Anatomical changes correlated with chronic pain

Anatomical changes correlated with chronic pain in forensic medicine – Free full-text /PMC6197126/ –  Jun 2017

This article from the NIH has a good summary of physical changes that come about due to chronic pain, not just psychological “problems”, but numerous physical harms resulting from unrelieved pain.

This study was performed to determine the relationships between chronic pain and anatomic changes that may occur in the body.Autopsies were performed on fatalities that required death investigation in Linn County, IA, or adjacent and nearby areas.

Certain causes of death may also have been related to chronic pain. The heart, lungs, liver, spleen and kidneys were significantly heavier in persons with chronic pain; emphysema and pleural and abdominal adhesions were more common in persons with chronic pain.  

Diabetes, hypertension and depression were more common in persons with chronic pain.

There appear to have been diffuse changes in the body related to chronic pain. These changes may have been mediated by a number of systemic mechanisms that are involved with chronic pain, including cardiovascular activity, the immune system, the neuroendocrine system and others.

Results

Based on medical records and scene investigations, 54 persons had been diagnosed with chronic pain ante-mortem, and 320 had no known chronic pain.

The demographic data are summarized inTable 1.

The types of chronic pain encountered are listed in Table 2.

Systemic or widespread pain was the most common type, such as neuropathic pain, fibromyalgia, multiple sites of arthralgia or pain from disseminated carcinoma; musculoskeletal or site-specific pain followed, particularly chronic low back pain.

Table 1.
Subject data (case number).

Subject Parameter/classify Chronic (N = 54) Control (N = 320) Significance
Age (years old) Mean ± SD 50 ± 13 44 ± 18 P = 0.020 4
Range 29–82 13–88
Sex Men 34 224
Women 20 96
Race Caucasian 52 269 P = 0.018 3
Other 2 51
Height (inches) Mean ± SD 68 ± 4 69 ± 4
Range 60–75 55–77
Weight (pounds) Mean ± SD 194 ± 66 180 ± 48
Range 101–422 55–375
Body mass index (BMI) Mean ± SD 29.0 ± 9.0 26.9 ± 6.6
Range 15.8–52.7 10.2–57.1
Social Caffeine 14 63
Tobacco 1 23
Alcohol 9 96
Marijuana 3 48
Medical Diabetes 10 21 P = 0.006 2
Hypertension 18 52 P = 0.004 0
Psychiatric Depression 28 60 P < 0.000 1
Bipolar affective disorder 3 8
Schizophrenia 0 5
Substance abuse 13 42 P = 0.005 2

Table 2.
Sites of chronic pain (N = 54).

Sites Number
Systemic 20
Back 14
Abdomen 5
Neuropathic 6
Other musculoskeletal 5
Chest 2
Headache 2
Total 54

Death from natural causes was significantly more common among persons with chronic pain (chronic pain n = 28, control n = 109; P = 0.014 6).

The Cox analysis of survival showed no differences based on sex, race, height, weight and BMI.

Based on clinical factors (P = 0.000 4), systemic hypertension was significantly correlated (P = 0.000 8) with early mortality, while chronic pain, narcotic use, depression and diabetes mellitus did not appear to contribute significantly as covariates to overall survival.

This is good news: “narcotic use did not appear to contribute significantly”.

The Cox analysis using organ weights as the hazard is reported in Table 3. Chronic pain was identified as a significant covariate in heart weight

Chronic pain was also identified as a significant covariate in spleen weight, along with Caucasian race and increased body weight.

Anatomic findings from autopsy are summarized in Table 4.

All of the visceral organs were significantly heavier in the chronic pain group compared to the controls.

Table 4.
Anatomic findings.

