We believe that the body generates pain from injuries or maladies, and that the brain passively receives the signals and we try to cope with it. We also see the brain as a fixed, well-defined entity. However, the truth is that the pain system is spread through the brain and spinal cord and far from being a passive recipient of the pain, the brain always controls the pain signals we feel and plastically changes itself creating pain from non-existent locations.
The British admiral, Lord Nelson, lost an arm in a sea battle. Still, Nelson felt the arm's presence and concluded that it was "direct evidence for the existence of the soul" - if an arm can exist w/o being there, he reasoned, so could a "soul" after death.
There were many amputations during the US's Civil War as it occurred before antibiotics manifested, and removal was the only medical treatment available for serious injuries. A surgeon coined the term "phantom limb" at Gettysburg.
As battlefield care has improved, many folk who previously would not have survived are returning home with amputated limbs, with "phantom pain" for 95% of them for the rest of their lives. (P. Wall, Pain, 1999)
Phantom pain also occurs when organs are removed. Women suffer menstrual cramps and labor pains from uteruses that are no longer there (Dorpat, 1971). Men feel ulcer pain after it and its nerves are removed (H. Gloyne, 1954). Rectal pain is experienced after removal (Ovesen, P. et al. Pain, 1991). A painful need to urinate manifests after bladders are removed. (Wall, 1999)
These injuries also change our pain networks/brain maps, resulting in the sensations of missing limbs waving to friends, reaching for objects, and gesturing while talking.
This got the attention of V.S. Ramachandran, an M.D. neurologist w/a Ph.D. in psychology from Cambridge.
Ramachandran's patient, "Tom" (Ramachandran, et al. Science, 1992) , had a chronic annoying itch in a severed arm, which obviously couldn't be scratched. Amazingly, Ramachandran discovered that when Tom scratched his cheek, the itch was scratched and relieved.
As Tom's brain maps were measured w/a magnetoencephalograph, his map for the severed hand was now processing facial sensations - the hand and face maps had been blurred together neuroplastically. Another team demonstrated that the intensity of phantom pain is directly related to the extent of merging of brain maps.
Ramachandran believes that map "invasion" occurs by the release of nerve growth factors from the unused map of the severed limb, which invites nearby maps to send out neural sprouts to the limb map.
This can cause "cross-wiring" errors, with unpredictable results, such as touch causing pain in a phantom arm, or orgasms from genitals arising in adjacent phantom hands and feet.
Ramachandran, like Merzenich in the blogpost "How the brain continually changes and reorganizes itself", demonstrated that brain maps are constantly changing. This occurs w/disorganized and shrunken phantom maps as their input has been so radically changed.
Phantom pain also arises where the original agony was "frozen in time" by an explosion or other traumatic event. Soldiers whose grenades blew up in their hands endlessly repeat the excruciating pain of the incident.
Painful "frozen arms" arise when arms are in slings or casts for months before the amputation as their brain maps "locked in" the position of the arm. Afterwards, w/no indication of arm response or sensory input, the brain keeps signaling the arm to "Move! Move! Move!" causing excruciating pain.
Ramachandran had the insight to fight illusion with illusion and designed his "mirror box" to fool the patient's brain as shown in this BBC video. In a mirror box the patient places the good limb into one
side, and the damaged limb into the other.
The patient sees the good limb and makes "mirror symmetric" movements, as a symphony conductor might. Seeing the reflected image of the good hand moving, it appears as if the missing limb is moving, hopefully tricking the brain.
This visual illusion can make it possible for the brain to "move" the phantom limb from painful positions. Half of the "phantom limb" patients lost their pain. (Ramachandran, et al., Proc. Royal Soc. B, 1996)
This approach has also been used w/some success w/stroke victims where a limb is no longer mobile. The mirror box remains controversial, but it works well in some situations.
The traditional belief was that pain sensors send a one-way signal to the brain and pain is perceived at levels corresponding to the seriousness of the injury. However, the "most important article in the history of pain" by Ronald Melzack and Patrick David Wall in "Pain mechanisms: A New Theory" in Science defined a pain system spread throughout the brain and spinal cord. This system is an active recipient of the pain, as the brain controls the pain signals we feel with several gates between the injury and the brain.
