Chronic pain: Destined for pain

When you have Fibromyalgia the pain process involves is this central sensitization… your brain becoming more sensitive and heightened for pain. There is a lot of pain dysfunction in FM. We feel it faster, with less stimulus, and longer, for no reason. People can get FM it seems for no reason but some after an accident, injury or illness. Like a trigger event traumatizes that nervous system and sets into motion this FM process which the person might have been predetermined for. And with migraines again people who are episodic go into chronic migraines at times with this process of central sensitization… the brain becoming more sensitive to pain and to triggers making the attacks more frequent. But certainly many people have episodic migraines and never have this occur.

With FM you sort of think, well, I have a brain wired for the pain it is hardly surprising when I got migraines it continued with that process. But… did I have a brain designed for this, set up, if you will for chronic pain prior to anything of the sort?

In the journal of Pain research ” has shown that there are clear differences that distinguish the brains of those with chronic pain from those without such pain. Chronic pain sufferers consistently show reduced volume in the brain’s gray matter, the cortical structures key to perception, movement, memory, and reasoning. Researchers have also shown that compared to healthy patients, the brains of chronic pain sufferers are wired differently, in ways that suggest that physical sensations and emotional responses are bound more tightly together. ” (When the pain is all in the head)

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But they had to answer which came first. The chronic pain and then the chances structurally, or the structural changes then the chronic pain as a result of injury.

“They did so by recruiting 46 subjects, who had experienced a first episode of back pain that had already lasted four to 16 weeks, and performing regular brain scans on those subjects for a year.



Focusing largely on the bundles of axons that carry nerve impulses across the brain, they found that within two months of recruiting patients, discernible differences in the structure and integrity of that “white matter” could be used to distinguish subjects whose pain persisted from those whose pain was beginning to resolve.


By the 12-month mark, the structural differences in white matter allowed researchers to distinguish — without error — subjects whose pain had disappeared from those whose pain was persistent.



Compared to subjects whose pain resolved, subjects whose pain would become chronic also showed differences in the density of connections that lashed their nucleus accumbens — a central structure in the brain rewards, motivation, pleasure and reinforcement learning circuit — together with their medial prefrontal cortex, a switchboard for decision-making, emotional response and long-term memory.


The authors made further comparisons between the original 46 subjects and two new groups: healthy recruits and people with a established history of chronic pain. Those comparisons showed that, from the earliest scans, the brains of subjects who would go on to become chronic pain sufferers had structural abnormalities that made them look much more like the chronic pain veterans than like healthy controls or the subjects with back pain that went away.



And throughout the study period, the white matter and brain connections of subjects with back pain that went away looked much more like those of healthy control subjects than they did like the brains of subjects whose pain became chronic.



The brain’s white matter normally deteriorate with age, and the Northwestern researchers made a shocking calculation to show the difference that separated subjects with and without chronic pain: compared to healthy controls or those whose pain subsided, the white matter in the subjects whose pain went on to become chronic “exhibits 30 to 50 years of additional aging”.”(When the pain is all in the head)

I suspect in cases of FM where it is a syndrome with many potential causes and symptoms this might not be of any use… but FM does change the brain structurally. There is atrophying in certain areas and they are at least suspected at this time to do with the pain dysfunction system in FM… more in the lack of dopamine to relieve pain in those areas. Nonetheless one does wonder if having a brain structurally set up for pain also is a factor in developing conditions of this nature.

When it comes to migraines… they are again not an injury and yet some people, not overusing medication, do slowly get more and more migraines until they are chronic. Is this because of central sensitization? Is it literally because their brain already had the set up for chronic pain to be mapped out?

And if we have such a brain makes one not want to have any injury that might just not heal right. Like we need more chronic pain to add to the mix.



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