According to a 2023 study, approximately 21% of adults in the United States live with chronic pain. Yet, studies show that pain is often undertreated by healthcare providers, which can lead to ongoing stress in patients and long-term health complications.
The cognitive and emotional toll this puts on these patients raises an important question: how does chronic pain affect the brain?
With the right assessment tools, healthcare providers can track the impact of chronic pain on all facets of their patients’ health. Better yet, these tools can pinpoint comorbidities, and help providers identify the treatments that will improve the lives of chronic pain patients.
In this article, we’ll discuss the different types of pain, as well as:
- The parts of the brain impacted by chronic pain
- How constant pain affects cognitive function and mental health
- The connection between physical and emotional pain
- How to measure the impacts of pain on mental and cognitive health
Types of Pain
There are two different types of pain that patients display:
Acute pain typically has a sudden onset, identifiable source, and can be resolved with appropriate treatment. More often than not, it’s nociceptive pain, arising from injury or trauma to non-neural body tissue. This pain is usually localized and characterized by its intensity.
A few examples of acute nociceptive pain include:
- Pulled muscles
- Broken bones
- Labor and childbirth
- Pain during surgical recovery
Inflammatory pain is a type of nociceptive pain, and presents as hypersensitivity to the damaged tissue. This can look like tenderness, swelling, redness, or heat, and typically resolves within a few days. If the inflammation lasts between 2-6 weeks, it’s referred to as subacute inflammation.
Without the proper treatment, it is possible for some acute pain to become chronic pain over time. A thorough assessment is the key to identifying the source of pain early and making a treatment plan.
Chronic pain can be defined as any type of persistent pain that lasts for more than three months. The pain levels and symptoms can fluctuate, but if pain is constantly active either most days or every day during the three month period, it is considered chronic. When the pain experience limits patients from working and living their daily lives, it is defined as high-impact chronic pain (HICP).
Chronic pain can present differently from patient to patient, and often does not have an immediately obvious source. Typically, it comes with an element of central sensitization, heightening a patient’s pain perception.
One common type of chronic pain is neuropathic pain, which comes from damage to the nervous system. Peripheral neuropathy arises when nerves outside of the brain and spinal cord are damaged, whereas central neuropathy is caused by damage to the central nervous system. Both types of neuropathic pain can present as a widespread pain with no clear cause, and come on in the form of a “flare” or “attack.”
Neuropathic pain is typically diagnosed through an identified lesion or disease, and presents with physical pain signals including:
- Shooting, stabbing, tingling or burning sensations
- Struggling to distinguish hot from cold
- Allodynia (experiencing pain from light touch)
- Hyperalgesia (central sensitization)
- Intermittent or chronic mobility issues
Roughly 7% of the population lives with neuropathic pain, which may arise from conditions such as:
- Nerve damage
- Spinal nerve compression
- Spinal cord or brain injury
- Multiple sclerosis
- Parkinson’s disease
- Phantom limb pain
Chronic Inflammatory Pain
Chronic inflammation can arise from factors like long-term infections or prolonged exposure to foreign materials like silica dust, as well as autoimmune and autoinflammatory diseases like arthritis or lupus. The prevalence of chronic inflammatory diseases is projected to increase over the next 30 years in the United States.
Common symptoms comorbid with chronic inflammatory pain include:
- Gastrointestinal distress
- Fluctuations in weight
- Frequent infections
- Depression, anxiety, and mood disorders
- Chronic insomnia
- Chronic fatigue
While chronic fatigue and unrefreshing sleep does not always come from pain conditions, it is a factor in exacerbating them. Along with this, age, smoking, diet, weight, low sex hormones, and sleep disorders increase pain patients’ likeliness of inflammatory chronic pain conditions.
Assessing the relationship between these symptoms is crucial for diagnosing chronic pain conditions and developing individualized treatment plans.
What Happens in the Brain in Chronic Pain Patients?
Along with identifying the underlying causes of chronic pain, it is valuable to review what pain does to the brain itself. Understanding these mechanisms of brain activity and their relationship to chronic pain can help physicians identify treatment options.
Which parts of the brain are associated with pain?
There are several parts of the brain that are associated with pain, including the prefrontal cortex and limbic system. Many of these connected regions also play a role in complex cognitive processes and emotional regulation.
Pain impacting these brain regions may be associated with impairment in their respective cognitive functions. For example, when the amygdala and prefrontal cortex are impacted by chronic pain, patients can experience impaired emotion-based decision-making.
However, patients who receive social and emotional support have also been found to have increased activity in the medial prefrontal cortex, which may help to produce anti-nociception and pain management.
Cognitive, Mental, and Emotional Symptoms of Chronic Pain
Understanding and measuring the cognitive, mental, and emotional impacts of chronic pain, as well as identifying comorbidities, is beneficial to creating a pain management plan.
How does pain affect cognitive function?
