Talk to Your Patients About Chronic Pain

By Karin Krisher

Chronic PainThe phrase “It’s all in your head,” really might bear some credence. Researchers at the Northwestern University Feinberg School of Medicine have shown for the first time that cross chatter in two regions of the brain is related to the persistence of pain. In other words, chronic pain is related to the brain’s original response to the pain.

Ten years of research led the team to conclude that in relation to chronic back pain, the injury itself was not enough to explain the pain, but the injury combined with brain state might very well be. The pain’s persistent nature could be related to an emotional response.

The study relied on fMRI scans to detect brain changes that happen early. The two parts of the brain involved, the insula and the nucleus accumbens, exhibited a much higher level of cross talk between them in study participants whose pain continued than in the participants whose pain faded. While the insula is active when people have an emotional response to an event or environment, the nucleus accumbens region is involved in teaching the brain how to respond to environmental changes.

The amazing part? The scientists found that their initial scans could predict the chronic nature of pain with 85 percent accuracy, suggesting that the more emotional the initial reaction to the injury was, the longer the pain will last. Further, the study found that participants with chronic pain lost gray matter density over time.

What does this mean for the future of pain? The researchers hope to develop new therapies for chronic pain based on the findings. Many medical endeavors are now leaning sharply toward the neurological, and pain is no exception. Pain is the main reason for medication, a driving factor behind disability, and some estimates note that in the United States, its chronic form could cost up to $635 billion per year.

Perhaps approaching pain from a neurological standpoint can help your patients who don’t even have chronic pain. Addressing this concept now could give patients the information they need to make rational decisions at the time of an injury, thereby avoiding the emotional burden and response chronicled in the study participants.

What kinds of chronic pain do you treat most often? What is your main course of treatment? Is there something you would suggest to other practitioners?