Hello and welcome.
My name is Yaesha Bryan.
I'm a psychiatric physician associate,
Trauma-informed yoga teacher,
And chronic pain coach.
I've also walked my own path with chronic pain,
So if you are living in pain,
I truly understand how many layers of challenge this can create.
I hope this talk offers a new framework for understanding your pain,
And perhaps even a glimmer of hope.
Science now tells us that many cases of chronic pain aren't rooted in tissue damage or structural issue in the physical body.
Instead,
They're caused by neuroplastic pain,
Also called neurocircuit disorders or gnociplastic pain.
It's important to note that all pain is generated in the brain.
Let's walk through an example of acute injury to get a better understanding of that process.
So say I sprain my ankle.
The injury itself causes cell damage,
Which leads to the release of mediators.
These mediators activate sensory nerve fibers,
Which transmit a signal to the spinal cord.
The spinal cord then relays this message through the spinothalamic tract up into the brain.
The brain processes this message in multiple regions,
But primarily in the somatosensory cortex.
This area of the brain helps us to interpret physical sensations and determine their location.
For example,
Allowing me to know the pain is coming from the inside of my right ankle.
To recap,
An injury happens,
Then a chain of events occur,
Which lead to activation in the area of the brain that processes and registers physical sensation.
This is an example of an appropriate pain response.
But we now know that the brain can also generate pain in the absence of injury.
That's what we mean by neuroplastic pain.
The creation or persistence of pain without occurring injury or tissue damage.
The brain is generating a pain response without an acute cause or long after an injury has healed.
Let's dive a little deeper.
Over the past decade,
Researchers have shifted how we understand chronic pain.
In one study,
Epkirian and his team followed people with new onset back pain.
They scanned their brains with an fMRI machine shortly after their pain began,
And then about a year later,
Some participants recovered fully,
Others went on to have chronic back pain.
In people who developed chronic pain,
Brain activity shifted.
Pain processing moved away from areas like the somatosensory cortex,
Which we just learned handles physical sensation and is what we would expect in acute pain,
Into regions that are responsible for emotion,
Memory,
And learning like the medial prefrontal cortex and the limbic system.
In a second study,
They looked at white matter structure,
Essentially how the brain is wired.
Incredibly,
They were able to predict with 85% accuracy who would go on to develop chronic back pain after an injury,
Based on the brain scans alone.
The stronger the connections between areas like the medial prefrontal cortex and the nucleus accumbens,
The more likely the pain was to persist.
These areas of the brain are deeply involved in learning and emotional processing.
Just imagine a brain scan being more accurate at predicting the development of chronic back pain than an actual image of the spine.
These studies,
And many more,
Show us that chronic pain is often learned by the brain.
If you have neuroplastic pain,
The pain you feel isn't in your head,
But it is held in your brain.
The pain is absolutely real,
But the brain is generating it outside of your conscious control.
This is not your fault,
And you are not broken.
It also explains why,
For many people,
Procedures that target the site of the pain,
Like the ankle,
Often don't relieve the pain.
To find true relief,
We need to target the brain itself.
You are probably thinking,
That may be true for some people,
But it is not true for me.
My pain is different.
Most people with chronic pain feel that way.
I know I did too,
But treating my neuroplastic pain has been the most helpful intervention I've done for myself on this journey,
Even more than surgical intervention.
And don't just take my word for it.
In one study of 222 people with chronic back or neck pain,
88% were found to have neuroplastic pain.
Another 6% had a mix of neuroplastic pain and structural pain,
Which means 94% of those 222 people could have benefited from approaches that treat neuroplastic pain.
And even if part of your pain is structural,
There could still be a neuroplastic component,
Especially if you've been living with pain for a long time.
This is just a starting point.
For now,
I want you to know,
If you've been struggling with pain,
It is not your fault.
There is a biological story behind it,
And there is a path forward.
I'd love to keep walking that path with you.
Thank you so much for being here.
