美国国家公共电台 NPR Can You Reshape Your Brain's Response To Pain?（在线收听）

STEVE INSKEEP, HOST:

About 50 million Americans suffer from chronic pain. We typically think of pain as coming from an injury or an illness. But there can be another source. Studies show repeated exposure to trauma, anxiety or depression, especially in childhood, can leave a physical imprint on the brain. This makes some people more vulnerable to feeling physically hurt. NPR's Patti Neighmond reports.

PATTI NEIGHMOND, BYLINE: Jeannine is 37 years old and lives in Burbank, Calif. She's suffered pain from head to toe since she was a child. We're not using her last name for reasons of privacy. Over the years, Jeannine's gone to dozens of doctors. X-rays and MRIs found no physical damage. She changed her diet, wore belts to correct her posture and exercised to strengthen muscles. Nothing helped.

JEANNINE: Lightning bolts kind of going up from my shoulders through my neck to my head. Then I also get this, like, grinding pain in my hips, where I feel like I can't walk anymore. It's just very painful to walk.

NEIGHMOND: She was eventually diagnosed with fibromyalgia, a disorder characterized by widespread pain throughout the body. The cause is unknown. Then, about eight months ago, a friend suggested a new type of therapy - emotional awareness and expression therapy. And Jeannine started writing in a daily journal.

JEANNINE: That paragraph I wanted to share with you here...

NEIGHMOND: In her journal, she looked backwards at the past when her health problems began.

JEANNINE: I wrote down all the different health symptoms I've had throughout my life, pain-wise, but also other things.

NEIGHMOND: Things that caused her distress. For Jeannine, who grew up in an abusive household, there was a lot to write down.

JEANNINE: If I was dressed in a way that my dad thought was too provocative, like, it wasn't anything for him to call me a whore, like, just say, well, you look like a whore today. Like, it just wasn't a - and he'd call my mother that too.

NEIGHMOND: And the aggression was also physical.

JEANNINE: Pushing, shoving, hitting and certainly a lot of belts in childhood, so spanking, you know.

NEIGHMOND: It didn't take much therapy for Jeannine to make a startling discovery. The backaches, stomachaches and headaches she suffered in childhood came around the same time as the hitting and the yelling. As a young adult, she moved out of the house. The abuse stopped, but the pain didn't. Psychologist Mark Lumley at Wayne State University in Detroit says this is the case for a number of chronic pain patients.

MARK LUMLEY: There's a growing number of studies that have followed people prospectively over the course of years trying to predict who develops chronic pain. And they show clearly that difficult life experiences, adverse experiences in childhood are later predictors of chronic pain and widespread pain years later.

NEIGHMOND: So how does this happen? Amy Arnsten is a neuroscientist at Yale Medical School. Under healthy conditions, she says, higher circuits in a part of the brain, the prefrontal cortex, can regulate whether individuals feel pain and how much pain they feel.

AMY ARNSTEN: But these higher brain circuits atrophy when we're exposed to chronic stress, especially stressors where we feel uncontrolled and frightened.

NEIGHMOND: In other words, things like fear, depression or anxiety can weaken these circuits. And if the circuits aren't working properly, then Arnsten says people can feel more prolonged pain long after a physical injury has healed. And without proper regulation, the brain can also generate pain when there's no other physical damage.

ARNSTEN: The brain actually has pathways where it can go down and control our body and actually create a pain response.

NEIGHMOND: And Arnsten says this pain is real. It can happen to adults too. But when it starts in childhood, psychologist Lumley says it can set in motion a lifetime of chronic pain.

LUMLEY: Most people don't necessarily outgrow so easily some of those difficult early childhood experiences. And even though one's life might look good now, people still remain haunted as memories of or thoughts about family come to the fore.

NEIGHMOND: This is what happened to Jeannine at a specific time every day during the week.

JEANNINE: Literally on the drive home, I would start getting pain. And so then you think, well, maybe it's because it's your long commute. You know, you are in the car for 45 minutes to an hour. Maybe it's your chair. So I had lumbar support. I had, like, heating elements.

NEIGHMOND: But in therapy, she realized it wasn't the car or the commute. It was going home.

JEANNINE: Nothing bad is meeting me here on the drive home. But when I was younger, you know, walking home, getting home was like, ugh, I got to go back there again. And it was just a dreadful feeling of now I have to go back to that environment. My house never felt like a safe place for me.

NEIGHMOND: The idea that there was a connection between her pain today and the trauma she suffered during childhood just sounded, she says, kind of crazy.

JEANNINE: To me, it just doesn't sound logical. You never - you think about pain like something hits you, something hurts, that it's physical. It's not like something hits you emotionally, and then something hurts.

NEIGHMOND: But in fact...

JEANNINE: In fact, it - that is the way it happens.

NEIGHMOND: With emotional awareness and expression therapy, Jeannine learned how to confront what had happened to her as a child. Psychologist Mark Lumley and colleagues developed the therapy. He says it helps patients face emotions like anger, sadness or loss of love that they may have suppressed at the time of abuse.

LUMLEY: And part of facing it means talking about it, giving it some expression with your words and your face and your body.

NEIGHMOND: Because when you face it, you feel more in control. And you can actually repair the weakened pathways in the brain and make them strong again. Jeannine's psychologist Laura Payne says it wasn't easy.

LAURA PAYNE: It got very tough, and the pain got a lot worse. And it became more persistent. And she continued. We just continued to push through with doing all the things that she, you know, was supposed to be doing and engaging in what she would typically avoid. And we kind of got past that. But it was a hard time.

INSKEEP: Now, this is a new therapy. And so far, the evidence of its effectiveness is largely based on one study. More research with larger studies is needed to truly gauge its worth. But Jeannine said the therapy worked for her, her pain is way down. And some days, she says, she has no pain at all. Patti Neighmond, NPR News.

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