Neuroplastics for Persistent Pain: Realistic Recovery

Three months ago, I did a thirty day challenge of writing daily blog posts about my experience using neuroplastic techniques to come out of persistent pain. At the time I had no definable cause for the pain. In the subsequent two months I’ve had scans that confirm whiplash-associated arthritis where my head joins my spine.

Despite the lack of updates in that time, I have mostly kept up the pace with visualisation. My routine is a thirty minute sit (visualisation not meditation) before anything else each morning, another sit after breakfast and one more before bed. These are scaffolding. They keep the imagery fresh enough in my mind that I can recall it as needed while going about my daily tasks for the rest of the day.

Yes, the pain spikes still happen. I still have damage to my neck. I use a subjective scale of pain from one to ten, one being pain free and ten being dropped in boiling oil. And the pain spikes are still at the 6/10 that they were before starting the visualisation.

(Of course, comparing levels of pain is where a subjective scale becomes unreliable but it has to suffice, given that pain is a perception. There can be no objective measure of pain.)

That’s where the similarities end, however. In other ways, the most astounding changes have occurred:

  1. I can get the pain to stop. If I’m diligent and prepared to prioritise visualisation whenever a pain spike hits (any time of day or night, even if this means sacrificing the task or timeline I’m running with) then I can get rid of it. There are exceptions, but generally the pain recedes. After a ten minute break, I can carry on with my day. (Major flare ups are a whole ‘nother ball game that still require me to drop everything for a day or two. I have other tactics in place to avoid them, see below).
  2. Two-hours pain free is now a daily occurrence. I can now be pretty much guaranteed of a period in the afternoon where I can work, move around, talk etc without needing to stop and visualise or take breaks. It’s like I’m back to my old self for those couple of hours.

Note that both these effects are occurring while completely free of painkillers ๐Ÿ™‚ No paracetamol (aka acetaminophen for my US readers). No ibuprofen. No codeine and definitely no tramadol.

To me, this is worth any amount of slow-down, drop-everything-and-visualise type behaviour that I need to undertake for the rest of the day in order to attain the pain free states.

That’s the good news.

Major Pain Triggers

Six months ago I had to limit my activities to avoid what I’m calling “major flare ups”. Usually lasting two days, but sometimes up to four, even visualisation brings no relief during these periods. Restorative yoga and sleep is about the only thing for me.

Those limitations persist — that’s the bad news. Unfortunately for me (and my erstwhile yoga students) they include actions that are commonplace in many asana. Downward dog or plank pose shoot whole body pain and headache into my eyes, confusion, nausea, visual field like a broken mirror, tiredness. Shortness of breath. Ringing in my ears. So I’m still not back on the regular teaching circuit. I don’t know if I ever will be, now that we’ve discovered the arthritis.

My physio gave me an ingenious set of exercises. Attach a laser pointer to your glasses frame, and use it to draw around door frames etc from a distance of three metres. This is to retrain the tiny muscles at the base of your skull. If you have a laser pointer, try it! But they’re no good for me. It’s great training for those muscles, but the actions flare up the actual joint itself so I’m in bed the next day. For a couple days.

I’ve also had to limit or eliminate heavy lifting and hammering (so no DIY for me), computer use for more than half an hour without a break to move around, driving for long periods. Even just being in a hurry can start me on a spiral that can lead a strong burst of long-lived pain. So I’ve had to slow down my life a lot just in general.

Realistic Recovery

Speaking loosely, I wouldn’t call it “normal life” yet, but it’s heading that way. I can approach each day with more optimism, just knowing that each afternoon I will get a period of relief. And knowing that, if I am sensible and realistic about my activities through the day, then I’ll be able to head off pain spikes as they occur. It feels manageable.

It’s tricky to remain realistic with those activity goals after so long being on tenterhooks. Staying realistic without stifling the optimism — that’s the next phase of this recovery journey.

