Pippa Cossens’ agonising medical condition began with pain in her back. But soon the discomfort had spread to the muscles in her arms and legs, even her face. “At its worst, it almost felt like the muscles were being ripped off the bones,” she said.

After several tests and scans, doctors told Ms Cossens she had degeneration of her spine as well as fibromyalgia, a mysterious pain syndrome, the cause of which is unknown. They could do nothing to help and she would have to live with it.

But after learning a “brain retraining” technique for banishing pain, she is now back to normal and even climbs up mountains to raise funds for charity.

The approach is not widely known about, but some doctors are trying to spread the word. After three years’ of agony, Ms Cossens stumbled on the approach at a medical conference in 2017 and improved overnight, although she only fully recovered once she underwent the therapy.

“I learned at that conference that there were doctors here from all around the world who understood completely [my condition], and they had a solution,” she said. “I was bowled over.”

Brain misinterprets incoming signals

Brain retraining can work because in people such as Ms Cossens, the pain is believed to be caused, not by physical damage or illness, but because the brain starts misinterpreting signals coming in from the body.

Mild pain sensations can be read as severe, and as the condition progresses, even ordinary feedback to the brain from muscles and other parts of the body are wrongly interpreted as pain.

This kind of pain is sometimes called “neuroplastic”, referring to the fact that neural pathways in the brain are modifiable.

Neuroplastic pain often leads to other medical problems developing through neuroplastic processes too, such as fatigue, gut problems, dizziness and memory and concentration issues – sometimes referred to as ‘brain fog’.

That happened for Ms Cossens. Together, the problems meant she could barely keep working as an osteopath. “I couldn’t even walk my dogs around the block,” she said. “I was just about taking care of my son. But beyond that, my life had really shrunk.”

Fibromyalgia is a chronic condition that causes widespread pain throughout the body, along with fatigue, sleep disturbances, and cognitive difficulties (Photo: Galina Zhigalova/Getty)

Ms Cossens told her story this week at a repeat of the same conference, run by a medical body called SIRPA, for Stress Illness Recovery Practitioners’ Association. Its members include GPs, hospital doctors, physiotherapists and mental health therapists.

A growing number of health care staff are learning about neuroplastic pain and are helping their patients by teaching them about brain retraining, also known as mind-body techniques, said Professor Deepak Ravindran, director of Berkshire Pain Clinic.

“I have been able to suggest mind-body techniques for close to seven years now on the NHS in my secondary care pain clinic and my private work,” he said. “A lot of NHS doctors are practising and offering mind-body approaches in the NHS, more so in primary care rather than in secondary care.”

Some NHS health services also work with a charity called Flippin’ Pain to raise public awareness of neuroplastic pain.

Deliberately doing pain-causing activities

For those affected, doctors first need to explain that the symptoms are not caused by physical damage to their body but by faulty pain-processing pathways in their brain, said Dr Howard Schubiner, clinical professor at Michigan State University, who has written a book called Unlearn your Pain.

Then the brain retraining therapy can begin. This involves people getting used to doing activities that can cause pain, while staying calm and getting reassurance that they are not damaging their body. It can be done using self-help books or websites, or the person may need coaching from a therapist. Breathing and relaxation exercises can help, as can mindfulness meditation.

“You learn to feel the sensations within the body, but detach the fear and the panic from them,” said Ms Cossens. “We tend to understand that pain means danger. But when you understand you can have pain without tissue damage, you change what you’re experiencing.”

Dr Schubiner said it is crucial that people with pain are medically assessed to rule out structural causes of pain. “Each person needs a very careful individual assessment,” he said. “But let’s be open to the possibility that the [pain] signals are not being triggered by physical illness, but a neural circuit.”

Dr Rajesh Munglani, vice-president of the British Pain Society, said that some people have both kinds of pain going on at once – caused partly by structural damage and partly by neuroplastic processes. “In many cases, treatment of the social, psychological and psychiatric dimensions can make a massive difference and reduce the disability, even if not much can be done about the biomedical source of the disease,” he said.

But brain retraining doesn’t help everyone with long-term pain, he added. “There are situations where the underlying source of pain is so overwhelming, that physical treatment of the pain source is the best approach.”

Ms Cossens no longer considers that she has fibromyalgia. “Am am I pain free? Yes, most of the time, but not always, because that is part of being human.”

She is now incorporating brain retraining into her work as an osteopath. Some of her patients can initially think that she is saying their problems are “all in their head”, she said.

“I’m not saying it’s in your head. But your brain is responsible for some of the symptoms. And you do need to change the way your neural pathways are running, otherwise you don’t change the pain.