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Brain research.
May 14, 2006 10:11 AM   Subscribe

The Pain in the Brain. (NYT)
posted by semmi (36 comments total)

 
It is all in your head.
posted by bigmusic at 10:23 AM on May 14, 2006


What a fascinating article.

I wish they could create some sort of real-time brain scanner that fit in your pocket, like an ipod.
posted by Baby_Balrog at 10:34 AM on May 14, 2006


Interesting article - having studied Neuroscience I'm always a little suspicious when there's a neuro article in the NYT or some such, but this is good.

People who aren't familiar with fMRI always think of it as some miracle machine, but really its uses are very restricted. Knowing the general area associated with a thought process or sensation, in real time, is fantastic... but it doesn't mean much when you need to be working with individual neural circuits or spinal relays, that kind of thing. I tend to think that the article is, as the researcher fears, describing an extremely expensive placebo machine. The lady in the story learned to understand her pain, that it was a process inside an immense machine that she controlled, and the fMRI helped with that. That said, the same could be accomplished lying in bed at home, or meditating under a waterfall or whatever. Thanks for the link!
posted by BlackLeotardFront at 10:59 AM on May 14, 2006


That said, the same could be accomplished lying in bed at home, or meditating under a waterfall or whatever.

True. But as was also pointed out, they'd like to be able to jump-start that process rather than having you meditating under a waterfall for thirty years. As I deal with chronic pain myself, I can tell you that patience is in short supply. Your life is passing while you're stuck on the sidelines...anything that can get you back in the action quickly is far more valuable than something which cannot.
posted by moneyjane at 11:26 AM on May 14, 2006


The brain has more than a hundred billion neurons. All functional imaging can tell us now is that a few hundred million of them in various areas become more active at certain times. It's as if you were trying to conduct a symphony by watching a silent film of the concert. You would see the players in the bass section active at one moment, vigorously gesturing, and then the rest of the orchestra would join in, but you couldn't hear the notes...

I thought this was an excellent analogy.
posted by Zozo at 12:18 PM on May 14, 2006


the really important issue for me as someone with chronic pain is opiophobia (and the DEA). call me old-fashioned, but howsabout we give people nice strong pain meds first, and if they don't work, then we pull out the $2 million placebo machine?
posted by overanxious ducksqueezer at 12:52 PM on May 14, 2006


Really interesting article, thanks.

I hope they come up with some sort of magic watch-your-brain machine someday to control epilepsy. That would be awesome. I have yet to find an anti-convulsant that worked for me, I'd love to just watch the part of my brain that was going to have a seizure and just turn it down.
posted by grapefruitmoon at 2:31 PM on May 14, 2006


True, moneyjane. As long as they can prove this setup really helps people accomplish this faster, I'm all for it.

And Zozo, neuroscientists have to be really good at analogies, it's the only way they can make sense of things ;). Brain as computer, brain as symphony, neuron as telegraph, action potential as morse code, we have to make the brain like other things to understand it because as it is, it's simply too much.
posted by BlackLeotardFront at 2:34 PM on May 14, 2006


"the really important issue for me as someone with chronic pain is opiophobia (and the DEA). call me old-fashioned, but howsabout we give people nice strong pain meds first..."

Seriously. The anti-opioid DEA dipshit squad can blow me.

The idea that I'm somehow failing society by being addicted to not feeling like shit on their behalf pisses me off no end. I can't get anything stronger that tylenol with codeine - even here in Canada - and with the number of OTC painkillers I wolf down I know that I'm probably killing my liver.

Oh well. Maybe I'll get the good drugs after the liver transplant. Why the hell should anybody care if I was to actually become addicted - not that it's very likely at all, given the difference in how opioids work medically versus recreationally - if it significantly improved my quality of life?

