Emotional and Motivational Brain Connections Predict Chronic Pain

An exciting study reported in the latest issue of Nature Neuroscience from the laboratory of Dr. Marwan Baliki at Northwestern University in Chicago casts light on the changes that occur in the brain when acute pain becomes chronic. The study strongly suggests that subjects’ emotional responses to acute pain play an important role in predicting these changes in the brain. Subjects who are more distressed about their acute pain not only tend to go on to develop chronic pain but their distress actually caused changes in the brain that were observed on brain scans. To my knowledge, this is the first time we have actual observations of the changes our attitude and feelings can cause in the brain over time that can lead to the development of a chronic pain problem.

Dr. Baliki and his colleagues took brain scans of subjects with acute back pain. They also measured pain intensity and the level of distress the subjects were experiencing. These data were obtained 4 times over the course of one year. During this time, some subjects experienced a resolution of their back pain whereas others continued to experience significant back pain which by the one year mark, had become chronic.

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Chronic Fatigue Syndrome

Imagine that you go through the day carrying two extremely heavy suitcases and wearing ankle weights. You constantly feel tired, weak, exhausted, and heavy from when you wake up in the morning to when you go to bed at night. This goes on for months or years on end. Imagine that no matter how little you do, you still feel terribly exhausted and that no matter how much sleep you get, you still feel extremely tired. These are the hallmark symptoms of Chronic Fatigue Syndrome (CFS) otherwise known as Myalgic Encephalomyelitis.

How is CFS diagnosed?

CFS is diagnosed by excluding other illnesses and disorders that cause similar symptoms such as thyroid disorders, diabetes, and infections. You should consult with your family physician if you have symptoms of CFS and have not had them investigated to rule out some other disorder or illness.

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Most of us experience headaches from time to time but when they occur frequently and with an intensity of pain that interferes with our lives, they become a serious, life-altering problem. If you develop a headache problem it is important to consult with your family physician in order to rule out causes related to illness, medication side effects, or other factors that can be investigated and treated medically.

Types of Headaches

There are many different types of headache. The International Headache Society has grouped headaches into two major categories: primary and secondary. Primary headaches do not have a clear link to another disease or injury, secondary headaches do. Primary headaches occur more often than secondary headaches, and include, migraine, tension and cluster headaches.

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When people have diabetes, their bodies do not produce enough insulin or are not able to effectively use the insulin they do produce. Insulin is a hormone. It is used to turn sugars into the energy that our bodies need to run on a day-to-day basis. When everything is working normally, insulin is produced as needed to control the level of sugar that is released into the bloodstream. When not enough insulin is produced or when the body cannot use the insulin properly, the level of sugar and insulin in our bloodstream rises. If this condition continues over a period of time, diabetes can develop.

Research has indicated that there is a genetic link for diabetes. We also know that certain ethnic groups appear to possess genes that increase their risk. These include people whose families descend from Aboriginal, Hispanic, Asian, South Asian, and African populations.

It is a challenge to live with any chronic illness such as diabetes, because to do so effectively requires us to make lifestyle changes. Most of us find this very difficult. As humans, we are creatures of habit. We get used to living a certain way, and we resist change it even when we know it will be good for us. The true challenge in effectively coping with diabetes is in making the necessary lifestyle changes.

Psychologists are specialists when it comes to lifestyle change. We help people implement the changes they want to make even if they have mixed feelings about those changes. We help people resolve the inner conflict that we all experience when confronted with changes we need to make.

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Irritable Bowel Syndrome

People with Irritable Bowel Syndrome (IBS) experience abdominal pain and cramps, and usually diarrhea alternating with constipation. Sometimes they experience frequent diarrhea or constipation rather than one alternating with the other. Other common symptoms include a feeling of gas, bloating, fullness in the abdomen, and a poor appetite. Often a bowel movement temporarily relieves these symptoms. The disorder is also known as spastic colon, irritable colon and nervous stomach. Many people experience IBS symptoms as life-altering.

You should see your family physician if you have experienced any of these symptoms and have not yet discussed them with him or her.

What Causes IBS?

The cause of IBS is unclear. Sometimes IBS occurs after an intestinal infection. Other times it occurs after a stressful experience. But most of the time IBS occurs without any clear cause. Some people with IBS have symptoms most days. Others may have long periods with few or no symptoms between episodes.

Some research studies have found that people with IBS have abnormal levels of the neurotransmitter serotonin in their gastrointestinal system. Neurotransmitters are chemicals that enable nerve cells to communicate with each other. The abnormal levels of serotonin cause problems with the movement of smooth muscles within the intestines (motility) and increased pain sensitivity in the gastrointestinal system. Some people with IBS obtain relief from their symptoms when they take antidepressants that focus on restoring a more normal neurotransmitter level.

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What is fibromyalgia?

Imagine that you experience pain in many areas of your body and tenderness in your joints, muscles, tendons and other soft tissues. Imagine that you also experience problems with sleep, low energy and fatigue. Imagine you feel depressed and anxious and that you have problems with thinking clearly (often called “fibro fog”). Now, imagine that you feel this not just for one day, one week or one month but for many months and possibly for years on end. This is the reality of fibromyalgia, a syndrome that often has a profound impact on every aspect of a person’s life.

Most people with fibromyalgia endure many medical examinations before they are diagnosed. Many are told that their pain is “all in their heads” and feel that their symptoms are not believed. The diagnosis of fibromyalgia is still controversial among many health care professionals. There are still some who question whether this is, in fact, a real syndrome at all.

However, if you have fibromyalgia, the reality of your symptoms is not in question.

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Pain is the most frequent reason people seek medical help and take medications. You should consult with your family physician if you develop any new pain problem, if you have had an ongoing pain problem, or if you experience any change with respect to the quality or intensity of the pain.

However, most people with a pain problem think only about medical consultation and medications. Most of us have become accustomed to look for external help only. We do not usually look inward to use our own resources to cope better and promote healing. Psychological treatments for pain educate people and empower them so that they can take control of their pain, whatever the cause, and help themselves cope better. This approach complements whatever medical approach their physician may have recommended. Psychological strategies can be especially helpful in dealing with chronic pain.

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