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Pain & decisions
48188 posted:
How does pain effect your ability to make decisions Can it cause you to not make normal decisons in a high stress and high pain environment
30 Replies |Watch This Discussion | Report This| Share this:Pain & decisionsHow does pain effect your ability to make decisions Can it cause you to not make normal decisons in a high stress and high pain environment
annette030 responded:
I believe that high levels of acute pain might impede your ability to make good decisions during that moment, but chronic pain is different. I think one would need a lot more information to answer your question.
Take care, Annette
Take care, Annette
Report This| Share this:Pain & decisionsI believe that high levels of acute pain might impede your ability to make good decisions during that moment, but chronic pain is different. I think one would need a lot more information to answer your question.<br /><br />Take care, Annette
Peter Abaci, MD responded:
This is a very interesting question because most folks who are in pain find that it can interfere with how mentally sharp they feel. The experience of pain can impact brain activity in many different ways. For example, with more acute pain, the body goes through what is known as the fight or flight response. This is how we react to stress, and we can become very anxious, agitated, or sensitive when under stress and at the same time have trouble focusing and concentrating on specific tasks.
Chronic pain can also disrupt normal brain function. Research indicates that chronic pain interferes with nerve function in the central nervous system and can lead to atrophy in the brain similar to what is seen with aging.For example, a study done by Dr. Vania Apkarian out of Northwestern showed that chronic low back pain can lead to an 11% loss in brain volume, which is equivalent to the loss seen with aging over a period of 10-20 years.
There are a number of things that you can do to boost brain activity to counteract these potential changes including exercise, meditation, and challenging the brain with new things. Learning how to better manage stress will also help.
Chronic pain can also disrupt normal brain function. Research indicates that chronic pain interferes with nerve function in the central nervous system and can lead to atrophy in the brain similar to what is seen with aging.For example, a study done by Dr. Vania Apkarian out of Northwestern showed that chronic low back pain can lead to an 11% loss in brain volume, which is equivalent to the loss seen with aging over a period of 10-20 years.
There are a number of things that you can do to boost brain activity to counteract these potential changes including exercise, meditation, and challenging the brain with new things. Learning how to better manage stress will also help.
Report This| Share this:Pain & decisionsThis is a very interesting question because most folks who are in pain find that it can interfere with how mentally sharp they feel. The experience of pain can impact brain activity in many different ways. For example, with more acute pain, the body goes through what is known as the <i>fight or flight response</i>. This is how we react to stress, and we can become very anxious, agitated, or sensitive when under stress and at the same time have trouble focusing and concentrating on specific tasks.<br /><br />Chronic pain can also disrupt normal brain function. Research indicates that chronic pain interferes with nerve function in the central nervous system and can lead to atrophy in the brain similar to what is seen with aging.For example, a study done by Dr. Vania Apkarian out of Northwestern showed that chronic low back pain can lead to an 11% loss in brain volume, which is equivalent to the loss seen with aging over a period of 10-20 years.<br /><br />There are a number of things that you can do to boost brain activity to counteract these potential changes including exercise, meditation, and challenging the brain with new things. Learning how to better manage stress will also help.
Caprice_WebMD_Staff replied to Peter Abaci, MD's response:
This topic is so interesting. Thanks for your great response, Dr. Abaci!
We must let go of the life we have planned, so as to accept the one that is waiting for us.
~Joseph Campbell
~Joseph Campbell
Report This| Share this:Pain & decisionsThis topic is so interesting. Thanks for your great response, Dr. Abaci!
vesuvius13 responded:
I can tell you from personal experience that high pain levels do affect your judgment. I have learned not to agree to anything of a legal nature IE magazine subscriptions, bank issues, ETC when in high pain.
So much of your brain function is dealing the pain when you are in high pain that almost all your functioning ability is used. It doesn't allow you to put enough thought into other decisions.
So much of your brain function is dealing the pain when you are in high pain that almost all your functioning ability is used. It doesn't allow you to put enough thought into other decisions.
