Monday, December 5, 2022

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Pain memory: when pain burns in the brain

Chronic, untreated pain can change pain processing in the brain to form a pain memory. Those affected feel pain even when the cause of the pain has long since been eliminated.

The brain has “learned” the pain and reacts to the smallest stimuli with strong pain signals. Erasing the memory of pain goes a long way – and sometimes it can fail.

Painful stimuli are activated on the skin, joints, nerves or internal organs. For example, if a wasp stings the skin, the pain stimulus is transmitted through the skin nerves to the spinal cord and from there along the spinal cord to the brain.

When it reaches the brain, the pain signal is processed in such a way that pain is perceived. Persistent and intense pain can lead to permanent changes in this communication path: the “pain sensitive” of some nerves may at some point react more sensitively and more quickly to painful stimuli in chronic pain; Pain stimuli are increasingly transmitted to the brain, and incoming pain signals can be misjudged in the brain itself, and this erroneous information can eventually be learned. A pain memory is formed.

If a pain memory has developed, the pain is literally “burned” in the head. The pain reaction is invoked by the brain again and again in response to certain stimuli, even if there is no real reason to feel pain.

“Once a pain memory developed, the pain symptom became an independent clinical picture,” explains Professor Gereon Nelles, neurology specialist at Neuromed Campus Hohenlind, lecturer at the university’s neurology clinic.

Duisburg and member of the board of the Professional Association of German Neurologists (BVDN).

“Intense pain felt over a long period of time can overstimulate the nerve fibers that conduct pain so that biochemical processes take place that change the circuitry in the brain in such a way that persistently increased pain sensitivity develops. For example, the cotton swab on the skin can trigger intense pain reactions in some sufferers. “

Not all pain carries the risk of pain memory. The likelihood is increased, for example, in the case of severe and persistent nerve pain (neuropathic pain), which can occur after nerve injury or severed nerves, such as following a serious accident. A pain memory can also form in the context of polyneuropathy, in which the peripheral nerves in the arms and legs no longer function properly. Polyneuropathy can be caused by infections, autoimmune diseases, cancer, or diabetes.

“Phantom pain is also pain that neurologists call pain memory,” says Nelles. “With phantom pain, patients feel pain in an amputated body part, even if it is no longer there. Phantom pain shows very clearly how the brain can learn and remember pain even when the pain trigger is not there. more present “.

Not only does the cause of pain, such as destroyed nerve fibers, play a role in developing a pain memory. According to the neurology specialist, pain memory formation is a very individual process.

“It also depends on how the individual constitution is: how can the person cope with the pain? What is his situation in life? What is his physical and mental constitution like? All of this interacts. Affected people often show previous mental illness, because example “, explains Nelles. “It is not possible to predict if and when a joke memory will develop. There is also no time limit for when the risk increases.”

Three factors in particular indicate learned pain:

“It can be said that pain takes on a life of its own when pain memory develops,” explains Nelles.

Once the pain is learned, it is difficult to treat. Once something has been etched into the pain memory, it cannot be easily erased. Those affected are often treated for months or years and are accompanied by analysts, neurologists and psychotherapists. The purpose of therapy is to achieve desensitization, that is, to inhibit overreaction to certain stimuli.

Pain medications play an important role in pain memory management. These work differently than “normal” pain relievers with active ingredients such as ibuprofen, acetaminophen and acetylsalicylic acid, which attach to pain receptors and block the sensation of pain.

The drugs used are intended to stabilize the nerve membranes and nerve cords and reduce the willingness to lead, so that they are less irritable. Pregabalin, for example, is a drug used to reduce the excitability of neurons in the central nervous system. It is one of the anticonvulsants that are used, among other things, for the treatment of epileptic seizures.

Antidepressants can also be prescribed for pain. “The so-called tricyclic antidepressants, which have a distancing and pain-reducing effect, are particularly noteworthy because they inhibit pain transmission,” says Nelles. “Antidepressants are also widely used because chronic pain patients are more susceptible to mental illnesses such as anxiety disorders and depression.”

Attempting to avoid actions that cause or increase pain can result in pronounced avoidance behavior. This in turn affects one’s drive, mood, thinking, and personal attitude and perception. Many are withdrawing more and more from their social environment. Pain can cause tension that can lead to mental illness.

Experts recommend treating persistent pain early to prevent it from leaving traces in the brain. With pain treatment by a specialist, the pain can usually be treated in a way that prevents the formation of a pain memory.

“If pain is not treated appropriately and a pain memory develops, there is a risk that complete freedom from pain can no longer be achieved,” says the pain expert.

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