This "gate control" determines if/when pain messages pass through these gates based on their importance, which explains many surprising pain experiences. When U.S. troops landed in Italy in WW II, 70% of those seriously wounded reported no pain. (P. Wall).
This is a frequent report of wounded folk on the battlefield who continue fighting w/o pain. When my hand was mangled in a garage door opener, there was no pain and other functions responded immediately.
This is an evolutionarily-critical system. If our ancestors always curled up, writhing in pain, after being attacked on the African veldt, we wouldn't be here. Their brains learned to have the pain manifest later.
The placebo effect (Blogpost "Placebos...how and when they work...new studies/science") occurs when patients who expect to get pain relief from a pill (w/o active ingredients) have less pain. fMRI brain scans show that during the placebo effect, the brain dials down its pain-responsive regions. (Wager, et al., Science, 2004).
The pain we experience is also affected by current mood, past pain experiences, psychology, and how serious we think our injury is.
Wall and Melzack showed that pain maps in the spinal cord can change following injury, resulting in a neuroplastic alteration that makes a person hypersensitive to pain.
Maps also enlarge their receptive field which increases pain levels, and spill over into adjacent maps resulting in "referred pain", where we feel pain in another part of the body.
Gate control has led to new treatments based on pain blocking. Wall co-invented Transcutaneous Electrical Nerve Stimulation, or TENS, which uses electric current to stimulate pain-inhibiting neurons to close the gates. i had TENS treatments in PT after shoulder surgery.
The gate theory also makes Western scientists less skeptical of acupuncture, which may also be turning on pain-inhibiting neurons to close gates and block pain perception.
So, the brain can generate pain from imagined sources in confusing ways as it neuroplastically changes to make the best use it can of its available real estate. It has also evolved to manage pain levels to ensure our survival in difficult circumstances. The amazing, changing, brain...
 |
| Lord Nelson |
The British admiral, Lord Nelson, lost an arm in a sea battle. Still, Nelson felt the arm's presence and concluded that it was "direct evidence for the existence of the soul" - if an arm can exist w/o being there, he reasoned, so could a "soul" after death.
There were many amputations during the US's Civil War as it occurred before antibiotics manifested, and removal was the only medical treatment available for serious injuries. A surgeon coined the term "phantom limb" at Gettysburg.
As battlefield care has improved, many folk who previously would not have survived are returning home with amputated limbs, with "phantom pain" for 95% of them for the rest of their lives. (P. Wall, Pain, 1999)
Phantom pain also occurs when organs are removed. Women suffer menstrual cramps and labor pains from uteruses that are no longer there (Dorpat, 1971). Men feel ulcer pain after it and its nerves are removed (H. Gloyne, 1954). Rectal pain is experienced after removal (Ovesen, P. et al. Pain, 1991). A painful need to urinate manifests after bladders are removed. (Wall, 1999)
These injuries also change our pain networks/brain maps, resulting in the sensations of missing limbs waving to friends, reaching for objects, and gesturing while talking.
 |
| V.S. Ramachandran UC San Diego |
This got the attention of V.S. Ramachandran, an M.D. neurologist w/a Ph.D. in psychology from Cambridge.
Ramachandran's patient, "Tom" (Ramachandran, et al. Science, 1992) , had a chronic annoying itch in a severed arm, which obviously couldn't be scratched. Amazingly, Ramachandran discovered that when Tom scratched his cheek, the itch was scratched and relieved.
As Tom's brain maps were measured w/a magnetoencephalograph, his map for the severed hand was now processing facial sensations - the hand and face maps had been blurred together neuroplastically. Another team demonstrated that the intensity of phantom pain is directly related to the extent of merging of brain maps.
 |
Noigroup Publications
© Copyright 2013
Explain Pain 2nd Ed. (2013),
David S. Butler & Lorimer Moseley
|
This can cause "cross-wiring" errors, with unpredictable results, such as touch causing pain in a phantom arm, or orgasms from genitals arising in adjacent phantom hands and feet.
Ramachandran, like Merzenich in the blogpost "How the brain continually changes and reorganizes itself", demonstrated that brain maps are constantly changing. This occurs w/disorganized and shrunken phantom maps as their input has been so radically changed.