Report This| Share this:Pain & decisionsI can tell you from personal experience that high pain levels do affect your judgment. I have learned not to agree to anything of a legal nature IE magazine subscriptions, bank issues, ETC when in high pain.<br /><br />So much of your brain function is dealing the pain when you are in high pain that almost all your functioning ability is used. It doesn't allow you to put enough thought into other decisions.
hobart01 responded:
long term chronic pain can definitely cloud judgement and affect confidence.
After 40 yr. of chronic back/leg/feet pain I became unable to concentrate on basic tasks of my job (insurance underwriter). Confidence in my solutions dropped to the floor. I had to go on Social Security disability 4 yr. ago. This may have had as much to do with the handful of drugs I finally found to help dull the pain as the long term pain itself.
After 40 yr. of chronic back/leg/feet pain I became unable to concentrate on basic tasks of my job (insurance underwriter). Confidence in my solutions dropped to the floor. I had to go on Social Security disability 4 yr. ago. This may have had as much to do with the handful of drugs I finally found to help dull the pain as the long term pain itself.
Report This| Share this:Pain & decisionslong term chronic pain can definitely cloud judgement and affect confidence. <br />After 40 yr. of chronic back/leg/feet pain I became unable to concentrate on basic tasks of my job (insurance underwriter). Confidence in my solutions dropped to the floor. I had to go on Social Security disability 4 yr. ago. This may have had as much to do with the handful of drugs I finally found to help dull the pain as the long term pain itself.
abbismom731 replied to hobart01's response:
Speaking from experience, chronic pain greatly affects my ability to make decisions. I say things and don't even remember having the conversations. I truly get "brain fog". There are days that I am completely bed ridden and can't care for my children or myself.
I don't dare talk on the phone, handle money or anything like that. It is horrible for me and my family. The pain meds manage daily but when I have breakthrough pain, it gets real bad.
I don't dare talk on the phone, handle money or anything like that. It is horrible for me and my family. The pain meds manage daily but when I have breakthrough pain, it gets real bad.
Report This| Share this:Pain & decisionsSpeaking from experience, chronic pain greatly affects my ability to make decisions. I say things and don't even remember having the conversations. I truly get "brain fog". There are days that I am completely bed ridden and can't care for my children or myself.<br /><br />I don't dare talk on the phone, handle money or anything like that. It is horrible for me and my family. The pain meds manage daily but when I have breakthrough pain, it gets real bad.
Mpathia replied to Peter Abaci, MD's response:
Well, it doesn't take a "doctor" to know that chronic pain can very well interfere with the human body's coping mechanism. MRI's can show when pain centers are active. Neuron transmitters, dendrites, synapsis, etc... can be affected and also cause symptoms... if the brain is lacking serotonin and other chemicals; the synapsis do not connect. Many antidepressants address this. That's why many doctors prescribe these and also why many of these antidepressants have become categorized as "pain meds"; which were formally antidepressants.. Pain centers of the brain are very difficult to analyze. Management of stress becomes very difficult with chronic pain. It takes over everything. So, of course, it will affect your abilities in many areas. Adrenaline comes into play with "Fight or Flight"... which can be and is researched to going back to our early ancestors.... Relaxation techiques may help. Yoga, meditation, breathing exercising, etc., may only partially alleviate acute pain. If possible, stretching muscles very slowly may help aleve some issues. If overdone, it will exacerbate pain, so slow is better than over doing it... However, in many cases when all of these techniques are applied, they will not "take away" pain completely. If pain center are being activated, then meditation & physical therapy, etc. will not be a complete solution. Medication is also very important. However, finding the right meds or combination of meds may be difficult to assess. Good luck...
