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Chronic Pain Effects the Brain

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Unread 05-22-2009, 10:52 PM   #1
Dew58
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I found this article to be very informative on the subject of how chronic pain effects the brain;specifically,how the brain adapts in various situations.

My short term memory is gone. I sometimes lose my words. I find it difficult to focus and complete sentences and tasks, etc. How has chronic pain effected your brain function? Is it the RSD ,the chronic pain,or pain medications that change the brain's gray matter? Could it be a combination of the above stated?


Chronic Pain Effects the Brain


http://www.myembody.ca/RESOURCES/dow...ronic_Pain.pdf
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WC Injury 03/24/07;Two Right Knee Surgeries on 5/22/07 and 01/16/08. Surgeons and Physical Therapists ignored my concerns of burning pain, swelling, and no improvement and getting worse. Diagnosed RSD/CRPS I/Sympathetically Mediated Pain Syndrome/Chronic Pain on 06/2008 by family doc;on 08/2008 and 12/2008 diagnosis confirmed by two WC PM Doctors: Both legs;hips; hands; and spine effected by this culprit. SSDI granted 01/2009.
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Unread 05-23-2009, 02:02 AM   #2
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To go with the brain and pain thing...I got this the other day. It's a small abstract on crps and peripheral pain can sometimes rewrite neural networks.

Functional Imaging of Central Nervous System Involvement in Complex Regional Pain Syndrome

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Unread 05-24-2009, 03:17 AM   #3
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Prof. A. Vania Apkarian is probably the leading neuroscientist specializing in pain today, at least in the U.S., his lab at Northwestern may be the place, and quite possibly the best overall article out there right now is the following, which has made freely available on the website of Abkarian's "Pain & Passions" Lab at Northwestern:
"The Brain in Chronic CRPS Pain: Abnormal Gray-White Matter Interactions in Emotional and Autonomic Regions," Paul Y. Geha,1 Marwan N. Baliki,1 R. Norman Harden,2 William R. Bauer,6 Todd B. Parrish,3 and A. Vania Apkarian1,4,5,*, Neuron 60, 570–581, November 26, 2008

1Department of Physiology
2Rehabilitation Institute
3Department of Radiology
4Department of Anesthesia
5Department of Surgery
Northwestern University, Feinberg School of Medicine, Chicago, IL 60611, USA
6Department of Neuroscience, University of Toledo, 3000 Arlington Avenue, Toledo OH 43614-2598, USA
*Correspondence: a-apkarian@northwestern.edu
DOI 10.1016/j.neuron.2008.08.022

SUMMARY

Chronic complex regional pain syndrome (CRPS) is a debilitating pain condition accompanied by autonomic abnormalities. We investigated gray matter morphometry and white matter anisotropy in CRPS patients and matched controls. Patients exhibited a disrupted relationship between white matter anisotropy and whole-brain gray matter volume; gray matter atrophy in a single cluster encompassing right insula, right ventromedial prefrontal cortex (VMPFC), and right nucleus accumbens; and a decrease in fractional anisotropy in the left cingulum-callosal bundle. Reorganization of white matter connectivity in these regionswas characterized by branching pattern alterations, as well as increased (VMPFC to insula) and decreased (VMPFC to basal ganglion) connectivity. While regional atrophy differentially related to pain intensity and duration, the strength of connectivity between specific atrophied regions related to anxiety. These abnormalities encompass emotional, autonomic, and pain perception regions, implying that they likely play a critical role in the global clinical picture of CRPS. [Emphasis added.]

PMID: 19038215 [PubMed - indexed for MEDLINE] PMCID: PMC2637446 [Available on 2009/11/26] http://www.ncbi.nlm.nih.gov/pubmed/1...ubmed_RVDocSum
And here's the corresponding text from pp. 575 - 577:
Role of VMPFC in CRPS in Relation to Emotional Decision-Making

