Co-written with Gordon Irving, MD STOMP Dr. Gordon Irving is the medical director of the pain center at Swedish Hospital in Seattle, WA. He has developed a wonderful set of resources for dealing with chronic pain. His version of a structured program is STOMP (Structuring Your Own Management of Pain). He and I are co-editing the core book that will link you to many resources, which will enable you to take charge of your care. “You Can Only Lose Brain Cells” Historically scientists have thought that a person was born with a maximum number of neurons and you would slowly lose them over a lifetime. Although the brain activity the first few years of life is intense it has been clearly shown that the brain can change at any age—for better or worse. Neuroplasticity Neuroplasticity is the term that refers to the ability of the brain to adapt and change. Unless your brain is appropriately stimulated this is not necessarily a positive process. Several of the ways it can occur are: Growth of new nerve cells (neurons) Shrinking of neurons from disuse Increasing or decreasing the number of connections per neuron Laying down or losing layers of insulation (myelin). This layer improves the speed of nerve conduction Substitution of an injured part of the brain with an already functioning area. The new area takes on new capacities. The bottom line is that your brain is constantly in a dynamic state of change depending on how much it is stimulated—or not. There is an incredible upside potential because the nervous system has a large capacity to continue to positively change but it must be kept active. The terrible dark side is that when your brain shrinks or atrophies then you have less ability to pull yourself out of the hole. It is still a solvable problem but you need help and tools. Brain Changes are Measurable With the advent of modern brain scans that can actually measure brain size and activity we are able to document these changes and they can happen quickly. A recent study showed that certain parts of medical students’ brains would significantly enlarge within a few months after starting school. (1) It has also been shown that the brains of patients in chronic pain shrink. Fortunately the brain also re-expands with successful resolution of their pain. (2) Brain Shrinks?? Why would your brain shrink in the presence of chronic pain? One way of thinking about it is to view the pain nervous system as obsessive circuits. These circuits become monsters that suck the creative part of you dry. The brain area that enjoys good friends, music, art, wine, etc. gradually shrinks. There is a huge amount of neural activity involved with these enjoyable endeavors that just does not occur in the presence of unrelenting pain. Once a pain pathway in your brain is laid down it is essentially permanent. It may become less functional but it is not going to disappear. Once you know how to ride a bicycle or walk you cannot unlearn the skill. Creating Detours So what is the solution? There is only one and that is what the STOMP project is all about. You must lay down alternate pathways or detours around the existing problematic pathways. Once you learn the tools and choose the ones that are the best fit for you it is remarkable how consistently the pain will diminish and may even disappear. Welcome to a big adventure and the start of your new brain. It will not be easy and it will be you that will do the brain building. Use the STOMP project as your resource. The aim of the STOMP team has been to assist you in regaining a rich and full life. Dragananski, et al. Temporal and spatial dynamics of brain structure changes during extensive learning. The Journal of Neuroscience 2006; 26: 6314-6317. Apkarian AV, Sosa Y, Sonty S. Chronic Back Pain is associated with decreased prefrontal and thalamic gray matter density. Journal of Neuroscience 2004; 24: 10410 -10415.