Monday, March 28, 2016

Why do I Hurt…I didn’t do Anything!

The Problem Stated

Ever since my first year in practice I have had people come into my office with the same complaint.  Their pain has returned.  They want to know why.  That is never a bad question.  It happens in every profession.  If the Chiropractor moves a bone and gets pressure off of a nerve and the pain comes back – what’s wrong?  When the Physical Therapist prescribes an exercise regimen which is followed in exquisite detail and the strength increase is documented – why does the pain come back?

In my case – when the Massage Therapist calms my nervous system and my pain goes away – why does it return?  More emphatically – Why does it return when I did nothing wrong and everything I was supposed to do!

Understanding the Problem

The easiest thing to do in cases like this is to find a way to blame the patient.  They must have done something wrong.  I remember in my early years as a therapist that I often resorted to this method.  My work was good.  You were fine when you left me.  You must have done something wrong.

Of course, I did not phrase it that way.  It would not have sounded kind and people would not have returned.  I learned about something President Kennedy’s doctor, Janet Travell, had written of.  She described what she called Perpetuating Factors in this article[i].

I have gotten a lot of mileage from what she taught me.  I learned to look at many other aspects of a person’s health that when dealt with appeared to help many of my clients.  Yet, there were a few things that I was missing.  I would like to discuss one of them here.  It is called a Neurotag.

A few months ago I walked into my local mall.  I knew where I was without looking.  I could smell the cinnamon rolls.  I could see them on my mother’s table.  I could taste them.  Yet, I was in the mall walking by Cinnabon™!

What happened?  I activated a neurotag.  Let me explain.  When something happens to us various aspects of it are recorded in different parts of our brain.  We have visual, auditory, and other memories that get stored all over our brain.  As we repeat things these parts of the brain begin to all fire at the same time.  Hebb’s Law, as summarized by Siegrid Löwel, states, "neurons wire together if they fire together."[ii]  When this happens a neurotag is formed.  

 In the future various parts of the brain will fire in other situations.  The more of these separate areas fire at the same time the more likely it is that the memory formed by that neurotag will manifest itself.  This is why I got transported back to my mother’s kitchen table while walking through the mall.

This is not limited to people.  Consider this story.  The Denver Zoo received a Polar Bear but the bear habitat was not yet ready.  That was not too big of a problem.  The bear could walk 4 steps in either direction in the cage he had been delivered in.  The project would be completed quickly.

Or - perhaps someone’s idea of quickly would not agree with the Bear’s it would not be quick at all.  The bear remained trapped in that cage for 3 years before the habitat was complete!  After the 3 years there was a real concern as to what the bear might do when released.  He was darted with A tranquilizer and the cage was removed.  All eyes were on the massive bear as he awoke.  He got up and guess what?  He walked 4 steps in either direction.  His brain was now wired that way.[iii]

As Christians – we often find ourselves in a similar situation.  Our life has been radically transformed by God’s grace.  We desire to do what is good.  Yet we keep falling back into the same old sin.  We are wired that way.

Examples of this abound.  We see it in others but we see it most often in ourselves.  We desire to know God better.  We have our devotions.  We go to church.  We cry out for deliverance from our sin.  Yet, we still choose to be our own idol and choose to serve ourselves instead of Christ.  We have the tools of renewing our minds (Romans 12:1-2) and putting off old behaviors and clothing ourselves with new ones (Ephesians 4 describes this).  Apart from the work of God’s Spirit it is literally impossible to do this.

Dealing with the Problem

In pain it is much easier, though often incredibly difficult, to deal with our issue.  This is because of the difference between sin and pain.  Our brain seems pretty much hard wired with use - but it can change!  It changes by paying attention to and working with the neuromatrix model of pain.  

We have 3 major sources of input to our brain. These are our:

·       Thoughts/Beliefs
·       Sensory Input
·       Emotions/Affections
It is by working with these that we can often change our own neurotags.  Here is an example.

Dale had been injured about 30 years before in a hit and run accident while riding a bicycle.  He experienced a good deal of pain in the area of his shoulder and torso that had made contact with the asphalt.  His history of pain detailed multiple treatments over the course of time but the pain was still a daily experience.

