Season Two, Episode Twenty: Understanding and Treating Neuroplastic Pain

In this episode we continue the discussion about recent advances in understanding and treating neuroplastic pain. Pain can exist on a spectrum between purely structural and purely neuroplastic, and many types of chronic pain might involve elements of both. We explore different clinical indicators that can point to the role of learning and neuroplasticity in the development of chronic pain. Although there is not currently a reliable survey or measure to definitively distinguish structural pain from neuroplastic pain, the presence of any of these indicators suggests that there may be a significant neuroplastic component to a patient’s pain experience, which likely means that a person would benefit from psychotherapeutic interventions designed to reset the neurophysiological alarm system and help that patient un-learn being in constant pain and discomfort.

Next, we briefly review the role that pain management techniques can play in helping a patient learn to cope with the stress of being in constant pain. Unfortunately, the process of seeking care for chronic pain can strain a person’s support system and their relationships with family, friends, and the medical team that is treating them. Pain management therapies seek to reduce the stress associated with the role of patient and empower the person to advocate for better and more effective support from the important people in their life.

We then turn our attention to pain recovery therapies by discussing the cutting edge of pain psychology, Pain Reprocessing Therapy. We provide an overview of three of the main phases of PRT by discussing the important role of initial psychoeducation, the subsequent training of the patient to engage in somatic tracking, and the management of relapses. Psychoeducation helps the patient understand why they are experiencing chronic pain and provides them with evidence that supports the use of the PRT techniques. Somatic tracking, a technique used in several other mind-body approaches, is a central strategy in PRT. The way it is applied in PRT consists of learning to practice the skills of mindfulness, safety reappraisal, and positive affect induction.

When a patient is trained in these skills and begins to practice them, they typically experience a reduction or cessation of their chronic pain. However, there may be a time when a person experiences a new injury or when their pain returns in some form. Relapses are so common that clinicians have recognized that there are three distinct stages involved. We will examine the stages of relapse and explore how these events can actually be leveraged to reinforce the positive effects of re-training the brain to respond differently to pain signals. Paradoxically, relapse episodes often serve to strengthen the long-term effectiveness of pain recovery techniques.

Exciting new developments in neurophysiology  have paved the way for cutting edge psychotherapy techniques that can help you to better manage the effects of chronic pain and in some cases to reduce or eliminate chronic pain entirely.