How Chronic Pain Gets Into Your Brain

Long-Lasting Pain May Also Explain Depression and Other Mental Problems: Study
ABC News Medical Unit
Feb. 6, 2008

For many, the impact of chronic pain may not be limited to the pain itself; it could also negatively affect their mental state. New research by scientists at Northwestern University in Chicago may explain why people who have chronic pain also suffer from seemingly unrelated problems such as depression, anxiety, lack of sleep and trouble focusing. “The pain is in your head,” said Dr. Dante Chialvo, lead author of the study and associate research professor of physiology at the Feinberg School of Medicine. “The whole head.” The study showed that people with chronic pain have a portion of the brain that is always active: the region associated with mood and attention. This constant activity rewires nerve connections in the brain and leaves chronic pain sufferers at greater risk for mental problems. Chialvo said that a healthy brain exists in a state of equilibrium, with about the same number of regions turned on and off. As certain regions are recruited for various tasks, other regions turn off to maintain the equilibrium. But a person in chronic pain is not so even-keeled. “We knew there are important differences in behavior in [chronic pain] patients,” Chialvo said. “That has to come from brain abnormalities.” Chialvo described chronic pain as an idea that gets stuck in your head. The brain may not be able to attend to other tasks as well or as quickly because it is preoccupied with the pain signals. Chialvo suggested that receiving pain signals constantly can result in mental rewiring that negatively affects the brain, and in particular, the regions associated with attention and mood. The rewiring forces their brains to allocate mental resources differently to cope with everyday tasks — from mathematics, to recalling a shopping list, to feeling happy.

Everyday Pain. The pain-brain connection has been well documented, at least anecdotally, and many doctors say they have seen firsthand how a patient’s mental state can go downhill when they suffer chronic pain.

[link to the remainder of article]


What follows is a question sent in by a 16 year old RSD patient from the RSDHope Teen Corner. Her question is above. After posting my answer to her and seeing the responses it generated I thought it might be a good idea to post this to the website for everyone to read. It was an excellent question that Danielle asked and one that so many of us have asked ourselves over the years. I tried to answer her based on my thoughts and experiences over the years. Thank you Danielle for starting this topic and for letting us share this with others. Keith

From Danielle
Hi Everyone,
I decided to write in because I’m really struggling with my RSD and the pain. As I said in my last email I start the Rehab program next week. My pain is really starting to affect my life and my attitude. I could have this for the rest of my life. I’m 16. How will I get through this?

From Keith
I guess I can probably speak to this topic based on the length of time I have had this disease. As of last month (April 2007) it has been 33 years since my RSD began. Back then it was called RSD. Now it is called CRPS. So many battles over the years about what to call it. Since mine is Type 1 it can be called either CRPS Type 1 or RSD. CRPS Type 2 is technically the old “causalgia”. I am not sure what I would have felt back when I was 14 if I had been told that I would still be dealing with this in my 40’s and beyond. This year I turned 47. I have had this disease 33 of my 47 years, seems like my entire life. I really don’t remember not dealing with pain. I have dealt with the wheelchair issues, being stuck in bed for months, even a year or more at a time, close friends leaving, even spouse’s leaving due to the disease and the havoc it wreaks on relationships. I have dealt with dozens of hospitals, Doctors, treatments, injections, medications, blocks, etc., Some of these have helped but most didn’t, some were more painful than others and one even left me paralyzed for more than a day. I have had surgery that had a 75% chance of failure, where failure meant never being able to walk again. To me that meant a 25% chance of success.

Life is about attitude. Life is about learning from everything thrown your way. Abraham Lincoln said “Always bear in mind that your own resolution to succeed is more important than any other one thing.” I have learned many things over the years on this journey. I have learned that when your body is weak your mind and spirit becomes stronger. I learned that while some people will disappear from your life, even those who profess to be with you through sickness and health, others will appear who will lighten your heart when it is heavy, lift your mood when it is low, brighten your day when it is dark, and make even the worst situation seem like it can get better. 

