Ouch! Does Pain Change The Brain?

Find Out Why This Matters WAY More Than You Think It Might

For some of us, it’s a deep secret.

We ache, we suffer and spend part of our lives full of misery. We know that all of us, our students and ourselves, experience pain. Whether it’s a headache, or more serious back, leg or shoulder pain, we feel miserable when we hurt. While temporary pain is one thing to our body and brain, chronic pain is a whole different entity. I’d guess you know that the pain we feel is a result of the signaling processing in our brains as much as or more than the signaling from site of the injury in our body. Why is this relevant? Why should you care about chronic pain as an educator?

Actually, you’d care a LOT if you knew what happens to your brain when you experience chronic pain. In fact, you’ll be so shocked at how your brain responds to it that you’ll say to yourself, “Oh, that’s why such-and-such happens!” It will also help you understand WHY some kids at school perform and behave they way they do. It’ll help you understand why some staff at your school (who complain of chronic pain) behave the way they do.

Well, what is it? What happens to your brain when you experience chronic pain?

Here, we’ll explore three questions: 1) is there real evidence that chronic pain changes our brain? 2) is the change positive or negative to learning and behavior? 3) what does this suggest we actually do about it?

First, is there any evidence that chronic pain changes the brain PHYSICALLY?

Yes, there is. I won’t review all the studies in this area: there are way too many for this brief article. But, yes, there is altered brain morphology (real tissue has changed) located in areas related to pain processing. It is found in patients with chronic back pain (Apkarian et al., 2004; Schmidt-Wilcke et al., 2006), fibromyalgia (Kuchinad et al., 2007; Schmidt-Wilcke et al., 2007; Hsu et al., 2009), complex regional pain syndrome (Geha et al., 2008), irritable bowl syndrome (Davis et al., 2008), tension-type headache, and migraine (Schmidt-Wilcke et al., 2005, 2008; Kim et al., 2008; Valfrè et al., 2008).

But, does the SOURCE of the pain/inflammation CAUSE the brain to change, or does the pain we feel from the problem CAUSE the brain changes?

Here’s a novel way to find out. Find someone who has no inflammation, no damage or real inflammation, but they experience real, hurtful pain. Would you pick someone who is faking their pain? No need to do that. Pick someone who has “phantom limb” pain. This is a person who has lost a limb but continues to feel painful sensations in the limb that they don’t have. Neuroscientist V.S. Ramachandran from UCSD has studied these patients extensively and found that their brain is easily fooled, but the pain is real. So, do they have brain damage from the pain from a limb that they don’t have?

Yes, they do. (Draganski et al., 2006). This suggests that the pain we feel in the short-term is a good “alert system” for the brain. But in the long-term, pain makes our brain change.

But how does it change and why should we care?

While the exact process underlying these pain-caused structural changes remains to be fleshed out, here’s what the early research tells us. May (2008) did some strong research suggesting chronic pain may change the actual structure of the brain! Chronic pain is correlated with (read this carefully), cell atrophy, synaptic loss, decreases in cell size, blood volume and worse yet, decreases in gray matter (Draganski and May, 2008). In short, our brain goes downhill!

Why should you care?

At school, kids with chronic pain (from nerve disorders, sports injuries, abuse, back pain or just breaking up with their latest flame) will have an underperforming brain! When we are in pain, we change our behaviors, which, in turn, change our brains even more! We exercise less, socialize less, eat worse and shy away from new learning. My father recently lost his wife from cancer. The expected depression is part of the pain in his brain, which has contributed to recent cognitive declines. No gains from pains in our brains! That’s the bad news.

The good news is that most of these processes are reversible. This information reminds us of the amazing chemical and anatomical changes possible from environmental input. But it’s a two-way street; change can be for the better or for the worse.

PART TWO: Applications

Let’s “flesh out” what we learned from the studies above. Long-term pain is bad for the brain. Pain can come from physical, emotional or imagined causes. The brain can change for the better or for the worse.

Now, let’s get practical.

First, be a good listener. Do not ignore students who complain of long-term pain. Whether it’s s sports injury, a breakup with their boyfriend or girlfriend, or a nerve disorder, pain is pain to the brain. And chronic pain is bad.

Second, provide opportunities for kids to write about their pains. English teachers are an obvious choice to encourage student writing, but teachers at most grade levels can do this. Many kids are taught to “quit complaining” when, in fact, there might be something pretty bad going on.

