Higher-processing center of the brain, the insular cortex, or insula, actively processes pain information. It seems to play an active role in connecting pain sensations with mood changes, and helps regulate body homeostasis, as well as the formation of judgments and opinions. So when
you smell the scent of a skunk and decide it’s really putrid, your insula has played a key role in forming that decision. The insula also helps with awareness and may be integral to formulating opinions about the intensity of pain. So if something really hurts, the insula will make sure you know about it.
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In more ways than we have yet discovered, chronic pain changes the brain, physically and functionally. It takes hold of the brain, creating a “pain matrix” that keeps the pain turned on— always! It activates various circuits that create a symphony of pain: This activation is often referred to as central sensitization, a way of saying that the pain intensity is turned up like the volume on a stereo. The various brain centers involved in this pain matrix continually interact with each other, perpetuating the chronic pain experience. For example, the amygdala can interact with the hippocampus during emotional stress, diminishing the brain’s ability to remember. And both the prefrontal cortex and the amygdala regulate emotional responses and behavior, so when they’re ensnared in the pain matrix you can suffer from “ping ponging” changes that each seem to make each other worse.
Pain pills, implanted devices, and surgeries have their use, but they do nothing to break up the pain matrix and restore the “pain brain” back to health. The only way to alleviate this kind of pain is to change the brain. The good news is that the power to heal and overcome pain lies within you.
Learning how to work with the brain and body in a coordinated way optimizes your ability to make positive neuroplastic changes. Providing the right environment for recovery is a critical component, and engaging in activities and therapies that take advantage of the brain’s ability to adapt to and remodel can lead to better pain control—without overdependence on medications or other interventions.
Solving the Pain Equation
Perhaps the best way to understand chronic pain is to think of it as an equation, rather than a single “thing” arising from some injury or anomaly in the body.
Back in the 1960s, Ronald Melzack, a Canadian psychologist and professor of psychology at McGill University, introduced the idea that pain is multidimensional; that is, multiple parts of the brain contribute to pain and are affected by it. He believed that chronic pain is a multidimensional experience, with a sensory component, an affective component, and a cognitive-evaluative component. Each of these components interacts with the others and shapes the final pain response.
In other words, pain is not a single entity, it’s more like an equation with multiple factors. There’s the sensory factor, which consists of what you are feeling in your nerves, joints, muscles, and other parts of the body. There’s the affective factor, all the emotions that come into play with chronic pain, from mild annoyance to deep depression and rage. It’s how you feel about what is happening to you. Finally, there’s the cognitive-evaluative factor, or how you interpret your pain, as well as any disability, job loss, or other problems associated with your pain.
If we were to write it out, the pain equation would look like this: sensory + affective + cognitive-evaluation ^ your unique body and brain = your unique experience of chronic pain
Obviously, this is not an equation I can solve by dashing off a prescription for some pills, or you can solve by taking a few medications. Real relief can only come from modifying each factor in the equation. And that’s what you’ll learn to do in the coming chapters.