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NIH-funded study: Brain is hard-wired for chronic pain

Friday September 27, 2013
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Brain structure may predict whether a person will suffer chronic low back pain, according to a recent small study using brain scans of patients with low back pain.

“We may have found an anatomical marker for chronic pain in the brain,” Vania Apkarian, PhD, a senior author and professor of physiology at Northwestern University Feinberg School of Medicine in Chicago, said in a news release from the National Institutes of Health.

The research, published in the October issue of the journal Pain, was funded by the National Institute of Neurological Disorders and Stroke, part of NIH. The findings support a growing idea the brain plays a critical role in chronic pain, a concept that might lead to changes in the way clinicians treat patients.

Chronic pain affects nearly 100 million Americans and costs the U.S. as much as $635 billion per year to treat, according to an Institute of Medicine report. The report’s authors noted chronic pain affects a growing number of people.

“Pain is becoming an enormous burden on the public. The U.S. government recently outlined steps to reduce the future burden of pain through broad-ranging efforts, including enhanced research,” Linda Porter, PhD, the pain policy adviser at NINDS and a leader of NIH’s Pain Consortium, said in the release. “This study is a good example of the kind of innovative research we hope will reduce chronic pain, which affects a huge portion of the population.”

According to an NIH survey, low back pain represents about 28% of all causes of pain in the U.S.; about 23% of these patients suffer chronic low back pain. In the past, scientists thought its cause would be found at the injury site. However, recent research suggests the brain is more involved with chronic pain.

“Currently we know very little about why some patients suffer chronic low back pain,” Debra Babcock, MD, PhD, a program director at NINDS, said in the release. “The earlier we detect pain will become chronic, the better we may be able to treat patients.”

In the study, Apkarian and his colleagues scanned the brains of 46 people who had low back pain for about three months before coming to the hospital but who had not had any pain for at least a year before onset. The researchers repeated brain scans and evaluated the subjects’ pain via physicians examination and questionnaires four times during the one-year study period. About half the subjects recovered at some time during the year; the other half had pain throughout, which the researchers categorized as persistent.

The researchers used diffusion tensor imaging to measure the structure of white matter, which connects brain cells in different parts of the brain. They found a consistent difference in white matter between the subjects who recovered and the subjects who continued to experience pain.

“Our results suggest that the structure of a person’s brain may predispose one to chronic pain,” Apkarian said in the release.

Their findings also showed the white matter of subjects with persistent pain looked similar to the white matter of a third group of subjects known to have chronic pain. In contrast, the white matter of the subjects who recovered looked similar to that of healthy control subjects.

They then looked at the participants’ initial brains scans and found the white matter correctly predicted whether 80% of patients would recover or experience persistent pain.

Study abstract: http://bit.ly/1gIB2Lc


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