Shared Circuits
Look at the graphic on page 54 of the workbook and compare it to the Key Graphic on page 13. You will notice that six of the areas (the amygdala, insula, prefrontal cortex, anterior cingulate cortex, posterior cingulate cortex and posterior parietal cortex) are involved in both the perception and regulation of mood and pain. This common circuit explains a lot about the direct relationship between persistent depression and stress with persistent pain. In fact chronic mood problems are not so much a risk factor for persistent pain as they are another manifestation of the same illness. Treating one without treating the other becomes an exercise in futility.
When nerve cells used to regulate mood are stolen by pain processing circuits, emotional regulation, calming and self-soothing are negatively affected. The ability to stay motivated and solve problems becomes impaired and people live with fear. Poor problem-solving and decision making leads to a further erosion of self-esteem and people often become less active because they are in more pain and lose the confidence to deal with life. As activity decreases more inflammatory molecules are released in both brain and body and the brain-body loop of chronic inflammation, chronic pain and chronic mood disturbance is reinforced. People become traumatized by their pain and fight-flight centers are activated. The fear of pain looms so large that people become frightened of challenging and opposing it, seeking increased passive treatment modes and less active lifestyles.
