AAPM 2009: Specialists Study Brain Plasticity and Its Transformative Potential

Allison Gandey

February 13, 2009

February 13, 2009 (Honolulu, Hawaii) — Some suggest the discovery of neuroplasticity is the most important breakthrough in neuroscience since the revelation of the brain's basic anatomy. Proponents say the brain is pliable and can alter its own structure and function. Here at the American Academy of Pain Medicine 25th Annual Meeting, the keynote speaker called this work the most important medical advance in 400 years.

Neuroplasticity suggests the brain can alter its own structure and function. (Source: Arthur Toga, University of California, Los Angeles)

"Any change in our understanding of the brain has implications for all human activities," Norman Doidge, MD, from the University of Toronto, in Ontario, said during his address. Dr. Doidge is a psychiatrist and a member of the research faculty at Columbia University, in New York.

During an interview with Medscape Neurology & Neurosurgery, Dr. Doidge said, "The amount of synaptic changeover in the brain is much greater than we ever dreamed. The brain is far more malleable than we thought. It isn't infinitely malleable, but far more than we knew."

"This is revolutionary," session moderator Michael Moskowitz, MD, from the University of California, Davis School of Medicine, in Sacramento, said at the meeting. "This has implications not only for patients in chronic pain but for all humans on the planet."

Perry Fine, MD, from the University of Utah School of Medicine, in Salt Lake City, said he agrees. Exploring the concept of neuroplasticity, he says, "has enormous potential."

Ajay Wasan, MD, from Harvard Medical School and Brigham and Women's Hospital, in Boston, Massachusetts, echoed these comments and during the discussion period at the end of the session called this "a fabulous presentation."

Synaptic Changeover Profound

Dr. Moskowitz noted, "We used to think the brain was wired after about the first 3 years and what you had was what you got and you work within that because there was no chance of changing it. If on top of that the brain was damaged, you had to live with that damage. Neuroplasticity says that's not so — the brain is changing all the time."

Dr. Doidge says neuroplasticity is a powerful part of everyday life. "It's the reason that when we develop an accent when speaking, it's hard to get rid of, or when we get into a pattern or an addiction, it's hard to change." Chronic pain, he says, may also be explained in part by neuroplasticity. "Neurons that fire together, wire together."

Dr. Moskowitz says he agrees. "When you look at chronic pain, it's probably a case of neuroplasticity gone bad. What's happened is the spinal cord and the brain have reorganized so much that the nociceptive thinking part of the brain has become pain, and this dramatic change can occur anywhere over the course of hours to years."

The brain is flexible, Dr. Doidge suggests, but it also produces many rigid behaviors. "Neuroplasticity is competitive, and processes begin to dominate cortical real estate and inhibit other routines from developing. Just because a behavior or process is unwelcome doesn't mean it isn't part of the plasticity."

Dr. Doidge suggests that doctors will need to figure out how neuroplasticity engenders flexibility so they can work to help undermine rigidities that develop. "Sometimes a concerted effort to unlearn some patterns and relearn new ones can yield remarkable results," he said.

Plasticity Working For and Against Patients

"Dr. Doidge is unwittingly my cotherapist in my practice," Dr. Moskowitz said during an interview. "I ask every patient to read his book." Dr. Doidge is the author of the New York Times best seller, The Brain That Changes Itself: Stories of Personal Triumph from the Frontiers of Brain Science.

The book follows the lives of several injured patients and details how the brain adapts to compensate for disabilities. It explains how the brain is plastic and highlights how it is both resourceful and adaptive but also vulnerable to outside influences.

"This is all well and good," 1 attendee commented at the meeting, "but if a patient has a severed spinal cord, they have a severed spinal cord."

When asked to comment on this point, Dr. Moskowitz said, "I think there's some truth to it." But he notes, "We need to find ways to recruit nerves that aren't injured so that they can do the bidding for the processes that have been damaged."

Dr. Moskowitz reports he has been applying the principles of neuroplasticity in his pain practice for about a year and a half. He says similar work is being explored in US Department of Veterans Affairs to help those returning home from war recover from injuries.

Some stroke centers are exploring the principles of neuroplasticity by constricting the functioning limbs of patients to encourage the body to use injured extremities, with some success. "By restricting the good side and asking patients to do activity all day long, it helps the brain reorganize itself," Dr. Moskowitz said.

Much to Be Learned

During an interview, Norman Harden, MD, from the Northwestern University Feinberg School of Medicine, in Chicago, Illinois, raised some concerns about physicians rushing to new treatments without really understanding how this concept works.

"People are glibly talking about neuroplasticity at this meeting as though they understand the changes that occur. I'm worried this is fast becoming a trendy catchphrase and we're lumping a lot of things into it without really understanding it," he said.

Dr. Doidge acknowledged during his presentation that much remains to be learned and the understanding of neuroplasticity is still in its infancy. But he says doctors should move away from some of the ideas of philosopher and mathematician René Descartes that are so popularly taught in medical school.

"We often think of the brain as a machine with parts. We think the brain is hardwired like a computer. But machines don't change, and they can't grow new parts," Dr. Doidge said. "We now know that our understanding was spectacularly wrong."

Dr. Doidge has disclosed no relevant financial relationships with industry. He is receiving profits from the sale of his book.

American Academy of Pain Medicine 25th Annual Meeting: Keynote address. Presented January 29, 2009.

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