Study shows early brain changes predict which patients develop chronic pain

When people have similar injuries, why do some end up with chronic pain while others recover and are pain free? The first longitudinal brain imaging study to track participants with a new back injury has found the chronic pain is all in their heads –- quite literally.

A new Northwestern Medicine study shows for the first time that chronic pain develops the more two sections of the brain --- related to emotional and motivational behavior --- talk to each other. The more they communicate, the greater the chance a patient will develop chronic pain.

The finding provides a new direction for developing therapies to treat intractable pain, which affects 30 to 40 million adults in the United States.

Researchers were able to predict, with 85 percent accuracy at the beginning of the study, which participants would go on to develop chronic pain based on the level of interaction between the frontal cortex and the nucleus accumbens.

The study is published in the journal Nature Neuroscience.

"For the first time we can explain why people who may have the exact same initial pain either go on to recover or develop chronic pain," said A. Vania Apakarian, senior author of the paper and professor of physiology at Northwestern University Feinberg School of Medicine.

"The injury by itself is not enough to explain the ongoing pain. It has to do with the injury combined with the state of the brain. This finding is the culmination of 10 years of our research."

The more emotionally the brain reacts to the initial injury, the more likely the pain will persist after the injury has healed. "It may be that these sections of the brain are more excited to begin with in certain individuals, or there may be genetic and environmental influences that predispose these brain regions to interact at an excitable level," Apkarian said.

The nucleus accumbens is an important center for teaching the rest of the brain how to evaluate and react to the outside world, Apkarian noted, and this brain region may use the pain signal to teach the rest of the brain to develop chronic pain.

"Now we hope to develop new therapies for treatment based on this finding," Apkarian added.

Chronic pain participants in the study also lost gray matter density, which is likely linked to fewer synaptic connections or neuronal and glial shrinkage, Apkarian said. Brain synapses are essential for communication between neurons.

"Chronic pain is one of the most expensive health care conditions in the U. S. yet there still is not a scientifically validated therapy for this condition," Apkarian said. Chronic pain costs an estimated $600 billion a year, according to a 2011 National Academy of Sciences report. Back pain is the most prevalent chronic pain condition.

A total of 40 participants who had an episode of back pain that lasted four to 16 weeks --- but with no prior history of back pain --- were studied. All subjects were diagnosed with back pain by a clinician. Brain scans were conducted on each participant at study entry and for three more visits during one year.

 

Interesting stuff of course, but I still have to wonder how (as even Sarno states) that the oldest people are not the ones in the most pain from any physical maladies etc. and also one of the prime suspects in TMS people are that we are more type A personalities ie: worriers, over achievers, copers, etc. So that still raise a red flag to me that something in the thought or emotion process has a role.
I know we are in very elementary stages/areas at this point, unraveling some of the workings of the human brain. (We apparently only use about 13%-15% of it's capabilities.)
It is extremely interesting to me, how the brain will find different ways to route new paths, if say one is injured or loses a part of the brain (as in some young children having surgeries) to gain the old patterns, thru a new area of it.
I really agree with the areas of synapses being over or under used and certainly changing thinking patterns can give rise to new better habits or reactions that could be more positive than our old less efficient ones.
I also liken it to being right or left handed, as we can (with practice and over some time) re/learn to be quite coordinated, especially at something we have never done with our opposing hand like being left handed, but playing the guitar right handed. (Which is what I do)

 

That Northwestern study is very interesting, but it seems to skirt around what we know about TMS
causing chronic pain. The study seems to be afraid to talk about the Mindbody connection more directly
and repressed emotions or our personality. So everyone who goes to TMSWiki.org learns the truth,
that it doesn't take medication to be free of pain, it takes thinking what emotions caused it.

 

This is a highly relevant study published in a very high impact journal! Thank you for sharing! As you mentioned Walt, the study does not link pain to repressed emotions or personality, but it does completely throw the mechanical theory out the window. The researchers demonstrated that the BRAIN is responsible for chronic pain, not a MECHANICAL issue with the spine, which would indicate that anyone who attempts to treat a chronic pain problem with physical therapy, shots, surgery, etc... is barking up the wrong tree. This is a huge step in the right direction!

 

Sounds like the two sections of the brain become more "talkative" following a traumatic accident (trauma with a big T), or, when long term stress gradually creates trauma with a little t. Perhaps they're more prone to becoming "chatty" in the aftermath of a Holmes-Rahe life stress event like loss of income or a death in the family? This new theory doesn't sound completely incompatible with Dr. Sarno's doctrine of repressed emotions creating unconscious rage. Sounds pretty chicken or the egg.

But Painfreefuture is right about this new theory debunking the structural diagnosis. More griss for our TMS mill.