'Understand That All Pain is in the Brain,' Says Dr. Bradley Fanestil

Sadly, dealing with chronic pain—from back problems to joint pain and headaches—can often be a frustrating process. While traditional treatments help many people, not everyone gets the same relief. For some, the discomfort can linger on for weeks, months or even longer.

BCH internal medicine physician Dr. Bradley Fanestil is no stranger to this reality. “About 10 percent of my chronic pain patients have been through everything and seen everyone—MRIs, CT scans, multiple specialists—or even had major surgery. But they don’t get better. They’re at the end of their ropes,” Dr. Fanestil told a crowd of nearly 275 people during a free health lecture held on Tuesday, July 24, in Boulder.

“I kept asking, ‘What can I do for their pain?’ I started looking for some answers,” said Dr. Fanestil. During his research, he learned how new neuroscience discoveries are offering hope to many chronic pain sufferers.

He said, “One of the major new understandings in neuroscience is the concept of neural pathways—how neural pathways in the brain process and ‘remember’ pain. These discoveries are helping many people who have been told that their problem is caused by tissue damage or chronically irritated tissue to actually get relief."

Neural Pathway Pain
Dr. Fanestil is now one in a number of a growing group of doctors and neuroscientists who believes that pain is constructed by the brain. “Pain is nothing more than our brain’s alarm mechanism for alerting us to danger,” Dr. Fanestil stated.

When we suffer a physical injury or disease, the brain thinks something should hurt and its "danger-alarm mechanism" then activates certain neural pathways. Once the brain’s alarm mechanism activates those neural pathways, they will not be forgotten. They become a pain memory.

A neural pathway pain memory can be reactivated in the future when triggered by different types of stimuli. This type of pain can even become chronic.

“Neural pathway pain is common, and it can be every bit as severe as pain caused by tissue damage from injury or disease,” Dr. Fanestil said.

Fortunately, it's possible to turn off neural pathway pain.

Dr. Fanestil said, “I believe that when patients who experience neural pathway pain learn to think differently about it, that's when their pain will disappear. By embracing this paradigm—that pain is in the brain– they often come to understand that neural pathways have been sensitized and need to be switched off.”

Teaching Your Brain to 'Forget' Pain
“With chronic neural pathway pain, there is some part of your brain that continues to perceive danger from your area of pain. Your job now is to convince your brain that the sensory input it is receiving is not dangerous, so it can turn off the alarm,” Dr. Fanestil told the crowd.

He said to educate yourself about how negative thoughts and emotions can cause "hypervigilance" in your brain. “Learn that pain is nothing more than our brain’s alarm mechanism, alerting us that something is wrong,” Dr. Fanestil advised.

Here are two strategies he suggested for learning how to switch off neural pain pathways:

• Expressive Writing - Once a day for 20 minutes, try stream-of-consciousness writing about your thoughts and emotions. Dr. Fanestil said that you shouldn't worry if your writing is legible or grammatically correct. Just get your stream-of-consciousness thoughts onto the page. Then destroy the page. Do not keep it.
  
  Negative emotions, such as fear and anger, essentially tell your danger-alarm mechanism that things are bad and it must remain hypervigilant. According to Dr. Fanestil, getting the negative self-talk and unproductive repetitive thoughts out of your subconscious and onto a page, (then discarding what you wrote) can sometimes rapidly reduce hypersensitivity in your nervous system.


• Somatic Tracking - When performed mindfully, somatic tracking teaches your brain that the pain or distress is not dangerous, and that you are safe and in control of the situation. Dr. Fanestil recommended practicing it throughout the day.
  
  When you notice pain, he said to take two or three minutes to do the following:

1. Notice the pain, distress or negative thoughts you're having with interest, but with less emotional reactivity. Pay attention to how the pain moves around or changes in quality, but do so without emotion.
2. Accept them as happening right now but realize that this thought or body sensation is transient and caused by the brain. Repeat to yourself, “This is just a thought. Just a sensation. Just neurons firing.”
3. Remind yourself that since these are just sensations, they are not in any way threatening to you. These sensations are not dangerous and cannot harm you.
4. Tell yourself, “I don’t need to do anything about this right now, because this is not harmful. It will pass.”
5. Tell yourself, “I’m OK. I’ll be fine. There is actually nothing wrong with my [body part experiencing pain] because I am healthy and strong. I am safe, and there is no danger from these nerve impulses. I am safe. I am not in danger.”

Important Note About Somatic Tracking from Dr. Fanestil
Dr. Fanestil said there is a paradoxical element to somatic tracking that is important to understand: The purpose of the exercise is not to get rid of the pain or discomfort. Instead, the aim is to teach your brain that it’s safe and in no danger—that it’s not threatened in any way by sensory input coming from the area of pain.

During the two-to-three-minute exercise, you shouldn’t care whether you have pain or whether it worsens, improves, changes or moves around. You are just watching it without emotional reactivity and reminding yourself that you’re safe. If the pain does not improve, that doesn’t mean you “failed” at the exercise. Regardless of the outcome of any single somatic tracking exercise, if you keep reminding your brain that it is not threatened, he said it will eventually turn off the alarm signal of pain. Assuming the pain is nonstructural in nature, Dr. Fanestil said often times the pain will resolve or diminish.

To schedule an appointment with Dr. Bradley Fanestil, call 303-415-4250.

Click here to view PowerPoint slides from his lecture on “New Treatment Option for Chronic Back Pain.”

Click here to download an article written by Dr. Bradley Fanestil on neural pain pathways.

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