Pain in the Brain


If you are alive, you have experienced pain. Each individual experiences and processes pain differently. A person’s response to pain is a result of biological, psychological and social factors which ultimately determine one’s ability to effectively manage pain and restore function. Health care professionals and patients alike strive to control pain levels and achieve the highest level of pain free function. Pain is a protective response by the body to prevent further trauma or injury (picture pulling your hand off of the proverbial hot stove top).

To effectively manage pain requires a basic understanding of pain mechanisms in the body. This includes neurophysiology of pain and pain processing. Historically, it was believed that the brain was not capable of change. That it was hardwired and once damaged, it was extremely difficult or impossible to fix. Emerging evidence continues to demonstrate that this belief is not true and that the brain is indeed capable of change or “rewiring”. This is referred to as “neuroplasticity”.   These changes in the brain can be adaptive or maladaptive. Areas of the brain normally devoted to specific body parts or functions may begin to overlap after an injury or trauma. The sensory cortex, may become too sensitive to move and the motor cortex may have more difficulty to isolate and move a specific body part. There is emerging evidence that injury to peripheral nerve tissue causes functional and structural changes in the brain. Understanding this interplay will assist both healthcare providers and patients in achieving satisfactory outcomes and maximizing function. As we begin to better understand the interplay between the peripheral and central nervous systems, we may improve patient motor and sensory outcomes following injury.

Graded motor imagery (GMI) has been shown to be an effective technique in rewiring the brain. It has been utilized for a variety of conditions including enhancing recovery from chronic pain conditions and improving professional athlete’s performance skills. It includes the use of normal sensory input to over-come altered motor control or dysfunctional movement patterns. Emphasis is on non-painful movement, sequentially activating the cortical motor network for improved cortical organization. The three major components to a GMI program are laterality training, visual motor imagery and mirror therapy.  Laterality training or reconstruction involves restoration of the brain’s concept of left and right. This may involve the use of laterality cards and visualizing your hand in that position. Visual and Motor Imagery involves visualizing a specific body part in certain positions, progressing that visualization to actual movement by that body part. The brain is working really hard here without the affected body part actually moving. With Mirror Therapy, the brain is tricked into thinking that the affected body part is able to move better than the brain thinks it can. The mirror box “hides” the affected body part and uses the unaffected part to trick the brain.

In summary, it is helpful to remember that the brain is capable of change. Imagine your brain as a dynamic connected power grid with pathways and roads lighting up every time you think, feel or do something. Some of the roads are well traveled, these are our habits. Every time you have a thought, feel an emotion or perform a task this road lights up. It becomes easy for our brain to travel this pathway. When we think differently, learn a new task or choose a different emotion, our brain carves out a new road. The more this new road is used by the brain, the old pathway is used less and less and weakens. This new way of thinking, feeling or doing becomes second nature. This process of rewiring your brain by forming new connections and weakening old ones is neuroplasticity. We are all capable of rewiring our brain with repeated and directed attention to desired change.

*Goswami R, Anastasia DJ, Katz J, Davis KD. A longitudinal study of pain, personality, and brain plasticity following peripheral nerve injury. Pain,2016;157:729-739