Monday, 30 March 2015

The remarkable case of the shrinking brain

Last week, we took a broad look at the relationship between chronic back pain (CBP) and depression. While you don't need to be Einstein to deduce a potential relationship between the two, what might be less obvious is the significant extent to which such chronic pain can affect the structure and chemistry of the brain.

According to a study in the Journal of Neuroscience, reportedly the first to examine the changes that occur to the brain during chronic pain conditions, CBP actually shrinks the brain by as much as 11%  - which is about the same amount of grey matter lost in approximately 10 to 20 years of normal aging!

Researcher Apkarian, and his co-workers, compared the brain morphology of 26 healthy volunteers and an equal number of patients who had been suffering from unrelenting back pain for at least a year, using magnetic resonance imaging (MRI). Those in the CBP group experienced pain primarily localised to the lumbrosaccral region, with or without sciatica.

Patients in this latter group demonstrated a large decrease in grey matter compared with the control group. Proposing a mechanism for this observation, Apkarian suggested:
"Given that, by definition, chronic pain is a state of continuous persistent perception with associated negative effects and stress, one mechanistic explanation for the decreased grey matter is overuse atrophy caused by excitotoxic and inflammatory mechanisms."
He went on to say that the observed atrophy may be a function of an irreversible process, such as neurodegeneration, given that other research has shown that neuronal death occurs in rats with neuropathic pain.

In earlier research, Apkarian had found that back pain sustained for at least six months is accompanied by abnormal brain chemistry in the area known to be important in emotion, decision-making and regulating social behaviour.

His body of work points to tangible evidence of actual changes to brain structure and function under the influence of pain - in this case, specifically, chronic back pain. It underscores the potential need to address such pain as early as possible, so as to avoid potentially irreversible changes to the brain.

If you have patients (or perhaps are a patient) with chronic back pain, consider the expert treatment available in our back pain clinic at 96 Harley Psychotherapy. John Rutherford, physiotherapist and Giles Webster, exercise physiologist, have many years of experience in successfully treating chronic pain and work within our multidisciplinary framework to achieve extraordinary results for patients. You can read more and/or contact the clinic here,

Written by Jacqui Hogan

Friday, 20 March 2015

The link between depression and back pain

When it comes to depression, we seem to spend a lot of time, collectively, trying to figure out the cause. But there is a group of patients for whom the cause might readily be identified - those with chronic back pain.

Depression is easily the most common emotion associated with back pain. In fact, research has shown that depression and chronic pain are the two most common conditions presenting to health professionals, and the rate of major depression increases in a linear fashion with pain severity. This should make the treatment of chronic back pain a high priority, both for the individual and society at large.

It's not so difficult to see how this relationship is being mediated, when you consider the many symptoms often experienced by patients who present with chronic back, or other spine-related, pain. These can predispose to feelings of hopelessness, despair and other symptoms of clinical depression. They might include:
  • Difficulty with sleeping at night, leading to tiredness and irritability during the day
  • Restricted movement, which may lead patients to stop participating in social activities 
  • Inability to work, leading to isolation and financial difficulties
  • Gastrointestinal problems caused by anti-inflammatory medications, as well as mental dullness from pain medications
  • Mental distraction, leading to memory and concentration difficulties
The consequences on family life can also be significant. Physical limitation hampers parents' ability to take care of children, perform necessary household chores and engage in family leisure activities. Stress and strain in family relationships can then contribute to a growing depression.

At 96 Harley Psychotherapy, we are well equipped to treat patients seeking relief from back pain as well as depression, be it endogenous or directly caused by pain.

Physiotherapist John Rutherford is a leading practitioner in the treatment of back pain, and works alongside our mental health team to provide relief for those chronically afflicted. With over 25,000 back treatments to his name, there are few who can offer such expert diagnosis and equally few who can so rapidly pinpoint a course of treatment designed for a return to functional mobility. You can read more about him here.

With depression being so very prevalent, it makes sense to eliminate that which can be relatively easily treated. Allowing back pain to continue is to run the risk of feeding a downward emotional spiral which can ultimately lead the patient to feel it is impossible to change the situation.

Do you have hands-on experience of depression linked to chronic back pain? Perhaps you've experienced a dramatic turnaround with the resolution of your own symptoms? If you have any reflections on this topic, please comment - we'd love to hear from you.

