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Brain Structure May Predict Chronic Pain

Update Date: Sep 17, 2013 09:11 PM EDT

Brain structure may predict chronic pain, a new study suggests.

Researchers found that abnormalities in brain structure may predispose people to develop chronic pain after a lower back injury, a new study suggests.

Researchers said the latest findings provide new insight into how doctors could potentially treat patients' pain.

Scientists and clinicians have long believed that chronic back pain stems from the site of the original injury.

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

Scientists said that they could predict with about 85 percent accuracy which patients will develop chronic pain after sustaining a new lower back injury using MRI brain scans. Researchers said the predictor was a specific irregularity in the axons, pathways in the brain's white matter that connect brain cells so they can communicate with each other. The study found that abnormalities were found in multiple white matter axon bundles surrounding two brain regions involved in processing emotion and pain: the nucleus accumbens and the medial prefrontal cortex.

Researchers said that the findings could change the way doctors treat patients' 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."

Chronic pain is one of the most expensive health care conditions in the United States. The condition also takes an enormous toll on quality of life. However there is still no validated therapy for the condition. Researchers said that lower back pain represents 28 percent of all causes of pain in the U.S., and about 23 percent of thee patients suffer long-term pain.

The latest study involved 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. Researchers said that the participants had to rate their pain at least five out of 10 on a pain scale to be included in the study.

Researchers followed the participants for a year, and scanned their brains at the beginning of the study and one year later.

Study results revealed that while half of the participants had improved, the other half continued to suffer pain. Researchers found that those who continued to feel 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," 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, said in a news release. "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."

The findings are published in the journal Pain

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