Learn about Neuroplasticity to Start your Self-Healing Journey

• Neuro = refers to brain & nervous system; plastic = moldable

• Neuroplasticity = the ability of the brain and nervous system to form and reorganize connections in response to learning, experience, or following injury

• Neuroplastic disorders involve long-term symptoms that result from stressful experiences or transient physical injury

• Involves the brain and nervous system as the command center of the body, directing control of all unconscious / involuntary body systems

•Chronic / persistent / recurrent pain

•Primary or Centralized pain

•Tension Myoneural Syndrome (TMS)

•Functional disorders

•Medically unexplained symptoms

•Psychophysiologic disorders

•Mind-body disorders

•Functional Neurologic Symptoms

Anything self-negating:

• Regarding the value of others above self; self-sacrificing

• High self-expectations or standards; overly self-critical

• Overly conscientious or responsible

• Frequent guilt

• Often worrying

• Being a rule follower

• Difficulty letting go

• Difficulty making decisions easily

• Holding in of thoughts & emotions; harboring resentments

• Dependency on others

• Cautious, shy, or reserved

ACEs are stressful or traumatic experiences in childhood that make a person more susceptible to developing chronic pain & neuroplastic symptoms as a child or later in life. They may include:

• Abuse (physical, sexual, emotional, neglect)

• Substance abuse in household

• Parental divorce

• Mental illness in household

• Domestic violence in household

• Incarcerated household member

• Significant physical illness or disability in household

• Other significant experiences may contribute as well

•Accident or injury

•Marital problems or divorce

•Illness or death in family

•Marriage or new relationship

•Change in family structure such as a new family member, new baby

•Change in living situation or move

•Work stress

•Financial stress

•Legal problems

•Violent experiences

•Natural disaster

•Immigration

•War

Classical Conditioning is learning by association. When a normally neutral stimulus (e.g. dad’s cologne) is paired with a stressful or traumatic stimulus (e.g. the cologne-wearing dad abusing the child), the child may be conditioned to develop neuroplastic symptoms (e.g. headaches) from the no-longer neutral stimulus (men’s cologne).

Think back to what was going on in life at the time you first developed symptoms. It may have been months, years, or decades ago. Symptoms are learned in the nervous system when strong emotions get associated with a particular body part. Just like muscle memory of any learned activity (throwing a football, playing an instrument), the nervous system has memory too. And just as practicing a new tennis serve can modify poor form, underlying emotions of learned symptoms can be reprocessed to extinguish the symptoms.

1. Rule out a dangerous structural problem, chronic inflammatory condition, or infection with appropriate lab testing, imaging and other diagnostic testing from your primary care provider and / or specialists.

2. Rule in a neuroplastic condition by considering functional, inconsistent, and triggering characteristics (see video above).

•85% of cases of back pain involve no evidence of abnormality in the back itself [Deyo et al, 1992].

•Conversely, a systematic review of the prevalence of spinal imaging findings in patients without symptoms of back or neck pain found that disc degeneration, disk bulge or protrusion, annular fissure, facet degeneration, and spondylolisthesis are common [Brinjikji, et al, 2015]. Other structural changes like scoliosis or kyphosis may become linked with pain but are also not causative.

•Large studies on the shoulder, hip, and knee make similar reports that a high prevalence of anatomical findings (rotator cuff tears, labral tears, meniscal tears, etc.) exist in pain-free individuals [Conner et al, 2003; Englund et al, 2008; Kaplan et al, 2005; Silvis et al, 2011].

•Therefore, we cannot conclude causation of age-related wear & tear findings with pain.

•Additionally, about 70% of patients diagnosed with a pinched nerve (carpal tunnel syndrome, sciatica) based on symptoms do not have true nerve impingement on imaging or have a normal nerve conduction study [Schmid et al, 2020].

• See summary or full article of 2023 study for evidence of effectiveness of a neuroplastic approach to treatment of Long-COVID

•Opioids: tramadol/Ultram, Vicodin, Norco, Percocet, morphine, oxycodone, Fentanyl, and others.

•Non-opioids: acetaminophen/Tylenol, corticosteroids such as prednisone, NSAIDs (ibuprofen/Motrin, naproxen/Aleve, meloxicam/Mobic, celecoxib/Celebrex) SNRIs like duloxetine/Cymbalta, TCAs (amitriptyline), gabapentin and pregabalin/Lyrica, muscle relaxants (baclofen, carisoprodol/Soma, metaxolone/Skelaxin, metocarbamol, Robaxin, tizanadine/Zanaflex, cyclobenzaprine/Flexeril), and topical medications like capsaicin and lidocaine.

•Procedural interventions including peripheral nerve blocks, epidural steroid injections, and sympathetic nerve blocks. Corticosteroid and hyaluronic acid injections have mixed results for long-term pain management.

[Dey, S et al, 2024]

•Surgery for suspected entrapment neuropathies such as Carpal Tunnel Syndrome and Sciatica yield significant numbers of patients who do not improve or worsen [Schmid, et al 2020] suggesting erroneous diagnosis of such conditions.

By linking body parts or body systems with negative emotions such as fear, anger, shame, guilt, or disgust, the brain and nervous system learn pain & symptoms. PRT reprocesses these symptoms through exercises in desensitization. These may be specific guided meditations or other interventions that gradually decondition the associated symptomatic body part(s) from ingrained negative emotion and recondition the body with strength, safety, and empowerment.

Ashar YK, Gordon A, Schubiner H, et al. Effect of Pain Reprocessing Therapy vs Placebo and Usual Care for Patients with Chronic Back Pain. JAMA Psychiatry, 2021.

•Studied 151 adults aged 21 to 70 years who had back pain more than half the days of the previous six months and a 1-week average pain intensity score of at least 4/10. 

•3 treatment categories:

1. One third of the studied patients received Pain Reprocessing Therapy (PRT) which involved an initial telehealth physician visit followed by 8 psychological treatment sessions over 4 weeks. 

2. One third received open-label placebo (they were told they were receiving a salt-water injection without any particular medication to stimulate the body’s own healing)

3. One third received no particular care for their back pain (termed “usual care!”)

•66% of patients were not just improved, but actually pain-free (0/10) or nearly pain-free (1/10) after PRT, compared to 20% of patients who were given the placebo and 10% randomized to usual care.

•fMRI results showed healing changes in the brain where pain is known to be processed. 

•Treatment effects persisted a year later.

EAET safely guides a patient to process stressful emotions that became linked with the painful or symptomatic body part. EAET involves review of past trauma or psychological stress and expression of emotions linked to it.

Meditation connects you to the present moment, free from future worry or past regret. It calms the nervous system and can help reassociate symptomatic or painful body systems with safety. Dr. Hollander can guide you on specific meditations for this. A regular meditation practice may decrease pain, blood pressure, and heart rate.