Psychology of=20 Pain

Created by Gary B. Rollman, Professor of Psychology, = University of Western Ontario, London, ON N6A 5C2 (in addition to links = below,=20 see weekly archives in the right column)

Wednesday, February 06, 2008

ABC News: How Chronic Pain Gets Into Your Head =

How=20 Chronic Pain Gets Into Your Head

Long-Lasting = Pain May Also=20 Explain Depression and Other Mental Problems: Study

By RADHA CHITALE
ABC News Medical=20 Unit

Feb. 6, 2008

For many,=20 the impact of chronic pain may not be limited to the pain itself; it = could also=20 negatively affect their mental state.

New research by scientists at Northwestern University in = Chicago may=20 explain why people who have chronic pain also suffer from seemingly = unrelated=20 problems such as depression, anxiety, lack of sleep and trouble=20 focusing.

"The pain is in your head," said Dr. Dante Chialvo, lead author = of the=20 study and associate research professor of physiology at the Feinberg = School of=20 Medicine. "The whole head."

The study showed that people with chronic pain have a portion = of the=20 brain that is always active: the region associated with mood and = attention. This=20 constant activity rewires nerve connections in the brain and leaves = chronic pain=20 sufferers at greater risk for mental problems.

Chialvo said that a healthy brain exists in a state of = equilibrium, with=20 about the same number of regions turned on and off. As certain regions = are=20 recruited for various tasks, other regions turn off to maintain the=20 equilibrium.

But a person in chronic pain is not so even-keeled.

"We knew there are important differences in behavior in = [chronic pain]=20 patients," Chialvo said. "That has to come from brain = abnormalities."

Chialvo described chronic pain as an idea that gets stuck in = your head.=20 The brain may not be able to attend to other tasks as well or as quickly = because=20 it is preoccupied with the pain signals.

Chialvo suggested that receiving pain signals constantly can = result in=20 mental rewiring that negatively affects the brain, and in particular, = the=20 regions associated with attention and mood. The rewiring forces their = brains to=20 allocate mental resources differently to cope with everyday tasks =14 = from=20 mathematics, to recalling a shopping list, to feeling happy.

The=20 pain-brain connection has been well documented, at least anecdotally, = and many=20 doctors say they have seen firsthand how a patient's mental state can go = downhill when they suffer chronic pain.

"Disordered sleep, less mental focus, mood irritability, and = even=20 depression with less overall joy and enthusiasm for life are what I see = in this=20 patient population," Dr. Doris Cope, professor and vice chairman of pain = medicine at the University of Pittsburgh Medical Center's Pain Medicine=20 Program.

Such may be the case with John Cannon, 70, who has had chronic = low back=20 pain for 40 years and says it takes him quite a while to fall = asleep.

"There are nights that are better than others," he said. "It = will take me=20 a while to get into a comfortable position to go to sleep. & I just = learned=20 to operate differently."

Cannon, who is a participant in Chialvo's study, said he tries = to not let=20 the pain affect his life drastically, but in some situations, he wishes = it=20 weren't there.

"I do most things that I always do but I do them more slowly. = & I=20 know I'm going to pay the price if I lift [heavy things]. You get over = those=20 things, and I have."

Misconceptions about the pain-brain connection may have arisen = from a=20 lack of evidence that pain has a measurable, lasting impact on the=20 brain.

But Chialvo believes his research finally quantifies the = connection. His=20 group's experiment monitored patients' brains while they tracked a = moving object=20 on a computer screen, a task that required minimal attention. Chialvo = and his=20 group found that patients with chronic pain had 50 times as many active = regions=20 in their brains than their pain-free counterparts.

"We are providing objective evidence that is not a first person = report;=20 this is a third-person report," Chialvo said. "There is something inside = the=20 patient's head, which is different, and we should pay = attention."

But some are=20 not convinced that these brain changes are as lasting as Chialvo and his = group=20 suggest.

"It really is the 'chicken and the egg' question," said Dr. = John Wilson,=20 residence program director for the department of neurosurgery at the = Wake Forest=20 University School of Medicine. "It may well be that this type of = underlying=20 brain dysfunction was present in this group of patients to start with = and=20 predisposed this group of patients to develop a chronic pain=20 syndrome."

Others point out that the study did not report whether patients = were=20 taking pain medication, nor did it discuss how the brain may change over = time if=20 a patient were to experience less pain through = rehabilitation.

"There is no question that changes occur. The question relates = to=20 permanency," said Dr. Joshua Prager, director of the Pain Medicine = Center at the=20 University of California at Los Angeles. "I see people come back to life = and=20 become who they were. When they had pain they were not who they=20 were."

Still, Chialvo hopes that with further research into the = mechanism of how=20 chronic pain makes people more susceptible to mood disorders, people = will be=20 able to improve their quality of life. Cognitive therapy and other = techniques=20 that teach people how to distract from their pain may help them as=20 well.

"Maybe if we treat the consequences, their quality of life will = be better=20 and they forget about the pain," Chialvo said. "If you are better = prepared to=20 cope, you are always better."

http://www.abcnews.go.com/Health/PainManagement/story?id=3D= 4249610&page=3D1

posted by Gary @ 10:09=20 AM =

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Wednesday, February 06, 2008

ABC News: How Chronic Pain Gets Into Your Head =

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