(Workbook Page 9)
R.A.F.T. is one of the core concepts of Neuroplastic Transformation Treatment. Review Page 9 of the Neuroplastic Transformation workbook. People living with persistent pain experience phases of their disorder, going through matching phases of treatment. Persistent pain marks the transformation of pain from a symptom that warns about danger to a disease that is marked by changes in the entire body. Injury to tissue is not cleared up by normal inflammatory and anti-inflammatory processes. Nervous System signaling is amplified by unrelenting painful input from the sensory nerves in injured parts of the peripheral body. This results in perpetual firing of nerve cells in the spinal cord and the brain and activation of nerve cell receptors that cause rapid and long term firing of nerves.
One nerve cell fires another with enough intensity or for long enough that the second nerve cell continues to fire long past stimulation by the first nerve cell. This is called Long-term potentiation. While this process is very useful for memory, it is also one of the factors that causes pain to last long past its usefulness.
Inflammatory discharges of non nerve cells in the brain, within which these perpetually firing nerve cells are located, results in expansion of the pain map in the brain, at the cost of other important regional functions.
In the brain, nerve cells run through other brain cells called astrocytes. When nerve cells in the pain circuit fire continuously, these astrocytes release inflammatory molecules that keep the nerve cells firing. This leads to the pain processing nerve cells taking on nerve cells from less active surrounding areas and expansion of the pain map in the brain. This also results in more of the main pain neurotransmitter being produced and sent back to the area in the body where the injury or dysfunction has occurred, resulting in a chronic inflammatory response
Taking back that expanded pain map and restoring the brain to normal can be accomplished by counter-stimulating the brain whenever pain intrudes upon consciousness.
Examples of ways to decrease the numbers of cells dedicated to maintaining persistent pain in the brain are demonstrated. Each process stimulates other functions in the areas where pain is experienced to stimulate the brain to take away cells from where pain is perceived, reassigning those nerve cells to these other functions. Using these techniques and being relentless with pain spikes or intrusions by counter-stimulating the brain, leads to changes in brain function and plasticity. This exploits the same process that pain uses to become persistent.
Inflammatory compounds are released by the brain into the injured peripheral tissue and a loop is set up.
The result of inflammation in microscopic areas of the brain is that Astrocytes and Microglia react to the long term firing of embedded nerve cells by producing inflammatory molecules called cytokines. This in tern provokes the nerve cells to continue firing. Ultimately through changes in the nerve cells DNA and RNA more of the main pain neurotransmitter, Substance-P is produced. When this increase in Substance-P is sent to nerve endings the brain cells dedicated to processing pain increased three to five fold. The majority of this excessive Substance-P is sent down nerve shafts, backwards through synapses and released into the painful areas in the body, overwhelming the unit-inflammatory response, resulting in more inflammation and a positive feedback loop promoting pain persistence.
Look at the writing under the R.A.F.T. graphic on page 9 of the Neuroplastic Transformation workbook. Review the description of the four phases of treatment, Rescue, Adjustment, Functionality and Transformation. Like the picture of the raft full of paddlers, it takes a team to wend through these phases and there are likely to be many treacherous traps along the way to prevent ending persistent pain’s fury. Diligent and relentless work will overcome obstacles.