/pet peeve derail
posted by moneyjane at 3:22 PM on May 14, 2006


Actually, I'd like to push the brain real-time interaction thing a little further. I want to get in the ring with that motherfucker and get slappin'. First thing, I'd say. "Quit trying to kill me, you jello-ass bucket of cauliflower", and then go at it, mano a mano, until that bastard agreed to be a little less like a rat in a coffee can, and more like a nice soft kitten of reasonableness.

That would be most excellent.
posted by moneyjane at 3:34 PM on May 14, 2006


Fascinating how the firing pattern (or "symphony") of neurons creates the experience of pain. Thought experiment: remove every neuron from a brain, leave only those involved in pain creation. Now trigger the pain firing pattern. Is the pain still felt? Don't know the answer, but i suspect yes.

Something else: she seems to feel a bit awkward with regards to her neurofeedback fantasies, or wants to sound like that in the article (so that the typical reader can resonate). That's of course not the right attitude for a placebo disciple.
posted by vertriebskonzept at 3:42 PM on May 14, 2006


Excellent article, though I do take exception to this analogy:

"Consciousness is not neurons firing — consciousness is a transcendent emergent phenomenon that depends on the firing of neurons," says Dr. Daniel Carr, an eminent pain researcher who is now the C.E.O. of Javelin Pharmaceuticals. "The gears of a watch rotate and keep time, but the turning of the gears is not time."

Uh, so time is a transcendent emergent phenomenon that depends on the mechanics of our wristwatches?
posted by joe lisboa at 3:43 PM on May 14, 2006


vertriebskonzept : "Thought experiment: remove every neuron from a brain, leave only those involved in pain creation. Now trigger the pain firing pattern. Is the pain still felt? Don't know the answer, but i suspect yes."

Including the neurons regulating autonomic functions (breathing, heartbeats)?

Anyway, I don't think the brain works that way. Modules are relative to each other.

joe lisboa : "so time is a transcendent emergent phenomenon that depends on the mechanics of our wristwatches?"

No, the mechanics of your wristwatches allows you to relate to the passage of time, but "isn't time" itself.
posted by Gyan at 4:00 PM on May 14, 2006


Well, duh. But how does the analogy stand, then?
posted by joe lisboa at 5:18 PM on May 14, 2006


The analogy stands, in term of the lack of equivocation (neurons != consciousness, gears rotating != time), but falls in terms of the polarity of precedence (time -> watch, but neurons -> consciousness).
posted by Gyan at 5:43 PM on May 14, 2006


the really important issue for me as someone with chronic pain is opiophobia (and the DEA).

I'd agree with that, but who wants to live their whole life in an opioid haze? OK, maybe some people, but not me.

I'm dealing with some relatively minor headache and backache brought on by stress right now, and I hate it when I give in and take a lousy Advil. Sometimes I think that our dependence on pain killers is what causes the pain in the first place.

So wouldn't it be better to be able to kill the pain on your own? I'm intrigued. Thanks for pointing out the article; I can't believe I missed it when I skimmed the paper this morning.
posted by fungible at 6:47 PM on May 14, 2006


moneyjane, it's because they don't understand the distinction between dependency and addiction. do they even teach this in medical school? i begin to wonder...

i don't believe the study about giving morphine covertly to pain patients didn't help their pain, does anybody know more about that one? what level of pain, what dose of morphine, yada yada...
posted by overanxious ducksqueezer at 7:02 PM on May 14, 2006


I'm dealing with some relatively minor headache and backache brought on by stress right now, and I hate it when I give in and take a lousy Advil. Sometimes I think that our dependence on pain killers is what causes the pain in the first place.

