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January 4, 2011

Brain Controls Pain

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  How you feel pain


The brain's natural painkiller system

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Scientists are finding that it truly is the brain that decides what is or is not painful. As this ScienCentral News video explains, scientists are also finding that there may be a way to teach people to train their brain to better handle pain.

Brain Over Pain

Sean Mackey, associate Director for the Pain Management Division of Stanford University School of Medicine, found that if people could watch a certain part of their brains in action in real time, they could use that feedback to learn how to manage pain. He calls it a case of, "Brain over pain."

"What's unique about this specific experiment," says Mackey, "is that this experiment, for the first time, studied a group of people and taught them to learn how to control their own brain, a specific region in their own brain. And by doing so, it changed their behavior… that's never been done before."

The specific part of the brain that is involved in pain perception and regulation is deep inside the brain. It's called the Rostral Anterior Cingulate Cortex (rACC). It was that part Mackey and his team wanted people to watch.

People were put in an MRI scanner similar to those used to scan parts of the body for injuries. However this was a functional real-time MRI scanner, which allowed people, according to Mackey, "To then see their own brain activity on a moment by moment basis."

Some of the people Mackey observed were patients who suffered chronic pain. Others were volunteers who agreed to endure a moderately painful hot probe touching them. While the volunteers were watching their own brains in action, the team then gave them various strategies on how to manage the pain.

If the volunteers focused on the pain, pain center activity increased.
"When people would focus their attention on the pain," says Mackey, "the activity in that part of the brain [the rACC] would go up. And when they would focus their attention away, they would see that the brain activity would go down." Mackey says that when people saw the brain activity change, "after a period of time they would learn to then take control of it themselves."

Writing in Proceedings of the National Academy of Sciences he said "the vast majority" of healthy volunteers either learned which strategy suggested by the researchers worked best or sometimes they came up with new strategies on their own.

"What's nice about this is that we demonstrated that not only people can control the area of their brain, but that with time that control improved, which means that there was learning involved. Which means, by definition, that there was neuroplasticity. In other words, that with repeated sessions people were actually changing their own brain."

While the results were encouraging, Mackey wondered if, "We just designed the world's most expensive placebo," referring to the phenomenon where people report feeling better when they believe they are being treated, even if the "treatment" is fake. He added, "Let's face it, you've got an extraordinarily high-tech environment. You've got this big, expensive MRI system that's making all sorts of noise. We're telling people to go into this scanner and to control their brain activity and then with that we expected that there may be some change in how they perceived pain."

Mackey's team re-ran the experiments taking parts of the feedback chain away. One group got pain control instructions, but without the MRI scanner. A second got instructions and were inside the MRI scanner, but got no real time feedback. A third were told to observe in real time a part of the brain not involved in pain processing. A fourth, control group, underwent the process while watching someone else's brain activity.

MRI Machine
Mackey says of all those groups, "The only session… where they were able to learn how to control their own brain activity and see a change in their pain was with that real-time moment-by-moment information."

Not everyone was successful. Mackey says there were people who "were not significantly able to change their brain activity. And what we found is that they were also the people who tended not to be able to have significant control over their pain."

Those who suffer from chronic pain should not expect to see this method used for pain control anytime soon. In addition to being very expensive, Mackey says that right now the technology is, "not ready for prime time as a clinical treatment."

For one thing, they need to study the mechanism of exactly what went on for this control to happen. Mackey says, "People were just able to learn how to do it and that's what we're actually studying right now, is to figure out how they were able to do what they do."

In addition, they need to study the long-term benefits of this technique. He says, "We're running the studies right now."

But, what the study does show is what role the brain plays in determining what is or isn't painful. As Mackey puts it, "It's not pain until it hits your brain."

This research was published in the December 13, 2005 issue of Proceedings of the National Academy of Sciences and was funded by the National Institutes of Health, the Oxnard Foundation, the Dodie and John Rosekrans Pain Research Fund, and the Stanford University Department of Anesthesia.

       email to a friend by Jack Penland

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