Strategies to Reduce Chronic Pain, Part One

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In the previous post I discussed the fact that chronic pain is sometimes not so much a problem with actual ongoing physical damage to the body, but instead due to issues with the way the central nervous system processes pain.  In other words, the pain alarm system is just going off too often, too loud and too long for no good reason.  If this is the case, then you need a pain relief strategy that targets the brain and not just the body.

This post lists some basic mechanisms that can help turn down the volume on the alarm system.  Although you may not have heard of any of these mechanisms before, one or more of them almost certainly explain a great amount of the pain relief that people sometimes get from almost any type of therapy, including bodywork, feldenkrais, chiropractic, yoga, pilates, tai chi, acupuncture, etc.   Here they are.

Creating Noise to Block the Pain Signal

One of the primary ways that movement, exercise or bodywork can reduce pain is the phenomenon of sensory gating.  Sensory gating means that the processing and perception of sense information is reduced by the presence of other competing sense information.  If your nervous system is busy trying to process signals resulting from movement or touching, it has less ability to perceive and process pain signals.  Most people will instinctively take advantage of sensory gating by rubbing an area that has just been injured.  The rubbing sends sensory signals to the brain which compete with the pain signals and reduce their processing and perception.   An active muscle contraction will also serve to reduce the perception of normal or painful stimulus to the skin.  In fact, during vigorous exercise and for 10-15 minutes after, pain perception is reduced.   It appears that sensory gating and resulting pain relief will be greater where: the competing stimulus is closer to the area of pain; the competing stimulus is more interesting and novel; and the stimulus comes from active movement rather than passive movement or touching.

Based on these facts, we can conclude that sensory gating will be maximally effective with active movement that is novel, interesting, rich in proprioceptive and sensory information, and near the site of pain, without aggravating the pain.  An example might be trying to reduce knee pain by doing slow, mindful, non-threatening, novel and interesting movements at the ankle and hip joint, without causing any pain in the knee.   Sounds like Feldenkrais or Z-Health in a nutshell.

The gating theory is an excellent way to understand how movement, exercise or bodywork can make us feel better.  In fact, a great amount of pain relief that occurs with any of these modalities is likely explained by this mechanism.

Refine Your Body Maps

Body maps are important. They are neuronal networks in the brain that act as representations or maps of body parts.  They are in essence virtual bodies.  As far as pain goes, the representation is the reality.  If your brain map says that your left arm is on fire, you will feel like your left arm is on fire, even if you don’t have a left arm on fire, or even if you don’t have a left arm at all.  Phantom limb pain is a very real and very common ailment for people with amputated limbs, and it is an example of the fact that the virtual body is just as important as the real body in determining what you feel.

Accordingly, we want to make sure that our maps are as clear and accurate as possible, so that the brain does not mistakenly put pain somewhere it doesn’t belong, or mistake normal sensory information for pain signaling, or otherwise just become threatened by the fact that it doesn’t really know where the body is or how to move it well.  Recall that all pain is an alarm signal that occurs when the brain believes the body is under threat.  We would guess that the brain would be inherently threatened by not having an accurate map of a certain joint, just as we would feel threatened by walking into a room without the lights on or by using a power tool with a blindfold.  If you walked into a dark basement, and brushed up against some unknown thing, you might let out a scream even if you weren’t hurt.  Similarly, the brain might create pain in a joint where it doesn’t have any accurate information about what is going on there.

Our body maps are developed and modified primarily from the sensory feedback that comes from movement and touching.  The modifications can be sensed very quickly.  Without looking, try to sense the exact direction that your right big toe is pointing.  Now move the toe in a circular arc from the ankle for a few seconds, let it come to rest, and try to sense where it is pointing again.  It should now be easier to sense the direction of the right toe compared to the left.   If you spend a minute or two carefully and slowly writing the alphabet with your toes, you will find that the whole foot is now easier to sense and move in a coordinated fashion.  The change is not to your foot, but to the virtual foot in your brain.  The sensory information provided by the movement has filled in some gaps or blind spots in the brain maps.  This is good, because if pain is an alarm system, more accurate sensation of what is going on in the foot will lead to fewer false alarms.  We would further expect that the clearer map and enhanced movement skill would reduce threat coming from the ankle, which might reduce pain.   In fact, many people who perform this exercise find that walking immediately feels softer, easier, more balanced and possibly less painful.

