Month: July 2016

Neuroplastic Visualisation for Chronic Pain: Day 7

One week in, and today I have let go of meditation. Anyone who knows me knows what a huge statement that is. I don’t just skip that part of the day though — I still sit down as if I were to meditate. But rather than traditional shamatha-vipashyana, instead I’m reallocating the time for dedicated visualisation. The pain is bound to interrupt a meditation practice of any decent length anyway. I mustn’t let meditation distract me from the technique. I must be more relentless than the pain.

Focused visualisation for a good thirty minutes helps prime the pump. I’ve been unable to sit quietly today at times, despite feeling a pain spike, but I’ve found that I can bring to mind the visualisations even when e.g. in a conversation. It’s a good sign if I can do both at once. To me it seems as if the practice is maybe — just maybe — starting to get a subconscious foothold. Why? Well, I don’t think I can discount the simple fact I’ve been doing it for a week now. But I also attribute it to the focused practice that I began the day with.

The pain relief is also noticeable today, which is welcome, and even better is a sense (whether a sign of neuroplastic change or other side effect) that the relief is lasting longer. Today, whenever I run through the full practice, I get a good few minutes pain-free.

Having said that, I’m still very unsure if I’m doing enough to make permanent change in my neural anatomy. For this reason, I dug deep into my wellbeing fund and ordered a copy of Moskowitz’s Neuroplastic Transformation Workbook (see http://zigzagyogi.com/2016/07/visualization-for-chronic-pain/ for some links to that book and other resources I am using).

I must not fear. Fear is the mind-killer. Fear is the little-death that brings total obliteration. I will face my fear. I will permit it to pass over me and through me. And when it has gone past I will turn the inner eye to see its path. Where the fear has gone there will be nothing. Only I will remain.
Frank Herbert, Dune

Neuroplastic Visualisations for Chronic Pain: Day 6

I have found this the most challenging day so far. I haven’t had a day with this many pain spikes since I started. Because of the frequency of eruptions, the “Relentlessness” aspect of the technique interferes with everything! The only thing I don’t interrupt is yoga teaching — both arriving on time to teach, and the teaching itself. Everything else is fair game — appointments, meetings with friends, housework. When I become aware of a pain spike, I drop everything and focus on the pain maps. Even during mindfulness practice. Normally, meditation gives a cumulative benefit, but I have to let go of it in order to maintain the relentlessness of the neuroplastic technique. I miss it, but need to remember that this is a time-limited thing. The neuroplastic retraining takes 6 — 8 weeks. After that it should no longer be necessary.

Neuroplastics for Chronic Pain: Day 5

This is my fifth day of using Michael Moskowitz’s visualisations for chronic pain. The relaxation response is starting to become ingrained. In Day One I noticed that when I stopped whatever I was doing, closed my eyes and went through all the steps (establishing intention, crafting a visual map of my brain’s pain system, and then shrinking them in my mind’s eye) that I became more calm. In response to this, the pain, always in my peripheral awareness, eased to 1-2/10 and my whole body, but especially neck, shoulders and core, relaxed. Today, it seems all I need to do is start the process, even visualising with my eyes open and the relaxation starts to take place — not, perhaps, to the same degree, but subjectively still very noticeable.

Two things from this. Firstly, an observation and some speculating. On Day One, the relaxation response was so pronounced that, as I said, the pain all but disappeared and this disappearance was accompanied by feelings of freedom and blissful breathing that I’ve hardly experienced all these years since the accident (June 2012). Since then I’ve been able to access this level of pain relief only a half dozen or so times in total across the four days.

Could it be that my body-mind is accustomed to the new level of comfort, and though the relaxation response is actually occurring to the same degree, my experience of relief has faded? Or is there some objective difference between the way I was visualizing and the effect it had on Day One vs the way and effect of subsequent days? Perhaps some inhibitory response has begun taking place alongside the visualisation that wasn’t present on Day One but is now having a dampening effect?

Perhaps (and this seems most likely to me) the newness of the practice and the novelty on Day One stimulated my brain to higher levels of concentration and this, combined with early placebo effects, led to greater temporary relief than in the days since?

Regardless, the practice does not actually rely on achieving a certain level of temporary relief in each session. The aim is to reassign the duties of certain networks of the brain that also happen to process pain input (the posterior parietal lobe and the posterior cingulate as well as the prefrontal area which is involved with creativity). By relentlessly coaxing these systems to work with stimuli other than pain, we make structural changes in these areas so that the neurons are less dedicated to pain processing. So, while I suspect that having a greater sense of temporary relief equates to stronger motivation, deeper concentration and therefore more vivid visualisation and greater engagement of the above brain regions, which we could assume would lead to faster progress, in the long run, repeated effort will still create the desired result — it may just take a week or two longer. Still worth it.

