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Howard Schubiner M.D.

The Role of Neuroplasticity in Pain: For Better or Worse

The brain learns pain; and this process is surprisingly common.

It is obvious that we do many physical things automatically.  It generally takes little conscious effort to walk, gesture, chew, or balance while riding a bicycle.  We routinely accomplish relatively difficult tasks without too much thought.  It is frequently not necessary to think about how to accomplish these tasks because our brains have learned and practiced these skills so well that they occur with little or no effort.  In addition to physical activities, we have learned certain cognitive skills that we typically perform with minimal mental effort, such as adding simple numbers, reading, typing, and recognizing certain patterns of speech as belonging to certain dialects. 

The reason we are able to accomplish these feats quickly and effortlessly is that neural networks or pathways have been formed in our brains with connections to our bodies.  These pathways are very specific and unique to an individual, and they consist of thousands of brain cells devoted to these tasks.  They can be very simple or quite complex.  For example, most people have the experience of driving somewhere familiar and not recalling exactly how they got there.  They were in autopilot mode.

The more time we devote to learning certain skills, the better we get at them.  Accomplished musicians or athletes can perform amazingly complex activities with ease, after years of practice.  The more these neural pathways are activated or practiced, the more engrained and repeatable they become.  Practice creates stronger pathways for whatever is being practiced.  Practicing a poor golf swing or practicing procrastination tends to engrain habits that may be difficult to break.

Students of the brain know this process as neuroplasticity.  Recent books by Norman Doidge and Sharon Begley describe this process in detail.  When we encounter new stimuli, no matter what they are, our brains respond to the event and are changed by it.  In addition to learning new physical and mental skills, our brains can also learn things that may affect our physical health.

Our bodies depend on our brains for constant monitoring, feedback and activation of neural pathways in order to function properly.  Our heart, kidneys, lungs, gastro-intestinal tract, and muscles send neural impulses to the brain and these impulses interact with neural networks to create homeostasis, a state of internal stability.  These complex interactions occur primarily without our conscious awareness, i.e., on autopilot. 

What happens to these pathways in states of disease or dysfunction?

An acquaintance told me this story.  He served in Vietnam in the late 1960’s and his company was ambushed.  His unit sustained many injuries and some were killed.  He incurred shrapnel wounds to his left leg and was eventually “medevacked” to safety.  He returned home and limped on that leg with a fair amount of pain for several months.  However, after rehabilitation, he recovered.  Both the pain and limping resolved and he felt fine.  About 20 years later, while taking a walk with his wife, he had a sudden recurrence of the old pain and limping.  He mentioned this to his wife, who asked, “Did you notice that?”  A helicopter was buzzing overhead.  The pain was learned by the brain due to an injury and then reactivated later by a triggering stimulus.

A young woman injured her back in a horseback riding accident as a teen.  She had lower back pain for about two weeks, which then resolved completely.  Twelve years later, the back pain recurred on the day before her wedding after her fiancé informed her that he was breaking up with her.  The triggering event wasn’t a physical injury, but an emotional injury.

I have seen firsthand over and over that the brain can learn pain.  When we incur a physical injury, the brain learns that specific pain and will remember it as a neural pain pathway, or what could be called a pain memory.  And once the brain learns pain, it will not be forgotten.  As shown in the examples above, it can be reactivated in the future when triggered by different types of stimuli.  More alarming, this type of pain can become chronic.  In other words, chronic pain can occur in the absence of a tissue damage situation in the body.  And, it turns out, this is a common occurrence.

Physicians are trained to search for the source for pain in the body.  We look for fractures, inflammation, infections, tumors or other pathological, structural processes in the body.  When we don’t find them, we are often at a loss.  Few doctors are aware that neural pathways can cause pain.  And surprisingly, this type of pain is common and it can be every bit as severe and chronic as pain caused by tissue damage conditions.  I saw a young man with severe leg pain.  He had extensive medical testing and all of studies were normal.  His doctors were unable to explain to him why he had pain.  The only option he had was to take pain medications, which helped to some degree.  However, he still suffered with daily, severe pain.  When I listened to his story, examined him, and reviewed his medical testing, it was clear that he didn’t have pain due to a structural problem.  His pain was caused by learned neural pathways.  I explained to him that his pain is real, not due to a structural disease process, and reversible.

Neural pathway pain is the cause of many disorders that will be discussed in this blog, including fibromyalgia, irritable bowel syndrome, chronic headaches and several other common conditions.  Fortunately, it is very possible to reverse neural pathway pain for the same reason that it began: neuroplasticity.  The brain has non-pain neural pathways to all areas of the body, which have not been forgotten, and activation of these pathways will turn off the painful pathways.  I saw a woman who had pain in two areas: her wrist and her jaw.  However, instead of having pain that was present on a regular basis, her pain alternated between these two spots.  She would have pain in her wrist for several days and this pain would completely disappear only to be replaced by pain in the jaw; then the situation would reverse.  This pattern of pain is highly suggestive of neural pathway pain.  Another common pattern is for people to develop pain in one spot for several months, which disappears only to be replaced by pain in another area, and at a later date, that pain resolves leading to a different pain.

For people who suffer with chronic pain, it is vital to distinguish between the two main causes of pain because the treatment is completely different.  All doctors have an obligation to identify structural disorders that require medical treatment aimed at correcting the underlying disease process.  Neural pathway pain does not require medical treatments because a structural disorder is not present.  In order to treat neural pathway pain, one must alter the source of the pain, i.e., the brain.  As I will describe in future blogs, it is often surprisingly simple to diagnose and reverse these neural pathways.  Thousands of people have had their pain completely disappear by using the neuroplastic properties of the brain to their advantage.

To your health,

Howard Schubiner, MD

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