Report This| Share this:Pain & decisionsWell, it doesn't take a "doctor" to know that chronic pain can very well interfere with the human body's coping mechanism. MRI's can show when pain centers are active. Neuron transmitters, dendrites, synapsis, etc... can be affected and also cause symptoms... if the brain is lacking serotonin and other chemicals; the synapsis do not connect. Many antidepressants address this. That's why many doctors prescribe these and also why many of these antidepressants have become categorized as "pain meds"; which were formally antidepressants.. Pain centers of the brain are very difficult to analyze. Management of stress becomes very difficult with chronic pain. It takes over everything. So, of course, it will affect your abilities in many areas. Adrenaline comes into play with "Fight or Flight"... which can be and is researched to going back to our early ancestors.... Relaxation techiques may help. Yoga, meditation, breathing exercising, etc., may only partially alleviate acute pain. If possible, stretching muscles very slowly may help aleve some issues. If overdone, it will exacerbate pain, so slow is better than over doing it... However, in many cases when all of these techniques are applied, they will not "take away" pain completely. If pain center are being activated, then meditation & physical therapy, etc. will not be a complete solution. Medication is also very important. However, finding the right meds or combination of meds may be difficult to assess. Good luck...
CTBeth replied to Peter Abaci, MD's response:
Dr A,
Can you tell us more about Dr. Vania Apkarian's study? I have read some of her interesting articles regarding pain on this site:
http://www.apkarianlab.northwestern.edu/
I wonder how long and how many were studied to come up with the 11% loss of brain volume? In which part of the brain is this loss observed?
Also, from a physiological level, can,
"the number of things that you can do to boost brain activity to counteract these potential changes" actually prevent the "atrophy in the brain that is similar to what is seen with aging"?
Once brain volume is lost, can it be recovered?
If chronic pain disrupts normal brain function on a cellular level, how does Dr Apkarian suggest that boosting brain activity change atrophied tissue?
This leads me to wonder much pain for how long does it take to exhibit an 11% loss in brain volume?
Perhaps you would be so kind as to post a link to the actual article. That would be a great help.
Thank you,
CTB
Can you tell us more about Dr. Vania Apkarian's study? I have read some of her interesting articles regarding pain on this site:
http://www.apkarianlab.northwestern.edu/
I wonder how long and how many were studied to come up with the 11% loss of brain volume? In which part of the brain is this loss observed?
Also, from a physiological level, can,
"the number of things that you can do to boost brain activity to counteract these potential changes" actually prevent the "atrophy in the brain that is similar to what is seen with aging"?
Once brain volume is lost, can it be recovered?
If chronic pain disrupts normal brain function on a cellular level, how does Dr Apkarian suggest that boosting brain activity change atrophied tissue?
This leads me to wonder much pain for how long does it take to exhibit an 11% loss in brain volume?
Perhaps you would be so kind as to post a link to the actual article. That would be a great help.
Thank you,
CTB
Report This| Share this:Pain & decisionsDr A, <br /><br />Can you tell us more about Dr. Vania Apkarian's study? I have read some of her interesting articles regarding pain on this site:<br /><br /><a href="http://www.apkarianlab.northwestern.edu/">http://www.apkarianlab.northwestern.edu/</a><br /><br />I wonder how long and how many were studied to come up with the 11% loss of brain volume? In which part of the brain is this loss observed? <br /><br />Also, from a physiological level, can,<br />"the number of things that you can do to boost brain activity to counteract these potential changes" actually prevent the "atrophy in the brain that is similar to what is seen with aging"? <br /><br />Once brain volume is lost, can it be recovered?<br /><br /> If chronic pain disrupts normal brain function on a cellular level, how does Dr Apkarian suggest that boosting brain activity change atrophied tissue?<br /><br />This leads me to wonder much pain for how long does it take to exhibit an 11% loss in brain volume?<br /><br />Perhaps you would be so kind as to post a link to the actual article. That would be a great help.<br /><br />Thank you, <br /><br />CTB
annette030 replied to CTBeth's response:
I wonder what the amount of loss of cognitive function would be that would correspond with the 11% loss of brain volume. When I was a kid, it was said that we only used a small percentage of our brain cells, was that true?
Since all folks lose brain volume with aging, but do not necessarily lose cognitive function, how important is all this?
I do puzzles, exercise daily, read the paper every day. What else can one actually do to change the loss of cognitive function that MIGHT come with aging?
Thanks for the link Bet, I will go there and see what she has to say.
Dr. A, I would love to read any more info you might have on this.
