​How Chronic Pain Changes the Brain

September is Pain Awareness Month

Paula* started feeling pain in her shoulder at the end of last year. It started out as a pain, but it wasn’t long until routine things like saying hello to a friend or putting on a sports bra became too painful.

He began having trouble sleeping and paying attention at work because of the pain.

Paula was eventually diagnosed with a shoulder tear and said some days are worse than others, but the pain is always there. “I don’t remember what it’s like to not feel pain,” he said.

Paula is not alone: ​​About 1 out of 5 People living in the US have experienced chronic pain. Research shows that women and people assigned female at birth are more likely to have chronic pain than men, and women of color are more likely to have chronic pain. less likely to be treated for pain compared to whites.

Living with chronic pain can affect all aspects of life and even change the way your brain works.

What is chronic pain?

By definition, chronic pain It is a pain that lasts more than three months. It can be constant, like Paula’s, or it can come and go.

There are many causes of chronic pain, including a past illness or injury from which you have recovered but the pain persists. Health conditions such as rheumatoid arthritis, osteoarthritis, chronic migraine, and temporomandibular disorders can be a cause of chronic pain. And some people have chronic pain for unknown reasons without past injuries or illnesses.

Regardless of the cause, a growing body of research shows how chronic pain affects the brain.

Read: After 14 years of chronic pain, I’m finally embracing pain management >>

How chronic pain changes the brain

“Studies have shown that chronic pain can actually decrease gray matter in the brain,” he said. Puja Shah, MDinterventional pain management specialist and member of HealthyWomen’s Women’s Health Advisory Council.

Gray matter is the tissue in the brain and spinal cord that helps with important things like learning, memory, emotions, and movement—pretty much everything you need to do everyday activities. So a decrease in gray matter can cause problems in related areas.

For example, one study They found that chronic pain causes a reduction in the size and activity of the hippocampus, the part of the brain responsible for short- and long-term memory, among other things. Other research shows that chronic pain has a negative effect on the regions responsible for emotions and motivation. These changes can lead to personality changes and feelings of anger and anxiety.

Chronic pain has also been linked to various brain-related health conditions, including:

Chronic pain can also alter areas of the brain responsible for cognitive function. “These disturbances can cause difficulties with concentration, learning and problem solving, even when pain is not at the forefront of that person’s experience,” he said. Jane Wigginton, MDdirector of research in medical sciences Center for brain health.

The presence of constant pain also has a great impact on mental and emotional health. “Emotional centers of the brain, such as the amygdala and regions involved in emotional regulation, become more reactive under the constant pressure of pain,” Wiggington said. “This can lead to increased anxiety, frustration and feelings of hopelessness.”

Over time, chronic pain can reduce the brain’s ability to experience joy and pleasure, which can exacerbate emotional problems.

Chronic pain and depression.

Emotional burnout combined with constant pain can make people living with chronic pain more vulnerable to mental health conditions such as depression.

Chronic pain shares neural pathways with the mood and reward systems in the brain, which explains why chronic pain has been linked to depression and substance use disorders.

“Persistent pain can alter the balance of neurotransmitters such as serotonin and dopamine, which regulate mood, pleasure and motivation. “This disruption can lead to feelings of depression, anxiety, and a decreased sense of reward, making it harder for people to find relief or experience joy,” he said.

The fact that chronic pain is an invisible illness can also lead to feelings of loneliness, which can lead to social isolation and depression. Studies show that people living with chronic pain are more vulnerable to social isolation and, in turn, isolation can worsen chronic pain symptoms.

Stress is another factor that can worsen chronic pain because it accelerates changes in brain function. Basically, the body releases cortisol, also called the “flight or flight” hormone, which can decrease the brain’s ability to handle emotions and pain. “Chronic stress can also make the brain more sensitive to pain signals, increasing both discomfort and emotional tension,” Wigginton said.

Shah said that recent studies and advances in medical images have helped highlight how chronic pain changes the brain. “It also shows that pain itself is a true mind/body illness,” Shah said. “It’s validation that suffering is causing long-term damage.”

Read: Technological solutions for chronic pain >>

Chronic pain in women.

There is still a lot we don’t know about chronic pain. But we do know that Women and men experience pain differently. and women are more sensitive to pain in general compared to men. Wigginton said this is due, in part, to hormonal fluctuations. “These fluctuations, particularly during menstruation, pregnancy and menopause, can increase sensitivity to pain and alter the way the brain processes pain signals,” he said.

Shah noted that chronic pain isn’t necessarily about tolerance: Chronic pain is a complex, interconnected disease that feels different depending on the person. And there can be a stigma around chronic pain that can prevent people from getting the help they need.

Read: Breaking barriers to pain treatment >>

“Women are less likely to speak up when they experience a chronic pain condition,” Shah said. “This is due to many reasons, including cultural norms, difficulty finding the space and time for women to prioritize their self-care, and biases in the medical community regarding treatment for men versus women.”

Historically, women have been excluded clinical trials and conversation around chronic pain despite being more likely to be diagnosed with painful conditions compared to men.

The issue of chronic pain and chronic pain treatment is personal for Shah. she had migraine attacks for years, but she said a mind/body approach that includes medications and aligning her posture has helped her gain better control over her migraine attacks.

The first step, he stated, is awareness. “Too often we downplay things as if they are normal when they are not.”

Both Shah and Wigginton said brain-healthy habits, such as reducing stress, practicing mindfulness, and getting enough sleep and physical activity, can help with chronic pain symptoms.

“It is essential that women know that they are not powerless in this process,” Wigginton said. “There are multiple pathways to improving brain health and well-being, and by understanding and addressing the brain’s role in pain, women can feel empowered to thrive in their lives, despite the challenges that chronic pain can bring.” .