November 25, 2004
Chronic Pain And Obesity Both Cause Brain Damage

First off, chronic back pain causes brain shrinkage that is equivalent to 10 to 20 years of brain aging.

CHICAGO --- Chronic back pain, a condition afflicting many Americans, shrinks the brain by as much as 11 percent — equivalent to the amount of gray matter lost in 10 to 20 years of normal aging, a Northwestern University research study found.

Loss in brain density is related to pain duration, indicating that 1.3 cubic centimeters of gray matter (the part of the brain that processes information and memory) are lost for every year of chronic pain, said lead researcher A. Vania Apkarian, associate professor of physiology at Northwestern University Feinberg School of Medicine and a researcher at the Northwestern University Institute of Neuroscience.

The study, the first to examine brain changes in chronic pain conditions, was published in the Nov. 23 issue of The Journal of Neuroscience.

About 6 percent of the American population is probably suffering from brain shrinkage from chronic back pain. On top of that there are people suffering from chronic stomach pain and other forms of chronic pain. So it is likely that more than 20 million Americans are suffering cognitive losses due to chronic pain.

At least 25 percent of Americans suffer from back pain; in one fourth of these individuals, back pain is chronic and unremitting.

Although chronic pain greatly diminishes quality of life and increases anxiety and depression, it previously had been assumed that the brain reverts to its normal state after chronic pain stops.

Apkarian and co-researchers used structural magnetic resonance imaging brain scan data and two automated analysis techniques to contrast brain images from 26 participants with chronic back pain with those from matched normal subjects.

All participants with chronic back pain had unrelenting pain for more than a year, primarily localized to the lumbosacral region, including buttocks and thighs, with or without pain radiating to the leg.

The participants were divided into neuropathic — exhibiting pain because of sciatic nerve damage — and non-neuropathic. Brain scans showing gray matter volume were compared.

In earlier research, Apkarian and colleagues found that back pain sustained for six months or longer is accompanied by abnormal brain chemistry, indicated by chemical changes in the area of the brain known to be important in making emotional assessments, including decision-making and for controlling social behavior. Based on these results, Apkarian’s laboratory group embarked on the brain atrophy study.

It is possible that some of the observed decreased gray matter shown in this study reflects tissue shrinkage without substantial neuronal loss, suggesting that proper treatment would reverse this portion of the decreased brain gray matter, Apkarian said.

The atrophy also may be attributable to more irreversible processes, such as neurodegeneration. Other research has shown that spinal cord neurons undergo apoptosis — cell death — in rats with neuropathic pain.

“Given that, by definition, chronic pain is a state of continuous persistent perception with associated negative affect and stress, one mechanistic explanation for the decreased gray matter is overuse atrophy caused by excitotoxic and inflammatory mechanisms,” Apkarian said.

The researchers hypothesize that atrophy of brain circuitry involved in pain perception may dictate the properties of the pain state, such that as atrophy of elements of the circuitry progresses, the pain condition becomes more irreversible and less responsive to therapy.

Other researchers on the study were Yamaya Sosa, physiology; Sreepadma Sonty, neurology; Robert M. Levy, M.D., neurosurgery; R. Norman Harden, M.D., physical medicine and rehabilitation; Todd B. Parrish, radiology; and Darren R. Gitelman, M.D., neurology, radiology and the Cognitive Neurology and Alzheimer’s Disease Center, at Feinberg.

Obesity also causes brain losses.

St. Paul, Minn. – Women who are obese throughout life are more likely to lose brain tissue, according to a study published in the November 23 issue of Neurology, the scientific journal of the American Academy of Neurology. Loss of brain tissue has been linked to cognitive decline.

Researchers in Sweden studied the relationship between body mass index and brain atrophy (loss of brain tissue) in 290 women. The women were born between 1908 and 1922 and had four follow-up examinations between 1968 and 1992. During the final exam, they had a computed tomography (CT) scan to measure for any loss of brain tissue. Body mass index (BMI) is a measure of body fat that shows weight adjusted for height. Overweight is a BMI of 25 to 30 kg/m2. Obesity is a BMI of 30 kg/m2 and above.

