A study recently published in the European Journal of Pain found that people with chronic pain have significantly lower levels of certain chemical messengers in the medial prefrontal cortex, a part of the brain that helps regulate emotions. The findings help provide a deeper understanding of the connection between chronic pain and mental health conditions.
The Study
Using neurological imaging technology, researchers from Australia and the U.S. compared the brain chemistry of 24 people with chronic pain with 24 other people who had no history of persistent pain. Participants in the control group were matched to others of the same ages and genders in the chronic pain group. The research team found that those with chronic pain had significantly lower levels of gamma-aminobutyric acid (GABA). This neurotransmitter reduces activity in the central nervous system, which may have several effects on the body, including potentially inducing a calm state of mind. The results also showed a reduction of glutamate in the brains of people with chronic pain compared with the control group. Glutamate is a neurotransmitter that plays a role in certain brain functions, like memory and cognition, as well as activity in the immune system and gastrointestinal tract. Taken together, this chemical imbalance in the brain may influence how people experience chronic pain and how pain can damage mental health, the study authors say. “While it has a small sample size, it’s an important study as it helps individuals struggling with pain to understand that the depression or anxiety they may be having is directly related to brain changes that come from the pain,” says Shamin Ladhani, PsyD, a psychologist who has designed clinical programs for people with chronic pain. “This study builds on other research in the field that has shown that the brain undergoes significant changes when pain persists or becomes chronic.”
Understanding the Brain-Pain Connection
Chronic pain has been linked to a variety of mental health conditions, including anxiety and depression. The findings in this study help offer a potential physiological explanation for the overlap between chronic pain and emotional wellbeing. “The study seems to suggest that difficulty regulating emotions, especially negative emotions, is at least partially influenced by different brain chemistry,” explains Desreen Dudley, PsyD, clinical psychologist and senior behavioral health quality consultant for Teladoc. “One reason may be that when the brain experiences long-lasting and intense pain signals, neurons in the prefrontal cortex may diminish, leaving less neuron activity for people to use to modulate intense emotions, such as depression and anxiety.” These neurotransmitter imbalances might not be the only brain changes at play in people with chronic pain. “Pain and emotional well-being are deeply intertwined due to various connections in the brain. The pathways implicated in pain utilize similar neurotransmitters as the pathways implicated in mood and anxiety disorders,” says Leela R. Magavi, MD, a child, adolescent and adult psychiatrist, and regional medical director for Community Psychiatry and MindPath Care Centers. “Chronic pain, like chronic depression, can modify activity in the brain and, consequently, perpetuate itself.” This cycle might be worsened by how chronic pain can impact other areas of physical health, as well, says Dr. Dudley. “People with chronic physical pain often report having problems with sleep, fatigue, concentrating, memory, and appetite,” she says. Another confounding factor in the mental health outcomes of people with chronic pain might be the practical impact of living in perpetual discomfort. Chronic pain can make it challenging for a person to function at work, participate in their favorite activities, and have healthy and fulfilling relationships with others, all of which can impact mental health, says Dr. Ladhani. She adds, “Pain is an invisible illness and patients with chronic pain often experience rejection or a minimization of their experiences which can make them feel alone, isolated, and can further worsen their mental health.”
Tips on Coping With Chronic Pain
Living with chronic pain can be a stressful experience, both physically and emotionally. Finding ways to cope with the discomfort and the negative feelings it can cause can help improve your quality of life and your emotional well-being. Start by reading up on the condition that causes your pain and the potential treatments that may be available for it. You may also consider connecting with others in a similar situation, says Dr. Magavi. “Many individuals remain in denial [about their condition], which can increase frustration, depression, and pain itself. I recommend making peace with the diagnosis, joining support groups, and advocating to raise awareness,” she suggests. “This connectedness and altruism can truly be healing for many people.” Try out different relaxation techniques that can help take your mind off the pain when your symptoms are particularly bad. This might include mindfulness, breathing exercises, and even hypnosis, says Dr. Ladhani. “A simple strategy to start using now is distraction. There is research to support that simply redirecting your attention to something you enjoy, even for a small amount of time, can help to reduce your pain and emotional suffering,” she adds. When you feel up to it, try to take part in your favorite activities, whether that’s gardening, reading, playing an instrument, or something else. “Doing enjoyable activities can trigger and possibly strengthen brain signals which tap into our ‘feel-good’ emotions,” says Dr. Dudley. Finally, consider connecting with a mental health professional, who can help you work through your feelings in a safe space. “Dealing with chronic pain can feel isolating, and you don’t have to deal with it alone,” says Dr. Dudley. While living with chronic pain can have a profound effect on your emotional well-being, there are methods that can help you cope. Experts recommend learning about the disease causing the pain, joining a support group, and practicing relaxation techniques. You may also consider meeting with a mental health professional for one-on-one support.