In summary, over time chronic pain can have negative effects on cognitive function, including struggles with:
- Working memory
- Executive function
In one study of patients with chronic pain, two thirds of the participants performed in the clinically impaired range on an attention task. These negative effects were consistent across all ages and education levels, and were not explained by the degree of sleep interruption. Even more critically, it was found that temporary pain relief had no significant impact on performance.
Memory challenges are particularly common for patients with neuropathic pain from sources like fibromyalgia. In fact, the cognitive challenges these patients experience even has its own term: fibro fog. While classic physical pain symptoms arise in fibromyalgia patients, they often report that the cognitive impairment has the highest impact on their quality of life.
The negative impact on cognitive function can cause patients to struggle to assess risk, or identify strategies for managing their physical and mental health. This ongoing physical and mental distress can lead to complications such as pain medication misuse.
Testing cognitive function can make a significant difference in identifying the cognitive symptoms of pain-related conditions like fibromyalgia. From there, healthcare providers can make treatment plans to manage chronic pain that address both physical and cognitive symptoms.
Pain medication is also known to have potential cognitive side effects. This is where cognitive assessments can also be a critical tool in monitoring the impacts of medication, and adjusting doses as appropriate to balance pain management and healthy cognitive function.
Measure the impacts of pain on cognitive performance
How does chronic pain affect mental health?
The link between chronic pain and mental health cannot be overstated. Primary care clinics report that an average of 27% of pain patients (with reports as high as 46%) have concurrent major depression.
Sensory pain pathways tied to physical pain actually share the same brain structures that are involved with mood management, including the:
- Insular cortex
- Prefrontal cortex
- Anterior cingulate
The impact of persistent pain on patients’ quality of life can lead to a great deal of emotional changes. Pain is not just a physical experience, but also an emotional one, causing psychological symptoms. Many chronic pain patients seek psychological care.
Emotional distress can be exacerbated by factors including:
- Unpredictable pain levels
- Loss of independence
- Impaired cognitive function
- Social isolation
- The financial strain of treatment
- Unpleasant medication side effects
- Challenging patient-provider relationships
- The build-up of chronic stress
Along with depression, some of the most common mental health comorbidities in chronic pain patients include:
- Mood disorders
- Excessive or abnormal thought patterns
- Insomnia and sleep disruption
As many as 90% of chronic pain patients who attend pain management centers report at least one complaint about their sleep. This is a complex cycle to break—pain makes it difficult to sleep well, and then a lack of sleep heightens patients’ sensitivity to pain and provokes spontaneous pain symptoms.
This consistent lack of rest and increase in pain can cause a greater spike in anxiety for patients with chronic pain, as well as depression and other mood disorders. Tools like the PHQ-9 Measure for Depressive Symptoms include questions about sleep and fatigue, and help healthcare providers get a full picture of patients’ mental health symptoms.
Similar to sleep deprivation, chronic stress is both a risk factor for and a result of persistent pain, which can create a challenging cycle for patients. Measuring stress can help doctors understand the degree of stress in their patient’s life, and explore stress management strategies that can help break the loop.
Chronic pain, stigma, and systemic challenges
When it comes to measuring the impacts of stress, physicians can benefit from understanding the systemic challenges that contribute to a patient’s stress. Strategies for stress management might look different among chronic pain patients.
In other words, patients with disabilities related to brain health have to manage systemic stigma and discrimination. This stigma adds unique stressors to patient experience that strategies like meditation or journaling cannot fully address.
Along with this, healthcare providers and patients might have different perceptions of what quality of life looks like. Therefore, strategies for chronic pain patients need to address these additional challenges in addition to addressing stress itself.
Connecting with individuals about their specific experiences, as well as documenting them in session notes for future consultation, is the key to meaningfully supporting their emotional and mental health needs.
Measuring the Impacts of Pain on Cognitive Function and Mental Health
Getting a full understanding of a patient's individual experiences with chronic pain can be simplified with the right assessment tools. At Creyos, we offer healthcare providers solutions, including patient self-assessment questionnaires and objective cognitive assessments.
Our assessments can help you measure:
- Cognitive function
- Perceived stress levels
- Levels of anxiety and depression
- Mood disorders, such as bipolar disorder
- Drug and alcohol abuse
- Opioid misuse risk
- Pain medication misuse risk
- Autism and ADHD indications
These assessments can either be completed in clinic or remotely, which can ease the burden of travel for chronic pain patients. Plus, the self-assessment tools give patients the opportunity to document their experiences.
With a complete look at individual chronic pain patients’ cognitive and mental health, healthcare providers can build treatment plans that serve their unique needs. Contact Creyos for a free product demo today!
Creating Impactful Treatment Plans and Beyond
Along with isolating cognitive and mental health comorbidities associated with chronic pain, assessment tools can also measure the impact of treatment over time. It is true that the impact of chronic pain can be measured in the brain, but the brain also has the capacity to change and heal. With appropriate physical and emotional treatment, such as regular cognitive assessments to monitor the impacts of pain or pain medication, these areas can be restored.
Even if there is currently no cure for some diseases associated with chronic pain, the right tools have the capacity to address comorbidities and elevate chronic pain patients’ quality of life.