In my opinion, most of the benefits of most bodywork and movement therapies are due to changes in the body maps that occur with touching or movement.  Pilates, yoga, and tai chi provide particularly interesting sensory feedback from movement that feeds the maps.  Bodywork, massage, chiropractic, and acupuncture provide novel and interesting touch stimuli that has the same effect.  I think one of the reasons I enjoy strength training is that for a day or two after a good session, the mild soreness of the workout provides me with a much clearer image of where my muscles are and what they are doing.  It also makes me feel heeuuge, bro’.

So what is the best way to refine the body maps?  Just as with sensory gating, refinements to the proprioceptive maps are more likely to occur with active movements that are mindful, novel, curious, exploratory, active, and purposeful.  Babies develop their understanding of where their limbs are in space with exactly this type of movement.  Moshe Feldenkrais developed the logic of his method with these ideas in mind, in order to develop what he called the self image.

Develop Movement Skills

Pain is often is related to a certain movement or posture.  For example, there is no pain until you bend your knee a certain way, or twist your spine in a certain way, or sit in a chair in a certain way.  For whatever reason, the CNS obviously thinks that the painful move or position is a bad idea, and it is sending you a pain signal to discourage you from making it again in the same way.  One strategy to reduce the pain is to move in a subtly different way that does not threaten the CNS.  In general, we can expect that the more you move with coordination, control and efficiency, the less threatened the CNS will feel about that movement.  Therefore, improving your movement skill is a way to give the CNS some good news that will reduce perceived threat related to movement.  This means that anything you can do to improve movement skills and physical capability will likely help with pain related to movement.  So, another reason that pilates, yoga, tai chi, martial arts, dance, or weight training can reduce pain is due to improvement in movement skill that lowers threats related to movement.

Usually people will explain the therapeutic aspects of improved movement in purely physical or mesodermal terms – more efficient movement simply causes less wear and tear on the body which reduces pain.  I think that is a valid argument but there is probably also a purely ectodermal or “virtual” benefit to improved coordination as well – it calms a threatened nervous system about the dangers of moving, even when actual tissue health is relatively unaffected.

Conclusion

I think the above three methods for reducing threat to the CNS – sensory gating, improving body maps and movement skills – account for a significant amount of the benefit seen in most bodywork or movement therapies.  In the next post I will discuss some additional strategies that are also aimed directly at the ectoderm.

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14 Responses to Strategies to Reduce Chronic Pain, Part One

  1. char brooks says:

    you know what strikes me about this article? all of these are excellent do-able ways for dealing with chronic pain and NONE of them are covered by our health insurance. there are so many excellent well trained practitioners in these areas too who are scraping by when they should be making a great living truly being in service to those who need their help.

    sorry for the rant and very glad you brought this to my attention. i will share it with my readers.

    my passion and my work is about helping people make informed choices about their healthcare. your work describes viable avenues for taking care of our health in pro-active ways. thank you for explaining this so clearly.

    • Todd Hargrove says:

      Thanks for the comment Char. A good ins. plan will sometimes cover various forms of bodywork, but it usually won’t pay for your gym membership.

  2. […] system, which processes and controls pain.  Here are some posts on how that process works and what can be done with that information. Categories: core strength, myths, pain reduction Tags: back pain, core strength […]

  3. Tim says:

    Do we know approximately for how long a certain nerve stimulus will be providing information for the map before it’s pushed out again? Let’s say I stimulate nerve A and this is recorded in the map. Let’s say I don’t stimulate nerve A again. For how long does the map know about nerve A? When can I expect SMA?

    Phantom pain, why does one have that? Does the CNS feel threatened because it can’t sense the lower limb?

    Pilates seems it could be something for me. Will definately try it out. Seems it can be a good workout both for the nervous system and for the muscles.

    Some people can perform splits. I assume that one usually do stretch exercises again and again and again in order to be able to perform a split. What is it that one actually is achieving with the stretching? Do the muscles get longer or is it only about learning the brain that lengthening the muscles is not a threat?

    Just being somewhat curious :)

    • Todd Hargrove says:

      Tim,

      Good question about how long a stimulus will cause a change in the map. I think it depends on how relevant and interesting the brain finds the new sensory information. If I just brush a finger on my leg it will remain easier to sense for maybe a few seconds and after that will feel just like the other leg. It would be a bad idea for the brain to make huge changes to its movement maps every time it wiggled a toe or brushed up against a leaf. I assume that the brain will only make permanent or meaningful changes to the sensory and movement maps for a good reason, such as a clear demonstration that the new way of moving or sensing is more efficient or less painful. Feldenkrais does a good job of making the movements very novel and interesting to get the attention of the CNS, and also doing them in a way that will convince the CNS that this is a better way to move. My personal experience is that movement work sometimes makes me feel better for just an hour, and sometimes I experience benefits that are more or less permanent.

