Bodily Damage from Uncontrolled Chronic Pain

Here is a list of posts (through August 2017) covering the damage caused by uncontrolled chronic pain, both physical and mental. (Use tag ‘PAIN-DAMAGE for the latest).

While the news is filled with stories of damages from opioid abuse, the media never mentions the damages of pain itself. Such information is hard to find because it is buried under all the studies on drug abuse.

This censoring leaves the public completely ignorant of all the biological damages pain patients suffer if they are not provided effective pain relief quickly.

These are arguments for allowing pain patients access to opioids, showing how important it is to eradicate pain by any means possible as soon as possible.

Below, is a list of posts with short excerpts that explain the damages of chronic pain.


Chronic Pain Causes Brain Damage – Aug 2017

Functional Reorganization of the Default Mode Network across Chronic Pain Conditions – PLoS One. – Sep 2014

Here we use resting-state functional magnetic resonance imaging to investigate functional changes in patients suffering from chronic back pain (CBP), complex regional pain syndrome (CRPS) and knee osteoarthritis (OA).

We isolated five meaningful resting-state networks across the groups, of which only the default mode network (DMN) exhibited deviations from healthy controls.

All patient groups showed

  1. decreased connectivity of medial prefrontal cortex (MPFC) to the posterior constituents of the DMN, and
  2. increased connectivity to the insular cortex in proportion to the intensity of pain. 

Neuropathic Pain Leads to Changes in Gene Expression – Aug 31, 2017

Long-Term Neuropathic Pain Leads to Changes in Gene Expression in Brain Areas Associated With Depression by Nathan Fried on 19 Apr 2017

Over half of all chronic pain patients also develop depression. [only half?]

Researchers know that short-term pain affects brain areas implicated in depression, but few studies have scrutinized the effects of long-term pain on gene expression in those regions or examined gene expression alterations in multiple brain regions at once.

Now, researchers use network analysis along with a mouse model of chronic pain and a mouse model of stress-induced depression to identify changes in gene expression throughout the brain that may underlie the connection between pain and depression.

The Consequences of Untreated Pain – Aug 7, 2017

The Consequences of Untreated Pain — Pain News Network – By Roger Chriss

Pain is an alarm signal requiring attention. Whether the pain lasts minutes or months, it demands a response.

To ignore pain is to invite serious consequences, from burned skin or an infected wound to a damaged joint or dysfunctional nerve. It is for this reason that healthcare professionals ask patients where it hurts.

Recent research found the consequences of untreated pain go farther and deeper than are generally recognized.

People With Chronic Pain May Die Earlier – Jun 2017 

Why People With Chronic Pain May Die EarlierKorin Miller – June 8, 2017

More than one in 10 Americans, or 25.3 million adults, suffer from pain every day, according to NIH data released in 2015.

Chronic pain seems to be just that—a serious pain—but new research has found that ongoing pain is associated with an increased risk of dying early.

For the analysis, which was published in Arthritis Care & Research, researchers looked at data from two large population cohorts of 50-year-olds.

They discovered that people who reported suffering from chronic pain had a nearly 30 percent increased risk of dying during the study.

Chronic pain linked to increased risk of dementia – Jun 2017

Chronic pain linked to increased risk of dementia in study of older adults – Medical News Today – June 2017

Researchers at UC San Francisco have found that older people with persistent pain show quicker declines in memory as they age and are more likely to have dementia years later, an indication that chronic pain could somehow be related to changes in the brain that contribute to dementia.

This study gives us good reason to demand effective treatment for our pain.

Treat us for our pain now or for our dementia later.

Chronic pain leads to epigenetic changes – Apr 2017

Chronic pain changes our immune systems | Channels – McGill University – By Cynthia Lee – Jan 2016

Many anti-opioid folks believe it’s always better not to prescribe/take opioids because they are so extremely dangerous, while pain is “just a feeling” that a person can “deal with”.

However, they are wrong. Pain is not just a “feeling”.

Leaving pain poorly controlled can lead to changes in how our genes are expressed, especially in the immune system.