I’m fumbling my way a bit. In the past I relied on my gung-ho attitude to get me through just about any confusing situation (“fake it till you make it”). That won’t cut it here. I need to develop the patience, persistence and self-awareness to chip away at tasks without going into hyperfocus mode on them. An hour here, an hour there and plenty of walks and breaks in between.

If you have any tips to share with me about realistic recovery please share them in the comments. I’m particularly looking to learn more about my warning signs when I’ve overdone it, ways to structure a day so I can get the most out of them while remaining true to my capacity. Useful activity worksheets, for people in recovery. Forums or blogs to follow … I’ll collect any suggestions, plus what I learn from my own experience and research, and put them into a future post to follow soon.

Don’t forget to comment! ๐Ÿ™‚

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?

Don’t “Break” your Bad Habits: Neuroplastic Brain Hacking for Persistent Pain Day 29

Maybe I’m particularly prone, but to me it’s amazing how subconscious we can be in our routines. When I successfully gave up smoking fourteen years ago, it was only the last in a line of attempts, dozens-long. Each attempt on that line was a step towards the outcome I eventually crafted. I got discouraged after the early attempts were unsuccessful until I realised this.

Those first few attempts I tried to “break the bad habit”. But fighting with myself just lead to stress. What’s a common way to unwind when you’re stressed? Settle into something familiar like (for me) rolling a durry. Boom, smoking again. That’s what some of my early attempts looked like. I’d literally be sitting there smoking before I remembered how I was supposed to be quitting.

To an extent, life is about habits. They keep us alive and well (think of the many habits we use while driving, or the habits of hygiene). It’s useful to do things habitually. The problem is when we discover the need to change a behaviour pattern. Our brains are very good at forming, but not so good at “breaking” these routines.

I’ve learned from the smoking experience that it’s not helpful to create the intention to cease a habit. That just sets up internal conflict — a fight with yourself, resulting in stress. At the very least, stress saps motivation. If you’re unlucky, the habit will resurface as a coping mechanism for the stress that you’ve created by trying to get rid of it! Instead, much more helpful is to look at replacing that habit with another, beneficial one. [1]

When we replace an old habit with a new one, we are creating a competition between the two, and if we continually feed the desired habit, the undesired one will become weaker and weaker.

This is making use of competitive neuroplasticity. It applies equally well when working to unwind from persistent pain. We must replace the body’s neuro-inflammatory habit of wind-up pain with other habits and continually feed this habit until we weaken the pain pathways for good. Like an ex-smoker, we then need deal only with the occasional flare-up.

As a twenty-four-year-old, I somehow cottoned on to this. Once I reframed each “failed” attempt as actually a step on the path to being free of smoking, I started looking at these steps as crucial learning that I could take into the next time around the cycle. I was evolving a set of new habits like tools, that eventually did win out. Smoking was just smoking. It wasn’t evolving. There was no way I could lose — it was just a matter of time.

Today I’m digging deep, returning to the visualisation technique after three days in no-man’s-land due to gastro. I find that I’ve fallen behind by about a week from where I was in terms of motivation, clarity of visualisation, pain relief. All those are cloudy.

I just want to break the cycle. I want to work my body. I want to stretch myself to create things no one’s ever seen, to seek things I’ve never seen. But I know what happens when I follow those urges. If I ignore what’s wrong in my body, the flare ups return. There’s no escaping.

The frustration is real. I just want to break the cycle. But frustration leads to stress. Stress leads to tension. Tension leads to pain. Boom, back to square one, just like smoking.

So I regather myself, re-reading passages of neuro-biology to return a sense of motivation, visioning my particular imagery to activate networks only four weeks old in the competition vs those four years old. I remind myself that this is crucial learning. Resilience in the face of setbacks is how we effect lasting change.

