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

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