Dr. Alan Gordon and Alon Ziv in their compelling book “Way Out”, introduce the concept of Pain Reprocessing Therapy (PRT), a radical approach to eliminating chronic pain instead of just managing the discomfiture by taking recourse to conventional remedies such as surgeries, physiotherapy and opioids intake. Complementing their contentions with real life examples and empirical analyses. Gordon and Ziv argue that it is not a mere pipe dream for billions of sufferers across the globe to rid themselves from the vice like grip of chronic pain. Dr. Gordon himself is a ‘convert’ to PRT. Ailing from chronic pain himself, he was a walking embodiment of aches and twinges. In addition to back, neck and knee pains, he also suffered from heel pain tongue pain, eye pain, tooth pain toe pain (three different toes!), hip pain, stomach pain, wrist pain, foot pain, leg pain TMJ heartburn, vertigo, tinnitus and itching fatigue. “I got so many MRI scans of my back, my friends joked that my spine was turning into a magnet.” I felt my own injured hip (following a nasty automobile accident four years later) act truant by the time I finished listing Dr. Gordon’s litany of woes, above.
When every other form of orthodox treatment only succeeded in bestowing upon Dr. Gordon a false and fleeting illusion of ‘cure’, he fortuitously was handed a book on the brain-body connection to pain. Even though initially the book was met with extreme skepticism, it paved the way for Dr. Gordon to conduct his own spectacular research into the neuroscience of pain. The result, a revolutionary approach to solving the pernicious effects of pain. Alan Gordon now leads a team of twenty-five therapists at the Pain Psychology Center (of which he is the founder and Director too). Gordon has also completed a groundbreaking neuroimaging study on the efficacy of PRT in conjunction with the University of Colorado-Boulder.
The first step in treating chronic pain is to ascertain its cause. While to the cynic, this may read like fundamentals of medicine 101, there is an underlying method to the madness. Usually, signals are generated and transmitted by the body to the brain, which in turn processes them. For example, whenever the body experiences an injury, the brain generates the feeling of pain. “But sometimes the system goes haywire. Sometimes the “pain switch” in our brains can get stuck in the on position and cause chronic pain. We call this neuroplastic pain. Normal pain is caused by damage to the body. But pain that persists after an injury has healed, or pain that has no clear physical cause, is usually neuroplastic pain.” For a permanent evisceration of any chronic pain, it is thus imperative to ‘rewire the brain’ so that neuroplastic pain is not mistaken for an otherwise common structural pain.
So what is neuroplastic pain? It is a false alarm created by the brain of the sufferer. The brain misinterprets normal messages from the body as if they were dangerous. The body is fine, but the brain creates pain anyway. Gordon, along with an authority in pain management, Dr. Tor Wager and Dr. Wager’s research assistant, Yoni Ashar conducted comprehensive empirical analysis and studies on hundreds of patients to corroborate this incredible fact. They also realised that it would be possible to rewire the neurons in the brain in such a way so that they recognise the typical characteristics and tell tale signals of neuroplastic pain and cease from creating any form of pain.
The insidious trifecta of worry, self-criticism and self-imposed pressure combine in the most adverse of fashion, according to Gordon to exacerbate the degree of neuroplastic pain. However employing the technique of “somatic tracking” according to Gordon and Ziv enables the patient to concentrate instead on the nature of the chronic pain itself and thereby observe it from the “outside in.” This unique sense of perspective lends a degree of stability and infuses a refreshing feeling of safety and ultimately leads to the alleviation of sustained discomfiture. A combination of mindfulness and therapy, somatic tracking imbibes the philosophy popularized by Jon Kabat-Zinn, who helped popularize mindfulness in the West. Neuroscientists have proved that mindfulness increases feelings of safety by deactivating the brain’s fear circuits. This disrupts the pain-fear cycle and helps your brain interpret signals properly. Somatic tracking dispatches messages of safety to the brain. Also known as safety reappraisal, this technique has been shown by scientists to significantly decrease fear.
In addition to observing pain and sending safety, there is according to Gordon a third element of somatic tracking. This involves observing our physical sensations with lightness and curiosity. “Paying attention with lightness is an important component of somatic tracking. Scientists study positive affect by having subjects look at happy images, watch funny videos, or listen to joyful music. Experiments like this show that when people’s moods are lightened, they are better at overcoming pain-related fear.”
But Gordon and Ziv warn their readers to be prepared for the occasional ‘relapse’ of a neuroplastic pain episode. This is a result, they aver of wafting back into bad habits induced by a sense of complacency and over confidence. However, the relapse in itself according to the duo ought not to cause much disillusionment. The trick is to overcome the relapse by employing the same tactics that caused the neuroplastic pain to disappear in the first place, and originally. There are 3 stages to every relapse; Panic, Forcing it Down (practicing somatic tracking with a ferocity and vehemence that defeats the very purpose) and finally the conquering of the relapse by the patient by getting a grip over herself and practicing the technique of somatic tracking in a relaxed, unforced and flowing manner.
The authors before closing their engrossing book rightly bemoan the complete disdain given to the concept of understanding pain, in medical curricula across the globe. “Medical students spend thousands of hours learning everything from anatomy to genetics. So how much of the medical school curriculum is devoted to pain? In the United States, it’s eleven hours. Not eleven hours per class. Not even eleven hours per year. Eleven hours of pain content in the entire four-year curriculum. The rest of the world doesn’t fare much better. In Europe, it’s twelve hours. In the U.K., it’s thirteen. Canada, Australia, and New Zealand are on the high end, with twenty hours dedicated to pain. Eleven hours?! Twenty hours?! Of all the stories, studies, and statistics that I’ve presented in this book, this is the most mind-boggling. In school, I spent at least thirty hours learning the periodic table of the elements. I have used that knowledge exactly zero times. And yet future doctors are spending less time than that studying something that afflicts more than a billion people worldwide!”
‘The Way Out’ – an experiment towards probable excelsis.