Atrophy in the right VMPFC was correlated with the interaction of duration and intensity of CRPS pain, which functionally segregates the atrophy in this region from right AI [anterior insula] and suggests a more global impact, or ‘‘emotional load,’’ of CRPS on the VMPFC. Atrophy within this region was our primary hypothesis because CRPS patients perform poorly on the emotional decision-making task (Apkarian et al., 2004a), which has been shown to critically depend on an intact VMPFC (Bechara et al., 2000). In fact, even when CRPS pain is transiently reduced, performance on this task does not improve and CRPS patients do not show evidence of learning the task (Apkarian et al., 2004a). In contrast, chronic back pain patients who exhibit atrophy in the thalamus and dorsolateral prefrontal cortex (DLPFC) (Apkarian et al., 2004b), although also abnormal on this task, exhibit clear signs of learning and improved performance over time. Emotional decision-making critically depends on the ability to evaluate options in terms of potential reward or punishment; such decisions require proper capturing and evaluation of sensory cues, including bodily autonomic responses. It is thus not surprising that autonomic regulation and monitoring involve many of the same cortical regions implicated in emotional decision-making, especially ACC, VMPFC, and AI. Therefore differential atrophy of gray matter and abnormal connectivity of associated white matter tracks involving ACC, VMPFC, and AI in CRPS, in contrast to atrophy of DLPFC in chronic back pain, must underlie their differential responses on emotional decision-making, especially given the fact that CRPS is associated with autonomic abnormalities and chronic back pain is not.

Neurons within the VMPFC encode the emotional value of sensory stimuli (Kringelbach, 2005; Rolls, 2000). Moreover, patients with VMPFC lesions exhibit diminished emotional responses and social emotions (Anderson et al., 1999), as well as poorly regulated anger and frustration tolerance (Koenigs and Tranel, 2007). A recent study showed also abnormal utilitarian judgments on moral dilemmas that pit considerations of aggregate welfare against emotionally aversive behaviors (Koenigs et al., 2007). Parts of the region are activated during anticipation of pain (Porro et al., 2002), anticipation of placebo (Wager et al., 2004), when acute pain is enhanced (Lorenz et al., 2002), and especially when spontaneous pain of chronic back pain is high and sustained (Baliki et al., 2006, 2008). Importantly, this region projects to the hypothalamus and brainstem areas that link autonomic bodily processes with emotional responses (Ongur and Price, 2000). It also projects to the periaqueductal gray, thereby modulating spinal cord responses to nociceptive inputs (An et al., 1998). Therefore, the VMPFC region together with AI may be directly involved in determining characteristics of CRPS pain and associated autonomic abnormalities. We also demonstrated that the strength of white matter connectivity between VMPFC and NAc was related to the heightened anxiety generally seen in such patients. This is consistent with studies on mood and anxiety disorders emphasizing the role of hyperactivity in Brodmann area 25, part of VMPFC, in the pathophysiology of depression and its response to treatment (Ressler and Mayberg, 2007). Deep brain stimulation in the same white matter bundles we mapped here between NAc and VMPFC leads to decreased brain activity in VMPFC and remission of symptoms in treatment-resistant depression (Mayberg et al., 2005).
http://www.apkarianlab.northwestern....S_Neuron08.pdf (It's tough going, but the illustrations and schematic diagrams - which can't be copied here -are easier to follow than the text.)
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Unread 05-24-2009, 12:59 PM   #4
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Dew -

Forgive me for not going first to the question you raised about loss of short term memory. I know with me, whatever are the structural effects of CRPS, the principle day-to-day culprit is Baclofen, a drug I take for spasms, and one that has no ready substitutes for me, where I've been on everything else in its class, without success. I don't know if you're on it, but it might be worth thinking about if you are.

Digging a little deeper into the article you posted, I found the lead article it cited, also by Apkarian at al. It's one that's been referred to in a number of threads on the old BT and three on NT. [See, in particular, http://neurotalk.psychcentral.com/sh...ad.php?t=12479 for a 2007 thread that also includes an upload of a related article.] However, it's important and certainly bears repeating, that this article should be understood by everyone with chronic CRPS and is available in free full text. So, without further introduction:

"Chronic back pain is associated with decreased prefrontal and thalamic gray matter density," Apkarian AV, Sosa Y, Sonty S, Levy RM, Harden RN, Parrish TB, Gitelman DR, J Neurosci. 2004 Nov 17;24(46):10410-5, free full text at: http://www.jneurosci.org/cgi/content/full/24/46/10410

