The stress felt by chronic pain patients may be directly related to the physical pain. But emotional stress is almost always present as well, due to frustrations, fears, and the difficulties associated with constant pain. And when a healthy brain is physically altered and becomes a “pain brain,” thinking may prove difficult, increasing mental stress.
To get an idea of what’s happening inside the brain of a stressed-out pain patient, let’s look at the amygdala, twin almond-shaped areas deep within the brain. You can think of the amygdala as the “integrative center for emotions,” the part of the brain that tells you when to be sad, fearful, angry, and so on. It’s as if information goes to the amygdala, which analyzes it and tells the rest of the brain, “That’s bad news, so feel sad,” or “This is good; smile!” When the amygdala is hyper-stimulated, as it is in chronic pain, it sees bad news everywhere, part of the reason that people in pain can find themselves awash in negative emotions like anger, fear, and depression.
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Normally, other areas of the brain, like the anterior cingulate cortex (ACC), help restrain the amygdala, making sure that your emotions don’t run away with you. Think of the amygdala as a guy at a bus stop wailing that the bus is late. “We’ll be late, it’s never going to come and we’re going to lose our jobs,” he howls, making everyone else jittery. Now think of the ACC as a woman flipping through the bus schedule on her cell phone and serenely announcing that the bus is just two minutes late, so everything is fine. “Nothing to worry about, it’s coming,” she says. Unfortunately, the changes that produce the “pain brain” interfere with the ACC’s ability to regulate the amygdala, so negative feelings can flow unrestrained.
Further triggering the troubled amygdala is the insular cortex (IC). The IC, another key processor of pain information, eggs on the amygdala even more, increasing and perpetuating feelings of fear. In other words, the IC makes the anxious guy at the bus stop even more panicky and harder to calm down.
Making matters worse, the stress of chronic pain hammers the hippocampus, the portion of the brain that helps regulate learning and memory. Imagine being in a schoolroom trying to study, with a bunch of people right outside the window wailing that the world is coming to an end. You can’t close the window, so you have to listen to them all day long. How much studying will you get done with all that racket going on outside? The same thing happens when chronic pain upsets your hippocampus.
Disruption of the hippocampus can be very frustrating as it can be difficult to learn new things, or even remember something that happened only minutes earlier.
These physical changes have been studied using new brain imaging techniques that track the parts of the brain that “light up” when subjects engage in various selected tasks. While we have much to learn about the “pain brain,” it is clear that physical changes to the brain make it difficult for those in chronic pain to control their emotions, make decisions, focus, reason things through, and much more.