What changes do you want to see in the [healthcare] system to get the neuroscientific perspective out there?
The brain is a phenomenal organ. There’s a reason why it’s my favorite part of the body. Part of that is that it’s very bidirectional. It takes in a lot of information from our physical bodies and it of course is the executive over our physical functions. But we also have this whole vast array of sensory systems. We’re able to take in information about our environment, and we’re able to act on our environment through our behavior. That side of things is completely absent from most mainstream healthcare right now for any kind of complex condition, but I think we see it very much in pain.
We have this assumption that the body is acting on the brain and that’s it. And it’s so far from the truth. What I would love to see, what would really flesh out a more accurate neuroscientific understanding of pain, is to understand that it requires what is often referred to as a biopsychosocial solution. In other words, it requires a more holistic, whole patient treatment that takes into account the fact that we’re impacted by much more than the involuntary signals we get from our bodies throughout the day.
We also create a lot of things in our bodies through prediction and our brains trying to anticipate what’s going to happen. We anticipate what’s going to happen based on signals we’re getting from our environment. We are changing our environment. We need to sit down with each patient and get a sense of their environment. What are their beliefs about their environment? What are their beliefs about their own pain and their bodies? And how is all of this coming together? Why are they experiencing pain more than they should be? What’s going on with this pain response? Why is pain being activated as a default stress response?
There’s things we understand about this through central sensitization - this learning of a pain response and associating that with stress. We know that this starts to happen. Pain catastrophizing is another really interesting and very critical process. It’s very social, psychological and biological, this very significant fear of pain. Fear associations are very strong in the brain and can create a lot of really intense physiological responses. Pain catastrophizing is a very big aspect of that. It can also lead to something called kinesophobia which is the fear of moving as a result of thinking it’s going to cause pain. None of these things involve a singular physical, psychological or social process. They are all highly interrelated; it’s very complex.
So we need to start putting together interventions that live in all of these areas. And we need to start considering not just biological but also psychological and social aspects of complex conditions, particularly in this case, of pain.
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