Prof. Pavel Goldstein of the University of Haifa is leading a revolutionary approach to treating chronic neuroplastic pain, based on training the brain to change the “danger signal” – and showing that even pain that has lasted for years can pass when it is understood that it is the brain that produces it.
In the room that was once his office Prof. Pavel Goldstein At the University of Haifa, something unique is happening now. The space is gradually being transformed into a treatment room, part of a new center designed to simulate the health system. “We will bring people together with doctors and psychotherapists who have undergone special training in diagnosing chronic pain and guiding them through the recovery process, as we focus on the most common type of chronic pain that has recently been discovered – neuroplastic pain,” he explains.
The goal? Nothing less than to transform the way the health system treats chronic pain and offer real hope to millions of Israelis who have not found a solution in traditional treatments. Goldstein, who has been researching in the field for over 13 years, is leading, together with Yulia Zatolovsky, the development of a therapeutic approach based on a revolutionary understanding: Chronic pain in many cases does not stem from a problem in the body, but is a warning message that the brain sends. And just as the brain created it – it can also stop it. Just last November, the world marked International CRPS Awareness Month, an excellent opportunity to hear about chronic pain and the attempt to solve it.
When the brain changes
“Acute pain is the most basic thing we know,” explains Goldstein. “We fall at a young age, get hit, and then we feel pain that comes to alert us that there may be some damage here.” This is an important adaptive action. Our tissues usually heal up to 3 months. But what happens when the pain lasts beyond this period and becomes chronic? More than 3 million Israelis live with chronic pain. For many of them, the pain becomes a crippling daily reality that does not respond to conventional treatments.
The problem, according to Goldstein, is conceptual. “We grow up with the insight that we know what pain is. My knee hurts, so the problem is probably in my knee. My back hurts, so the problem is probably in my back.” This is the localization model, which works great in most areas of medicine. “But the problem is that pain is a system that is not local.”
Pain is created by the brain. “There are ‘alarm sensors’ in the body that respond to injury, and the signal travels through the spinal cord to the brain.” But the brain is not a simple button. “There’s a very complex system there – there’s not one pain area in the brain. There are actually entire systems there that you can think of as a security cabinet that makes very difficult decisions.” Emotional processing mechanisms, expectations and context are involved. To illustrate, Goldstein describes an experiment in his lab: “If I give the exact same thermal stimulus, say heating the palm of your hand to forty-five degrees, one person will rate it as a pain of 3 out of 10, and another person will rate it as an 8 out of 10 – the exact same stimulus.”
The key discovery is that the brain changes in chronic pain. “There are studies today that show that the brain’s response to acute pain is not the same mechanics as chronic pain.” The brain, thanks to neuroplasticity – the flexibility of the brain – changes. This is the same neuroplasticity that allows us to learn new languages or recover from a stroke – but in the case of chronic pain, it works against us. The brain “learns” to produce pain even without a physical cause.
“In most cases, the pattern of pain representation in the brain changes completely. And it turned out that for this pain, too, there no longer needs to be an injury. The brain has created a new mechanism – it knows how to create the mechanism that simply produces the pain.”
This phenomenon has a name: neuroplastic pain, or by its diagnostic name – primary pain. “Primary means that the pain is the problem and there is no organic problem in the body that can explain it.”Prof. Pavel Goldstein
The personal journey
Goldstein’s path to the field began as a postdoctoral fellow in Colorado, where therapists approached him with a bold claim: “We’re managing to get people to recover.” The word “recover” is almost taboo in the healthcare system when talking about chronic pain. The study showed that 66% of the group that underwent the treatment recovered completely, and the recovery remained a year later.
But Goldstein also has a personal story. When he set up the lab at the beginning of the coronavirus pandemic, he worked from home. “I sat in front of a computer every day, hardly got up, and I also gained a few pounds. And back pain started that lasted for several months. I told myself that the pain must be because of the prolonged sitting and the weight.” After watching a film about the therapeutic approach he recommended to all those who come in with neuroplastic pain, the pain simply disappeared. “It was a moment of sudden insight,” Goldstein describes. “I realized that my body was healthy, and the brain simply continued to transmit a danger signal that no longer had justification. As soon as I really understood this – the pain was released. Even though I theoretically knew all this before – I fell into the same trap of neuroplastic pain.”
“At the end of the film, I suddenly realized that the pain in my back was completely gone, and it hasn’t returned since.” This is a psycho-educational approach – the film explains the mechanism of pain and provokes reflections, and “there really are people for whom this is enough to heal.”
PDSR method
Then, in collaboration with methodologist Yulia Zatolovsky, PDSR – Personalized Danger Signal Reprocessing – was born – brain training for recovery from neuroplastic chronic pain.
“We took the knowledge of the neuroscience of chronic pain and combined it with personal training tools to help people apply it to their daily lives.” The study showed that over 50% of the group members who underwent training using PDSR recovered from chronic pain, and the results remained at a follow-up of a year and a half.”
The method focuses on primary, neuroplastic pain: back, neck, knee, joint pain, migraines, fibromyalgia, endometriosis, and CRPS. “It is important to note that approximately 50% of people with chronic pain also suffer from clinical depression or anxiety, and many also suffer from post-traumatic stress disorder. The connection between mental states and pain is important in understanding the phenomenon,” says Goldstein.
The perceptual challenge
“One of our biggest challenges is explaining to people that chronic pain can be cured,” Goldstein admits. “It’s counterintuitive—for most people, it’s a medical problem. Get me a pill, get me surgery.” That’s why he creates a lot of educational material, interviews with those who have recovered, and videos that explain the logic.
Today, several projects are underway in the lab, including recruiting participants with back pain who will receive free treatment as part of a study. There are already trained psychotherapists working with the method, but right now it is private. “We really want it to be accessible to everyone, for it to be part of the healthcare system,” Goldstein concludes. In the meantime, he continues to guide, research, and spread the message: Chronic pain is not a fate. The brain that created it can also stop it.
More of the topic in Hayadan:
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If you can send me the video, I can watch it and understand the cause of the pain that the brain is mistakenly transmitting, and maybe I too will be able to disconnect from the pain.
What is the name of the movie in question?