Phantom pain also arises where the original agony was "frozen in time" by an explosion or other traumatic event. Soldiers whose grenades blew up in their hands endlessly repeat the excruciating pain of the incident.
Painful "frozen arms" arise when arms are in slings or casts for months before the amputation as their brain maps "locked in" the position of the arm. Afterwards, w/no indication of arm response or sensory input, the brain keeps signaling the arm to "Move! Move! Move!" causing excruciating pain.
 |
| Mirror box |
The patient sees the good limb and makes "mirror symmetric" movements, as a symphony conductor might. Seeing the reflected image of the good hand moving, it appears as if the missing limb is moving, hopefully tricking the brain.
This visual illusion can make it possible for the brain to "move" the phantom limb from painful positions. Half of the "phantom limb" patients lost their pain. (Ramachandran, et al., Proc. Royal Soc. B, 1996)
This approach has also been used w/some success w/stroke victims where a limb is no longer mobile. The mirror box remains controversial, but it works well in some situations.
The traditional belief was that pain sensors send a one-way signal to the brain and pain is perceived at levels corresponding to the seriousness of the injury. However, the "most important article in the history of pain" by Ronald Melzack and Patrick David Wall in "Pain mechanisms: A New Theory" in Science defined a pain system spread throughout the brain and spinal cord. This system is an active recipient of the pain, as the brain controls the pain signals we feel with several gates between the injury and the brain.
 |
| Ronald Melzack McGill University |
This is a frequent report of wounded folk on the battlefield who continue fighting w/o pain. When my hand was mangled in a garage door opener, there was no pain and other functions responded immediately.
This is an evolutionarily-critical system. If our ancestors always curled up, writhing in pain, after being attacked on the African veldt, we wouldn't be here. Their brains learned to have the pain manifest later.
 |
| The late Patrick David Wall Oxford, Yale, Harvard, MIT World's leading pain expert |
The pain we experience is also affected by current mood, past pain experiences, psychology, and how serious we think our injury is.
Wall and Melzack showed that pain maps in the spinal cord can change following injury, resulting in a neuroplastic alteration that makes a person hypersensitive to pain.
Maps also enlarge their receptive field which increases pain levels, and spill over into adjacent maps resulting in "referred pain", where we feel pain in another part of the body.
 |
| TENS rig |
Gate control has led to new treatments based on pain blocking. Wall co-invented Transcutaneous Electrical Nerve Stimulation, or TENS, which uses electric current to stimulate pain-inhibiting neurons to close the gates. i had TENS treatments in PT after shoulder surgery.
The gate theory also makes Western scientists less skeptical of acupuncture, which may also be turning on pain-inhibiting neurons to close gates and block pain perception.
So, the brain can generate pain from imagined sources in confusing ways as it neuroplastically changes to make the best use it can of its available real estate. It has also evolved to manage pain levels to ensure our survival in difficult circumstances. The amazing, changing, brain...
"The brain controls the pain signals we feel with several gates between the injury and the brain"
ReplyDeleteGary, could you describe how you handle pain? Do you have more control over these gates now than you did when blah-blah was still in existence?
Hi Bob,
DeleteAs far as how do "i" handle pain, i really don't, as there isn't anyone here to "do" that. Without a self-referential internal narrative to turn pain into suffering with lots of stories, projections and fears, there is just the "pure" pain which the brain handles with its gates "all by itself".
This body-mind has always had a fairly high threshold for pain but there's no way to do a meaningful comparison from over 15 years ago as to how it might have changed w/different injuries. Recent shoulder surgery resulted in surgeon giving me many days of percoset on my prescription, but only one day was used, whatever that means.
The most important thing about "dealing with pain" is to just move into and open "into it", and ask "Who/what feels this pain?" Watch for fears arising that create stories, which will generate deep concern, project bad outcomes and generate suffering, which is the big problem.
Try to be fully present w/the fears and see if you can feel their stories, and then do the Byron Katie and Sedona methods to let go of them. The blogpost "Surrendering the 'I', letting go of suffering" describes these powerful approaches in detail.
