The Psychology of Back Pain

[Javier Gonzalez]

I have found this article about chronic pain looking in Google for some information. It isn't a scientific article, it's a divulgative article.

I don´t know where to post this thread so feel free to move it where you this is its site.

http://www.bestlifeonline.com/cms/publish/health-fitness/The_Psychology_of_Back_Pain.shtml

[Gil Haight]

Javier,
This is an interesting article. However, I see these folks stepping in the same trap as the mesodermalists. The basic premise is that there is either something wrong with your body or there is something wrong with you. In either case the solution lies in the capacity to control (mind over matter) . The fixation with control is really the problem. The narrow mindedness of this approach is what can cause the problem in the first place. Now, isn't that strange? Here we have an expanded model for chronic back pain and yet it may really not be truely expanded at all.
Having said this, we need to recognise that looking at something other than the mesoderm is a good thing.
Gil

[Diane]

Although it perpetuates the mind-body dichotomy somewhat, I rather liked the article (http://www.bestlifeonline.com/cms/publish/health-fitness/The_Psychology_of_Back_Pain_printer.shtml), for the following reasons:

1. Straight-forward English, making it accessible to a wide range of the public; simple, clear explanation
2. Hopeful in tone
3. Deals successfully/preemptively with the implication that mental=crazy
4. States clearly that back structure has little or nothing to do with back pain
5. Does not contradict in any major way anything we've put in our "consensus on pain" forum package
6. Raises the issue of yellow flags, leaves the medicos to select out/ deal with the red ones
7. Properly points out the lack of data from Sarno, and explains actual studies that have been done
8. Leaves the locus of control with the patient: The fixation with control is really the problem. Since there will always be a 'fixation with control', I suspect ensuring that the patient is in ownership of its locus is the best that can be done.

The writer, Jonah Lehrer (http://www.jonahlehrer.com/About%20Me%202.html), is also the author of this blog, Frontal Cortex (http://scienceblogs.com/cortex/).

[Jon Newman]

Hi Javier,

I have a writing assignment to do and this article will be great for the subject. I'll post my thoughts by Wednesday.

[Javier Gonzalez]

Hi Javier,

I have a writing assignment to do and this article will be great for the subject. I'll post my thoughts by Wednesday.
OK Jon, we will be waiting for your thoughts then. :)

[Javier Gonzalez]

Does not contradict in any major way anything we've put in our "consensus on pain" forum package

This was what I thought when I read the article, that it seems to be in the same way as the "consensus of pain" that all of you wrote in the thread.

...making it accessible to a wide range of the public; simple, clear explanation
Hopeful in tone
States clearly that back structure has little or nothing to do with back pain

I agree with you completely. I think that the article is interesting for the general public.

[ian s]

http://www.technologyreview.com/read_article.aspx?id=17058&ch=biotech&pg=1

in a similar vein .

I agree with you Diane --well written and relevant for the general public .

[Bas]

Diane, I agree too. My only issue with the article is that it mentions "mind" frequently instead of "brain" - probably typical from a psychological perspective, but to me, it is a teensie bit facile, and it may relate to what Gil said in his first post (#2) here..

[Erica]

Nice article Javier, thanks for posting it!
Erica

[Diane]

From article 1: A standard session goes like this: A patient lies in a brain scanner while experiencing pain, and he watches as his brain flares up in agony. He sees the smear of neural activity that makes him suffer. Then, with the help of a trained therapist, the patient learns how to consciously turn off the specific brain areas that correlate with the chronic pain. After a few sessions, the awful symptoms begin to fade away. The pain is no longer permanent. It’s a real-world example of mind over matter.

From article 2: the MRI is measuring changes in the blood flow to selected parts of my brain. The patterns of blood flow tell the computer how neural activity is changing. By trying to control the size of the fires, I am attempting to control brain activity in the cingulate and insula, and in turn to quell the chronic back pain that has irked me in recent years.

Both these articles but especially the second (all the way through) emphasize doing something with visualization;
1. turning it inward (with the help of a huge MRI feedback machine)
2. creating a "thought object" (as per Damasio), to hold in one's attention, that represents one's "pain" (in this case, it's a red spot that flickers in a part of the brain that brain research has identified as being associated with persistent pain, therefore as "real", as closely associated as it's possible to get, probably - boosting the "trust" factor)
3. finding ways to "deconstruct" the now-visible "thought object", the visualization of the pain, the "source" of it.

I guess this works (finally) for those who can't just go ahead and do a facsimile of this on their own. (In fact, I wonder if one could find correlations between low back pain and lack of imagination? Image-ination? Ability to form visual images?)

But MRIs are still pretty expensive to use as feedback devices.
My only issue with the article is that it mentions "mind" frequently instead of "brain" That's my only issue with it too, Bas, and Gil.

[Gil Haight]

Diane,
I'm with you. An MRI seems like a pretty expensive biofeedback unit.