      Re phantom pain, there is evidence that the CNS is threatened by smudged movement maps, just as you would be threatened by walking around with a blindfold. Researchers can sometimes create pain in subjects by creating sensory illusions that they call a sensory mismatch. Perhaps phantom limb pain is a kind of sensory mismatch.

      Re splits, I would guess that for the avg. person to learn the splits, there might have to be some structural change to the length of the muscle, by adding sarcomeres. This takes a huge amount of effort, e.g. sitting around in the splits while watching t.v. every night. Of course CNS training and threat reduction would be necessary as well.

  4. […] a previous post I discussed some basic strategies to reduce chronic pain, based on what we know about pain […]

  5. […] For a better understanding of how and why the Feldenkrais Method works, you can read various blog posts that explain the science and reasoning behind the Method, including posts describing: Movement Efficiency; Making the Hard Easy and the Easy Elegant; Why Slow Movement Works; Skeletal Awareness; The Body Maps; Sensory Motor Amnesia; and Strategies to Cure Chronic Pain. […]

  6. […] to figure out what is causing the CNS to feel threatened and how can we reduce the threat.  In the next post I’ll discuss some specific strategies based around […]

  7. […] persuasion. Show your brain that you know what you are doing and won’t get hurt doing it. Get out of pain, even mild pain. Coordinate your joints with mobility drills. And don’t forget to lift some […]

  8. pam says:

    i’m late to your wonderful series.

    just want to comment that i recently started meditation. & there’s a “survey of body” (moving one’s awareness around body parts). it sounds this is the same idea of improving “body map” in our brain.

    regards,

  9. Donna Hitz says:

    I was injured in a pedestrian/car accident at age 15. I had a concussion with a fractured spheroid. Before this accident I was doing cartwheels on a balance beam. After it I couldn’t run around a city block. By age 26 I was diagnosed with Fibromyalgia(FMS), a pain syndrome.

    I have much in common with people with PTSD and realized that the ‘Guardian’ as I like to call it, was calling the shots. I think you refer to it as the Central Nervous System(CNS). Newer treatments for PTSD involve assuring the CNS that the original threat to the persons safety has passed. Similar reasoning in the methods you prescribe.

    I am wondering if the body map is smudged in FMS. My original injury was serious, for sure, but not observable soon after the accident. I seemed to be alright. I have met many many women with the FMS diagnosis and their injury was not considered very significant but there was almost always an injury or shock to the body prior to their diagnosis and FMS is most assuredly a significant diagnosis.

    Perhaps people should be evaluated for ‘re-integration’ type therapy after even a mild head injury to prevent the future manifestation of a pain syndrome like FMS.

    • Simon Neal says:

      There is a very strong relationship between PTSD and the development of long term pain. I do lots of work with folk with Fibro. More often than not there is a history of trauma or the pain started with one musculoskeletal problem and grew like Topsy. PTSD is a threat state as is chronic pain. I suspect they have lots in common. One of the most effective treatments for chronic pain is Rapid Rewind – see the Human Givens web site. As you say this technique is about persuading the threat response system, particularly the amygdela that a response to certain patterns or inputs is no longer required. Pain neuromatrix treatments likewise. I don’t think there is any fMRI research to suggest cortical smudging in FMS. I think it is simply a heightened threat state. Mindfulness based meditation practise seems to work pretty well with FMS in my clinical experience

      Cheers

      Simon

      • Simon Neal says:

        oops It should read one of the most effectif treatments for PTSD… Sorry

        My colleagues and I work in a Pain Clinic. We are looking hard at developing reintegration strategies for people with all sorts of chronic pain and we offer trauma based therapies as standard, ‘cos trauma seems to be of such great importance.

  10. Maureen says:

    Hi Todd, I just found your website yesterday and am learning a lot. I have read soooo many posture help books in effort to relieve some tension I have in my right hamstring and stiff back. I thought my s curve scoliosis, DDD, and bulging disc at L4- SI were to blame. I have a lot of postural imbalances and get Rolfing to keep me in alignment, and i treat with a chiro as well. Whenever I am stressed my stiffness and tension greatly increases–is that because of the startle reflex? In your article you give ideas to help with knee pain. Which areas should I focus on for right hamstring and LBP? Also, I checked ou the z health website but it appears to be for trainers. Do you know of a program for a regular person to do at home? Thank you so much for putting together this website. I have so much to learn! I would love to stop Rolfing because it costs so much money and doesn’t last. Thank you!

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