An overweight or obese BMI was linked to a loss of tissue specifically in the temporal lobe. Nearly 50 percent (144) of the women had temporal atrophy. At the time of CT scan, their body mass index was an average of 27 kg/m2, which was 1.1 to 1.5 kg/m2 higher than the women without brain atrophy. Overall the women’s BMI increased over the 24-year period, but the increase was greater for those who lost tissue in the temporal lobe. The risk of atrophy increased 13 to 16 percent per 1.0 kg/m2 increase in BMI.

“This study indicates that a high BMI is a risk factor for dementia in women. Other studies have reported similar findings,” said Deborah Gustafson, PhD, of Sahlgrenska University Hospital in Göteborg, Sweden and also the Medical College of Wisconsin in Milwaukee. “Obesity is another factor that should be actively intervened upon to reduce diseases of advanced aging.”

The researchers didn’t pinpoint a reason why obesity leads to brain atrophy. They said there are several possible mechanisms.

“Obesity is related to ischemia, hypertension, and cerebrovascular and cardiovascular diseases. These conditions contribute to an unhealthy vascular system, and therefore, to a higher dementia risk,” said Gustafson. “Obesity may also increase the secretion of cortisol, which could lead to atrophy.”

The temporal lobe appears to be highly susceptible to the effects of ischemia and other vascular diseases in the brain, and is evidence of cerebral degeneration and neuronal death, Gustafson said.

These two reports effectively raise the stakes for two major health problems. Losses in cognitive ability have huge macroeconomic and personal costs. Overweight people with chronic pain suffer a cognitive double whammy. We need both better treatments for chronic pain and better therapies to prevent obesity.

Share |      Randall Parker, 2004 November 25 05:04 PM  Brain Aging


Comments
Howard said at November 26, 2004 5:29 PM:

Thanks for posting these studies they are interesting. I see that a high BMI is associated with more cognitive problems when compared to a normal BMI. I'd be curious to know if a lean BMI would be even better than a normal BMI in this regard. Has anyone seen any evidence showing that?

Aaron said at January 9, 2005 4:05 PM:

Does the degree of pain affect brain loss? How much, in your opinion, would somebody with 6 months of back pain be affected?

Randall Parker said at January 9, 2005 5:06 PM:

Aaron,

I would expect the nerve effects would scale with both intensity of pain and length of time feeling chronic pain.

6 months of pain: I don't know. Certainly not as bad as 1 year which is not as bad as 2 years and so on. You might want to look into acupuncture. Also, vitamin D might help.

A person who is overweight and suffering from back pain should treat the need to lose weight as a very urgent matter. Weight loss will probably provide two benefits since it is likely to reduce the back pain as well.

Randall Parker said at January 9, 2005 5:07 PM:

Howard,

I would expect lean BMI to be better than normal BMI. After all, calorie restriction slows down aging overall. I'm sure that applies to the brain as well.

Denise said at May 7, 2005 8:43 PM:

I have a severe case of TMJ. I have strong, but episodic pain, in my jaw about once or twice a month, lasting for anywhere from a day to 2 or 3. It is painful to the touch and will often bring me to tears because it is so painful. I'm 34 and have had this for about the last 8 years. How can I tell if this is causing cognitive problems?
Thank you.

barbara said at June 28, 2005 7:14 PM:

I concern as I have a 19 year old with chronic back pain. It started about age 14 and I was told it was growing pains. He had a severa quad accident in May 2000 when he crushed about 2 inches or his tibia, was knocked out for a bit, and brock his collarbone. He had surgery to add bone marrow to rebuild the tibia and the fibula was ignore as it broke about 4-6 inches above the ankle. He wore a external fixator, a bone stimulator for about 8-10 months and two different leg brace until Spring 2002. He was not released to play soccer until Dec. 2003. My concern is that has mentioned to have a picture of his brain as he thinks its disapearing so to say. He was diagnosis with ADD, had bouts of depression and anxiety in fourth grade and by freshman year he was diagnosed with short term memory and was severaly depressed (demoralized)and developed psorasis-skin. I was hoping you had some suggestions or advise. I live in Chandler, Arizona.
Thank you, Barbara

Kelli Ann Henricks said at November 24, 2005 8:11 AM:

Hi, my nameis Kelli, I was doing a search on brain atrophy this morning. I have a very thorough OB/GYN. My Mom goes to the same man and with one look he said she needed a thyroid workup. She has a non-functioning thyroid and now it is under control. I found out the 15th that my thyroid is not up to snuff either. Well, the
doc wants me to have an MRI on my pituitary gland to check for abnormalities. All is
ok there. However, He and the radioligist were concerned since at the age of 47, my
brain is atrophying as he said(SHRINKING) I don't know how bad. Obesity has been a factor for periods of my life.When I got married in 1987 I wore a 10-12, I bounced around a lot topping out after a very serious pick-up accident in January of 2000. Brain hemmorage,& 3 other kinds of brain damage. I don't know if mymemory is worse or not because, my kids and my husband think that I am making it up beause sometimes
I can remember. Anyway in January of 2005 my family doc put me on a medication to
help both the migraines I was having and headaches from the accident. And well the rest of me is shrinking too so the obesity is not going to be a problem. Without the
medication, I was having the headaches every-I didnt

Sonja Fox said at February 18, 2006 2:55 PM:

Hello,
My family has just found out after a CT-Scan of my Father-In-Law, that he had 1/2 in., of brain shrinkage. He will be 62 on June 10, and he has had 3 open heart surgeries and 5 years ago he messed up his back in the Lower Lumbar #3, #4, #5. His four back surgery they fused it. He can't ever get away from him pain. He has no feeling in his feet and it is so sad to see him in this condition as far as not being able to escape the pain no matter what he does, or takes. He forgets things a lot and that has increased greatly and some days you think that he has it all together and he is like his old self and the next day you never know. Dear Dr. Apkarian is there anything that we can do to help him and maybe stop the process of the progression of the shrinkage. He is a wonderful man and and the best Father and Father-In-Law any one person could ever ask for. This man showed me what a Father was all about and I love him so much, as I came from an home where my dad was very physically abusive and mentally as well and he became my Father and since he has given me such a wonderful gift, I was hoping that maybe I could not only give him my love but give him a gift of HOPE. I hope to hear from you and maybe find out where we can start to maybe just stop this from getting any worse.
I Thank you so much for you time and I look forward to hearing back from you.
Please keep up the great work that you are doing and May God Bless You.
Sonja Fox

Sandra Savstrom said at March 9, 2006 3:31 PM:

Hello, Yesterday I went to the ER because I have been Having severe headaches associated with lumps that appear on my head. These, to my understanding, are caused by a 3rd world parasite I am being treated for. Unfortunately there is a meth epidemic in this region of Salen OR. One of the other symptoms of this parasite are wounds that appear , heal, then reappear. There is a resemblence to methamphetimine sores as great amounts of bacteria are involved. It is one of the food sources of this parasite.

What a shock as I am and have been sober from all use for years and only was a social drinker, and never have used meth. At this point I was profiled as a chronic meth user. The headaches were accompanied with the loss of close up vision in my right eye. Also, the parasites cluster into soft cysts or nests. My right temple hasn't any meat or flesh. A cat scan was done and after being profiled, even though I offered to take a urine test, hair test and a fingernail test. The er doctor , an intern, said the ct scan showed abnorl atropy for a woman of my age, 55 yrs. , due to sustained abuseof drugs and alcohol.

I am physiclly disabled due to a o the job injury. Chronic pain is my daily friend and I have been treated for this using pain meds and neurontin since 6/02. Could this be the cause?

