Anyone who lives with unexplained chronic pain knows that it can be depressing. In fact, of the more than 47 million American adults who suffer from chronic pain—often with no identifiable cause—at least two-thirds also have depression.
It’s no coincidence, according to Gary Kaplan, DO, a pain expert who believes that the two disorders may be an important symptom of the same underlying condition—inflammation in specific cells of the brain. To learn more about his theory, Bottom Line/Health recently spoke with Dr. Kaplan.
What actually causes chronic pain? There are many possible causes, including joint or nerve damage and cancer. However, if a doctor cannot identify the origin of chronic pain or pain persists beyond the point of expected healing, inflammation in the brain could be the cause.
What role does brain inflammation play in causing pain? The brain contains different kinds of cells, among them microglia, which make up about 10% of brain cells. These cells act as the immune system of the central nervous system. If threats (see below) make it into the brain, microglia go into attack mode—they become upregulated—to destroy the threat.
While upregulated, microglia secrete inflammatory chemicals to create swelling that helps to protect the healthy brain cells. Even in relatively tiny amounts, inflammatory chemicals make us feel sick, even though the body is fighting illness. Signs of inflammation include fever, fatigue, headaches and pain virtually anywhere in the body.
What causes microglia to become upregulated? Infections (such as meningitis or Lyme)…toxins (including heavy metals, mold or excessive alcohol)…loss of oxygen to the brain, which occurs in sleep apnea…autoimmune disorders such as celiac disease…physical traumas…surgery…and chronic use of narcotics. In addition, emotional traumas—experienced due to long periods of stress, a physical assault or a car accident, for instance—can turn on the microglia. That explains why a person who grew up in an emotionally or physically abusive household is more likely to suffer chronic pain as an adult—an association that has been shown in numerous studies.
With enough repetitive assaults, the microglia can become so hyperreactive that they constantly spew inflammatory chemicals. Constant inflammation in the brain can result in not only chronic pain but also depression, anxiety disorders and other health issues.
Why does chronic pain affect only certain people? Each of us has a different level of resilience (due to genetics and environmental factors such as emotional nurturing). Some people can take a huge number of physical or mental blows and remain healthy…others can be physically affected by just a few assaults.
So how do we “turn off” the microglia that are making us sick? That’s still being researched. In my practice, however, we try to address each of the factors provoking the inflammation in the brain.
My advice for people who are suffering from unexplained chronic pain…
1. Create a time line of life and health. On one sheet of paper, write down the major traumas of your life—physical and emotional—along with the dates (or approximate dates) they happened. On another sheet, write down the dates your pain, depression or illnesses began. By comparing the two, you should be able to see a correlation between them.
2. Consider psychotherapy. If you recognize a pattern in your time line, some of your pain could be due to unresolved feelings about the traumas. Unresolved guilt, shame, resentment and anger inflame neurons in the central nervous system. But resolving these issues can reduce or reverse inflammation.
MRIs of patients who have post-traumatic stress disorder (PTSD) have shown that with cognitive behavioral therapy or eye movement desensitization and reprocessing—in which certain eye movements and discussion of the trauma are combined—neuron function can return to normal.
3. Avoid NSAIDs. Occasional use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as Aleve or Motrin, is fine, but frequent use (three or more times a week) can, over time, lead to chronic intestinal inflammation, which can spread to other organs, including the brain.
4. Ask about medication. I sometimes prescribe low-dose (1.25 mg to 4.5 mg) naltrexone (a medication that is used to treat addiction), which can return microglia to a noninflammatory state. Other drugs that may help include minocycline, an antibiotic, or an angiotensin receptor blocker, a medication that relaxes blood vessels. If you have chronic pain, ask your doctor about these.
Certain lifestyle factors can promote pain-causing inflammation. What helps…
• Test your diet. For six weeks, avoid all foods with wheat, soy, milk and milk products (foods that often trigger allergies or sensitivities that promote inflammation). Eat only fresh fruits, vegetables, brown rice, fish, chicken and eggs—these foods, in general, are the least likely to cause inflammation.
After six weeks, add back one category of food—such as dairy—per week. Note whether these foods have a negative effect on your energy, mood or level of pain. If so, eliminate that food from your diet entirely.
• Try meditation. Research shows that meditation builds new neuronal tissue and helps create a natural resilience to future trauma. Your meditation doesn’t have to be a formal program—you can start by simply sitting quietly in a room for 20 minutes each day, allowing your body to gradually relax while you focus on your breathing. Aerobic exercise and adequate sleep also help control inflammation.
