Brain May Be Hard-Wired for Chronic

The structure of the brain may predict whether a person will suffer chronic low back pain, according to researchers who used brain scans.  The results, published in the journal Pain, support the growing idea that the brain plays a critical role in chronic pain, a concept that may lead to changes in the way doctors treat patients. The research was supported by the National Institute of Neurological Disorders and Stroke, part of the National Institutes of Health.

"We may have found an anatomical marker for chronic pain in the brain," said Vania Apkarian, a senior author of the study and professor of physiology at Northwestern University Feinberg School of Medicine in Chicago.

Chronic pain affects nearly 100 million Americans and costs the United States up to $635 billion per year to treat.  According to the Institute of Medicine, an independent research organization, chronic pain affects a growing number of people.

"Pain is becoming an enormous burden on the public. The U.S. government recently outlined steps to reduce the future burden of pain through broad-ranging efforts, including enhanced research," said Linda Porter, the pain policy advisor at NINDS and a leader of NIH's Pain Consortium. "This study is a good example of the kind of innovative research we hope will reduce chronic pain which affects a huge portion of the population."

Low back pain represents about 28 percent of all causes of pain in the United States; about 23 percent of these patients suffer chronic, or long-term, low back pain.

Scientists have thought the cause of low back pain could be found at the site of injury.  However, recent studies suggest that the brain may be more involved with chronic pain.

"Currently we know very little about why some patients suffer chronic low back pain," said Debra Babcock, M.D., a program director at NINDS.  "The earlier we detect pain will become chronic, the better we may be able to treat patients."

Apkarian and his colleagues addressed this by scanning the brains of 46 people who had low back pain for about three months before coming to the hospital but who had not had any pain for at least a year before.

The researchers scanned the subjects' brains and evaluated their pain with doctor's examinations and questionnaires four times over a period of one year.  About half of the subjects recovered at some time during the year; the other half had pain throughout, which the researchers categorized as persistent.

Previously, the Apkarian laboratory showed that the volume of grey matter in the brains of the same subjects who had persistent pain decreased over the same year.  Grey matter describes the area of the brain where the central bodies and branched antennae, or dendrites, of nerve cells reside.  They also showed that brain activity could be used to predict whether a subject recovered or experienced persistent pain.

In this study, the researchers used a scanning technique called diffusion tensor imaging, which measures the structure of white matter, the nerve cell wires, or axons, which connect brain cells in different parts of the brain.  They found a consistent difference in white matter between the subjects who recovered and the subjects who experienced pain throughout the year.

"Our results suggest that the structure of a person's brain may predispose one to chronic pain," said Dr. Apkarian.  


Lifestyle intervention boosts teens' health, social skills, grades

A teacher-delivered intervention program promoting healthy lifestyles improved health behaviors, social skills, severe depression and academic performance in high school adolescents, a study has found.  Routine integration of such programs into health education curriculums may be an effective way to prevent high-risk teen populations from becoming overweight or obese, and could lead to improved physical health, psychosocial skills, and academic outcomes, according to the study.

The study, supported by the National Institute of Nursing Research, part of the National Institutes of Health, appears in the online September issue of the American Journal of Preventive Medicine.  It is one of the first studies to report multiple immediate improvements that were sustained over time using a teacher-delivered, cognitive-behavioral skills-building intervention program incorporated into a high school health education class. Cognitive-behavioral skills training teaches coping techniques, social functioning skills, and problem solving skills.     

The randomized controlled trial examined the short- and long-term effects of the COPE (Creating Opportunities for Personal Empowerment) Healthy Lifestyles (TEEN) Thinking, Emotions, Exercise, Nutrition Program. The COPE TEEN program is an intervention targeting obesity, social skills, and mental health. The study was led by Bernadette Melnyk, R.N., the Ohio State University's chief wellness officer and dean of the College of Nursing.

"Nutrition and physical activity-based interventions are often tested when it comes to preventing obesity, but mental and psychosocial health can also be contributing factors," said NINR Director Patricia Grady. "This NINR-supported study highlights the importance of an evidence-based lifestyle intervention that addresses the complex interplay of these factors."

The researchers measured healthy lifestyle behaviors, body mass index, depressive symptoms, social skills, and the academic performance of 779 culturally diverse 14- to 16-year-old high school students, randomized to receive the COPE TEEN program or an attention control program. At the end of the program, COPE TEEN participants had significantly higher levels of physical activity, as measured by daily pedometer steps (an average of 13,861 steps per day compared to an average of 9,619 steps per day), and had a significantly lower mean BMI than the control group.  

COPE TEEN adolescents scored higher averages on a social skills scale measuring cooperation, assertion, and academic competence, and earned higher grades in the health course in which the intervention was given. They also reported significantly lower levels of alcohol use than teens not receiving the intervention (13 percent vs. 20 percent, respectively). Students with high depression scores prior to the intervention showed significantly lower depression scores that dropped from severe depressive symptoms into the normal range following COPE compared to similar students in the control group.

Overall, the study results suggest that combining health education with cognitive-behavioral skills-building may be an effective way to prevent and treat overweight and obesity in teens.