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What do you anticipate when you are about to go for a 20-minute walk, but struggle with chronic pain in your back, legs, or feet? You probably dread the inevitable ache radiating from your back or the debilitating twinges in your feet. How we visualize physical activity directly impacts how the brain prepares for what we are going to experience. To manage chronic pain, we need to harness our ability to rewire the brain through visualization.
Our thoughts about what is going to happen as we move, sit, stand, bend, walk, or reach prepare our brains and bodies for what is to come. We are not just thinking that walking might be painful—we are rehearsing for a painful walk. This is why, before you even reach the stairs to go down into the basement, you already feel the pain.
To break this trap of picturing and then experiencing pain, we need to change how we think so as to modify our brain map through visualization.
The Changeable Brain
Scientists are now learning that there is a seamless connection between what is happening in the brain and how brain activity impacts the body. This is also true of the body; the behaviors we engage in, such as physical exercise, change the brain.
Neuroplasticity is a compound word: “Neuro” refers to the brain and “plasticity” means changeable. We are born with 86 billion neurons, and about 15,000 connections will be made over our lifetime between those neurons, which are called synapses. Neurogenesis—growing new neurons—occurs rapidly in childhood but continues throughout our lives. We can increase the number of connections in our brain (synapses) through physical exercise, learning, memorizing, working puzzles, and focusing our attention using activities like meditation.
Neuroplasticity helps explain why acute pain can become chronic pain, and why chronic pain spreads to other areas. When a person has a herniated disc in their lower back pressing on a nerve, two different brain events occur. First, the sensory map in the parietal lobe of the brain becomes active for that area of the back. Secondly, the pain map (located throughout the brain) which produces signals indicating discomfort also becomes active. Once the sensory neurons and the pain neurons in our brain map fire together enough times, they become linked. The saying, “Neurons that fire together, wire together” is a simple way to remember this process.
What happens when the pain map and sensory map are wired together? Once linked, all it takes is thinking about the movement for the pain to occur; the thought activates the pain map because it is now connected to the sensory map. Even when the disc is not pressing on a nerve, by visualizing movement, the pain map will still be triggered to produce a pain signal.
Six Steps Toward Change
Michael Moskowitz, M.D., in an attempt to understand his own chronic pain that spread throughout his body, began looking for the answer with what he already knew about the brain maps for pain and about how neurons wire together and fire together. He developed a guide to help teach chronic pain patients how to rewire their brains. His method encourages patients to visualize a reduction in pain-related brain activity using the acronym, MIRROR (Motivation, Intention, Relentlessness, Reliability, Opportunity, and Restoration).
To use these steps, picture an activity that you often associate with pain. As you visualize the activity, picture your movements as comfortable and effortless, and imagine your pain-related brain activity calming down. One way to do this is to imagine your brain activity changing from the color red to blue. Another method is to imagine the areas of your brain related to pain shrinking in size. Use the following six steps to develop the right perspective on managing pain through visualization:
- Motivation—View your pain as a motivator for action. When pain flares up, use the pain as a reminder to actively engage in the visualization exercise.
- Intention—The purpose of the visualization is not to control or get rid of the pain. The intention of the exercise is to learn how to focus your mind and change brain activity. New pathways are only developed with repetition and hard work over a long period of time.
- Relentlessness—Chronic pain is relentless, and the effort required to rewire the brain must be equally relentless. There is no lasting change that comes with tolerating or distracting yourself from pain. Focused attention and concentration are required for changing brain activity. Every time pain shows up, it needs to be challenged with focused visualization of the brain calming down.
- Reliability—Your brain is not your enemy. The brain is not creating chronic pain to punish you or make your life miserable. For complex reasons, pain can become a stable state for the brain, but it can return to its normal level of threat sensitivity with some help. When you work to bring about change in your brain, have confidence that your brain can change.
- Opportunity—Intense pain is frightening. Fear itself sets off an alarm in the amygdala, the part of our brain that helps prepare for emergencies. We need to view pain and its sudden flare-ups as opportunities to repair our broken alarm system. The alarm, much like a malfunctioning smoke detector, needs to be repaired. Every time you have a surge of pain, it is an opportunity to turn off the fear response that increases the sense that something is wrong. You can help this process by using the calming responses of diaphragmatic breathing (breathing into your belly), the mindful body scan, or progressive muscle relaxation.
- Restoration—The goal of using visualization is not to cover up your pain, but to restore the balance and harmony of the brain to a healthy state. The key principle to follow when addressing your chronic pain is to direct your entire life toward health. As you eat nutritious food, drink water throughout the day, lose weight, stop smoking, practice good sleep hygiene, walk, stretch, perform strength training, do breathing exercises, and relentlessly work on visualizing the reduction of your brain map of pain, you will move toward a healthy, balanced life and away from illness and chronic pain.
If you only want to stop the pain, you might be tempted to look for passive approaches to pain management such as medications, injections, and surgery. The healthcare system often treats chronic pain sufferers as passive recipients of treatment; we are taught to take a pill, get an injection, have surgery, and lie down. Passive coping strategies need to be replaced with active strategies. Use active visualization to help rewire your brain by picturing your life moving toward what is important to you—a good life.
