How to Get the Brain to Work Again
The thought that the brain is plastic in the sense of child-bearing, adaptable, malleable is, I've come up to believe, the single most important change to our agreement of the human being brain in 400 years. Norman Doidge
Michael Moskowitz's office is not a place you want to end upwardly. If you're in hurting, though, he might just be the one you desire to see.
The Bay Expanse Medical Associates in Sausalito, California is not a place you lot want to cease up at. This pain clinic treats people with intractable pain – people who have tried everything they can think of without success. It'southward the cease of the line for most of the pain patients it treats. It is, as Michael Moskowitz, director of the clinic, told Norman Doidge, the place "where people come to die with their hurting".
Moskowitz's story was the first one featured in Doidge's captivating 2016 volume "Moskowitz knows of what he speaks when he'south talking about pain. In 1994, while waterskiing he flipped over and hit the water awkwardly with his caput. Despite everything Moskowitz tried – morphine and other opioid drugs, physical therapy, traction, self-hypnosis, anti-inflammatory drugs etc. – the pain strengthened, and fifty-fifty worse, spread. Thirteen years later, non only was it present on both sides of his cervix only it had spread to the middle of his back. In constant hurting and out of options, Moskowitz turned to an unlikely thought – neuroplasticity.
Neuroplasticity
Neuroplasticity refers to the ability of the brain to alter the way it'due south functioning. If a portion of your brain is damaged, for instance, other portions of your encephalon can take over the functions that have been lost. People who've had strokes can regain performance by physically and mentally prodding the brain to create new connections. Over time, bit by chip, undamaged areas of the brain tin larn, at least to some extent, to accept over those functions.
Neuroplasticity's core thesis is that neurons that wire together burn down together. The more than they fire together, the stronger the connectedness they produce and the more powerful they become. Think of a river carving out a aqueduct. The more water that flows through that channel the slicker and deeper it becomes – and the harder it is for the river to breach its banks. On earth, rivers that become securely entrenched can cleave their way through rising mountains.
Neuroplasticity proposes that the sensations nosotros experience, activities we engage in, the thoughts that we think, the feelings that we return to again and again – they've all carved out channels in our encephalon.
At the time Moskowitz began his experiments, however, the relationship of neuroplasticity to pain, however, was hardly known. Now we know that if nosotros feel an injury or an illness that continuously saturates our encephalon with hurting or other unpleasant sensations, those pathways will strengthen.
Hurting that persists is terrifying because information technology sets off the amygdala, before the parts of the encephalon that change our emotional responses can be turned on. The result is that nosotros re-experience the trauma that caused the hurting and this trauma is continuously reinforced past information technology. The terror demoralizes usa. Moskowitz
Past the same token, the "employ it or lose information technology" dominion also applies to the brain. If you stop appreciating things, finding means to be joyful, etc. those pathways and your ability to experience those feelings will diminish.
The Chronicity of Hurting
Chronic pain is a much more complex procedure than acute hurting. In contrast to acute short-term hurting, chronic pain includes an of import "learned" component. Many studies take shown that the brain takes what it believes will happen in the future into account when information technology decides how much pain information technology should deliver.
If the brain believes that actions tin be taken to relieve hurting, our experience of hurting will diminish, just if the brain believes that the pain volition get worse, information technology will really ramp up our hurting levels substantially. (The aforementioned procedure presumably applies to activity and fatigue; if the brain anticipates that fatigue or hurting volition result, information technology will clench down on our ability to be agile.)
Believing that future injury is likely, the brain keeps whacking us with pain stimuli in guild to hogtie u.s. to find ways to heal the injury. Immobilization certainly works in acute pain – an injury, later on all, needs time and balance to heal – but in chronic pain, it produces a physiological state that results in more – not less – pain. Similarly, the brain produces fatigue, hurting and other flu-like symptoms during an infection to give united states of america time to heal.
Merely what if the brain for 1 reason or another gets stuck in a hurting-producing fashion? Xiii years afterwards, later taking all the medications and therapies medicine could provide, Moskowitz, a pain specialist, non simply remained in pain but his hurting had spread from one side of his neck to the other side and down his back. He was getting worse, not ameliorate.
Competitive Plasticity to the Rescue
"I don't believe in pain management anymore. I believe in trying to cure chronic hurting." Moskowitz, in "The Brain's Way of Healing"
The key gene, Moskowitz constitute, however, had to practice with the "employ it or lose information technology" miracle and a procedure called "competitive plasticity". Competitive plasticity recognizes that the aforementioned areas of the brain can engage in many different functions.
Nowhere in the brain is this better demonstrated than with pain. Pain is such a fundamental and important awareness that the areas of the brain that procedure pain signals overlap with other areas of the brain which govern motion, emotions, vision, thoughts, etc. Because six of the nine parts of the brain involved with pain are also involved with mood, it's piece of cake to run into why pain is so oftentimes associated with depression and vice-versa.
