By Dr. David Alter in MindMatters

Do you believe that simple problems can be solved with simple solutions but that complex problems require complex solutions?  When it comes to the brain, neuroscience suggests that relatively simple solutions are quite capable of producing dramatic change.  The secret lies with the brain’s ability to reorganize itself on a moment-to-moment basis.

The brain is made up of 100 billion neurons that form more than 100 trillion inter-connections to other neurons.  That level of “connectivity” makes the human brain one of the most complex structures in the known universe!  Out of that degree of complexity emerges the brain’s ability to safely smoothly bring a mug of hot aromatic coffee to your lips and to compose an hour-long symphony orchestra’s score that coordinates the movements of 100 musicians playing 25 types of instruments at the same time. 

The brain wires some neurons to other neighboring neurons, and wires others to far-away neurons.  This wired network allows the brain to exercise incredibly fine-tuned regulation of sensation, emotion, thought and action.  Limited inputs have far-reaching effects.  The key is that the brain is also a creature of habit: its firing patterns don’t change unless we deliberately and consistently work to change them.

What effort is required to take advantage of the brain’s ability to reorganize itself on a moment-to-moment basis?  The brain appears to be eager to learn.  It is designed to take in new experience.  New experience is assimilated into the brain’s complex neural circuitry. With repeated practice what was new and challenging becomes routine and effortless.  For example, within three weeks of practicing juggling skills an hour a day, brain imaging studies showed that people with no prior juggling experience had expanded the complexity and activity of the neuron firing patterns in brain areas that regulate fine motor movements needed for juggling.  Just three weeks!

What is the lesson for us?
• Visualize a change you want to make
•Identify the elements of the change in behavioral terms (e.g., what do people do who act in the way you are seeking to develop)
•Focus on consistently practicing one or two elements for three weeks
•Observe the changes that result

Congratulate yourself on using the simple steps to reorganize and transform your brain’s complexity to help you  achieve your goals.

Brought to you by Dr. David Alter's MindMatters

When all you have is a hammer, everything looks like a nail!  For far too long, the treatment of pain has relied on strong pain killing medication and invasive back surgeries.  These two approaches represent the "hammers" that have tried to "nail down" chronic pain.  The results, as nicely pointed out in the accompanying article, entitled "Back Surgery May Backfire on Patients in Pain," have been disappointing for too many pain sufferers.  Too many patients undergoing surgery for back pain experience limited benefits or actually experience increased pain with decreased ability to function. 

 To treat chronic pain effectively demands recognition that CHRONIC pain does not simply reflect damaged tissue that can be fixed with surgery.  Chronic pain is a body and mind condition that requires a body and mind treatment approach!  Chronic pain involves changes in networks of nerves that carry signals between the body and the brain; chnages in the types and amount of messenger molecules that circulate in the blood that cause the body to be more sensitive to pain; changes in mood related to worry, sadness, fear and despair; changes in thought patterns and beliefs that can keep the body in an over-aroused state; and changes in key relationships that influence the level of support or comfort that is so needed WHEN affected by chronic pain. 

 At Partners in Healing of Minneapolis, we have developed a body and mind treatment approach called the Program for Conscious Living that addresses the uniqueness and complexity of your chronic pain condition.  Call our office at 763-546-5797 to learn more about the Program for Conscious Living, and take that next step on your path to better health and improved daily functioning. 

Back surgery may backfire on patients in pain
Patients who had spinal fusion were less likely to return to work and needed more opiates, study says
by Linda Carroll (October 14, 2010) www.msnbc.com 

Just a month after back surgery, Nancy Scatena was once again in excruciating pain. The medications her doctor prescribed barely took the edge off the unrelenting back aches and searing jolts down her left leg. “The pain just kept intensifying,” says the 52-year-old Scottsdale, Ariz., woman who suffers from spinal stenosis, a narrowing of the chanel through which spinal nerves pass. “I was suicidal.”

Finally, Scatena made an appointment with another surgeon, one whom friends had called a “miracle worker.” The new doctor assured her that this second operation would fix everything, and in the pain-free weeks following an operation to fuse two of her vertebrae it seemed that he was right. But then the pain came roaring back.