Pain is the body’s alarm system, intended to get you moving to either fight or flee. It’s an extreme stressor which initiates a chain of biochemical consequences, including those that turn some of our genes on and off.  

Epigenetic Changes in Post-Surgical vs Chronic Pain – Dec 2016

Distinct Sets of Genes are Activated in Post-Surgical and Chronic Pain Conditions– Clincial Pain Advisor – Florence Chaverneff, Ph.D. – December 02, 2016

The locations of epigenetic changes brought on by pain show how long-term pain affects numerous areas of our physical functioning, including:

  1. neurodevelopment,
  2. cell-mediated immune response,
  3. amino acid metabolism,
  4. humoral response (involves substances found in the humors, or body fluids), and
  5. cell cycle.

The dynamic effect of pain on attention – Dec 2016

The dynamic effect of pain on attention – Body in Mind – 12/14/16

Pain tends to grab our attention, making it difficult to concentrate on other tasks.

This is generally a useful feature of pain – if we burn ourselves while cooking, it’s good that our attention switches away from the food and towards the pain so that we can adequately protect ourselves.

However, if the pain doesn’t signal threat (e.g. a tension headache) or if it becomes chronic, this could have negative consequences for our ability to concentrate, with no benefit to our safety.

What Happens When Pain Goes Untreated? – Oct 2016

What Happens When Pain Goes Untreated? | October 16, 2016

Untreated or under-treated pain is more than uncomfortable. There are profound effects in someone who lives with pain

A 1999 Chinese study of cancer patients showed that, after taking into account the effects of cancer, the more pain someone had, the worse the effects on their health and how they functioned.

Understandably, the relationship between the severity of pain and impairment was nonlinear: patients with no pain or only mild pain were significantly better functioning than those with moderate and severe pain.

Microglial Inflammation: Pain and Memory Deficiency – Mar 2016

Microglial Inflammation: A Promising Target in Neuropathic Pain Also Plays Role in Memory Deficiency – Consult QD | Cleveland Clinic

Promising research by Cleveland Clinic investigators demonstrates that microglial inflammation is a common pathway ‒ and a potentially treatable one ‒ for neuropathic pain and other treatment-resistant neuroinflammatory conditions, including Alzheimer disease

“Microglial inflammation is a mechanism of many CNS disorders ‒ neuropathic pain, AD, multiple sclerosis, parkinsonism, you name it,” says lead researcher Mohamed Naguib, MD, of Cleveland Clinic’s Anesthesiology Institute, which includes the Department of Pain Management.

His team has synthesized a molecule called MDA7, a cannabinoid type 2 (CB2) receptor-selective agonist, to inhibit microglial inflammation in hopes of effectively treating neuropathic pain and other conditions.

What chronic pain does to your brain – Mar 2016

What chronic pain does to your brain – ABC News Australia – March 2016 – by Lynne Malcolm and Olivia Willis

‘At the moment we have focused our work to two areas in the brain,’ says Dr Sylvia Gustin from Neuroscience Research Australia. ‘One is called the thalamus—the other is the prefrontal cortex.’

Described as the ‘border in the brain’, the thalamus acts as the gateway between the spinal cord and higher brain centres.

When you sustain an acute injury there is an opening in the thalamus for information to pass through from the affected body part to the brain.

‘This is very important because then we need to heal, we need to relax, we need to look after ourselves. After an acute injury is healed, we know that this border should actually close.‘

When researching people who experience chronic pain, Gustin identified a key neurological difference: the opening in the thalamus remains open long after acute pain is gone.    

The Long-Term Effects of Untreated Chronic Pain – Jan 2016

The Long-Term Effects of Untreated Chronic Pain – NAIDW iBlogger – Jan 2016

Chronic pain, a diagnosis including arthritis, back pain, and recurring migraines,can have a profound effect on a person’s day to day life when it goes untreated.

People dealing with ongoing or long-term pain can become irritable, short-tempered, and impatient, and with good reason. Constant pain raises the focus threshold for basic functioning, which leaves the pained person with a greatly reduced ability to find solutions or workarounds to even relatively mundane problems.

