Combatting the Biological Burden of Pain, Part 1

Author: Emily Bartley

Dr. Bartley: We know that chronic pain does have a biological interface. There are structural and functional changes in the brain, such as gray matter loss and a functional reorganization. We also know that chronic pain is associated with systemic effects, such as increased inflammation throughout the body such as IL-6 and C-reactive protein. Chronic pain also tends to increase stress reactivity, such as enhanced cortisol reactivity after the induction of some sort of a stressor.

Dr. Sibille: When we look at things like frequency, intensity, duration, and extent of pain, we’re better able to evaluate the effect on the system and it’s not only affecting the brain, as Dr. Bartley was just mentioning, it’s affecting all the stress response systems. There is work that’s showing that we can actually capture this and show that not only is there a burden from chronic pain on the system but in fact, resilience factors that can buffer that. There’s some really nice findings both clinically and in population-based studies that I think are going to be encouraging to clinicians and patients and I think give us some guidance for alternative treatments.

Dr. Bartley: These factors could be psychological such as positive affect or self-efficacy. They could be behavioral such as getting a good night sleep or having a good social relationship with your family and your friends. There are existential factors such as having life purpose or acceptance. So there are multiple factors, which is really nice from an intervention sense because we can utilize multiple resources to enhance these various protective or resilience factors in people.

Dr. Sibille:  All of those factors that Dr. Bartley was just identifying actually have a neurobiological/biological interface and so when we target resilience factors, we’re also doing hoping to enhance neuroplastic functioning and changes in the entire system. An additional piece to that and one area that we’re looking at is can we enhance or promote neuroplasticity; can we optimize the body and the brain to be more responsive to these interventions. And particularly as we age, our metabolic and neurobiological functioning changes and yet there are some noninvasive strategies out there that might help us optimize that so we can improve our learning and memory and response to treatment interventions. I think we’re starting to venture into some exciting areas that may help improve pain care and treatment.

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