Experts estimate that nearly 600,000 Americans opt for back operations each year. But for many like Scatena, surgery is just an empty promise, say pain management experts and some surgeons.

A new study in the journal Spine shows that in many cases surgery can even backfire, leaving patients in more pain.

Researchers reviewed records from 1,450 patients in the Ohio Bureau of Workers’ Compensation database who had diagnoses of disc degeneration, disc herniation or radiculopathy, a nerve condition that causes tingling and weakness of the limbs. Half of the patients had surgery to fuse two or more vertebrae in hopes of curing low back pain. The other half had no surgery, even though they had comparable diagnoses.

After two years, just 26 percent of those who had surgery returned to work. That’s compared to 67 percent of patients who didn’t have surgery. In what might be the most troubling study finding, researchers determined that there was a 41 percent increase in the use of painkillers, specifically opiates, in those who had surgery.

The study provides clear evidence that for many patients, fusion surgeries designed to alleviate pain from degenerating discs don’t work, says the study’s lead author Dr. Trang Nguyen, a researcher at the University of Cincinnati College of Medicine.

Unfortunately, for most patients with bad backs, there is no easy solution, no magic bullet. Pain management experts — and some surgeons — say that patients need to scale back their expectations. With the right treatments, pain can be eased, but a complete cure is unlikely.

In the wake of her operations, Scatena has turned to less invasive therapies. She’s learned to baby her back and to find ways to avoid irritating the nerves in her spine. She’s working to strengthen muscles in her lower back and abdomen so her spine will get better support. “I’ve been getting some relief from physical therapy,” she says. “And I hope that’s going to be permanent.”

27 million adults with back problems
A recent report by the Agency for Healthcare Research and Quality, a federal organization, found that in 2007, 27 million adults reported back problems with $30.3 billion spent on treatments to ease the pain. While some of that money is spent on physical therapy, pain management, chiropractor visits, and other non invasive therapies, a big chunk pays for spine surgeries.

Complicated spine surgeries that involve fusing two or more vertebrae are on the rise. In just 15 years, there was an eight-fold jump in this type of operation, according to a study published in Spine in July. That has some surgeons and public health experts concerned.

For some patients, there is a legitimate need for spine surgery and fusion, says Dr. Charles Burton, medical director for The Center for Restorative Spine Surgery in St. Paul, Minn. “But the concern is that it’s gotten way beyond what is reasonable or necessary. There are some areas of the country where the rate of spine surgery is three or four times the national average.”

Burton and others recommend that patients get a second opinion when back surgery is recommended for the treatment of back pain without neurological symptoms, such as sciatica, especially if other treatments haven’t been suggested first.

“We are very successful at improving leg symptoms," says Dr. William Welch, vice chairman of the department of neurosurgery at the University of Pennsylvania Medical Center and chief of neurosurgery at Pennsylvania Hospital. “We are less successful at treating back pain.”

Source of pain is often hard to pinpoint
The reason, Welch says, is that it’s often hard to pinpoint the exact cause of someone’s back pain. Even MRIs can be misleading because abnormalities, such as degenerating discs, can be seen on scans for virtually everyone over the age of 30 regardless of whether they have pain. Even when the surgery is a success, it rarely dispels 100 percent of back pain, Welch says.

And while many surgeons are careful about which patients they recommend for spine operations, some are not so discriminating, says Dr. Doris K. Cope, professor and vice chair for pain medicine at the University of Pittsburgh School of Medicine. “It’s a case of, if you have a hammer, everything looks like a nail,” she explains.

In general, the best results come about through a combination of approaches, Cope says. Each strategy may reduce pain by just 10 or 20 percent, but those percentages can add up so ultimately the patient’s pain is cut back by as much as 70 or 80 percent. Strategies can include exercise and weight loss, Cope says.

That advice resonates with Marilyn Seiger, a friend of Nancy Scatena in Scottsdale. Seiger opted to skip surgery, not wanting to follow her friend's painful path, even though her doctor recommended an operation to fuse two of her vertebrae.

