The Brain's Way of Healing: Remarkable Discoveries and Recoveries from the Frontiers of Neuroplasticity

Intriguingly, the researchers found that the pain increased when the image of the hands was magnified, and decreased when it was miniaturized.

Intention is a subtle concept. The immediate intention is not to get rid of pain—it is to focus the mind, in order to change the brain.

Moskowitz began formulating acronyms, based on neuroplastic principles, to remind patients in chronic pain how to organize their minds (minds that were slightly foggy and disorganized by the pain) as they sought to undermine that pain. One was MIRROR, for Motivation, Intention, Relentlessness, Reliability, Opportunity, and Restoration.

Next, she started going off all her medications, terrified the pain would return, but it didn’t. “I wondered, Is it a placebo? But the pain still hasn’t come back. It has never come back.”

“I started to take what you were saying in the book,” she told me, “and what he was saying and put them into practice. He told me to look at the brain pictures seven times a day. But I sat in the massage chair and I looked at them all day long, because I had nothing else to do. I would visualize the pain centers firing, and then I thought about where my pain was coming from in my back. Then I would visualize how it went into the spine and then into my brain—but with no pain centers firing. In those first two weeks, I had moments when there was no pain. . . . It wasn’t profound, because I felt, Oh, it’s not going to last. Then I thought, Oh, it’s back again—don’t get your hopes up.

the first three weeks, he thought he noticed a very small decrease in pain, and he doggedly continued to apply the technique, telling himself to “disconnect the network, shrink the map.” After a month he was getting the hang of it and applying the technique so conscientiously that he never let a pain spike occur without doing some visualization or other mental activity to oppose it.

It worked. By six weeks, the pain between his shoulders in his back and near his shoulder blades had completely disappeared, never to return. By four months, he was having his first totally pain-free periods throughout his neck. And within a year he was almost always pain free, his average pain 0/10. If he had a brief relapse (usually from his neck being in a weird position, after a long drive, or having the flu), he was able to get his pain down to 0 in a few minutes. His life was totally changed, after thirteen years of chronic pain. During those thirteen years, his average pain had been 5/10, but could range up as high as 8/10 even on medication, and even his best days were 3/10.

The disappearance of the pain reversed the original pattern of its expansion. After his injury, he had acute pain on the left side of his neck, exactly where the injury had occurred. As time passed and the pain became chronic, it had neuroplastically extended to the right side of his neck and down to his midback. Now, with the visualizations, he noticed that the borders of the pain on the right were the first to get smaller. Then the pain on the left side began to retract and went away.

After six weeks of results, he started to share his discovery with his patients.

First he would visualize his picture of the brain in chronic pain—and observed how much the map in chronic pain had expanded neuroplastically. Then he would imagine the areas of firing shrinking, so that they looked like the brain when there was no pain. “I had to be relentless—even more relentless than the pain signal itself,” he said. He greeted every twinge of pain with an image of his pain map shrinking, knowing that he was forcing his posterior cingulate and posterior parietal lobes to process a visual image.

April 2007 he put this theory into practice. He decided that he would first use visual activity to overpower the pain. A huge part of the brain is devoted to visual processing, and it couldn’t hurt to have it on his side in this competition. He knew of two brain areas that process visual information and pain, the posterior cingulate (which helps us to visually imagine where things are in space) and the posterior parietal lobe (which also processes visual input).

Each time he got an attack of pain, he immediately began visualizing.

What if, while he felt pain, he was to flood himself with vibration and touch sensations? Might those sensations prevent the somatosensory areas from being able to process pain?

Moskowitz’s inspiration was simple: what if he could use competitive plasticity in his favor? What if, when his pain started—instead of allowing those areas to be pirated and “taken over” by pain processing—he “took them back” for their original main activities, by forcing himself to perform those activities, no matter how intense the pain was?

What if, when he was in pain, he could try to override the natural tendency to retreat, lie down, rest, stop thinking, and nurse himself? Moskowitz decided the brain needed a counterstimulation. He would force those brain areas to process anything-but-pain, to weaken his chronic pain circuits.