Bene Gesserit Litany Against Fear by Frank Herbert in "Dune"
Bene Gesserit Litany Against Fear by Frank Herbert in “Dune”

[1] I just found that James Clear has talked about the same thing. I must say, I’m not a fan of that pop-psychology stuff that reduces all of these lessons to little flow charts and worksheets. It seems a bit sterile. But he does present a similar idea here, and it’s worth a read: http://jamesclear.com/how-to-break-a-bad-habit

Neuroplastic Brain Hacking for Persistent Pain: Day 28

Days 26 and 27 went by in an unfortunate episode of unwellness completely unrelated to whiplash or neurology but entirely to do with a bad choice of takeaways on Friday night! Amazing dreams, worthy of Salvador Dali. On speed. At a masquerade ball. I’m largely on the mend today, but let me just say there’s nothing like being under attack by truly vigorous bacteria to remind us how our mind is so much an embodied arising of consciousness. Change the body, and the mind changes drastically.

Needless to say, I don’t have a lot to report for today. Although I have dim memories of visualising while in the throes of gastro, it could have been I was merely dreaming about visualising. Or visualising my dreams. It all gets a bit blurry.

Just returning to the visualisations in earnest today, and expecting to have slipped backwards a bit. Nothing wrong there — further integration of the practice with daily life. Next time food poisoning strikes, it’ll be the second time it’s happened since I changed my brain’s wiring. I wonder if I’ll even be visualising still, then?

Neuroplastic Brain Hacking Day 25!

Today has been a busy day, and I’ve managed to ride it out with little drama by remembering to slow down and visualise at certain times. Transitions between activities are a classic time to forget the technique and just race ahead with the next thing — but pain is functioning beautifully as a messenger to be mindful and do the practices that unwind my brain.

I’m now pretty convinced of the technique’s effectiveness. There will be future setbacks, but I’m excited.

I have another piece I’m writing about this stuff and the crossover between it and mindfulness / vipassana. But it will have to wait as there’s more research required. Watch this space.

What Gets Fired Gets Wired — Is “Pain Free” a Sensible Goal? Neuroplastics for Persistent Pain: Day 24

Pain is not an enemy — it is an important messenger in our bodymind. It is a protective mechanism that saves our lives through letting us know about our environment. We’re going to need a frequent stream of those messages to keep ourselves safe. Getting rid of them is not realistic, or even desirable. It’s also not what this technique is about.

What the neuroplastic hack I’m crafting should accomplish is the ability to feel pain normally again. Without it spilling over into a large-scale take over of important brain processing regions.

The only reason that spillover is happening in the first place is because my brain has done its job. It’s not a malfunction or some kind of disorder — it’s a side effect of repeat pain signals (nociception) from the peripheral nerves. They have kept the pain centres of my brain in a state of alert. The actual biology of this is fascinating. I am not a doctor, but this is my understanding: inflammation, as it becomes chronic in the site of injury, eventually generates a flurry of rapid-fire signals that set up long-term activation in the pain regions of the brain. Once this long-term activation occurs, neurons can continue to fire off signals for days or even years, without receiving any new triggers. They become self-activated. This particular state (called Long-Term Potentiation) also triggers the release of a specific pain neurotransmitter called Substance P. Substance P then traverses the spinal cord to the periphery where it triggers the release of further inflammatory molecules from cells in the fascia called fibroblasts. An unending cycle of triggers has been established.  

Enter the 1st Law of Neuroplasticity: What Gets Fired, Gets Wired. This law describes the  experiential bias in our brain pathways: the more we use a given network, the more priority is given to it and the larger its physical size within our brain. The unending inflammatory cycle I outlined in the earlier, coupled with the 1st Law, leaves us primed to fall afoul of chronic pain. If we do not intervene, we will continue to add wiring to the pain pathways, until we see an increase in neuronal involvement in pain from 5% of neurons in a “normal” brain, up to 15% or even 25% in a brain with chronic pain syndrome.

That’s a lot of processing power been commandeered by the pain, when it could be being used to remember things or form sentences or make plans.

