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How chronic pain gets into your head

Wednesday, February 06, 2008 | 10:29 AM

RADHA CHITALE

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

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

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

The study showed that people with chronic pain have a portion of the = brain=20 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.

Story=20 continues below

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 = equilibrium.=20

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. The=20 brain may not be able to attend to other tasks as well or as quickly = because it=20 is preoccupied with the pain signals.

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

Everyday Pain

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

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

Such may be the case with John Cannon, 70, who has had chronic low = back pain=20 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 a=20 while to get into a comfortable position to go to sleep. & I just = learned to=20 operate differently."

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

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

Misconceptions about the pain-brain connection may have arisen from a = lack of=20 evidence that pain has a measurable, lasting impact on the 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; this=20 is a third-person report," Chialvo said. "There is something inside the=20 patient's head, which is different, and we should pay attention."

Pain for Life?

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

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

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

(Copyright =A92008 ABC News Internet Ventures.) =

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Raises an event which bubbles through the each parent container = until one is listening=20

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=20

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=20

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Set the content to appear in the widget

Id of the widget in the Widget_Man New HTML to replace old content **/ TempestNS.WidgetManager.SetContent =3D function(widgetId, sContent) { var id=3D widgetId; if(this.Widgets[widgetId]) { this.Widgets[widgetId].SetContent(sContent); } } /**

Create a setInterval to run loadWidgets() every 1 second

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Clear an interval that matches the pollId

**/ TempestNS.WidgetManager.StopPolling =3D function()=20 { if(!this.pollId)=20 { return; } clearInterval(this.pollId); this.pollId =3D null; } /**

Create a new src to pass to the widget's update function

Id of the widget in the Widget_Man Fully qualified URL of the new content Optional: Id of the element on the page to = scroll to **/ TempestNS.WidgetManager.UpdateContent =3D function(widgetId, uri, = scrollId) { if(this.Widgets[widgetId]) { this.Widgets[widgetId].UpdateContent("http://" + = TempestNS.Server.domain + uri, scrollId); } } TempestNS.WidgetManager.prototype =3D new Object(); TempestNS.WidgetManager.prototype.GetEnvironment =3D = TempestNS.WidgetManager.GetEnvironment; TempestNS.WidgetManager.prototype.GetRootDomain =3D = TempestNS.WidgetManager.GetRootDomain; TempestNS.WidgetManager.prototype.Initialize =3D = TempestNS.WidgetManager.Initialize; TempestNS.WidgetManager.prototype.LoadWidgets =3D = TempestNS.WidgetManager.LoadWidgets; TempestNS.WidgetManager.prototype.SetContent =3D = TempestNS.WidgetManager.SetContent; TempestNS.WidgetManager.prototype.StartPolling =3D = TempestNS.WidgetManager.StartPolling; TempestNS.WidgetManager.prototype.StopPolling =3D = TempestNS.WidgetManager.StopPolling TempestNS.WidgetManager.prototype.UpdateContent =3D = TempestNS.WidgetManager.UpdateContent; window.PT_WIDGET_MAN=3Dnull; =20 /**

Create Widget Object

Pointer to the DOM element holding the widget = or an html place holder if widget defined by def a jsonized collection of parameters representing = the parameters on the widget **/ TempestNS.Widget =3D function(Element, def) { /* Initialize this widget instance as a Registered Container */ TempestNS.Registered_Container.call(this); this.register(TempestNS.Widget.Prefix); this.onWidgetRefresh =3D function(){}; this.canvas =3D null; this.script =3D null; /* Set a flag to make sure only one request at a time is made to the = server */ this.callingProspero =3D false; this._def =3D def; this.element =3D Element; if(!this._def) { =20 this.DeriveParamsFromPawTag(Element); } else { this.DeriveParamsFromDef(def); } } /**

=20

**/ TempestNS.Widget.DeriveParamsFromPawTag =3D function() { /* Get parameters passed from */ /* Currently only webtag is mandatory */ this.app =3D this.element.getAttribute("app"); if(!this.app || this.app =3D=3D "") { /* Current default is forum*/ this.app =3D "forum";=20 } this.args =3D this.element.getAttribute("args"); this.config =3D this.element.getAttribute("config"); this.plan =3D this.element.getAttribute("plan"); this._includeCSS =3D this.element.getAttribute("includeCSS"); if((!this._includeCSS || this._includeCSS =3D=3D "") && (this.app = =3D=3D "forum" || this.app =3D=3D "wiki")) { /* Current default is false*/ this._includeCSS =3D "false";=20 } /* If a unique id for a preload message is supplied by the customer, = hide it when the widget content is loaded */ if(this.element.getAttribute("preloadid")) { this.preloadId =3D this.element.getAttribute("preloadid"); } /* Otherwise, pass id of old preloader for backwards compatability */ else { this.preloadId =3D "ptcloading"; } =09 this._userId =3D this.element.getAttribute("userid"); this._loginCode =3D this.element.getAttribute("loginCode"); this._profileName=3D this.element.getAttribute("profileName"); if(this.element.getAttribute("onWidgetRefresh")) { try { this.onWidgetRefresh =3D new = Function(this.element.getAttribute("onWidgetRefresh")); } catch(e) { this.onWidgetRefresh =3D function(){}; } } this.type =3D this.element.getAttribute("type"); this.webtag =3D this.element.getAttribute("webtag"); /* If a unique key is supplied by the customer, use it to create the = widgetId */ if(this.element.getAttribute("key")) { this.widgetId =3D TempestNS.Widget.Prefix + = this.element.getAttribute("key"); } /* Otherwise, use the elementCount of the Widget_Man Registry */ else { this.widgetId =3D TempestNS.Widget.Prefix + = TempestNS.WIDGETMANAGER.elementCount; } } /**

=20

**/ TempestNS.Widget.DeriveParamsFromDef =3D function(Def) { /* Get parameters passed from */ /* Currently only webtag is mandatory */ this.app =3D this._def.app; if(!this.app || this.app =3D=3D "") { /* Current default is forum*/ this.app =3D "forum";=20 } this.args =3D this._def.args; this.config =3D this._def.config; this.plan =3D this._def.plan; /* If a unique id for a preload message is supplied by the customer, = hide it when the widget content is loaded */ this.preloadId =3D "ptcloading"; this._userId =3D this._def.userid; this._loginCode =3D this._def.loginCode; this._profileName =3D this._def.profileName; if(this._def.onWidgetRefresh) { try { this.onWidgetRefresh =3D new Function(this._def.onWidgetRefresh); } catch(e) { this.onWidgetRefresh =3D function(){}; } } this.type =3D this._def.type; this.webtag =3D this._def.webtag; if(this._def.widgetId) { this.widgetId =3D this._def.widgetId; } else { this.widgetId =3D TempestNS.Widget.Prefix + = TempestNS.WIDGETMANAGER.elementCount; =20 } TempestNS.WIDGETMANAGER.Widgets[this.widgetId] =3D this; TempestNS.WIDGETMANAGER.elementCount++ if(!this._def.preventLoad) { =20 this.Load(); } } /**

=20

**/ TempestNS.Widget.GetSeq =3D function() { var seq =3D TempestNS.Widget.SeqCount++; return seq; } /**

Create a new src to pass to the widget's update function

**/ TempestNS.Widget.Load =3D function() { src =3D this.WidgetSource(); /* Call widget's Update function */ this.UpdateContent(src); } /**

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