What you Should Know About Brain Pain

Too little attention to neural approach to chronic pain
Chronic pain is increasingly common, but it is still too unilaterally approached from either somatic or psychological perspective. Although it is known that the central nervous system could play a major role, it is with this knowledge has been little in practice.


Chronic pain is not necessarily a somatic or psychological cause. Also, the central nervous system plays a role in chronic pain syndromes and which will be more and more research fitted.2 In practice, however, still too little taken into account here, and holds it, in spite of disappointing results, often stuck to the traditional therapies.

We have gained experience from various disciplines with an active, on function-oriented approach in CRPS patients. To combine these experiences was established CRPS group Heliomare. We have come to the conclusion that the concept of neural reorganization 'are practicable for the explanation and treatment of chronic pain. We have found that neural reorganization can be an important approach in the treatment of chronic pain, where there is too little use is made of. The Working Group therefore considers it important to bring this concept under the name Neural Reorganisation Therapy (NRT) attention and hopes to initiate a discussion on new treatment options for chronic pain.

Pain as 'substantially'
Previously, chronic pain was often attributed to (persistent) peripheral causes, for example, blunt irritation with phantom pain, inflammation in CRPS, hernia back pain, whiplash neck injury. If a peripheral cause could be found (or not working a peripheral gripping therapy), it was assumed that the cause mental 'disorder' was, people with persistent phantom pain are psychotic (they indeed have hallucinations) and CRPS patients have pain their neurotic character structure. This dualistic approach is still dominant in our medicine. It is noteworthy that in these peripheral and psychiatric fixation, the role of the nervous system for a long time is left out of consideration.

Common pain therapies are often passive character

Recent developments in neuroscience clearly shows that each peripheral disease always has a central component and that our (peripheral and central) pain system is not static. There are pain modulatory systems that can make sensitive or less sensitive to our pain system (sensitization, habituation). It was also found that our system pain lasting of properties can change: to change the sensitivity and the involvement of brain regions and nerve fibers: plasticiteit.2

We now know that the origin and cure inflammation goes hand in hand with a sensitization desensitization of the pain neural system, respectively: an obvious useful mechanism. A peripheral condition is never alone! (Sometimes this mechanism will have failed and turns against us. The question is why.) In osteoarthritis example, there is a striking discrepancy (in both directions) between the (objective) anatomical abnormalities (X-ray) and the (subjective) experience pain . This can be explained by the varying characteristics of the pijnsysteem.3 With a 'sensitive' pain system (for example, by genetic makeup, created by diseases or negative expectations) will cause a lot of pain slight arthritis and carpal tunnel syndrome omgekeerd.Bij leads drop-out of input from the affected hand to a greater sensitivity of central structures: the brains trying in this way the contact with the "risk basis" to secure: better a painfully sensitive hand than a numb hand 4!

The complex regional pain syndrome (CRPS) has been shown that the involvement of central neural structures (including the somatosensory and motor cortex, cingulate gyrus) was amended substantially by pain. The neural pain ensemble has become more comprehensive and more sensitive and normaliseren.2 5 to repair this proves again 6

Analogous mechanisms are likely to back pain, phantom pain, fibromyalgia and even pain conversiesymptoom.2 7

neural reorganization
The usual pain therapies are often peripherally oriented: "treatment" of the peripheral tissue damage or blockage of nerves. If this does not work (which is often the case) is centrally come under fire (of opiates to neurosurgery). And finally, the psychiatrist is asked consultation, the patient is branded as psychotic or mentally unstable, loses his self-esteem and despair. In addition, conventional pain therapies often passive character: the patient "undergoing" treatment but not actively contributes. The control is with the doctor or therapist. Experience shows that this passive attitude the persistence of pain in the hand is working and can cause increased disability. That's why today there is for example a much more active approach to low back pain (compared to the former 'ligkuur).

In 2010, we assume that neural reorganization is an important factor in explaining chronic pain there is no peripheral tissue damage (more), there is not a mental disorder, but the pain system has changed (plastic). Neural reorganization is a broad concept, that is to say, the plastic changes within the pain system may be transient and functional (for example, sensitization of membrane receptors / synapses), or more durable and morphologically sealed (such as altered networks by synaptogenesis and / or neurogenesis) and everything in between . Interventions designed these neural reorganization to reduce in some way and thereby normalize the pain system we call Neural Restructuring Therapy (NRT), a concept that is not directed to the affected body part, but on changing the central neural representation of the body part. The interesting thing is that many and varied approaches may contribute to this: cognitions, pills, sensory stimulation, exercises and even meditatie.8 Some examples:

Cognition: someone change their minds, for example, explain that pain is a false alarm (CRPS), that pain is useful (baring), that there is nothing wrong with the affected hand or foot, the pain system in the brains 'set incorrectly' is . Recent studies clearly show that ideas and expectations largely perception, or determine the pain: placebo and nocebo effect.9

Normalizing movement patterns (immobilization may have led to neural sensitization). The function is central (one leg is to walk along); there is a brain recognizable input, sensitization can be reversed. Also train of a motor skill, a reorganization of the pain system bewerkstelligen.10

The row examples currently grows steadily: motor imaging (mentally performing movements), mirror therapy, numerous pacing therapies (massage, acupuncture, TENS) and, last but not least, the favorable impact of the environmental context (light, views, friendly staff ) .11-13

We now know that not only somatic but also psychological and social factors play an important role in the development of chronic pain and the brains in this all play a prominent role: no pain no brain. The brain appears to be much more plastic than we ever thought and that offers unexpected possibilities.

Although evidence from RCTs (randomized controlled trial) is sometimes nice to questionable therapies, medical progress is mainly driven by the evolution of ideas and rarely by RCTs. We think about notable events, which can bring something valuable. An RCT may be an "icing on the cake; the 'i' was, however, even without tip already read.