Department of Physiology and Institute of Neuroscience, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA. a-apkarian@northwestern.edu
The role of the brain in chronic pain conditions remains speculative. We compared brain morphology of 26 chronic back pain (CBP) patients to matched control subjects, using magnetic resonance imaging brain scan data and automated analysis techniques. CBP patients were divided into neuropathic, exhibiting pain because of sciatic nerve damage, and non-neuropathic groups. Pain-related characteristics were correlated to morphometric measures. Neocortical gray matter volume was compared after skull normalization. Patients with CBP showed 5-11% less neocortical gray matter volume than control subjects. The magnitude of this decrease is equivalent to the gray matter volume lost in 10-20 years of normal aging. The decreased volume was related to pain duration, indicating a 1.3 cm3 loss of gray matter for every year of chronic pain. Regional gray matter density in 17 CBP patients was compared with matched controls using voxel-based morphometry and nonparametric statistics. Gray matter density was reduced in bilateral dorsolateral prefrontal cortex and right thalamus and was strongly related to pain characteristics in a pattern distinct for neuropathic and non-neuropathic CBP. Our results imply that CBP is accompanied by brain atrophy and suggest that the pathophysiology of chronic pain includes thalamocortical processes.
PMID: 15548656 [PubMed - indexed for MEDLINE]

http://www.ncbi.nlm.nih.gov/pubmed/1...ubmed_RVDocSum

Please note as well that is is heavily referred to in the most recent Apkarian article cited above; I should have really included it there. Sorry.

Mike

Last edited by fmichael; 05-24-2009 at 03:02 PM.
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Unread 05-24-2009, 06:54 PM   #5
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If you were to have a Neuropsychotic Brain Study done. They would probably find, that your "mental effects/affects, may just as well be caused by your medication.
I know that simple diazepam will cause it.

No Sugar!?

Yep.

Look closely at the side effect/affects (I hate that) of your meds.
If it's an old "standby" med, it'll be there, newer meds don't have ALL the side's listed. (Yet).

Being one who has rsd, and tbi, I Know the difference.
You don't want a tbi!
It's just "medicine brain". While it's true, and does exist, would you give up your meds?
Heck no!

I'd rather carry a Palm (which I did) or a small notebook. which I do.

Be well ya'll.

Look to the good side.

Pete
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Unread 05-26-2009, 12:50 AM   #6
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i have had neuropysch testing and i have memory problems and language and sight relay issues. mine is also caused from the car accident that i was in i hit my head on something in the car dont remember what. probably dash. but i also some colors different and cant name things some times like i will say you know that thing that you put the mail in etc. i think its a combo of med.RSD. brain

carrie
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Unread 05-26-2009, 12:31 PM   #7
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I'm sorry,
I was too fast to speak there.
Our meds DO make a difference, but the RSD also, affects our brains, or visa versa.
I didn't mean to negate that!

Thanks, Michael, for posting those facts.

Dr S. told me long ago, that the rsd had "hit my brain", I believe that was the end of the sympathetically maintained pain....?
I get those confused...
So, I think that one is linked to the brain more than the other,.... S.Independent P.?
possibly?

Pete
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Unread 05-26-2009, 01:01 PM   #8
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IMO it's a combination of the meds, RSD, fatigue. When we don't sleep well it will mess up everything in our life. My concenstration is terrible. When I worked (I was a customer service rep. for a manufacturing plant) I was use to handleing several tasks at a time. I would talk to one customer on the phone while I was on hold I would talk to one on the computer. I had a wireless headset and I could walk all over the building when I was on the phone. I loved to multi task. I CAN NOT HANDLE THAT TODAY!! I loss my train of thought and concentration daily. Sometime I get aggrivated but it does no good to get angry. These are the side effects of RSD like accepting we have it we must accept the side effects. It's like living in a brain fog.
I hope I helped in some way.
Take care,
Sherrie
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Unread 05-23-2011, 08:41 PM   #9
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[quote=Dew58;513882]I found this article to be very informative on the subject of how chronic pain effects the brain;specifically,how the brain adapts in various situations.

My short term memory is gone. I sometimes lose my words. I find it difficult to focus and complete sentences and tasks, etc. How has chronic pain effected your brain function? Is it the RSD ,the chronic pain,or pain medications that change the brain's gray matter? Could it be a combination of the above stated?



I think that's probably standard. They should be able to tell on me because I've also had many brain MRI's. I also have a very deformed spine and bones and other problems. Not only that, but I think chronic pain makes people also "pain sensitive" in other areas. It never used to hurt to get needles in my gums at a dentists, for example, and now it nearly sends me through the roof.

