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My Pain, My Brain
By MELANIE THERNSTROM
Published: May 14, 2006
Who
hasn't wished she could watch her brain at work and make changes to it, the way
a painter steps back from a painting, studies it and decides to make the sky a
different hue? If only we could spell-check our brain like a text, or reprogram
it like a computer to eliminate glitches like pain, depression
and learning disabilities. Would we one day become completely transparent to
ourselves, and — fully conscious of consciousness — consciously create
ourselves as we like?
Illustration
by Marcos Chin
Illustration
by Marcos Chin
The glitch I'd like to program out of my brain is chronic
pain. For the past 10 years, I have been suffering from an arthritic
condition that causes chronic pain in my neck that radiates into the right side
of my face and right shoulder and arm. Sometimes I picture the pain — soggy,
moldy, dark or perhaps ashy, like those alarming pictures of smokers' lungs.
Wherever the pain is located, it must look awful by now, after a decade of
dominating my brain. I'd like to replace my forehead with a Plexiglas window,
set up a camera and film my brain and (since this is my brain, I'm the director)
redirect it. Cut. Those areas that are generating pain — cool
it. Those areas that are supposed to be alleviating pain — hello? I need you!
Down-regulate pain-perception circuitry, as scientists say. Up-regulate
pain-modulation circuitry. Now.
Recently,
I had a glimpse of what that reprogramming would look like. I was lying on my
back in a large white plastic f.M.R.I. machine that uses ingenious new software,
peering up through 3-D goggles at a small screen. I was experiencing a clinical
demonstration of a new technology — real-time functional neuroimaging — used
in a Stanford University study, now in its second phase, that allows subjects to
see their own brain activity while feeling pain and to try to change that brain
activity to control their pain.
Over six
sessions, volunteers are being asked to try to increase and decrease their pain
while watching the activation of a part of their brain involved in pain
perception and modulation. This real-time imaging lets them assess how well they
are succeeding. Dr. Sean Mackey, the study's senior investigator and the
director of the Neuroimaging and Pain Lab at Stanford, explained that the
results of the study's first phase, which were recently published in the
prestigious Proceedings of the National Academy of Sciences, showed that while
looking at the brain, subjects can learn to control its activation in a way that
regulates their pain. While this may be likened to biofeedback, traditional
biofeedback provides indirect measures of brain activity through information
about heart rate, skin temperature and other autonomic functions, or even EEG
waves. Mackey's approach allows subjects to interact with the brain itself.
"It
is the mind-body problem — right there on the screen," one of Mackey's
collaborators, Christopher deCharms, a neurophysiologist and a principal
investigator of the study, told me later. "We are doing something that
people have wanted to do for thousands of years. Descartes said, 'I think,
therefore I am.' Now we're watching that process as it unfolds."
Suddenly,
the machine made a deep rattling sound, and an image flickered before me: my
brain. I am looking at my own brain, as it thinks my own thoughts, including
these thoughts.
How does
it work? I want to ask. Just as people were once puzzled by Freud's
talking cure (how does describing problems solve them?), the Stanford study
makes us wonder: How can one part of our brain control another by looking at it?
Who is the "me" controlling my brain, then? It seems to deepen the
mind-body problem, widening the old Cartesian divide by splitting the self into
subject and agent.
But most
of all I want to know: Will I be able to learn it?
or most of history, the idea of watching the mind at work
was as fantastical as documenting a ghost. You could break into the haunted
house — slice the brain open — but all you would find would be the house
itself, the brain's architecture, not its invisible occupant. Photographing it
with X-rays resulted only in pictures of the shell of the house, the skull. The
invention of the CT scan and magnetic resonance imaging (M.R.I.) were great
advances because they reveal tissue as well as bones — the wallpaper as well
as the walls — but the ghost still didn't show up. Consciousness remained
elusive.
A newer
form of M.R.I., functional magnetic resonance imaging (f.M.R.I.), used with
increasingly sophisticated software, is accomplishing this, taking
"movies" of brain activity. Researchers are able to watch the brain
work, as the films show parts of the brain becoming active under various stimuli
by detecting areas of increased blood flow connected with the faster firing of
nerve cells. These films are difficult to read; researchers puzzle over the new
images like
Perhaps
more than any other aspect of human existence, persistent pain is experienced as
something we cannot control but desperately wish we could. Acute pain serves the
evolutionary function of warning us of tissue damage, but chronic pain does
nothing except undo us. Pain is the primary complaint that sends people to the
doctor. Of the 50-odd million sufferers in the
Integration of Behavioral and Relaxation Approaches Into the Treatment of Chronic Pain and Insomnia
NIH Technology Assessment Panel on Integration of Behavioral and Relaxation Approaches Into the Treatment of Chronic Pain and Insomnia
Objectives.-To provide physicians with a responsible assessment of the integration of behavioral and relaxation approaches in the treatment of chronic pain and insomnia.
Participants.-A non-federal, non-advocate, 12-member-panel representing the fields of family medicine, social medicine, psychiatry, psychology, public health, nursing, and epidemiology. In addition, 23 experts in behavioral medicine, pain medicine, sleep medicine, psychiatry, nursing, psychology, neurology, and behavioral and neurosciences, presented data to the panel and a conference audience of 528 during a 1 ½-day public session. Questions and statements from conference attendees were considering during the open session. Closed deliberations by the panel occurred during the remainder of the second day and the morning of the third day.
Conclusions.-A number of well-defined behavioral and relaxation interventions now exist and are effective in the treatment of chronic pain and insomnia. The panel found strong evidence for the use of relaxation techniques in reducing chronic pain in a variety of medical conditions as well as strong evidence for the use of hypnosis in alleviating pain associated with cancer. The evidence was moderate for the effectiveness of cognitive-behavioral techniques and biofeedback in relieving chronic pain. Regarding insomnia, behavioral techniques, particularly relaxation and biofeedback, produce improvements in some aspects of sleep, but it is questionable whether the magnitude of the improvement in sleep onset and total sleep time are clinically significant.
JAMA, July 24/31, 1996-Vol 276, No. 4