“The greatest evil is physical pain.” - St. Augustine, forth-century theologian

by Sharon J. Proctor, PhD
Illustration: By Anne Horst

Imagine being crushed by a massive weight – or having your head squeezed in a vise, or your leg being on fire, or a knife splitting you open, or a red-hot poker searing your insides. Now
imagine the pain lasting for months, years, forever.

Chronic pain is a silent epidemic in North America. It affects one in five people. Ignored for decades as something that is “all in your head,” it’s finally being taken seriously. In fact, SFU’s Surrey campus is at the forefront of chronic-pain research. The epicentre of this research is Diane Gromala, Canada research chair in the School of Interactive Arts and Technology. As it happens, she’s among the one in five who suffer from chronic pain.

Chronic pain differs from acute pain.
Acute pain starts with an injury. It disappears once the injury heals. Chronic pain begins with or without an injury. After six months it has assumed a life of its own. Whether it feels dull, stinging, itchy, stabbing, squeezing, aching, gnawing, shooting, or cutting, it becomes deeply embedded. It is tormenting, wreaking havoc on a person’s life.

Then there’s the emotional pain a person feels when no one believes the hurting is real. “It’s your imagination,” they say. “Stop feeling sorry for yourself. Get a life!” No matter how hard sufferers try, they can’t make others understand that the agony is genuine. “You feel alone,” adds Gromala. “You want to hide, curl up, and just try to keep breathing, to get any relief, however brief.” Over time you spiral downward into isolation, hopelessness, and depression.

Many sufferers lose their jobs, friends, family, and normal lifestyle. And if the pain continues long enough, it starts to seriously affect the immune system, hormonal interactions, organs, and cognitive (mental) function.

Chronic pain is a legitimate disease.
Researchers have found that the cause of chronic pain may be a malfunctioning of so-called glial cells in the spinal cord. When a person is injured, the glial cells control the firing of pain messages to the brain. They gradually shut off the pain neurons as the injury heals. In the case of chronic pain, the shut-off mechanism doesn’t work properly. So the pain cells continue firing their messages. In some people they start firing spontaneously without any injury.
The non-stop firing of pain signals over time begins to alter the nervous system itself. For one thing, it stimulates more nerve cells to send pain messages to the brain, making the pain worse. Still more damaging is that the constant flow of pain signals starts carving its own right-of-way channel – an express highway – from spinal cord to brain. The firing of pain signals becomes entrenched. In time, even parts of the brain itself become altered by the constant signals.

There are several treatments for chronic pain. Opiates (e.g., morphine, heroin, codeine) are one option. But they create a dependency, and their effectiveness is reduced by the aforementioned glial cells. Marijuana sometimes works, as do acupuncture, hypnosis, anaesthetics, biofeedback, cognitive behaviour therapy, electrical stimulation, and meditation. None of these, however, provide a permanent cure. They give temporary relief and, in some cases, help manage the pain.

Diane Gromala brings unique qualifications to chronic pain research.
Gromala’s life has been anything but conventional. She grew up in Michigan and Oregon, attending Montessori and Catholic schools. As a child she was often ill and stayed home from school. Fortunately she was smart, inquisitive, and an A+ student. She taught herself to read at age four; she loved books, especially her dad’s medical encyclopedias. “Also, I was curious about things I saw in doctors’ offices. Sometimes they’d give me a poster or anatomical model.” Her interests ranged from dissecting specimens in biology class to making art posters and banners for church.”

Naturally she went on to university. She obtained a Bachelor of Fine Arts in photography and design from the University of Michigan. She then earned a Master of Fine Arts in design from Yale, where she also studied culture, philosophy, and medical school anatomy. Next it was on to the University of Plymouth for a PhD in computing science. There she investigated the physiological responses of people immersed in virtual reality. When she was in her mid-twenties (between Yale and Plymouth), Gromala began experiencing chronic pain.

“I tried every form of traditional and alternative medicine available in North America. Nothing cured it. But I did find that meditation and acupuncture at least made the pain bearable.” Today, working with a physician, a neuroscientist, a computer scientist, an engineer, and an artist, she’s merging meditation, art, and high tech to create new hope for chronic pain sufferers.

She uses “immersive virtual reality” to enhance meditation’s effects.
The third floor of SFU at Surrey is a computer geek’s paradise. Room after room is filled with computers and other high-tech equipment. Here faculty and students immerse themselves in visual analytics, feral computing, spatial cognition, computational environments, bio-media, ubiquitous computing, and other futuristic themes. This is Dr. Gromala’s home base.

“If your chronic pain is entrenched,” she explains, “you must re-map your pain experience – push it to the back of your mind, alter nerve-impulse pathways.” Meditation has long been used to reduce stress. But in recent years scientists have shown it can also reduce pain. And why not? Both meditation and chronic pain involve mind and body, and chronic pain is closely linked to physiological stress.

A few years ago Gromala’s group developed a “meditation chamber.” It uses virtual reality and biofeedback to teach pain sufferers how to decrease their feelings of pain and stress. Users sit in a comfortable chair with 3D (stereoscopic) goggles over their eyes and biometric sensors on three fingers. They then immerse themselves in a guided meditation experience. The sensors track galvanic skin response and blood pressure, which in turn change the images seen through the goggles.

First, users of the chamber view a lovely sunset over water, and they are asked to concentrate on making the sun set. As blood pressure decreases, the sun sets and the moon rises. Next come muscle-tension and relaxation exercises, in which a 3D picture of the human-body mirrors actions as users slowly relax their muscles. Finally, through a meditation and breathing exercise, soothing images and sounds fade as a true meditative state is achieved. The experience gives people the tools to calm pain and stress without outside help. In fact, 20 clinics and hospitals around the world are now using this approach.

Often chronic pain limits mobility. If it hurts to move, a person will obviously avoid moving. But inactivity worsens overall health, so the SFU group has addressed this issue with its latest project: a “virtual meditative walk.” They’ve added a treadmill to virtual reality and biofeedback. Individuals physically “walk” through the 3D forest seen in the goggles. “As you approach a relaxed meditative state,” notes Gromala, “changes in your physiological state cause the trees to become abstract.”

These experiences teach people how to meditate more effectively, to subdue those parts of the mind and body involved in pain. As well, the walking meditation encourages the body to produce natural substances called endorphins, which act like opiates to dull pain.

What about Gromala’s own chronic pain? “I was practising meditation long before starting this research. The meditation chamber, however, enhanced my ability to push back the pain.” aq

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