She has gotten some relief from physical therapy, a back brace that reminds her to keep her back straight, and the occasional pain pill.

“I don’t know anyone who’s had surgery for back pain who had success,” says Seiger, 61. “I just figure this is part of growing older. We’re living longer than our bodies were meant to last and we’re just constantly shoring things up.”

         Authored by Dr. David Alter on MindMatters

My daughter recently completed a Rube Goldberg assignment for 9th grade science class. Students had to invent a machine that, once started, would run on its own, and in the process demonstrate four “energy transfers” involving mechanical, chemical, thermal and electrical energy. It occurred to me later that our bodies do the same thing all the time.

•Sound wave energy is converted into electrical and chemical energies so that we can “hear” the sounds of the world.

•Our eyes receive photons of light and convert these packets of light energy into electrical and chemical signals that enable us to perceive the stunning visual world around us.

•Our thoughts are themselves made up electrical and chemical energies. Our thoughts convert these energies into production of protein molecules in our cells that power the activities of our daily lives.

Perceiving pain also requires energy transfers.

Pain is the name for particular types of chemical and electrical energy signals that are translated at different points in the body (e.g., spinal cord nerve roots & structures in the brain itself) into the experience we call pain. We are now rediscovering that imagination has the power to influence these various energy transfers in ways that alter the signal of pain.

How can you learn to do this for yourself?

•Explore imagery training (e.g., guided imagery training, develop hypnosis skills, use cognitive-behavioral techniques for modifying pain maintaining thoughts)

•Imagery training changes the sensitivity of our tissues to pain (i.e., it takes more signals to produce pain)

•Imagery changes the form of the sensation that is perceived (i.e., it changes what was pain into more tolerable sensations)

•Imagery produces physical changes in the way that networks of nerves connect to each other. Our imagination changes the structure of the physical body.

•Using imagery approaches helps your thoughts and mental images to literally restructure the brain, rewire the pain, and enable higher levels of daily functioning to be achieved.

Now, that is a Rube Goldberg project worth repeating!

At Partners in Healing of Minneapolis, we offer a number of imagery training approaches. Find out which is right for you and your body. Contact us at 763-546-5797 or visit us at www.pih-mpls.com for more information.

         Authored by Dr. David Alter on MindMatters

Do you know how to manage your pain with your mind?

Pain is a real attention-getter. Before explaining how to use your mind to manage your pain, you should know that there are two kinds of pain. Both demand that we pay attention:

Acute pain: Acute pain sensations typically signal danger involving some kind of immediate threat to our body. Acute pain directs us to pay attention so that we can address the problem. For example, if you put your finger on a hot surface, your mind tells you stop or reduce that pain and MOVE YOUR FINGER RIGHT NOW!!! 

Chronic pain: Chronic pain sensations rarely signal that your body is actually under threat. Chronic pain describes pain sensations lasting more than six months without any clear explanation for the pain. Chronic pain usually involves some way that the automatic “off-switch” for pain has gotten stuck in the “on-position.”

That is why using your mind to deal with chronic pain is so critical. Using your mind to turn off the pain switch may be challenging …but you can learn to use your mind to reduce and even eliminate your chronic pain. Here’s how:

•You can learn to turn down the intensity of the pain, like turning down the dimmer switch on a light (intensity of attention)

•You can learn how to focus away from pain (selective attention) so that it isn’t the focus of your attention

•Combining selection & intensity: When you learn to combine these skills, management of and relief from pain can be accomplished.

Rewiring the Brain

Using attention skills over time actually rewires the pathways in the brain. This enables you to develop better pain management skills. Now that is new learning that is really worth learning!

At Partners in Healing of Minneapolis, we can teach you how using our Program for Conscious Living. You have the power of your mind to manage, relieve and even eliminate your pain! Stop suffering from your pain. Contact us today at 763-546-5797 and we will show you how. 

Authored by Dr. David Alter

The conductor of the body’s orchestra is the mind. That is why it is so critical that chronic pain treatment includes methods of restoring the mind’s ability to function as the body’s conductor, and to lead the body back to producing the harmonious rhythms among the different parts of the body that define good health.

