Navigation Links
Predicting who will have chronic pain

CHICAGO --- Abnormalities in the structure of the brain predispose people to develop chronic pain after a lower back injury, according to new Northwestern Medicine research. The findings could lead to changes in the way physicians treat patients' pain.

Most scientists and clinicians have assumed chronic back pain stems from the site of the original injury.

"We've found the pain is triggered by these irregularities in the brain," said A. Vania Apkarian, senior author of the study and a professor of physiology at Northwestern University Feinberg School of Medicine. "We've shown abnormalities in brain structure connections may be enough to push someone to develop chronic pain once they have an injury."

Based on MRI brain scans of people who had a new lower back injury, Northwestern scientists could predict with about 85 percent accuracy which patients' pain would persist. The predictor was a specific irregularity or marker the scientists identified in the axons, pathways in the brain's white matter that connect brain cells so they can communicate with each other.

The findings provide a new view of treating chronic pain, which affects nearly 100 million Americans and costs up to $635 billion a year to treat.

"We think the people who are vulnerable need to be treated aggressively with medication early on to prevent their pain from becoming chronic," Apkarian said. "Last year, we showed people who take medication early on had a better chance of recovering. Medication does help."

The research, funded by the National Institutes of Health, was published Sept. 16 in the journal Pain.

Brain abnormalities have been observed in other long-term chronic pain conditions. Apkarian's study is the first to show brain structure abnormalities are a marker of a predisposition to the chronic pain, not a result of living with it.

The lead author of the study is Ali Mansour, M.D., formerly a postdoctoral fellow in Apkarian's lab.

Apkarian's research focuses on the relationship between chronic pain and the brain. One of his previous studies showed chronic pain patients lose gray matter volume over time.

Chronic pain is one of the most expensive health care conditions in the U.S. and takes an enormous toll on quality of life, yet there still is not a scientifically validated therapy for the condition. Lower back pain represents 28 percent of all causes of pain in the U.S.; about 23 percent of these patients suffer long-term pain.

The abnormalities identified in the study were found in multiple white matter axon bundles, some surrounding the nucleus accumbens and medial prefrontal cortex, two brain regions involved in processing emotion and pain. Last year, the Apkarian group showed that the physiological properties of these two regions identify which patients will persist with back pain. The new results identify a pre-existing culprit for these physiological responses to the injury.

"The brain abnormalities exist in the general population, but only those people with a back injury go on to develop the chronic pain," Apkarian said.

For the study, Apkarian and his colleagues scanned the brains of 46 people who had an episode of lower back pain for at least four weeks and had not experienced any pain for at least one year before that. Their pain had to be rated at least five out of 10 on a pain scale for them to be included in the study.

Scientists followed the patients for a year, scanning their brains at the onset of study and one year later. After a year about half of them had improved, regardless of whether they took anything to treat the pain, and half of them continued to have pain. Those with the persistent pain had the same structural abnormalities in their white matter at the onset of the injury and after one year.

"The abnormality makes them vulnerable and predisposes them to enhanced emotional learning that then amplifies the pain and makes it more emotionally significant," Apkarian said.

"Pain is becoming an enormous burden on the public," said Linda Porter, the pain policy advisor at National Institute of Neurological Disorders and Stroke (NINDS) and a leader of the National Institutes of Health (NIH) Pain Consortium. "The U.S. government recently outlined steps to reduce the future burden of pain through broad-ranging efforts, including enhanced research. This study is a good example of the kind of innovative research we hope will reduce chronic pain, which affects a huge portion of the population."


Contact: Marla Paul
Northwestern University

Related medicine news :

1. DXE Medical Inc. Welcomes Forecast Predicting 50% Increase in AED Market
2. Moffitt Cancer Center researchers identify genetic variants predicting aggressive prostate cancers
3. Parker Waichman LLP Comments on New Study Showing that MRI is Useful for Predicting Failure of Metal-on-Metal Hip Implants
4. Predicting infectious influenza
5. Predicting risky sexual behavior
6. Mathematical models out-perform doctors in predicting cancer patients responses to treatment
7. Medtronic Infuse Bone Graft Lawsuits: Bernstein Liebhard LLP Notes New Report Predicting Hundreds of Medtronic Infuse Lawsuits
8. Predicting hotspots for future flu outbreaks
9. Predicting risk of arrhythmias and sudden cardiac death: Theres a computer model for that
10. Combining diagnostic tests more accurate at predicting Alzheimers
11. Valuable tool for predicting pain genes in people
Post Your Comments:
(Date:11/24/2015)... , ... November 24, 2015 , ... Aided by seed ... announced an innovative study designed to yield insights into how to detect and treat ... biomarkers for pancreatic cancer from small, non-coding RNA molecules (ncRNA), genetic material that is ...
(Date:11/24/2015)... ... November 24, 2015 , ... Dr. Rodney E. Willey , has answered a ... Koala Center for Sleep Disorders, provides treatment for snoring and sleep apnea through ... a Koala Center for Sleep Disorders in the US, one of four in the Illinois ...
(Date:11/24/2015)... (PRWEB) , ... November 24, 2015 , ... Autism Speaks, ... the global movement driven by social media and the generosity of people around the ... encourage their social media networks to give – and share the personal stories behind ...
(Date:11/24/2015)... Tennessee (PRWEB) , ... November 24, 2015 , ... ... Pharmacy Quality Trend Report . Throughout the past year there have been multiple breakthroughs ... mature state. During this transition, PharmMD has enabled their customers and partners to stay ...
(Date:11/24/2015)... (PRWEB) , ... November 24, 2015 , ... “I am so thrilled, as a newbie ... after learning she had won a $7,500 School Lounge Makeover® from California Casualty . ... most of the staff has a much longer tenure. , “This is such an amazing ...
Breaking Medicine News(10 mins):
(Date:11/24/2015)... --> --> ... by Product Type (Bone Graft, Bine Graft Substitute, Platelet Rich ... Lumbar Interbody Fusion), End User, and Geography - Global Forecast ... at $1.90 Billion in 2014 and is expected to reach ... the forecast period of 2015 to 2020. Browse ...
(Date:11/24/2015)... BERN, Switzerland , November 24, 2015 ... for Biomedical Engineering Research of the University of ... Endocrinology, Diabetes and Clinical Nutrition of the Bern University ... an exclusive collaboration to develop a novel generation artificial ... personalised delivery of insulin for diabetic patients with the ...
(Date:11/24/2015)... 2015 st  Scientific Assembly and Annual Meeting ... (RSNA) taking place in Chicago on Nov-29 ... --> st  Scientific Assembly and Annual Meeting of the ... place in Chicago on Nov-29 th ... Molecular Dynamics will present its revolutionary whole body CZT digital ...
Breaking Medicine Technology: