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Why some people develop chronic pain: It’s all in the head

Kathleen Blanchard's picture
New research shows chronic pain  literally starts in the head.

Scientists have uncovered new information about why some people develop persistent and long-term pain; yet others with the same type of injury don’t. In a first study, researchers have found that it’s a combination of the injury and the state of the brain that leads to chronic pain.

Strong emotional response to injury predicts chronic pain

It took ten years of research to uncover what happens in the brain that allows some people to recover after an injury heals, while others continue to hurt.

The Northwestern University Feinberg School of Medicine investigation found that chronic pain starts when two specific areas of the brain communicate with each other. The more the two areas ‘talk’ to each other, the greater likelihood that chronic pain will develop.

For the study, researchers looked at brain imaging in 40 people with back pain and found they could predict with 85% accuracy who would go on to develop chronic pain, depending on the level of communication between the frontal cortex and the nucleus accumbens brain regions.

The participants were all diagnosed with an initial episode of back pain that persisted for 4 to 16 weeks. Brain scans were performed at the start of the study and three more times during a 12-month period.

A. Vania Apakarian, senior author of the paper and professor of physiology at Northwestern explained in a press release, "The injury by itself is not enough to explain the ongoing pain. It has to do with the injury combined with the state of the brain.

It may be that these sections of the brain are more excited to begin with in certain individuals, or there may be genetic and environmental influences that predispose these brain regions to interact at an excitable level."

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The more emotionally charged the brain is when the injury occurs, the greater the likelihood a person will experience chronic pain.

The finding is important because treating pain costs $600 billion a year, according to a 2011 National Academy of Sciences report, with back pain being the most common condition.

Pain that persists after an injury has healed is difficult to treat because there isn’t any intervention that is scientifically proven to work.

Apkarian explains that the nucleus accumbens is responsible for ‘teaching’ the rest of the brain. When an injury occurs, it may be telling the rest of the brain to develop chronic pain.

The study also showed that people with chronic pain lose gray matter, meaning they have fewer neurons that are essential for communication between brain regions.

The study, published in the journal Nature Neuroscience, is the first to show the link between early brain changes and chronic pain. "Now we hope to develop new therapies for treatment based on this finding," Apkarian said. The finding suggests pain that doesn’t go away after an injury heals is literally all in the head. The research finding could help millions in the United States who suffer from chronic unrelieved pain by providing an entirely new treatment approach.

Nature Neuroscience (2012) doi:10.1038/nn.3153
July 1, 2012

Image credit: Morguefile



I have chronic pain after an extensive spinal fusion four years ago. The article is a little depressing because the last statement, " The research finding could help millions in the United States who suffer from chronic unrelieved pain by providing an entirely new treatment approach." This statement doesn't mention what the new treatment approach is or should be. I, for one, would really like to know where to go for help, as my grey matter is shrinking every week, month and year that goes by with chronic severe pain.
I'm sorry to hear about your pain. As nurse I 'touch' people daily whose life if negatively impacted because of lack of treatment options. This study is an insight. There is no new treatment yet. When a finding is new, researchers move forward from there. Unfortunately, there is no spring to action. I think the approach suggested though is to 'retrain' the brain. Guided imagery, meditation, cognitive therapy or hypnosis should all be approaches that would work - based on this finding, though it wasn't mentioned in the study. I think researchers might try to find a pharmaceutical approach, but at this point I have no idea what that might be - something that alters brain chemicals and signaling, but that takes years. Phantom limb pain is poorly understood and a perfect example of how pain can persist. Here is a wonderful; in depth look at chronic pain from TIME magazine: http://www.rsds.org/pdfsall/Time%20Article%20on%20Pain.pdf I don't know what kind of pain you are dealing with or your limitations, but if possible, no matter what, remain active, even if it is in the water, which is a wonderful way to promote natural chemicals to alleviate pain. I wish you the best. Search for alternative pain management in your area also - even 'touch' therapy - massage - does wonders.
Nurses should advocate for better solutions for people in pain. Nurses, like doctors, underestimate peoples pain and overestimate the amount of care they provide. They also dont believe in cures for pain. As Ida Rolf indicated take care of the physiology and psychology will take care of itself. The biggest obstacle to improving pain care is not the "untrained" minds of pain sufferers-but rather the lack of training of medical professionals. No wonder more and more medicine place blame on peoples minds- the real fault is the uneducated mind of medical professionals who have neglected peoples pain and suffering for several decades
What types of 'cures' for pain do nurses and doctors not believe in?
If you go to the aapm website or read the June 2011 IOM report on pain or read works by Gatchel-they clearly indicate they dont believe in cures for pain. Dont we have a cure for peptic ulcer? Arent 15% of people with migraines and people with rheumatoid arthritis overcome their condition? Didnt Senator Spectre indicate NIH puts roadblocks in the way of curative research. Modern medicine is intent on treating and not curing disease- so what else is new.
Point taken, but different conditions.
U can't cure rheumatoid arthritis. In fact it is a very painful disease that can easily lead to chronic pain. I should know I have both. I know how u feel when the pain is so bad u want to scream. But u can't compare people's pain. Unfortunately there is enough to go around.
Research shows 15% of people w rheumatoif arthritis do become cured. Captain cooke 200 years ago was cured with lomi lomi experiential and anchoring biases abound in the world of health care.
RA is a DISEASE it cannot be cured. A person can go into remission but otherwise there is no magical cure. I think I would know after living n learning about it for 30 years.. now juvenile RA can burn out of ur system but that is still not considered being cured.