Chronic pain affects the body the way an orchestra is affected by the absence of a conductor. Chronic pain causes the body to:

•Lose the coordinated rhythms of the body that define good health

•Develop sleep problems and other essential biological rhythms of the body

•Develop fatigue, weight gain or loss

•Develop increased risk for depression or anxiety patterns

•Develop metabolic disturbances

•Develop focusing, concentrating and learning and memory problems

•Develop problems in your key relationships

When the conductor arrives on the scene and steps onto the podium baton in hand, the individual musicians in the orchestra undergo a wonderful and magical transformation. The conductor transforms the chaos of uncoordinated individual musicians into a coordinated and choreographed unit that produces beautiful music.

At Partners in Healing of Minneapolis, we teach you to be the conductor of your body. We help you to restore the mind to its rightful place as the conductor of your body so that you can overcome pain and restore healthier levels of functioning. We offer many treatment approaches. Contact us at 763-546-5797 or visit us at www.pih-mpls.com for more information. Find out what is right for you and your body.

Authored by Dr. David Alter

In the last entry we introduced the idea of pain as a faulty memory signal; a state-dependent signal that can be activated by many triggers.  We emphasized the importance of learning memory-modifying steps you can take to put you back in charge and learn to have the remembered past – the pain signal that keeps on firing – pass right on by.  By recognizing that The Pain, its Plain, Stems Mainly from the Brain, here are six suggestions to consider that help free the brain from old pain memory patterns, and allow it to express different nerve firing patterns that modify your experience of pain.

1.    Shifting the focus of attention from what can be done for you to what you are able to do for yourself.  This shift in focus orients the brain to how and where you can exercise control, which disrupts old patterns of helplessness in the face of failed efforts to obtain relief.

2.    Develop a toolbox of safe and simple movements.  The body is designed for movement.  The body needs movement the way it needs food and sleep.  Whether the safe movement involves simple stretches, a walk to the mailbox several times per day, or involvement in a yoga class, develop a movement routine you maintain.  It disrupts the memory circuits that say movement is dangerous and painful.

3.    Restoring restful sleep. While we sleep, the brain filters our experience from the past.  Sleep revises, discards or strengths aspects of past experience.  Without adequate sleep, our ability to restore energy reserves, rebound from the past experience, and feel prepared for the future is hobbled.  Explore proven methods for re-establishing restorative sleep so you give the brain the energy it needs to construct new habits of functioning during the day.

4.    Learn focused awareness skills.  When pain is present, it can be like a magnet that draws attention to it.  Pain-focused attention almost always makes the perception of pain worse!  A number of methods for developing the capacity to direct attention away from pain, or toward perceiving sensations in the body in new ways can be very useful.  Meditation, breath awareness, guided imagery and self-hypnosis are examples of focused awareness skills you can learn.

5.    Become a “sensualist”.  We are blessed with five senses.  Pain tends to make us aware of only one of them.  If pain becomes the dominant sensation that people experience, awareness of other sensations dulls.  It is important to involve yourself with activities that bring alive other sensations – taste, sight, sound, smell, taste and touch.  In addition, there is good evidence that laughter and humor release molecules that flood the brain and body with strong pain dampening effects!

6.    Letting go of what’s past (passed).  People with persistent pain tend to have much higher rates of depression, anxiety and even high rates of histories that include past traumas of various sorts.  Of course, having persistent pain can be depressing, anxiety provoking and traumatizing!  Still, past trauma tends to keep the doors to pain in your present life wide open.  Therefore, it is important to learn methods of resolving the on-going influence of past trauma on your daily life.  Doing so powerfully rewires the brain and frees up the mind to experience life anew.

Authored by Dr. David Alter

In the movie musical My Fair Lady made famous by Audrey Hepburn, she sings a song whose words begin, “The Rain in Spain Falls Mainly in the Plain.”  Her song signals her growing ability to achieve her full but untapped potential.  Every day, millions of people struggle to overcome the limitations imposed by their personal histories.  These are individuals who face the misery and despair that all too often arises with chronic pain.