I learned that faith is a powerful thing. I learned that there are caring Doctors, nurses, and physical therapists out there who will go out of their way to make a positive difference in your life. Overall I learned that this disease, as horribly painful as it is, as personally devastating as it is, as financially draining as it is, that it is an obstacle than can be overcome. If you cannot go over it, figure out a way to go around it. If you cannot go around it, figure out a way to just plow through it. Don’t spend your time obsessing over what you have lost in your past but rather what you can gain by changing your present. As Helen Keller once said “When one door of happiness closes, another opens; but often we look so long at the closed door that we do not see the one which has been opened for us.” 

Let me close with just a few thoughts. 

  • Never be afraid to ask for help. 
  • Never forget to do your own research. 
  • Never assume the medical professionals always have your best interests at heart.
  • Always protect yourself and always be involved in your own care.
  • It is your body, your future.
  • Make sure you know what is going to happen before, during, and after any treatment and/or medication

Never give up hope, never give in to despair, never stop looking towards tomorrow, never, never, never.

–Keith Orsini
American RSDHope

December 18, 2008

For an 11-year-old Libertyville girl and her family, a common soccer injury has opened up a world of pain that most people will never know, and has forced her to display a level of courage few could expect from a fifth grader. Danielle Pacholski is an athlete. In the spring it’s softball, in the summer it’s athletic camps, in the fall it’s soccer and in the winter it’s basketball. At least that’s the way it was and that’s the way she is working hard to make it again. “She is still on a no running, jumping, hoping, or skipping regime, and a goal of hers and the physical therapist is to be able to participate in extracurricular basketball starting in January. But she has to be able to run and jump for that to happen,” said Colleen Pacholski, Danielle’s mother. Colleen contacted Pioneer Press wanting to share the family’s story as way of possibly helping other families by giving a name to that which has so affected her own family.

Nerve disorder
The diagnosis is Complex Regional Pain Syndrome or CRPS. It is, researchers believe, a complication involving the central nervous system, the network throughout our body that alerts us when something is too hot or too cold, or lets us know when we’re hurt by making us feel pain. According to the National Institutes of Health, CRPS is a chronic pain condition usually triggered by an injury. An Institute Web site dedicated to CRPS describes the symptoms: “The key symptom of CRPS is continuous, intense pain out of proportion to the severity of the injury, which gets worse rather than better over time CRPS most often affects one of the arms, legs, hands, or feet. Often the pain spreads to include the entire arm or leg. Typical features include dramatic changes in the color and temperature of the skin over the affected limb or body part, accompanied by intense burning pain, skin sensitivity, sweating, and swelling.”

A diagnosis
For Danielle the onset of CRPS came this summer after reinjuring a tendon in her foot. “On the first day of soccer camp, I went to pick her up and the arch of her foot was hurting. She tends to be a child who when she says something hurts, it’s real, so I took her in,” said her mother. An orthopedist diagnosed her with an aggravated tendon and placed her foot into a walking boot. “It was supposed to be a simple injury,” Colleen recalled. But after four weeks the pain had not subsided. A cast was placed on her foot and was removed two weeks later. “The pain continued, so they put the cast on for what was supposed to be another two weeks.” As time passed and the injury failed to heal, Colleen took her daughter to a second orthopedist for a second opinion. That doctor agreed with the first, saying the tendon should have healed, and that the pain had to be coming from something else. But about a week into the second cast things rapidly began to change. “She said the whole cast was really hurting her,” Colleen said. Colleen finally took her daughter to a sports medicine specialist at Children’s Memorial Hospital. They chose the doctor because she has previously diagnosed Danielle with Sever’s disease, which causes heel pain. “That’s when they gave us the diagnosis of Complex Regional Pain Syndrome,” she said, “She gave us the diagnosis, prescribed physical therapy, gave us a prescription for Lyrica [a nerve block], and gave us a handout that briefly described it and said ‘come back in two weeks.’ We thought, ‘OK.’ But when I got home I Googled it and found that it was a little more involved than ‘here’s the diagnosis and here’s the Lyrica.’”

