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Chronic pain precedes disrupted eating behavior in low-back pain patients
The influence of chronic pain disorders is not limited to somatic symptoms, but extends to causing behavioral alterations, as seen with anhedonia (i.e., loss of ability to feel pleasure) and observed reductions in motivation occurring alongside chronic pain. These behavioral alterations are postulated to occur due to cerebral limbic system dysfunction (responsible for regulating survival functions like eating), which would explain the concurrent obesity seen in chronic pain patients. The mechanisms governing the relationship between behavioral alterations, limbic dysfunction, and chronic pain are not well known to date. Thus, Lin et al. (2022) sought to investigate whether eating behavior is altered through the transition from low-back pain to chronic pain in some patients compared to others who recover from low-back pain, and whether the changes seen in the hedonic approach to fat-rich foods (i.e., the action of seeking fatty food, motivated by pleasure or by escapism from pain) seen in chronic pain patients is related to derangement in the nucleus accumbens (which is the cerebral juncture between motivation and behavior). The authors’ working hypothesis is that the nucleus accumbens, a central part of the limbic system, is responsible for the hedonic drive towards fat-rich food in patients suffering from pain, due to its function in survival behaviors. Thus, the authors conducted behavioral assays and structural brain imaging to investigate sub-acute back pain (SBP) patients and healthy controls, at the beginning of the study and at one year during follow-up, and acquired further data from chronic low-back pain patients (CLBP). The authors discovered that SBP patients who recovered from pain at the time of follow-up (SBPr) and CLBP patients displayed deranged dietary habits, compared to SBP patients who still had persistent back pain at follow-up (SBPp), who were found to display intact dietary habits. Through neurological examination, SBPp and CLBP patients displayed significant links between hedonic insight of fatty food and the volume of the nucleus accumbens, denoting that the alteration in nucleus accumbens seen in SBPp patients outlined in published literature might provide a protective effect from hedonistic behavioral derangements during the preliminary trajectory of the disease process. The authors thus conclude that disruptions seen in the eating behaviors occur after the disease course becomes chronic and that these disruptions are linked to alterations in the nucleus accumben’s structure. [NPID: Sub-acute back pain, chronic back pain, eating behavior, limbic dysfunction, hedonic perception]
Year: 2022
