Episode 7: New Insights for the Neuroimaging of Chronic Pain. A conversation with Dr. Vania Apkarian

Dr. Maxwell Boakye
September 1, 2021

Chronic pain impacts fifteen to twenty percent of the world and costs the population of the United States somewhere around $500 billion a year. And even though opiates are commonly prescribed to treat chronic pain, the epidemic we’re seeing from opiate addiction is staggering. There has to be a better way! That’s exactly what my guest for this episode has dedicated his life to discovering. Join me for a fascinating conversation with Dr. Vania Apkarian as we discuss what causes chronic pain, its relationship to the brain, and the future of chronic pain management.

You will want to hear this episode if you are interested in…

Defining chronic pain [1:59]
How well do we manage chronic pain? [4:20]
The biggest misconceptions about the relationship between acute and chronic pain [6:07]
Dr. Apkarian’s most significant findings on the mechanisms of chronic pain [7:18]
The role of the mesocorticolimbic system in chronic pain [13:52]
The relationship between addiction and chronic pain [16:19]
The role of learning and memory for development and maintenance of pain [18:42]
Examining the ways chronic pain changes the brain [23:42]
What Dr. Apkarian needs surgeons to know about chronic pain [26:42]
Dr. Apkarian’s most gratifying contribution to his field [29:25]

Prescribing addiction

You would be hard-pressed to find a physician who doesn’t at least have a surface-level understanding of the difference between chronic pain and acute pain. Chronic pain can be defined as pain that persists after the initial injury-related healing process ends while acute pain typically lasts no more than six months and is strictly related to the injury. The problem we run into is that too many doctors treat both types of pain the same way. This often leads to the prescription of opiates, a great short-term solution for acute pain, but a terrible long-term solution for chronic pain patients that puts them at high risk for opiate addiction. Opiate abuse is as big of an epidemic as chronic pain itself! So what do we do? Dr. Apkarian offers insights and solutions on this episode of Optimal Neuro|Spine.

When perception becomes reality

The first step to solving the chronic pain epidemic is understanding that chronic pain is different from acute pain. I’m repeating this point for emphasis because Dr. Apkarian helped me understand just how different chronic pain is! Through his research, Apkarian and his team used neuroimaging to discover that chronic pain shows up in a completely different part of the brain than acute pain does; demonstrating that the brain perceives acute and chronic pain differently. While acute pain is perceived as an external stimulus, chronic pain has more of an introspective perception and is associated with the neural circuitry that deals with emotions, motivation, and learning. This knowledge has many implications, but the most obvious seems to be treating chronic pain with prolonged opiate use is like trying to tighten a screw with a hammer: it’s just not going to work.

Pain on the brain

One of the biggest takeaways from my conversation with Dr. Apkarian is that circuitry properties in the brain change as pain becomes chronic. The constant negative emotional state that pain patients suffer from causes abnormalities in how the brain processes information as a whole. This is due to the role of the mesocorticolimbic system in chronic pain. Because the mesolimbic circuitry provides an emotional overlay of the cognitive calculations that the cortex is doing, if acute pain persists, that circuitry will push the cortical circuitry to reorganize connectivity resulting in a chronic pain state for the cortex and the patient. This kind of pain goes beyond external stimuli and becomes a much deeper and more complicated issue to treat. While current alternative treatments vary in approach and effectiveness on a per-patient basis, Dr. Apkarian hopes that one day we will have targeted medications and therapies to bring some much-needed relief to the millions who suffer from chronic pain.