Change the Brain; Relieve the Pain; Transform the Person
Section 5: Soothing
Vetoing Pain
In reality, people with pain are the only ones who can truly help themselves. They are the only ones who know what they feel. They are the only ones who can determine which treatments work. For pain care to be effective, it must be self-directed and self-regulated, with a team of professionals and non-professionals. Positive outcome is measured by improved pain control, improved function and improved quality of life. Ultimately, the person with pain has to become the leader of their treatment team. They assess the situation, determine needs, set goals, find help and pursue appropriate strategies. They must reach out and connect with friends and family, reject self-isolation and fear-based limitations, reconnect to the pleasurable aspects of life and re-establish the rhythm and harmony of social existence.
Sniffing Out Pain Relief
Peppermint shows significant evidence of efficacy for pain control. Peppermint molecules are effective as both anti-nausea and analgesic agents. There is excellent pharmacologic evidence that peppermint blocks Substance-P, the main pain neurotransmitter in the nervous system. Aside from pain, Substance-P is also involved in nausea, anxiety, depression and inflammation. Peppermint has been used to treat post-herpetic neuralgia, trigeminal neuralgia, chronic low back pain, neck pain, migraine and chronic daily headache, inflammatory pain, nerve pain and irritable bowel pain. One of peppermint’s main components is menthol, a soothing substance when placed on the skin. It is used in various rubs and ointments to activate cold temperature receptors on the skin and reduce musculoskeletal pain. Additionally, peppermint evokes a feeling of well being and has a positive effect on mood.
Accessibility and Connectivity of the Scent Circuit
Scent is of great interest in trying to deal with pain because of the scent circuit’s connection to the amygdala and it’s tracing of the subsequent pain circuit. Review the graphic on page 48 of the Neuroplastic Transformation workbook and note the strong overlap of scent and pain circuits. Scent receptors are buried in the upper 1/3 of the mucous membrane in the nose designed to pick up odors and mingle these with taste receptors to come up with the array of scents that people are capable of distinguishing from each other. These include 300 to 400 specific scent receptors in nasal mucus membranes, that when combined allow for a vast array of scent discrimination.
Scent, Memory and Emotion
The amygdala receives first signals of scent, and a second scent signal, once it is processed by the scent circuit. It then assigns it a positive or negative meaning. This allows for a second chance to mount a fight flight response. Some of the most highly charged emotional memories are evoked by scent. The hippocampus, where memory is stored, also takes a direct connection from the olfactory bulb, linking scent to powerful memories. Furthermore the connections between the hippocampus and the amygdala are numerous and account for the emotional coloring of scent memories.
Scent and emotion are also highly interconnected. Look at the text on page 47 of the Neuroplastic Transformation workbook. Several scents evoke pleasant memory and pleasurable experience to counteract pain. Lavender, rose, spruce, peppermint, spearmint, wintergreen, orange, grapefruit, tangerine and lemon can be used to stimulate brain pleasure centers. Moreover, during periods of traumatic memory and excessive pain processing, these scents can be used to interfere with the stimulation of the circuit between the amygdala and the hippocampus. This can block the fight-flight response accompanying persistent pain.
Belief Processed in Sensory Cortex
Look at graphic on page 49 of the Neuroplastic Transformation workbook. Belief is located in the sensory processing area of the brain. When we are born with our abundant, but sparsely connected set of nerve cells, we are truly helpless and dependent upon others. We wire by the sensory experiences of life and this wiring forms basic connections of the sensory and motor functions of our bodies. We begin to connect our nerve cells via our sense of touch, movement, position, pain, vibration, pleasure, temperature, physical comfort, sound, taste, scent, sight. It is by believing these experiences that we begin to reliably predict reality. The sensory experience of our bodies is sent to the sensory portions of the brains in the posterior parietal cortex, the primary somatosensory area and the secondary somatosensory area. These are major brain areas where we perceive pain, but other senses, as well. Our increasing sense of predictability, reliability and truth is intertwined with our sensory experience long before we have developed the ability to reason and think. Literally, what our senses teach us to believe is the basis of how we begin to define the world we live in. Our introduction into the bright, cold, painful, loud world, while being removed from the dark, warm, quiet, gestational comfort of the womb is our first brush with pain unpleasantness, and we greet it with a cry as we breathe in air for the first time. Our consciousness awakens into a riot of sensations, and new experiences come fast and furiously. From the very beginning the experiences of our senses lead to our beliefs and our beliefs will always have their underpinning in believing what we sense.
Patient and Provider Beliefs About Pain
Low expectation of pain control on the part of patients and providers leads to poor pain control. Settling for any improvement is not enough. Patients state clearly that they are always going to have pain, always need to be on medication and always be limited because of this pain. Providers set low expectations of pain relief. Statements are made to patients that they will have to learn to live with their pain and the best they can hope is to manage it. The provider-patient relationship is a powerful example of the social synapse, the connection between people involving mirror neurons and the highest Associational centers of the brain. As such, the words passed from provider to patient strongly determine patient beliefs. As belief centers in the sensory part of the brain become dominated by the expectation of pain, nerve cells in those belief centers are taken over by pain processing. The belief in the inevitability of pain expands the pain map in the sensory cortex where beliefs are born.
The process of healing starts by embracing the core belief that patients can be pain free. Providers need to believe that their patients can be free of persistent pain. They must continue to try new approaches to achieve this goal. The traditional model of care changes here. Patients become partners with their providers, rather than passive recipients of care.
Using Belief for Pain Relief
An active approach to meet every pain spike with the belief that it can be stopped is the foundation for patients taking control of their lives. It may take a while to take control, but practice, repetition, relentlessness, adaptability and belief in yourself will result in pain relief. To do so, your brain and body have to work together as increasingly seamless parts of the entire whole. Pay attention to the pain and recognize it for what it truly is, a short circuit in a very useful system. Believe the brain can be rewired.
See yourself as moving through the phases of treatment. Your treatment will vary whether you are in the Rescue, Adjustment, Functionality or Transformation phase of care. The belief that medication management is all that is left for the treatment of persistent pain is flawed. Medication management and interventional treatments are methods we employ to move patients from the Rescue phase into the Adjustment phase. These are steps to being able to control pain, while they are applying neuroplastic strategies to overcome pain. Each has its place, but neither is the foundation of treatment.
Do not settle for partial pain control. Stabilizing out of control pain is essential, but so is the belief that we can end pain persistence. Remember that all beliefs require a leap of faith at some point. This is that point. This cannot be a thinly held belief, but must be unshakable. Your pain will try to shake it over and over and you must teach your brain and your body that it is the belief and experience of abnormal pain that is to be disbelieved.