Potsdam Fibromyalgia Support Group
Newsletter
November-December, 2012
The Neuropsychology of Pain
Most people with chronic pain have been told,
at some point, that their pain is “all in their head.”
The awareness of pain does, indeed, involve the
brain. But that doesn’t mean the pain isn’t real. So,
where does the brain end and the mind begin? Why
are some people vulnerable to chronic pain while
other people who have sustained extensive physical
injuries, do not develop chronic pain?
Understanding the way that pain is processed in the
brain can help answer some of these questions,
along with how we can use the brain to help us
manage pain.
First, it is important to recognize that the brain
behaves differently for different types of pain. One
way to classify pain is as ‘acute,’ ‘recurrent,’ or
‘chronic.’. Acute pain is typically defined as less
than 3-6 weeks and it is usually associated with
tissue damage. A sprained ankle, sunburn or
surgical pain are examples of acute pain. Recurrent
pain is like acute pain but the cause either recurs or
is constant. Arthritis, multiple sclerosis or old scar
tissue are examples of recurrent or persistent pain.
Chronic pain is often defined as anything that has
lasted for longer than 3 months.
However, chronic pain can be distinguished
from recurrent pain because chronic pain persists
past the healing phase for an injury or the symptoms
outlast the tissue damage. Chronic pain can
therefore be a problem in the central nervous system
where pain persists in the nerves and brain, even
though there might not be tissue damage to signal
pain. Chronic pain can be thought of as pain
memory, where the nerves and brain remember and
re-experience pain even when there is no new tissue
damage. It is important to realize that remembered
or re-experienced pain is just as real in the
brain as pain from a broken leg or a
surgical incision. Functional MRI
studies that show brain activity
indicate that remembered pain
shows up in the brain
much the same as ‘real’
pain – that is, remembered
pain is just as real.
The disconnect between tissue damage and pain,
seen in chronic pain, can be explained by a second
way to classify pain: nociception, neurogenic pain,
pain perception and suffering. Nociception is the
process where pain sensitive nerve endings are
stimulated by tissue damage. This is what you feel
when you twist your ankle or scald your hand.
Neurogenic pain comes from the nerves themselves,
if they have been damaged or irritated. Neurogenic
pain occurs in nerve injuries such as a herniated
disc, carpal tunnel or diabetes. Pain perception
occurs when the pain signal reaches the brain and
we become aware of the pain. Pain perception can
be affected by many things, such as our emotional
state or thought processes. Negative thoughts and
depression can amplify pain because they can
amplify the neural processes in pain perception.
Suffering occurs as a result of the emotional and
cognitive response to pain. Emotional factors, such
as depression, anger or stress can amplify both
perception of pain and suffering. Thought
processes,
such
as
negative
thinking,
catastrophizing (having a huge reaction to minor
events) or helplessness can also amplify suffering.
Suffering and pain, while they often happen
together, do not have to happen together. Hence the
saying “Pain may be inevitable, but suffering is
optional.” One of the key principles to managing
chronic pain is that we can sometimes modify the
extent of suffering even if we cannot alter the pain.
It isn’t necessarily easy, but it can be done.
The brain modifies the pain experience in some
other ways, as well. Some of these brain changes
can last a whole lifetime. Research shows that
many people who have chronic pain have had
some traumatic experience, particularly
during childhood. As many as 58% of
people with chronic pain
experienced
childhood
abuse or trauma.
The
physical explanation for this
is coming out in the new
field of epigenetics: how
gene expression is modified
by the psychological and
physical environment. The
genes, themselves, are not altered; instead, the
instructions for reading the genes are changed. It
seems that childhood trauma will activate or
inactivate certain genes that may predispose a
person to chronic pain. So far, it does not seem that
we know how to reverse these effects on gene
expression.
Incorrect wiring of the nerves can also
contribute to chronic pain.
Our sympathetic
nervous system provides the
‘fight or flight’ mechanism to
prepare us for highly stressful
situations, such as fighting sabertoothed tigers. People with
chronic pain may have stress
nerve endings connected to pain
nerve endings; as a result,
stressful
experiences
are
perceived as pain. Remember that
pain perception is how the brain
experiences pain; if the brain receives pain signals
when the sympathetic nervous system is activated
by stress, the pain feels just as real as the broken leg
or whiplash or back pain or whatever. This is one of
the reasons why stress aggravates pain. Many other
physical processes also link stress and pain in a
complex interaction involving the hypothalamicpituitary-adrenal axis and the immune system.
Mood affects pain in other ways, as well. Fear,
depression and anger can all sensitize the central
nervous system, amplifying pain. Some people will
actually perceive emotional pain as physical pain.
Brain areas activated during physical pain can be
activated by intense emotion or social distress.
Negative emotions can also predispose an
individual to develop chronic pain. For example,
depression at the time of injury increases the
likelihood that acute pain will become chronic.
Although we know that this process involves parts
of the brain that control the emotional aspect of pain
(i.e., suffering), the mechanism is not fully
understood.
With all these ways that your experiences and
thoughts can alter your pain experience, it may be a
surprise to learn that almost half of the pain
experience is determined by genetics. The whole
system of genes, nerves, and neural connections
formed by your experience is called the ‘pain
neuromatrix.’ Pain is therefore not a simple cause
and effect system where tissue damage causes a
proportional amount of pain. Pain is in fact a
complex web of interactions that are affected by
both current and previous physical and
psychological experiences. No wonder it is so
difficult to understand and treat!
A few resources are listed below for people
interested in learning more about these things.
Books:

The Pain Survival Guide: How to Reclaim
Your Life by Dennis W. Turk, PhD and
Frits Winter, PhD. Good explanation of
chronic pain. Describes 10 practical steps
to regaining control over your life in spite
of pain.
 Managing Pain Before It Manages You,
by Margaret A. Caudill-Slosberg provides
clear explanations of pain, how it affects
us, and a workbook format for learning to
manage your own pain.
 Explain Pain by David Butler and Lorimer
Moseley explains the physiology of pain and how your
body changes in response to pain. The scientifically sound
text is enhanced by humorous artwork.
Web sites:
 The National Pain Foundation at
http://www.nationalpainfoundation.org/ is primarily for
people with pain.
 American Chronic Pain Society at http://www.theacpa.org/
is primarily for people with pain.
 www.painACTION.com is a web site specifically intended
to educate people about how to manage chronic pain.
Potsdam Support Group Meeting:
The December meeting of the Potsdam Fibromyalgia
Support Group will be at 5:00 pm on Monday,
December 17th. The topic will be "The
neuropsychology of pain: how mind and body
interact." Meetings are in Clarkson Hall, at 59 Main St.
For information about meetings, contact CPH Physical
Therapy Department at 261-5460.
Massena Support Group:
The Massena Support Group meets at 1:30 pm on
the 2nd Saturday of each month in the Massena Hospital.
For more information, please contact facilitator Maxine
Dodge, at 769-5778.
This newsletter is a joint effort of Clarkson University and Canton-Potsdam
Hospital. If you would prefer to receive these newsletters electronically,
please send your email address to gilberta@clarkson.edu. You can access
current and previous Potsdam Fibromyalgia Support Group Newsletters on
our web site: www.people.clarkson.edu/~lnrussek/FMSG
.