chronic pain be treated as a disease in its own right?
published in The Journal of Pain1, outlines and
addresses the complexities involved in chronic pain, and raises the
issue that improvements in the assessment and management of pain for the
7.8 million people in the
our understanding of chronic pain and its mechanisms will lead to better
treatments that hopefully will enable people to regain their
independence as well as significantly enhance their quality of life”,
said Professor Irene
Tracey, co-author of the article and Director of the Functional Magnetic
Resonance Imaging of the Brain (FMRIB) Centre and Nuffield Professor of
Anaesthetic Science at the University of Oxford.
and Bushnell reviewed a number of functional, structural and molecular
brain imaging studies on patients suffering chronic pain, even if the
underlying cause of the pain differed, examining conditions such as:
irritable bowel syndrome (IBS), chronic back pain, fibromyalgia,
neuropathic pain, rheumatoid arthritis, osteoarthritis of the
knee and stroke pain. Although these painful conditions affect a
range of different parts of the body, similar changes were observed in
the brain and the authors examine the evidence against the current
definition of a disease1.
changes: Experiencing pain for a long duration of time,
results in the brain being less able to cope, ultimately resulting in
functional changes. These changes include a reduced ability to
inhibit the painful stimuli and over activity in brain areas
that make the experience of pain more unpleasant.
changes: The changes seen to the structure of the brain
provide the best evidence that chronic pain should be regarded as a
disease in its own right. Chronic pain affects the brain
structurally by causing grey matter (areas dense with nerve cell bodies)
in the thalamus and lateral prefrontal cortex of the brain, as well as
other areas, to reduce in size. It is hypothesised that the
reduction in grey matter in chronic pain may be due to excitotoxicity
(continuous nerve stimulation) and nerve loss.
changes: Brain imaging studies have shown that healthy
brains respond differently to pain compared to people living with pain
over a prolonged period of time. In people with chronic pain there
appears to be a drop in the concentration of chemicals namely glutamate,
N-Acetyl aspartate and dopamine.
affects approximately 20% of the world’s population1 and
has a large impact on people’s emotional and physical wellbeing.
There is also a large financial cost associated with chronic pain,
estimated to be around 200 billion Euros per year in Europe1
and in the
Chronic pain is
persistent and can be progressive. In contrast to acute pain, which
arises suddenly in response to a specific injury and is usually
treatable, chronic pain persists over time and is often resistant to
There are a
number of different medical conditions that can cause chronic pain
including (but not limited to) diabetes, arthritis, migraine,
fibromyalgia, cancer, shingles, sciatica, and previous trauma or injury3.
FMRIB Centre is a recognised world-class MR imaging
laboratory that integrates research into key neurological and
neuroscientific problems with cutting-edge developments in MR physics
and data analysis (http://www.fmrib.ox.ac.uk).
The Centre has a large number of scientists and clinicians and is highly
services undertaken by Galliard Healthcare Communications to increase
awareness of this research have been funded by MSD.
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