Is pain all in the mind?

Today’s Times reports how new medical technology suggests that the best way of treating chronic pain is with CBT style brain re-training rather than with drugs.

Chronic pain affects nearly eight million people in the UK and as well as being debilitating and distressing for the people affected, costs the economy more than £12 billion a year in disability and care costs.

Professor Irene Tracey of the Oxford Centre for Functional Magnetic Resonance Imaging of the Brain, is pioneering a new scientific understanding of pain which reveals how we may be wrongly treating millions of patients who suffer it every day.

Until now, pain has been seen as a symptom. But it is a disease in itself, argues Tracey: one that can cause serious brain damage. She and a growing number of specialists are using hi-tech imaging scanners to reveal how medicine often tackles pain from the wrong perspective. The source of the problem is in our heads — and as such, the way we treat it needs to be radically reassessed.

Powerful modern medical scanners mean that we can now see our pain responses in detailed action. The brain scans also reveal how our mood, attitude and beliefs all determine how we experience pain. “When you are anxious or depressed, it can make pain worse,” says Tracey. “When you are distracted, enjoying a song or movie, it does not feel so bad.”

The long-term effects of negative beliefs may create a devastating spiral. The more anxious, stressed and depressed you become about your pain, the more you may physically rewire your brain’s architecture so that it ultimately becomes hypersensitive to physical stimulus.

To break the stress-anxiety-pain cycle, chronic pain sufferers need to be given emotional support early on. University Hospital Leicester, for example, offers a two-month pain-management programme based around cognitive behavioural therapy (CBT) rather than drugs.

The Leicester course is run by Dr Beverly Collett, a consultant in pain medicine for 24 years. “In many of my patients it is not possible to find any physical cause of pain in the area that seems to be affected. I see people with constant back pain whose back-scans show up as normal. I see women with chronic pelvic pain who test negative for conditions such as endometriosis,” she says. “But we know now that in persistent pain, calcium and sodium signalling channels are activated in the spinal cord and brain. Once you start these cells firing, they continue to fire.”

This theory has signifiant implications for how we treat pain. Will people readily accept that therapy and not drugs are the answer? I can’t help thinking that many people will resist the idea that “the pain is in their head” and seek CBT only as a last resort once they have exhausted all the medications available.

To read the article in full, go to:

http://www.timesonline.co.uk/tol/life_and_style/health/features/article7054236.ece