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Dear all,

Article from BBC website (my pet subject and worst nightmare relating to MS is the brain atrophy issue). Is it MS that causes brain shrinkage or the pain with MS? Over to you OddDuck.


PS If anyone out there wants to swap arthritis / Crohns disease or a combination for my MS I'd be happy to oblige. I can cope with pain - it's the brain thing that does my head in (literally) with MS.

Bromley



Pain link to permanent brain loss

Loss was related to duration of pain
Chronic pain may permanently shrink the brain, US researchers believe.
The Northwestern University team had previously shown patients with back pain had decreased activity in the same brain region called the thalamus.

This area is known to be important in decision-making and social behaviour.

The team's current study in the Journal of Neuroscience suggests some of the changes may be irreversible and render pain treatment ineffective. More research is needed, they say.

Shrinkage

If true, it makes it all the more important to treat pain early to prevent any permanent change, say Dr Vania Apkarian and colleagues.

They scanned the brains of 26 patients with chronic back pain and 26 healthy people.

The patients with chronic pain caused by damage to the nervous system showed shrinks in the brain by as much as 11% - equivalent to the amount of gray matter that is lost in 10-20 years of normal aging.

It does correspond with what other people have found.

Dr Nigel Lawes, senior lecturer in biomedical science at St Georges Medical School

The decrease in volume, in the prefrontal cortex and the thalamus of the brain, was related to the duration of pain.

Every year of pain appeared to decrease gray matter by 1.3 cubic centimetres.

What the researchers now need to find out is whether this loss is permanent or whether it can be reversed with treatment.

Dr Apkarian said: "It is possible that some of the observed decreased gray matter shown in this study reflects tissue shrinkage without substantial neuronal loss, suggesting that proper treatment would reverse this portion of the decreased brain matter."

Permanent loss?

But Dr Apkarian said other research in rats had shown that spinal cord neurons die, which suggests the brain changes could be irreversible.

Dr Nigel Lawes, senior lecturer in biomedical science at St Georges Medical School, London, said: "This is a very interesting study.

"Other imaging studies have shown in chronic pain conditions these areas of the brain are less active, so it does correspond with what other people have found."

He said the brain areas involved, which control decision making such as how to consciously move the body, might be important.

He said people with chronic back pain tended to move in automatic ways that perpetuate the pain.

Therapies to teach people how to pay attention to and control their movement to limit this pain might help, he said.

"Studies could look at whether any of these therapies improve the way they cope with their pain, do you reverse the underactivity in that part of the brain and, after you have reversed it for long enough, will that then change the brain volume?

"It might well be that it is reversible, but that depends on whether they get the right treatment or not."

Hi, bromley.

Ok, now........I'm going to TRY to help you feel less anxious about the brain shrinkage issue.

Brain shrinkage isn't only associated with MS, as you are finding. So far, there are findings that it shrinks from social drinking, ADHD, depression, some mental diseases (i.e. schizophrenia), from some medications, and it just plain can shrink as you get older. And as you just found, it can even shrink from pain, apparently.

A lot of people can have MS for many many years, and their brains don't shrink at all.

Had you not been diagnosed with MS, would you be as concerned about your brain shrinking, or would you have never given it a second thought (and your brain might have shrunk anyway and you would never have known it)?

I'm certainly not trying to diminish your concern, but I also hate to see you overly concern yourself about something that may never come to pass (you know I care and even worry about you and others quite often), and even if it does, how will you know from which association/condition that it shrunk as a result of?

On the other side of the coin, in doing some other research today regarding axons, I did run across some interesting information that it is believed now (by some researchers) that brain shrinkage (atrophy) from MS is most likely due to some degeneration or shrinkage of the axons in the brain, and not from any loss of pure "brain cells".

Also, I read additional information that says lack of physical exercise will cause your brain to shrink, which again could be associated with MS due to decreased physical activity (as or if you become physically impaired).

On the other side of the coin again, you CAN also increase your brain size (believe it or not) by doing mental exercises (thinking and doing crossword puzzles, etc.) and by incorporating as much physical exercise as is reasonable for your particular physical condition.

Now........having said all that, I hope you take from my comments that you are not simply at the complete mercy of brain atrophy or shrinkage due to MS. I believe there is quite a bit that you can do to counter-act it.

Deb

EDIT: You are not going to believe this, I just now found that jet-lag causes brain shrinkage, also.

SECOND EDIT: Oh....geez.....I forgot to mention that some medications have even shown indication of either arresting or reversing brain shrinkage.

OK...here's a quick excerpt from an article that I just grabbed real quick to help show what I'm talking about (and what you've seen Robin and I banter about regarding "plasticity"), but there are many other articles and research abstracts that you can locate that substantiate all this, too:

http://www.healthandage.com/html/min/af ... her6_2.htm

....Plasticity
On the bright side, the brain has a great capacity for adaptation, modification, and repair. The term plasticity refers to the ability of the brain to modify its structure and function. This capability continues throughout life. For one thing, there is a certain amount of redundancy in the brain. If one network of neurons is damaged or dies, another network can take over the function. The death of neurons can also be compensated for by surrounding neurons sprouting new connections to take the place of the lost ones.

The brain is a dynamic, not a static, system. The neurons respond to mental stimulation and environmental factors. And there is the capacity to respond to age-related changes. It appears likely that cognitive changes are noticed at a point when the compensatory mechanisms of the brain are unable to overcome physical changes taking place. There may be strategies, either with medications, mental exercises, or something else, to enhance the brain's natural capacity for plasticity and thus forestall cognitive declines associated with aging. ...."

Hi Bromley
For an example MND is also known to cause cognitive decline. One famous sufferer of MND is Stephen Hawking.

There are many, including myself who would argue that his is one of the great minds of our time. His affliction has not stopped him publishing seminal works.

Puts it into perspective doesn't it?

Robin

As to what is causing the shrinkage - pain or the MS itself - I think we'll have to assume it's the neuronal death caused by MS (which is what I've heard referenced in a number of talks at MS meetings). Pain isn't present in many with MS but atrophy is.

I echo OddDuck in saying that it probably isn't something to worry *too* much about given that brain atrophy is largely unnoticable unless you're getting MRIs

Stephen Hawking?! I just told my PCP at my last appointment that Hawking was my hero!



Deb