I'm thinking that a minor headache and backache are not the same thing as the chronic pain she's talking about...and last time I checked fibromyalgia caused my pain. It'd be great to have that technology available to me, however, I'm supposed to politely deep-six my life in the meantime to avoid offending somebody with my 'opioid haze'?
posted by moneyjane at 7:05 PM on May 14, 2006


Pain and opioids.
posted by moneyjane at 7:19 PM on May 14, 2006


fungible, when you are treating chronic pain with opioids a lot of the side effects recede as your body gets used to the meds. (the problems that remain are things like constipation)

And not many are prescribed opioids whose pain is not so severe or unrelenting that an opioid haze does not sound like a vast improvement. You are fortunate if you've never been there, yet. And in my case, my mind has been made much clearer on opiates at specific times, when it took away moderate to severe pain and allowed me to function normally.

some people have bad reactions to opiates, those are the people I really feel sorry for.

Also, you may not know that pain is bad for your health, the body heals faster when pain is treated.

Advil is not an opioid (I couldn't tell whether you knew that based on your comment). It seems sensible in your case, where stress is the main cause, that relieving stress is the best treatment. For god's sake, take the Advil, so you can listen to your stress relaxation tape with full concentration. I love Jack Kornfield's tapes. He leads a meditation where you focus on all the feelings in your body as they come and go, or linger, on "the Inner Art of Meditation" that I have found very helpful.

I'm not saying people gots ta take opioids, believe me, though, there are thousands, even millions? of people in this country being undertreated for pain. People are dying of cancer and still not getting enough pain meds. It is insanity. I guess I just see this elaborate therapy with the fMRI machine as yet another attempt by the medical establishment to get out of treating pain with the most effective, efficient method we have so far: opiates.
posted by overanxious ducksqueezer at 7:30 PM on May 14, 2006


I'd agree with that, but who wants to live their whole life in an opioid haze? OK, maybe some people, but not me.

Are you saying you'd like to live your life in constant pain?

Well, be my guest. I'll take the haze. Or at least I would, if opiods did cause a 'haze' which they don't if used in doses small enough to avoid pain.

Sometimes I think that our dependence on pain killers is what causes the pain in the first place.

Well, that's what we call 'crazy'.
posted by delmoi at 7:44 PM on May 14, 2006


You are fortunate if you've never been there, yet. And in my case, my mind has been made much clearer on opiates at specific times, when it took away moderate to severe pain and allowed me to function normally.

When I was dealing with back pain, taking a codeine would make it much, much easier for me to study, pain causes a 'haze', much more so then opiods.
posted by delmoi at 7:46 PM on May 14, 2006


I guess I just see this elaborate therapy with the fMRI machine as yet another attempt by the medical establishment to get out of treating pain with the most effective, efficient method we have so far: opiates.

I don't have any experience with chronic pain or dealing with the judgments of the uninformed with regard to it, and I have sympathy for anyone told "it's just in your head" by someone who doesn't realize how real things in your head can be, but I am nonetheless surprised at the cynicism and hostility displayed by some in this thread toward the possibility of a new therapy. You said it yourself: some people have bad reactions to opiates Isn't that reason enough to be pursuing new avenues? It seems to me that unless opioids are perfect, we ought to be trying new things.

It sounds like one benefit a neurofeedback therapy might offer is a greater likelihood of permanently rewiring away the pain, so that no further treatment is necessary. It seems like you should welcome these researchers, and not cast them off as tools of the medical establishment, as they are aware of the intimate link between mind and brain and know that the reason that your pain doesn't go away is that your brain has changed. They want to help you change it back.

I know next to nothing about the pain research field, but my limited experience with people in it suggests that pain researchers are very aware of problems in pain treatment today. Morphine is a wonderful drug, a prof said to us in class last year. Admittedly, we tittered, but he was right.

I think that people don't like the idea that pain treatment could be affected by your mental state--that a placebo can be a real pain treatment--because it suggests that those who said "it's all in your head" were right. Really, though, we all need to change our attitudes toward what it means for something to be "in your head." If we all learned to accept that problems in our heads are real, then there would be no shame in a responding to a treatment that is only in our heads. Our definition of pain treatment should be a tautology: A treatment for pain is something that relieves pain. The relevant questions are things like efficacy, side effect profile, cost, and duration. Whether your treatment comes from pharma or from your head shouldn't matter.
posted by epugachev at 8:17 PM on May 14, 2006


epugachev,

you are right that I am displacing my frustration and anger for doctors onto the researchers of this study, which is unfair. i believe the researchers are well-intentioned, excited to be learning new things and helping people.

