The neurology of learning can teach us a lot about persistent pain
By Paul Bolger. Chartered Physiotherapist at Nano Physiotherapy, Kilkenny (www.nanophysio.ie).
Developing an understanding of pain helps to relieve suffering and improve treatment. The neuroscience of learning can teach us a lot about how persistent pain states come about and what we can do to lessen suffering from this type of pain
Learning an Instrument
The process of learning involves changes within the nervous system and the brain. Take learning how to play an instrument as an example. Initially, when you start out, it takes conscious effort to position your fingers, to apply the right pressure and move them in the right sequence to play the tune you want.
With time and consistent practice, this all begins to feel more automatic, until eventually you can play your favourite tune with ease.
Strengthening Nerve Pathways
Throughout this process, nerves from the fingers send signals to the brain about things like finger position and pressure. These signals, along with many other messages like those coming from the eyes (what my fingers look like playing this tune) and from the ears (what the tune sounds like) all interact in the brain. The brain processes this and sends out signals along other nerves that instruct the fingers what to do next.
With practice and repetition, these nerve pathways within the nervous system strengthen and become more ingrained and our ability to play the instrument improves. Simply put, we form memories that become ingrained in our nervous system.
Think of it like skiing down a snowy mountain. The more that skiers select the same route down, the deeper the tracks that they create and the easier it is for the next skier to slip into the same tracks and follow the same path. This is one way to think about the strengthening of these nerve pathways.
Learning the Pain Tune
Pain, in a sense, can work in a similar way. Acute pain acts like a protector. If we are at risk of harm, experiencing pain helps to prevent or reduce the potential harm. Think of how you quickly remove your hand from a scalding stove top or how pain prevents you from running on a sprained ankle.
Occasionally pain hangs around much longer than is helpful, long after the acute injury is healed. Changes in the nervous system that look very similar to changes associated with learning play a role in pain becoming persistent (pain scientists call this type of pain ‘nociplastic pain’ – noci- meaning hurt and –plastic meaning mould or adapt).
In nociplastic pain, nerve pathways sending danger signals from the painful body area to the brain become strengthened. You also see strengthening of pathways within the brain itself associated with danger and pain.
In a sense, the body has ‘learned’ this pain and it has formed strong and embodied ‘memories’. Things that did not previously cause pain, like bending or mild pressure at the part of the body, set off this response within the nervous system and result in a very real painful experience. In a sense, we get better at playing the pain tune.
Can We ‘Unlearn’ Pain?
The question must be then, if we ‘learned’ how to become good at feeling this pain, is it possible to ‘unlearn’ it? Or perhaps, is it possible to learn how to feel differently in this part of the body?
While it is not always straightforward, the answer is yes, it is possible to relearn how our body feels. Next week we will explore this more. In the meantime, for those interested, look up the brilliant video ‘Tame the Beast’ on YouTube with renowned pain scientist Prof Lorimer Moseley.
