There is a fascinating new approach to treating chronic pain.
The story goes back two years, to the publication of important research from a team at the Royal National Hospital for Rheumatic Diseases, in Bath in England. They wrote a paper in which they tried to link joint pain in neurological conditions. They wanted to see how the pain of rheumatoid arthritis, fibromyalgia and complex regional pain syndrome might relate to phantom limb pain (PLP) experienced by many amputees.
They suggested that in each condition there is reorganization in the sensory regions of the cerebral cortex. And it is this reorganization that generates pain and an altered body image. It seems to be just the same in rheumatology patients as has previously been hypothesized for amputees with PLP; that is a motor/sensory conflict. The body and the sense don’t match and it hurts. Their initial research indicated that something incredibly simple: using a mirror could help people correct of this conflict. They were able to show that a mismatch between motor output and sensory input creates sensory disturbances, including pain, in rheumatology patients and also in healthy volunteers.
In a second paper the investigators were able to show that doing a movement while looking at a distorting mirror could quickly induce uncomfortable symptoms in fit healthy people.
For over two decades, David Blake - the senior author of this research - has championed the idea that there is an important neurological component in inflammatory arthritis. It all started with a simple observation that has puzzled generations of clinicians: why is it that joint involvement in inflammatory arthritis is so often symmetrical? It isn’t surprising if both hips get arthritis: they will likely both have been subjected to a lot of wear and tear. But why should arthritis involve the second joint of the index finger in both hands? It has always looked as if this might imply some neurological contribution.
The idea is that although pain may have originated in inflamed joints, it is maintained and exacerbated by the nervous system. This fits with a fact that has been known to acupuncturists for centuries and has been replicated in pain clinics around the world. If you can interrupt what we call the pain cycle - constant chronic pain that feeds on itself and gets progressively worse – then you may often see pain relief for weeks or months, or sometimes even indefinitely. It is quite common for chronic pain to have had a clear physical precipitant, but to be maintained by key regions in the brain.
This new research strongly supports these observations, implies that the successful treatment of chronic rheumatological pain may involve a neurological approach, and offers a brand new therapeutic option.
“The speaker is only a mirror. Where you can see yourself. When you recognize yourself clearly, you can put aside the mirror.”--Jiddu Krishnamurti (Indian Spiritual Teacher, 1895-1986)
“Perception is but a mirror, not a fact. What I look on is my state of mind reflected outward.”--A Course in Miracles
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