So a lot of people with Endometriosis suffer from chronic pain…hell, a lot of people without Endometriosis suffer from chronic pain.  There are theories and studies out there that suggest chronic pain affects memory, cognitive function, and mental health.  Not only does Endometriosis present painful symptoms, but it’s also incurable.  And there are many people who do not get any symptom-relief from any of the treatments available.  You can see where this may cause some “mental health” issues.  Here’s some interesting tidbits on how pain affects brain activity and function.

What is gray matter all about?  It maintains memory, sight, hearing, emotions, speech, impulse control, and executive functions (reasoning, problem solving, cognitive functions, etc.).  Gray matter volume naturally decreases with age.  So…it happens naturally.  Chronic pain may just spur it along a bit more.  Studies have indicated that children who suffer from chronic pain have a greater loss of gray matter volume when they are adults.

A study published in January of 2016 found that women with chronic pelvic pain may suffer from hyperalgesia (a heightened sense of pain), as well as a decrease in gray matter in pain-processing areas of the brain…a change of brain chemistry.  Several published studies also found that chronic pain affects the brain and disrupts cognitive function, especially memory.  A 1997 study found that people who suffer from chronic pain may exhibit post-concussive symptoms, such as disturbed sleep, fatigue, irritability, forgetfulness, and difficulties paying attention, focusing, and thinking. None of the people in the 1997 study suffered from a head injury.

Complain a lot about brain fog?  Trouble remembering things? Not feeling yourself?  Well, perhaps this explains why…

In 2015, the Endometriosis Foundation of America invited Sawsan As-Sanie to speak at their Sixth Annual Medical Conference.  She confirms findings that women who suffer from chronic pain have decreased gray matter volume in the areas of the brain that process those pain responses.  These women also exhibited altered brain chemistry and function.

Suffering with chronic pain may also, understandably, affect your choices to do certain things.  A May 2016 study found that women with Endometriosis and severe pelvic pain “may display a tendency to avoid new potentially risky situations…to experience pessimistic worries, fear, and inhibition…and to perceive themselves as unable to manage problems and obstacles which are considered as caused by external circumstances…”  The more severe the pain, the higher the harm avoidance and “lower the self-directedness.” It also found that women with severe pelvic pain were more fatigued, which may be the body’s response to pain, rather than a symptom of the Endometriosis.  This fatigue-response may also lead to depression and increased stress.

What?  English, Lisa, English!  I interpret this as saying some women with chronic pain and Endometriosis find themselves more tired, less motivated, and scared to do things for fear of making their pain worse.  Sound familiar?  I’d also like to add in an inability to get off the couch or out of bed…or off of the floor…to do things.  There’s a reason why we cancel social calls, dates, dinners, parties, call in sick to work, etc.  Is it because we’re wimps or pussies? No.  It’s because we’re in severe pain.

That same study suggests that, “endometriosis patients with chronic pelvic pain who are high in harm avoidance and low in self-directedness represent an at risk population for physical and psychological suffering. Due to high harm avoidance, these women are more likely to be constantly worried and perhaps focused on their pain sensations, with increased fear and anticipation of disability, which may cause significant limitations to normal activities. Low self-directedness involves low self-efficacy, such that these women may perceive themselves as unable to manage the disease and its symptoms. Pessimistic worries, hypervigilance toward pain, fear, and hopelessness may not only influence pain perception, but also hinder the effectiveness of therapy by affecting women’s responses to treatment.”  The authors hope that their study leads to further research about treating the mental challenges of Endometriosis.   Albeit a small study consisting of 133 Italian women, it’s a stepping-off point for the need for broader research in this area.

A 2015 study linked chronic pain and stress with decreasing the volume of the Hippocampus, which is also linked to depression.  Stress causes inflammation, which, in turn, weakens the immune system, which may cause pain to flare-up, which continues to alter the brain’s chemistry and deteriorate gray matter volume.  The study also states that chronic pain affects cognitive function, which we discussed above.  It’s a snowball…

A 2017 study stated that even in a “resting state,” the brain may reserve a certain amount of activity for dealing with pain and pain-related issues, which may effect cognitive and emotional function.

Ways to Increase Gray Matter Volume

You may be reading this freaking out screaming, “My brain is shrinking?”  Don’t fret.  A 2010 study offers hope for your squishy-bits-of-gray.  The authors followed-up with patients who had surgery and were now pain free (theirs was hip-related chronic pain; not Endometriosis).  Once pain free, their gray matter volume began to increase.  The authors theorize that gray matter decrease is partially reversible with pain management.  It can bounce back!

Worried about your possibly shrinking brain?  There are several ways you can increase your gray matter volume:

• exercise
• yoga
• meditation
• physical activity
• social interaction
• nutritional diet
• Omega 3 fatty acids
• constantly learn and train
• playing action video games (oddly enough)

Now what?

The one thing I read over and over again in these studies was an underlying call to reduce your pain as best you can. Whether this be through stretching, meditation, or even medication – try to reduce the pain to be able to try to reduce the affects on your brain.

Seek support of friends, families, loved ones, others going through the same experience, or even professional help.  Biofeedback treatments, Cognitive Behavioral Therapy, and Acceptance & Commitment Therapy have been shown to alleviate pain levels, as well as lessen depressive symptoms.  A 2015 study about the benefits of psychological treatment for chronic pain concludes their study with one phrase, “Patients will benefit!”

Take positive steps to increasing your gray matter.  Look up “brain teaser” or “brain trainer” games.  Even try to find games that help you strengthen your memory.  There are several webpages online that offer these games for free.

I’ve grown up all my life hearing alcohol and drugs kill brain cells, but nobody has ever mentioned pain damaging the brain.  Do what you can to help your body in any way you can…

** Updated March 28, 2019**

Resources:

About Memory –  Gray Matter

Albuquerque Journal (Article; Nov. 2014) – Study: Heavy Pot Smoking Shrinks Gray Matter

Endometriosis Foundation of America (Transcript, 2015) – Sawsan (Suzie) As-Sanie – Pain Mechanisms in Endometriosis: Understanding the Neurobioligy of Chronic Pain to Enhance Patient Care

European Journal of Pain (Abstract, 2017) – Brain Changes Associated with Cognitive and Emotional Factors in Chronic Pain: A Systematic Review

Expertscape

Health – Beat Brain Drain: Foods that Boost Your White and Gray Matter

Hormones Matter – Chronic Pain, Your Brain, and Yoga

Human Reproduction (Abstract; May 2016) – Personality in Women with Endometriosis: Temperament and Character Dimensions and Pelvic Pain

Human Reproduction Update (Article; Sept. 2014) – Central Changes Associated with Chronic Pelvic Pain and Endometriosis

Inner Light Publishers – How to Increase Gray Matter in the Brain

Pain (Abstract; June 2008) – Chronic Pain May Change the Structure of the Brain

Neuroscience & Biobehavioral Reviews (Abstract; June 2015) – The Hippocampus and TNF: Common Links Between Chronic Pain and Depression

Anesthetic Techniques in Pain Management (Abstract; July 2015) – Psychological Interventions for the Management of Chronic Pain: a Review of Current Evidence

Taylor & Francis Online (Abstract; 1997) – ‘Postconcussive’ Symptoms in Persons with Chronic Pain

The Journal of Neuroscience (Article; Nov. 2009) – Brain Gray Matter Decrease in Chronic Pain is the Consequence and Not the Cause of Pain

The Journal of Neuroscience (Article; Feb. 2008) – Beyond Feeling: Chronic Pain Hurts the Brain, Disrupting the Default-Mode Network Dynamics

The Journal of Pain (Abstract; Jan. 2016) – Functional Connectivity is Associated with Altered Brain Chemistry in Women with Endometriosis-Associated Chronic Pelvic Pain

The Journal of the International Association for the Study of Pain (Abstract; April 2015) – Effect of Environment on the Long-Term Consequences of Chronic Pain

I’d again like to thank Gary for granting me access to several of these full studies for review.  If you’d like to read any of the studies in their entirety and I’ve only listed an abstract, drop me a note.

~ Again, I am a layman.  I do not hold any college degrees, nor mastery of knowledge.  Please take what I say with a grain of salt.  If curious, do your own research Validate my writings.  Or challenge them.  And ALWAYS feel free to consult with your physician. Always.  Yours ~ Lisa