A team of Stanford neurologists have found evidence that chronic pain triggers a series of molecular changes in the brain that may weaken patients’ motivation.

“There is an actual physiologic change that happens,” said Dr. Neil Schwartz, a postdoctoral scientist who helped lead the Stanford research. “The behavior changes seem quite primary to the pain itself. They’re not just a consequence of living with it.”

Schwartz and his colleagues hope their research may someday open the door to new treatments for the behavior changes that come with chronic pain. In the short term, the research helps understanding of the biochemical effects of chronic pain, and may reassure patients who blame themselves for their lack of motivation.

Approximately 100 million Americans have some kind of chronic pain, according to the Institute of Medicine. The source varies – it could be migraines, arthritis or back pain. Cancer can cause chronic pain long after treatment is complete.

“Chronic pain is not just prolonged acute pain. There are changes that define the chronic pain condition,” said Allan Basbaum, a UCSF specialist in chronic pain research.

In a recently published paper, Schwartz and other Stanford scientists identified a molecular pathway that, at least in mice, appears to link chronic pain and decreased motivation.

“You always hear, ‘pain hurts, but pain is useful,” With chronic pain, it’s in no way useful,” said Schwartz. “I really feel like we’re looking at a failure of the system. It’s a maladaption.”

For many patients, dealing with the effects on their mood is more important to their quality of life than treating the pain itself.

Said Dr. Darshan Patel, an anesthesiologist at Kaiser San Jose Medical Center who specializes in pain management, “Are we going to come up with a magic pill that we give to patients and the motivation returns? I don’t think so. But it might help us to convince more patients to get up and do something.”     sanfranciscochroniclehealth.com    8/27/14

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