Practical story telling strategies are required for the therapeutic neuroscience education movement that has emerged essentially from ‘Explain Pain’ and associated research. We suggest a series of neuroscience stories that can be adapted, such as “loving the body part again” for disembodiment or “majesty of the brain” stories to enhance the notion that the person is much bigger and more powerful than the pain which may have taken them over.
One of the most popular stories is the “drug cabinet in the brain”- the story of our own powerful and underused pharmacy and one which is hijacked by the pharmaceutical industry which prefers exogenous rather than endogenous medication. The story attached here is a 5:30 minute clip in didactic form. It is particularly useful for patients who are reducing medications, to know that they have their own free pharmacy with no side effects. I think everyone should be aware of this potent drug cabinet within.
What are your thoughts on the “Drug Cabinet in the Brain” as a clinical story?
Have you any little brain metaphors that you use with patients?
[wpvideo BAABgIYI]
David Butler
www.noigroup.com
Great video. I look forward to many more interesting and stimulating conversations.
I talk about the drug cabinet in the brain to patients a lot but I have changed how I have done this over the years. Initially it sounded too much like “you can think your pain away”, that was certainly some of the feedback I got from patients. I feel now you have to do this almost by stealth, by the way you act and communicate with painful problems. If done wrong it can sound very challenging.
A great point Dave. I wonder sometimes if this tendency towards the “think your way out of pain” understanding stems from a primacy in the west of conscious thinking- the idea that “we” are in complete control which leads logically, to blame.
I will sometimes tell people in pain that they can open the drug cabinet in the brain by not “thinking” ie. mindfulness or meditation.
I love the way you explain this concept, and I have used quite a bit with my patients.
Inspired by Moseley’s vision metaphor, I have been using the experience of ‘tickling’ as a metaphor for pain. I am very ticklish, and my kids love to tickle me. They know the exact spot on my neck to touch, which inevitably causes me to break out in uncontrolled laughter and twitching. However, I have noticed some interesting things about the experience.
#1. If I am in a bad mood, or my kids are past their bedtime, I don’t react to the neck stimulation with as much laughter or twitching.
#2. Sometimes, I start laughing even before their fingers can get to my neck. Just seeing them move their fingers towards my neck can trigger the laugh reaction.
#3. If a stranger on the street (I live in New York city), were to jab his fingers into my neck in the same way my kids do, I would not find it funny…..
Thus, the experience of being tickled is more than just the sensory stimulation alone, but rather relies on a lot of interpretation of the context of the stimulation. And amazingly, the same effect can be elicited even without the sensory stimulation, if the context is present.
For mine, this little story is one of the most powerful in the clinic.
It leads to wonderful, practical discussions about things that people can Do to open the drug cabinet, as well as explaining why some situations/contexts may lead to the drug cabinet “closing” and hence the pain experience increasing.
There’s also a really nice opportunity to lead towards a bit of deep reflection. I commonly get the response from a person in pain along the lines of “well, why isn’t my bloody cabinet opening “. My response, after indicating some of the contexts/experiences that might “close” the cabinet (other threats in life, sense of loss of control, worries, concerns, poor coping and so on) that I’ve written down is simply to repeat their question “ok, why do you think you’re cabinet is not opening?”
Invariably the response then is a list of all the worries and concerns of that person (even sometimes worries that the person had previous denied having) followed by a moment of silent, thoughtful consideration.
Great story, great post, great blog!
I love the practical analogy. Patients with persistent pain can always relate to pain medicine and its powerful effects. What better than to have your own medicine, much like the analogy I use involving oxygen and the act of breathing as a free and available drug without side effects to calm the system and ultimately reduce pain. Getting patients to want to learn about their pain/ brain physiology can be challenging, especially when they are looking for the quick fix. I think David’s story is a nice way to transition into the explain pain methods. I also like to talk about the altered pain system in chronic or persistent pain in comparison to other senses that have the possibility to lose their reliability as time wears on or injury occurs (vision, taste, smell, sensation). For example, if our vision becomes impaired, we must make adjustments and use accommodations (glasses, contacts, braille) to remain functional since our vision in no longer a reliable sense. Likewise, when our pain system becomes impaired (sensitized), we must adapt through pacing and graded activity since our pain is a less accurate determinate of tissue damage /tolerance. This seems to give some patients more confidence (less threat) or less fear to move, when allodynia remains.
OK, talks to understanding how the brain perceives pain but does not talk to what I thought it would. I was looking for how to open the cabinet. Some days, Ibuprofen doesn’t take the pain away (spine issues including spondylolisthesis, nerve impingement and more, I have bursitis and osteophytes in both hips. I don’t want stronger meds, nor steroid injections. I also have scoliosis and osteoporosis so surgery isn’t an answer. I don’t want surgery anyway. I am 84. How do I get the information on how to open the cabinet?