Pain and DepressionAnalysis of my mother’s

chronic pain

By T.Y13 July 2014

Final Project for “Understanding the Brain: The neurobiology of Everyday life”

Introduction Last May when I was hit by dehydration one

couldn’t help thinking about what was going on in my brain even amused by it during the events of nausea and headache.

From these events, I realized that learning about brain is learning about my own self and peoples around me.

My 78 years old mother was recently released from upper back pain with the help of antidepressants.

This lead to the current research into pain to understand my mother’s experience.

Mechanism of Pain Mechanism of Pain Modulation The Relationship of Pain and Depression Analysis of my Mother’s Pain Summary Acknowledgements Reference

Contents

Mechanism of Pain (Transduction)

Pain Producing Substance

Pain receptor(Nociceptor)

noxious stimulus

Ion channel open

MechanicalChemicalThermal From damaged

cell K+

H+

ATPFrom blood Bradykinin Serotonin Histamin

Others Prostaglandin Cytokine SubsatnsP

Primary neuron excited

Mechanism of Pain 　　　　　　　 (Transmission 　＆　Perception)

Thalamus

Neocortex(somatosensory cortex)

Limbic system

ouch

emotion

Brainstem

Hypothalamus

Spinal Cord

Nociceptor

Dorsal Root Ganglia

Pain Producing Substance

Mechanism of Pain 　　　 (Axson Reflex)

Thalamus

Neocortex(somatosensory cortex)

Limbic system

ouch

emotion

Brainstem

Hypothalamus

SubstancePCGRP

VasodialationTo collect white blood

cell

Spinal Cord

Nociceptor

Dorsal Root Ganglia

Pain Producing Substance

Thalamus

Neocortex(somatosensory cortex)

Limbic system emotion

Brainstem

Hypothalamus

Spinal Cord

Nociceptor

Dorsal Root Ganglia

sympathetic nerves

NA

 vasoconstriction 

ouch

Pain Producing Substance

Mechanism of Pain 　　　 (Sympathetic nerves Facilitation)

Mechanism of Pain Modulation

Thalamus

Neocortex(somatosensory cortex)

Limbic system emotion

Brainstem

Hypothalamus

Spinal Cord

Nociceptor

Dorsal Root Ganglia

Pain Producing Substance

β-endlphine

GABA

Midbrain(PAG)

PONS(nucleus raphes magnus)

Serotonin

PONS(locus ceruleus)

Noradrenaline

descending pain control pathways

Relationship between Pain and Depression

Pain causes more pain.Pain causes stress.Stress causes more pain.

Stress Stress Stress

Depression

The experience of the chronic pain cause neuroplasticity .-- strengthening nerve connections or adding new nociceptor

More pain, more stress

The continuous stress weakens the descending pain modulation system.

Sympathetic nerves facilitation

Pain

Stress

vicious cycle of pain

The back pain was not from her back but from her brain

Analysis of my Mother’s pain

<Detail>

<Symptoms> She could not look down because that caused strong pain.

My mother’s back pain started in November 2013.

The pain accelerated and by the new year of 2014, she could hardly cook for looking down caused terrible agony on her back.

In March 2014, her jaw started to ache. She went to a psychotherapist and started

to take antidepressant medicine in April 2014.

The back pain was not from her back but from her brain

Analysis of my Mother’s pain

<Result of the treatment> First 5 weeks, Mother felt very sleepy much of the

time, but realized the back pain was softer.

Late in June 2014, she said “ Today I cleaned up the toilet of the house. Can you imagine how happy I am ? Because it was the first time in about 6 month!!”

The back pain was not from her back but from her brain

Analysis of my Mother’s Pain

<What was wrong with her ?> My mother’s severe back ache was a result from the

vicious cycle of pain.

<What was her original stress> Colonic diverticulitis: caused continuous pain for

last 2 years. High blood pressure : for last 6,7 years.

Increasing deafness: caused communication difficulties for last 2,3years. Diverticulosis happens when pouches form in the wall of the colon. If these pouches get inflamed or infected, it is called diverticulitis. Diverticulitis can be very painful( by WebMD)

The back pain was not from her back but from her brain

Analysis of my Mother’s Pain

<What made it worse ? Secondly stress> Relation with her doctor : Her doctor does not

understand her pain from the diverticulitis.

Diminishing hobby : the pain prevented her from sitting in front of the computer to edit and share her photos.

Pain itself: “What else could be more stressful than the pain prevent you from looking down for 6 months!!” – by My mother

Analysis of my Mother’s PainThe back pain was not from her back but from her brain

How the medicine work to her painSNRI： Serotonin & Norepinephrine Reuptake Inhibitors

Prevent Noradrenaline to be uptaken

More Noradrenalin to be used for

modulate the pain

More serotonin to be used for

modulate the pain

Prevent Serotonin to be

uptaken

It helps the descending pain control system

It is very hard to convince oneself the physical problems are caused by your own brain when you having severe pain.

A person with chronic pain even if he/she is not showing explicit symptoms of depression, but implicit symptoms of depression could be progressing in the body.

Dealing with old people’s pain is very important because dementia is believed to have some relationship with depression.

Summary

Many thanks for the wonderful lectures by Professor Peggy Mason, your passion for understanding the brain really made me amused . And thank you for all of the staff of the University of Chicago and Coursera.

Thanks to my mother who had been suffered severe pain, but always showed her happy face to me when I visited her.

Thanks to my husband for setting up the studying desk and encourage me to research new things. Now I will do bit more housework.

Thank for Weblio which is free english-japanese dictionary site. Without it I could never finished the course. (Weblio: http://ejje.weblio.jp/)

Acknowledgements

Reference

Web Site Pain Relief: http://www.shiga-med.ac.jp/~koyama/analgesia/ (Japanese)Karada no shikumi: http://blog.physicalsupportnagoya.com/ (Japanese)MNT: What is serotonin : http://www.medicalnewstoday.com/articles/232248.php

WebMD : http://www.webmd.com/TheBrain From Top To Bottom: http://thebrain.mcgill.ca/Wikipedia and Many other websites