Two of the most interesting new treatments for chronic pain are graded motor imagery and mirror therapy. A related experimental treatment which is being studied as we speak is called “tactile discrimination.” What’s this about?
Chronic pain creates changes in your brain. We think that these brain changes cause other functions to become impaired as well, for example, right-side and left-side discrimination. Right-side and left-side discrimination is simply knowing your left side from your right side. If you have chronic pain in your right hand, your brain will have a harder time identifying right hands. Re-train the brain to again be able to discriminate right versus left, and pain can decrease.
We are finding out that chronic pain also creates an impairment in “tactile discrimination,” which is simply your brain figuring out what is touching your body, without you looking with your eyes. Here’s an example: While you look the other way, I can touch your arm with, let’s say, the point of a pencil or an eraser. Your brain should be able to figure out which is which – the pencil point is pointy and the eraser would feel softer.
However, in chronic pain, this ability becomes impaired in the area you have pain. For example, patients with back pain have a harder time figuring out if they’re being touched by that pointy pencil or the soft eraser on their back.
What is being researched right now is if re-training patients to again discriminate touch can help decrease their pain. In other words, does this type of re-training work the same as re-training to figure out right and left.
One of my favorite researchers, Lorimer Moseley, recently published a small trial looking at this question. 13 patients with complex regional pain syndrome (CRPS) of one limb had tactile discrimination for 2 weeks. The control group were simply touched, without being asked to figure out what the touch was. Thus this tested if just touch or actual discriminating what the touch is results in any change in pain.
The results: There was no change in pain or being able to discriminate after simply being touched. But, pain and touch discrimination were better after practicing touch discrimination. And the improvements still continued at a 3-month follow-up.
This is very exciting work! I have been using this type of treatment with some of my patients, and look forward to more studies coming out. Several national pain associations are trying to spread the word about these treatments and train clinicians in using them. Knowledge is power!
The original article is Tactile discrimination, but not tactile stimulation alone, reduces chronic limb pain, Pain 2008, Vol 137, Pages 600-608.
Reminder: November Pain-Blog Carnival submissions due by this Friday, 11/21.
10 responses so far ↓
Nickie // Nov 17, 2008 at 5:37 pm
Wow! This is really neat! I’m especially excited as a blind person with CRPS. I’ll definitely look at the article and share it with my health care providers.
How to Cope with Pain // Nov 17, 2008 at 5:49 pm
Yes, this is another way, in addition to new ways that use the visual system, to change things directly in the brain. And once you undertstand the underlying theory, the actual technique is very easy to implement.
If a health care provider runs into problems implementing the treatment, they’re welcome to post a question here, and I can see if I can clarify any issues.
jeisea // Nov 17, 2008 at 10:06 pm
This is a really great post!
I have a definite problem with recognizing left or right hands and feet. Like others with complex regional pain syndrome I have altered sense of touch.
Just as retraining the brain by moving normally and desensitization the skin by using a variety of things, this new idea of training the brain to recognize touch is brilliant. It’s a different variation and will build on the brains experience of touch using different pathways.
On a few occasions I’ve lost my sense of my body in space (proprioception I think it’s called). At one time I wanted to scratch my left with my right hand. I was in bed at night so it was dark. I couldn’t find my left hand. I kept trying but I just couldn’t touch it. I ended up having to turn the light on and watch what I was doing. I then practised touching myself with my right hand until I re-learned the task. Once I’d re-learned the task I was right.
In the same way mirror therapy retrains the brain. Once it is retrained it’s permanent until something happens to trigger problems again.
This is simply amazing stuff.
jeisea
Barbara K. // Nov 19, 2008 at 3:49 pm
This is very interesting (I had also read about mirror therapy of Jeisea’s blog) . Do you know how to find practitioners or teachers of these methods?
How to Cope with Pain // Nov 19, 2008 at 4:55 pm
Barbara, unfortunately, it isn’t easy to find someone. I’d ask your current pain management team if they know how to use this treatment, or if they know someone else who does.
Another option is to look on mirror box websites to see if they have “practitioner” links. A good one to try is NOI Group.
Overall, PT and PMR (physical medicine and rehab) practitioners are probably the best place to start. (I say this even though I’m a psychiatrist, but psychiatrists using it is even more unusual.)
Let us know if you’re successful in finding someone.
How to Cope with Pain // Nov 22, 2008 at 5:17 pm
I’ll be posting in December on articles on this treatment and other ideas for finding a practitioner. Check back (or, even better – sign up for email or RSS delivery of How to Cope with Pain, so you get the info right away).
thematrix777 // Feb 11, 2009 at 2:12 pm
I have the VERY same problem. I can’t find my hand without looking for it visually. My first occupational therapist taught me that. It was almost like a “trick”.
I said if I was ever got stopped by the police and asked to do those drunk things like touch the tip of your nose, I’m dead meat. I can’t do that sober!
I did de-sensitizing in the beginning and it worked. But 5 years later, it’s back like before. I have all the beginning symptoms like sensitivity, loss of limbs feeling, can’t tell left from right; just everything!
Why would I regress? Does it only last awhile? I can’t remember stuff for more than 15 minutes and my husband is starting to get really annoyed!!!!
I need brain help! Please!!!!!
thematrix777
How to Cope with Pain // Feb 11, 2009 at 2:48 pm
Matrix, usually when pain and other symptoms return, it’s because of re-injury, but sometimes ‘why’ isn’t so clear. Starting treatment sooner would probably be better. If your previous OT used things which were helpful, it might be good to start there, after a medical eval to determine exactly what’s going on.
KAREN // Feb 13, 2009 at 2:54 am
please send me any and all info that you may have in regards to help with pain, I have crps and am in chronic pain, someone told me you could be hyptnotized and have your brain re-programmed?? i’ve never heard of this before, but this article is wonderful, mirror immagery i don’t quite understand?? i’ll ask my pain dr. thankyou so much!!
How to Cope with Pain // Feb 13, 2009 at 1:04 pm
Karen, while I can’t send you info, I do suggest you talk with your pain doctor about various treatment options – hypnosis, mirror work, etc. As well, take some time to look over this website – there’s lots of info!
Regarding “re-programming” and mirror work, you and your pain doctor might start here: Info About Newer Treatments.
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