Thanks to advances made in the field of magnetic resonance imaging (MRI), it is now possible to visualize brain activity as it actually takes place. This type of imaging detects changes in the level of oxygen and blood flow during neural activity. When an area in the brain is active, it needs more oxygen, which means blood flow to that area increases. On the scan, these areas will appear to “light up”. With the advent of the functional MRI (fMRI) it has become possible to investigate and map which areas in our brains are responsible for the different neural processes required to keep us moving, thinking and feeling. Researchers interested in studying pain have, of course, also availed themselves of this technology.
One important discovery in the last few years has been the connection between what we think and feel about pain with the actual experience of pain. Turns out that how a physical problem is explained to us – that is, the choice of words that are used – can actually increase or decrease how much pain we perceive. Our willingness or fear to move seems to be directly related to this perception.
The following single case study* using fMRI demonstrates the effect a session of therapeutic neuroscience education (TNE) had on a patient who was scheduled to have surgery for a lumbar disc herniation. TNE seeks to increase the patient’s knowledge and understanding of pain and to reduce the fear associated with injury and movement. The intricate concepts about what pain is and how it works are explained with metaphors and pictures that the patients can easily understand.
The images below** are of the fMRI scan of a patient facing surgery for a herniated disc in the low back. Preoperatively, this person received a session of TNE. The top row of images show the patient at rest. The middle row shows the patient performing a painful spine movement prior to TNE. The bottom row of images show the patient performing the same movement after TNE.
One important discovery in the last few years has been the connection between what we think and feel about pain with the actual experience of pain. Turns out that how a physical problem is explained to us – that is, the choice of words that are used – can actually increase or decrease how much pain we perceive. Our willingness or fear to move seems to be directly related to this perception.
The following single case study* using fMRI demonstrates the effect a session of therapeutic neuroscience education (TNE) had on a patient who was scheduled to have surgery for a lumbar disc herniation. TNE seeks to increase the patient’s knowledge and understanding of pain and to reduce the fear associated with injury and movement. The intricate concepts about what pain is and how it works are explained with metaphors and pictures that the patients can easily understand.
The images below** are of the fMRI scan of a patient facing surgery for a herniated disc in the low back. Preoperatively, this person received a session of TNE. The top row of images show the patient at rest. The middle row shows the patient performing a painful spine movement prior to TNE. The bottom row of images show the patient performing the same movement after TNE.
Pain is the result (output) of an interpretation (neural processes) that the brain makes in response to threat messages it receives (input). This does not mean that pain is imagined. It is a real and very individualized neural event as the fMRI demonstrates. It is, however, influenced by various outside sources. The words that are used to explain the reason for pain are one of those sources.***
Footnotes:
* Preoperative Neuroscience Education: Single fMRI case, submitted for Publication Louw, Diener, Peoples and Puentedura, 2014
** Permission to use these images was obtained from Adriaan Louw, PhD, PT, CSMT
*** It should be noted that a single case study cannot prove cause and effect. Randomized controlled trials (RCT) with larger numbers of individuals included in the trial are the rigorous studies one seeks. At least one such study was published by the same authors last year: Louw A, Diener I, Landers MR, Puentedura EJ. Preoperative Pain Neuroscience Education for Lumbar Radiculopathy: A Multi-Center Randomized Controlled Trial With One-Year Follow-Up. Spine. May 28 2014.
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