Changing Thoughts/Beliefs

He learned that the stages of healing for soft tissue were pretty complete after a couple of months with the entire healing of scar tissue complete in about a year.  That was a major change in thought.  He had been constantly thinking about scar tissue, adhesions, and trigger points and knew all about such things.  He explained what was wrong with his posture.  Now he realized that his pain had much more to do with neurotags and nerve irritation as opposed to some deep seated pathology.  He continued to read in this area and changed how he thought.  He effectively dealt with the first mentioned aspect of input into his neuromatrix – his Thoughts/Beliefs.  It took work to change his thinking.

Handling and Manipulating Sensory Input

The second input into the neuromatrix that he dealt with was his Sensory Input.  Rather than just passively receiving the input of his senses and the interpretation of his brain that something was “wrong” he began to use his sensory cues to change and adapt his behavior and to explore movement.  His senses became his partner in pain relief instead of their former more adversarial role.
I instructed him in some slow gentle non-threatening movements that he could do as he paid close attention to his sensations.  The very act of focusing on the movement acted as a distraction and showed his brain that non-painful movement was indeed possible and that it could even be enjoyed.  Many of these are described in the book Relaxercise.  I highly recommend it.

Now that he knew that his tissues did not have hidden danger in them, Dale began to explore movement on his own.  He desensitized the irritated nerves and retrained his brain by moving just before the point where he felt pain.  He continually explored this area until it was no longer a threat and was able to develop to the point where the movement was no longer painful.  Cory Blickenstaff PT refers to this as Edgework.  His YouTube page is worthy of your exploration.

Perhaps the most freeing work that Dale performed was realizing that his habit of fidgeting and squirming was actually healthy.  He was looking for positions of comfort that got pressure off of his nerves and allowed the free flow of blood that they needed.  This kept them from sending danger signals to his brain.  The brains response is to not be threatened and not send pain because Dale had learned to handle it preemptively.  This type of movement is inherent to our life and is self-corrective.  It is called Ideomotor movement and has been developed as an approach by Barrett Dorko PT.  He had been avoiding such movement in many cases because he was afraid of looking strange in front of other people.  He got over that!

Dealing with the Emotional/Affective Contributors to Pain
The third thing Dale had to deal with was his fear.  There was the fear of something sinister lurking in his tissues.  There was the fear that certain movements would be painful.  There was the fear that certain positions had to always be avoided.  There was fear because he had seen other people with traumatic injuries that had been in pain for many years.  He had seen their suffering.  He had seen the suffering of people he loved.  Dale was pretty much characterized by fear. 

In Dale’s case the fear was able to be overcome by focusing on what he now knew to be true.  There was nothing scary lurking in his tissues.  They had healed a long time ago.  He now had tools to use and a reasonable expectation that they would work. He had irritated nerves and neurotags in his brain.  He knew they could be dealt with.   The fear was replaced with confidence and he was no longer paralyzed by freeze, fight or flight.”  This input from the first 2 sections of his neuromatrix helped to change the third.
Neurotags are a very good explanation of why we complain of pain when we “have done nothing wrong.”  There are sometimes other contributors but this one is incredibly frequent and rarely discussed.  Neurotags can be changed.  That is the message and now you have the information to help you to deal with yours!

[i] Chronic myofascial pain syndromes: Mysteries of the history. In: ADVANCES IN PAIN
RESEARCH AND THERAPY, Fricton, J.R. and Awad, E.A., Editors, Volume 17, Raven Press, New York, Chapter 6, 1990, pp. 129 – 137.
[ii] Siegrid Löwel, Göttingen University; Löwel, S. and Singer, W. (1992) Science 255 (published January 10, 1992) "Selection of Intrinsic Horizontal Connections in the Visual Cortex by Correlated Neuronal Activity". United States: American Association for the Advancement of Science. pp. 209–212. ISSN 0036-8075

[iii] This story was recorded slightly differently in 2 places:  Lift Up Your Eyes By Clyde E. Nichols and Hypnosis and Treating Depression: Applications in Clinical Practice edited by Michael D. Yapko