Trust this is useful.
stillness, love and surrender
gary
Dr. John Sarno has written some interesting books on a similar subject:
ReplyDeletehttp://en.wikipedia.org/wiki/Tension_myositis_syndrome
Hi David, i don't post comments with links in them, which is what youTube does as well, so this is an exception, primarily because i included so much on TENS and the mirror box.
DeleteThese treatments are controversial, as is TMS, as folk can see from the Wikipedia articles there is not a 100% success rate. i would urge folk looking at any of these protocols to be aware of that.
stillness
gary
Pain is a really important subject. My wife has had chronic pain for 30 years and in that time I have known many people in the same condition and done the dance through modern medicine. In some ways pain seems like the perfect expression of the "I" . It is a vivid and direct experience, self referential, self contained, complete and effectively filters the external world. And pain comes with its defense mechanisms. The pain is experienced intensely as "my" pain. In a twisted way the "I" can appear to continue pain, as the experience proves that "I" exist.
ReplyDeleteI hasten to add that I am not saying that pain is all in a person head or that the body doesn't get its mechanisms mixed up - it clearly does. And I'm not living with my feet in the fire either. But self enquiry can be a valuable way to explore pain - its just very difficult to do when a person is in an acute pain situation.
Hi Mike,
Deletei recognize that it may be difficult to do self-inquiry with chronic pain, but often the surrender techniques are more useful for folk suffering like your wife. They are described in the blogpost "Surrendering the 'I', letting go of suffering".
The Sedona Technique is simple, quick and easy to remember and can be very effective. The Byron Katie approach is also useful but it may be harder to engage in chronic acute pain. They are both critical tools for anyone on the path, and they may be the most effective way to deal with the suffering brought on by your wife's pain.
Best to your wife, and you,
stillness
gary
Thank you. Both are proving useful - to both of us :)
DeleteAs an acupuncturist, I find the Gate Theory fascinating. It makes modern-medical sense of the mysteries behind this pre-scientific practice, and explains a lot of what I encounter in my clinic.
ReplyDeleteAs a spiritual practitioner, any evidence of brain plasticity makes me hopeful. I sometimes feel as if my brain is getting increasingly stiff and solid, stuck in it's old habits and patterns, returning continuously to the same thoughts and fears and fantasies... But i definitely find that diligent meditation and inquiry practices subtly change the ways my brain functions. It's not always easy to understand or explain exactly what shifts; it sometimes feels like my practice dumbs me down and makes me forgetful and emotional. I just trust the process and let it happen naturally.
Thanks for a great post, Gary!
Shaul
Hi Shaul. Yes, the gate theory does give a good scientific background for why/how acupuncture might work. The research on brain plasticity has surprised many medical and scientific folk who only a short time ago believed that the brain was a fixed entity.
DeleteA recent research result on the facial brain maps of monkeys has shown that the brain map changes from week to week. Other recent work has shown that the "edges" of the brain maps for specific functions or regions are basically "in play" for adjacent maps so the boundaries are continually moving as we undertake new activities or skills, or abandon old ones.
The shifting that we all feel as we do meditation, particularly self-inquiry, is old neural networks being deconstructed and new ones being formed. The pattern of "progress, consolidation, progress, consolidation..." is how the brain operates. Tear down an old building, haul away the debris, build a new one, haul away the debris, build a better building, haul away the debris, etc.
It is a process that is continually in operation as the "plastic" brain continues to optimize and "re-purpose" its available real estate.
Great that you are finding the work useful.
stillness
ReplyDeleteGary: I'm so appreciative of this post and the many others here on your blog. I've spent way too much time over the years with Tolle's "Pain-Body" and Sarno's TMS concepts/models. And I don't have so-called Chronic Pain - for "me" now it's just discomfort and at times intense (just an experience "for now" I say). What helped the most up until more daily self-inquiry practice was witnessing/listening to the repetitive story I was telling my wife as well as myself. It was easy to drop the story I told others - feels like it took years to stop the self-narrative. The suffering only came through the chronic story-telling which feeds the symptoms. Now there is just a sensation- sometimes intense- although "I" can still hear/feel the tendency at the edge wanting to re-engage in the "I'm so tired of these symptoms! Who or what teaching has the solution?" recording. "I" now say, "who or what and where is this I?"
