If we really broke down what we have learnt from the pain revolution in neuroscience over the last 20 years, it might come down to three key points;
1. The brain is very, very changeable
2. The brain plays a major role in how we, as humans, construct pain
3. The brain is a ‘neuroimmune’ organ and the science that we are really talking about is ‘neuroimmune science’
Although saying that pain is ‘constructed’ in the brain may upset some of our friends in the philosophies of mind and consciousness, it has become a shorthand way of talking about the amazing complexity of pain and the first step towards informing society that learning about the brain and pain can be beneficial.
At NOI, we have trialled, played with, and guessed at ways to tell people about their brain and pain. Like many clinicians out there, we have had some great wins –“Yes. I understand it now, of course that makes sense, thanks“… and some spectacular failures – “bloody physio thinks it’s all in my head”. Over time I think we are getting better and better at this complex intervention – future clinical studies will let us know. But for now, there is research from educational psychology and science that we can and should apply – there are ‘guidelines’ from evidence based multimedia to power up and improve our ‘made in the brain’ narratives. (We have written about these before.)
Talking about brains is an intimate thing
When you really think about it, talking about someone’s brain can be an intimate thing. It’s right up there in the league of chats about bladders, bowels and sex! Not only can it be intimate, it can be exhausting discussing a three dimensional, hidden structure with complex, everchanging, abstract and emergent workings. While many people have something of a mental picture of the external view of a brain, the internal workings are especially hard to imagine. Patients and other learners need something solid to grasp onto when trying to make sense of this very abstract idea.
A nail box (also called a pin box – see the video below) can be used to explain aspects of brain function and the therapeutic potential of interventions that target the brain. These boxes were popular in the 70s and 80s but can still be found online, or in toy and gift shops. In terms of evidence based multimedia, the box is an external, animated model which allows a reasonably accurate, metaphorical, three dimensional model of neuroplasticity. It is particularly powerful because it can demonstrate the ‘elasticity’ of the brain – it’s ability to change, and also change back.
The nailbox is also something you can touch, experience and ‘see’ changes in. Demonstration of the brain’s working via a nailbox requires minimal scientific language and, via this simple mechanism, it’s possible to show complex aspects of neuroplasticity. For those who find the brain story a bit too personal, the metaphorical nailbox also allows a bit of distance from the real thing and may help to, respectfully, get past cognitive defences.
Here is my version of telling a person about smudging in the brain and the changeability of the brain with a nailbox. Take a look and let me know your thoughts, how you might use the story, and how we can make it better in the comments below.
Supercharging Explain Pain and Explain Brain at EP3 2015
We owe a debt of gratitude to the pioneers in brain imaging here. The many blobs of activity on early fMRI scans proved that there was no ‘pain centre’ in the brain and that nociception triggered off a cascade of parallel, distributed activity in the brain that we now label as neurotags (as well as the fact that nociception wasn’t even required for brain activation and a pain output).
At the forefront of modern brain imaging is Robert Coghill, who will be travelling to Australia next year to present at EP3 2015. Robert and his team work to better understand the role of the brain in pain, combining psychophysical and functional magnetic resonance imaging to explore the relationship between regional brain activation and discrete aspects of the pain experience.
Joining Robert in Melbourne for EP3 in 2015 will be Kevin Vowles. Kevin is the world’s leading exponent of the application of Acceptance and Commitment Therapy (ACT) to chronic pain. Kevin’s work has established the validity of the ACT model for chronic pain and he has published widely on the notions of psychological flexibility, fear and anxiety in relation to pain.
Robert and Kevin will also be joining a stellar line up at PainAdelaide on 30 March 2015 for “Probably the best little pain meeting in the world” – definitely making March the best time to visit Australia next year. Both Robert and Kevin will add their unique perspectives and expertise to the growing multidisciplinary science, and evidence, behind Explaining Pain – I’m looking forward to powering up my brain narratives even further with the latest findings from brain imaging and the world of psychology. See the details below for more information and how to register for EP3 2015. website | flyer
– David Butler, Noigroup