It sounds like one benefit a neurofeedback therapy might offer is a greater likelihood of permanently rewiring away the pain, so that no further treatment is necessary. It seems like you should welcome these researchers, and not cast them off as tools of the medical establishment, as they are aware of the intimate link between mind and brain and know that the reason that your pain doesn't go away is that your brain has changed. They want to help you change it back.

You said it yourself: some people have bad reactions to opiates Isn't that reason enough to be pursuing new avenues? It seems to me that unless opioids are perfect, we ought to be trying new things.

People aren't getting the opioids they need. There have been similar articles hyping hydrotherapy, biofeedback, TENS machines. None of them compare to opiates in effectiveness. You said it yourself: A treatment for pain is something that relieves pain. The relevant questions are things like efficacy, side effect profile, cost, and duration. My point was just that opiates win hands down, but they're not getting where they're needed.

It's like I've got an infection, and doctors are too scared to prescribe antibiotics because they're afraid I'll start wanting to take them all the time and there's a big government agency tracking their antibiotic prescribing and they don't want to risk their jobs. So instead I have to wait, sick and feverish, and read articles about some cool new brain scanning technique that someday just might allow people to visualize the immune activation parts of the brain and start to control it themselves, and someday, maybe I can cure myself of the infection. If insurance will cover such an expensive therapy...

i'm really surprised that i came across as that hostile, so i apologize. pain makes people ugly.
posted by overanxious ducksqueezer at 8:59 PM on May 14, 2006


I'd agree with that, but who wants to live their whole life in an opioid haze?

From personal experience I can tell you that regularly taken opioid painkiller causes no "haze" other than the "euphoria" of not having pain. Untreated pain gets "embedded" in the brain/mind and the physical accommodation of the pain cripples the body further. With appropriate opioid painkiller the body (and the mind) functions as normal, and, as in my case, it is the lack of pain that becomes "embedded," which allowed me to cut back and, in time, to be able to function without the help of opioids altogether.
posted by semmi at 9:04 PM on May 14, 2006


Problem with opioids, they don't make big profits. They are cheap and effective, and have been around for ages.
posted by Goofyy at 9:59 PM on May 14, 2006


This was an interesting article for me to read. When I went through chemotherapy this last autumn and winter I was astounded that the medical oncologist I saw knew next to nothing about pain meds. The high doses of chemo he gave me, Paclitaxel and Carboplatin, for late stage cancer caused me bone wracking agony, 24 hours a day, month after month.

When I went off the chemo and was left with ongoing, painful nerve damage (neuropathy) in my feet and asked for a prescription to buy a TENS gizmo, he refused because he said he knew nothing about it! And he didn't want to know either. Insane.

I had NO idea how painful chemo was going to be. The shock added to the distress. It wasn't only the intense nausea, malaise, or side effects from the steroids so my body wouldn't reject the chemo, the fatigue...it was sheer PAIN, deep in my bones. I needed opioids and bad. Oxycodone 750 every four hours just took the edge off enough so I could squint at the TV. And they caused horrible constipation, which added to the pain.

I learned mentally to surf the pain, ride with it, surrender to it. Some days I wiped out and felt suicidal. Some days I could go into the oblivion of just being-in-pain. I learned to play cyber Solitaire as a distraction but wish there were more entertaining but not-very-challenging games to play by oneself online as a pain management tool.

Months into this ordeal I learned about some pain management resources on the web:

The American Pain Society

The American Pain Foundation

HelpForPain

This was written about cancer pain but is actually very intelligent and useful pain management info.

A decent article from 2000 on pain killers in New York Magazine.

