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Sunday, August 26, 2012

Playing at the Intersection of Sensation and Suffering

Pain is a very serious issue for many people, so they might reasonably ask, "Will the AT help with my pain?"  I want to say right upfront that I would not claim that the AT will help with pain.  The AT teaches conscious control of self which leads to better use of the self.  It does not diagnose any pain syndrom and does not treat any malady including pain.  Does the AT help with pain?  Well, it certainly might, but if it does it's a happy byproduct.  I imagine some who have pain might walk away: "Why would I want to pay for lessons in something that does not claim to help me with my pain?"  That is reasonable.  Others might linger a bit and ask "Well studies do suggest that AT can help with pain, so tell me: How might the AT help with my pain?"  I think AT teachers should have something to say to this.  Further, I think it is compassionate to market the AT to those who suffer from chronic pain.  They really need any help they can get.

And suffering from chronic pain is a big deal.  I'm not talking about the "duka" or dissatisfaction that is at the core of the Buddhists first noble truth.  I'm talking about the effect of chronic pain which is terrible.  Not having had chronic pain, it is not really my place to talk about it, and I apologize if I am insensitive in my ignorance, but I would like to make a few comments.

Attitudes towards pain has changed quite a bit in my lifetime.  As a middle class child in the US in the early 60's, I was expected to sit quietly while the dentist drilled cavities without any anesthetic.  These memories are still vivid.  While studying medicine 15 yrs ago I was taught that the patient has pain if she says she has pain.  And that it should be taken seriously and treated, with narcotics if necessary.  Now, in Oregon, more people die from prescription narcotics than from illegal drugs.  Yet chronic pain is still very much an issue (back pain is the sixth largest expense in managed care) and it is very difficult to treat.  Increasingly the medical establishment is working with other providers to help sufferers.  There seems to be greater openness in the medical community - an opportunity for other professionals.

There have been insights into the science behind chronic pain.  This blog entry is based on an article written in the Journal of Dental Education by Ronald Melzack, Ph.D who is a professor Emeritus at McGill University.  The article was recommended by a reader, Tim Kjeldsen: Thanks!  You can read it at

http://ipcoregon.com/pdf/pain_and_the_neuromatrix_in_the_brain.pdf

My last blog was also based on this article, but the focus was on it's implications on the reliability of our senses.

I have read it four times, slowly, and an not confident I can summarize it.  Please read it.
The author says that current pain theory has evolved away from the Cartesian concept of mind/body separation and the concept that tissue injury is the sole instigator of pain, to a much more complex theory.  The author has studied the phantom limb pain phenomena.  This refers to the very genuine limb pain that can seem to be produced by a limb that has been lost.  This phenomena suggests that the production of the awareness of pain is independent of the body part that seems to be effected.
   He says that there is a "body-self neuromatrix" which is a gridwork or template.  It is a very complex, widely distributed, communicating, cyclical processing neural networks that has inputs from the body sensory apparatus, the mind, and the endocrine system.  Outputs also go to a sentient neural hub which produces the continually changing stream of awareness.
If the body-self neuromatrix decides these inputs are adequate, it triggers outputs that include behavioral changes, stress regulation changes, cognitive changes as well as the sensation of pain.



Central to this formulation of pain is a notion of homeostasis.  It supposes that the body is always striving to maintain equilibrium.  You're body is good at 98.6 degrees ferinheit, and maybe OK with 98.5 but much lower and your feeling uncomfortable, you look for a jacket, you're shivering.  The homeostasis model mostly seems to work, but I doubt it was developed by a perimenopausal woman durring a hot flash.

The body self neuomatric then has a simple job.  It takes all these inputs and and answers the question "Am I OK?"  If it decides that homeostasis exists it does not trigger these pain perception + action programs + stress-regulation programs.  If it decides that homeostasis does not exist then all these are triggered.  I suppose these outputs are the brains attempt to re-establish homeostasis.

I think this is a delightful model for several reasons.  First, it finally defines pain not as some solid, real thing, but as one part of the creation of an incredibly complicated body-self neuromatix with many inputs.  Second, it defines "suffering".  "Suffering" is the entire package of outputs from the body-self neuromatrix if it has decided that homeostasis has been lost.   Third, it gives me a framework that I can use to explain how the AT might help with suffering.   Finally, it gives us so many opportunities to intervene and suffer less.

This model as explained in the article says that inputs from the mind, sensory apparatus and endocrine systems all contibute to unsettling the body-self matrix.  But I think it extreemly important do consider: can these inputs have a calming, palliative influence?  It seems obvious to me they can.  If I am well fed and rested I will be less likely to be upset by a minor sprain?  It's alarming to see that there are so many inputs to irritate the body-self neuromatix, but it is equally hopefull that we can use these same pathways to placate it.

