All Pain Occurs in the Brain
Pain is the body’s way of warning you about an injury that needs to be taken care of. With chronic pain, pain persists long after the injury has healed. Pain signals keep firing in the nervous system for weeks, months, even years.
The experience of pain involves multiple interactive neural pathways that influence pain signals at several levels at once: Pain pathways become stimulated by painful stimuli and, with repeated stimulation, these pathways can become altered and start firing independently of a painful stimulus. With repeated exposure to certain stimuli, a person becomes more sensitive to the stimuli and responds with greater and longer lasting pain. These changes in the brain, in turn, affect the endocrine and immune systems of the body. Through these multiple and interacting pathways, pain becomes amplified, it triggers more neural networks, and it becomes self-sustaining and resistant to treatment. These events result in disturbances of mood, sleep, energy, libido, memory, concentration, behavior and stress tolerance.
The neural pathways that are involved in pain sensation overlap the pathways involved in depression. So, pain not only stimulates sensory areas of the brain, but activates emotional centers as well, resulting in depression, anxiety and fear.
In addition, depression activates brain centers involved in pain sensation. Research has shown that the experience of pain is linked to EEG, or brain wave, activity. Teaching clients to alter EEG activity to reflect activity that has been shown to be associated with reduced pain may be promising. More intense pain sensation has been associated with a decrease in alpha activity and an increase in beta activity. Acute pain relief has been associated with decreases in beta and increases in alpha activity. Decreasing some types of medically-related pain has also been associated with rewarding SMR activity, a special frequency of low beta activity, and inhibiting theta activity.
Research applying neurofeedback to the treatment of pain has included multiple chronic pain conditions, including chronic back pain, peripheral nerve injury, pain from cancer, fibromyalgia and migraine headaches. Much of the evidence for the use of neurofeedback to treat chronic pain can be found in the following journal article.
Stress is often a big trigger for migraine sufferers. Neurofeedback is showing promise as a non-invasive and painless method to relieve the stress reactivity and resulting rebound into migraine headache pain. With Neurofeedback, the brain learns to function with better self-control and stability through increased self-regulation. With better regulation, stress decreases and migraines lessen or disappear.
In a 2010 study, 37 migraine patients were treated with Neurofeedback, and 70% experienced at least a 50% reduction in the frequency of their headaches, which was sustained on average 14.5 months after treatment. See article.
In this 2011 study, more that 50% of those trained with Neurofeedback experienced complete cessation of their migraines. The researchers concluded, “Neurofeedback appears to be dramatically effective in abolishing or significantly reducing headache frequency in patients with recurrent migraine”.
Neurofeedback and pain management
Research has shown that Neurofeedback can have a direct influence on the processing of pain. By learning self-regulation of brain functions, a client can modify the electrical activity in areas of the brain involved with pain processing, perception, or pain memory. This allows the reduction or even elimination of pain, along with associated issues, including depression or anxiety, for example.
The psychological factors that influence pain perception can modify our body’s biochemical processes. Thoughts can have a direct impact on these processes and potentially produce analgesia.
Another way in which neurofeedback can alleviate pain is the regulation of the emotional component associated with pain. The frontal cortex houses the unpleasantness associated with pain, and neurofeedback training applied to this region of the brain has been able to induce changes in pain affect in clients with acute and chronic pain, leading to an increased pain tolerance.
Chronic pain can also induce changes in the functional organization of the brain. Neurofeedback can allow the control of pain by altering the connectivity between brain regions, thereby inducing long-lasting changes in neuronal networks that can counterbalance the changes induced by chronic pain.
Indeed, clinical data has demonstrated the efficacy of neurofeedback therapy in a number of chronic pain conditions: it can decrease headache intensity, being particularly effective in children and adolescents, as well as migraine and pain associated with fibromyalgia. Neurofeedback can also be effective in post-operative pain and in cancer pain.
As new methods arise, it is likely that Neurofeedback will gain awareness and importance as a non-pharmacological therapy for a multitude of disorders.
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