clinical focus
Pain and personality
Chronic pain can alter your brain
and character, study finds.
By Conor Burke
A
n Australian study has discovered
that people with chronic pain
experience changes to their brain
that can negatively alter their personality.
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 the 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 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 anymore.’
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 says.
Chronic pain is thought to affect over
three million Australians, with a million of
those aged 65 years or older.
It is estimated that chronic pain costs
the economy $139.3 billion a year in
productivity and health system expenditure,
among other things.
28 agedcareinsite.com.au
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 responsible
for regulating emotions and cognition.
And this area is called the media prefrontal
cortex. And it sits directly behind your
forehead,” Gustin says.
“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
dysregulation 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 that
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,” Gustin says.
“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. ■