chronic pain brain

Brain Implants Are Helping To Decode Chronic Pain

/ Thomas Cohn, MD

brainChronic pain is one of the most common reasons why people visit a doctor’s office, but because of the highly individualized nature of chronic pain, figuring out a diagnosis and effective treatment plan isn’t always easy. It’s tough to really get inside the brain of a person who is battling a chronic pain condition, but that’s exactly what researchers tried to do with this most recent study.

To get a better understanding of chronic pain pathways, researchers implanted electrodes into the brains of four volunteers who were experiencing pain following an amputation (known as phantom limb pain). The participants went about their day as normal while the implants recorded activity in two specific brain regions where researchers believe pain responses occur – the anterior cingulate cortex and the orbitofrontal cortex. Patients were also asked to rate their pain levels on a standard scale several times a day over the course of six months, and when they would do this, they would also press a button that would cause the implants to record their brain signals for 30 seconds.

The captured information was then fed through a machine learning model that could find patterns in the data and predict each patient’s pain level based on the signals in their brain.

“From these models, we found that [electrical waves with] low frequencies in the orbitofrontal cortex corresponded with each of the patients’ subjective pain intensities, providing an objective measure of chronic pain,” said Prasad Shirvalker, a neurologist at the University of California, San Francisco and a co-author of the study, writes in the Conversation. “The larger the shift in low-frequency activity we measured, the more likely the patient was experiencing intense pain.”

Chronic Pain Brain Signals

Shirvalker went on to say that pain is highly individualized, but eventually they hope to decode unique pain signals to come up with patient-specific treatment plans.

“This is the first time ever chronic pain has been measured in the real world,” Shirvalkar tells the New York Times’ Priyanka Runwal. “Every patient actually had a different fingerprint for their pain.”

Researchers also wanted to better understand how the brain responded to painful stimuli, so they applied heat to each patient’s body to see how their brains reacted. They found that acute pain led to a more involved response from the anterior cingulate cortex. Because chronic pain involved a greater reaction from the orbitofrontal cortex, researchers say it’s the first time that there is direct evidence that chronic pain and acute pain involve different areas of the brain.

The data is extremely limited and was only collected on individuals who underwent amputation, but it is a step in the right direction for better understanding chronic pain and how our brains respond to these stimuli. Hopefully future research can continue to build on these findings and focus on more discoveries around the orbitofrontal cortex and its response to pain. The more we learn about how our brains react to chronic pain, the easier it will be to come up with targeted treatments.

In the meantime, if you need a more traditional approach to diagnosing and treating your chronic pain, reach out to Dr. Cohn and his team today at (952) 738-4580

How Untreated Chronic Pain Can Increase Your Dementia Risk

/ Thomas Cohn, MD

dementiaNew research published this week found that untreated chronic pain can increase a person’s risk of cognitive decline and dementia, and that risk increases based on the number of areas in the body suffering from chronic pain.

The findings, published this week in the journal Proceedings of the National Academy of Sciences, found that chronic pain had an interesting effect on a person’s hippocampus, the area of the brain that is associated with learning and memory. Researchers compared the size of the hippocampus in patients with chronic pain to the size of the hippocampus in aging individuals without chronic pain. When comparing these models, researchers found that chronic pain may artificially age the hippocampus. When compared to a healthy 60-year-old patient, researchers found:

  • Patients with one chronic pain site had a hippocampus that had aged by an additional year.
  • Patients with two chronic pain sites had a hippocampus that had aged by roughly two additional years.
  • Patients with five or more chronic pain sites had a hippocampus that had aged by up to an additional eight years.

“In other words, the hippocampal (grey matter volume) in a 60-year-old individual with (chronic pain) at two body sites was similar to the volume of (pain free) controls aged 62-year-old,” wrote corresponding author Tu Yiheng and his colleagues.

So while you may only be 60 years old, if you are suffering from chronic pain in five or more locations in your body, your hippocampus may have experienced aging similar to that of a 68-year-old. Aging is a common underlying factor in dementia onset, and if your brain is artificially aged due to chronic pain, you may be more likely to experience dementia or cognitive decline.

Prevent Dementia By Treating Chronic Pain

While the findings may be a little concerning for patients dealing with chronic pain, fortunately we can try to reduce our dementia risk by really working to control and treat our chronic pain condition. This is certainly easier said than done, but if you develop a plan and work closely with a pain management specialist like Dr. Cohn, not only can you lead a more comfortable life free of chronic pain, but you can keep your brain healthy as you age.

Treating chronic pain is highly individualized, but may patients find that a combination of the following techniques can help them gain more control over their chronic pain condition:

  • Exercise
  • Posture Improvements
  • Dietary Changes
  • Physical Therapy
  • Stress Relief
  • Sleep Quality Improvements
  • Cognitive Behavioral Therapy
  • Deep Breathing Techniques

As you can see, all of the above techniques are active treatments that focus on improving one or more aspects of your health. Pain medications can certainly play a role in chronic pain management, but the above techniques are better at targeting the underlying pain cause and providing long-term relief.

Of course, working with a pain management specialist can help you find the right combination of treatments for your specific needs. If you want help identifying a pain treatment plan that’s right for you, or you just want to talk to a pain management provider about your symptoms, reach out to Dr. Cohn and his team today at (952) 738-4580.

Chronic Pain Can Affect Your Ability To Regulate Negative Emotions

/ Thomas Cohn, MD

chronic pain emotionsA new study out of Australia has found evidence that chronic pain can alter the brain in such a way that a person may have a harder time regulating negative emotions.