Secondly: a cautionary realization that I must follow the full practice through each time, from setting intention to creating visual maps to shrinking them, and not simply stopping when I feel the realaxation. While that may be tempting, such a method skips the step of engaging the specific brain areas mentioned, so will not lead to the kind of neuroplastic change that this technique is designed to engender. Instead, I’ll become reliant on the temporary relief of relaxation through visualisation, which although real and beneficial, is in the end just like any other form of pain relief in that when stopped, the pain returns.

The ‘I’ in MIRROR stands for Intention and the intention is this: to focus the mind, in order to change the brain.

“Mental efforts help build new circuits and weaken the pain networks.” Norman Doidge, The Brain’s Way of Healing

“If focus is merely on immediate pain control, positive results will be fleeting and frustrating. Immediate pain control is definitely poart of the program, but the real reward is to disconnect excessively wired pain networks and to restore more balanced brain function these pain processing regions of the brain.” Michael Moskowitz, Neuroplastic Transformations Workbook

Visualization for Chronic Pain

I have begun reading The Brain’s Way of Healing by Dr. Norman Doidge. It details case histories in the new medical field of neuroplasticity (the ability of the brain to change itself), and was recommended by my GP at Helios Medical Centre. It appears to be well researched, and is endorsed by neurologists, psychiatrists and physicians from institutions like the University of California, Boston School of Medicine, Harvard Medical School…

Bless Doidge for putting chronic pain as the subject of chapter one.

In that chapter, Doidge reports a way of retraining the pain circuitry in our brains that was discovered by a pain specialist in the United States named Michael Moskowitz. Not wanting to necessarily wait on a copy of Moskowitz’s “Neuroplastic Transformation Workbook” to arrive from Amazon, I will be undertaking that mental rewiring programme at home here in Christchurch, kiwi-style. I will be using as motivation and further study all the blogs and websites I can find of people doing the same. I’ll also be using that single chapter by Doidge, while continuing to inhale the rest of his book. And I’ll write a brief post each day about my findings, and changes or setbacks I notice.

There are likely to be plenty of the latter over the next six to eight weeks, which is the timeframe Dr. Moskowitz suggests before results are truly signs of neuroplastic change, and not just placebo and the result of temporary distractions from the pain. Hopefully I already have some useful experience from my seven-years-since, daily meditations.

Eventually, the visualizations and constant relentless effort of retraining the circuitry should be pretty much unnecessary, and my pain circuitry will have returned more or less to what it was before the chronic feedback cycle set in.

So, the preliminaries.

May all beings be happy. May all beings be free. May all beings share my good fortune.

Days One — 3

I’m currently on Day 5 — here are my brief catchup notes for the previous four days.

Day 1: elated. Probably mostly due to the placebo effect and the simple fact that, when in pain, anything that takes your mind off it is going to have a relaxing effect. Went to the park with my partner and her toddlers. Because of the elation, I probably overdid things. Lots of monkeying around — shoulders and neck!

Day 2: confused about the technique. Setback in terms of pain — possibly caused by trying to keep up with toddlers yesterday! Lots of questions — do I have to interrupt what I’m doing at any time of the day when I feel pain, and visualize? I am in almost constant pain sometimes for hours. Should I continue visualizing all that time? Feeling as though I can’t guarantee I’ll be on time for things if I need to keep stopping all the time. Even visiting friends was tricky today. Don’t seem to be getting any relief from the technique at all today.

Day 3: Moskowitz uses the MIRROR acronym to describe how to apply the technique. The first ‘R’ is for ‘Relentless’. So, in answer to yesterday’s questions — yes. All of that. “Anytime pain intrudes on consciousness”, writes Moskowitz, “it is greeted with visualization.”

Which seems intimidating — and yes, it’s hard to be that consistently motivated. But, reading about the experiences of others helps. Learning about the science behind the technique is motivating for me. And I’m also learning to do the visuals “on the fly” — closing my eyes at red lights to imagine the brain maps. Sometimes the visualization is bringing relief from the pain. Other times, I’m working on accepting that sometimes the visualization will be feeble or feel ineffective.

Day 4: elation returned. Feel emboldened to continue with the technique. Visualizations more vivid. Relaxation more pronounced than last two days. Quite significant relief from the pain if I stay focussed, fades as soon as I stop visualizing though. And still nothing like as much relief as Day One.

There! All caught up. From now on I will post each day separately.

Further Reading

This blog post has a reasonable summary (if you squint past the typos): http://www.lifeinslowmotionblog.com/visualization-chronic-pain-and-neuroplastic-transformation-an-introduction-to-dr-moskowitzs-neuroplastic-pain-management-strategies/

Here is Dr. Moskowitz’s book on Amazon: https://www.amazon.com/Neuroplastic-Transformation-Workbook-Michael-Moskowitz/dp/0615814654?ie=UTF8&keywords=neuroplastic%20transformation&qid=1456245317&ref_=sr_1_1&sr=8-1

And The Brain’s Way of Healing on Norman Doidge’s website: http://www.normandoidge.com/?page_id=1042