Laying off Opioids, Part 3: TNE
Note: If you haven’t read my earlier posts, “The War On Opioids Comes Home” , “Laying Off Opioids: Part 1,” and Laying Off Opioids: Part 2, you might want to do that now. They’ll give context to this post.
I’ve practiced my own simple form of mindfulness for decades, starting about a year after my diagnosis with rheumatoid disease. At the time, it took the form of consciously taking note of the small gifts the world around me offered. They included such things as enjoying the scent of gardenias in the warm, summer night air, or noticing and savoring the exquisite taste of raspberry ice cream.
Noting things like this helped me be grateful for my life even as frequent, severe, and sometimes disabling joint pain nearly overwhelmed me. These small gifts gave me something else to focus on and to think about when I was hurting so badly. Continuing that early practice, along with a more structured mindfulness meditation practice, has kept me optimistic through the years. I still live day by day. I do my best not to worry uselessly about a future I can’t control or about a past I can’t change.
But there are other ways to manage chronic pain. In June and July I participated in a class on Therapeutic Neuroscience Education (TNE). It taught me about how pain originates in the brain, not the “hurt” part of the body, and how awareness of how it works may potentially help me manage it.
In addition, I joined a chronic pain support group—a weekly meet-up with other chronic pain patients, all of them veterans like myself. The group has, unexpectedly, given me real joy and camaraderie, and I enjoy attending it immensely.
I will be taking in-depth course on Cognitive Behavior Therapy in the near future and will have more to share about it then.
In my last post in this series, I promised I’d write about TNE. Here’s my simple take on a rather complex set of ideas:
Therapeutic Neuroscience Education (also Pain Neuroscience Education) teaches patients the basics about the nervous system, the brain, and how the two work together to produce the sensation of pain. This understanding helps patients reduce their fear of pain and engage in therapy and self-management.
If you slam your toe into the coffee table in the dark in the middle of the night, your toe’s nerve endings send an instant message up through your spinal cord to your brain, screaming “DO SOMETHING NOW!” The brain responds just as quickly by creating a sharp sensation of pain in your toe. You yelp, cuss, and hop around on the other foot for a minute while your body and brain work out how much damage you’ve actually done your toe. If it’s not bad, your brain dials back the pain signals fairly quickly. You limp the rest of the way to the fridge for your midnight snack. By the time you get back into bed, your insulted toe barely hurts at all.
If you’ve hurt your toe badly—let’s say you broke it—then the brain continues sending sharp pain signals so you won’t want to step down on it, period. That way, the outraged bone and tissues around it can start healing. As the fracture heals, your brain changes the intensity of its pain signals so that your toe hurts you less, allowing you to gradually put more weight on it. Eventually you can walk again without the pain that’s protected your toe while it heals. All is well in toe-land.
TNE suggests that chronic pain generally starts the same way: with an injury or, perhaps, an illness, that causes pain.
But for some reason, that stubbed and broken toe (we’ll just keep this analogy) doesn’t stop hurting once the tissues have healed. The nerve endings in the once-injured area have become hypersensitive. They continue sending frantic “DO SOMETHING!” messages to the brain—and it keeps sending pain signals that you “feel” in your toe. It continues to hurt badly and you, naturally, continue to react to the “injury.” Your memories of your previous pain play into this as well, keeping you wary and reluctant to force the issue.
Scientists aren’t sure why this happens in some people. But proponents of TNE believe that because we know, intellectually, that all pain originates in the brain, those of us who have chronic pain can use this knowledge and understanding to our advantage.
Our toe may hurt, but we know the injury has healed—perhaps long ago—and that what we’re feeling is in error. Sure, the pain is as real now as it was when we originally injured the toe. The difference is that we know it healed. There are no longer any injured tissues to protect.
Understanding how the brain works in regard to chronic pain has the potential to lessen the anxiety and fear we feel about it. That, in turn, lowers our stress levels. Lowered stress results in less pain. Less pain means less anxiety and fear … and the cycle repeats. Each of these processes have positive physical results along with mental and emotional results.
Lowered pain means we can do more. We can work more, exercise more, and play more. And all those are positives that will, in turn, help us keep our pain under control, preferably without the aid of opioid analgesics.
I’ll be honest. I’m not sure how well TNE can help someone who has rheumatoid disease, an autoimmune disease that causes, as one of its main symptoms, chronic joint pain from synovial tissue inflammation and, over time, the pain that results from bone and tissue damage and destruction. We don’t really “heal.”
When I asked the class instructor about chronic pain from chronic disease vs. pain that originates with an acute injury or illness, he told me that under that circumstance, cognitive behavior therapy (CBT) might be more useful. I agreed.
TNE is fascinating, at least to people who’re interested in how the brain works, like I’ve always been. I’m sure it does help many people as they work to manage their chronic pain without drugs, particularly when used as an educational tool along with CBT and other alternative pain management techniques.
Have you tried TNE? Did it help? I’d love to hear from you.
Right now, what RA tips would most be helpful for you?