Chronic Pain is Often Caused by Stress or Adversity

A large body of literature shows that exposure to stress or adversity, such as trauma, childhood difficulties or job dissatisfaction, predicts chronic symptoms, including back pain, fibromyalgia and irritable bowel syndrome, better than any physical measure.

It’s long been known that expectations and beliefs about pain can affect how and whether it’s experienced, with sham surgeries and other placebos able to trick people into feeling relief, and simulated injuries able to produce pain when people think they’re being harmed. If emotional and experiential factors predict chronic pain, that suggests the culprit is not physical, as does the fact that legions of people have resolved their symptoms using psychological interventions alone.

Imaging technology further validates that psychological and emotional factors spur chronic pain. A. Vania Apkarian, who runs a neuroscience pain lab at Northwestern University, predicted with 85 percent accuracy which subjects would develop chronic pain by looking not at their backs but at their brains. His team found that, when pain shifts from acute to chronic, it actually moves to different regions of the brain, regions that — tellingly — are also involved in controlling emotion, memory and learning.

Apkarian now views chronic pain as a brain-learning phenomenon linked to “emotion-related” circuitry. Clinicians usually want to treat the site of the pain, he told me. “What we are saying is that’s often the wrong thing to do, because that’s not where the pain is coming from.” Pain researchers find that more than 90 percent of people with lower-back pain recover in just days or weeks. Chronic pain, by contrast, is a whole different animal, and it appears that it’s born in the brain.

SOURCE: The Washington Post