June 30th, 2009

rtfMRI Strategy Session No. 2

rtfMRI Strategy Session No. 2

Today I didn't have a scan, but spent the time coming up with different strategies to experiment with for my remaining 3 scans, to find the most effective one to reduce my brain's pain center activity.

The strategy I'll be using next is the discriminative strategy, where I focus on what hurts vs. what doesn't hurt. We reviewed least week's homework, where I shaded in the areas on a silhouette drawing of a body where I do not experience chronic pain, and wrote down the physical sensations, thoughts and feelings that came up when I concentrated on the healthy tissue areas. Next we did a visualization exercise where I focused my attention on the painful area of my back and formed a visual image of it. A large violent whirlpool of red-hot lava came to mind. Then I focused my attention of the non-painful areas of my body, and a cool, green, mossy forest came to mind.

I had to try to incorporate the whirlpool of lava into the mossy forest and describe what happened. Well, the forest got scorched, that's what! Duh. All the moss shriveled up, the underbrush caught fire and the trees withered away into smoking husks. Then I had to try to imagine the lava going away and the mossy forest regrowing and regenerating. That was difficult to do, because my mind kept on telling me that growing more moss next to a whirlpool of lava will not make the lava go away, it will only destroy the moss, as well as everything else nearby.

So we tried a different exercise, where I imagined the specific borders of the painful area on my back and increasing my pain by spreading the border upward. This was all too easy to do by imagining grabbing the upper border of the pain with my fingers and pulling it up my back toward my shoulders. Then for the decrease strategy I had to push the border of the pain back downward again. I surprised myself by succeeding just by imagining my hand pushing downward on the upper border of the pain (although I couldn't get it back down all the way into its original borders).

So that is the strategy I will be practicing this week, pulling the painful area up into the non-painful area, and pushing it back down again. But as a twist I will be imagining not just pushing the painful area back down to its original size, but also pushing the pain-free area down into the painful area. The point of this exercise is to connect with my non-painful areas and engage with them, to discriminate between the painful and non-painful areas. Since the painful tissue is the same kind of tissue as the non-painful tissue, I should be visualizing the non-painful tissue taking over the painful area and establishing itself there.

At my next scan on Monday I will be alternating between this new discriminative strategy and the winning strategies from the last scan (the affective technique of using the feelings of anger, discouragement and frustration to increase my pain, and the sensory technique of imagining warmth soothing the painful area to decrease my pain) to see which ones work best. In the meantime I have to practice pulling and pushing the painful area to increase and decrease it, one minute up and one minute down, for a minimum of 10 minutes, 3 times per week. I really dislike these practice sessions because I have to fight the urge to fall asleep in the middle of them. Plus, up till now my coping strategy has been to disconnect from the pain completely, not engage with it, and these strategies are based on me engaging with the pain. I don't want to engage with it, I just want it to go away. And stay away.