Take care, Annette
Since all folks lose brain volume with aging, but do not necessarily lose cognitive function, how important is all this?
I do puzzles, exercise daily, read the paper every day. What else can one actually do to change the loss of cognitive function that MIGHT come with aging?
Thanks for the link Bet, I will go there and see what she has to say.
Dr. A, I would love to read any more info you might have on this.
Take care, Annette
Report This| Share this:Pain & decisionsI wonder what the amount of loss of cognitive function would be that would correspond with the 11% loss of brain volume. When I was a kid, it was said that we only used a small percentage of our brain cells, was that true?<br /><br />Since all folks lose brain volume with aging, but do not necessarily lose cognitive function, how important is all this?<br /><br />I do puzzles, exercise daily, read the paper every day. What else can one actually do to change the loss of cognitive function that MIGHT come with aging?<br /><br />Thanks for the link Bet, I will go there and see what she has to say.<br /><br />Dr. A, I would love to read any more info you might have on this.<br /><br />Take care, Annette
Beth/Annette,
I think one of the cool things about this forum is that it is a great way to bring together what is going on in the scientific world with the needs of the real world. Doctors usually don't have time to talk about new academic research projects going on with their patients. Here is the link to Dr. Apkarian's article as well other related articles that you might find interesting: http://www.jneurosci.org/content/24/46/10410.abstract .
There are a couple of concepts to help understand this exciting area of neurology and pain research. One is the notion of brain plasticity. This means the brain is a malleable and ever changing organ. It doesn't stay static, and we can influence how it changes.
The other concept is that of neurogenesis which means our brains have the capacity to grow new nerve cells, even when we are older. This gives us the ability to learn and adapt, and I believe help us better manage pain. I have a chapter devoted to this subject in my book "Take Charge of Your Chronic Pain."
I think one of the cool things about this forum is that it is a great way to bring together what is going on in the scientific world with the needs of the real world. Doctors usually don't have time to talk about new academic research projects going on with their patients. Here is the link to Dr. Apkarian's article as well other related articles that you might find interesting: http://www.jneurosci.org/content/24/46/10410.abstract .
There are a couple of concepts to help understand this exciting area of neurology and pain research. One is the notion of brain plasticity. This means the brain is a malleable and ever changing organ. It doesn't stay static, and we can influence how it changes.
The other concept is that of neurogenesis which means our brains have the capacity to grow new nerve cells, even when we are older. This gives us the ability to learn and adapt, and I believe help us better manage pain. I have a chapter devoted to this subject in my book "Take Charge of Your Chronic Pain."
Report This| Share this:Pain & decisionsBeth/Annette,<br /><br />I think one of the cool things about this forum is that it is a great way to bring together what is going on in the scientific world with the needs of the real world. Doctors usually don't have time to talk about new academic research projects going on with their patients. Here is the link to Dr. Apkarian's article as well other related articles that you might find interesting: <a rel="nofollow" href="http://www.jneurosci.org/content/24/46/10410.abstract">http://www.jneurosci.org/content/24/46/10410.abstract</a> .<br /><br />There are a couple of concepts to help understand this exciting area of neurology and pain research. One is the notion of brain <i>plasticity. </i>This means the brain is a malleable and ever changing organ. It doesn't stay static, and we can influence how it changes.<br /><br />The other concept is that of <i>neurogenesis </i>which means our brains have the capacity to grow new nerve cells, even when we are older. This gives us the ability to learn and adapt, and I believe help us better manage pain. I have a chapter devoted to this subject in my book "Take Charge of Your Chronic Pain."
annette030 replied to Peter Abaci, MD's response:
Thanks for the link, I read the article.
I do understand plasticity and neurogenesis, thanks for the easy definitions.
I would ask you at what point do you trust studies as far as the number of participants in the study goes? When would you think perhaps we need to do more research, and when would you consider perhaps we have done enough and try using the results clinically?
Thanks for writing a book about chronic pain, I have found many of them useful.
Take care, Annette
I do understand plasticity and neurogenesis, thanks for the easy definitions.
