Memory is one of the most important functions of our brain. It's what allows us to learn new things, recognize people and places, and build a sense of continuity in our lives. In the simplest terms, memory is the brain's ability to encode, store, and retrieve information. Though it often seems like something obvious, it is actually the result of incredibly complex cooperation among many brain regions.
All it takes, however, is for that delicate balance to be disrupted, and we begin noticing small changes in daily functioning. We forget words, lose the thread of a conversation, or walk into a room and suddenly can't remember why we came in.
I talk about memory — or rather, memory problems — regularly with my "pain companions." Increasingly, the same experience comes up in these conversations: it's harder to find the right word, harder to focus, sometimes we forget what we were just about to do. Then comes the question: is this just fatigue and stress, or does chronic pain truly affect the way our brain works?
What neuroimaging research shows about people with chronic pain
Chronic pain is one of the greatest challenges of modern medicine. Unlike acute pain, which serves a warning function and usually resolves once the injury or illness heals, chronic pain can persist for months or even years. During this time, it affects not only the patient's daily functioning but also gradually changes how the brain operates.
A growing body of neurobiological research shows that long-term pain experiences can lead to deterioration of memory, concentration, and decision-making abilities.
One example of a condition where chronic pain is particularly severe is trigeminal neuralgia — a disorder of the nerve responsible for facial sensation. The pain appears suddenly, is extremely intense, and is often described by patients as an "electric shock."
However, the latest research using functional MRI shows that the effects of this condition extend far beyond pain perception itself.
Chronic pain as a brain problem
In the past, pain was viewed mainly as a signal from damaged tissue. Today we know it is a complex experience arising in the brain's extensive neural networks.
Many structures are involved in pain processing, including:
- The prefrontal cortex, responsible for planning and behavioral control
- The insula, which integrates information about body state and emotions
- The cingulate cortex, involved in processing the emotional aspect of pain
- Limbic system structures such as the hippocampus and amygdala, linked to memory and emotions
Prolonged activation of these areas can lead to lasting changes in brain function. These are exactly the changes that researchers attempted to identify when analyzing brain activity in patients with trigeminal neuralgia.
How the effect of pain on the brain is studied
The study in question used resting-state functional MRI (rs-fMRI). This technique allows observation of spontaneous brain activity even when the person is not performing any specific task.
By analyzing subtle signal changes in different brain regions, scientists can assess several important parameters:
- ALFF (Amplitude of Low-Frequency Fluctuations) — the intensity of spontaneous neuronal activity
- ReHo (Regional Homogeneity) — the degree of activity synchronization in neighboring brain areas
- DC (Degree Centrality) — the importance of a given region within the entire brain network
The study compared 34 people with trigeminal neuralgia to 30 healthy participants. In addition to brain scans, all participants completed tests assessing cognitive function, including memory, attention, processing speed, and executive abilities.
Cognitive decline in pain patients
Test results showed clear differences between groups. People with chronic pain performed worse in many areas of cognitive functioning, including:
- Memory and learning
- Attention and concentration
- Executive functions (planning and behavioral control)
- Information processing speed
- Motor coordination
Particularly notable differences appeared on the MoCA scale (Montreal Cognitive Assessment), used to evaluate overall cognitive performance. Patients with neuralgia scored significantly lower, indicating clearly reduced cognitive efficiency compared to healthy individuals.
This confirms earlier clinical observations. Many people with chronic pain complain of difficulty concentrating, remembering information, or making decisions.
What changes in the brain
Brain imaging analysis revealed significant changes in several regions responsible for both pain processing and cognitive functions.
In patients with neuralgia, increased activity was observed in structures such as:
- The temporal pole — involved in processing smells, emotions, and memory (sensory integration)
- The superior temporal gyrus — responsible for processing sounds, speech (Wernicke's area), and language comprehension
- The insula — involved in perceiving pain, hunger, emotions, empathy, and autonomic nervous system regulation
Interestingly, the higher the activity in these areas, the worse patients performed on cognitive tests.
Scientists interpret this as a possible compensatory mechanism — the brain tries to cope with chronic pain by increasing activity in certain neural networks. However, long-term overload of these structures may lead to cognitive deterioration.
Reduced activity in other regions
At the same time, decreased activity was observed in areas related to visual information processing:
- The lingual gyrus — responsible for recognizing written words and early stages of reading
- The occipital cortex — responsible for processing vision, shapes, colors, and movement
- The calcarine sulcus — responsible for distinguishing complex objects and spatial scenes
Changes in these regions were associated with difficulties in tasks requiring visual information analysis, logical thinking, and data processing.
Reorganization of brain networks
The study also showed changes in the degree of connectivity between different brain areas. Some regions — particularly in the frontal lobe and limbic system — became more "central" in the neural network, meaning they are more strongly connected to other parts of the brain.
