Chronic pain damages the brain

 Pain is not a purely physical experience. When we feel pain it is difficult for us to think of anything else. The painful part requires our attention continuously. It does not let us rest. To sleep. To think. To be…

When a person is continually in pain, day after day, it is understandable that their mood is also affected. It is not easy to deal with a malaise that does not give respite. As a result, these people often suffer from depression and / or anxiety. They may also have difficulty making decisions, even the simplest ones.

In addition to emotional pain and discomfort, these people often have to deal with the misunderstanding of others, who believe that their psychological problems are due to weakness or lack of willpower. However, pain changes brain functioning, and this could explain many of the emotional and cognitive difficulties these people suffer from.

The brains of people with chronic pain do not rest

In a healthy brain, the different zones maintain homeostasis, they are in a state of balance. When one region is activated, the others calm down. But neuroscientists of the Feinberg School of Medicine of Northwestern University have discovered that the brains of people with chronic pain works differently.

These neuroscientists used functional magnetic resonance imaging (fMRI) to scan the brains of some people with chronic low back pain and a group of painless volunteers as both groups watched a moving bar on a computer screen.

Chronic pain patients did the job well, but their brains functioned differently from people who didn't feel pain. When some areas of the cortex were activated in the painless group, others were deactivated, maintaining a collaborative balance between the different areas of the brain. This balance is also known as "resting brain networks".

But in people suffering from chronic pain, one of the nodes of this network did not calm down. The frontal region of the cortex, associated primarily with emotion control and decision making, never calmed down.

Those areas aren't disabled when they should. It is as if they are trapped running at great speed, disrupting neural connections and wearing down neurons under constant work. And this constant firing of neurons could cause permanent damage leading to psychological disturbances or cognitive deficits.

The trail of damage from chronic pain

“If you are a chronic pain patient, you have pain 24 hours a day, seven days a week, every minute of your life, the permanent perception of pain in your brain makes these areas continuously active. This ongoing dysfunction in the balance of the brain can change connections forever and could damage the brain.

“When neurons are too active, they can change their connections with other neurons or even die because they can't maintain this activity for too long,” the neuroscientists explained.

Subsequent changes in brain connections are likely to cause the psychological problems that many people with chronic pain suffer from. In fact, they may underlie ailments such as depression and anxiety because the balance of the brain is disturbed as a whole.

Depression, for example, affects 5% of the general population, but its incidence increases to between 30 and 45% in patients with chronic pain. The relationship between depression and pain is two-way: depression predicts the development of chronic pain, and chronic pain increases the risk of depression. It is no coincidence that both problems, depression and pain, share a dysregulation of the noradrenergic and serotonergic pathways in the brain.

In people with chronic pain, depression often coexists with anxiety, as shown by a study from St. Thomas Hospital in London. In fact, there is a term in psychiatry to refer to this state: agitated depression . In that case, the person suffers from depression, but also suffers from restlessness, insomnia and a widespread feeling of apprehension typical of anxiety.

Chronic pain also affects our cognitive resources and the ability to make decisions. It is not accidental because the neural systems involved in cognition and pain overlap and modulate each other.

In fact, several studies have found that patients with chronic pain often fail to make effective decisions, especially in risky and emotionally charged situations.

Science, therefore, indicates that the emotional and even cognitive problems that people with chronic pain suffer are not just "in their mind", but have a neurobiological basis.

Sources:

Vadivelu, N. et. Al. (2017) Pain and Psychology — A Reciprocal Relationship. Ochsner J ; 17 (2): 173-180.

Walteros, C. et. Al. (2011) Altered Associative Learning and Emotional Decision Making in Fibromyalgia. J Psychosom Res ; 70 (3): 294-301.

Woo, A. (2010) Depression and Anxiety in Pain. Rev Pain ; 4 (1): 8-12.

Baliki, M. et. A. (2008) Beyond Feeling: Chronic Pain Hurts the Brain, Disrupting the Default-Mode Network Dynamics. J Neurosci ; 28 (6): 1398-1403.

Apkarian, AV et. Al. (2004) Chronic Pain Patients Are Impaired on an Emotional Decision-Making Task. Pain ; 108 (1-2): 129-36.