Today I’m going to try and describe the theory behind this neuroplastic technique in my own words (mostly)* in the hopes that someone finds it interesting. Hopefully, nobody finds it useful! Because although that would mean my writing was not in vain, one more person with chronic pain is one too many.
The visualisation I’m doing involves imagining the boundaries of the brain regions that process pain and then making them shrink in your “mind’s eye”. But what are these regions? And how does that help?
There are (at least) sixteen brain regions involved in processing pain
According to Michael Moskowitz, quoted in Norman Doidge’s book, there are many different regions involved in processing a single incident of pain. Without having done my own research to verify these, I won’t go into specifics of which areas he mentions (they all have funny names like ‘hippocampus’). But what is worth knowing is that pain is processed in many parts of the brain.
When not processing pain, these regions do other stuff
When an acute (new and intense) pain signal is generated somewhere in our bodies, those sixteen brain regions light up on brain scans. But in fact, even before the pain signal, those regions are not dormant. They do other stuff too. They just light up even more once the pain signal arrives. Before the interruption, these sub-networks do things like (quoting from Doidge again) “sense pressure, position, vibrations. [They] detect conflict … solve problems [that are presented to them], plan movement sequences, process and retrieve emotional memories. [They] connect emotion with bodily sensations, empathise with others, retrieve autobiographical memories” 
And finally, the posterior parietal lobe “processes visual perception [and] internal location of stimuli”. The prefrontal area is involved in “executive function, creativity, intuition, emotional balance”. And the posterior cingulate processes “visuospatial cognition”. 
Those last three are where the visualisation comes in.
Chronic pain is neuroplasticity gone wild
When those regions process acute pain, only about five percent of the neurons in each area are dedicated to processing the pain signal, leaving about ninety-five percent to carry out the other important tasks they are involved with.
What Doidge reports is that Moskowitz discovered that in chronic pain, the number of neurons processing pain has grown to between fifteen and twenty-five percent. This leaves a shortfall in the number of neurons that can carry out other jobs.
Essentially, the constant ongoing signals of alarm and damage have rewired the brains of people (like me!) with chronic pain, so that the neural networks no longer function like they used to. That is neuroplasticity — but not in a good way.
Incidentally, to me this seems to explain why those of us with chronic pain can seem to lack concentration or struggle to form sentences, solve problems or recall facts. We may have trouble empathising with others or controlling emotion. Our own brain is being appropriated by excessive signals from our peripheral nerves.
Our posture comes to reflect a defensiveness that is nothing to do with how we feel about the world, but has everything to do with how much finesse and fidelity has been lost in our actual cognitive experience.
Disconnecting is harder than connecting
Making new connections between things in our minds is relatively easy — just repeat it a few times and soon you’ll have no trouble remembering the way to a friend’s house, or how to tie a shoe. But have you ever tried to unlearn something? That’s not so easy. Many of us have nights we’d rather forget 😉 But how many of us have managed to intentionally ditch those unpleasant scenes? Or once we hear a song that we detest and it’s going round in our head, how do you stop it?
That’s essentially what we’re doing with the visualisation technique. We focus our mind and use thoughts themselves (visual images) to literally force our brains into using the neurons for their original purpose — visual perception, internal location of stimuli, creativity, intuition, visuospatial cognition. Visualisation involves all these functions and more. By doing this, we are unlearning a pattern of neural behaviour that has become so ingrained that we were until now unable to break free in any meaningful way, as the neurons became more and more tightly connected. That is why we need to bring such seemingly unreasonable levels of conscious determination to the situation. Relentlessness, as Moskowitz calls it. We must be more relentless than the pain, or else we stand no chance of disconnecting a network that has become progressively more deeply wired over time.
A final point
Eventually, the goal is to use the mind to return our brains largely to the same state they were in before they began producing the experience of chronic pain. When that has been achieved, the visualisation is no longer necessary and we can go about our lives with more normal pain-processing neurology.
We will still receive normal pain signals. The five percent of neurons that are dedicated pain processors will still do their jobs. And the injuries or limitations in our bodies will remain — they will need to be treated in their own way.
An as-yet unanswered question
Although there are sixteen brain regions responsible for processing pain, Moskowitz’s technique only targets three of them. Despite this, anecdotally it seems to have had remarkable success. Why is this? Are these three more central to the experience of pain?
 Doidge, Norman. The Brain’s Way of Healing. Penguin Books 2015. pp13-14
- Note that this is not a systematic scholarly review of the latest research. My list of sources is minuscule. There may well be errors or mistakes compared to the latest neuroscience. I’m just trying to present the basic gist of what I’m doing so people can do their own reading about it if they choose.
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