Chronic pain has bedeviled healers for thousands of years.  Invisible, untouchable, and yet so many are touched by it – more than 70 million Americans per year!  A key aspect of chronic pain that makes its successful management so challenging is its disconnection from obvious tissue injury.  Typically, as the physical body heals, the process of healing turns off the nerve signals that generated the pain sensations in response to the original injury. 

What is difficult to understand is that over time pain signals become disconnected from actual tissue damage.  This involves a modification to the body’s pain signaling process.  Pain is an experience that is encoded in the brain in through state dependent learning experiences.  In other words, the experience we call pain is a type of memory that is encoded into the neural circuits of the brain, ready to be reactivated when any of the other elements that were present at the time of the original injury are once again present.  For example, when my young adult son was injured playing his favorite sport he needed stitches that were sown into his mouth without sufficient anesthetic.  When he began to anticipate going to have the stitches removed, he began to hurt again.  The hurt he felt involved reactivation of the state dependent learning that linked together the memory of stitches with the memory of pain.  The anticipation of going to have stitches removed reactivated pain!  The original emotional state (scared), the physical context (doctor’s office), the sensory cues (white coat, hospital smell, overhead paging, etc.) also served to reactive the pain because they were encoded as part of the original state dependent pain experience.

While this example involves an acute pain experience, you can appreciate the relevance to chronic pain conditions, where the encoded emotional, contextual, sensory, and cognitive cues linked to pain are more common and have been reactivated so much more powerfully over a longer period of time.  Still, the implication is clear: As hard as it is to accept, the fact of the matter is that chronic pain really is “in your head!”  It is wired into the brain’s network of nerves, ready to “fire” in response to so many different triggers. 

That the pain is in the head makes it no less real!  In fact, it allows a whole new approach to managing it: learning ways to re-program pain program wired into the brain.  To return to our theme, the key to management of chronic pain involves learning to change the “remembered pain,” the memory pattern that gets established in the brain and which is responsible for the activation, maintenance and exacerbations of chronic pain conditions.  If Audrey Hepburn were to star in a pain management movie, perhaps she would sing, “The Pain, its Plain, Stems Mainly from the Brain!”

There are a number of ways to modify chronic pain memories: the pain-maintaining signaling patterns that are at the core of chronic pain conditions.  In the next entry to this blog, six suggestions for modifying pain maintaining memory circuits will be introduced to you.  Each of the pattern-modifying techniques is useful precisely because of its proven capacity to alter the ways in which remembered pain signals are generated. 

Authored by Dr. David Alter

In the last blog I introduced the idea of adaptive flexibility as a core skill to restoring health.  Learning to be adaptive allows you to adjust to life’s challenges in ways that keep symptom patterns from getting to firmly established.  Where can you turn to learn about revving up your adaptive flexibility?

My patients and I have found it helpful to draw upon the “wisdom of the body.”  Look at how the wisdom of your cells can be tapped to improve your health by adopting the four questions that each cell in our body uses to maintain its health.  We are made up of several trillion cells that are interconnected with one another.  The patterns of interaction among and within these cells are unimaginably complex.  And yet, the vast majority of the time, this vast network of interconnected cells hums along in ways that allow you to smoothly carry out the activities of your daily life.  Cells actively regulate their boundary (i.e., the cellular membrane) with the world around them by asking four basic questions that you can learn to apply to yourself as you regulate your relationship to yourself and to the world around you.

The Four Basic Health Restoring Questions – Brought to you courtesy of your Cellular Mind!

1. Cell: What is in my external environment that is toxic to my health and well-being that I need to keep out?  You: Am I engaging in relationships or situations that hurt me, that drain my energy, that put me down, that make me sick?  What are they?
   
   
2. Cell: What is within my internal environment that is toxic to my health and well-being that I need to release and let go of?  You: Am I carrying around expectations, beliefs, attitudes, or memories of events from my past that are poisoning me?  What are they?
   
