When pain takes over

To help people deal with their fears of reinjury, some experts are using a technique called exposure. “We ask people to identify the activities they’re afraid of, and we teach them to confront their fears,” Turk says. “We start at a lower level of activity and build up 10 to 20 percent each day. Patients see that they can do more, and they acquire a sense of mastery.” The technique doesn’t cure pain — but it can help reduce it.

The brain on pain
Finding ways to alleviate pain quickly is important not only for preventing permanent changes in the central nervous system but also because chronic back pain may actually shrink areas of the brain that regulate memory and information processing, according to a study in The Journal of Neuroscience. Researchers using MRI scans found that patients who had chronic back pain for at least two years had 5 to 11 percent less gray matter in the brain’s prefrontal cortex and thalamus than people without back problems. The decrease is equivalent to the gray matter volume lost in 10 to 20 years of aging. A possible explanation: Nerve cells are dying in these brain regions. “We think the suffering causes the loss of gray matter, because we showed that patients who were in chronic pain for a long period of time were worse off,” explains A. Vania Apkarian, Ph.D., professor of physiology at the Feinberg School of Medicine at Northwestern University in Chicago.

What’s more, people in pain may also have trouble with emotional decision making because the prefrontal cortex — which is also responsible for sizing up emotional situations—is affected. In a separate study published in Pain, Apkarian examined chronic-back-pain patients who were each given a gambling card game to play. (Gambling is considered an emotional task.) They performed poorly compared with healthy participants. The explanation? “Suffering keeps people in an emotionally overwhelmed state, so they’re less able to address other emotional demands,” Apkarian says. Based on his findings, he is starting a clinical trial this year to test a new chronic-back-pain drug that targets the brain chemistry involved in the areas of degeneration. Although the drug might not be able to replace lost brain cells, it may help decrease suffering.

Searching for a cure
The array of conventional and complementary treatments for chronic pain have been shown to have varying levels of success among patients. That makes research such as Apkarian’s critical to finding targeted options for patients — a trend that’s already starting to take hold. For example, because recent research indicates that people who suffer from chronic lower back pain for which no cause can be found and fibromyalgia have hypersensitive central nervous systems, doctors are prescribing medications, like certain tricyclic antidepressants (such as amitriptyline and imipramine), to address that sensitivity, according to Daniel J. Clauw, M.D., director of the Chronic Pain and Fatigue Research Center at the University of Michigan at Ann Arbor.

Other studies are showing that when it comes to stopping pain, your mind may be as powerful as any drug. Recent brain-imaging research reveals that focusing on the discomfort enhances the pain signal that goes to your brain. But if you’re distracted, the signal will be dampened.

For instance, if a friend criticizes a patient about her discomfort instead of trying to take her mind off things, the pain could get worse rather than better. “Attention is like a spotlight,” Arizona State’s Zautra says. “When you shine it on something else, the pain darkens and you won’t suffer as much.” Your mood also plays a role in your experience of pain. “When we changed people’s emotional state — putting them in a bad mood or making them anxious by showing an unpleasant video — their pain bothered them more,” says M. Catherine Bushnell, M.D., director of the McGill Centre for Research on Pain at McGill University in Montreal.

As I write this, now nearly six years after my first injury, I’m not in pain. My symptoms have improved over time and through physical therapy to the point that there are days when I actually forget I have a back problem — that is, until I push, pull or lift something heavy. Still,
I refuse to let fear control my every movement. I can painlessly open and close my front door (slowly and avoiding twisting), change diapers and push a cart half-full of groceries. And when the pain returns, as it does now and then, I simply try to ignore it and move on. My brain seems to appreciate the distraction, and often relief soon follows. I know I may never have a completely pain-free life, but I have a new appreciation for what my body can do. 

MORE FROM BEHAVIOR

Behavior Section Front

Why (most) women like to shop   Bad memories wiped away with unique therapy Decking the halls? Watch out for danger Be jolly — or else! 14 ways to force it or fake it Sweat glands are secret sensory organs Be jolly — or else! 14 ways to force it or fake it Teen Internet addicts more likely to self harm Angriest Americans: Young people, parents Compulsive hoarders suddenly in the spotlight Early treatment may help kids with autism Behavior Section Front   Add Behavior headlines to your news reader: