Anatomical changes correlated with chronic pain

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Anatomical changes correlated with chronic pain in forensic medicine – Free full-text /PMC6197126/ –  Jun 2017

This article from the NIH has a good summary of physical changes that come about due to chronic pain, not just psychological “problems”, but numerous physical harms resulting from unrelieved pain.

This study was performed to determine the relationships between chronic pain and anatomic changes that may occur in the body.Autopsies were performed on fatalities that required death investigation in Linn County, IA, or adjacent and nearby areas.

Certain causes of death may also have been related to chronic pain. The heart, lungs, liver, spleen and kidneys were significantly heavier in persons with chronic pain; emphysema and pleural and abdominal adhesions were more common in persons with chronic pain.  

Diabetes, hypertension and depression were more common in persons with chronic pain.

There appear to have been diffuse changes in the body related to chronic pain. These changes may have been mediated by a number of systemic mechanisms that are involved with chronic pain, including cardiovascular activity, the immune system, the neuroendocrine system and others.

Results

Based on medical records and scene investigations, 54 persons had been diagnosed with chronic pain ante-mortem, and 320 had no known chronic pain.

The demographic data are summarized inTable 1.

The types of chronic pain encountered are listed in Table 2.

Systemic or widespread pain was the most common type, such as neuropathic pain, fibromyalgia, multiple sites of arthralgia or pain from disseminated carcinoma; musculoskeletal or site-specific pain followed, particularly chronic low back pain.

Table 1.
Subject data (case number).

Subject	Parameter/classify	Chronic (N = 54)	Control (N = 320)	Significance
Age (years old)	Mean ± SD	50 ± 13	44 ± 18	P = 0.020 4
Range	29–82	13–88	–
Sex	Men	34	224	–
Women	20	96	–
Race	Caucasian	52	269	P = 0.018 3
Other	2	51	–
Height (inches)	Mean ± SD	68 ± 4	69 ± 4	–
Range	60–75	55–77	–
Weight (pounds)	Mean ± SD	194 ± 66	180 ± 48	–
Range	101–422	55–375	–
Body mass index (BMI)	Mean ± SD	29.0 ± 9.0	26.9 ± 6.6	–
Range	15.8–52.7	10.2–57.1	–
Social	Caffeine	14	63	–
Tobacco	1	23	–
Alcohol	9	96	–
Marijuana	3	48	–
Medical	Diabetes	10	21	P = 0.006 2
Hypertension	18	52	P = 0.004 0
Psychiatric	Depression	28	60	P < 0.000 1
Bipolar affective disorder	3	8	–
Schizophrenia	0	5	–
Substance abuse	13	42	P = 0.005 2

Table 2.
Sites of chronic pain (N = 54).

Sites	Number
Systemic	20
Back	14
Abdomen	5
Neuropathic	6
Other musculoskeletal	5
Chest	2
Headache	2
Total	54

Death from natural causes was significantly more common among persons with chronic pain (chronic pain n = 28, control n = 109; P = 0.014 6).

The Cox analysis of survival showed no differences based on sex, race, height, weight and BMI.

Based on clinical factors (P = 0.000 4), systemic hypertension was significantly correlated (P = 0.000 8) with early mortality, while chronic pain, narcotic use, depression and diabetes mellitus did not appear to contribute significantly as covariates to overall survival.

This is good news: “narcotic use did not appear to contribute significantly”.

The Cox analysis using organ weights as the hazard is reported in Table 3. Chronic pain was identified as a significant covariate in heart weight

Chronic pain was also identified as a significant covariate in spleen weight, along with Caucasian race and increased body weight.

Anatomic findings from autopsy are summarized in Table 4.

All of the visceral organs were significantly heavier in the chronic pain group compared to the controls.

Table 4.
Anatomic findings.

