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Medication & Treatment

Exactly How Chronic Pain Affects the Brain

Author| Ben Bobrow, MD

There is increasing evidence that chronic pain is characterized by alterations in brain structure and function. The huge advances in brain imaging techniques in the last few decades have shifted our appreciation of chronic pain conditions and has opened the door for new and exciting treatment strategies. Advanced neuroimaging techniques have reshaped the concept of chronic pain from a disease affecting mainly the sensory system, to a condition in which emotional and cognitive areas of the brain are affected.

Plasticity is a term used to describe the changes that occur in the nervous system. Chronic pain has been shown to be associated with neuroplasticity at several levels of the nervous system long after the original cause of pain is gone. Several studies have suggested a decrease in gray matter in pain-transmitting areas in patients with constant pain, reinforcing the notion of chronic pain as a progressive disease.

The brain and opioids

Chronic pain and the closely related overuse of opioid pain medications (such as hydrocodone, oxycodone, and OxyContin) have become dangerous problems. More people are disabled due to chronic pain than any other reason and as doctors are prescribing more painkillers and performing more surgeries, the number of people suffering from chronic pain is growing. The U.S. Centers for Disease Control describe opioid overdose as “the fastest growing drug problem in the U.S.”1

Novel and exciting science into the neurobiology of pain now helps us better understand why so many people are suffering and gives us new insights and hope into how we can get better. The brain processes information for all types of pain (acute, chronic and emotional) in a similar way. It records pain as traumatic events that require automatic responses from our nervous system that we don’t “intellectually control.” This insight now allows us opportunities to introduce therapies designed to inhibit the exaggerated physiologic response of chronic pain of all types.

Just as people with long standing pain need to alter their thinking and behaviors related to their pain, as a society, we need a shift in our philosophy and approach to this widespread problem in order to avoid getting the same negative results we have gotten.

Recent research in the treatment of Post Traumatic Stress Disorder (PTSD) has led to exciting new therapies for emotional pain associated with traumatic events. The use of functional magnetic resonance imaging (fMRI) techniques provided a quantum leap in our knowledge of what areas of the brain are involved with the processing of induced pain and painful memories of trauma

With more people suffering than ever before, the time for action is now.


References

  1. http://www.cdc.gov/drugoverdose/prescribing/guideline.html