Increased Connection Of Medial Prefrontal Cortex to Nucleus Accumbens(pleasure center) Predicts Chronic Pain

Saw recent talk by Dr. Apkarian  where he noted overactivity of nucleus accumbens (pleasure center) in chronic pain – he called it “addicted to pain” (no relation to painkillers). Now this appears to be driven by increased white matter circuitry from medial prefrontal cortex (a thought center) with nucleus accumbens . This increased circuitry “robustly” predicts transition to chronic pain. They speculated that the “brain structural differences, most likely existing before the back pain-inciting event and independent of the back pain, [and] predispose subjects to pain chronification”

Pain. 2013 Oct;154(10):2160-8. doi: 10.1016/j.pain.2013.06.044.
Brain white matter structural properties predict transition to chronic pain.
Mansour AR, Baliki MN, Huang L, Torbey S, Herrmann KM, Schnitzer TJ, Apkarian AV.

  • Previous research showed that mPFC is involved in pain perception
  • Nucleus accumbens is the preasure center – lights up with various preasurable drugs etc. Apparently becomes highly lit in chronic pain
  • They took 22 patient with new low back pain “and found they could accurately predict which patients would develop persistent pain”
    as per
    JAMA  Oct 23/30 2013 310(16) p 1666
    Scientists Find Clues to Why Some Develop Chronic Pain

Comment –  I thought activation of NA was a vain attempt by brain to block the pain by making it “pleasurable” but it looks like the tracts are laid out enhanced even before chronic pain started. Could be an objective finding in chronic pain but most likely perverted by those who want to prove a subject is not in pain – (ie a malingering test). None-the-less it objectifies that people really are in pain.

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