Organs	Parameter/classify	Chronic (N = 54)	Control (N = 320)	Significance
Brain	Weight (grams)	1 340 ± 167	1 362 ± 156	–
	Cerebral oedema	11	61	–
Heart	All (non-surgical), weight (grams)	426 ± 87	389 ± 118	P = 0.032 4
	Normotension, weight (grams)	401 ± 81	366 ± 100	P = 0.046 4
	Hypertension, weight (grams)	476 ± 78	505 ± 135	–
	Cardiac hypertrophy	35	89	P < 0.000 1
	Atherosclerotic cardiovascular disease (ASCVD)	26	148	–
	Myocardial infarction (MI)	3	9	–
Pleural cavities	Adhesions	11	13	P = 0.000 1
Lung, right	All, weight (grams)	639 ± 193	569 ± 230	P = 0.036 3
	Pneumonia(−), weight (grams)	641 ± 201	555 ± 213	P = 0.012 1
	Pneumonia(+), weight (grams)	630 ± 156	848 ± 352	–
Lung, left	All, weight (grams)	557 ± 220	492 ± 197	P = 0.028 3
	Pneumonia(−), weight (grams)	568 ± 235	484 ± 189	P = 0.007 9
	Pneumonia(+), weight (grams)	501 ± 116	639 ± 283	–
	Pneumonia	9	14	P < 0.002 5
	Emphysema	21	82	P = 0.044 6
Abdomen	Adhesions	7	6	P = 0.000 7
Appendix	Present	35	250	P = 0.000 6
Liver	Weight (grams)	2 026 ± 568	1 769 ± 544	P = 0.001 9
	Weight range (grams)	1 200–3550	700–3910	–
	Steatosis	27	135	–
	Cirrhosis	4	14	–
	Hepatitis	13	62	–
Gallbladder	Present	38	283	P = 0.000 2
Spleen	Weight (grams)	245 ± 112	186 ± 107	P = 0.000 3
Kidney	All, weight (grams)	339 ± 78	310 ± 94	P = 0.037 3
	Normotension, weight (grams)	335 ± 76	301 ± 90	P = 0.033 9
	Hypertension, weight (grams)	346 ± 84	356 ± 99

 

Discussion

This study investigates whether a documented experience of ante-mortem chronic pain may have been related to anatomic changes in the body that could be observed at autopsy.

The task can seem daunting, since chronic pain does not have a single clinical signature.

It has a number of causes and presentations, although they share a common experience of persistent distress that impairs one’s experience of life, activities of daily living, work and relationships.

Yet, in opioid studies, such persistent and impairing distress is completely discounted.

It is important to consider that chronic pain is a very diverse condition arising from many aetiologies, so to consider them as a single diagnosis would be inappropriate.

Yet all opioid studies assume that all chronic pain is alike. This seems li,e a gross scientific and logical error that would completely corrupt any such study and make it meaningless.

This study furthermore appears to find that the body may undergo changes that may be correlated with chronic pain.

While many organs had interacting covariates in their size at the time of death, the heart and spleen were specifically correlated with chronic pain at the time of death, and all of the other visceral organs in persons with chronic pain weighed more than controls as independent variables.

Systemic changes may suggest systemic mechanisms that cause the visceral organs to enlarge, such as those mediated by the

• central nervous system [2,7,8,15,17,18,20–26],
• peripheral nervous system [23],
• neuroendocrine system,
• endogenous opioids and cytokines [2,20,21,23,25,26,28],
• the circulatory system including blood pressure [8,10],
• serum factors [21,35–39], and
• the immune system [2,20,21,23,25,26,28].

Under the direction of these interacting systems, chronic pain may induce stress that leads to reactive enlargement of the organs.

For example, systemic mechanisms that could enlarge the organs may include fluid redistribution to the interstitial space due to endocrine stimulation; immune cells may evoke inflammatory reactions; the central nervous system may stimulate sympathetic reactions; and others.

The significant incidence of pneumonia in persons with chronic pain could be related to decreased mobility in persons who experience ongoing pain, or the higher incidence of emphysema that was found in the pain group.

Adhesions were more common in the pleural and abdominal cavities of the pain group, suggesting systemic inflammation. Conversely, there was no increased incidence of cerebral oedema, atherosclerotic cardiovascular disease, myocardial infarction, steatosis cirrhosis or hepatitis.

The anatomic changes with the corresponding clinical or demographic correlations found in this study suggest that differences in the body are possibly correlated with chronic pain in many ways, such as

• organ enlargement,
• pneumonia,
• depression and
• increased likelihood of abdominal surgery such as cholecystectomy and appendectomy

Filed under: General Problems