Reframing Pain: The Neural Basis of LifeĀ“s Ups and Downs.

Claudius Nestvogel, M.A.

 

As Maturana and Varela, and, well before them, also Jean Piaget, have pointed out, perception is action. We do not passively open our doors of perception to let the information flow in. We actively do something to perceive and thus cannot help but get caught in a loop of creating perceptions and perceive creations. In this process our bodies mediate between our environment and our nervous system - the brain cannot feel itself as there are no proprioceptors, but it can feel the body. And much of our information about the environment is actually an almost inseparable mix of proprioception and exteroception. If you push your eyeball with your fingers the world starts to jump: the brain has to compute the activity of the eyemuscles and, of course, of all our other muscles which move the eyes in space, into the picture it gets on the retina. Otherwise our world would not be stable. A pushing finger interferes with this delicate, well evolved process. If we perceive an object by touching, it is mainly our touch perceptors plus a lot of proprioceptors that inform us about the amount of force we apply with our muscles, the movement of our joints, the shearing forces in our tissues, etc., which are computed into an image of the object handled. This, by the way, would not work without the background of having fingered, looked at, "mouthed" thousands of objects before, thus building a frame of reference for object recognition. The sensitivity of our touch is dependent on our muscle tonus - the more tension, the less sensitivity - and thus again contingent upon our mood and our level of activation. Here we enter another loop: some objects, either by themselves or as part of a bigger picture of our environment, can change our mood and activation level considerably - but are we "open" enough to take them in? Our exteroception, our history, our interoception, our present state form one pattern of nervous system activity. In other words, our environment, our "psyche", our "body" and our actions broil down to discharge patterns of brain cells.

Well, probably this reads pretty abstract and vague, but recently I stumbled upon a fascinating case history in a medical journal as a case in point. (D. Soyka, C. Haase, V. Lindner, U. Stamer 1996: Der vergessene Schmerz. Der Schmerz 10: 36-39.)

A woman, aged 55, had had suffered back pain, which started 17 years ago. A number of conservative treatments failed to give her relief. After five years she was finally operated, on the grounds of the diagnosis of a herniated disc (L5/S1). The nucleus was taken out, but afterwards the pain was still with her. It got even worse and within a short time the patient was bound the her bed. Even standing caused excruciating pain. Apart from supplying this poor lady with a wheelchair and daily nursing care at her home, other means were tried to ease her condition. Pain medication, acupuncture, triggerpoint injections and the like were applied, even anti-depressive medication, but all to no avail. When the pain increased even more some 16 years after its first onset, a device for electrical spinal cord stimulation was implanted. This did not work either and now she was put on oral doses of morphine, which finally reduced the pain. As she became nauseous with the oral intake of morphine, a catheder was applied intrathecally, which got her a meningitis. So, they switched the catheter to an epidural one. Still, problems with the application of the catheter persisted and the was referred to another clinic. There, a thorough check-up of her back did not show any organic problems - no recurrence of herniation, no problems of muscle innervation, no atrophy of the muscles concerned. It was suggested to her to get her off the morphine and start a different way of pain management. During the necessary withdrawal phase the heroine of this story went through the climax of her dramatic journey. On the eighth day she suffered first a generalized epileptic seizure, then a failure of her circulatory system, had to be put under oxygen and was comatose for several hours. When she came to, she had a complete loss of memory for the last twenty years. Of course, she also could not remember her long pain afflicted life period - and there was no pain! When she was told what she had gone through the last 17 years she could not believe it. Fortunately there was no brain damage after the withdrawal accident and within days she could leave her bed and move about. Again, no pain! It took her about two weeks to recover her immediate memory and, after some time, the memory of the missing years. Finally, a psychotherapy started to unravel how her familial background had turned into her backpain.

Although on first sight a psychodynamic interpretation seems obvious, it also becomes clear that psychodynamics depend on patterns of brain activity. The memory of her conflicted youth and even long parts of her adult life was still there, and with it the "reasons" for her pain. So the pain could have been there, still. What was no longer there was the memory of the pain itself and of living a life embedded in and constructed around the pain. Her perception-construction had to switch to another pattern, fortunately one without pain.

Maybe a similar process or switch occurs in successful Rolfing when the practitioner refuses to deal with local pain and to do "fix it" work. As the whole body is molded into a different pattern of tonus regulation and spatial relationships within the body, the proprioceptive part of the brain pattern changes. Processing of exteroception and of memory is then based on a completely different "background" firing of the interoceptive system. In a sense, the "equations" have to change, and these new equations may offer solutions were pain can be reduced, in the dual sense of the word. And this possibly, no matter if the physical basis (e.g. a damaged disc, an arthritic joint) of the former pain is still there. The context has changed, the pain has been "physically" reframed.