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Thursday, November 15, 2007

The Brain in Chronic Pain

Sophisticated brain-imaging studies = suggest=20 new ways to treat chronic pain.

By Emily Singer

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Pain = relief:=20 Imaging studies have indentified brain = areas gone=20 awry in people with chronic pain. =
Credit:=20 Technology Review =

Anyone who suffers from chronic pain knows = that the=20 experience is fundamentally different from = enduring a=20 scratch or a broken toe. Growing evidence from=20 brain-imaging studies supports this notion: = people with=20 chronic pain show fundamental differences in = both the=20 structure and function of their brain. = Scientists are=20 now using these findings to develop and test new = drugs=20 created specifically for chronic pain.

"It should eventually be possible to identify = patterns of brain activity involved in = perpetuating=20 chronic pain, and then to introduce = interventions that=20 we know from published evidence can block or = compete=20 with those patterns," says Richard Chapman, director of = the Pain=20 Research Center at the University of Utah, in = Salt Lake=20 City.

Chronic pain is one of the biggest medical = health=20 issues in the Western world; it costs the United = States=20 about $150 billion a year. Unlike with acute = pain, the=20 causes of chronic pain are often unclear--for = example,=20 doctors can identify a physical source in only = about 10=20 percent of those with chronic back pain. A = growing=20 number of studies suggest that chronic pain = should be=20 viewed as a progressive disease, likely = triggered by=20 aberrant but potentially permanent changes in = the brain.=20

The painkillers that help headaches and = broken bones=20 do little for chronic pain, leaving a huge need = for new=20 treatments. But developing them has been = difficult.=20 Perception of pain depends strongly on our level = of=20 attention and our emotional state--two factors = that are=20 difficult to study in animal models. "We don't = have one=20 drug developed from preclinical models of pain = that=20 works for chronic pain," says Irene Tracey, a scientist at = the=20 University of Oxford, in England, who studies = pain.

Now scientists are aiming to develop and test = new=20 drugs using human brain imaging. A. Vania Apkarian and his = colleagues=20 at Northwestern University have found a series = of=20 abnormalities in the brains of chronic pain = sufferers:=20 the part of the prefrontal cortex linked to = decision=20 making appears to have shrunk in chronic pain = patients.=20 And another part of the prefrontal cortex linked = to=20 emotion is hyperactive. In fact, a unique study=20 assessing background pain in chronic back-pain = patients=20 suggests that the constant pain these people = experience=20 is linked to activity almost entirely in=20 emotion-regulating parts of the brain.

Researchers used functional magnetic = resonance=20 imaging (fMRI), which measures brain activity, = to study=20 background pain. They asked back-pain patients = to=20 continually rate their pain while lying in the = scanner,=20 and then the researchers compared brain activity = patterns during periods of constant pain with = those=20 during periods of worsening pain.

While activity patterns during flare-ups = resembled=20 those previously linked to acute pain, the = pattern=20 associated with constant background pain was = distinct:=20 it centered on the medial prefrontal cortex, a = brain=20 area involved in emotion and sense of self. "It = almost=20 seems like they've turned off the sensory part = and are=20 suffering entirely from the emotional aspect," = Apkarian=20 says.

Given these findings, the scientists are = beginning=20 human tests of a compound called d-cycloserine, = an=20 FDA-approved antibiotic that also blocks certain = receptors in the brain. (It is currently being = tested=20 for treating post-traumatic stress disorder and = other=20 conditions.) "We think it increases transmission = within=20 the prefrontal cortex to better control the = emotional=20 component of pain," says Apkarian. "This will be = the=20 first hypothesis-driven test for a pain drug = driven by=20 human-imaging studies."=20

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Comments

Pain
dib=20 on 11/15/2007 at 10:37 AM

Comments:
5

I had an = accident=20 hicking in '65. My back's been worse every = year=20 thereavter. I use guided meditation to keep my = pain=20 around 7 ou 8 because I must know when it's = sharply=20 rising. At 10 I black out (broke a foot once = and a=20 clavical another time passing out on the=20 stairs).

So, what I need is back = repair. I've=20 been working on this problem for 40 years. No = one=20 knows what's wrong. If this sounds familliar = to anyone=20 please email=20 me.

dib

dib_at_home@comcast.net=20 Rate=20 this comment: 3D1=20

(Reply)=

pain for 40=20 years
rhansing=20 on 11/15/2007 at 11:19 AM

Comments:
11

Avg Rating:

I'm feel you = pain and I=20 know it's real. My impression about pain is = multi=20 factoral. First there are different cultural=20 tolerances to pain. Mexican women with = indigenous=20 indians genes, are very tolerant to pain... = yet, latin=20 men, will climb the wall just when you show = them a=20 needle.

English and northern german's = seem to=20 have a high tolerance for pain, more so than = those=20 further south, spain and italy.

In = addition,=20 low pain tolerance is higher in the patient as = I put=20 it, have been put up with crhonic illnesses... = these=20 patients have been punched and poked so much, = that it=20 seems that they just can't take it = anymore.

My=20 gut feeling is that chronic pain, is an = autonomic=20 nervous system learned response. Think Phantom = Pain,=20 that amputees have. With this caveat I feel = that the=20 neural pain tracks are get programed to feel = pain...=20 and work has been done to reprogram these = neural=20 tracks, or to bypass these track to allieviate = the=20 chronic pain. It involves functional MIR's = where the=20 pain is visualised and the patient is taught = to think=20 about another focus in the brain, and this in = time=20 reprograms nerual tracks around the site = elicting the=20 pain.

This is relative new reserach = and I=20 donlt know who is doing this, but a google = search may=20 help.

In the 20th century, we were = taught, and=20 believed that the brain was static and fixed, = and=20 could not be changed. The 21st century will be = the=20 century of learning how to remold the brain's = neural=20 pathways around the deficits.

The = brain is=20 plastic and malleable. It's a fantastic = concept and I=20 expect great and rapid = changes.

Ironically, we=20 knew this in the 20th century but didn;t = really=20 believe it. for example, physical therapy can = rewire a=20 brain damaged by a stroke. Just look at Kirk = Douglas=20 and his ability to learn how to talk again = after his=20 stroke.

So, don't dispair. help is on = the=20 way.

ron hansing.=20 Rate=20 this comment: 3D1=20

(Reply)=

Add=20 New = Thread

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