Readers questions on joint pain and back pain answered
But are those brain differences a response to chronic pain — the brain’s response to the experience of months or years of physical misery? Or do those differences predate chronic pain — nudging what for another patient would be a short-term experience of discomfort into a lifelong ordeal? The authors of the current study, working under a federal government initiative aimed at consolidating research on pain, devised a series of experiments designed to clarify which came first. They did so by recruiting 46 subjects who had experienced a first episode of back pain that had already lasted four to 16 weeks, and performing regular brain scans on those subjects for a year. Focusing largely north york chiropractor on the bundles of axons that carry nerve impulses across the brain, they found that within two months of recruiting patients, discernible differences in the structure and integrity of that “white matter” could be used to distinguish subjects whose pain persisted from those whose pain was beginning to resolve. By the 12-month mark, the structural differences in white matter allowed researchers to distinguish — without error — subjects whose pain had disappeared from those whose pain was persistent. Compared to subjects whose pain resolved, subjects whose pain would become chronic also showed differences in the density of connections that lashed their nucleus accumbens — a central structure in the brain rewards, motivation, pleasure and reinforcement learning circuit — together with their medial prefrontal cortex, a switchboard for decision-making, emotional response and long-term memory. The authors made further comparisons between the original 46 subjects and two new groups: healthy recruits and people with a established history of chronic pain. Those comparisons showed that, from the earliest scans, the brains of subjects who would go on to become chronic pain sufferers had structural abnormalities that made them look much more like the chronic pain veterans than like healthy controls or the subjects with back pain that went away. And throughout the study period, the white matter and brain connections of subjects with back pain that went away looked much more like those of healthy control subjects than they did like the brains of subjects whose pain became chronic. The brain’s white matter normally deteriorate with age, and the Northwestern researchers made a shocking calculation to show the difference that separated subjects with and without chronic pain: Compared to healthy controls or those whose pain subsided, the white matter in the subjects whose pain went on to become chronic “exhibits 30 to 50 years of additional aging.” If this research holds up, future patients may want to know what the stakes are if they get hurt, and make their recreational and career choices accordingly.
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Brain Likely Hard-wired for Chronic Pain
15:48 Dr Abhay Dandawate: Walking is a good exercise. Individuals can develop arthritis but that is not because of walking. When we say hereditary, it means you can get it from your preceding generations. There is no known cure for osteoarthritis. We can only attempt to slow down its progress. 15:51 Sudha Kathuria: Thanks doctor, but can we reduce its effect by making changes in our food habits and daily regime? 15:55 Dr Abhay Dandawate: Osteoarthritis bayview sheppard chiropractic commonly affects the knees. One can reduce the effects by keeping ones weight under control. Walking, as I said, is a good exercise and does not deteriorate the joints. There are now supplements like glucosamine and chondroitin sulphate, which are found to be useful. No other dietary foods affect it.
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Some brains may be hard-wired for chronic pain
Each year, Americans spend more than $50 billion on low back pain. It is the most common cause of job-related disability and a leading reason for missed work. Various treatments are available, but none have proved to be highly effective for chronic back pain. Several small studies have found that yoga may ease back pain. Based on ancient Indian philosophy, yoga has been practiced for more than 2,000 years. It typically combines physical postures, breathing techniques and meditation or relaxation. Because it integrates both mind and body, some people suspect yoga might be more beneficial than other exercise techniques in improving back pain. However, no studies have conclusively shown that yoga has this advantage. To investigate, a team of researchers launched a clinical trial that enrolled 228 adults. All had moderate low back pain that had lasted for at least three months.
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According to the Institute of Medicine, an independent research organization, chronic pain affects a growing number of people. Pain is becoming an enormous burden on the public. The U.S. government recently outlined steps to reduce the future burden of pain through broad-ranging efforts, including enhanced research, says Linda Porter, the pain policy advisor at NINDS and a leader of NIHs Pain Consortium. This study is a good example of the kind of innovative research we hope will reduce chronic pain which affects a huge portion of the population. Low back pain represents about 28 percent of all causes of pain in the United States; about 23 percent of these patients suffer chronic, or long-term, low back pain. Scientists have thought the cause of low back pain could be found at the site of injury. However, recent studies suggest that the brain may be more involved with chronic pain. Currently we know very little about why some patients suffer chronic low back pain, says Debra Babcock, a program director at NINDS. The earlier we detect pain will become chronic, the better we may be able to treat patients. Apkarian and his colleagues addressed this by scanning the brains of 46 people who had low back pain for about three months before coming to the hospital but who had not had any pain for at least a year before. The researchers scanned the subjects brains and evaluated their pain with doctors examinations and questionnaires four times over a period of one year. About half of the subjects recovered at some time during the year; the other half had pain throughout, which the researchers categorized as persistent. Previously, the Apkarian laboratory showed that the volume of grey matter in the brains of the same subjects who had persistent pain decreased over the same year. Grey matter describes the area of the brain where the central bodies and branched antennae, or dendrites, of nerve cells reside.
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Yoga, stretching eases low back pain
About half of the patients recovered during the year; the other half continued to have persistent pain throughout the study. Looking back at the brain scans, the researchers found structural differences in the brains of people who recovered compared with people who developed chronic pain. The differences were found in the brains white matter, which mostly consists of long connections between neurons and brain regions. Specifically, the differences lay in the connections between brain regions thought to be involved in pain perception, the researchers said. We may have found an anatomical marker for chronic pain in the brain, study researcher Vania Apkarian, professor of physiology at Northwestern University Feinberg School of Medicine in Chicago, said in a statement. [ 5 Surprising Facts About Pain ] Such structural differences most likely exist independent from the incident that triggers back pain, and may mean that some people are more susceptible to developing chronic pain , the researchers said in the study, which will be published in the October issue of the journal Pain. Most people who suffer pain after an injury eventually return to a healthy state. However, some continue to suffer long after the injury has healed. It is not clear what mechanisms drive the transition from acute pain to chronic pain , which may persist for years. In the study, the researchers used a brain imaging technique called diffusion tensor imaging (DTI) , which measures the integrity of the brains white matter. The results were further confirmed when the researchers compared the study participants with additional groups of people. They found that the white matter of patients with persistent pain looked similar to a third group of people who also suffered from chronic pain. In contrast, the white matter of patients whose pain did not persist looked similar to the white matter of healthy people.
For the original version including any supplementary images or video, visit http://www.foxnews.com/health/2013/09/18/some-brains-may-be-hard-wired-for-chronic-pain/