The news isn’t all that surprising, especially since there have long been links between chronic pain and feelings of anxiety or depression, but it does help to provide more hard evidence that it’s imperative that you care for your mental health if you’re been diagnosed with the physically debilitating condition of chronic pain. It’s clear that chronic pain doesn’t just cause physical pain, it also affects how we process and regulate emotions, which can make treatment all that more difficult.

Pain And Emotion Regulation

For the study, researchers compared 24 individuals with chronic pain to 24 individuals with no history of chronic pain. Researchers examined the GABA levels of each patient, which is an inhibative neurotransmitter in the medial prefrontal cortex. Lower levels of these transmitters means that brain cells can’t communicate as effectively, which can make it harder to regulate emotions like anxiousness or worry. Researchers found that patients with chronic pain were found to have significantly lower levels of the neurotransmitter than the control subjects, regardless of what type of chronic pain condition they were suffering from.

“A decrease in GABA means that the brain cells can no longer communicate to each other properly,” said Sylvia Gustin, lead researcher on the study. “When there’s a decrease in this neurotransmitter, our actions, emotions and thoughts get amplified.”

Researchers said that the study only found a correlation between chronic pain and neurotransmitter imbalances, but they also believe that it’s possible that pain could be the root cause of these brain changes.

“Everything starts with stress,” said Gustin. “When someone is in pain, it increases stress hormones like cortisol, which can trigger massive increases in glutamate. This happens during the initial, acute stage of pain.”

They believe that immune cells in certain parts of the brain then attempt to regulate this downturn in neurotransmitter ability, but this process can make it harder for the body to manage certain emotions.

“As a result of this disruption,” said Gustin, “a person’s ability to feel positive emotions, such as happiness, motivation and confidence may be taken away – and they can’t easily be restored.”

Hope On The Horizon

However, it’s not all doom and gloom when it comes to chronic pain. With this further understanding, researchers hope to conduct additional testing that can better understand this connection and in turn develop some treatment techniques that specifically target GABA and gluatmine levels in the medial prefrontal cortex. And while those treatments are being developed, the study also shines a spotlight on the importance of mental health management if you’re dealing with chronic pain.

So if you are battling chronic pain and you’ve noticed that you’re having a tough time regulating emotions or that mood swings have become more frequent, reach out to a specialist who understands the importance of managing the chronic pain condition in its entirety. Dr. Cohn and his team can help find an individualized treatment that’s right for you and that accounts for your mental and physical needs. For more information, reach out to his clinic today.

Is Your Chronic Pain an Addiction?

/ Thomas Cohn, MD

Brain Pain Addiction SartellNew research out of Northwestern University suggests that chronic pain can rewire your brain so a person actually becomes “addicted” to chronic pain.

The new research published in Nature Neuroscience examined how brain neurons in rats were affected by negative emotions and pain. When looking at the rodents, researchers noted that some rats experienced a hyper-excitable collection of neurons after an injury or pain. These neurons not only controlled some negative emotions, but their hyper-expression was also associated with a drop in the neurotransmitter dopamine, which plays a large role in our reward motivation. In essence, the brain was misconstruing why these neurons were firing, and it slowly became addicted to their hyper-expression. In essence, your body becomes addicted to pain.

“The study shows you can think of chronic pain as the brain getting addicted to pain. The brain circuit that has to do with addiction has gotten involved in the pain process itself,” explained corresponding author A. Vania Apkarian, PhD, adding that pain is both sensory and emotionally based.

New Understanding, New Solution?

With their new understanding of how some people’s body’s perceive pain, Dr. Apkarian began working on new ways to treat chronic pain. Using a combination of two different drugs, they were essentially able to rewire the brain so it stopped seeing pain as a rewarding behavior.

“It was surprising to us that chronic pain actually rewires the part of the brain controlling whether you feel happy or sad. By understanding what was causing these changes, we were able to design a corrective therapy that worked remarkably well in the models,” said the study’s lead author Dr. D. James Surmeier. “The question now is whether it will work in humans.”

The team hopes to take their study to the next stage and see if it produces a similar positive affect in humans whose brain’s have been affected by chronic pain.

Chronic Nerve Pain Can Impact Mood and Motivation

/ Thomas Cohn, MD

Chronic Pain BrainChronic nerve pain doesn’t just make it painful to go through your daily routine, it may actually make it psychologically harder for your brain to get motivated to complete certain tasks, according to California researchers.

Researchers at UC-Irving and UCLA say their findings suggest that brain inflammation caused by chronic nerve pain can have significant psychological effects. In a lab study, researchers uncovered that rodents with brain inflammation exhibited “accelerated growth and activation” of immune cells known as microglia. These microglia cells cause chemical signals that restrict the release of dopamine, a chemical that helps control our brain’s reward and pleasure centers.

New Approaches To Chronic Pain Care

What’s more, the researchers may have uncovered new evidence in the battle to control and conquer chronic pain. Researchers found that certain opioids designed to spur the release of morphine may actually be ineffective in certain cases. One such case occurred with these rats. In rodents with brain inflammation, these opioids did not stimulate dopamine release as designed.

Instead, when the same rodents were treated with an opioid designed to inhibit the release of the microglial cells, dopamine levels returned to normal.

“For over 20 years, scientists have been trying to unlock the mechanisms at work that connect opioid use, pain relief, depression and addiction,” said Catherine Cahill, an associate professor of anesthesiology & perioperative care at UCI. “Our findings represent a paradigm shift which has broad implications that are not restricted to the problem of pain and may translate to other disorders.”

Cahill and her team hope to recreate the study in humans in order to combat mood swings, depressive attitudes and behavioral disorders.

“We have a drug compound that has the potential to normalize reward-like behavior,” she said, “and subsequent clinical research could then employ imaging studies to identify how the same disruption in reward circuity found in rodents occurs in chronic pain patients.”