Chronic Pain: When Brain Plasticity Work Against Us

I’ve recently learned about a type of pain called ‘nociplastic pain’, where the brain becomes ever-more sensitive to pain stimulus, and actually rewires itself over time to feel pain more intensely. This is linked to a progressive sensitisation of the brain and nervous system, where they become hyper-responsive, and struggle down-regulating our neural response to life. It is now thought that both nociplastic pain and central sensitisation play a role in almost all chronic pain conditions [REF1].

The standard approach to chronic pain is to deaden the sensation by using ever-bigger doses of liver-heavy painkillers and opiates. Tragically, studies now show that painkillers, especially opiates, actually increase pain sensitivity and pain levels slowly over time, meaning you need to constantly increase the dosage or end up worse than you started [REF2]. Understanding the nociplastic pain cycle is crucial to avoid this trap.

Side note: Nociplastic ~
‘noci’ means bad or pain, ‘plastic’ means mouldable. Brain plasticity refers to the ability of the brain to mould and remould itself over time, laying down constantly different neural networks. Brain plasticity is generally a positive thing, and is increased by constant learning, new environments and psychedelics, and is reduced by age.’Nociplastic’ therefore means flexible/mouldable response to pain.

Chronic pain is an unruly beast.

Some days you think you’ve got this; other days it is a constant niggling in the background that subtly drains your energy and good cheer, and other days it destroys your sleep, work, mood, and ability to feel like a normal human.

1.6 million Australians live with chronic pain that interferes with basic daily life. That’s 1 in 5 of all adults over 45. And nearly half of them are clinically depressed, for obvious reasons: being in pain constantly really gets you down! [REF3]

The last few years I have become much more interested in chronic pain, as I’ve had my own journey with it. I’ve had moderate pain levels in my hips and lower back due to an old injury being triggered by stress. Currently, I can walk about 20 minutes before It starts to flare up. I sit on a large swiss ball at the dinner table, and need to stand up while using the computer. I spend at least $80 a week at the osteo and remedial massage, and if I don’t I rapidly go downhill. While I was pregnant, the extra pressure in my pelvis meant there were days I couldn’t walk to the toilet unaided, or stay standing long enough to make myself breakfast. I say this not to elicit torrents of sympathy, but rather to provide a personal window into the challenges of this ambiguous illness. Keeping my pain at a tolerable level is exhausting and expensive. And honestly, I’m on the lower end of the chronic pain scale. It gets much worse than this!

So what is nociplastic pain, and how does it provide some hope for chronic pain sufferers?

Basically, it is a form of pain that is out of proportion to the tissue damage, injury or nerve damage that exists in the body, and sometimes even occurs in the absence of any damage. It is due to an abnormal processing of pain signals in the brain. It is a learned behaviour – as in, the brain learns to do this over time, rather than being a disease or developmental fault. Anyone’s brain can learn this (oh joy!).

It seems likely that this is why chronic pain is so often experienced more intensely by people over 45. Personally, I always thought I had a great pain tolerance, but have slowly started to question that. Since learning about nociplastic pain I’ve realised that although I did used to have a good pain tolerance, my brain has newly developed a very low tolerance for pain due to a number of factors.

What causes nociplastic pain?

Our old friend inflammation, plus a little bit of unhelpful brain activity.

When we have inflammation somewhere, it sends signals to our brains that something is wrong. Ideally, the body then mounts an effective immune response, repairs the damage and those signals die down. This is inflammation being a great emergency responder  worker and doing us a real favour. However, many problems of modern life cause inflammation that cannot be easily repaired by the body. This leads to chronic (ie, ongoing) and generalised inflammation.

Chronic inflammation still sends alert signals to the brain and local nerve tissue, but the body fails to fix the problem. So the alert signals increase, and the brain starts to become more sensitive to these signals hoping that we can somehow mop up the damage. This actually causes more inflammation, which causes an increase in pain sensitivity. And so on.

It’s an unfortunate negative feedback loop between the immune system and the neurological system.

Think of it like the climate crisis: the inflammation is like the temperature. A warm day or a warm summer is no problem, but once the temperature rises throughout the whole climate even a small amount, it triggers problems like drought and flood that then make the environment even more unstable, killing off forests (drought) and washing away topsoil (flood) that then raises the temperature a little more. And so on.

Nociplastic pain and its cousin, central sensitisation syndrome (where there is increased activity in pain sensors, poor in-built pain relief mechanisms and altered processing of sensory input in the brain, leading to nociplastic pain and a heightened sensitivity to all stimulus such as loud sounds, bright lights or colours and strong flavours), are a major part of the following conditions:

• pain that is disproportionate to the injury or damage
• fibromyalgia
• chronic fatigue syndrome
• IBS
• intensely painful periods without endometriosis
• migraines.

Perhaps you can see the common thread here: all of these conditions tend to slowly worsen over time, there is little detectable tissue damage, the pain and debilitation is real, and there are cycles of flare ups but rarely a full recovery.

