’m doing, it takes 2-3 minutes each time I do it if I go the full version. Perhaps it’s better to have a lean, quick little visualisation more often, than less frequent visualising for a longer duration? A bit of both perhaps — I guess that’s what I’m doing with my “lite” version and my “full-cream”.

But when I do the lite version, I don’t get the same level of pain relief — often, pain is still intruding on consciousness. So by Moskowitz’s “Relentlessness” rule, I should visualise again… That kind of repeated visualising eventually uses as much time as the “full-cream” practice. But the difference is, I can get things done at the same time, albeit slowly.

I stopped for a couple of minutes for every line of the last paragraph. Just did it again.

I’ve noticed lately that there’s a rhythm that the colours emerge to — sometimes the colours cycle rapidly, other times it’s slow. Until now I’ve always tried to slow that down so I can get more high-resolution in the fades, but just now I went with the natural pacing and it felt more calm, relaxing, helped with the pain and went more quickly too. So I’ll go with the rhythm it seems to want from now on.

I just did some trigger pointing of my upper trapezius – often the only thing that gives me relief during a flare up of this magnitude. Usually when I have acute LHS neck pain they’ll be eye-watering to the touch. Today, hardly noticeable when I pincer-grip them.

Trigger points work by being adjacent to pain signalling neurons within the “body maps” of our somatosensory cortex. And they’re often firing due to neuronal spillover from the “neuroplasticity gone wild” of chronic pain. I they’re not online today, especially given how much pain I’m feeling just in general, could that indicate I am slowly shrinking the spillover?

Neuroplastic Brain Hacking for Persistent Pain: Day 23

Support groups are not really my thing. If I hadn’t kept a diary today, then I’d probably not have considered the idea of looking for one.

This morning Leo asked if I’m hurting a lot and I paused before replying to his question, but just to assemble my thoughts. I’d been visualising way more than yesterday — interrupting myself, or him, mid-sentence even, to close eyes and wrest some processing back from protesting brain regions, before jumping back into the flow of conversation, or finishing coffee extraction, or spreading my toast. But when he asked that, I was feeling pretty good.

“It’s funny. Today the pain is coming in waves, so there are these gaps where the pain stops. That means that I notice when it resurfaces and I’m like Oh! I can use this to practice some more. Yesterday, the pain was actually way worse but it was constant. I think I was visualising less. When there’s never a moment when you’re not getting a hot-knives feeling in three, five, ten body parts, you don’t get the cue to visualise. It just grinds on incessantly. I don’t want to just sit in a chair all day doing this, but it’s like, ‘Well, if I don’t do it all day, when, then?’ When the pain is constant, there’s no contour or trigger to visualise.

“I still don’t know what to do on these kinds of days.”

I wrote about this exchange in my diary after breakfast, and it has been echoing in my head all day.

If I’m to make a success of this practice then these flare-up episodes are the proving ground. If I don’t rewire the networks to the level where I can prevent all or most episodes, then it will have failed. I don’t want just another crutch like breathing techniques or restorative yoga. Wonderful as those practices may be, they do not unravel the wiring of chronic pain, they are basically just an alternative to pain medication — when stopped, the pain gradually returns. As the quote from Doidge I posted earlier says “unlike medication … the neuroplastic technique allows patients to reduce its use over time, once their networks have rewired.” [1]

Although I might be starting to find traction with the days in between the flare-ups, I still don’t have a handle on the flare-ups themselves. This realisation dawned on my gradually, almost reluctantly, over the course of the day, through writing and mulling it over in my head. Tonight as I type this entry up I have the problem staring me in the face again. So as I said at the start of this post, I’ve begun researching and tracking down a few pain forums online. One of them is even based out of NZ and may lead to me finding a local face-to-face group that I can refer to when stuck like this. More investigations to come.

This is a perfect illustration of why keeping a diary is so incredibly beneficial for me while making a lifestyle change like this. Thanks to those of you who are reading, and those of you who are not, well, up yours!

Offending those who will never read it is a victimless crime right? 🙂

[1] http://give.kiwi/2016/07/quote-doidge-on-moskowitzs-neuroplastic-cure-for-persistent-pain/

Quote: Doidge on Moskowitz’s Neuroplastic Cure for Persistent Pain

What Moskowitz has added to our understanding of this ability of the mind to eliminate a particular pain is that constant mental practice is necessary to strengthen this ability and change the firing of the brain in a way that is sustained. Unlike medication or placebo, the neuroplastic technique allows patients to reduce its use over time, once their networks have rewired.

The effects last. Moskowitz has patients who have kept their gains for five years. Many of his relatively pain-free patients still have damage in their bodies, which can, on occasion, trigger acute pain. He thinks that once they have learnt and practised the technique over hundreds of hours, their unconscious mind takes over the task of blocking pain by using competitive plasticity. When it doesn’t, they can still use the spike of pain as the signal to consciously use competitive plasticity to do more rewiring. “I don’t believe in pain management anymore,” says Moskowitz. “I believe in trying to cure persistent pain.”[1]

[1] Doidge, Norman. The Brain’s Way of Healing. Penguin Press 2015.

Neuroplastic Brain Hacking Day 20 — On to Section Two

Feeling like my motivation has slipped a bit in the last few days, and as such I’m not really progressing. I think I got thrown off a bit by a few things. Not to worry though — I’m sure that’s all part of the learning cycle. But I’ll need some external input to keep taking this deeper. Moskowitz has five sections in his book [1] and recommends taking them one at a time so that we can develop familiarity with each technique before moving onwards. Visualisation is actually just Section One. On to Section Two then!

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

Socially Hacking the Neuroplastic Brain — Day 18

Why am I writing these updates? I don’t expect they’ll be relevant to many people (and that’s a good thing!). Maybe someone stores away the info for later and circumstances change and it becomes important for them — that’s one possibility. But mostly it’s just a way of keeping a diary; I’ve rarely been able to determinedly effect change in my life without one. And I’m aware this time that a) the stakes are high and b) the level of moment by moment commitment required to make this work is unprecedented. So diarying out in public makes sense to me — it’s as though I’m accountable. Not to anyone in particular. It’s just a social hack to eke every bit of determination I can get out of the situation.

Same reason people go on silent retreats in groups. Gathering together to be silent. Not for the idle banter that’s for sure! But because socially we get an extra ounce of energy from doing things together. Which illustrates another reason, really. It’d be just too damn lonely doing it on my own.

Almost into the twenties. Bring it!

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