Anon said at April 2, 2006 2:57 PM:

Hello. This webpage overstates the significance of marginal anatomical findings in one small study. I reviewed the first study in J. Neurosci. and, as usual lately, it was published for "impact" rather than significance. The methodology is marginal, the statistics are flawed and the study lacks even face validity: Who can doubt that the human brain has been selected to accomodate persistent pain? The state of nature is inherently painful, and would have eliminated the chronic pain response long ago if it could damage the CNS as rapidly as Apkarian and this website imply. Moreover, the silly but persistent notion that reduced brain volume, in toto or in region du jour, correlates with cognitive function, while attractive to men with large heads, has never been validated.

Chronic pain may lead to chronic stress in some because they are socialized to think their pain is "abnormal" or "degenerative" and, therefore, something horrible. Habitually focusing on problems or situations beyond one's control is a major cause of the physiological stress response in humans (an non-human primates). This sort of manmade chronic stress, we know from numerous studies, is the real killer. Reading pseudoscience and irresponsible websites can increase your stress level-- go for a walk, try relaxation methods, or talk to a friend. Drinking excessively or self-medicating for chronic pain can also harm your normal brain function-- stop drinking and taking more narcotic or corticosteroids than is minimally necessary to control your pain.


Michael Roberts said at March 26, 2007 2:15 PM:

You can substantially reduce or even completely eliminate many kinds of chronic pain with a special diet that's rich in certain carbohydrates, and low in fats, protein and sugar.

Substantially increase your consumption of complex carbohydrates, these include foods such as wholegrains, ( with the exclusion of corn), beans vegetables and fruits, so these make up 70-80% of your food intake.

Avoid refined carbohydrates, such as sugar, honey, and syrups, and cut your total sugar intake by at least 40%.

Avoid all fats and oils including butter, margarine, meat fats and lard, as much as possible. Also avoid fatty meats, whole milk, cheese with more than 1% fat content, and egg yolks.

Give both caffeine and alcohol a miss.

Take an amino acid supplement called tryptophan, this is converted by the body into serotonin, a pain relieving chemical.

The combination of the special diet and the tryptophan should dramatically elevates your pain tolerance.

Michael Roberts said at March 28, 2007 5:11 AM:

You can substantially reduce or even completely eliminate many kinds of chronic pain with a special diet that's rich in certain carbohydrates, and low in fats, protein and sugar.

Substantially increase your consumption of complex carbohydrates, these include foods such as wholegrains, ( with the exclusion of corn), beans vegetables and fruits, so these make up 70-80% of your food intake.

Avoid refined carbohydrates, such as sugar, honey, and syrups, and cut your total sugar intake by at least 40%.

Avoid all fats and oils including butter, margarine, meat fats and lard, as much as possible. Also avoid fatty meats, whole milk, cheese with more than 1% fat content, and egg yolks.

Give both caffeine and alcohol a miss.

Take an amino acid supplement called tryptophan, this is converted by the body into serotonin, a pain relieving chemical.

The combination of the special diet and the tryptophan should dramatically elevates your pain tolerance.

Anonymous said at July 11, 2010 4:03 AM:

I don't doubt it. I've suffered a lot of pain in the past 20 years or so and I'm becoming forgetful. And I'm not that old. People should be allowed to get better pain killers. Not the cheap organ damaging stuff like Ibuprofen and Acetaminophen. But the naturally occurring in nature plant preparations. They're safer. The ancients had access. And we should too.

Nancy said at March 7, 2011 8:25 PM:

Michael Roberts, what are your credentials? I think the diet you suggest is the one everyone should be using. Where is the research about tryptophan? How much? What kind of research has been done to determine if this even crosses the blood-brain barrier and if the serotonin is enough to help pain? It's not right to make recommendations like this without backing it up with good, peer reviewed, well done, scientific research. This might interfere with someone's medication or cause side effects.

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