IPPS Highlight: Neuroplasticity for the Clinician

At this year's International Pelvic Pain Society (IPPS) meeting held in Las Vegas last weekend, I found myself wishing that I had reviewed neuroanatomy prior to the conference. Many speakers addressed portions of the brain such as the insular cortex as the brain continues to be a prominent piece of the puzzle in chronic pain anywhere in the body. Dr. Alain Watier, a Canadian gastroenterologist who specializes in treatment of pelvic pain, gave a lecture that included research based on chronic pain as well as practical advice for the clinician. He states in his lecture that a provider should be familiar with the neurobiology of pain. Functional brain imaging studies have identified that the brain can be activated simply by anticipating pain relief, and that the brain can then activate pathways that modulate a patient's pain experience. There is significant anatomy and physiology involved in the modulation of pain, and reduction in pain can be achieved through pharmacology as well as through the brain.

How do we encourage our patients to maximize the ability to use the brain for pain reduction? Here is a practical suggestion based on the idea that the brain must re-learn "normal" pain perception. The patient can be taught to actively engage the brain in soothing thoughts, feelings, memories, touches, smells, and new beliefs. When a patient experiences an increase in pain, she should "...flood the brain with memories of how they felt and who they were before pain." Patients can be taught to use mindfulness meditation, many forms of biofeedback (thermistor for skin temperature, mirror therapy, heartbeat regulation, and blood pressure. ) Cognitive behavioral therapy can be helpful in reducing anxiety as well as gastrointestinal disorders.Other techniques that can help a patient heal were discussed such as EMDR, hypnosis, art therapy, massage, and acupuncture.

When patients are dealing with chronic pain, according to Dr. Watier, is is critical to engage a multidisciplinary approach and to focus on changing the brain/body patterns of pain perception. The pelvic rehab therapist can play an important role in explaining that the brain can physically change during chronic pain experiences, and that to heal, the brain must be addressed in addition to the peripheral pain. The patient can be guided back to gentle, graded movements so that moving can again become a positive experience, even in small doses.