Pain is more than just a sensory experience; rather, it is a complex phenomenon involving three components: the direct sensory component, the immediate emotional experience, and the long-term emotional implications. Each of these components is mediated by a different neural pathway. In cases of chronic pain, these pathways can become overly sensitized, resulting in a reduced pain threshold and exacerbation of symptoms. In such cases, it is no longer just the bodily source of the pain that is causing our experience but rather the feedback loop between our brain and body.
In other cases, our brain might be overwhelmed with the pain for so long that it starts numbing and suppressing all sensations in an attempt to cope. This can reduce our ability to feel positive emotions and pleasurable sensations, such as affective touch and joy, thus impacting our overall happiness and quality of life.
Furthermore, chronic pain can cause significant physical and emotional stress, causing our nervous system to enter into a chronic sympathetic (i.e., stressed) state. Such stress overload then increases our risk for anxiety, depression, substance abuse, insomnia, attention deficits, memory problems, and other conditions that impact our quality of life and ability to function at our best. Moreover, this stress further harms the health of various systems and organs within our bodies, thus increasing our risk for health conditions such as heart disease, endocrine imbalances, respiratory illnesses, gastrointestinal disorders, and neurological impairments.
Fortunately, there is hope! Studies have shown that interventions which address these underlying brain regions can have a significant impact on an individual’s experience of the pain, even if the bodily source of the pain remains unchanged! Research has shown that neurofeedback, neurostimulation, and peripheral biofeedback can all be effective for alleviating chronic pain, improving coping abilities, reducing secondary consequences, and enhancing quality of life.
Getting to the roots
The purely sensory response to a painful stimulus is detected by the primary and secondary somatosensory cortices; the immediate emotional response occurs primarily within the anterior cingulate and insular cortices; and, consideration of the long-term implications (how this pain might impact the individual’s career, relationships, and quality of life) occurs primarily within the prefrontal cortex.
Chronic pain has been associated with maladaptive reorganization within the central nervous system and electrical brain activation patterns. For example, recent studies have observed that neuronal network oscillations within the thalamocortical system likely play an important role in the pathophysiology of chronic pain. An excess of fast brainwave frequencies within pain-related brain regions can also increase our hypersensitivity to pain and heighten our pain reactivity.
Chronic migraine sufferers, for example, have been found to have increased functional connectivity with affective pain regions than healthy individuals without migraines, and the extent of connectivity is correlated with the number of years an individual has been dealing with migraines.
Furthermore, in some cases, the brain-body-pain connection can be similar to phantom limb syndrome. Phantom limb syndrome occurs when a person continues to feel pain and/or other sensations within a limb that has been amputated. In such cases, there is no longer a limb there to cause the pain, but the brain continues to feel the pain through its memory of that connection. Similarly, even when the source of the pain in the body has healed or improved, we can continue to feel pain as if it has not.
Not only does our brain impact our pain, but our pain impacts our brain in return. For example, evidence suggests that chronic pain can limit the hippocampus’s ability to create new neurons, thus impairing learning, memory, and emotional processing. Over time, this can contribute to cognitive decline, learning disorders, and mental health challenges such as depression, anxiety, and PTSD.
Chronic pain can also increase sympathetic responses and inhibit parasympathetic responses, interfering with the body’s homeostatic processes and impacting various other systems throughout the brain and body. These imbalances (for example, systemic inflammation) can then loop around to further exacerbate our pain, sending us into a downward spiral.
Chronic pain can affect our sleep, diet, activity levels, and digestive functioning, as well. Each of these is important for key neurological processes like neurotransmitter production, neurogenesis (i.e., growth of new neurons), neuroplasticity (i.e., creation of new neuronal connections), and hormone balance. Imbalances within these processes have been associated with a number of mental, physical, and neurological disorders.