Obviously the AT can help with chronic pain by improving use and thus minimizing the noxious muscular input to the body-self neuromatrix.  This is the classic understanding.  But there are a few other ways that the AT can influence the body-self neuromatrix.
  - First, is that it can influence the "tonic inputs from the brain" (tonic sensory input adapts slowly to a stimulus), that is attention, expectations, anxiety and depression.  I think it can be quite healing for the chronic pain suffer to take a break from spending time with those who are concerned about their pain.  Chronic pain sufferers are surrounded continually by solicitous caregivers, coworker, family and therapists.  Everyone is wrapped up in the persons pain.  But not the AT teacher.  Pain, or lack of it, is not the issue.  In fact the AT is not really interested in sensation at all.  Durring a lesson pain issues are set aside and students work on learning how to inhibit and direct.  What a relief!  How healing!
  - Second, the AT teaches, in part, a unified field of awareness: up, front, back, both sides (and even down).  Not that anyone suggests ignoring pain, but the training is to be aware continually of everything else as well.  This unified awareness changes the "phasic inputs from the brain" (phasic receptors adapt rapidly to a stimulus).  That is, the AT helps teach the brain to input a broad variety of inputs into the body-self neuromatrix: not just the one-pointed fixation on pain.
  - Third, there is an emphsis on the primary control, the relationship of the head, neck and back.  The primary control is the key to not contracting and pulling down.  The primary control is the gateway to enter the startle reflex, it is the threshold that must be crossed to enter into a habit.  The AT teaches inhabition and direction of the primary control to allow one to use oneself consciously, to use onself in a new way.  The effect then is to alter the "tonic somatic input".  Chronic pain, as well as PTSD, are characterized by axial rigidity.  The AT gives students the tools to intefer with this habit.  As the students employ these tools this rigidity diminishes.  When it does, the input from the body to the body-self neuromatrix changes from being irritating to homeostasis to being reassuring.  There may still be big somatic sensory inputs, but instead of the mind being preoccupied with intense narrow preoccupation with neurotic thinking and the body tensed and pulled down, the pain will be combined with global awareness and a tall and wide stature.  These will be reassuring to the body-self neuromatrix.

Try this next time the dentist is coming at you with her drill.  Stop yourself.  Then think "I wish my neck to be relaxed to allow my head to go forward and up.  And I want my torso to be long and wide."  Put plenty of energy into this, but be sure not to actually "do" anything.  You will see that your dental experience will be transformed.  Sure, huge sensory input!: she's drilling your tooth!  But you won't be suffering: your body-self neuromatrix is combining the irritative tooth sensation with palliative input from the brain and body.  The body-self neuromatrix is saying "Wow, lots of tooth sensation! But the brain is otherwise calm and focused, not crazed like it usually is when bad things are happening.  And the body is not all tightened like it is when we're panicing.  So maybe we're OK, maybe for now there is no need to press the "NOT OK!!" button."
You can actually play with this.  While the dentist is having at you, stop your inhibiting and directing and concentrate on the drilling.  You can feel your thoughts chang, the body tightening and the panic set in.  Then go back to inhibiting and directing and feel the body-self neuromatrix back down.  Although this sounds like simply playing at the intersection of sensation and suffering, it is actually important work.  The dentist is a fairly safe place to play, but I'm sorry to say that there may be more significant slings and arrows coming at us at some point.

I humbly suggest that the thrust of pain research should be to find ways to anchor us homeostasit.  How can we convince the body-self matrix that we are still in homeostasis even if there are big somatic inputs?  Sure, the AT helps with pain through better use.  But at least as important is that it anchor us in homeostasis.  It gives us the tools to use our bodies and minds in such a way as to reassure our body-self matrix that we are indeed 'OK' despite other stimuli that would normally "put us wrong" and produce suffering.

Zen practitioners explore this while sitting.  Zen student get plenty of experience in influencing tonic and phasic inputs from the brain in the midst of significant sensory input.  Few westerners can sit on a cushion, and not move for 40 minutes, without some significant sensory inputs that tend to nudge the body-self neuromatix out of homeostasis.   There is an interesting Buddhist Geeks podcast (#249) with Rob McNamara.  He is a weight lifter, who, like me, is very interested in how to practice physically.  Playing at this intersection of sensation and suffering burns off the undergrowth and fertilizes the forest of compassion.

Ultimately, the Zen student can not ignore what the Heart Sutra has to say about chronic pain: it is empty, without an abiding independent reality.  It is so hard to understand this, but so important, I think, if we want to find true liberation from suffering.  The body-self neuromatix theory shows us that pain does not have an enduring, seperate existance, that it is empty.

It may take time for the Zen student to creatively engage pain till it's emptiness can be preceved.    But since the effects of chronic pain are so serious, it makes sence to aquire all the skills to reassure the body-self neuromatrix.   Zen and the AT gives us overlapping tools to inhibit the manufacturing of suffering.  My experience is that 30 years of zen practice is very roughly equivalent to 20 one hour lessons in the AT.

