I am a chronic back pain sufferer as a result of a simple surgery I had done four years ago. I keep watching the news for any miracle cures. So far: nothing. But I did hear a news report that they have shown there is altered brain function in people like me and maybe this will be a breakthrough in research. What sort of help would that bring me?

Posted November 25th, 2009 by Matt

Pain Management

Over the past twenty years or so, scientists have been able to take a different research approach to the problem of chronic pain. Using studies like Positron Emission Tomography known as PET scans and Functional Magnetic Resonance Imaging (fMRI), magnetoencephalography (MEG) and the more traditional electroencephalgraphy (EEG) has changed how chronic pain is viewed. With visible and measurable changes in the brain now documented, chronic pain fits the medical definition of disease.

But does this change in how we view chronic pain (as a disease state) change anything? Not yet, but maybe it will change the way we treat chronic pain patients and hopefully so in the very near future. Armed with this new information, scientists are changing their focus of study. Now, they are looking at groups of patients with the same problem (e.g., fibromyalgia, irritable bowel syndrome, depression, arthritis, back pain) and examining what's going on in the brain associated with these conditions.

They are finding that common disturbances are present in the brains of people who have the same disorder. For example, patients with knee osteoarthritis have increased brain activity in three areas: the amygdala (survival center), thalamus (relays sensation and motor signals to the main part of the brain), and cingulate cortex (emotion processing and formation). It may be possible to find ways to shift brain activity or change the pain experience through direct brain stimulation. If there are people with a particular pattern of biochemistry more likely to anticipate pain or amplify pain, there may be ways to alter the body chemistry to change their response to pain.

The bottom line is that chronic pain is linked with structural changes and altered neurochemistry in the brain. This information alone gives a focus and direction for research that may ultimately result in changes not only in the way we view chronic pain, but also in finding more effective ways to treat it centrally (at the brain level). The results of these neuroimaging studies also open the door for changes in treatment for other chronic nervous system-related problems that are currently considered irreversible such as Parkinson disease, post-stroke, and drug addiction (narcotics).

Since back pain makes up a large portion of the adult population with chronic pain, this problem will remain a major focus of many pain researchers. Scientists who are pursuing this new approach to understanding and treating chronic pain may even find a cure, not just better ways to manage chronic pain.

Irene Tracey, and M. Catherine Bushnell. How Neuroimaging Studies Have Challenged Us to Rethink: Is Chronic Pain a Disease? In The Journal of Pain. November 2009. Vol. 10. No. 11. Pp. 1113-1120.

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