How we can help
At NeuroGrove, the first step of any treatment package is a comprehensive assessment that includes QEEG brain mapping, swLORETA 3D neuroimaging, various testing, and a thorough discussion of symptoms and goals. This allows us to assess for brain patterns most commonly associated with chronic pain and find imbalances that could be causing or exacerbating your symptoms. We will then design an individualized program specific to you, your brain, and your needs. Neurofeedback and neurostimulation can be used to restore healthy brainwave activity, calm hypersensitive/overactive regions, and improve communication across the brain.
Peripheral biofeedback, such as EMG (e.g., muscle) and HRV (e.g., heart) biofeedback, can also be helpful for balancing the nervous system, releasing natural endorphins, and gaining control over our physiological responses like heart rate, muscle tension, breathing, and surface temperature. It can also help to reduce pain and increase tolerance of physiological stimuli. For example, EMG biofeedback has also been found effective for reducing the frequency and severity of tension headaches.
Furthermore, we can help you harness the power of your mind to reduce and/or cope with your pain through healing visualizations, neuro-assisted meditation, and other psychotherapeutic processes. Additionally, improving the health of the body through detoxification, reducing inflammation, and enhancing nutrient absorption can reduce chronic pain as well as the secondary health consequences related to the chronic stress. As such, your program may include neuroscience-informed wellness coaching, personalized nutrition, and/or functional medicine services to help you successfully implement any necessary dietary and lifestyle changes.
We also provide specialized movement therapies, such as our unique NeuroFlow technique, which are designed to reduce muscle tension, improve posture, enhance flexibility/range of motion, and provide the body with healthy emotional and physical outlets. Chronic pain can make the body feel unsafe or uncomfortable, causing us to disconnect with it or dissociate from it. Movement therapies and mindfulness can be powerful tools to change one’s relationship with their body toward a more positive connection.
Whichever services you choose to engage with, we will work collaboratively with you to address your healing from an integrative lens and focus on improving your overall brain-body wellness so you can feel – and be – at your best!
What the research says
Research has shown neurofeedback, neurostimulation, and peripheral biofeedback to all be very helpful in the treatment of chronic pain.
A recent randomized, crossover, double-blind, sham-controlled study examined the effectiveness of transcranial alternating current stimulation (tACS) as an intervention for chronic low back pain. Outcomes showed that tACS stimulation of alpha brainwaves over the somatosensory region significantly enhanced alpha oscillations within this region when compared to the sham condition, and these neurological changes were significantly correlated with pain relief.
In another study, researchers examined the effects of neurofeedback training on individuals diagnosed with fibromyalgia (Kayiran, Dursun, Ermutlu, Dursun, & Karamursel). They used a variety of self-report and inventory scales to measure measure symptom intensity and frequency before and after neurofeedback training, as well as the impact of the illness on overall functioning. Results were very promising, with many participants showing significant symptom reduction after only ten sessions of neurofeedback.
Additionally, a study that utilized a combined neurofeedback-biofeedback intervention for adults with recurring migraines observed that 70% of the participants experienced at least a 50% reduction in the frequency of their migraines, which was sustained for an average of 14.5 months after treatments were discontinued.
For more research studies on this topic, see our Research page.
References:
Ahn, S., Prim, J. H., Alexander, M. L., McCulloch, K. L., & Fröhlich, F. (2019). Identifying and engaging neuronal oscillations by transcranial alternating current stimulation in patients with chronic low back pain: A randomized, crossover, double-blind, sham-controlled pilot study. The Journal of Pain, 20(3), 277.e1-277.e11. https://doi.org/10.1016/j.jpain.2018.09.004
Kayrian, S., Dursun, E., Ermutlu, N., Dursun, N., & Karamursel, S. (2007). Neurofeedback in fibromyalgia syndrome. The Journal of the Turkish Society of Algology, 19(3), 47–53.
Stokes, D. A., & Lappin, M. S. (2010). Neurofeedback and biofeedback with 37 migraineurs: A clinical outcome study. Behavioral and Brain Functions : BBF, 6, 9. https://doi.org/10.1186/1744-9081-6-9
