We can do better than pain management
Action Occupational Therapy Inc wants to do better than pain management! That was good enough when that was the best we knew how to do. This desire to do better leads us to keep learning and improving treatment approaches with the goal of reducing or eliminating pain so you can return to full and meaningful participation in your life. This has led Bonnie Klassen, Occupational Therapist, to add certification as a Pain Reprocessing Therapy Practitioner. This approach is not for all types of pain. It will be less effective for acute or structural types of pain. It is most effective for “neuroplastic” pain.
- Identify evidence that the pain might have been learned over time and amplified by the brain and nervous system (like a hearing aid turned up too loud)
- Onset of pain was gradual or happened at a time of stress
- The pain moves and changes, good days and bad days, affected by things that don’t make sense
- Multiple body parts affected, both sides of the body
- It’s hard to know for sure, but if there is an element of neuroplastic pain, that means it can be changed by targeting the nervous system
If you are interested in reading more about this pain treatment and the research validating it, the book “The Way Out” is an excellent resource.
The Way Out: A Revolutionary, Scientifically Proven Approach to Healing Chronic Pain
by Alan Gordon and Alon Ziv; paperback at Amazon and Chapters/Indigo.
Neuroplastic Pain
Recent studies have shown that chronic back pain, neck pain, fibromyalgia symptoms, repetitive strain injury, headaches, and other forms of chronic pain are often not the result of structural causes, but of psychophysiologic processes that can be reversed.1,2,3 This is known as neuroplastic pain.
Pain is a danger signal. Normally when we injure ourselves, the body sends signals to the brain informing us of tissue damage, and we feel pain. But sometimes, the brain can make a mistake! Neuroplastic pain results from the brain misinterpreting safe messages from the body as if they were dangerous. In other words, neuroplastic pain is a false alarm.
Though the pain can be addressed psychologically, this does not imply that the pain is imaginary. In fact, brain imaging studies have demonstrated that the pain is quite real.4 Recent research has shown that pain is often the result of learned neural pathways in the brain.5 And just as pain can be learned, it can also be unlearned.
- Castro WH, Meyer SJ, Becke ME, Nentwig CG, Hein MF, Ercan BI et al. (2011). No stress – no whiplash? Prevalence of ‘whiplash’ symptoms following exposure to a placebo rear-end collision. International Journal of Legal Medicine, 114, 316-22.
- Bigos SJ, Battié MC, Fisher LD et al. (1991). A prospective study of work perceptions and psychosocial factors affecting the report of back injury. Spine, 16(1), 1-6.
- Baliki MN, Petre B, Torbey S, Herrmann KM et al. (2012). Corticostriatal functional connectivity predicts transition to chronic back pain. Nature Neuroscience, 15, 1117-1119.
- Derbyshire SW, Whalley MG, Stenger VA, Oakley DA. (2004). Cerebral activation during hypnotically induced and imagined pain. Neuroimage 23(1), 392-401.
- Hashmi JA, Baliki MN, Huang L, et al. (2013). Shape shifting pain: chronification of back pain shifts brain representation from nociceptive to emotional circuits. Brain, 136(Pt 9), 2751-2768.
Pain Reprocessing Therapy
Pain Reprocessing Therapy (PRT) is a system of psychological techniques that retrain the brain to interpret and respond to signals from the body more accurately, helping to break the pattern of chronic pain. Pain Reprocessing Therapy has five main components:
- education about the role of the brain and nervous system and how they influence pain,
- gathering and reinforcing personalized evidence that the brain and nervous system are predicting and modulating pain, as this demonstrates potential for unlearning pain,
- attending to and appraising pain sensations through a lens of safety,
- addressing other emotional threats, and
- paying attention to positive feelings and sensations, as a part of retraining the brain and nervous system.
A randomized controlled trial at the University of Colorado Boulder validated Pain Reprocessing Therapy as the most effective current treatment for chronic pain. In the study, there were 150 participants with chronic back pain. 50 participants received PRT twice a week for four weeks, 50 participants received treatment as usual, and 50 participants received an open-label placebo injection. In the PRT group, 98% of patients improved and 66% of patients were pain-free or nearly pain-free at the end of treatment. These outcomes were largely maintained one year later. This was published in in JAMA Psychiatry.
A secondary analysis of the trial demonstrates that PRT significantly reduces pain intensity and fear avoidance behaviors by increasing mind- or brain-related attributed causes of pain. Results suggest that using simple language to reattribute pain from the body to the brain may support effective treatment to relieve pain. This was published in JAMA Network Open.
Find more resources: Pain Reprocessing Therapy
Link to video of Alan Gordon demonstrating Pain Reprocessing Therapy: Bing Videos