I have always refused to take pain killers though, feeling that they only led to addictions. Sometimes at night I do take them but mostly take just anti-spasm drugs to stop the neurological pain in the toes.

I always felt that any drug, including even marijuana, can eventually make the brain lazy when it comes to dealing with either pain or depression, and soon it becomes so dependent on those drugs that it no longer remembers how to stop the pain on its own which is why people end up needing more and more pain killers all the time yet still suffer from the same amount of pain.

Those I know who are on marijuana, for example, no longer no how to be happy without using the drug. It's like their brains have forgotten how to be happy so most suffer from depression and find that they need it all the time -- recreational use they call it, even when it ends up being three times a day.

But I do think that chronic pain does interfere markedly with brain function in that it does prevent a person from focusing most definitely, not just because of the pain but because people suffering from pain are always wondering how much worse it will get and where else it will travel and when they will die. Although I think I handle it well, those thoughts are always there.

But I don't like the idea much of taking any sort of pill for chronic pain, really. It reminds me of something I read on the Internet awhile back where they were working with drugs so that cattle wouldn't be terrified out of their wits or feel pain when they went to slaughter. In other words, the pain isn't gone; the brain just can't register it. It become robotic.

Some people think of pain as something extremely hellish, but in a sense I think of it as a gift because it always lets the user know the degree he's at and whether his condition is getting worse. If he takes pills to prevent the pain from registering in his brain he is too likely to harm himself more, thinking he is well. That's my 2 cents worth anyway.
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Unread 05-24-2011, 04:13 AM   #10
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[quote=24HrShck;773182]
Quote:
Originally Posted by Dew58 View Post
I found this article to be very informative on the subject of how chronic pain effects the brain;specifically,how the brain adapts in various situations.

My short term memory is gone. I sometimes lose my words. I find it difficult to focus and complete sentences and tasks, etc. How has chronic pain effected your brain function? Is it the RSD ,the chronic pain,or pain medications that change the brain's gray matter? Could it be a combination of the above stated?



I think that's probably standard. They should be able to tell on me because I've also had many brain MRI's. I also have a very deformed spine and bones and other problems. Not only that, but I think chronic pain makes people also "pain sensitive" in other areas. It never used to hurt to get needles in my gums at a dentists, for example, and now it nearly sends me through the roof.

I have always refused to take pain killers though, feeling that they only led to addictions. Sometimes at night I do take them but mostly take just anti-spasm drugs to stop the neurological pain in the toes.

I always felt that any drug, including even marijuana, can eventually make the brain lazy when it comes to dealing with either pain or depression, and soon it becomes so dependent on those drugs that it no longer remembers how to stop the pain on its own which is why people end up needing more and more pain killers all the time yet still suffer from the same amount of pain.

Those I know who are on marijuana, for example, no longer no how to be happy without using the drug. It's like their brains have forgotten how to be happy so most suffer from depression and find that they need it all the time -- recreational use they call it, even when it ends up being three times a day.

But I do think that chronic pain does interfere markedly with brain function in that it does prevent a person from focusing most definitely, not just because of the pain but because people suffering from pain are always wondering how much worse it will get and where else it will travel and when they will die. Although I think I handle it well, those thoughts are always there.

But I don't like the idea much of taking any sort of pill for chronic pain, really. It reminds me of something I read on the Internet awhile back where they were working with drugs so that cattle wouldn't be terrified out of their wits or feel pain when they went to slaughter. In other words, the pain isn't gone; the brain just can't register it. It become robotic.

Some people think of pain as something extremely hellish, but in a sense I think of it as a gift because it always lets the user know the degree he's at and whether his condition is getting worse. If he takes pills to prevent the pain from registering in his brain he is too likely to harm himself more, thinking he is well. That's my 2 cents worth anyway.
"Some people think of pain as something extremely hellish, but in a sense I think of it as a gift because it always lets the user know the degree he's at and whether his condition is getting worse. If he takes pills to prevent the pain from registering in his brain he is too likely to harm himself more, thinking he is well. That's my 2 cents worth anyway"

Most neurological type disorders tend to get worse over time so you will never end up controlling your pain since it tends to "get worse". chronic pain destroys lives and relationships usually starting with loss of your job. I doubt serious pain is a "gift" pain is hell

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