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How is the brain of a person with chronic pain affected?

Norman Doidge, MD
Psychiatry
The brain of a person with chronic pain gets so sensitive to pain, it is sensed more intensely, in more areas of the body, over longer periods of time. Watch psychiatrist Norman Doidge, MD, explain how neuroplasticity can help treat chronic pain. 
Chronic pain can occur in the absence of ongoing tissue damage -- this is an example of the sensory component of pain. One component of pain is a reflex avoidance behavior that can occur before the conscious appreciation of pain. In terms of brain physiology, this implies that more primitive parts of the brain contain several discrete nuclei (e.g., the thalamus, cingulate gyrus, hippocampus, amygdyala and locus ceruleus) that interact to form a functional unit called the limbic system. This is the part of the brain that subserves many reflex phenomena, including the association of sensory input with specific mood states (e.g., pleasure, fear, aversion, etc.).

These facts form the physiological basis for considering the emotional aspect of pain. Interestingly, the electrical stimulation of the brain during neurosurgical procedure does not induce pain sensations in pain-free subjects. However, in people who have had past pain, it often reawakens previous pain experiences. It is surmised that such stimulation re-activates cortical and subcortical pain circuits that were previously dormant. It is not known whether there is a single cortical structure that subserves pain memory. Currently it appears that different cortical and subcortical structures are involved in the pain experience. For instance, removal of the somatosensory cortex does not abolish chronic pain, but excision of lesions of the anterior cingulated cortex reduces the unpleasantness of pain. The anterior cingulated cortex is involved in the integration of affect cognition and motor response aspects of pain and exhibit increased activity on positron emission tomography (PET) studies of people with pain. Other structures involved in cortical pain processing include the prefrontal cortex (activation of avoidance strategies, diversion of attention and motor inhibition); the amygdala (emotional significance and activation of hypervigilance); and the locus ceruleus (activation of the "fight or flight" response).

All these structures are linked to the medial thalamus, whereas the lateral thalamus is linked to the somatosensory cortex (pain localization). One example of limbic system activation is the hypervigilance that accompanies many chronic pain states, including fibromyalgia.

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