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?
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