Chronic Pain

fMRI’s Ability to Show Pain

We are learning a great deal about pain from fMRI.  fMRI is a technique that allows us to look at areas of the brain that are metabolically active.  In this way, we can peer into the mind and see what parts of the brain light up when we are thinking about someone we love, or something we dislike.  We can also see what it looks like to feel pain.  Since we can see pain in the brain, we are able to study painful conditions.  What we are learning is very interesting.  First, we are beginning to be able to identify pain severity by viewing which parts of the brain light up when pain is being experienced. What we are able to see is that patients who suffer from chronic pain have these areas of the brain light up at lower levels of stimulation than normal controls. In other words, it takes less stimulation to cause pain in people who suffer from chronic pain.  They are more susceptible to pain.

So, we know that when a person says they are in pain, we can see signs of it in their brain.  People who suffer from chronic pain, actually experience more pain than normal people and that is also visible on fMRI. With this information, it is possible to see when the pain goes away.  With proper treatment, changes on fMRI normalize. The pain can be seen to resolve.  Can you learn to control your brain activity and control brain processes and will it lead to a change in pain perception The answer is yes. [Decharmes RC, et al. Proc Natl Acad Sci U S A. 2005 Dec 20;102(51):18626-31. Epub 2005 Dec 13.]Does it lead to durable changes? That is, changes that last?  Yes.[Presented by Mackey et al at IASP 2008.] Using real time fMRI training it is possible to teach people to control activation of areas of the brain associated with pain.  It seems to be similar to biofeedback or EEG feedback, but much more pronounced and effective.

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Chronic Pain

Reading Minds

http://www.scientificamerican.com/article.cfm?id=brain-researchers-can-detect-who-we-are-thinking-about

http://www.nature.com/nature/journal/v452/n7185/abs/nature06713.html

http://pinktentacle.com/2008/12/scientists-extract-images-directly-from-brain/

If the study posted previously about fMRI being able to peer into your mind and determine not only if you are experiencing pain, but how much pain you are experiencing didn’t give you pause, these reports should.

Researchers are developing techniques using fMRI to see what you are thinking, or who you are thinking about. Soon it will be possible to read your mind, see your dreams and see what you are feeling. MRI technology is increasing in speed every day. Soon it may be possible to acquire one when you walk through a doorway. No longer will you have to lie still in a magnet for an hour.

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Chronic Pain

Seeing Pain

http://www.nejm.org/doi/pdf/10.1056/NEJMoa1204471

fMRI is a technique that allow us to see inside your mind. Other studies such as CT and MRI let us visualize anatomy.  They take a snapshot of what the brain looks like. fMRI, on the other hand, superimposes an image of which parts of the brain are metabolically active on the anatomy of the brain.  This technique allows us to see which parts of the brain are thinking.  Keep in mind that the brain is active in a lot of ways that we don’t realize. When you feel the joy of victory or the agony of defeat, many parts of the brain are active to create those feelings.

With fMRI, we are able to see the brain in action. We can see what parts of the brain are active and by controlling what the subject experiences, we are able to see what parts of the brain are responsible for what experience.

Up until very recently, when someone told me they were experiencing pain, I had no way to confirm or disprove it.  I had to take someone at their word. Unlike a symptom with a sign I can see-like a rash, there is nothing to look at when someone is having pain.  Sometimes there is a broken bone that accompanies the pain that I can point to as the cause, but very often, figuring out what is causing the pain is not so clear cut and often I am unable to find anything at all to explain the symptom. Things are becoming much clearer now. In the case of pain, I can pinch you to induce it, or shock you to cause pain and then look and see which parts of your brain are involved in the experience of pain you feel from my pinch, or electric shock. This study demonstrates that it is becoming very possible to see experimental pain as it is being experienced. Soon we will be able to see any pain, not just experimental pain. Finally we will have a test to determine not just where the pain is coming from, but how much pain you are actually experiencing.

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