Something like a traffic jam, which most people would be mildly annoyed by but ultimately take in stride, could seriously throw off the rhythm of someone who is putting forth so much effort just to get through the day.

Chronic pain leads to epigenetic changes – Jan 2016

Chronic pain changes our immune systems | Channels – McGill University – By Cynthia Lee – Jan 2016

Many anti-opioid folks believe it’s always better not to prescribe/take opioids because they are so extremely dangerous, while pain is “just a feeling” that a person can “deal with”.

However, they are wrong. Pain is not just a “feeling”.

Leaving pain poorly controlled can lead to changes in how our genes are expressed, especially in the immune system.

Pain is the body’s alarm system, intended to get you moving to either fight or flee. It’s an extreme stressor which initiates a chain of biochemical consequences, including those that turn some of our genes on and off.

The deadly effects of untreated or under-treated pain – Dec 2015

The deadly effects of untreated or under-treated pain | National Pain Report | Emily Ulrich

Regarding a recent article about opioids in the New England Journal of Medicine. In the latter, Jane Ballantyne, MD, and Mark Sullivan, MD, wrote that reducing pain intensity – pain relief – should not be the primary goal of doctors who treat pain patients. They suggest that patients should learn to accept their pain and move on with their lives.

This statement is nothing short of infuriating to me and I imagine to anyone who has to live with chronic pain.

There are so many things wrong with that ideology, and the “facts” that are being used to support it in the anti-opioid movement, that it’s difficult to know where to begin.

Chronic pain remodels brain region for emotion – Dec 2015

Chronic pain remodels brain region for emotion – Futurity | December 22, 2015

Chronic pain remodels a brain region that controls whether we feel happy or sad, as well as addiction, a new study reports.

The scientists have also developed a new treatment strategy that restores this region and dramatically lessens pain symptoms in an animal model.

The new treatment combines two FDA-approved drugs: a Parkinson’s drug, L-dopa, and a non-steroidal anti-inflammatory drug.

The combined drugs target brain circuits in the nucleus accumbens and completely eliminate chronic pain behavior when administered to rodents with chronic pain.

Chronic Pain leads to Impairments in Neurocognitive Tests – May 2015

Pain Medicine News – Neurocognitive Tests Potential Tool for Understanding Impairments in Chronic Pain Patients

Chronic pain is strongly correlated with poorer performance on tests that measure

  • thinking speed,
  • working memory,
  • learning and
  • other abilities such as attention.

Researchers believe that neurocognitive tests can be used to determine which cognitive functions are most disrupted by chronic pain

“It’s important for neuropsychologists to know what influence pain has on particular tests they’re administering,” said study author William Parkinson, PhD

Microglial Inflammation: Pain and Memory Deficiency – Feb 2015

Microglial Inflammation: A Promising Target in Neuropathic Pain Also Plays Role in Memory Deficiency – Consult QD | Cleveland Clinic

Promising research by Cleveland Clinic investigators demonstrates that microglial inflammation is a common pathway ‒ and a potentially treatable one ‒ for neuropathic pain and other treatment-resistant neuroinflammatory conditions, including Alzheimer disease

“Microglial inflammation is a mechanism of many CNS disorders ‒ neuropathic pain, AD, multiple sclerosis, parkinsonism, you name it,” says lead researcher Mohamed Naguib, MD, of Cleveland Clinic’s Anesthesiology Institute, which includes the Department of Pain Management.

His team has synthesized a molecule called MDA7, a cannabinoid type 2 (CB2) receptor-selective agonist, to inhibit microglial inflammation in hopes of effectively treating neuropathic pain and other conditions.

Danger of  “Fail First” Treatment Plans for Pain – Dec 2014

Former radio personality Radene Marie Cook rues ‘fail first’ treatment plans for chronic pain | Drug Store News

This is a sad story exposing the further harm caused by “fail first” policies for pain treatment after an injury.