And you?

Wednesday, August 22, 2012

Sensory appreciation and the Body-Self Neuromatrix

If there is one defining feature of Zen, is the emphasis on the posture while in meditation.  Universally, Zen teachers are strikingly upright and expansive.  And this emphasis can also be found in Japanese Zen teachings.

This Blog is about how to sit upright.  For many it may sound silly.  Many think it happens "naturally" or comes with experience without any effort.  Some might think they already sit upright just fine, thank you very much.  Others might say "Well, I feel my body and rely on the sensations to guide me.  I can feel when I'm leaning over, and I can feel my self making an adjustment, and then I feel upright.  If I feel upright I am upright."
It's this last group that I want to talk to.  The fundamental assumption in this blog is that the sensation we get from our bodies is not a reliable basis upon which to make decisions about how to do something.  You may feel like you are leaning one way, when in fact you are not.  You may feel tightness around your chest when it may, or may not be, tight.

I have lots of examples from my own life, but I have not shared them because I'm sure it would not convince anyone.

This post is based on an article suggested by a reader, Tim Kjeldsen.  He suggested reading:

http://ipcoregon.com/pdf/pain_and_the_neuromatrix_in_the_brain.pdf

I have found it very interesting and highly recommend it.  It has to do with chronic pain, but the theory of the existence of a "Body-Self Neuromatrix" has relevance here.  The article from the Journal of Dental Education by Ronald Melzack, Ph.D who is a professor Emeritus at McGill University.  Apparently he is an expert in phantom limb phenomena.  This is when a person feels a perfectly real limb, that is not actually present.  Since this non existent limb can hurt, brain researches have had to throw out the old Cartesian concept of pain as a sensation produced by tissue pathology.
The body-self neuromatrix is thought to be a group of very complex, widely distributed, multiple, communicating, cyclical processing neural networks.  The inputs into this matrix include all the sensory inputs, but also cognitive inputs such as cultural inputs, personality, past experiences, etc.  Inputs also include from the the endocrine and immune systems.  Obviously complicated, but hey, it's brain science.
While the input and output from the body-self neuromatrix sound very complicated, the functions sound are pretty simple.  It decides "Am I OK?".  If it decides "Not OK" it triggers pain perception, actions and alters stress regulation.  I'll write more about this later.  But more germain to this blog entry is that the output from the body-self neuromatrix is projected to a sentient neural hub - in which the stream of nerve impulses is converted into a continually changing stream of awareness.  This is where the experience of movement is created.

To back up a bit, I used to believe that "I" exist somewhere in my brain.  I get accurate sensory information directly from my body and make decisions based on this.  Brain science does not support this at all.  Setting aside for now the location of any "I" in my brain, I clearly am not sensing my body at all.  Sensations from my body are constantly mixed up with a whole lot of other inputs, mixed and remixed, and fully processed.  When done it goes to the sentient neural hub and it is here that the stream of awareness and experience of movement is created.

I had to think about this a bit.  And please read the article for yourself to be sure I'm getting this right.  When concepts are complicated I reach for metaphors.  I hesitate to do this because I have to acknowledge my limits to think clearly and write effectively.  Sorry.  Here is the way I see it: Trying to feel my body while sitting in order to figure out if I'm upright is like figuring out what is happening in the middle east by watching a powerpoint presentation on the middle east given by a EU prime minister.  What the powerpoint presentation tells me is based on intelligence from the middle east, but also politics, economics, cultural issues, etc.  Will the powerpoint give me a good idea of what is going on?  Uh, maybe.  Is it adequate to make a decision to go to war?  Yeah, I'm thinking WMD here.  Is this slideshow adequate to make decisions to "adjust" your posture?

There are two other articles I've read recently that have moved me.  One was from a recent issue of Buddhadharma that talked about the Heart Sutra, which is the most commonly recited teaching at the zen groups that I have attended.  It is a simple but uncompromising denial of the inherent nature of anything and everything.  There is nothing with an abiding separate self.  Everything is empty.
It is relatively easy to see how our powerpoint presentation is empty.  But what about my eyes?  My ears, nose, body and mind?  Where is the solid reality in my ideas of myself or the sensations and stimuli?

The other wonderful article from Buddhadharma is by Reb Anderson regarding the "three turnings of the wheel", which really helps to organize the above.  The first turning has to do with the four noble truths: there are real problems in life, there is a reason for these problems and ways to help resolve them.  The second turning is the teaching on emptiness of all things.  The third turning combines the two teaching and enables us to act.

The AT explanes how to physical sit and how to bring our practice into everyday life.  Unlike yoga, the AT is based on intention and non-doing.  Like zen sitting it is based on a fundamental deep acceptance of the present moment - of who you are.  Both the AT and Zen are also in step with the body-self neuromatix theory.