I would ask you at what point do you trust studies as far as the number of participants in the study goes? When would you think perhaps we need to do more research, and when would you consider perhaps we have done enough and try using the results clinically?
Thanks for writing a book about chronic pain, I have found many of them useful.
Take care, Annette
Report This| Share this:Pain & decisionsThanks for the link, I read the article.<br /><br />I do understand plasticity and neurogenesis, thanks for the easy definitions.<br /><br />I would ask you at what point do you trust studies as far as the number of participants in the study goes? When would you think perhaps we need to do more research, and when would you consider perhaps we have done enough and try using the results clinically?<br /><br />Thanks for writing a book about chronic pain, I have found many of them useful.<br /><br />Take care, Annette
I think if we take a step back, we can see that from a research standpoint, there is a heck of a lot more work to be done in understanding and treating chronic pain. I see a lot of things takes place on the treatment side based on what we think seems to make sense as opposed to basing these opinions on sound scientific studies and outcomes. A few reasons for this include the fact that pain medicine is still a very new specialty that hasn't had enough time to do lots of great scientific studies, yet, and studying chronic diseases means the outcomes and effects need to be monitored over a period of years, not days, and that type of research is difficult to fund and come by.
Certainly, studies carry more credence and more statistical value when they are done with large sample sizes. I don't think drastic changes in practice habits should come from one study alone, either, but it is important to follow trends in data over time. The old adage about medicine being an art based on science still exists, but we have to be careful how we interpret both the scientific information and our own biases and perceptions of the art. In my own personal practice, anything that gets published will get evaluated against my personal experiences of working with thousands of patients over 16 years. It is natural to have a practice style or philosophy and try to build off of that when new research or treatments become available.
I am glad this original topic generated such a great discussion!
Certainly, studies carry more credence and more statistical value when they are done with large sample sizes. I don't think drastic changes in practice habits should come from one study alone, either, but it is important to follow trends in data over time. The old adage about medicine being an art based on science still exists, but we have to be careful how we interpret both the scientific information and our own biases and perceptions of the art. In my own personal practice, anything that gets published will get evaluated against my personal experiences of working with thousands of patients over 16 years. It is natural to have a practice style or philosophy and try to build off of that when new research or treatments become available.
I am glad this original topic generated such a great discussion!
Report This| Share this:Pain & decisionsI think if we take a step back, we can see that from a research standpoint, there is a heck of a lot more work to be done in understanding and treating chronic pain. I see a lot of things takes place on the treatment side based on what we think seems to make sense as opposed to basing these opinions on sound scientific studies and outcomes. A few reasons for this include the fact that pain medicine is still a very new specialty that hasn't had enough time to do lots of great scientific studies, yet, and studying chronic diseases means the outcomes and effects need to be monitored over a period of years, not days, and that type of research is difficult to fund and come by.<br /><br />Certainly, studies carry more credence and more statistical value when they are done with large sample sizes. I don't think drastic changes in practice habits should come from one study alone, either, but it is important to follow trends in data over time. The old adage about medicine being an art based on science still exists, but we have to be careful how we interpret both the scientific information and our own biases and perceptions of the art. In my own personal practice, anything that gets published will get evaluated against my personal experiences of working with thousands of patients over 16 years. It is natural to have a practice style or philosophy and try to build off of that when new research or treatments become available.<br /><br />I am glad this original topic generated such a great discussion!
annette030 replied to Peter Abaci, MD's response:
Dr. A,
I volunteered on a state committee to study opiates when used for chronic pain about ten years ago. For various reasons we found a dearth of good head to head studies of pain meds. We used a data base of evidence based studies done in English, and found very few good ones.
We did the best we could, and commented in our report that much more study was needed.
I totally agree that medicine is an art as well as a science. I have discovered while working as a nurse, that geography seemed to have a fair amount of effect on clinical practice. Some drugs were not used at all in one state, others were used instead. I had to do my own reading to keep up with all this too. I assumed that doctors affected each other as well as reading research studies. It was amazing when new doctors moved into town with new ideas.
I hope we have many more discussions like this one.
