COVER STORY but also can impact our mental and cognitive health. The correlation between pain and cognitive capacity is highly relevant. Research in the past two decades has provided tremendous insights into the bi-directional relationship that exists between pain and cognition, demon-strating the modulation of these do-mains on one another. 2 Pain is com-posed of sensory components, afferent components, and cognitive components -an example of the cognitive aspect of pain is illustrated in one’s anticipation of future harm. 5 Nociceptors, also known as sensory receptors that moni-tor damaged tissue and chemical signals indicating damage, become activated by noxious stimuli and thereby stimulate the insula and anterior cingulate cortex in the brain. Activation of these brain regions is connected with the subjective experience of pain. 5 At the most ele-mentary level, the pain pathway consists of transduction, transmission, modula-tion, and perception, respectively. 2 One of the proposed pathways of pain and cognition highlights the modulation of the parasympathetic nervous system via baroreceptors. 6 Baroreceptors serve as the gatekeepers to noxious stimuli at the level of brainstem nuclei, cortical and subcortical brain regions. Baroreceptors modulate neural activity that reaches these areas of the brain and therefore influences the diverse dimensions of pain perception at the anterior insula. 6 Literature examining functional MRI studies in humans demonstrates that the anterior insula is responsible for integrating pain intensity and expecta-tion of painful circumstances. Research-ers concluded that the influence of ba-roreceptors on the anterior insula as a gatekeeper affects pain perception on cognition. 6 Additionally, pain can exert its effects on cognition via stimulation of nerve fibers. Two players in the trans-duction of pain are A and C fibers, responsible for touch and pain, respec-tively. 2 These sensory fibers project in-formation to the dorsal root ganglion, which are then directed to the central nervous system. With patients experi-encing chronic pain, persistent noxious stimuli upregulate A fibers to compen-sate for an increase in pain information, in addition to C fibers; as a result, leading to hyperalgesia and central sensitization. 2 COVER STORY Painful path Pain and its impact on cognition P Photo: LIGHTFIELD STUDIOS/ Adobe Stock BY DESIREE CARUSO, B.SC. AND DR. ROMI FUNG, ND prevalence of diagnoses such as chronic pain, fibromyalgia, and chronic re-gional pain syndrome. A recent revision of the definition of pain was made in 2018, where the task force of the International Association for the Study of Pain (IASP) now cur-rently defines pain as, “[a]n unpleasant sensory and emotional experience as-sociated with, or resembling that asso-ciated with, actual or potential tissue damage.” 4 Pain can have psychological impacts, and can affect our cognition through neuronal damage. This article aims to introduce the idea of pain as not primarily a physical characteristic, ain and pain-related diag-noses leads the globe as the most common cause of disability and disease bur-den, with an estimated 1 in 6 adults suffering from pain and 1 in 10 chronic pain diagnoses in adults per year. 1 Pain significantly affects the quality of life of billions of individuals worldwide, and in addition to psychological and social influences of pain, functional domains can also be impacted. 2 In fact, the prevalence and epidemiology of pain is continuing to intensify. 3 Health care systems have seen a rise in the DESIREE CARUSO is a 4th year naturopathic student at CCNM. She has an undergraduate degree in biology during which she played collegiate soccer. Her special interests include concussions, post-concussion syndrome, sports medicine, and pain management. DR. ROMI FUNG, ND practices in Richmond, BC. A graduate of CCNM, Romi helps patients living with dementia improve their quality of life by taking an integrative and functional approach. On top of his practice, Romi is currently a Ph.D. candidate in Aging and Health at Queen’s University, an Adjunct Clinical Faculty and Academic Faculty teaching Traditional Asian Medicine at the Canadian College of Naturopathic Medicine – Boucher Campus. DrRomiFungND.com www.Cndoctor.ca May/June 2022 Chiropractic and Naturopathic Doctor 7
Chiropractic + Naturopathic Doctor June 2022: Page 7
