Trauma related chronic pain linked to PTSD

GLENVIEW, Ill., July 22 (UPI) — Patients with accident- or trauma-related chronic pain often have post-traumatic stress disorder and depression, University of Michigan researchers said. 

However, what isn’t clearly known, however, is how PTSD relates to mood disorders and pain severity in chronic pain patients.

University of Michigan researchers examined the contribution of PTSD to the pain experience, functional disability and frequency of depressive symptoms. They studied 241 patients referred to the university hospital’s pain rehabilitation program who reported their pain began after a traumatic injury. The subjects completed the McGill Pain Questionnaire and were administered the Pain Disability Index and the Post-traumatic Chronic Pain Test.

The study found PTSD and depression were significantly correlated and both disorders were associated with perceived disability attributed to chronic pain.

The study authors concluded that increased attention to treating PTSD as a primary focus in the rehabilitation of patients with chronic pain and co-morbid depression is important when prior treatment efforts for pain and depression have not been successful

Women feel chronic pain more than men

Women feel chronic pain more than men because their brains are different

By Lucy Cockcroft

Women feel pain more than men because their brains are not “wired” in the same way, scientists believe.

New research suggests that the basic architecture of the brain, and the way it operates, is different in the two sexes.

Previously the different sensitivity to pain between the sexes had been explained by hormones and social pressures.

However, a series of studies have suggested that there “is not just one kind of human brain, but two”, a male version and a female version.

It is well known that women are more likely to seek help for chronic pain than men, and the differences in the brain could explain this.

Men have a pain-suppressing circuit which links their brain to their spinal cord. When the circuit is activated by pain, endorphins are released and help lessen the feeling.

However, new studies have shown that the circuit does not release the analgesic endorphins in women.

Dr Anne Murphy at the University of Georgia in Athens has been examining the anomaly. She said: “This circuit is the Mecca of pain modulation in humans and all vertebrates, yet no one has asked how it is organised in females.

“This pathway is obviously not being used for pain in females.”

In one experiment, scientists chemically blocked the pain receptors found in the brain and spinal cord of a male and female mouse. While this helped control the feeling in the male mice, it had little effect on the females.

Dr Jeff Mogil, who led the research at McGill University in Montreal, Canada, said: “It suggests females have a separate pathway.”

The discovery could have an impact for how pain and illnesses in women are treated. Most of what is currently known about the brain comes from studies of male animals and male human volunteers.

A report, published in the New Scientist today, said: “If even a small proportion of what has been inferred from these studies does not apply to females, it means a huge body of research has been built on shaky foundations.

“Working out exactly how women are different could explain some long-running mysteries, such as why men and women are prone to different mental health problems and why some drugs work well for one sex but have little effect on the other.”

Recent research has suggested that male and female brains are built from markedly different genetic blueprints, which create numerous anatomical differences.

There are also differences in the circuitry that “wires them up” and the chemicals that transmit messages between brain cells, as well as a proportionate size difference in some areas of a male and female brain.

“The mere fact that a structure is different in size suggests a difference in functional organisation,” said neurobiologist Dr Larry Cahill of California University.

Dr Cahill carried out a series of brain-imaging experiments, in which he asked groups of men and women to recall emotionally charged images they had been shown earlier.

He also found that the different sexes used their brains in different ways.

Both men and women consistently recruited the same bundle of neutrons for the task. However, the men enlisted the right side of it, whereas women used the left.

And males recalled the gist of the situation whereas females concentrated on the details

How emotional pain can really hurt

Love really does hurt, just as poets and song lyric writers claim.

New brain scanning technologies are revealing that the part of the brain that processes physical pain also deals with emotional pain.

And in the same way that in some people injury can cause long-lasting chronic pain, science now reveals why some will never get over such heartbreak.

Emotional pain can take many forms; a relationship break-up or social exclusion, for example.

But it does not get any more extreme than losing a loved one, as Scottish broadcaster Mark Stephen did.

In July 1995 he was driving a tractor while hay-making and accidentally hit his young daughter. She died shortly afterwards.

Mark’s grief was overwhelming, he says

“When people talk about a broken heart, that for me was where it was seated, just below your sternum.

“It feels like your heart is leaking and you can’t run away from it because you are the source of that pain.”

Thinking he would go mad with grief, he sought help from David Alexander.

Professor Alexander is director of the Aberdeen Centre for Trauma Research. He led the psychiatric team that first responded to the Piper Alpha oil-rig disaster.

Since then, he has been involved in helping survivors of many disasters including the Asian tsunami, the war in Iraq and, most recently, the earthquake in Pakistan.

He also managed to get Mark Stephen through his darkest days.

‘My guts are aching’

Professor Alexander is not surprised about the link between physical and emotional pain:

“If you listen to people who are damaged emotionally, they will often translate their pain into physical similes: ‘My head is bursting, my guts are aching’ and so on. The parallel is very strong.”

But medical research has tended to concentrate on physical pain.

Neuroscientist Mary Frances O’Connor at the University of California, Los Angeles (UCLA) is one of the scientists who have propelled emotional pain up the research agenda.

“We’re at a very new time when we can use technologies to look at the brain and the heart,” she says.

Naomi Eisenberger at UCLA has shown which parts of the brain are active when we feel emotional pain.

She devised an intriguing computer game in which participants were deliberately made to feel left out.

Simultaneous brain scanning revealed that the pain of being socially rejected was processed in much the same way in the brain as physical pain and in the same area, the anterior cingulate cortex.

‘Complex grief’

Why should physical and emotional pain be linked in this way?

Social relationships are crucial to our survival as a species. In dangerous situations, a lone human is in peril whereas a group may survive.

“The social attachment system is piggy-backed onto the physical pain system to make sure we stay connected to close others,” says Naomi Eisenberger.

“Being wrenched from another or rejected by a group is painful, so we avoid it.”

There is an increased risk of dying in the six months after bereavement Professor Martin Cowie, Brompton Hospital

 

Physical pain warns us not to do something, walk on a broken ankle for instance. And emotional pain too can be a warning – “don’t go near that sort of man again”, “avoid women like her”.

But sometimes physical pain can become chronic, long outlasting its original purpose, and emotional pain is the same.

Mary Frances O’Connor calls it “complex grief” and it occurs in about 10% of people after bereavement.

“They experience a lot of bitterness and anger, that their future is senseless. They don’t adapt with time as others do.”

There is a very strong suspicion that people who are not adapting to bereavement are also those who experience the greatest levels of physical pain.

But can we die from a broken heart?

Martin Cowie is professor of cardiology at the Brompton Hospital. He is very sure of the answer: “Yes, we can.

“There is an increased risk of dying in the six months after bereavement and it’s particularly marked amongst men.”

The bereaved are much more likely to be involved in accidents, which is perhaps understandable, but also to die from heart attacks and stroke. The hormones involved in the stress of bereavement make these events more likely.

This knowledge makes it essential to identify and treat those whose emotional pain is likely to become chronic, causing debilitating depression or even death.

The Pain Of Emotion will be broadcast on Monday, 21 July, 2008 at 2100 BST on BBC Radio 4, and for seven days on BBC iPlaye