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Toward a Better Understanding of Chronic Pain
> 11/15/2007 1:33:37 PM

About 10% of American adults struggle with chronic pain, which can develop after an illness or injury or occur for no identifiable reason. Research indicates, however, that the brains of chronic pain sufferers differ from the brains of those who do not experience chronic pain. As scientists work to develop new and more effective treatments, others generate awareness of the crippling impact of chronic pain.

In the first two articles in a series of three on pain (the third will appear next week), the New York Times illustrates some of the obstacles faced by those who suffer from chronic pain. Debilitating pain can cause loss of mobility and interfere with a patient's ability to function on a daily basis. Some find that they can no longer work, and this can cause feelings of helplessness of uselessness. Chronic pain sufferers also feel frustration due to the reactions of others. You cannot tell by looking at a person whether or not they suffer from chronic pain. In fact, many chronic pain sufferers appear to be perfectly healthy and able to work, which leads many to the mistaken assumption that these patients make up or exaggerate their complaints. It is not surprising that chronic pain sufferers often develop anxiety and depression, and their friends and family also feel these effects. Chronic pain can increase financial problems and stress levels for the entire family, especially if the patient cannot work or needs to be cared for at home. Family members may also feel resentment if they must sacrifice some of their social life to care for a loved one.

Chronic pain can rarely be totally alleviated, and doctors and patients are often reluctant to try opioids, which can relieve both acute and chronic pain. As researchers search for new treatments, some studies have given us insight into chronic pain and how we may be able to treat it. Last year, researchers from Northwestern University used human brain imaging to study the brain activity of patients with chronic back pain. They asked participants to rate their level of spontaneous pain (fluctuating pain that occurs without an external stimulus) during an FMRI scan. They also asked participants to rate their level of pain as a thermal stimulus was applied to their backs. The researchers found that when the thermal stimulus was applied, the participants' brain activity resembled activity previously associated with acute pain. During spontaneous pain, however, the most active regions of the brain were those associated with the regulation of emotions. Scientists are now studying d-cycloserine, an antibiotic that blocks some brain receptors, which might be able to better address the emotional aspect of pain.

Brain imaging studies have had other benefits as well. By demonstrating that the brains of those who suffer from chronic pain differ from the brains of those who do not, researchers have provided evidence of this debilitating condition for anyone who may have doubted its reality. Hopefully, with more research we will have a better understanding of chronic pain as well as potential treatments for it.

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