July 10th, 2009

rtfMRI Scan No. 5

rtfMRI Scan No. 5

Today I had my fifth rtfMRI scan in the chronic pain treatment study, and this time I alternated between using the successful strategies for increasing and decreasing my pain found during the previous scans (the affective strategy, using the feelings of anger, discouragement and frustration for increasing, and the discriminatory strategy of imagining healthy, non-painful tissue spreading into the painful areas for decreasing the pain) with the new evaluative strategy of comparing my worst pain day ever with a day when I had little to no pain. This was to find out which of all of these various strategies worked best for controlling the activation of my brain's pain centers.

Since the previous scan, I've been practicing using this new strategy. I got some interesting results during the first practice session, but for the rest of the sessions I felt completely detached while thinking about those 2 experiences. Even reviewing my notes on those experiences and incorporating those intensely negative as well as positive thoughts and feelings, I still felt like I was watching a movie instead of having the experiences myself. I felt like it was having no effect on my pain level, either up or down, after that first practice session.

I went into the scan today doing the best I could anyway, and found that my brain's pain center activation as reflected in the little virtual reality flame was very chaotic and often not even in sync with which direction it was supposed to be going. I had a lot of trouble concentrating, and the droning noise of the MRI machine almost put me to sleep several times. (I had physical therapy this morning too, which stressed me a bit both physically and emotionally, and was probably not a wise thing to have scheduled on a scan day, but it's too late to do anything about that now. )

The winning decrease strategy is based on how far down I could bring the pain level, from the highest increase point. The result of this latest scan was that the affective strategy was still the most successful at increasing my pain level (the feelings of anger, discouragement and frustration of struggling to move a huge block of obsidian representing my chronic pain), but the new evaluative strategy was the winner for decreasing my pain level (imagining a day when I had little to no pain).

I'm slightly surprised by this, seeing how detached I felt while practicing this particular strategy at home between scanning sessions. I felt like I couldn't make my pain go either up or down with it, but the machine found evidence it had more of an effect than the other strategies. I fear that these results are skewed by how tired I felt today and the nasty trouble I had concentrating. Who knows what was really going on in my mind that made my pain center activation go so low during the times I was supposed to be thinking about my day of least pain but instead my mental focus was wandering all over the place and my day of least pain was actually the farthest thing from my mind at that moment?

I have one more strategy to practice for my final scan next week: the coping strategy, where I think about how bad things would get if my pain just got worse and worse every day until I was completely disabled by it, and then I think about how good things would get if my pain went away little by little every day until it was gone completely for good, and all the different ways my life would change in either scenario.

I'm starting to get really tired of practicing these strategies. I don't like thinking about how bad things could get. I don't like thinking about how bad it hurts. I don't like engaging with the pain at all, trying to make it go up. I know there is scientific evidence that to control pain it is necessary to learn how to increase it as well as decrease it, because pain pathways in the brain are like pathways in a forest that get deeper and more entrenched in the landscape the more they are traveled. And they are a two-way street, going both up and down, so theoretically the more I practice increasing as well as decreasing the pain, the better I'll be able to decrease it. Theoretically, that is. Maybe I'm just too tired right now to think straight, but I have my doubts about that particular premise.


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