June 26th, 2009

rtfMRI Scan No. 3

rtfMRI Scan No. 3

Wednesday I had my third rtfMRI scan in the chronic pain treatment study, only this time I alternated between using the sensory strategies and the affective, or emotional, strategies for increasing and decreasing my pain. This was so find out which strategy worked best for controlling the activation of my brain's pain centers.

While practicing the affective strategies I had a hard time using the emotions to increase my pain but found it fairly easy to decrease my pain. I had the opposite experience with the sensory strategies I used for the previous scan -- it was easy for me to increase the pain but difficult to decrease it while imagining the sensations. I only had 3 days to practice my new affective strategies, too (I had a whole week to practice the sensory ones).

My scan was scheduled to start shortly after this week's pain management class ended, and the class ran late, so I was in a hurry and feeling really frazzled by the time I got to Omneuron for my scan. I'm afraid I didn't try practicing the relaxation techniques we learned in the second pain management class, either. What can I say? It was not my best day Wednesday. (Nor was it my worst. It was just one of those days.)

Anyway, Wednesday they ran 8 scans to determine which combination of strategies had the greatest effect on my pain centers, alternating between the sensory strategies and the affective strategies. During the first and 5th scans I had to try increasing my pain by focusing on the pain itself and how it felt like a pair of pliers was pinching and twisting my back in its jaws, and during the second and 6th scans I had to try to decrease my pain by imagining heat soothing the area. During the third and 7th scans I had to try to increase the pain by feeling the anger, frustration and discouragement of trying to push against a gigantic, looming, monstrous slab of obsidian that symbolized my pain, and during the fourth and 8th scans I had to try decreasing my pain by feeling the pure joy and elation of being in a limber, flexible, pain-free body. And I had all of 60 seconds to turn these sensations and feelings on and off, on command.

It was utterly chaotic. During the scans the flame was going up and down seemingly independently of what I was feeling or thinking about. I tried to resist the temptation to make the flame do what it was "supposed" to do any way I could, and focus solely on the actual strategies. There are a few more strategies we're going to experiment with in the upcoming weeks, so the point is not to be successful with every strategy I try -- the point is to try them all and weed out the ones that don't work very well for me. So I did the best I could given the circumstances.

It turns out that, according to the scan results, I achieved the greatest pain center activation with the affective strategies, using the feelings of anger, discouragement and frustration (contrary to my experiences while practicing), and the greatest decrease came using the sensory strategy of imagining warmth soothing the area (again, contrary to my pratice experience). Oh well. The data from the scan doesn't lie, so that's what I need to utilize for now, regardless of my subjective experiences while practicing the strategies at home.

My next visit is a strategy orientation session only (no scan), where we will go over concepts for the upcoming strategies, talk about my experiences so far, and try to optimize my work with the flame feedback. I have homework to do, too -- on a silhouette drawing of a body, I have to shade in the areas that do not experience chronic pain, and write down the physical sensations, thoughts and fellings that come up when I concentrate on the healthy tissue areas. I also have to write down the sensations, thoughts and feelings that come to mind when I think about the worst pain I have ever felt and when I think about getting incrementally worse every day to the point of full disability. I also have to write down the sensations, thoughts and feelings I have when I think about my most favorite place or about my memory of least pain, as well as when I think about getting incrementally better every day and the pain eventually disappearaing entirely.

I asked if I should continue practicing my optimal strategies, but I forgot what they told me. It's been hard for me to practice, anyway -- it's very difficult to concentrate for the full 60 seconds, and I always have to fight the urge to fall asleep. Even inside the scanner I've found myself almost nodding off, in spite of the deafening racket going on all around me, believe it or not. I wonder what would happen to the flame if I actually did fall asleep during a scan?