How do we reduce nociplastic pain?

There are two major avenues of repair for nociplastic chronic pain.

Firstly, break the feedback loop between inflammation and sensitisation by reducing inflammation throughout the body and brain.

Secondly, protect the brain and nervous system, helping your neurological self to chill out and reduce hyper-sensitivity.

*Singing, dancing, reading or cycling for 30 mins in a fasted state increases PEA by 50% (and other ECBs to varying degrees) [REF4].

** 400mg 3x daily of PEA (an endogenous cannabinoid) has been shown to significantly reduce chronic pain and inflammation in 2 weeks) [REF5].

The king of all anti-inflammatory herbs is Turmeric.

I’ve personally being suspicious of all the claims about turmeric, but it turns out that it really does amazing things for the levels of pain, inflammation and neuroinflammation provided it can cross into the bloodstream from the gut. Most turmeric out there does not. Even large amounts of turmeric powder, turmeric juice or even straight curcumin will fail to replicate the results being seen in lab trials in a test tube because they will not actually get to the site of inflammation.

This means it will reduce inflammation in the intestinal tract (which is still a wonderful outcome if you have gut issues), but will not achieve the reduction in neuroinflammation, joint inflammation and tissue inflammation that is often claimed. I’m sure there are other turmeric products out there that are bioavailable, but the one I have looked into deeply enough to trust is a Mediherb product called ‘Curcufen’, that coats the curcumin in a gel extracted from fenugreek seeds, which helps it slide straight through the gut walls into the blood, with impressive bioavailability results [REF6]. [side note: Mediherb products are only available through a healthcare professional such as myself- you can source through me with a consultation.]

It might be hard to believe, but a pilot study in 15 people with acute pain found that 400mg of highly bioactive curcumin was similar in pain relief to 1000mg of paracetamol – with bonus health benefits rather than health damage! [REF7]

Other wonderful anti-inflammatory herbs that are useful here are Boswellia (frankincense), which is one of the few anti-inflammatory herbs to cross the blood-brain barrier, and Ginkgo, for all its neuroprotective effects.

Treating the whole picture.

This type of nociceptive pain is never the whole picture; you must also be using herbs that address the specific situation. EG, devil’s claw for joint pain, cramp bark for muscular pain, ginger for menstrual pain, passionflower where the pain coexists with anxiety and stress, siberian ginseng when there is extensive fatigue and debility. Real results with herbs only come through working with a professional who knows how to differentiate your specific situation from the next chronic pain sufferer.

If you are suffering from any chronic pain condition, my heart goes out to you! Even though western medicine cannot always find a clear cause for your pain (or a treatment), it is still just as real as a broken leg. Simply deadening the pain with painkillers every day is likely to worsen your experience over time, rather than give the relief you crave. You must break the cycle of inflammation and brain sensitivity.

Medicinal herbs can greatly assist with restoring balance and wellbeing to the body and mind, but remember that herbal medicine is never a silver bullet for what ails you. Most true recovery from stealthy and chronic conditions like nociplastic pain require deep shifts in lifestyle and mindset. Get support from a team of great professionals – body workers, herbalists, counsellors and meditation teachers – to walk with you on a journey towards greater ease and delight in inhabiting a human body.

If you would like to feel supported having less pain in your life, book a free 15 min health chat about your specific context with me here: Book Now

References:

REF1:

Yunus MB. Fibromyalgia and overlapping disorders: the unifying concept of central sensitivity syndromes. Semin Arthritis Rheum. 2007 Jun; 36(6): 339-356. doi:10.1016/j.semarthrit.2006.12.009. PMID: 17350675

REF2:

Yi P, Pryzbylkowski P. Opioid Induced Hyperalgesia. Pain Med. 2015 Oct;16 Suppl 1:S32-6. doi: 10.1111/pme.12914. PMID: 26461074. REF3:Australian Institute of Health and Welfare. https://www.aihw.gov.au/reports/chronic-disease/chronic-pain-in-australia/summary REF4:Stone NL. An analysis of endocannabinoid concentrations and mood following singing and exercise in healthy volunteers. Frontiers in Behavioral Neuroscience. REF5:Petrosino S et al. Palmitoylethanolamide: A Nutritional Approach to Keep Neuroinflammation within Physiological Boundaries- A Systematic Review. Int J Mol Sci. 2020 Dec 15;21(24):9526. doi: 10.3390/ijms21249526. REF6:Krishnakumar IM, Abhilash R, Kumar D et al. An enhanced bioavailable formulation of curcumin using fenugreek-derived soluble dietary fibre J Funct Foods 2012; 4(1): 348-357 REF7:Di Pierro F, Rapacioli G, Di Maio EA et al. Comparative evaluation of the pain-rellieving properties of a lecithinized form of curcumin (Meriva) and acetaminophen. J Pain Res. 2013; 6: 201-205