Chronic pain can also trigger alterations to the brain’s white matter, which contains the glial cells and myelinated nerve axons that pass signals from one region of the cerebrum to another. Glial cells provide support and nutrition for the neurons, as well as performing “housekeeping” functions such as clearing away debris and excess material. The myelinated nerve axons are covered with myelin, a white, fatty “sheath” that helps speed the transmission of impulses through the nerves. Serious problems such as multiple sclerosis can arise if the myelin sheath is degraded.
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If you compare the human brain to a computer, you can think of the gray matter as the central processing unit where decisions are made, while the white matter is the cables, cords, and wires linking everything together. Here’s what can happen to your “cables and cords” when chronic pain strikes.
White Matter “Pain Pattern ”—For a recent study2 sponsored by the National Institutes of Health, pain researcher Vania Apkarian, PhD, and his colleagues worked with 46 people who had suffered from low back pain for roughly three months before coming to the hospital for treatment. Dr.
Apkarian and his team scanned the patients’ brains, using a technique called DTI (diffusion tensor imaging), a form of MRI (magnetic resonance imaging) that allows researchers to study the “architecture” of the brain’s white matter, visualizing its structure and integrity down to the microstructural level. The researchers also tracked the volunteers’ pain levels over the course of a year.
By the end of the year, about half of the patients had recovered, while the other half continued to suffer from low back pain. The big surprise was that the DTI brain scans showed clear and consistent differences in the white matter between those who recovered and those who continued to suffer pain! Not only that, the white matter of those who continued to suffer looked quite a bit like the white matter of people who were known to suffer from chronic pain.
Here was striking evidence that the brain changes physically when pain settles in—and that an accurate prediction of who would continue to suffer could be made just by looking at the white matter!
Not only is the brain physically altered by chronic pain, there are also changes in the way it functions.
Chronic Pain Alters Brain Blood Flow—In 2008, a scientific study3 funded by the National Institutes of Health used fMRI (functional magnetic resonance imaging) to track the blood flow through various parts of the brain. Since blood flow increases to parts of the brain that are active, fMRI allows researchers to see which parts are in use at any given moment.
Two groups of volunteers—people suffering from chronic back pain, and healthy people who were not in pain—were asked to perform a simple visual attention task. It wasn’t difficult to do, but it required the use of certain areas of the brain. While the volunteers were performing the task, the researchers used the fMRI to measure blood flow to their brains to see which parts were activated and which were “at rest.”
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