Dr. Bradley Fanestil: 'Chronic Pain is a Disease of the Brain'

Millions of Americans are forced to cope with physical pain every year. For some, this pain is rather mild and doesn’t seriously impact their lives. For others, pain can be extremely debilitating, having far-reaching impacts on daily quality of life.

There are two different types of pain:

• Acute pain – Sudden onset, sharp rise, short course
• Chronic pain – Continuing or occurring again and again for a long time (at least six months)

According to Dr. Bradley Fanestil, the Medical Director at BCH’s Center for Mind Body Medicine, chronic pain is very different from acute pain. During a free lecture, he discussed the ways chronic pain impacts the brain and how mind body medicine treatment methods can help alleviate it.

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VIDEO: Watch Dr. Fanestil's lecture on Treating Chronic Pain with Mind Body Medicine
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Focus on the Brain, Not the Location of the Pain
“If you have pain that hasn’t responded to traditional medical therapies but has lasted longer than six months, chances are a big part of the problem is in the nervous system,” said Dr. Fanestil. “Chronic pain is not a result of ongoing tissue damage in the area where the pain is felt. Instead, functional MRIs have shown that chronic pain involves the emotional and learning centers of the brain.”

This has led Dr. Fanestil to believe that the primary reason we struggle to treat chronic pain is because “we are treating the wrong thing.” Instead of focusing on the area of the body exhibiting this chronic pain, Dr. Fanestil states, “We should be focusing on the brain, and specifically, we should be focusing on the emotional and learning centers of the brain, which seem to be running somewhat abnormally in people with chronic, long-term pain.”

The Neuroscience Behind Pain
According to Dr. Fanestil, traditional neuroscience viewed pain as a signal sent to your brain from the area of your body experiencing the issue. This would trigger a response in your brain to seek out some form of treatment to alleviate the pain being experienced by your body.

However, modern neuroscience views pain differently. Dr. Fanestil explains that when your body sends a signal to your brain regarding pain, the brain decides whether this signal is dangerous. If the brain decides the signal is dangerous, it alerts you by creating pain. This has led Dr. Fanestil to conclude that “all pain is in the brain.” This includes both acute and chronic pain.

As a result, Dr. Fanestil proposes that we should think of pain as “nothing more than my brain’s alarm mechanism to let me know I’m in danger or potential danger. If my brain thinks I’m in danger, it activates certain neural pathways to create for me the experience of pain.”

Based on this view of neuroscience, Dr. Fanestil has found that most of the chronic pain he sees is caused by a hypervigilant danger alarm mechanism. In other words, incoming sensory input is overinterpreted by the brain. As a result, the brain creates pain when it doesn’t really need to. This hypervigilant danger alarm mechanism is commonly found in individuals with:

• A history of childhood trauma
• Medical trauma

These prior experiences can cause your brain to make illogical decisions in an attempt to protect you.

Predictive Coding Determines the Neural Pathways Your Brain Runs
Your autonomic nervous system functions as an operating system that runs your body. It impacts a variety of essential functions, including:

• Bowel and bladder function
• Heart rate
• Breathing
• Blood pressure
• Sweat glands
• Muscle tension throughout your body

As part of its processes, the autonomic nervous system causes your brain to perform predictive coding, allowing it to process incoming sensory information based on previous experience. According to Dr. Fanestil, your brain is constantly assessing everything around you, including the data it receives from inside your body. Using all this input, your brain predicts what it needs to do for the next instant of your life. These predictions are guided by learned neural pathways.

Pain is a Neural Pathway
When you learn to do something, your brain wires neurons together. This is called a neural pathway, and it enables your brain to tell your muscles what to do. Dr. Fanestil explained that in just a matter of hours, your brain can wire millions of neurons together in new ways. Most of us know this phenomenon by the term “muscle memory.”

Once your brain creates these neural pathways, you have them for life. These neural pathways govern everything you do.

According to Dr. Fanestil, pain is a learned neural pathway that your brain is running because it believes it needs to warn you about danger in that area of your body. After your body creates pain, these neurons are wired permanently and are always there for your brain’s use. “Many times, neural pathways get stuck in the ‘on position’ when you experience chronic pain,” Dr. Fanestil explained.

Unlearning Chronic Pain
Dr. Fanestil described a vicious cycle that leads to chronic pain: “Pain begets fear of pain that begets more pain, because the brain is more worried and it turns on the pain alarm. This is why we often see people who have chronic pain whose pain has gotten worse over time or has spread from one part of their body to another over time.”

Fortunately, you can unlearn these neural pathways. Dr. Fanestil described a new theory of neuroscience, called neuroplasticity, which allows you to teach your brain to use different neurons and create new neural connections.

This theory applies to just about all chronic pain since, in the vast majority of instances, it is caused by a problem in the nervous system. “The human body is an amazing healing machine and if you have pain that’s lasted longer than six months, especially if nobody can quite figure it out or if you’ve had multiple procedures that haven’t been very successful, then maybe we’re focusing on the wrong area,” says Dr. Fanestil.

Dr. Fanestil described the primary concept of mind body medicine: “What we tell ourselves changes how our brain operates and our brain is controlling us.” This can be very powerful and have a significant impact on chronic pain. Most importantly, these mind body medicine techniques can be used with just about anyone experiencing chronic pain.

Treating Pain Begins With Education
According to Dr. Fanestil, the first step achieving the benefits of mind body medicine is to educate yourself. This isn’t traditional Western medicine, so most people are unfamiliar with the techniques used. Only you can change your neural pathways, so you need to understand how your nervous system works.

Dr. Fanestil recommends starting by reading Intro to Neural Pain Pathways to become more familiar with how neural pathways work. Keep in mind that you are re-educating the subconscious brain, which works differently than the cognitive brain. The subconscious brain learns by experience and repetition. You need to start giving it new information and experiences in order to re-educate it. This process can take time to complete, but once you’ve established these new learned neural pathways, there’s a good chance you’ll experience a significant improvement in your chronic pain.

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Dr. Fanestil is one of a growing group of doctors who have found that new discoveries in neuroscience hold great promise for those suffering from hard-to-treat medical conditions. Sessions with him at the Center for Mind Body Medicine include:

• Medical evaluation and diagnostic testing
• Neuroscience education
• Pain-reprocessing therapy

The Center for Mind Body also provides a group of integrative healthcare practitioners that support the patient, including acupuncture, massage and reiki.

To make an appointment with Dr. Bradley Fanestil, call 303-415-8615.

View PowerPoint slides (PDF) from Dr. Fanestil’s lecture on "Treating Chronic Pain with Mind Body Medicine."

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