Take care, Annette
I volunteered on a state committee to study opiates when used for chronic pain about ten years ago. For various reasons we found a dearth of good head to head studies of pain meds. We used a data base of evidence based studies done in English, and found very few good ones.
We did the best we could, and commented in our report that much more study was needed.
I totally agree that medicine is an art as well as a science. I have discovered while working as a nurse, that geography seemed to have a fair amount of effect on clinical practice. Some drugs were not used at all in one state, others were used instead. I had to do my own reading to keep up with all this too. I assumed that doctors affected each other as well as reading research studies. It was amazing when new doctors moved into town with new ideas.
I hope we have many more discussions like this one.
Take care, Annette
Report This| Share this:Pain & decisionsDr. A,<br /><br />I volunteered on a state committee to study opiates when used for chronic pain about ten years ago. For various reasons we found a dearth of good head to head studies of pain meds. We used a data base of evidence based studies done in English, and found very few good ones.<br /><br />We did the best we could, and commented in our report that much more study was needed.<br /><br />I totally agree that medicine is an art as well as a science. I have discovered while working as a nurse, that geography seemed to have a fair amount of effect on clinical practice. Some drugs were not used at all in one state, others were used instead. I had to do my own reading to keep up with all this too. I assumed that doctors affected each other as well as reading research studies. It was amazing when new doctors moved into town with new ideas.<br /><br />I hope we have many more discussions like this one.<br /><br />Take care, Annette
Lilredlora replied to Peter Abaci, MD's response:
Dr. Abaci,
I don't know about "pain" per se, but I am dealing with increasingly worsening tingling, numbness, temperature and color change in my lower left leg and foot, the last few months. I know that it is disrupting my thought processes, most notably the ability to make confident quick decisions.
Presently, I am trying a few suggestions from a vascular specialist after testing found no real circulation issues in the leg; compression stockings and elevating foot at night above heart level.
My concern is that I may have permanent nerve damage due to my left knee having undergone numerous surgeries since my late 20's. I am now 49 but do not want to lessen my activity level for a variety of personal and health reasons. I do not relish the idea of having an EMG confirm any nerve damage, especially if there really isn't anything concrete to improve my situation.
Wondering if I should just prepare myself for the inevitable, "learn to live with it" prognosis, and just continuously adjust my leg position to lessen the discomfort. Any feedback is appreciated.
Lora
I don't know about "pain" per se, but I am dealing with increasingly worsening tingling, numbness, temperature and color change in my lower left leg and foot, the last few months. I know that it is disrupting my thought processes, most notably the ability to make confident quick decisions.
Presently, I am trying a few suggestions from a vascular specialist after testing found no real circulation issues in the leg; compression stockings and elevating foot at night above heart level.
My concern is that I may have permanent nerve damage due to my left knee having undergone numerous surgeries since my late 20's. I am now 49 but do not want to lessen my activity level for a variety of personal and health reasons. I do not relish the idea of having an EMG confirm any nerve damage, especially if there really isn't anything concrete to improve my situation.
Wondering if I should just prepare myself for the inevitable, "learn to live with it" prognosis, and just continuously adjust my leg position to lessen the discomfort. Any feedback is appreciated.
Lora
Report This| Share this:Pain & decisionsDr. Abaci, <br />I don't know about "pain" per se, but I am dealing with increasingly worsening tingling, numbness, temperature and color change in my lower left leg and foot, the last few months. I know that it is disrupting my thought processes, most notably the ability to make confident <b>quick</b> decisions.<br />Presently, I am trying a few suggestions from a vascular specialist after testing found no real circulation issues in the leg; compression stockings and elevating foot at night above heart level.<br />My concern is that I may have permanent nerve damage due to my left knee having undergone numerous surgeries since my late 20's. I am now 49 but do not want to lessen my activity level for a variety of personal and health reasons. I do not relish the idea of having an EMG confirm any nerve damage, especially if there really isn't anything concrete to improve my situation.<br />Wondering if I should just prepare myself for the inevitable, "learn to live with it" prognosis, and just continuously adjust my leg position to lessen the discomfort. Any feedback is appreciated.<br /><br />Lora
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