Is It Really Possible to Retrain My Brain to Stop Pain?
If your pain system has become overprotective, is it is possible to train it to calm down?
Yes! By learning to interpret messages from the body as safe and not dangerous, over time the pain system will realize you do not need protection (pain).
In this article, we explore the process of retraining our pain response using Pain Reprocessing Therapy (PRT) and somatic tracking. We also explain some of the evidence for the effectiveness for managing fibromyalgia and other chronic pain conditions using this approach.
What are the key techniques for Pain Reprocessing Therapy?
“If the causes are in the brain, the solutions may be there, too.” – Dr Tor Wager (researcher in the Boulder Back Pain Study)
Pain Reprocessing Therapy is an approach to pain management that can help people rewire pathways in their brain and nervous system to switch off chronic pain. It involves education about pain processes (some of the information we have already outlined about the role of the brain and danger), somatic tracking and bringing down threat levels by focusing on safe sensations and addressing lifestyle factors that contribute to being in a high alert state.
Learning to cultivate messages of safety can flip an overprotective system and create new neural pathways. These help to break down the default danger alerts that drive nociplastic pain.
A key component is somatic tracking
Somatic tracking is a process of training the brain to realize that pain sensations are not dangerous. This might involve sitting comfortably and working your way through these few steps (you can do this via guided meditation or just figuring out your own way):
- Bring your attention to the sensations of pain in the body using mindfulness (the non-judgmental awareness of the present moment). Get curious about the location, intensity, quality of sensations – enquiring gently about your exact experience.
- Send messages of safety (literally tell yourself that the sensations of pain are not dangerous, that you are safe).
- Bring some lightheartedness to the process – a little joke or visualization that helps. Evidence suggests that when people engage in a bit of silliness they are more likely to overcome feelings of fear or concern1.
- Continue to observe the painful sensations. You are not trying to get rid of pain, just watching as it shifts and changes and you can do this in a safe and curious way.
Somatic tracking is an opportunity to retrain the brain and Alan Gordon refers to it, when done right, is a corrective experience. You need to feel safe when undertaking this exercise so that you can turn towards the sensations of pain without perpetuating fear. With enough of these corrective experiences, our brain can learn a new way of interpreting the sensations – as safety and not a danger. We want to avoid the opposite effect.
Somatic tracking is best done when pain is low to moderate. When pain is high (like in a pain flare), focus on self-care and things that can help when pain is intense. For example – taking frequent breaks if sitting is a known pain trigger, taking a hot bath, etc. At these times, it's important to feel comfortable (as best you can) and not push through intense pain (overdoing it or ignoring pain).
However, you can also use PRT and send yourself messages of safety, even when pain is intense. And you do that though your self talk. For example tell yourself:
“This is a moment of pain and will pass.”
“I am safe.”
“I know this is a false alarm.”
Pain Reprocessing Therapy also involves becoming aware of and managing other parts of your life that might contribute to high alert states and/or negative thought patterns – and doing so with self compassion.
Does Pain Reprocessing Therapy work?
Of course, that's the million dollar question we all want to know, right? Sounds great but does it work? The technique is relatively new and at this stage the largest study has been the Boulder Back Pain Study undertaken by Alan Gordon's team2. This research showed a number of impressive results including:
- Two-thirds of patients treated with PRT for four weeks were pain-free or nearly pain-free.
- 98 percent of PRT patients had at least some improvement.
- The outcomes held true a year later.
- Changes in the brain regions of people who had undergone PRT – a reduction in activity in the insula.
In a similar approach, another small study found similar mind-body symptom relief in patients with nonspecific back pain3.
How long before I see the results?
Just like any activity, when you live with pain, pacing is a good approach. You may want to start small with your somatic tracking, spending just a few moments exploring painful sensations. Once you get familiar with the process you might increase the length of time you explore and how often. The more corrective experiences you get, the more the brain learns safety. However, you want to bring lightness to the process too – don't go overboard or become regimented, or overly focus on the outcome. There is a possibility of seeing results in a few weeks.
Yeah but, what about my…
You might be thinking – sounds all very well and good but what about my … (insert another co-occurring condition, symptom or reason). Before I give my own example, a reminder that there will be some conditions that share common underlying causes (such as hyperactivity in sensory pathways and increased inflammation in the body) such as irritable bowel syndrome (IBS) and chronic fatigue syndrome (ME/CFS).
In The Way Out book, Alan Gordon states that unless you have a systemic disorder (like multiple sclerosis, cystic fibrosis or lupus), multiple pain conditions might all point to a single underlying cause – nociplastic pain4 – and, therefore, trying pain reprocessing therapy is worth a shot!
But what about the steel rods in my back? I asked this question for a really long time. My pain began in my late teens after two particularly intense back surgeries for scoliosis. So surely that is the reason for my pain, right? You only need to look at an x-ray of my spine to know there must be something going on. I mean, check it out – I am like a bionic woman and nothing quite says danger than looking at this!
So it is time for me to examine some possible evidence that could suggest nociplastic pain. For example, my pain changes with stress, it is unpredictable and I've had many failed treatments. Then there are those sneaky personality traits that are common in people with nociplastic pain such as people pleasing (let’s just say I tick all the boxes!). And then there are also many people who have had similar operations and not developed chronic pain. In fact, a good friend has had spinal fusion and is a successful endurance athlete. Science backs this up too - e.g. 64% of people with no back pain have disc bulges or herniations and not everyone with arthritis experiences pain, because wear and tear is a normal part of life. A person with a horrible looking x-ray may have no pain, and a person with an X-ray showing no damage could be in agony. Simply put, if there is no pain, it means these changes have not been perceived by your brain to be a threat….and for me, my threat detection system is stuck on high-alert!
You may also be wondering if a formal fibromyalgia diagnosis matters when it comes to exploring PRT? The techniques and strategies that we have outlined here are likely to be helpful in building confidence, function and overall well being in anyone living with chronic pain. If you want some more information on fibromyalgia diagnosis, please check out our recent series on gaining a fibromyalgia diagnosis, what to do after a fibromyalgia diagnosis and working with a rheumatologist.
Where to next?
If you would like to explore a little further, maybe watch this video and listen to Alan Gordon explain it himself! Or get your hands on a copy of the book: The Way Out: A Revolutionary, Scientifically Proven Approach to Healing Chronic Pain, by Alan Gordon and Alon Ziv.
A multidisciplinary, multimodal approach to fibromyalgia treatment is considered the gold standard and this is the basis of the MoreGoodDays® program. We focus on increasing function and activity, a sense of safety, and wellbeing thereby improving health and quality of life. The MoreGoodDays® foundational program is based on PRT among other evidence based pain management approaches. Feel free to get in touch with us to find out more.
Lastly, find out more by talking in a supportive community with people who understand – consider joining our Living well with Fibromyalgia Facebook community.
