‘The Cure Exacerbates the Problem’: How Chronic Pain and Obesity Form a Vicious Cycle

Research shows altered neural circuits that affect eating habits in patients with chronic pain.While it is well-known that obesity can lead to chronic pain, especially in major joints, it may be surprising to hear that the reverse is also true.Understanding the neuroscience of chronic pain and obesity could help prevent this painful cycle from taking hold.Does Chronic Pain Change Eating Behavior?Research suggests that chronic pain changes the nucleus accumbens, a central part of the brain’s limbic system, and causes overeating and potentially impulsive eating behaviors.The nucleus accumbens plays a major role in addiction behavior. It is involved in dopamine’s role in processing pleasure and reward. Dopamine—sometimes referred to as the “feel-good hormone”—is involved in motivating people to repeat certain behaviors.Researchers from the Del Monte Institute for Neuroscience in Rochester, New York, investigated the brain’s response to sugar and fat in patients with subacute low back pain, chronic low back pain, and no pain to examine how eating behavior was affected before and after chronic pain developed.The participants had MRI scans so that the researchers could see their nucleus accumbens, which showed disrupted satiety signals in the chronic pain group and in the subacute pain patients who recovered at the follow-up. The chronic low back pain patients reported that foods high in fat and carbohydrates, like ice cream and cookies, became problematic for them over time.Related Stories11/23/2023“We conclude that disrupted eating behavior specifically sets in after pain chronification and is accompanied by structural changes in the nucleus accumbens,” the authors wrote in the study.The study suggests that the system that tells the brain you are full or have had enough calories changed in response to the pain—affecting how much and what one eats. Further research is needed to show the mechanism, but the researchers believe it is the effect of pain on the reward circuitry.“There are other plausible factors that could disrupt satiety signals and alter the nucleus accumbens in those with chronic pain,” Eugene Aiello, chiropractic physician and neurologic researcher, told The Epoch Times.For example, certain diet and lifestyle factors, such as consuming ultra-processed food, are linked to an inflammatory state and disrupted satiety.The Risks of Coping With FoodChronic pain can interfere with everyday activities. When eating is the primary coping mechanism for pain, an emotional pattern uncontrollably unfolds.“Outside of a plethora of coping mechanisms, including alcohol, overeating is going to be a very sensible way to cope with chronic pain,” Katie Rickel, clinical psychologist and CEO of Structure House, a holistic residential weight loss center, told The Epoch Times. “Food is socially acceptable, accessible, and packs a powerful punch.“However, it becomes this vicious cycle where the cure exacerbates the problem,” she added.Many chronic pain conditions, such as low back pain, become worse when a person gains weight and becomes more sedentary.Gaining weight puts more wear and tear on the hips, knees, and feet. The additional weight around the waist shifts the pelvis forward, creating more instability in the joints. This condition puts abnormal pressure on the back muscles that are forced to bear the weight, weakening the abdominal muscles.However, there is more to this kind of pain than merely the mechanics of posture.“A lot of what I see with patients in pain lie mostly in unhealthy eating habits that cause bloating, constipation, gut irritation, and inflammation of the intestines because this causes abnormal abdominal pressure that leads to more lower back pain,” said Mr. Aiello. “To add to this is a lifestyle where people aren’t getting enough activity; they’re sitting too much.”Occasionally using food to cope is not usually cause for concern. However, it is important to recognize the signs of binge eating. Feeling a loss of control is the first criterion for diagnosing a binge-eating disorder. Other symptoms include frequently eating large amounts of food within a short period and eating past the point of physical discomfort.Restoring Order to the Reward System in the BrainA multidisciplinary or integrative approach is necessary to address all of the pieces of the chronic pain and obesity puzzle. “It’s important to give people experiences of feeling in control of their body and of their choices,” said Ms. Rickel.A behavioral pain management and weight-loss program with achievable quality-of-life goals can help people establish habits to counter the negative motivational aspects of pain.Addressing pain and addictive eating simultaneously involves slowly tapering off of “comfort eating with activities that bring pleasure and naturally boost dopamine and serotonin,” explained Ms. Rickel. “We need to diversify our coping menu to give someone who is struggling with chronic pain something that feels good to look f