It's non surprising, and so, that strong hurting – and/or presumably, fatigue – signals can interfere with very basic processes as the encephalon devotes more and more attention and energy to assessing, thinking most, worrying about, etc. hurting/fatigue.
As pain-processing areas expand in the brain, we lose our full ability to problem-solve, regulate emotions, resolve conflicts, relate to others, distinguish other sensations from pain, effectively plan… Every time the hurting worsens it feels similar it is here to stay…The amygdala is not a identify of moderation. Information technology is a place of extreme emotions, fight-and-flying and post-traumatic stress disorder. Moskowitz
Moskowitz's primal insight was to endeavor and devise ways to wrench dorsum the brain to normal functioning – to change its "learned behavior" and finish its focus on pain.
The procedure he devised was both counterintuitive and multidimensional. Recognizing the brain'south push to immobilize him and foreclose further injury had only strengthened his hurting pathways, he reasoned that overriding his brain'due south signals to rest, to lie down, etc. could aid, but that was but the first of the process.
Realizing that he needed a counter-stimulating forcefulness, Moskowitz developed a way to forcefulness his brain to process something other than pain. Considering our brains devote so much brainpower to processing visual stimuli, Moskowitz focused on using visual stimuli to steal dorsum regions of his brain that had been captured by pain.
His first patient was himself. Moskowitz drew a map of what a brain in chronic pain looked like: a map indicating that big parts of his brain had been hijacked by pain. Each time he experienced hurting, he pictured his encephalon every bit it was – and then he imagined his hurting map shrinking.
Relentless Battle
Moskowitz'south recognition that he had no like shooting fish in a barrel job before him provided another key insight. He'd, after all, been in pain for a long fourth dimension. His encephalon had had 13 years to learn how to procedure and deliver pain signals as efficiently and as devastatingly as possible.
Moskowitz literally rewired his brain to plow off a raging, out-of-command pain response.
He was engaged in a relentless battle to reconstruct how his encephalon was functioning – and so he practiced assiduously – and recognized it would accept fourth dimension to "unlearn" that process. Every time he experienced hurting, he fought back with the visual indicate of the hurting map in his encephalon shrinking.
Moskowitz's dedication made the difference. Information technology took him three weeks of exercise to detect a "very small" decrease in his hurting levels. After a month, his pain reduction visualization process had become so automatic that he never let a hurting spike get by without attacking it.
By six weeks, the referred pain that had crept from his original injury in his cervix to the middle of his dorsum had disappeared. Four months later, pain in his cervix began to close downwards. Within a year, the neck pain that had bothered him for thirteen years was totally gone. Moskowitz had effectively rewired his brain then that he no longer felt pain that area.
The Gist
Afterward an blow, Dr. Michael Moskowitz, a hurting medico, tried and failed to treat his pain – which widened and grew worse and worse over time.
As is mutual in a state of chronic pain, Moskowitz's brain, over time, devoted more and more than of its resources to assessing and paying attention to his hurting. This process not only increases pain levels merely, by taking resources away from other areas of the brain, it can impact i's mood, ability, cognition, movement, etc.
Applying neuroplasticity findings to hurting, Moskowitz created a visual based approach designed to tone down his brain'due south response to pain.
He used the process of "competitive plasticity" to consciously tell the pain-producing parts of the brain to disengage.
His arroyo required a relentless and disciplined approach but somewhen he was able to rewire his encephalon and completely turn off what had been a raging and out-of-control pain response. After xiii years, he became completely pain-free.
Moskowitz used the same approach with a nurse – with a back injury so severe surgeons were unwilling to operate on her. Despite being in severe pain for over a decade, and despite still having a serious dorsum injury, the nurse was able to turn off her pain response as well and now leads a normal life.
Moskowitz's is just one of many approaches which are using the innate neuroplasticity of the encephalon to treat disease.
Moskowitz and so took a greater challenge. Jan was a cardiac care nurse when a 280 pound women collapsed on her, damaging all five of the lower discs in her spine. Told she would probably need to have a five disc spinal fusion at some point, she turned to physiotherapy and heavy-duty painkillers. Several years later, she was told her back had deteriorated so much that surgery was no longer an option.
She was declared disabled. In constant pain no affair how many painkillers she took, she became depressed and suicidal. X years after her accident, she was taking huge doses of morphine and spent entire days in her Jacuzzi. The slightest move could trigger unbearable amounts of hurting.
It was all she could exercise to make it to Moskowitz'due south office. He'd been treating her for five years without much success when he developed his pain visualization process.
