A New Kind Of Brain Scan Can See Your Pain, Literally
http://www.popsci.com/we-see-your-pain-literally?UuS7BYJAVL4daYY0.01
Nothing hurts Americans more than chronic pain. It’s our single biggest health problem, affecting the lives of 100 million adults–more than heart disease, cancer, and diabetes combined. And that figure, from a 2011 Institute of Medicine report, doesn’t even count kids in pain, veterans with devastating war injuries, or people in nursing homes.
Yet despite the fact that chronic pain is the primary reason Americans receive disability benefits, its one of the least understood afflictions. Medical schools teach doctors almost nothing about it, spending a median of nine hours on the topic over four years. The federal government puts absurdly few dollars toward research: $4 a year for every person in pain versus $2,562 for every person with HIV/AIDS. One big reason for the lack of resources is that there’s no objective way to confirm that pain exists.
The good news, finally, is that scientists from Massachusetts General Hospital (MGH) in Boston have unveiled a new brain-scanning method that allows doctors to see chronic pain in exquisite detail for the first time. The technique, a merger of PET (positron emission tomography) and MRI (magnetic resonance imaging), clearly identifies that a patient is hurting, and offers a significantly better way to diagnose chronic pain. In trials, patients’ scans lit up in brain areas corresponding to where in the body they ached.
The new method produced dramatic images showing how glial cells–which are derived from the immune system but live in the nervous system–get activated in chronic-pain patients, ramping up the transmission of pain signals to the brain. “Over the past few years, we’ve seen this in animal studies,” says Marco Loggia, who led the MGH team. “But this is the first time we have proof that it works the same way in humans, and it’s a big step forward.”
The magnitude of these findings extends beyond the science. Many patients with chronic pain are mistakenly viewed by clinicians and society at large as drug seekers or hypochondriacs. Without a blood test or biomarkers for pain, they fight skeptics and suffer through trial-and-error treatments. This visible validation that patients’ pain is real will go a long way to ease the stigma.
But it’s only a start. Now that we can see the activation of chronic pain, pharmaceutical companies should be aggressive with clinical trials to pursue new and novel treatments. “Pain can be reversed,” says Loggia. “In five to 10 years, we could potentially have a pill to do just that.”
Filed under: General Problems
“It’s about damn time there is a definitive objective test to show that we are hurting.” Eating their words?
Sorry to rain on your parade RSD Lady but I must interject some reality into your discourse. There are cancer patients and many disabled w/ indisputable documented proof of incurable diseases and unfixable injuries KNOWN to cause severe pain being turned away right now. by both doctors and pharmacists. What makes you believe everything will change?
So you can show your pain? These people can now and Drs still dismiss symptomatic complaints and outright obvious suffering and either refuse to treat or under-treat them , and if one finds a doc to prescribe relief, many pharmacists refuse to fill.
*The issue is of ‘proving’ oneself is currently hitting close to home. It is possible such testing could be of help. I am disabled and after split w/ ex I am finding it all but impossible to live independently. Solution being moving 600 miles to another state and assembling a new ‘team’ of doctors. I have 6 docs I see regularly and others are referred as needed so this task is causing quite a bit of anxiety. The process of trial and error took a couple years the last time I moved.
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Exhibit 1- From Steve’s thread here featuring a retired pain doctor no less, quite the irony, being turned away while suffering intense pain from pancreatic cancer: https://www.pharmaciststeve.com/?p=10401
Exhibit 2- A new PCP describing himself as ‘fresh out of residency:
” I think we can all agree that the narcotic thing is out of control here in the United States, but I feel that flat out saying “no” to people who have MEDICALLY DOCUMENTED causes for pain seems a little callous to me…Trying to have the conversation that opioids are not meant to be chronic medications, that they have been shown to actually cause hyperalgesia, etc, etc, nearly never goes over well….” from link:
http://forums.studentdoctor.net/threads/opioids.1113660/
Responses from 4 members below reveals, the 1st especially,how you and I are stereotyped and pre-judged as ‘chemical copers’ by many physicians. [i added CAPS for emphasis]
1-“Patients seeking chronic opioids usually have, at the core of it all, problems coping with unpleasant sensations/feelings. They will want a hypnotic to sleep, a stimulant to wake up, muscle relaxers for their tender, unexercised muscles, benzos for anxiety, and of course opiates for pain. Naturally they smoke and drink too, and will never stop. This is why chronic narcotic patients seem “different” from other people. NORMAL PEOPLE WANT TO GET BETTER so they don’t need meds. For “chemical copers”, obtaining their drug of choice is the end point.”
