Chronic Pain and Jan Drew

From: Joel M. Eichen (joeleichen_at_yahoo.com)
Date: 03/01/05 

Date: Mon, 28 Feb 2005 20:34:09 -0500

Not much about break dancing though.

Joel

***

Chronic Pain Comes From the Brain

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Studies: Chronic Pain Comes From the Brain

Brain Scan Tech Revealing Chronic Pain Can Even Lead to Loss of Gray
Matter

By AMANDA ONION

Feb. 28, 2005 - Dial Lewis says she has seen nearly every kind of
doctor and taken almost every kind of pill to try and ease her chronic
back and hip pain, but it still hurts around the clock.

Ever since the La Porte, Texas, resident fell 15 years ago, no
treatment has made a dent in the constant throbs she feels in her
back.

"After tests, they say 'Oh, you're in chronic pain, so you're
depressed, aren't you?'" she said. "So they send you to a psychiatrist
and a sociologist and they give you antidepressants and painkillers. I
spent close to 14 years being on everything -- but nothing ever
works."

About 10 percent of Americans suffer from chronic pain, according to
studies. An April 2004 survey by the American Chronic Pain Association
found that for more than half of chronic pain sufferers, their
condition hinders their ability to work, while 45 percent say it
damages their personal relationships.

Considering the toll that chronic pain can take on a person's life,
being told that it is "all in your head," is not something most
patients like to hear. But new research using the latest in brain scan
technology is showing that some pain actually does originate in the
brain. And it's not imagined -- recent work has shown that chronic
back pain can even cause brain tissues to shrink if it is prolonged.

"I think when people say pain is 'all in my head,' it suggests it's
not real," said Catherine Bushnell, a researcher at McGill
University's Center for Research on Pain in Montreal. "These studies
don't say it's not real, they show that brain activity can create a
situation that produces real pain."

Less Pain Through Distraction

Using brain imaging, Bushnell has shown that something as simple as
being distracted has a real effect in decreasing the intensity of pain
signals in the brain. She and her colleague, Chantal Villemure,
subjected volunteers to slightly painful pulses of heat and, in other
tests, they had them listen to different tones at the same time.

The subjects reported that their perception of pain diminished when
they were listening to the tones -- and brain scans backed up their
word. The scans revealed that pain signals in their brain actually
lessened as they listened to the tones.

"This means that things like having family around constantly asking
how you feel can actually draw more attention to your pain and enhance
it," she said.

Emotion can also enhance or decrease people's perception of pain, her
studies show. Bushnell and Villemure demonstrated that subjecting
people to pleasant and unpleasant odors influences how much they are
bothered by pain. Pleasant odors eased the sensation of pain while
unpleasant smells made the pain feel worse. Bushnell's and Villemure's
work is published in a recent issue of the journal Pain.

Other recent studies have corroborated the notion that some pain
appears to originate in the brain and not necessarily in the place
where you feel it. Researchers at University College London and
University of Pittsburgh Medical Center found that volunteers who felt
pain as a result of hypnotic suggestion showed strikingly similar
brain activity to those subjected to physical pain from pulses of
heat.

Bushnell points out that work like this might be helpful when it comes
to thinking of new approaches to treating the problem.

"There may be a certain control over pain that we don't really realize
we have," she said.

Controlling chronic pain is obviously the challenge, not only to ease
suffering but also to limit possible damage to the brain.

Shrinking Brain Tissue

Vania Apkarian, an associate professor of physiology at Northwestern
University Feinberg School of Medicine in Chicago, used magnetic
resonance imaging technology to compare the brains of people with
chronic back pain to those from matched normal subjects and found a
striking difference. The brain tissue of those with chronic pain
showed shrinkage equivalent to the amount of gray matter lost in 10 to
20 years of normal aging.

What's more, this shrinkage was evident in the prefrontal cortex and
the thalamus -- parts of the brain associated with cognitive thinking
and problem solving.

"The longer the subject said they were in pain, the more their brain
volume was decreased," he said. "It translated to about 1.5 cc's of
brain volume loss for every year of chronic pain."

Apkarian's work seems to agree with his earlier research showing a
change in brain chemistry among those suffering from chronic pain and
his studies that have demonstrated those who have had chronic pain
take longer to solve mind puzzles than those who have been free of
pain.

Other work has drawn a correlation between stress and brain tissue
loss. Stafford Lightman of Bristol University in England reports that
response to stress has been shown to decrease the number of brain
cells and hinder memory.

Is there a connection? Apkarian points out it could mean that the
stress of chronic pain leads to brain shrinkage or that stress could
be behind the chronic pain, which leads to brain shrinkage.

Stopping the Hurt

Either way, the brain suffers. For people like Lewis, the key question
is, is there a way to stop the hurt? Both Apkarian and Bushnell are
looking at ways of targeting pathways in the brain to halt pain
signals from firing in the first place.

"Targeting circuitry may be a new, more effective approach to treating
chronic pain," said Apkarian.

Bushnell, meanwhile, believes her work also suggests that alternative
cures, including hypnosis, acupuncture and relaxation techniques may
be promising.

At this point, Lewis remains skeptical about any new treatments a
doctor may subscribe for her pain. Currently, she is seeing a doctor
who is treating her with regular injections of an energy molecule made
up of adenine, ribose and a phosphate. Lewis says the treatments have
had some positive effect. Meanwhile, she and her husband are selling
their home, due to spiraling medical insurance and hospital costs.

Still, she is somewhat relieved that researchers are at least finding
evidence of something she and others have said for years. "My pain
affects my ability to walk, stand, sit, take a shower -- it's real,"
she said. "It has been hard to get doctors to believe me."

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