What Gets Used Gets Enthused (I just made that up). My brain has become better and better at feeling pain because that’s been a continual source of stimulation for so long. What I’m doing with the neuroplasticity hack, is to benefit from our structural understanding of the brain in the 21st century, and to apply some formidable human abilities: 

  • to direct my focus
  • to sustain attention
  • to practise meta-cognition (thinking about what we’re thinking)

We use these capabilities we’re blessed with, to steer our mind away from pain whenever it is detected. To receive the message, but to intervene with the very neurons the pain regions need to use for their wind up, and instead give them a different job to do. What Gets Fired Gets Wired. We can use the 1st Law as a virtue and not a curse.

By cognitively altering the firing pattern in our pain networks, they will, over time, rewire themselves so that eventually we do not need to cognitively do the work. It’ll be part of the firmware — a habit, if you like, subconscious and lightning quick.
It takes a while for the cognitive effort to tip the balance though. There’s a lot of pain habit built into those networks, and the brain is weighted towards experience. It won’t just drop years of wiring in favour of a week’s stimulus — or even six weeks. 

Although the improvements should be starting to take place for me in the next few weeks, it’ll take months for them to truly set themselves as the new normal. And I’ll have to stay vigilant with every pain spike for the rest of my life, to keep the pain habit from reforming, because the injury and others will continue to be a source of niggles from time to time.
So no, the goal is not to live some kind of pain-free celestial existence. This is more pragmatic than that.

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? ๐Ÿ™‚

[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 doesnโ€™t, they can still use the spike of pain as the signal to consciously use competitive plasticity to do more rewiring. โ€œI donโ€™t believe in pain management anymore,โ€ says Moskowitz. โ€œI believe in trying to cure persistent pain.โ€[1]

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

Neuroplastic Brain Hacking for Persistent Pain: Day 22

Today I’ve been struggling with mental focus. The visualisation technique has been hard to access. I can really feel the cognitive effects of yesterday’s flare up (the mental clarity takes a couple days to come back). That’s interfering with motivation. All I want is pain relief, whereas the visualisation is not necessarily about that. The motivation is to rewire the brain. But because of pain and lack of clarity, I’m in a kind of flailing mood, where such abstract motivations don’t satisfy what feels like an impulse from my reptilian brain to “Do Something!”

Lack of clarity and that reptilian fear factor are also causing focus to fail before I’ve had time to run through the visualisation. My mind is sucked away into pain and paranoia.

I’ve found myself falling back on the “grit your teeth and bear it” approach that I used to have prior to finding this technique.

I’m annoyed and angry with myself for falling into this pattern.

On a brighter note, Section Two of Moskowitz suggests ways to disrupt the pain pathways that might be very helpful. Including a possible way to incorporate mindfulness / vipassana techniques. Although he doesn’t call them that, there is plenty of similarity between what he’s suggesting and what I have practiced in the past. I’ve missed my daily meditation, which I stopped during week one of the trial.

More on that to follow tomorrow.

Neuroplastic Brain Hacking for Persistent Pain: Day 21

Three weeks today. I did shoulder work this morning — by which I mean, some very simple physio exercises for serratus anterior and lower trapezius. It felt good! More energy and breathing was so … uneventful. Nothing but pure breath. This afternoon though, has been challenging. See, before I found the neuroplastics technique, shoulder work came with a one-hundred-percent certainty (I am not exaggerating) of an intense migraine-like episode of whole body pain, travelling in waves through myofascial meridians, for two or three days. I used to call them migraines because they were accompanied by intense headache in each eye socket, broken-glass vision, dizziness, nausea etc. I don’t know what else to call them, but I don’t think they’re classical migraines in the medical sense.

Anyway, I’m not sure I was ready for the shoulder work today. It was pretty ambitious. It’s been about three months since I tried anything like it, and that last time I had to take about a week off work it was so bad.

I’m feeling a lot of spasming all over my body. The level of challenge to keep up the visualisation is so high that I’ve basically achieved nothing since about lunchtime.

But, and this is huge for me, it appears to be simmering at a low boil rather than reaching the level of a full-scale pain attack. As long as I’m obsessive with the neuroplastic tech, it seems to be able to keep it from turning into an out of control wind up.

Suffice it to say, I’ll not be doing shoulder work again in the next wee while, but I’m happy with progress.