"In fact, I wonder if one could find correlations between low back pain and lack of imagination? "

This a great question and one that I think underscores the value of these articles. We are all different and this of course that means similar body relationships/images can and are perceived as well as responded to much differently from individual to individual. Are there general categories? Apparently many think so. (Cloniger-Temperament and Character Inventory) Pain 133 (2007) 197-209

I do think there is something lacking in patients with chronic pain along these lines and Imagination seems to be relevant. I know Barrett has often talked about the creative process and how it begins with an "internal conversation". Clearly imagination is a part of this.
Of course not all pts. but this could be a general category of resistance to recovery.
Gil

[Line M]

Isn't this where mental representation of movement comes around the corner?

[bernard]

I just googled "fmri cost" and found that its price varies between states and institutes: from 380 up to 2000$/hour.

[ian s]

sitting still and learning to meditate costs $0 ......Its interesting that Moreman in his excellent book on the 'meaning response' discusses a high tech 'lazer' guided intrevention which is or was popular for a heart disorder which turns out is a placebo. I think the interventions are interesting but fit in with the culture of high tech soloutions to what are low tech approaches (paying attention / learning to take responsibility / reducing threat ).
Many people are uncreative as they are too busy existing in what are continous threatening (or percieved to be ) environments/situations.
As a Physiotherapist said to me today this pain stuff is really interesting but you have to be a certain type of person to accept it and even to work with people suffering with it . I think she is right.
ian

[ian s]

http://www.jneurosci.org/cgi/reprint/26/47/12165.pdf

[Jon Newman]

I'm enjoying the comments on the paper and I don't have too much to add to what has already been said. I've decided not to post my writing assignment as it was an examination of the rhetorical devices and ideological slant of the article which has little to do with the content.

Is the mind something that people imagine in a way that is similar to the personification or objectification of pain?

[nari]

Ian,

I wonder what sort of person your colleague was thinking about when she made that remark. Resistance to learning about pain, both for physios and patients, may be a personality thing....curious.

I agree about the mind/brain thing, but maybe it is deliberate usage of the word 'mind'. After all, most people off the street relate to dualism; talking about the 'brain' except in imaging does not have much meaning.

Nari

[Erica]

I agree Nari. We can't get away from the "mind body" connection in today's society-even in Blakeslee's book "The Body has a Mind of its own". I just finished the book-(which I loved!). In the chapter entitled "The Heart of the Mandala"-the last sentence of the chapter reads " Striving to tune up the body maps of the right insula may be the best investment in yourself you can make". They had referenced biofeedback, imagery, meditation, yoga, breathing etc as all ways of doing this.
I wonder what those fmri's would look like if SC, Somatics or any other form of movement based therapy were employed? Just a thought...
Erica

[Gil Haight]

Erica,
Your last question is one that I have thought about for a long time. Regarding SC, I'm inclined to assume that since the movement is not intended the MRI would be different. There seems to be very little out there about neuro activity of ideomotion. If there is please direct me to it.
My hope is eventually it will be demonstrated that the activity associated with ideomotion has involvement with centers specifically anchored in those regions known to be part of top down modulation, namely antinociception. My guess is that it will involve limbic to hypothalamic pathways (motor/autonomic). Since the movement is non-conscious the frontal cortex may not be integral. I could be completely wrong about this.
The thing that has always intrigued me is how similar the response to SC is to "working out". -warming, diaphoresis and softening- We know that this response is tied to a rise in core temp with aerobics, but how does that happen during SC?
Gil

[Line M]

Erica,
Your last thought keeps me busy as well. Regarding Somatics as far as I know fMRI has not been performed yet. If it is the case otherwise please let me know. Problem with proving sensor motor amnesia is that as soon as brain activity is there one can't prove it wasn't there before. Research til now on came as far as EMG biofeedback.

[Luke Rickards]

Gil,

Recent neuroscientific studies suggest that intention-based actions are mediated by fronto-striatal circuits, including the dorso-lateral prefrontal cortex, anterior cingulate, and SMA (medial premotor cortex). By contrast, stimulus-based actions are supposed to be controlled by different, task-dependent pathways. (Herwig, Prinz, Waszak 2007)

the mere perception of learned action effects resulted in a circumscribed activation of the rostral SMA proper and of the right posterior hippocampus. (Elsner et al. 2002)

[Erica]

I also am not familar with research out there regarding movement (such as SC and Somatics) and insular activity. I would imagine that the fmri would be different as well. In an article written by Thomas Hanna in Somatics magazine, in 1987, he wrote:

"In ordinary language the core process is incorrectly referred to as the "body". Similarly, the cortical process of conscious, voluntary experience is incorrectly referred to as the "mind". These have never been accurate or appropriate terms, inasmuch as there is experientially no clear or fixed line between the usually involuntary process of the cortex. This is because voluntary functions-which are usually habitual-can be lost and fall under the control of the involuntary core, as in the case of sensory motor amnesia. Conversely, involuntary functions can be voluntarily mastered by somatic learning, becoming voluntary. Thus, there is absolutely no categorical distinction between an entity called mind and one called body. "

I guess if we can "learn" pain we can "unlearn" it also...:)
Erica