Thursday, July 1, 2010

Gray matter atrophy?

I've been bothered a lot by my cognitive changes over the last 10 years, which seem to get worse daily. I'm almost 40 so I shouldn't be having much, if any issues with memory, etc. However, those of us with EDS (and people with Fibromyalgia) know that it is all too common to lose thoughts, feel foggy, forget everything, and generally feel stupid. It is very frustrating to me that I cannot remember things that were once very important to me - for instance, I hear something interesting on the news (NPR) and then can't bring it into a conversation later that day. The only condition in which my memory doesn't seem to fail me as much is when there is a visual cue attached to it, which is very helpful especially when I need to find something I misplaced! At this point, how much of what I feel is from the pain, from the meds, or from EDS?

Anyway, because of where I work and my general interest in reading scientific literature, I've heard a lot about gray matter atrophy and chronic pain lately. Basically, the outer part (gray matter) of the brain shrinks and loses volume - it ages prematurely. In depression, treatment with anti-depressants can reverse some of the damage/shrinkage in the hippocampus. Is there anything that can help with pain-related damage to the gray matter? One of the articles below seems to suggest that pain management might be helpful.

I wish I understood this topic better and hope there is someone out there who can alleviate my fears of losing my cognitive skills/function at too early of an age. Maybe there will be someone at the EDNF conference this month who can address this issue? Without hope, there is nothing. 

"The function of gray matter is to route sensory or motor stimulus to interneurons of the CNS in order to create a response to the stimulus through chemical synapse activity. Grey matter structures (cortex, deep nuclei) process information originating in the sensory organs or in other gray matter regions. This information is conveyed via specialized nerve cell extensions (long axons), which form the bulk of the cerebral, cerebellar, and spinal white matter." Wikipedia

"As gray matter decrease is at least partly reversible when pain is successfully treated, we suggest that the gray matter abnormalities found in chronic pain do not reflect brain damage but rather are a reversible consequence of chronic nociceptive transmission, which normalizes when the pain is adequately treated." J Neurosci. 2009 Nov 4;29(44):13746-50. 

"Local morphologic alterations of the brain in areas ascribable to the transmission of pain were recently detected in patients suffering from phantom pain, chronic back pain, irritable bowl syndrome, fibromyalgia and frequent headaches. These alterations were different for each pain syndrome, but overlapped in the cingulate cortex, the orbit frontal cortex, the insula and dorsal pons. As it seems that chronic pain patients have a common "brain signature" in areas known to be involved in pain regulation, the question arises whether these changes are the cause or the consequence of chronic pain. The in vivo demonstration of a loss of brain gray matter in patients suffering from chronic pain compared to age and sex-matched healthy controls could represent the heavily discussed neuroanatomical substrate for pain memory." Schmerz. 2009 Dec;23(6):569-75.[in German]


  1. I was just talking with my therapist the other day about how frustrating it is to be losing my memory! In high school I was an honors student, less from diligent effort and more simply because I had a fantastic memory for anything I hear or write. But these days I can't retain anything! I found this interesting because I had never heard anything about pain physically altering the brain... I always assumed it was just the increased stress of dealing with the pain that caused our foggy mind.

  2. Given those quotes, I wonder whether chronic pain-related shrinkage may be because we have so much sensory stimulation coming in through the nervous system. I know that when I've pushed myself through the pain too far, every sensory input becomes painful until my CNS overloads; I end up vomiting and even passing out if I keep pushing.

    The brain and central nervous system are fascinating, and while we know a lot, there's so much we don't know yet. Like Maria Juanita, I'm actually relieved to read that there are physical changes that cause the brain fog. I've felt like I should be able to overcome it, and like I must be weak because I can't.

    Thank you for this post!

  3. I agree this is fascinating. I always thought it was fatigue and various meds that caused the fogginess. I work online so everything is organized and filed where I can get to it when needed. Several years ago I even started saving emails from everyone I communicate with so that I can go back and jog my memory about events and conversations. Thank goodness for the search feature on my email program!!

    Mine gets worse depending on pain level which determines pain meds. When I'm not on pain meds then my memory seems fine. I do remember some things better than others regardless of pain meds.

    So I'm sure I'm totally on board with the brain matter thing. If I'm in pain and for some reason (like driving) I don't take pain meds, I have no problem with memory. Also the more days I take pain meds, the foggier I get. And the longer it takes to return to normal after backing off the meds.

  4. Yes, it's so frustrating when you come from a background of rated intelligence (ie: graduated cum laude from university) and now I feel so clueless too much of the time. I am scared, however, that I'll never get back to a point where I feel intelligent and can remember things.

    Sherlock: I don't have a real choice about being on meds or not now, though I have noticed that I feel different on one vs another. When my pain was managed solely on tramadol, I could think clearly and had a bit more energy (seratonin boost?), but now I am on a long-acting pain med because the tramadol wasn't enough.

    My doc thinks a lot of my foggy brain issues have to do with pain management and that, even though I may not be feeling much pain on the long-acting med, I could still be having enough baseline pain that my brain fogs. So, tramadol is a breakthrough drug for acute pain but it is also for when my brain is goofy to the point of dysfunction. I am more of a danger driving without meds while being in pain than with them and feeling little pain.

    Heather wrote: "I've felt like I should be able to overcome it, and like I must be weak because I can't." I've been able to let go of this attitude when it comes to my EDS and depression, but the brain fog is a big struggle for me. I think some people around me, like my boss and husband, know I am more intelligent than I see myself but they didn't know me "before". It's been hard to let go of things I used to be excellent at remembering, like paying bills on time! My hubby has to do that now and I feel bad that I don't help out in this respect. It's all for the better, I suppose - we don't want late fees.

    Also, I agree with Sherlock: "Several years ago I even started saving emails from everyone I communicate with so that I can go back and jog my memory about events and conversations. Thank goodness for the search feature on my email program!!" I completely relate! I don't know what I'd do without email and search functions! They seem to make up for my brain's incapacity, though I do have to remember where I put files on occasion. :D

    Thanks for your input! It's an interesting topic and I welcome your thoughts.