For two decades, opiates have become a major way Americans treat chronic pain. Of course, bad side effects and addiction often accompany opiate use. But what if there was another way to fight chronic pain?
Philip Allen, Ph.D., and his colleagues at The University of Akron’s Conquer Chiari Research Center (CCRC) are exploring the effectiveness of alternatives to opiates and pain relief medicines by using his research in one clinical disorder, Chiari Malformation Type I, which causes chronic pain in thousands of people every day.
Because this is a little-known disorder with little research carried out on cognitive symptoms, much of The University of Akron and Allen’s research is critical to those around the world, and it’s all available in OhioLINK’s Electronic Journal Center (EJC). Allen himself gains tremendous insight from the research available in the EJC.
“I can search for oodles of journal articles, I can get up-to-the-minute stuff, whereas in the past it would take hours of extra work locating this information,” said Allen, who was a research presenter at OhioLINK’s 25th Anniversary celebration at the Ohio Statehouse. “I started my career in academia in Ohio at Cleveland State University in 1989; it would have taken me at least 10 times as long to do background searches on topics as it does today and my present research would have been delayed for several years. What OhioLINK is doing has allowed students to start research like this as a freshman, stuff that even professors couldn’t do 20 years ago.”
Allen, the non-STEM research director and professor of psychology at The University of Akron, researches cognitive aging and Chiari malformation. Chiari malformation is a medical syndrome in which the bottom part of the brain, the cerebellum, sinks into the top part of the spinal column. This causes extreme headache pain for the estimated 350,000 people who suffer from symptomatic CM.
Until recent years, there was not a lot of research into possible cognitive deficits associated with CM. However, Allen and colleagues at CCRC have helped spearhead research into this area.
When Allen began studying CM, neurosurgeons and neurologists lacked conclusive evidence concerning cognitive deficits in CM patients. Also, even if there were such cognitive deficits, it was unclear whether they were due to damage to the cerebellum or brainstem, or whether potential cognitive effects were due simply to chronic pain. Allen and colleagues have provided conclusive evidence that individuals with symptomatic CM have cognitive effects. Whether cognitive deficits are caused by brain effects separate from pain is still being studied.
“When you have chronic pain, the pain is always in the background or foreground messing up your life,” Allen said. “It’s an attention task, you have two potential things on which to focus: The one you want to pay attention to, like remembering to go to the dentist, and the one in the background distracting you—pain. Now, let’s thicken the plot, in the last 20 years we’ve used opiates to treat chronic pain.”
Pain relievers such as aspirin and ibuprofen work peripherally as anti-inflammatories to prevent swelling, thus fighting pain—but they do not always control severe pain. Opiates, however, work centrally, meaning you still feel the pain you just don’t care about it. However, over time, opiates tend to lose their effectiveness and have strong, potentially dangerous, side effects.
In the same way opiates work, yoga-like mindfulness interventions like ACT (acceptance and commitment therapy), have been shown to help some chronic pain sufferers learn to focus on a task rather than the pain they’re constantly feeling. Additionally, this intervention does not appear to become less effective over time, as opiates do.
Results from a 2018 study on individual differences in reflection, a measure of self-focused attention, seem to indicate individuals with stronger focusing abilities are better able to inhibit focusing on pain, and instead to focus on another task, such as remembering to go to the dentist.
Specifically, one group of Chiari patients with high levels of reflection was able to remember information better than Chiari patients with lower levels of reflection. However, in this study, Chiari patients with particularly high levels of pain still showed memory deficits even with high levels of reflection.
One possibility is a specific training program such as ACT might help even Chiari patients with severe headache pain to better inhibit distraction caused by this pain. This fall, Allen and colleagues at Kent State University will be conducting a web-based ACT intervention using Chiari malformation patients to test whether ACT does result in a more effective pain intervention than just individual differences in reflection.
“You have a limited amount of attentional resources and sometimes pain can grab all of the attention,” Allen said. “We have to learn ways of focusing on things we need to focus on, and inhibit these things sitting in the background like pain that can have catastrophic affects.”
Allen and his team, in collaboration with physicians at the Cleveland Clinic and Johns Hopkins University, are examining the different brain-based fiber-tract effects in Chiari malformation — those associated with cognitive effects and those associated with pain. This will allow Allen and colleagues at the CCRC to better understand the nature of cognitive and pain effects in CM. One additional aspect of this research is that it also has the potential to obtain more insight into pain such as migraine headaches.
“We have a large program of research that came out of a rare disease,” Allen said. “We have discovered some very interesting ways to study the effects of acute and chronic pain on everyday life, such as cognition, working at your job, driving your car, and quite honestly staying in a relationship or taking care of your kids. You’re not going to do that very well if the pain is distracting you from other important daily tasks.”
Written by Ross Bishoff