BehindTheMedspeak: Pain makes your brain shrink

No, this isn't the National Enquirer, Medical Edition: it's the bottom line of a study just reported in the Journal of Neuroscience.

Scientists at the Northwestern University Feinberg School of Medicine in Chicago found that people with chronic back pain showed measurable shrinkage of their brains, as measured by MRI scans.

The gray matter of volunteers with back pain was 5%-11% smaller than in control patients.

The researchers wrote, "The magnitude of this decrease is equivalent to the gray matter volume lost in 10 to 20 years of normal aging."

The lead author, Dr. A. Vania Apkarian, said he had done the research hoping that it would help explain earlier findings that people with chronic back pain experienced changes in brain chemistry that affected their performance on some kinds of tests of mental functioning.

"Chronic pain patients, and specifically chronic back pain patients, seem to have impairment in emotional decision making," he told New York Times writer Eric Nagourney in a story published in this past Tuesday's New York Times Science section.

The study has huge implications.

Doctors up to now have believed that changes in brain chemistry in such pain patients were temporary, and that they would go away if the pain did.

It now appears that if back pain is untreated for too long, the changes in the brain become permanent and may therefore make it even harder to ease the pain.

A few comments and thoughts from the bookofjoe peanut gallery.

I've seen this problem from both ends, as a patient and a doctor.

As a patient, the agony I was in from a herniated disk, with pain, insomnia, and mood changes combining into a more or less steady amalgam of rage and depression, made it clear to me that decision making is the first thing that goes by the boards when the pain amps up.

I can see how one's brain could become permanently damaged and shut down as a result.

As a doctor who's worked in a pain clinic, I know just how angry and difficult to treat are patients whose pain never goes away, 24/7.

I found working in the pain clinic environment unendurable as a result: everyone's in a bad mood, all day, every day.

It's infectious, too: by the time you go home after seeing 10-20 people with chronic pain, you feel like driving your car into a wall.

So it's not just Alzheimer's,

alcohol, and

drugs that rot your brain: endogenous things can have the same effects.

Most interesting.

We are truly what we feel.

Not what we feel we are - what we feel.

Those who would omit emotion in their decision-making are doomed to a lifetime of bad decisions.

Oh, you've noticed?