Radene Marie Cook had two complimentary careers: she was a professional actress, dancer and singer in southern California, and she enjoyed a 16-year run as an on-air radio personality  But on March 16, 2000, all that changed. While working, her aircraft was hit by a “microburst,” a wind shear event known for being especially violent and often deadly.

Placed in the workers’ compensation system, Cook said all of her care was “determined not by myself or my doctors, but by what benefits could be listed behind my case number.”

“But where my injuries started was nothing compared to where I ended up after four-plus years of ‘treatment’ under the bureaucracy of workers’ comp and ‘fail first’ treatment policies that continued to injure me despite protests,” Cook said.

Why it’s important to not ignore pain – Nov 2014

Why it’s important to not ignore pain | Medicine | Kentucky.com – by Dr. Karim Rasheed

This is a commendable article in a community newspaper pointing out the hazard of untreated pain. Ironically, it comes from one of the most opioid-restrictive states in the US.

Here’s the thing: Anytime you experience pain it can affect the rest of your body.

That means an escalation in your hormone levels, salt and sugar levels, heart rate, blood pressure — everything goes up.

Pain also makes you restless, which makes it hard to sleep well at night, and that makes you more aggravated in your daily life.

Pain even lowers your immunity, making you vulnerable to infections.

It is no surprise that many patients postpone going to a doctor — especially for pain. In our culture, pain is part of our life, and many patients feel it is a sign of weakness to suffer from it.

The irony is that the longer a patient suffers from pain, the more their body deteriorates because of it.

Chronic Pain and Depression – Aug 2014

Chronic Pain and Depression: Sorting Out Types of Mood Disorders

Depression is a common complaint of the patient suffering with chronic pain. And pain is a common complaint of patients with mood disorders and anxiety.

The challenge for the practicing physician is sorting out the psychiatric syndromes from the underlying pain triggers.

This article will explore the importance of differentiating types of depression in the diagnosis and management of comorbid pain and depression, and presents case examples.

One-third to more than 50% of patients presenting to chronic pain clinics have a current major depression.

Pain severity, pain-related disability, and health-related quality of life were significantly worse in patients with chronic musculoskeletal pain and comorbid depression

Decreased motivation during chronic pain – Aug 2014

results indicate that chronic pain … interferes with motivated behavior

Decreased motivation during chronic pain requires long-term depression in the nucleus accumbens – Science. 2014 Aug 1; – free full-text PMC article

People with chronic pain know how tiring it is to deal with pain every day all day and I thought this fatigue explained why I have so much trouble getting up off the couch.

This study suggests that our pain triggers changes in the brain that depress the nucleus accumbens core (NAc), which is a key node of the neural circuits mediating motivated behaviors,

Hormone Abnormalities in Uncontrolled Chronic Pain Patients – Jul 2014

Hormone Abnormalities in Uncontrolled Chronic Pain Patients: Use of Hormone Profiles   July 1, 2014

Hormone profile testing is readily available and may be recommended for any chronic pain patient who is not achieving good pain control with their current medical regimen.

some specialty laboratories that offer body fluid toxicology and pharmacogenetic testing to pain practitioners are beginning to add hormone panel testing to their portfolio of services

Keep in mind that today’s standard pain control regimens are extremely effective in the vast majority of chronic pain patients, so non-responders are somewhat uncommon.

Chronic pain increases Cardiovascular Disease risk – Feb 2014

Note: this article is no longer available

medwireNews – Cardiology – Chronic musculoskeletal pain increases CVD risk

medwireNews: Chronic musculoskeletal pain (CMP) is associated with an increased risk for cardiovascular disease (CVD), researchers have found.

the association could not be explained by reduced physical activity or increased sedentary behavior

Clinically, this study suggests the intriguing implication that CMP may be a modifiable risk factor for CVD.

Understanding Chronic Pain as a Disease of the Brain – Jul 2013

http://www.medpagetoday.com/resource-center/pain-management/brain/a/38479

Detailed scientific explanation of how chronic pain causes harmful changes in the brain.