Third, notice if there’s been a change in behavior or academic scores in a student. If so, pull them aside and have a quiet talk. There’s a good chance the kid is experiencing pain in their life. If all you can offer is empathy, that’s a great start. For many kids, that by itself, can reduce the pain.

Finally, remember the brain can change for the better. Chronic pain is a cue to make some changes so that the brain can change: 1) Add or increase exercise, recess or social play, 2) use novelty; take kids outside their classroom or trade classrooms with another teacher 3) strengthen social ties, both the teacher-student and the student-to-student, and 4) better nutrition can help. Add foods high in omega 3s such as egg, salmon and walnuts. Plus, when you cut the carbohydrates and sugar, your body will feel better. Today, I eat less than half of the amount of carbohydrates that I ate 5 years ago. This reduction helps by increasing energy and raising mood levels.

Let’s cut to the chase: everything you do in your classroom is likely to have SOME effect on the brain. Brain-based education says, “Be purposeful about it.” Now, go have some fun and make another miracle happen!

Our Teacher Workshop schedule is now up for January and Summer 2011. We are hosting teacher workshops in Florida, Texas and Charlotte, NC in 2011. Click here for details.

CITATIONS:

Apkarian AV, Sosa Y, Sonty S, Levy RM, Harden RN, Parrish TB, Gitelman DR (2004) Chronic back pain is associated with decreased prefrontal and thalamic gray matter density. J Neurosci 24:10410–10415.Davis KD, Pope G, Chen J, Kwan CL, Crawley AP, Diamant NE (2008) Cortical thinning in IBS: implications for homeostatic, attention, and pain processing. Neurology 70:153–154.Draganski B, May A (2008) Training-induced structural changes in the adult human brain. Behav Brain Res 192:137–142.Draganski B, Gaser C, Busch V, Schuierer G, Bogdahn U, May A (2004) Neuroplasticity: changes in grey matter induced by training. Nature 427:311–312.Draganski B, Moser T, Lummel N, Gänssbauer S, Bogdahn U, Haas F, May A (2006) Decrease of thalamic gray matter following limb amputation. Neuroimage 31:951–957.Geha PY, Baliki MN, Harden RN, Bauer WR, Parrish TB, Apkarian AV (2008) The brain in chronic CRPS pain: abnormal gray-white matter interactions in emotional and autonomic regions. Neuron 60:570–581Hsu MC, Harris RE, Sundgren PC, Welsh RC, Fernandes CR, Clauw DJ, Williams DA (2009) No consistent difference in gray matter volume between individuals with fibromyalgia and age-matched healthy subjects when controlling for affective disorder. Pain 143:262–267.Kim JH, Suh SI, Seol HY, Oh K, Seo WK, Yu SW, Park KW, Koh SB (2008) Regional grey matter changes in patients with migraine: a voxel-based morphometry study. Cephalalgia 28:598–604.Kuchinad A, Schweinhardt P, Seminowicz DA, Wood PB, Chizh BA, Bushnell MC (2007) Accelerated brain gray matter loss in fibromyalgia patients: premature aging of the brain? J Neurosci 27:4004–4007.May A (2008) Chronic pain may change the structure of the brain. Pain 137:7–15.Schmidt-Wilcke T, Leinisch E, Straube A, Kämpfe N, Draganski B, Diener HC, Bogdahn U, May A (2005) Gray matter decrease in patients with chronic tension type headache. Neurology 65:1483–1486.Schmidt-Wilcke T, Leinisch E, Gänssbauer S, Draganski B, Bogdahn U, Altmeppen J, May A (2006) Affective components and intensity of pain correlate with structural differences in gray matter in chronic back pain patients. Pain 125:89–97.Schmidt-Wilcke T, Luerding R, Weigand T, Jurgens T, Schuierer G, Leinisch E, Bogdahn U (2007) Striatal grey matter increase in patients suffering from fibromyalgia—a voxel-based morphometry study. Pain 132 [Suppl 1]:S109–S116.Schmidt-Wilcke T, Ganssbauer S, Neuner T, Bogdahn U, May A (2008) Subtle grey matter changes between migraine patients and healthy controls. Cephalalgia 28:1–4.
Valfrè W, Rainero I, Bergui M, Pinessi L (2008) Voxel-based morphometry reveals gray matter abnormalities in migraine. Headache 48:109–117.

Creative Commons License photo credit: lets.book

One Responseto “Ouch! Does Pain Change The Brain?”

  1. Carla says:

    WOW! In my gut I already knew this so glad to have confirmation!

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