Wednesday, February 13, 2008

Chronic Pain Harms the Brain

[Dr. Teicheira told me that chronic pain also damages the central nervous system, and that untreated pain may be the root cause of fibromyalgia.  He had nothing good to say about any doctor who refuses to prescribe pain medication or tells the patient to "tough it out".  I suffered for years without effective pain relief, and he suspects I'll suffer the rest of my life from the results of being refused appropriate treatment.]

Chronic Pain Harms the Brain

by Northwestern University


 People with unrelenting pain don't only suffer from the non-stop sensation of throbbing pain. They also have trouble sleeping, are often depressed, anxious and even have difficulty making simple decisions.

“Stuck on Full Throttle”
In a new study, investigators at Northwestern University's Feinberg School of Medicine have identified a clue that may explain how suffering long-term pain could trigger these other pain-related symptoms.

  • Researchers found that in a healthy brain all the regions exist in a state of equilibrium. When one region is active, the others quiet down.
  • But in people with chronic pain, a front region of the cortex mostly associated with emotion "never shuts up," said Dante Chialvo, lead author and associate research professor of physiology at the Feinberg School. "The areas that are affected fail to deactivate when they should." They are stuck on full throttle, wearing out neurons and altering their connections to each other.

This is the first demonstration of brain disturbances in chronic pain patients not directly related to the sensation of pain. The study was published Feb. 6 in The Journal of Neuroscience. [See abstract - “Beyond Feeling: Chronic Pain Hurts the Brain, Disrupting the Default-Mode Network Dynamics.” ]

Chronic Low Back Pain vs. Pain Free Volunteers
Chialvo and colleagues used functional magnetic resonance imaging (fMRI) to scan the brains of people with chronic low back pain and a group of pain-free volunteers while both groups were tracking a moving bar on a computer screen.

The study showed the pain sufferers performed the task well but "at the expense of using their brain differently than the pain-free group," Chialvo said.

When certain parts of the cortex were activated in the pain-free group, some others were deactivated, maintaining a cooperative equilibrium between the regions. This equilibrium also is known as the resting state network of the brain. In the chronic pain group, however, one of the nodes of this network did not quiet down as it did in the pain-free subjects.

This constant firing of neurons in these regions of the brain could cause permanent damage, Chialvo said. "We know when neurons fire too much they may change their connections with other neurons and or even die because they can't sustain high activity for so long," he explained.

"If you are a chronic pain patient, you have pain 24 hours a day, seven days a week, every minute of your life," Chialvo said. "That permanent perception of pain in your brain makes these areas in your brain continuously active. This continuous dysfunction in the equilibrium of the brain can change the wiring forever and could hurt the brain."

Chialvo hypothesized the subsequent changes in wiring "may make it harder for you to make a decision or be in a good mood to get up in the morning. It could be that pain produces depression and the other reported abnormalities because it disturbs the balance of the brain as a whole."

Study of New Pain Control Approaches "Essential"
He said his findings show it is essential to study new approaches to treat patients - not just to control their pain but also to evaluate and prevent the dysfunction that may be generated in the brain by the chronic pain.

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For more information, contact Dante R. Chialvo or Northwestern press representative Marla Paul

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Unfortunately, too many doctors don't understand these basic facts about pain.  According to Dr. Teicheira, the structural changes begin to occur in under 48 hours, so there is never a point when a patient should be told to tough it out and come back only if the pain doesn't get better after a week or two -- that's too late.

Ironically, the stance of the director of the pain management clinic at the medical group where I was repeatedly denied pain medication is that "pain is what the patient says it is".  If the patient says the pain is severe, then it's severe and should be treated as such.  Unfortunately, the doctors I dealt with refused to believe me that the pain was severe enough to prevent me from sleeping, and also refused to refer me to the pain management clinic where I would have been believed.

Unfortunately, by the time I ran into Dr. Teicheira, who would have gladly testified that they'd committed malpractice, the statute of limitations had run out.

Don't let it happen to you -- do whatever it takes to get a referral to a pain management clinic.  While a rheumatologist may be loathe to prescribe anything stronger than Advil for fear of government investigation leading to losing his license (which Dr. Teicheira calls an unreasonable fear if they're prescribing reasonable amounts -- only those prescribing excessive quantities to one patient have anything to fear), a pain management specialist is expected to be prescribing pain pills, and won't give you that hokey excuse for not giving you what you need.

Another excuse they'll use is that they don't want to turn you into an addict.  Statistically, less than 1% of patients become addicted to their pain pills, and almost all of those can be predicted because they have an addictive personality.  If you don't have a history of alcoholism, drug addiction, gambling addiction, internet addiction, etc., they have nothing to worry about. 

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