Overcoming Pain

Why people experience chronic pain, and the power they have to de-intensify it

Chronic Pain versus the Brain: And the Loser Is...

We need to tear up those newly paved routes before the cement hardens.

How does a person become a "chronic pain patient"?

That label, chronic pain patient, can often lead to prejudice on the part of the health care profession. This prejudice can be manifested as chronic pain patients being treated as simply drug-seekers and/or stigmatized as individuals better left to psychiatric intervention.

Unfortunately, psychiatrists and psychologists tend to become very frustrated with those who experience and (dare I say it) seek help for the conditions which so often result from experiencing chronic pain.

A study was published earlier this year in the "Journal of Neuroscience" which concluded that chronic pain has a pronounced and pervasive impact on overall brain function. This impact would appear to explain the common cognitive and behavioral stigmata noted in those patients suffering from chronic pain.

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The researchers used magnetic resonance imaging (MRI) to demonstrate that individuals with chronic back pain had alterations in the functional connectivity of the cortical regions compared to those individuals not suffering from chronic pain. Interestingly, these areas of the brain are unrelated to pain. And this altered brain function leads to additional and unwelcome diagnoses, such as depression, anxiety, sleep disturbances, and decision-making difficulties.

In the healthy brain, all the regions exist in a state of equilibrium. When one region is active, the others become quiet. In contrast, those with chronic pain experience continued activity in the frontal part of the cortex of the brain associated with emotion. These are disturbances of the brain not directly associated with the sensation of pain.

This added brain activity occurs through the firing of the brain cells, known as neurons. When these neurons fire too much they actually change their connections, paving new routes so to speak And depression, anxiety, sleep disturbances and cognitive dysfunction become a "part" of the chronic pain patient.

It is self-evident that these co-morbidities can be for the chronic pain patient as debilitating as the pain itself-if not more so as time goes on and life becomes more difficult for an individual patient.

Pain appears to tax the brain, "firing up" areas which are usually quiet: the perception of pain has an irritating effect which does more than just irritate. The MRI data demonstrates this.

It would appear that these results indicate a need for early and aggressive treatment of pain. This may favorably modulate the discomfort, and thus forestall the onset of depression, sleep disturbance and cognitive impairment.

Perhaps through concerted treatment by pain specialists and mental health specialists those malignant brain activities can be prevented from becoming established impairments.

We need to tear up those newly paved routes before the cement hardens.

Mark Borigini, M.D., is a board-certified rheumatologist who has devoted his career to treating illnesses that cause chronic pain and disability.

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