Axiom 1 of CognitiVR for persistent pain is – Treat the pain NOT the injury.
Properly understood, this is a massive and revolutionary shift. Almost all pain has its origins in acute nociceptive pain, mostly (not always) precipitated by a trauma, an accident, surgery or an illness. The co-existence of the trauma may be an important component in the development of persistent the pain story (this is discussed elsewhere).
This original pain is injury-based; persistent pain by definition persists beyond the healing of the injury. Some professionals then say the pain is not in the body or has no physical cause, (as it cant be seen on an X-ray) and therefore you are “imagining” it. This idea that because it is not in the body it must be in the mind is wrong. More correctly we should say the origin of the pain is no longer the injury, the origin of the pain is now the neurological/neuroplastic consequences of the injury. The pain as a real entity in itself, must become the focus of treatment.
It is an important shift for the clinician because the focus is now not on the injury but on the pain. It is also an important focus for the patient as they will not be looking to find or resolve the injury, but rather to treat the impact of the injury on their nervous system and their brain. This shift will create a different diagnosis for them and a different treatment path.
Persistent pain is pain that is no longer caused by the injury. Some experts describe pain as a ‘harm alarm’. If there is a fire, the fire alarm goes off and you put out the fire; then the alarm disarms. In persistent pain, the alarm misfires and becomes faulty – it continues to go off in the absence of a fire. At this stage there is no point in using a fire extinguisher, you need to fix the alarm.
The fire is the injury, the alarm is the pain. It is not imaginary and it is physical. It is in your body; however it is not caused by your injury and we don’t need to fix the injury, we need to fix the alarm system.
This is a very hard concept for pain sufferers to grasp because the narrative of their pain is very clear – I broke my leg and it hurts, it still hurts in the same way, therefore the pain is caused by my broken leg. This is true – the pain was caused by your broken leg and you now suffer from persistent pain which is a separate and very complex issue (worthy of its own article).
One of the principles of statistics is that correlation does not imply causality, if two things happen together or the one follows the other, it does not mean the one causes the other.
Understanding this for pain sufferers is even harder because our pain system resides in our ‘lizard brain’ – it is not very responsive to logic or psychology. (CognitVR is a way of speaking to your inner lizard.)
This alarm system is physical – it consists of the nerve pathways that link the original site of the injury to the brain and parts of the brain itself. The alarm system is also connected to the sprinkler system: these are the parts of our body designed to deal with threat both mentally – our stress response – and physically – our immune system and the body’s natural healing processes.
In persistent pain, both the alarm system and the sprinkler system are faulty and this is why persistent pain is sometimes accompanied by swelling or redness or skin changes in the previously injured part. For the patient, this is even more compelling evidence that the pain is caused by the injury, when it is not.
If we get a splinter in our finger, we feel our finger hurt. The pain however, does not belong in the finger: there is a complex chain of events that starts in our finger, goes up our hand and arm through the spinal cord to the brain and then out of the mouth (”Ouch”) as an emotional expression. (Another loop starts at this point – do you pull the splinter out, call for help, go to the GP, do nothing, cry and why do you pick this option?)
Through the process of developing persistent pain, pain sufferers are exposed to periods of prolonged unrelenting pain as they shift from the acute to the persistent phases. During this period the body learns pain, the brain learns pain and the mind learns pain.
The nerve pathways around the site of the injury change, the nerve pathways to the brain change, the brain changes, the immune system may change and the psychological response develops. Our whole system learns the pain. CognitiVR and the Tranceducer help us to unlearn them.
We do not treat the injury and we do not treat the psyche; we adress the multisystemic persistent pain process. We retrain your pain response. Our system is both bottom up and top down. Top down approaches try and shift the mind to change the body, bottom up systems work just with the body and your experience of it. We use the Tranceducer – a tailored XR environment using Virtual Reality – to engage with your body, and CognitiVR to retrain your pain response.
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