Controlling Pain in Our Minds

This blog post is based on an article in the New Scientist (17 Jan 2015, p.10) by Jessica Hamzelou titled “Pain Really Can Be All in Your Mind.”  She reported research  by Tor Wager at the University of Colorado Boulder that was published in the Public Library of Science (PLoS Biology, dpi.org/x55).    They used fMRI to examine the brain activity  of 33 healthy adults.  They first watched the changing activity  as they applied increasing  heat to the participants arms.  A range of brain structures lit up as the heat became painful.  This was a familiar pattern of activity  called the neurologic pain signature.

The researchers wanted to know if the participants  could control the pain by thought alone.  They asked the participants to rethink their pain either as blistering heat, or as a warm blanket on a cool day.  Although the participants couldn’t change the level of activity in the neurologic pain signature, they could alter the amount of pain they felt.  When they did this, a distinct  set of brain structures linking the nucleus accumbens and the ventromedial prefrontal cortex became active.

Vanaia Apkarian of Northwestern University noted,”It’s a major finding.  For the first time, we’ve established  the possibility of modulating pain through two different pathways.”  Brain scans can compare the strengths of activation of these two brain networks to work out how much pain has a physical cause, and how much is due to their thoughts and emotions.

These finding built on prior work by Apkarian’s team, who discovered that chronic back pain seems to be associated with a pattern of brain activity not usually seen with physical pain.  The brain regions active in Apkarian’s patients are the same as those active  in the participants controlling pain in Wager’s study.

It is possible that in chronic pain conditions, psychological pain might overtake physical pain as the main contributor to the overall sensation.  This might be the reason that traditional pain relief such as opiods don’t offer much relief from pain.

Hamezelou notes, “Wager’s study suggests that cognitive therapies and techniques such as nuerofeedback—where people learn to control their brain activity by watching how it changes in real time—might offer a better approach.”

Ben Seymour, a neuroscientist at the University of Cambridge notes, “in the next five to 10 years, we’ll see a huge change in the way clinicians deal with pain.  Rather than being passed on what the patient says, we’ll be building  a richer picture of the connections in the person’s brain to identify what type of pain they have.

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