Updated: 08/12/2023 por Jennifer Delgado | Published: 13/07/2020
Pain is not a purely physical experience. When we feel pain it is difficult to think of anything else. The sore area continually demands our attention. It doesn’t let us rest. Sleep. Think. Be…
When a person experiences pain, day after day, it is understandable that his mood is also affected. It is not easy to deal with a discomfort that does not give up. As a result, these people often experience depression and/or anxiety. They may also have difficulty making decisions, even the simplest ones.
In addition to emotional pain and discomfort, these people often have to deal with the misunderstanding of the others, who attribute their psychological problems to weakness or lack of willpower. However, pain changes brain function. And that could explain many of the emotional and cognitive difficulties that these people end up suffering.
The brain of people with chronic pain does not rest
In a healthy brain, the different zones maintain homeostasis, they are in a state of balance. When one region is activated, the others calm down. But neuroscientists at Northwestern University’s Feinberg School of Medicine found that the brains of people with chronic pain work differently.
These neuroscientists used functional magnetic resonance imaging (fMRI) to scan the brains of people with chronic low-back pain and a group of pain-free volunteers as both groups looked at a moving bar on a computer screen.
Chronic pain patients performed the task well, but their brains functioned differently from pain-free people. When certain areas of the cortex were activated in the group without pain, others were deactivated, maintaining a collaborative balance between the different brain areas. That balance is also known as “resting brain networks.”
However, in people who had chronic pain, one of the nodes in this network did not calm down. The frontal region of the cortex, associated primarily with emotion control and decision making, never calms down.
Those areas are not disabled when they should. It is as if they are trapped running at great speed, disrupting neural connections and wearing down neurons under continuous work. And this constant firing of neurons could cause permanent damage that leads to psychological disorders or cognitive deficits.
The trail of damages left by chronic pain
“If you are a patient with chronic pain, you have pain 24 hours a day, seven days a week, every minute of your life, that permanent perception of pain in your brain makes those areas continuously active. This continued dysfunction in the balance of the brain can change the wiring forever and could damage the brain.
“When neurons fire too much, they can change their connections to other neurons or even die because they cannot maintain high activity for so long”, neuroscientists explained.
It is likely that subsequent changes in the wiring of the brain may end up causing the psychological problems that many people with chronic pain suffer from. In fact, they could be at the base of disorders such as depression and anxiety since the balance of the brain is disturbed as a whole.
Depression, for example, affects 5% of the general population, but its incidence increases between 30 and 45% among patients with chronic pain. The relationship between depression and pain is bidirectional: depression predicts the development of chronic pain, and chronic pain increases the risk of depression. It is not by chance that both problems, depression and pain, share a dysregulation of the noradrenergic and serotonergic pathways at the brain level.
In people with chronic pain, depression often coexists with anxiety, as found in a study of St Thomas Hospital in London. In fact, in psychiatry there is a term to refer to this state: agitated depression. In that case, the person suffers from depression, but also suffers restlessness, insomnia and a feeling of diffuse apprehension typical of anxiety.
Chronic pain also affects our cognitive resources and the ability to make decisions. It is not accidental either since the neural systems involved in cognition and pain overlap and modulate each other.
In fact, different studies have proven that patients with chronic pain often fail to implement an advantageous strategy when making decisions, especially in situations of risk and emotional charge.
Science, therefore, indicates that the emotional and even cognitive problems that people with chronic pain suffer are not only “in their mind”, but have a neurobiological basis.
Sources:
Vadivelu, N. et. Al. (2017) Pain and Psychology—A Reciprocal Relationship. Ochsner J; 17(2): 173–180.
Walteros, C. et. Al. (2011) Altered Associative Learning and Emotional Decision Making in Fibromyalgia. J Psychosom Res; 70(3):294-301.
Woo, A. (2010) Depression and Anxiety in Pain. Rev Pain; 4(1): 8–12.
Baliki, M. et. A. (2008) Beyond Feeling: Chronic Pain Hurts the Brain, Disrupting the Default-Mode Network Dynamics. J Neurosci; 28(6): 1398–1403.
Apkarian, A. V. et. Al. (2004) Chronic Pain Patients Are Impaired on an Emotional Decision-Making Task. Pain; 108(1-2):129-36.