Another thing I learned about is that there are lidocaine patches, which can be cut and applied to various parts of the body. My med onc wouldn't give me this because he said "patches are only for terminal patients". The lying jerk.

For many years now I've been interested in EEG Spectrum, which I heard about on Public Radio. They are pioneers in neurofeedback and have a list of practitioners all over the world and machines one can purchase with various types of software for different applications, including pain management.

I was too weak and ill to fight for decent pain meds but would suggest to anybody going through chemo to research pain meds beforehand with somebody who has taken that type of chemo at that dose.

There are also some audio solutions for pain management that are interesting.
posted by nickyskye at 11:26 PM on May 14, 2006 [2 favorites]


I'm all for a new therapy, especially one that would put me so much more in control of a body that seems out-of-control, and I think this research is fantastic...but. What about the years and years spent waiting to ever have access to such treatment?

Honestly, when you're in "banging your head against a wall because after 72 hours of migraine it's the only thing left that will distract you" pain, theory doesn't count for shit. You want something that will work immediately and thoroughly. So I'm saying that in the meantime, regardless of promising research, pain patients need drugs that actually make the pain go away right now.
posted by moneyjane at 12:03 AM on May 15, 2006




Sorry if I seemed like a troll for posting and leaving... I just had children to feed and clothe.

But you guys missed the part where I said I AGREE. Yes I think people should have access to all the opioids they need and the war on drugs and the DEA are all total crap.

And no, I'm not in any way saying my little problem is in any way near what a lot of people go through, although it is something I deal with every day.

All I was saying is if there was an opportunity to control chronic pain without heavy drugs (and all drugs have their side effects, sorry) then wouldn't you want that?
posted by fungible at 5:06 PM on May 15, 2006


Oh wait let me rephrase: people should have access to all the opioids they need, except for Rush Limbaugh. Fuck that guy.
posted by fungible at 5:19 PM on May 15, 2006




I don't think anyone thought you were a troll. Yea, fuck Limbaugh. And fuck Ashcroft, who probably was doped to the gills with narcotics in the hospital when he had that pancreatitis/gall bladder thing.

I still see the fMRI therapy as a pie in the sky, when it comes to eradicating chronic pain, or even making it manageable without opiates. It would be great though.

Pharmaceutical companies continue to look for a way to take the opiate "high" out of opiates while keeping the pain-treating quality. For instance, tramadol is an unscheduled drug that works like an opiate but does not induce euphoria or haziness. It still causes dependence and withdrawal effects when stopped. It's pretty good, for what it's worth. But unlike many other opiates, it has the potential to cause seizures as a side effect... They can charge more for it though.
posted by overanxious ducksqueezer at 6:37 PM on May 15, 2006


My point was just that opiates win hands down, but they're not getting where they're needed.

Yeah, I meant to convey that I agree with you that people should get the drugs they need. I only felt the need to speak up because I thought that it was inaccurate to characterize this research as a part of a larger conspiracy to drive people of meds that work now. Because I agree with moneyjane--people hurting now rightfully care about what works now. My point was that today's care is a separate issue from technologies of the future, and there's no need to conflate the two.

A fair question is what this treatment offers you that existing meds don't. I don't know the answer to that. Maybe the possibility of a quicker or higher probability of rewiring away of the pain.

i'm really surprised that i came across as that hostile, so i apologize.

No, you weren't that hostile. Just wanted to keep things on track.
posted by epugachev at 8:04 PM on May 15, 2006


Months into this ordeal I learned about some pain management resources on the web:

Sadly, few of those organizations have been active in promoting and defending the most effective treatment for chronic pain in the majority of cases.

The Pain Relief Network, in contrast, stands out head and shoulders from the rest.
posted by PeterMcDermott at 5:44 AM on May 17, 2006


PeterMcDermott, thanks for that useful information!
posted by nickyskye at 11:55 AM on May 19, 2006


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