New page posted under “The Chicken or the Egg”: Pain or Brain Damage

A sneak preview of the conclusion in case you don’t want to read the whole thing:

….There’s a bottom line somewhere, but I’m not sure I can find it.  The chickens are glaring at the eggs at this point.  And the eggs are just smug.  There is really only one thing that everyone seems to agree on.  There are physical changes in the brain with chronic pain, including with fibromyalgia.  The longer a person endures the stress of chronic pain, the more pronounced the changes.  To me this indicates that the changes are caused by chronic pain.  However, there are other indications that the changes induce the chronic pain.  Medications such as pregabalin that work directly with brain mechanisms do have a positive impact on fibromyalgia symptoms by changing those affected areas, which then would make me think that the changes in the brain would be the cause of the pain.  The parallels between aging and the changes that occur in patients with fibromyalgia add a different dimension to the question.  So here are what seem to me to be the options:

1. Long term chronic pain causes changes in the brain, particularly in the pain network
2. Changes in the brain, particularly in the pain network, cause long term chronic pain
3. Fibromyalgia is caused by premature aging of the brain – people with fibromyalgia are actually “elderly” in a way.

My personal favorite: extended periods of pain train the brain to be oversensitive.  It becomes an involuntary habit, kind of like an addiction, and is “cemented” into the brain tissues themselves, affecting how the brain areas talk to each other. Unfortunately, there isn’t a 12-step program for fibromyalgia.