Organs Parameter/classify Chronic (N = 54) Control (N = 320) Significance
Brain Weight (grams) 1 340 ± 167 1 362 ± 156
Cerebral oedema 11 61
Heart All (non-surgical), weight (grams) 426 ± 87 389 ± 118 P = 0.032 4
Normotension, weight (grams) 401 ± 81 366 ± 100 P = 0.046 4
Hypertension, weight (grams) 476 ± 78 505 ± 135
Cardiac hypertrophy 35 89 P < 0.000 1
Atherosclerotic cardiovascular disease (ASCVD) 26 148
Myocardial infarction (MI) 3 9
Pleural cavities Adhesions 11 13 P = 0.000 1
Lung, right All, weight (grams) 639 ± 193 569 ± 230 P = 0.036 3
Pneumonia(−), weight (grams) 641 ± 201 555 ± 213 P = 0.012 1
Pneumonia(+), weight (grams) 630 ± 156 848 ± 352
Lung, left All, weight (grams) 557 ± 220 492 ± 197 P = 0.028 3
Pneumonia(−), weight (grams) 568 ± 235 484 ± 189 P = 0.007 9
Pneumonia(+), weight (grams) 501 ± 116 639 ± 283
Pneumonia 9 14 P < 0.002 5
Emphysema 21 82 P = 0.044 6
Abdomen Adhesions 7 6 P = 0.000 7
Appendix Present 35 250 P = 0.000 6
Liver Weight (grams) 2 026 ± 568 1 769 ± 544 P = 0.001 9
Weight range (grams) 1 200–3550 700–3910
Steatosis 27 135
Cirrhosis 4 14
Hepatitis 13 62
Gallbladder Present 38 283 P = 0.000 2
Spleen Weight (grams) 245 ± 112 186 ± 107 P = 0.000 3
Kidney All, weight (grams) 339 ± 78 310 ± 94 P = 0.037 3
Normotension, weight (grams) 335 ± 76 301 ± 90 P = 0.033 9
Hypertension, weight (grams) 346 ± 84 356 ± 99

 

Discussion

This study investigates whether a documented experience of ante-mortem chronic pain may have been related to anatomic changes in the body that could be observed at autopsy.

The task can seem daunting, since chronic pain does not have a single clinical signature.

It has a number of causes and presentations, although they share a common experience of persistent distress that impairs one’s experience of life, activities of daily living, work and relationships.

Yet, in opioid studies, such persistent and impairing distress is completely discounted.

It is important to consider that chronic pain is a very diverse condition arising from many aetiologies, so to consider them as a single diagnosis would be inappropriate.

Yet all opioid studies assume that all chronic pain is alike. This seems li,e a gross scientific and logical error that would completely corrupt any such study and make it meaningless.

This study furthermore appears to find that the body may undergo changes that may be correlated with chronic pain.

While many organs had interacting covariates in their size at the time of death, the heart and spleen were specifically correlated with chronic pain at the time of death, and all of the other visceral organs in persons with chronic pain weighed more than controls as independent variables.

Systemic changes may suggest systemic mechanisms that cause the visceral organs to enlarge, such as those mediated by the

  • central nervous system [2,7,8,15,17,18,20–26],
  • peripheral nervous system [23],
  • neuroendocrine system,
  • endogenous opioids and cytokines [2,20,21,23,25,26,28],
  • the circulatory system including blood pressure [8,10],
  • serum factors [21,35–39], and
  • the immune system [2,20,21,23,25,26,28]. 

Under the direction of these interacting systems, chronic pain may induce stress that leads to reactive enlargement of the organs.

For example, systemic mechanisms that could enlarge the organs may include fluid redistribution to the interstitial space due to endocrine stimulation; immune cells may evoke inflammatory reactions; the central nervous system may stimulate sympathetic reactions; and others.

The significant incidence of pneumonia in persons with chronic pain could be related to decreased mobility in persons who experience ongoing pain, or the higher incidence of emphysema that was found in the pain group.

Adhesions were more common in the pleural and abdominal cavities of the pain group, suggesting systemic inflammation. Conversely, there was no increased incidence of cerebral oedema, atherosclerotic cardiovascular disease, myocardial infarction, steatosis cirrhosis or hepatitis.

The anatomic changes with the corresponding clinical or demographic correlations found in this study suggest that differences in the body are possibly correlated with chronic pain in many ways, such as

  • organ enlargement,
  • pneumonia,
  • depression and
  • increased likelihood of abdominal surgery such as cholecystectomy and appendectomy

3 thoughts on “Anatomical changes correlated with chronic pain

  1. Kathy C

    This is interesting, there are not many studies on topics like this where they can actually quantify the effects. There is so much more funding for studies that create doubt, like misreported placebo studies.
    We live in the age of alternative facts. A study like this won’t get amplified by the media, or any thought provoking coverage anywhere. We won’t see any of the advertising dependent, pain related sites posting anything like this. The population has been brainwashed, by manipulative marketing, and military grade psi ops operations daily in their social media feeds.

    Liked by 1 person

    Reply
  2. Pingback: » When someone tells you that pain never killed anyone… you might want to share this PHARMACIST STEVE

Other thoughts?

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

This site uses Akismet to reduce spam. Learn how your comment data is processed.