Recent discoveries suggest new approach to chronic pain treatment

A new study funded by Arthritis Research UK indicates that the chronic pain in osteoarthritis patients may result from peculiarities of the way the brain processes pain signals.

The discoveries made by a team of researchers at The University of Manchester call for a new approach, including mindfulness-based therapies, that could make the brain better manage chronic pain.

Chronic pain, most often associated with arthritis, can be suffered by up to 30 per cent of people. When the pain extends to larger areas and starts interfering with their sleep, patients can find it hard to manage their everyday life and engage even in routine activities.

Up until now, the strength of pain suffered by arthritis patients has been considered to derive directly from the degree of joint destruction. But the strength of pain can be actually unrelated to the level of damage, as this pain sometimes extends to neighboring areas of the body, which are not affected by arthritis. Besides, a lot of arthritis patients with equal degree of joint destruction can experience very different degrees of pain.

The study team suggested that the increase and expansion of pain in arthritis can be similar to that during fibromyalgia, a common disorder associated with chronic pain of unknown origin resulting in interruption of sleep and depression. Previous studies had speculated that the pain in fibromyalgia patients can be a result of abnormalities in the way in which the brain experiences pain.

The researchers recorded brain waves occurring as reaction to brief painful laser impulses applied to the skin of patients with osteoarthritic or fibromyalgic pain and to the skin of patients with no pain. The records showed that anticipation of the painful impulse intensified activity in a part of the brain called the insula cortex. The activity in this brain area had been associated with such phenomena as body perception and emotional processing, which may lead to understanding why some patients experience stronger pain.

At the same time however, another area, the dorsolateral prefrontal cortex, situated at the front of the brain, showed reduced activity, which correlated to weaker ability to cope with pain in all of the tested patients.

The authors believe that the abnormalities of the brain mechanisms used to foresee pain may be similar for osteoarthritis and fibromyalgia, so a common approach may be employed to work out new therapies targeting these abnormalities and enhancing the brain’s control of chronic pain.

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