Study shows early brain changes predict which patients develop chronic pain

July 1, 2012
brain

When people have similar injuries, why do some end up with chronic pain while others recover and are pain free? The first longitudinal brain imaging study to track participants with a new back injury has found the chronic pain is all in their heads –- quite literally.

A new Northwestern Medicine study shows for the first time that develops the more two sections of the --- related to emotional and motivational behavior --- talk to each other. The more they communicate, the greater the chance a patient will develop chronic pain.

The finding provides a new direction for developing therapies to treat intractable pain, which affects 30 to 40 million adults in the United States.

Researchers were able to predict, with 85 percent accuracy at the beginning of the study, which would go on to develop chronic pain based on the level of interaction between the frontal cortex and the nucleus accumbens.

The study is published in the journal Nature Neuroscience.

"For the first time we can explain why people who may have the exact same initial pain either go on to recover or develop chronic pain," said A. Vania Apakarian, senior author of the paper and professor of physiology at Northwestern University Feinberg School of Medicine.

"The injury by itself is not enough to explain the ongoing pain. It has to do with the injury combined with the state of the brain. This finding is the culmination of 10 years of our research."

The more emotionally the brain reacts to the initial injury, the more likely the pain will persist after the injury has healed. "It may be that these sections of the brain are more excited to begin with in certain individuals, or there may be genetic and environmental influences that predispose these brain regions to interact at an excitable level," Apkarian said.

The nucleus accumbens is an important center for teaching the rest of the brain how to evaluate and react to the outside world, Apkarian noted, and this brain region may use the pain signal to teach the rest of the brain to develop chronic pain.

"Now we hope to develop new therapies for treatment based on this finding," Apkarian added.

Chronic pain participants in the study also lost gray matter density, which is likely linked to fewer synaptic connections or neuronal and glial shrinkage, Apkarian said. Brain synapses are essential for communication between neurons.

"Chronic pain is one of the most expensive health care conditions in the U. S. yet there still is not a scientifically validated therapy for this condition," Apkarian said. Chronic pain costs an estimated $600 billion a year, according to a 2011 National Academy of Sciences report. Back pain is the most prevalent chronic pain condition.

A total of 40 participants who had an episode of back pain that lasted four to 16 weeks --- but with no prior history of back pain --- were studied. All subjects were diagnosed with back pain by a clinician. Brain scans were conducted on each participant at study entry and for three more visits during one year.

Explore further: Treatment of chronic low back pain can reverse abnormal brain activity and function

More information: DOI: 10.1038/nn.3153

Related Stories

Treatment of chronic low back pain can reverse abnormal brain activity and function

May 17, 2011
It likely comes as no surprise that low back pain is the most common form of chronic pain among adults. Lesser known is the fact that those withchronic pain also experience cognitive impairments and reduced gray matter in ...

New imaging technique captures brain activity in patients with chronic low back pain

July 27, 2011
Research from Brigham and Women's Hospital (BWH) uses a new imaging technique, arterial spin labeling, to show the areas of the brain that are activated when patients with low back pain have a worsening of their usual, chronic ...

Negative emotions influence brain activity during anticipation and experience of pain

September 19, 2011
Neuroticism — the tendency to experience negative emotions — significantly affects brain processing during pain, as well as during the anticipation of pain, according to a new study in Gastroenterology, the official ...

Recommended for you

Deletion of a stem cell factor promotes TBI recovery in mice

November 20, 2017
UT Southwestern molecular biologists today report the unexpected finding that selectively deleting a stem cell transcription factor in adult mice promotes recovery after traumatic brain injury (TBI).

Brain cell advance brings hope for Creutzfeldt-Jakob disease

November 20, 2017
Scientists have developed a new system to study Creutzfeldt-Jakob disease in the laboratory, paving the way for research to find treatments for the fatal brain disorder.

MRI uncovers brain abnormalities in people with depression and anxiety

November 20, 2017
Researchers using MRI have discovered a common pattern of structural abnormalities in the brains of people with depression and social anxiety, according to a study presented being next week at the annual meeting of the Radiological ...

Schizophrenia originates early in pregnancy, 'mini-brain' research suggests

November 20, 2017
Symptoms of schizophrenia usually appear in adolescence or young adulthood, but new research reveals that the brain disease likely begins very early in development, toward the end of the first trimester of pregnancy. The ...

Theory: Flexibility is at the heart of human intelligence

November 19, 2017
Centuries of study have yielded many theories about how the brain gives rise to human intelligence. Some neuroscientists think intelligence springs from a single region or neural network. Others argue that metabolism or the ...

Investigating patterns of degeneration in Alzheimer's disease

November 17, 2017
Alzheimer's disease (AD) is known to cause memory loss and cognitive decline, but other functions of the brain can remain intact. The reasons cells in some brain regions degenerate while others are protected is largely unknown. ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.