Finding help
Colleen conceded that when she first read about CRPS online, she didn’t believe the diagnosis. At first all Danielle faced was the pain in her foot. “But within a two-day-period she started describing her foot as burning, and wasn’t able to move her feet at the ankle. We started seeing the symptoms I had been reading about. Icing would put her over the edge. Ice was just hurt and burn. Her whole nervous system was going haywire. I couldn’t rub it, because I couldn’t touch it. It hurt. She could not walk on her foot. She could not wear a sock because the sensation of a sock made her foot burn. After about three days the burning started to travel up her leg.”

A bigger plan
Being diagnosed at Children’s Memorial, the Pacholskis were plugged in to the hospital’s Pain Treatment Center. There they met Dr. Juliane Lee, an anesthesiologist who became one of physicians treating Danielle. Lee said that there are many complexities in treating CRPS. Firstly, most often, by the time the patient and family receive a diagnosis they are already frustrated. Then, she said, there’s the extent of the treatment. “It’s a multidisciplinary, multimodal approach. What we are interested in providing them is physical therapy, medical management, psychological management and complimentary and alternative therapy,” she said. What this means for each patient is different, Lee said. Typically, a patient will immediately begin physical therapy which will include electro-stimulus. They will also be given several drugs. “If they start one therapy and things have improved, but have not been completely resolved we’ll add things. But if I’m seeing the patient and I’m making the diagnosis, I’ll hit them with everything,” said Lee. They will also see a clinical psychologist to work with them on coping strategies. Finally, they will also be considered for acupuncture, massage therapy, biofeedback and mindfulness meditation and relaxation techniques, Lee said. “With multimodal therapy, resolution can occur, in up to 90 percent of cases,” she said. “But in 20 to 50 percent it will recur.”

Ted Krane – The Mystery of Chronic Pain – Video 

We think of pain as a symptom, but there are cases where the nervous system develops feedback loops and pain becomes a terrifying disease in itself. Starting with the story of a girl whose sprained wrist turned into a nightmare, Elliot Krane talks about the complex mystery of chronic pain, and reviews the facts we’re just learning about how it works and how to treat it.

Click here to see the video

Great video, worth a visit to the website!

Assessing Chronic Pain Treatment Practices and Evaluating Adherence to Chronic Pain Clinical Guidelines in Outpatient Practices in the United States

From the American Pain Society – Journal of Pain – June 2013  

Abstract: Chronic pain is a major health concern in the United States. Several guidelines have been developed for clinicians to promote effective management and provide an analytical framework for evaluation of treatments for chronic pain. This study explores sample population demographics and the utilization of various therapeutic modalities in an adult population with common nonmalignant chronic pain (NMCP) indications in U.S. outpatient settings. A cross-sectional study using the National Ambulatory Medical Care Survey (NAMCS) data from 2000 to 2007 was used to analyze various treatment practices for the management of NMCP and evaluate the results in comparison with guidelines. The study population of 690,205,290 comprised 63% females, with 45.17% of patient visits occurring in primary care settings. Treatment with at least 1 chronic pain medication was reported in 99.7% of patients. Nonsteroidal anti-inflammatory agents were the most common treatment prescribed, with use reported in approximately 95% of the patient visits. No other pain medication drug class or non- medication therapy was prescribed more than 26.4%. These results point to a potential underutiliza- tion of many recommended NMCP treatments including combination therapies and the need for enhanced education of chronic pain guidelines.

 To read this article click on the link above. Lots of interesting details and facts here.

Article supplied by the Howard Blacks latest CRPS/RSD Chronic Pain Newsletter – website;