2-For new patients, I told them that I don’t prescribe narcotics for chronic pain (exceptions for patients over 80 years if only 1-2 norco/day for documented arthritis)
3- “I agree with the THOUGHTFUL RESPONSES above. I am a neurologist and I tell patients that it is my job to find out what the underlying cause of the pain/headache is and correct it. Most reasonable people are on board with this and will give the plan of diagnosis and treatment a chance. My experience is that a large percentage of patients have a satisfactory clinical response. Some do not and I make it clear that I will not prescribe narcotics. Those who are just looking for narcotics without wanting to get well will not return, as the above poster described.
In my state, the Medical Board has gotten quite strict about contracts and urine drug testing. That is not how I want to spend my time.”
4-“You will see patients in chronic pain, much of which has a largely psychologic basis. I agree that it seems callous to refuse narcotics to people who have legit reasons for pain. You will have patients that refuse anything other than narcotics and refuse to taper them… some patients will leave the practice because all they want are narcotics. You need to be ok with that, as you are not in practice to indiscriminately prescribe narcotics.”
-Notice how the minority of his patients of whom #3 speaks? It is repeated by #2 and to a lesser extent by #4 (‘largely psychological basis’) If you have chronic pain and do not respond to non-opiate treatments, you do not WANT to get well?!?! Also how its an inconvenience to give UDTs and set up ‘pain contracts’.
As a reminder as to what we are up against, again, this is the response for patients WITH a DOCUMENTED diagnosis of serious injury and painful diseases.
We are going to see some amazing things resulting from the research taking place in neuroscience. I believe many of those suffering from “psychogenic” illnesses will soon have an answer to the question, “Why?”.
We have been waiting for a better method to measure pain as the 1 to 10 pain scale has limited value. Originally, I suffered horrible pain caused by a ruptured lumbar disc @ L4-5, which radiated down both legs making it difficult to walk. I used to mark an 8 or 9 on the pain scale in the paperwork at the doctor’s office. After I ended up with adhesive arachnoiditis (caused by by misplaced steroids in my spine), that original pain is nothing compared to the pain I experience now. Looking back, I would mark my original pain as less than one. In other words, arachnoiditis “reset” my pain scale.
The other important factor to measuring pain is determining whether pain has centralized or not. That original pain radiating down my legs was a “peripheral” pain condition – as opposed to a centralized pain problem, which now affects my brain and spinal cord. It is much more difficult to manage, and I would most definitely trade a peripheral injury for what I suffer now.
It’s about damn time there is a definitive objective test to show that we are hurting. Personally I have the pain pump and would have to get it removed in order to get this MRI. I think it’s life span is over in two years anyway so before getting a new one put in I would definitely get this test. I want to see those doctors, those pharmacist, those DEA agents, those family members and friends who called us drug addicts, and society as a whole who viewed us with suspicion eat their words. Touche
Couldn’t help catching the part of your comment where you say because you have a pain pump, you would have to have it removed for getting the MRI. I have had my pain pump since 2005 (medtronic syncromed II) and I have had several MRIs since then and never had a problem. It does have to be checked after each time to make sure all is well, but have never had any problem. Now, the neurostimulators forbid MRIs, but not pain pumps. You should talk to your dr if thats what youve been told.
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