   
3. Cell: What is in my external environment that is essential to my health and well-being that I need to absorb to nourish me?  You: Are there resources, hopes, aspirations, opportunities, or activities that would be supportive of my health and well-being that are available but that I have not risked seeking out?  What are they?
   
   
4. Cell: What is in my internal environment that is essential to my health and well-being that I need to learn to keep in because it nourishes me in fundamental ways?  You: Are there resources, qualities, desires, preferences and practices that I know are self-nurturing that I overlook, defer, or minimize the importance of, to the detriment of my overall health?  What are they?

This coming month, take the time to ask yourself these four questions.  Set aside 20 minutes several times per week, morning or evening, at a time when you will be free from interruptions, to consider the four basic questions and record your responses.  The responses you obtain may be verbal, they may be feelings or they may be bodily sensations.  After you discover initial answers to these core questions, use them as a blue print sent to you courtesy of your body’s wisdom.  Recognizing that initial answers to the questions arose from within you can be a sign that you have the internal resources needed to begin to implement the changes suggested by your body’s wisdom.  The prize is a healthier and balanced YOU.  Let me know what you find!

Authored by Dr. David Alter

Chronic pain. Depression. Gut dysfunction. Anxiety.  Relationship discord. Sleep disturbance.  Post-traumatic difficulties.  Energetic imbalances.  When people begin to describe their difficulties, they often use these labels.  Each of these labels is a blend of sensations, thoughts, feelings, emotions and behaviors that persist over time.  It is the fact that they repeat over time that makes them into symptom patterns.  I am going to offer four important questions that will help you learn to alter these symptom patterns.  By changing the symptom pattern, you can change your illness process – almost always for the better!

At first, the symptom pattern of chronic pain may seem unrelated to a pattern involving gut dysfunction, (Irritable Bowel Syndrome, for example), but all symptom patterns represent a loss of adaptive flexibility of the mind and body.  Adaptive flexibility involves the capacity to adjust to the ever-changing circumstances of your life while maintaining a steady sense of balance and control in your life.  The greater your ability to adjust and adapt to the circumstances of your life the greater the likelihood that you would describe yourself as healthy.  And the more you can learn to increase your adaptive flexibility, the more likely you are to regain or restore your health. 

The idea that we are designed to seek healthy balance is not new.  Ancient traditions described health in terms of the capacity to maintain balance among competing urges, functions, energies, or qualities (e.g., warm-cold; wet-dry; optimistic-guarded; active-sedentary; spicy-bland; thin-heavy; fast-slow; fiery-calm; stoic-vulnerable; thoughtful-emotional, etc.).  Sounds strange?  Think for a few moments about the kinds of suggestions we hear or give ourselves each day and you’ll recognize they are still suggestions about improving our ability to adjust and adapt in ways that are not all that different from what Hippocrates might have advised a patient in Greece 2500 years ago:  “I’ve got to stop burning the candle at both ends;” “I should eat less and exercise more;” “I’ve got to stop picking the same type of relationship partner over and over again;” “I have to take some risks if my situation is ever going to change;” “I have to get ‘in touch’ with my feelings;” “I have to give more and expect less;” “I have to over-extend less and take better care of myself.” “I have to live my life with integrity that is consistent with my basic values.”  Each statement reflects the recognition that you have gotten stuck in a repeating pattern of functioning that is negatively affecting your health.  Repeating unhealthy patterns of living is the primary sign of the loss of adaptive flexibility, and often predicts that a loss of physical, emotional or mental health will soon follow. 

Most of the time, our deeply wired ability to maintain balance in the face of constant change is something that occurs automatically (e.g., we don’t have to think about how heal a paper cut to a finger or how to walk, even though walking involves controlled falling!).  Sometimes, we have to make conscious decisions to maintain healthy balance (e.g., “Even though I want another helping of my dinner, I will listen to my body’s signals and push myself away from the table now.”).  And then there are times when we need to seek the help of a professional who is trained to identify what accounts for our imbalance and the symptom pattern the imbalance is generating. So, where to begin your efforts to alter the pattern of your symptoms?  In the next entry to this blog I will introduce you to what your own cells have to teach you about restoring your health.