A new Australian study has found that people who live with chronic pain experience changes to their brain which can cause negative personality changes.
The world first discovery found that people with chronic pain have smaller amounts of glutamate – the brain’s key chemical messenger – in the region responsible for regulating thoughts and emotions.
The lead author of the study, associate professor Sylvia Gustin from Neuroscience Research Australia and University of New South Wales, said that the disruptions that pain causes between brain cells can make sufferers “more negative, fearful, pessimistic or worried”.
Gustin, who is also a registered psychologist, has studied chronic pain for 20 years and says that perceived personality changes are a constant issue raised by patients.
“They say, ‘I'm not myself any more.’ And a lot of people with chronic pain are stigmatised. They are stigmatised to the level that other people say, ‘You developed chronic pain because of your personality,’ or, ‘You have a negative personality’. And this is not true,” Gustin tells Nursing Review.
Chronic pain is thought to affect 3.24 million Australians, with 1.03 million of those aged 65 years and over. It is estimated that chronic pain costs the economy $139.3 billion yearly in productivity and cost to the health system, among others.
The researchers studied participants with chronic pain and found that the lower the glutamate levels within the medial prefrontal cortex, the more a person experienced these negative personality changes.
“We know that there are structural, functional and biochemical changes in the brain, particularly in the region which is responsible for regulating emotions and cognition. And this area is called the media prefrontal cortex. And it sits directly behind your forehead,” says Gustin.
“However, we don't know exactly the process. Is it immediately occurring? Is it occurring after two weeks of pain? After four weeks? It could be very individualised. So it could be different from one person to the other. And I think it actually has something to do with stress.”
Gustin says that stress from the pain incident kills the brain cells' ability to communicate or talk properly to each other. And this results in emotional disregulation and a more negative-prone personality where people can report feeling tired, unmotivated and constantly worried.
“We know that stress really can kill brain cells because stress is increasing your levels of cortisol in the brain. And cortisol is also linked to glutamate and an increase in glutamate is toxic and can kill brain cells,” she says.
The next steps will be developing medication that can target glutamate, which may be some way off. However, in the meantime Gustin says that this research should make us rethink our approach to chronic pain.
Educating patients about the effects pain can have on personality can go some way to combating these changes and it is equally important for clinicians and carers to better understand chronic pain.
“I've talked to a lot of family members and carers and one of the most problematic things for them is that they can't help. And they're trying to help but it's not so simple. So for them, understanding what is going on is also relieving,” says Gustin.
“In regard to the medical professional, I think it's always good if we understand why people with chronic pain sometimes have more negative personalities … and understanding that hopefully helps the medical field to feel more empathy and to understand that there is a pathological reason for it.”
The research could also impact how we treat people in aged care, where chronic pain is often an issue.
“Brain function is similar between old and young people. It's biology. So, if a young person with chronic pain shows personality changes, an old person would show exactly the same.”
“With Alzheimer's and chronic pain, the changes are more exacerbated, because you have dementia and cognitive decline and that is, a lot of times, due to death of brain cells, plus pain also changes how the brain cells work.”
Gustin plans to continue her work in this area, looking at ways in which we can restore glutamate in the brain as well as developing trials using DBT (dialectical behavioural therapy) to see its effects on chronic pain.
The study Reduced Glutamate in the Medial Prefrontal Cortex Is Associated With Emotional and Cognitive Dysregulation in People With Chronic Pain can be found here.Do you have an idea for a story?
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