The plasticity of the CNS is characterized by functional, structural, and chemical changes in the brain. These changes are associated with activation of the pain matrix in response to chronic pain.

Advances in brain imaging technology reveal that patients with chronic pain have altered pain modulatory circuits as well as structural abnormalities.

Imaging techniques have a promising role to play in the diagnosis of different chronic pain disorders and assessment of responses to current and new therapeutic interventions.

Chronic, Noncancer Pain Boosts Suicide Risk – May 2013

Chronic, Noncancer Pain Boosts Suicide Risk – Fran Lowry – May 28, 2013

Certain types of noncancer pain conditions are associated with an increased risk for suicide, a new study suggests.

psychogenic pain, back pain, and migraine, but not arthritis or neuropathy, were associated with an increased risk for suicide.

As any pain patient, I find the concept of “psychogenic pain” to be unscientific, vague, and insulting to those of us who suffered for years from undiagnosed – not psychogenic – pain.  Dr Ilgen seems to agree in his comments at the end.

Although some of this risk appears to be due to co-occurring mental health problems, there may be something about the experience of pain that also contributes directly to suicide risk,

Watching Pain Become Chronic – Apr 2013

Watching Pain Become Chronic | Pain Research Forum

This research suggests it’s critical to suppress inflammation and pain when they first start so that the pain doesn’t become chronic and persist even after the inflammation is gone.  Could part of chronic pain be the body’s chemical exhaustion from fighting recurrent inflammation and pain?

the transition from acute inflammation to chronic organ damage and pain involves a switch from transient neuroinflammation driven by TRPV1 and TRPA1 channels on sensory neurons to a later, lasting pain state that is impervious to treatment with TRP inhibitors.

The work suggests that in mice subjected to repeated inflammatory insults “there is a transition point” in the molecular mechanisms driving inflammation and pain, Gebhart said. “There are some players that are involved in the beginning …but not after some critical point.”

Chronic pain increases Cardiovascular Disease Risk – Jan 2013

medwireNews – Cardiology – Chronic musculoskeletal pain increases CVD risk

the association could not be explained by reduced physical activity or increased sedentary behavior

Clinically, this study suggests the intriguing implication that CMP may be a modifiable risk factor for CVD.

Chronic Pain Leads to Mood Disorders – Jan 2013

Chronic Pain Leads to Concomitant Noradrenergic Impairment and Mood Disorders

Patients suffering chronic pain are at high risk of suffering long-lasting emotional disturbances characterized by persistent low mood and anxiety. We propose that this might be the result of a functional impairment in noradrenergic circuits associated with locus coeruleus (LC) and prefrontal cortex, where emotional and sensorial pain processes overlap.

As expected, nerve injury produced an early and stable decrease in sensorial pain threshold over the testing period.

Sudden, Unexpected Death in Chronic Pain Patients – Sep 2012

Sudden, Unexpected Death in Chronic Pain Patients – Practical Pain Management – September 2012

Severe pain, independent of medical therapy, may cause sudden, unexpected death. Cardiac arrest is the cause, and practitioners need to know how to spot a high-risk patient.

Unexpected, sudden death due to severe pain is poorly appreciated, since many observers still view severe pain as a harmless nuisance rather than a potential physiologic calamity.

In many cases, just prior to death, the patient informs their family that they feel more ill than usual and seek relief in their bed or on their couch. Unfortunately, some of these patients don’t awaken. Other patients die, without warning, in their sleep or are found collapsed on the floor

Complications of Uncontrolled, Persistent Pain – Jan 2012

Complications of Uncontrolled, Persistent Pain – Practical Pain Management – January 28, 2012

Persistent pain, which is also often characterized as chronic or intractable, has all the ramifications of a disease in that it may have pre-clinical and overt phases.

The most unappreciated clinical feature of persistent pain, however, is the plethora of complications that may result — particularly if the pain is constant and unremitting.

