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Vol. LXIV, No. 2
January 20, 2012
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Straus Lecturer Unravels Mysteries of Pain and the Brain

What if you could “pump up” regions in your brain to help manage chronic pain, like you build up muscles? That’s one of the theories holding scientific promise for addressing pain.

Recently, Dr. Sean Mackey gave the Stephen E. Straus Lecture in the Science of Complementary and Alternative Medicine, “Opening Windows to the Brain: Lessons Learned from the Neuroimaging of Pain.”

Mackey is chief of the division of pain management and associate professor in the departments of anesthesia, neurosciences and neurology at Stanford University School of Medicine. He is also director of Stanford’s Systems Neuroscience and Pain Laboratory and an NIH grantee. He has been at the forefront of research using real-time fMRI to modify brain activity and, as a consequence, pain.

Mackey emphasized a recent Institute of Medicine report that noted the high U.S. burden from chronic pain, which affects 116 million Americans. Vicodin, a highly addictive opioid, has become the nation’s most prescribed drug. “We need better solutions,” he urged. Pain is now understood to be not only a symptom, he added, but a disease entity in its own right. Many factors control an individual’s pain experience, from genetics, to early life experiences, to how much fear and anxiety a person may have.

Dr. Sean Mackey

Said Dr. Sean Mackey, “While we can’t prescribe a passionate love affair every 6 months for our patients, we can encourage them to engage in similarly rewarding experiences with the knowledge that it will have a pain-relieving effect.”

Photo: Lisa Helfert

Since pain is fundamentally an experience generated and processed in the brain, neuroimaging is opening windows to the brain, thereby deepening our understanding of pain. For example, Mackey said, we can see enduring effects of pain as accelerated loss of the brain’s gray matter over time. Importantly, treatment can reverse some changes, which could provide invaluable biomarkers to assess treatment effects.

“Voluntary brain mechanisms,” Mackey noted, “can also play a part in managing pain.” His team has found, for example, that real-time fMRI and specific cognitive strategies—such as “reappraisal” of one’s situation—can be used to train patients to control or “pump up” the activity of specific brain regions, including those involved in controlling pain. The consequence could be a decrease in pain reports.

The human connection can also play a role in managing pain. In one study, Mackey’s team found that participants who were in the early, intense stage of romantic love had a decreased response to a pain stimulus, similar to pain-killing drugs. Additionally, they found that the pain-relieving effects of passionate love engaged regions in the brain rich in our own endogenous painkillers as well as regions rich in dopamine, a neurotransmitter involved with reward and motivating behavior. “While we can’t prescribe a passionate love affair every 6 months for our patients,” Mackey said, “we can encourage them to engage in similarly rewarding experiences with the knowledge that it will have a pain-relieving effect.”

Dr. Josephine Briggs, NCCAM director, noted, “A number of complementary health practices are now showing promise in the management of chronic pain, such as acupuncture, massage, spinal manipulation, yoga and progressive relaxation for chronic low-back pain. Overall, however, while there has been progress in our scientific understanding, the need remains for improved pain-management strategies to help address this very debilitating and costly problem.”—Ellen O’Donnell NIHRecord Icon


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