Pain Chronification

One of my questions about chronic pain has always centered on what happens to the body when it is subjected to chronic pain over a long duration of time.  In other words, do baby pains grow up into monster pains at some point?  Is there a point of no return?  Is there a possibility of early intervention that may prevent the monster from rearing its ugly head?

Looking at studies regarding actual physical changes that occur in the brain with long-term chronic pain, things start leaning toward hopeless for pain veterans.  I may not have this completely right, but here goes:

  1.  There is a decrease in gray matter, but not in overall gray matter.  I’m not sure how that works.  It sounds almost like other bits of the brain make up for the bits that have deteriorated so the overall volume stays constant?
  2. There isn’t a definite link between the decrease in gray matter and an association with pain duration, depression, etc.  However, there is a link to pain sensitivity.
  3. The thalamus is “deactivated” as is the “brain’s pain-inhibitory network” (and other areas).  So there is more of a perception of pain.
  4. I’ve read a couple times too that there is more of an anticipation of pain due to these changes.  This is not a matter of the patient wincing and saying ouch before anything happens.  This is the brain reacting and the reaction being detected by functional MRI.
  5. There is a greater difference in patients depending on how long they have had chronic pain.  It gets worse as time goes on.

There are a lot more articles to read and I don’t know enough about brain and brain damage to understand the implications of these kinds of change, but it seems safe to say that the longer pain goes untreated, the worse it gets, the greater the physiological changes.

Thinking in terms of cause and effect, it would be possibly be safe to say that pain comes first, then brain damage.  So if deactivation of core parts of the brain are the consequence of long-term chronic pain, then we still don’t have a clue about the underlying cause of fibromyalgia….

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