Written by Jacqui Hogan

Friday, 13 March 2015

Exercise is good for your brain

We all know the benefits of physical exercise, such as sustaining and improving muscle tone, increasing circulation, keeping tissues well oxygenated and a myriad of positive long-term effects. But do we know the impact of exercise on the brain?

A recent study, published in Neurology, found that exercise has a very distinct neurological benefit which has, up until now, gone unnoticed.

White Matter Hyperintensities (WMH) are tiny areas of damage to the brain, which are age-related and frequently found in the brains of middle-aged and older people. They have commonly been associated with impaired motor function, such as difficulty walking.

In the current study, 167 elderly participants were asked to wear movement monitors to track their physical activity over the course of up to 11 days. Magnetic Resonance Imaging (MRI) scans were used to assess the volume of WMH in their brains.

The findings showed that those who were more physically active were less affected by WMH damage than those who were less active. In other words, physical exercise appeared to be protecting participants against the standard effects of age-related neural damage.

Lead author Dr Debra Fleischman commenting on the results said:
"These findings may indicate that exercise can make neural networks more resilient. Physical activity may create a 'reserve' that protects motor abilities against the effects of age-related brain damage."
That's good news for those of us who regularly take that 20 mile jog or cycle there and back from London to Hastings. But for those of us who are more inclined to inglorious couch-potatodom, there is help at hand.

At 96 Harley Psychotherapy, we are not only home to some of the world's leading psychotherapists and other psychological practitioners, but also have a whole floor dedicated almost exclusively to physical therapy, including a gym.

John Rutherford and Giles Webster, a physiotherapist and exercise physiologist respectively, specialise in helping those who are physically compromised because of.back pain, injury, ME or other conditions, restore pain-free functional mobility. They also work with those who have simply been chronically inactive and wish to improve their levels of fitness, strength and flexibility.

If this latest piece of research is anything to go by, the more we exercise, the lower our risk of succumbing to age-related neurological damage connected to poor mobility. Working at exercising optimally and regularly is one of the most important ways we can insure ourselves against future disability.

Written by Jacqui Hogan

Friday, 6 March 2015

When is depression not depression?

No one can dispute that depression is now a major public health issue, with incidences skyrocketing all over the Western world.

A new piece of research by Fried et al., published in the Journal of Abnormal Psychology, seems to offer a glimmer of hope by suggesting that depression is being over-diagnosed among the bereaved.

In the study, entitled 'From loss to loneliness: the relationship between bereavement and depressive symptoms', the researchers followed 515 married men and women over the age of 65, who lost a spouse during the observation period. They compared the depression symptoms of those who had lost a spouse with an equally large (n=241) still-married control group.

Lead author, Dr Eiko Fried, identifies the two key findings:
"First, we found that spousal loss causes a very small number of specific depression symptoms, the most important of which is loneliness. Second, we observed that these few initial depression symptoms, in turn, trigger a specific network of subsequent depression symptoms."
The implications are significant, Fried notes, because it opens the door to targeting symptoms, such as loneliness, to prevent the activation of further symptoms and possibly full-fledged depression.

One of the concerns raised by the team is the fact that the Diagnostic and Statistical Manual of Mental Disorders (DSM) in its latest edition (the DSM-5 published in 2013), actively removed the distinction between depression and natural bereavement. This has been highly controversial, since pathologising normal sadness increases the risk of labelling and medicalising those who are simply passing through the normal stages of grief.

This is not the first time the DSM-5 has been called into question. In 2013, another notable change to the text designated paedophilia a 'sexual orientation' rather than its former description as a 'disorder'. This is a radical shift, indicating as it does, that the desire for sex with children is just one other variant in the normal spectrum of sexual behaviours.

In the case of blurring the lines between bereavement and depression, it would appear that the DSM-5 has introduced the potential to put people at risk of misdiagnosis and unnecessary medicalisation; but in the case of reclassifying paedophilia as a lifestyle choice, it has potentially entered another realm.

We need more research like this to promote common-sense findings, which can make a real difference in peoples' lives and ensure they get the help they need, rather than suffer unnecessary harm. The authors are also to be applauded for shining a light on this subtle, but highly significant, edit to the DSM-5.

Do you have any thoughts on this topic? If so, we'd love to hear from you. Please comment.

Written by Jacqui Hogan