Such changes may indicate gradual reorganization of brain networks under the influence of chronic pain.
Pain, emotions, and memory
Chronic pain does not operate in isolation within the brain. Many regions involved in its processing are simultaneously linked to emotions, motivation, and memory.
For example:
- The insula integrates body signals and gives them emotional meaning
- The cingulate cortex participates in experiencing suffering and emotion regulation
- The hippocampus is responsible for creating memories and spatial orientation
Prolonged activation of these structures can lead to increased anxiety, depressive symptoms, and memory deterioration.
In the study, patients with neuralgia also showed higher scores on scales assessing anxiety and depression levels.
How chronic pain changes daily life
Changes in brain function translate directly into everyday life. People with chronic pain often experience:
- Difficulty concentrating at work
- Slower decision-making
- Short-term memory problems
- Mental fatigue
- Lowered mood
Many people also describe a phenomenon known as "brain fog" — a state in which it's harder to gather thoughts, recall words, or maintain focus during a conversation.
These symptoms are not merely subjective patient perceptions. Growing research shows they are reflected in measurable changes in brain activity.
In practice, this means chronic pain doesn't affect only the body. It gradually begins to impact nearly every sphere of life: professional work, social relationships, sense of agency, and mental health.
The broader picture
Research on trigeminal neuralgia is just one example showing how profoundly chronic pain affects the brain. Similar changes have been observed in other pain conditions, such as painful post-traumatic neuropathy, migraine, fibromyalgia, and chronic back pain.
The shared conclusion from these studies is clear: chronic pain is not merely a bodily symptom. It is a state that affects the functioning of the entire brain — and thus emotions, memory, thinking patterns, and quality of life.
The role of medications
It's also important to remember that cognitive function in people living with chronic pain may be affected not only by the pain itself and brain changes, but also by the treatment. In treating trigeminal neuropathic pain, antiepileptic drugs (such as carbamazepine, oxcarbazepine, gabapentin, or pregabalin) and certain antidepressants are commonly used, which also have analgesic effects through their influence on nerve signaling. For many patients, these are a crucial treatment component that can significantly reduce pain intensity. At the same time, some people notice side effects such as drowsiness, slowed thinking, or difficulty concentrating. In practice, this means that memory deterioration or "brain fog" may result from several overlapping factors — the pain itself, brain changes, and the medications used in therapy. That's why individualized treatment that is regularly discussed with your physician is so important.
Pain treatment should therefore address not only its physical source but also its neurological, psychological, and social aspects. Only such a comprehensive approach offers a real chance of improving quality of life for the millions of people living with chronic pain.
My own experience
In my case, I cannot take antiepileptic drugs. After their use, a very severe bone marrow reaction occurred along with severe leukopenia, so treatment had to be discontinued.
This means that I face pain largely "without a shield." Unfortunately, this has very clearly affected my memory and concentration. The difference in cognitive function is truly noticeable — sometimes it's harder to find a word, sometimes harder to focus or maintain a train of thought.
Despite this, I actively try to take care of my brain and exercise my memory. I'm looking for ways to support cognitive function despite living with chronic pain. I currently use creatine and citicoline — I'll write about why I chose this brain support and what the research says in a separate post.
And how about you? Since living with trigeminal nerve pain, have you noticed changes in memory, concentration, or thinking speed? Do you find yourself forgetting words, losing the thread of conversation, or having difficulty focusing?
Reference:
Cognitive Decline in Patients With Trigeminal Neuralgia: A Resting-State fMRI Study — https://onlinelibrary.wiley.com/doi/10.1002/brb3.70434
Natalia — since 2014 I've been living with trigeminal nerve pain. I write in plain language, based on reliable sources and personal experience. Read my story →
Frequently Asked Questions
What is trigeminal neuralgia?
Trigeminal neuralgia is a chronic facial pain condition. It manifests as sudden, severe, usually one-sided pain attacks — often described as an electric shock. A single attack typically lasts from a few seconds to about two minutes.
What is the difference between neuralgia and neuropathy?
In simple terms: neuralgia primarily involves paroxysmal pain along a nerve, usually without loss of sensation. Neuropathy involves nerve damage that more often causes constant pain along with numbness and sensory loss.
Do regular painkillers help with neuropathic pain?
Usually not. Neuropathic pain responds poorly to paracetamol or anti-inflammatory drugs. Instead, medications that act on nerves are used, such as anticonvulsants like carbamazepine.
How does carbamazepine work for trigeminal neuralgia?
Carbamazepine is the first-line medication for trigeminal neuralgia. In a large proportion of patients, it provides effective pain control. It requires gradual dose adjustment and medical supervision.
What is the difference between gabapentin and pregabalin?
Both are anticonvulsant medications used for neuropathic pain. They differ in absorption and dosing characteristics. The choice and dosage should be determined by a physician.
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