Moskowitz introduced Jan to his new approach by having her first read Norman Doidge'due south first book, "The Encephalon That Changes Itself". Then he had her visualize her pain brain maps shrinking. She besides visualized the hurting signals coming up from her lower dorsum into her brain, and and then having the brain non react.
Moskowitz told her to look at the brain maps 7 times a solar day, but Jan, locked into her massage chair at home, looked at them constantly. Past the third week, she was kickoff to have a couple of minutes a day without pain. Past the 4th week, she was hurting costless for as long as half an hour – the showtime time that it happened in over 10 years.
Past the time Doidge talked to her a twelvemonth and a half later, this woman, with intractable spinal injuries and so astringent that surgery was non an option, was completely out of pain. She told him that she felt that she had been asleep for a decade, and at present all she wanted to practice was to stay upwards for 24 hours a day and catch up.
Neuroplasticity
Doidge institute the process Moskowitz was applying no unlike than those he had seen working in the victims of stroke, physical trauma or other conditions. The gains are tentative at showtime, just if the exercise is aggressively practical they build over time. Doidge even compares learning to reprogram the brain to learning a musical instrument – or more than aptly, maybe, learning a new language. The practice is most hard at beginning but gets easier over fourth dimension.
Moskowitz's patients' pattern of change is also consistent with what nosotros run into when the brain learns a new skill, like playing a musical instrument or learning a language. The time frame is typical of what I have seen in significant neuroplastic alter: the change occurred over weeks (ofttimes six to eight weeks) and required daily mental practice. Information technology'due south hard work. Doidge
Eventually, though, Moskowitz's technique changed the programming of Jan's brain'southward so completely that it learned to disregard the pain signals emanating from her injured back without her thinking about information technology.
(Moskowitz) thinks that once they take learned and practiced the technique over hundreds of hours their unconscious mind takes over the job of blocking pain by using competitive plasticity" Doidge
This is where the lines nosotros like to draw between the brain, the mind and the body become blurred. Moskowitz's and Jan's brains, though no fault of their ain, had become broken. For whatever reason, the normal response to injury – which should effect in the pain signaling lessening – failed to kick in. Instead, no matter what treatments either tried – and both had access to all of them – their hurting levels increased and increased.
Note that Jan was an RN and Moskowitz was a highly trained professional working in the pain field. After trying everything under the sunday, what finally worked for them was a visualization exercise aimed at the brain – a procedure that virtually of us would probably scoff at. Notwithstanding that process was powerful to enable a adult female whose back was too damaged for a surgeon to operate on her to live without pain.
It was all done through "behavioral therapy" – a conscious manipulation of the brain to modify an unconscious brain programming. We program the brain all the time. Learning how to drive a car requires a conscious effort which ends up being an automatic, learned beliefs. Why not use the same process to program the brain to respond to internal stimuli – pain signals – differently?
"Information technology is a fact that encephalon and body reliably turn conscious try into unconscious effort to unconscious action that allows united states to movement from learning to mastery, returning the disease of persistent hurting to the fleeting symptom of acute pain." Doidge
It should exist noted that not everyone has had such a dramatic response. Moskowitz believes that the willingness to appoint in the practice – to once again, again and again visually beat back downwards those pain sensations – has something to practise with that. He's working with Dr. Maria Gilt to beat them down in another manner, though, by using pleasurable sensations to take hold of the encephalon's attention and wrench it out of its pain pathways.
You can find Dr. Moskowitz and his colleague, Dr. Marla Golden, at www.neuroplastix.com which, amidst other things, includes therapeutic brain animations which can be used to turn down pain levels, the doctors talking about their treatment approaches, and "The Neuroplastic Transformation Workbook" for those who want to try their techniques.
Moskowitz's program is just one case of many that have been developed to employ neuroplasticity to reduce pain and other symptoms.
Annie Hopper'southward Dynamic Neural Retraining System
Annie Hopper, for instance, is using neuroplasticity in a dissimilar way in her Dynamic Neural Retraining Organisation (DNRS) program to attempt to heal what she believes is a cleaved brain in MCS, FM and ME/CFS. She pins the blame on damaged sensory processing which results in inflammation, fatigue, pain, etc. and attempts to rewire the limbic arrangement and reduce an over-active stress response using unlike methods from Moskowitz's.
I started the six-month program this week. Five months with an unrelenting "cold" which has non responded to antivirals, supplements, etc. gave me an extra incentive to effort something new. Hopper, similar Moskowitz, emphasizes the need for repetition and practice, practice, practice.
- Coming up – a DNRS ME/CFS success story from a medical professional. This person is not over ME/CFS, but over time, she has seen substantial improvement
Back up Wellness Rise
Source: https://www.healthrising.org/blog/2019/08/03/rewiring-the-brain-to-get-out-of-pain-the-moskowitz-approach/
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