Many recent and emerging studies clearly document that persistent pain exerts profound impacts on the body’s endocrine, cardiovascular, immune, neurologic and musculo-skeletal systems

Long-term consequences of chronic pain – Jul 2011

Long-term consequences of chronic pain: mounting evidence for pain as a neurological disease and parallels with other chronic disease states. – PubMed – NCBI – Pain Med. Jul 2011

Here’s an official PubMed article documenting the damage of chronic pain.

OBJECTIVE: This article reviews the potential physical and psychological consequences of chronic pain and the importance of implementing effective therapeutic strategies to mitigate the harms associated with inadequate treatment.

RESULTS: A review of recent literature examining the neurobiology and pathophysiology of chronic pain reveals that this highly prevalent condition negatively impacts multiple aspects of patient health, including sleep, cognitive processes and brain function, mood/mental health, cardiovascular health, sexual function, and overall quality of life.

Damaging Effects of Chronic Pain on the Brain – May 2011

The Damaging Effects of Chronic Pain on the Brain : Illness and Health Blog | Wellescent.com

This article describes how ongoing pain damages the brain and how this damage is manifest.

How Does Chronic Pain Change Behavior?

Previous research has found a number of changes in mental function caused by chronic pain.

One example is that those suffering from chronic pain have difficulty making even simple decisions and interacting with other people.

Baffling Chronic Pain Linked to Rewiring of Brain – Nov 2008

Baffling Chronic Pain Linked to Rewiring of Brain: Northwestern University News | November 2008

Scientists peered at the brains of people with a baffling chronic pain condition and discovered something surprising. Their brains looked like an inept cable guy had changed the hookups, rewiring the areas related to emotion, pain perception and the temperature of their skin.

The people whose brains were examined have a chronic pain condition called complex regional pain syndrome (CRPS.)

Chronic Pain Harms The Brain – Feb 2008

Chronic Pain Harms The Brain — ScienceDaily | February 6, 2008

People with unrelenting pain don’t only suffer from the non-stop sensation of throbbing pain. They also have trouble sleeping, are often depressed, anxious and even have difficulty making simple decisions.

Researchers found that in a healthy brain all the regions exist in a state of equilibrium. When one region is active, the others quiet down.

But in people with chronic pain, a front region of the cortex mostly associated with emotion “never shuts up,” said Dante Chialvo, lead author and associate research professor of physiology at the Feinberg School. “The areas that are affected fail to deactivate when they should.”

Chronic Pain Harms the Brain Northwestern U. – Feb 2008

Chronic Pain Harms the Brain: Northwestern University News | February 2008

People with unrelenting pain don’t only suffer from the nonstop sensation of throbbing pain. They also

  • have trouble sleeping,
  • are often depressed,
  • anxious and even have
  • difficulty making simple decisions.

Researchers found that in a healthy brain all the regions exist in a state of equilibrium. When one region is active, the others quiet down.

But in people with chronic pain, a front region of the cortex mostly associated with emotion “never shuts up,” said Dante Chialvo, lead author and associate research professor of physiology at the Feinberg School.

The region is stuck on full throttle, wearing out neurons and altering their connections to each other.

The physiological effects of unrelieved pain – Sep 2003

Understanding the physiological effects of unrelieved pain | NursingTimes.net | Sept 2003

This is a lengthy, well-organized, and detailed list of each of the physiological reactions to chronic pain.

A noxious stimulus or pain is a stressor that can threaten homeostasis (a steady physiological state). The adaptive response to such a stress involves physiological changes that, in the initial stages, are useful and are also potentially life-saving.

However, if the stress response is allowed to continue, a variety of harmful effects may ensue that involve multiple systems of the body and are potentially life-threatening.

Severe Chronic Pain is a Killer, Literally – undated

Note: This valuable and informative website has been discontinued.

Pain-Topics News/Research UPDATES: Severe Chronic Pain is a Killer – Study Finds

Previous research has demonstrated a clearly negative influence of chronic pain on health.

Now, a new study portrays a profound link between severe chronic pain and death; inflicting nearly a 70% greater mortality risk than even cardiovascular disease.

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