I now coach others to orient similarly to their pain - at times with great success. It always amazes me how tenaciously some folks hold onto their stories. Why do they do that when I guarantee that their suffering will be less by engaging in a daily practice? What part of the "I" wants to keep struggling, fighting and suffering? Is it just cultural conditioning only? Is it fear of "ego death" a lost story of all that is familiar? Your thoughts on this are appreciated.
Cheers to HappinessBeyondThought.
"The Body and the Mind are interconnected and are interdependent. The body expresses the thoughts of the mind. Constantly thinking crooked thoughts will create a crooked body. If you have a happy mind, your face and body will reflect that happiness. Everyone will know something beautiful is happening within you."
-Swami Satchidananda
Hi Michael,
DeleteThe blogpost "How the changing brain turns our pleasures into addictions..." discusses in some detail how the ego/I is our greatest addiction and how the process of deconstructing it is equivalent to "withdrawal" and is accompanied by "grieving" just as if we were losing a loved one, which are doing.
The neural network that has encoded the ego/I/me/my/mine "program" is large and the billions of neuronal connections that make it up are strongly glued together. As the brain deconstructs this program and its connections, it does it by a process of "tear down, clean up/haul away, rebuild new networks".
As our understanding progresses as we work our way down the path, there is more modification to be made to the networks and the process continues.
It will appear to be uneven, and its pace will vary as the networks are complex and interconnected. It only appears uneven from our "conscious" standpoint as we can't see or know what is happening, thankfully. From the brain's standpoint, it is likely more continuous and is proceeding "just fine, thank you".
The fear of "ego death" is just that. Our most beloved addiction/illusion is falling away and is being hauled away. That is why there is so much temporary suffering. It will be much better afterwards with the new and improved networks, but it can be a painful process.
Trust this is useful.
stillness
gary
Useful post there Gary, thx. I can relate to the grieving and withdrawal bit. Egodeath. I guess people go through it in varying degrees. Some ppl the entire thing is deconstructed while others a part. Was this also why your friend John Galligar posted something like last year was a lot of happenings, now coming to rest in the true self?
DeleteChrisd
Hi Chrisd,
DeleteIf the ego/I is going to be completely deconstructed, it can take place over a long period w/less traumatic happenings and smaller individual events, or it can happen more abruptly in a shorter period with larger events and more trauma.
It is also important to remember than many/most folk are not willing to let go of all of their attachments, so they stop with only a partial deconstruction of the ego/I. It is, as the blogpost "The process of nondual awakening...a new model...fear vs desire" pointed out, the "battle" between our fear of letting go of our attachments vs our desire for awakening. The "last ones" are the hardest and they make the most difference.
stillness
Hi Gary,
DeleteI'd hope I'm with the last attachments here coming months. Much of the suffering daily is met with an "arg" reaction, trying to get it out (nonvoluntarily as it's seen as something that's just not supposed to be there). Some original design of this body to transform it I guess. I tried your techniques but just letting the args happen appears better for me. thx for the encouragements and articles.
Chrisd
Hi Chrisd,
DeleteSome of the attachments, deeply buried old fears and stories, will not go away, IME, unless you move into them w/o "trying to get it out". Just feel into them as you have and experience deeply that its "something that's just not supposed to be there". It is something in consciousness that is clearly not helpful, not whole, not resolved. Move as deeply as you can into it and see if there is anything there that is real, or does it just disappear "arg" all by itself, being seen for what it is.
stillness
Hi Gary,
DeleteThx for the advice. I think my brain on auto-pilot with some small adjustments here and there myself is sufficient now though, following what comes natural. New methods appear to interrupt more than help. I'll just go with args for the time being. If that's no longer sufficient I'm sure a method will appear out of someplace :p
Best,
Chrisd
Hi Chrisd,
DeleteBe watchful for who/what/where it is that is telling you that "small adjustments here and there myself is sufficient now though", and "New methods appear to interrupt more than help".
The ego/I is a crafty adversary and does not want this process to move forward. It routinely develops all sorts of "reasons", some very clever and subtle, to derail the process. Just be watchful to see if there is any progress, or if perhaps nothing really is happening.
Best
stillness
gary