Author: Richard H. Adler

The relationship between the brain and chronic pain is not well understood. However, a 2004 study published in The Journal of Neuroscience begins to shed light on this issue. The study compared the brain morphology of 26 chronic back pain patients to control subjects using MRI brain scans. The 26 chronic back pain patients were subdivided into two groups differentiated by the pain mechanisms:

1. Neuropathic: pain because of sciatic nerve
2. Non-neuropathic: pain not related to the sciatic nerve

Patients with chronic back pain showed 5-11% less neocortical gray matter volume than control subjects. This amount of loss is significant as it is the equivalent to the gray matter volume lost in 10-20 years of normal aging. Moreover, the decreased gray matter volume was correlated to pain duration with a 1.3 cm loss of gray matter for every year of chronic pain.

The authors also found that the location of the gray matter density reduction occurred in the bilateral dorsolateral, prefrontal cortex, and right thalamus. The affected regions were “strongly related to pain characteristic in a pattern distinct for neuropathic and non-neuropathic chronic back pain.” Their results imply that chronic back pain is accompanied by brain atrophy and suggests that the pathophysiology of chronic pain includes thalamocortical processes.

The authors conclude with the hypothesis that “atrophy of the brain circuitry involved in pain perception may dictate the properties of the pain state, such that as atrophy of elements of the circuitry progresses, the pain conditions become more irreversible and less responsive to therapy.”¹

As the study shows chronic back pain can trigger the over use of the prefrontal and thalamic gray matter causing excitotoxicity and inflammation leading to the loss of brain matter, it has medical, legal, and insurance implications for health care providers, and for attorneys dealing with traumatic back injury patients in particular. The study establishes an additional basis for the healthcare provider to consider immediately employing the modalities and therapies which have proven most effective upon the onset of back pain, whether traumatically induced or otherwise, in an attempt to prevent the development of chronic back pain.

Insurance adjusters will not be aware that reducing or eliminating spinal pain is important not just for function and livelihood, but also to prevent the acceleration of brain density loss. They may be unwilling to authorize or pay for the type and extent of healthcare treatment immediately after the onset of spinal pain that will be most effective in avoiding the development of chronic back pain. Given the severity of the consequences of chronic back pain indicated by this study, it is important the patient have a legal advocate to both educate and work with the insurance companies to obtain the treatment they will require to maximize the likelihood of recovery without the long term adverse impact on their brain physiology.

It is important the patient have access to and consult with experienced, highly skilled personal injury counsel early on to make certain the insurers do not prematurely deny care or benefits. Not all attorneys limit their practice exclusively to personal injury. Those who don’t may not be well enough informed to be the most effective patient advocates. Attorneys able to provide the best legal counsel will obtain recovery for the patient of care costs, as well as for the short and long term physical, emotional, occupational and financial consequences of their condition when that condition was caused by the wrongful acts of another.

1. A. Vania Apkarian, Yamaya Sosa, Sreepadma Sonty, Robert M. Levy, R. Norman Harden, Todd B. Parrish, and Darren R. Gitelman. Chronic Back Pain is Associated with Decreased Prefrontal and Thalamic Gray Matter Density, The Journal of Neuroscience, November 17, 2004, 24(46): 10,410-10,415.