Yesterday I went to one of the weekly Friday talks at the pain clinic. The topic was on the neurocircuitry of addiction, and how that can relate to obesity or chronic pain. It’s based on Dr. Nora Volkow’s research with the National Institute on Drug Abuse. It was really fascinating.
Here’s a basic recap (with me surely relaying some misunderstood or inaccurate scientific info.) The case managers presented and focused on this particular brain behavior where the emotional processing center (based around the amygdala) seeks out opportunities using Dopamine 1 (D1). The basic example was, “Oh look at that red berry over there!” D1 compels you to go look for the berry. Once you’ve found a berry and eaten it, a reward pathway builds in your brain, and teaches you berry = reward. So you repeat the behavior.
The case managers, talking to us as a chronic pain group, encouraged us to look for places in our lives where we have learned to find reward, or more relevant for us, relief. When we first got hurt we may have found it beneficial to get off our feet and rest in the recliner, or take an opioid, or avoid using the area that hurt, or withdraw socially. Certain things provided relief, and early on these behaviors made sense. Over time with chronic pain, those behaviors can actually cause more harm than good and they don’t make sense anymore. We may be repeating behavior because our brains are conditioned, so it helps to be mindful.
The other part of the presentation as about Dopamine 2 (D2). When the emotional processing center and D1 get activated, it creates a link to the frontal lobe and D2. D2 works with the frontal cortex as impulse control. It says, “I hear ya, but do you think that is a good idea?”
To keep our D1 and D2 in check so they can balance each other out, it helps to avoid super stimulating substances, like sugar, alcohol, or drugs. These things are so stimulating they tend to throw the D1 and D2 off balance, and the D2 can’t do its job when it comes to impulse control. Something that DOES help keep these in balance is deriving pleasure from small, daily experiences. (Like Amelie! I thought this was really interesting.)
One concept was that once you’ve established a connection with a reward, the neuro-connection doesn’t go away. They said it’s like a cucumber turning into a pickle- it can’t go back. All you can do is build new pathways around it by creating new options for yourself. That’s why ongoing support groups for addiction or chronic pain are important. We have to build and reinforce new pathways and options for ourselves.
For me, my example is that I like to go lie down and rest when I have pain because I’ve learned this is relief. My brain has learned it feels good and I can’t un-build that connection. But I can think of other things I can do that don’t involve my pain area, like sitting where I can do something, like cooking or stuff on my computer. I could yoga, stretch or do Qi Gong. I could talk to a friend. My brain might start to find these things relieving. The case managers wants us to build new connections and find new “berries” so we start seeking relief from healthier places.
One of the closing comments from a case manager, which was kind of an aside really, was that we can begin to “be with” whatever is happening rather than resist and think things should be a certain way or run in our habitual patterns. That really resonated with me. I think that’s the biggest shift the pain clinic has taught me. It’s a very subtle internal shift, but a totally different way of being that is challenging and incredibly interesting every day.