Professor Irene Tracy
Is pain all in the mind?
A lot of patients are confused by this and get worried that the doctor does not believe the pain is real. But in the world of neuroscience the mind is the brain. Damaged tissue messages are sent to the spinal cord, but it is the brain that puts all the signals together and gives you the experience of pain. All the factors that people associate with the mind are real factors and play out through brain regions and chemicals, so it is just as real as signals being sent from the damaged tissue, and the brain can turn the volume up and down.
Is there a region in the brain that specifically deals with pain?
There is no single spot responsible for experiencing pain, but about 10 different regions that are part of a network. It is a flexible system that has the ability to potentially turn off pain completely, during the fight or flight response for example. Different parts of the system activate depending on the pain and the situation, but there are some parts of the system that are permanently on, and these are the areas to target for pain relief.
Fibromyalgia and the brain
Brain imaging has shown that people with Fibromyalgia demonstrate very different brains to their counterparts in age and sex who do not have the condition. The systems responsible for experiencing pain in the brain are active and dysfunctional without any signals being sent to them. What this shows is that the pain is real, but its origin is not located in the limb or area that the damaged tissue is. This is important as now treatment can be focused on the right place.
How do we know this?
There are several different brain imaging tools which can look inside the brain and spinal cord which are non-invasive. These provide data from the brain about its structure and chemistry. Think of it as looking behind the scenes at what is really going on that contributes to what the patient is saying. Often the description of the patient and their behavioural symptoms are difficult to understand, but with these tools it is possible to see the brain in action while it is experiencing pain.
Anxiety and pain
It is not just the location of pain that can be tracked in the brain. Anxiety and fear of pain can be seen to activate certain regions of the brain. In certain patient groups anxiety and fear are key factors for their pain, and that is turning the volume of the pain up. This shows that changes in anxiety and depression levels switch certain brain systems on and this changes the way pain is processed, making the pain worse. So psychological and emotional factors that are particularly associated with people living with chronic pain for years, are not just changing the way people describe their pain, but actually changing the way the brain is working. This often makes the pain worse or at least different.
How can this research help those with chronic pain?
This research can help to diagnose what is underlying someone’s pain, and that can guide where the therapy should be focused. It can also be used for predicting the outcome of surgery or a certain drug. This does not mean that all patients will be referred for scans because it is specialised and quite expensive. What it will do is to lay the foundations for the next step which is to reverse engineer the information into simple tests that can be performed by a GP in a primary care environment. Brain imaging has also greatly contributed to making such conditions more widely recognised as it can be seen and measured.
Are Cognitive Behavioural Therapies and relaxation techniques still useful?
Brain imaging has shown that these therapies use the power of the brain to modulate a person’s management of their pain. These therapies train people to access different parts of the brain which can help reduce the pain, help them cope better and think differently about what pain is and means. An example of how to do this is based on the principle of pleasant pain. Some people enjoy the sense of pain during extreme exercise or eating hot and spicy food because it is associated with something good. So it should be possible to train people to change the meaning of the pain in order to alleviate it while they are waiting for drugs to block the pain. Ideally, controlling pain using these methods should be used at the same time as trying to get the right drug.