A study from the University of Colorado at Boulder released on Jan. 12, 2015, reports that the ability to use your thoughts to modulate perceptions of pain utilizes a completely separate brain pathway than the pathway used to send the physical pain signal to your brain. This discovery is a breakthrough.
As an ultra-endurance athlete, I have regularly used a technique called “cognitive self-regulation” to manage my perceptions of pain. Can you think of times in your life when changing your explanatory style and mindset has helped minimize your perceptions of pain?
This new study helps explain how cognitively controlling different pain pathways allowed me to compete in races like the Badwater Ultramarathon, which is a 135-mile run through Death Valley in July; win the Triple Ironman, which is a 7.2-mile swim, 336-mile bike and 78.6-mile run done nonstop; and break a Guinness World Record by running 153.76 miles on a treadmill in 24 hours.
Ultimately, the ultra-endurance athlete who can subject him or herself to the most intense levels of physical suffering and continue moving forward the fastest wins the race.
Throughout the ages, athletes, soldiers in combat, and prisoners of war have intuitively learned how to use cognitve methods like imagery and distraction to alter perceptions of certain types of pain. Anyone who has read or seen Unbroken knows that Louis Zamperini was a master of the cognitive self-regulation of pain.
People with chronic pain can also use cognitive self-regulation as a coping mechanism to manage their pain. Unfortunately, the neuroscience underpinning the ability of our minds to modify perceptions of pain was a mystery until now. This study gives us valuable new clues founded in neuroscience that might lead to more advanced ways to manage and cope with pain.
The January 2015 CU-Boulder study, “Distinct Brain Systems Mediate the Effects of Nociceptive Input and Self-Regulation on Pain,” was published in the journal PLOS Biology.
Choong-Wan Woo, lead author of the study and a doctoral student in CU-Boulder's Department of Psychology and Neuroscience, summed up the study in a press release saying, "We found that there are two different pathways in our brains that contribute to the pain experience.”
The first pain pathway sends signals via nerves about the intensity of painful stimuli to a number of regions in the brain that have typically been associated with pain perception, such as the anterior cingulate cortex.
The second pathway—which was just discovered in this new study—appears to mediate the effects of cognitive regulation on pain perception, and involves increasing activity in the medial prefrontal cortex and nucleus accumbens. These are brain regions that have typically been associated with emotion and motivation but were not typically linked to perceptions of pain in the body.
This second pathway may hold some of the keys to understanding the "emotional" aspects of debilitating pain.
Woo and his colleagues were able to untangle these two distinctive pathways based on recent work done in Wager's Cognitive and Affective Neuroscience Lab at CU-Boulder. In 2013, Wager and his colleagues published a revolutionary study in the New England Journal of Medicine that identified a distinct brain signature for physical pain for the first time.
There is one very important caveat I see when reporting on the latest study from CU-Boulder. Certain types of pain are so excruciating that no amount of cognitive self-regulation, visualization, positive self-talk, or distraction is going to minimize the intensity of experiencing this pain. If you are suffering from debilitating chronic pain please do not interpret these findings as having any type of ‘blame-the-victim’ rationale.
Flipping Moderately Painful Stimuli Into Pleasure Might Sound Masochistic ... But It Works
For the study, participants were given painful heat stimuli on their arms while their brains were scanned using functional magnetic resonance imaging, or fMRI.
During the first scan, the participants were asked to clear their minds and not think of anything in particular while being subjected to the painful heat on their arms.
In the second scan, the participants were asked to imagine that the burning heat was actually damaging their skin. This mindset was found to increase perceptions of pain.
In the final scan, participants were asked to imagine that the heat was actually a welcome sensation on an extremely cold day—this explanatory style was found to decrease the perceived experience of the pain.
When the brain scans were compared the pathways for experiencing physical pain remained the same across all three scenarios, regardless of how the participants rated their pain experience. However, the breakthrough discovery was that the researchers discovered a second brain pathway that changed in intensity depending on the type of thoughts, or "cognitive self-regulation" used by participants.
Can you think of a time in your life when you've flipped your perspective on a painful situation to make it seem more agreeable?
While reading the method used for this study, I was reminded of a mental imagery and distraction I would use to cope with blisters and the heat on the bottom of my feet when running 135-miles in 120° F temperatures through Death Valley. Every time that I have competed in the Badwater Ultramarathon, by about mile 100 the bottoms of each foot are one huge sheet of blisters from heel to toes that really hurts. Every step feels like you are walking barefoot on red-hot coals.
The only way that I could cope with taking another step to finish the final 35 miles—which is an ascent halfway up Mt. Whitney—would be to imagine that the jolt of pain I felt when my foot hit the pavement was actually a sign of a positive current entering my body.
In my imagination, I pretended that the bottoms of my feet had become a conduit and were absorbing energy from the core of the earth and transferring it through my nervous system and into my muscles to help me keep going. I know it sounds crazy, but it actually worked.
Instead of stepping lightly or thinking of the pain as being negative, I would actually stomp my feet harder into the ground and welcome the pain as a symbol of this outside source of power coming from the center of the earth into my body through my feet ... all the while chanting "Bring it on!" silently to myself as I charged ahead.
What cognitive methods work best for minimizing perceptions of pain?
Over decades of training and competing I came up with an endless Rolodex of cognitive tricks that I road tested and perfected in the field for dealing with pain. These findings became the foundation for The Athlete's Way: Sweat and The Biology of Bliss. I was excited to see that Woo and his colleagues came to similar conclusions in their laboratory.
In an email exchange with lead author Wani (ChoongWan) Woo earlier today I asked him, "Based on your findings, do you have any advice on ways that someone could increase his or her pain thresholds and minimize perceptions of pain, especially when that pain is chronic?" Woo responded saying,
I can't really say what is the ideal mix of mental imagery and narrative from our study because our study is not designed to answer that question. However, there is a nice, old meta-analysis study by Fernandez et al (1989), which analyzed more than 40 studies and found that the imagery methods are the most effective.
In addition, from our other studies (e.g., Buhle et al., 2012), distraction (e.g., focusing on other tasks) seems really powerful. So I'd guess that some techniques that contain both imagery and distraction components might be great for pain regulation.
Conclusion: Imagery and Distraction Can Be A Winning Combo for Pain Regulation
Based on my personal experience as an ultraendurance athlete I agree with Woo's conclusion that imagery and distraction are a winning combination for pain regulation.
"Previously people did not have this specific brain marker for pain," Woo concluded. "Incorporating that measure, and identifying a separate pathway that makes an independent contribution to pain, is a major innovation of this paper."
If you’d like to read more on this topic, check out my Psychology Today blog posts: