Tracking and Controlling Pain by Sight
RENEE MONTAGNE, host:
Pain is the number one reason people miss work in this country and a recent national survey found that half of all Americans have struggled with some kind of recurrent chronic pain. Often there's little that conventional medicine can do for these patients. Now Stanford University pain researchers are conducting some promising experiments. They're using new technology that can actually show patients and doctors where the pain is and how to control it. As David Gorn reports from Silicon Valley, this technique is giving hope to chronic pain sufferers.
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DAVID GORN reporting:
At the Stanford University Pain Clinic, the common MRI brain scan has been updated and is being used in an entirely new way.
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GORN: It's being used to track pain and to ease it.
Dr. SEAN MACKEY: He currently uses Vicodin, Vivactil, which is protriptyline, and Ambien at night and Clozapine .25 as needed throughout the day.
GORN: Dr. Sean Mackey and the Stanford pain team are crammed into a tiny lunchroom, a dozen physicians and interns elbow to elbow in a long narrow back room to talk over the latest set of pain patients.
Dr. MACKEY: A variety of tender spots in the right lower lumbar region, right trapezius, right posterior cervical region and right knee.
GORN: Dr. Mackey is experimenting with a new kind of technology called real time Functional Magnetic Resonance Imaging or FMRI, the results of which have not yet been published but which has caused a stir among pain doctors and researchers throughout the country.
Dr. MACKEY: You can play some physics tricks with that MRI scanner to be able to look at neural activity, nerve activation within the brain. And so over the last several years, what researchers have done is to use that tool to peer inside the brain to see where pain is being activated, to see how it's being processed and how that experience of pain finally comes about.
GORN: Patients can sit in the brain scanner, Dr. Mackey says, and see where the pain in their brain is.
Dr. MACKEY: And so for the first time, we're able to show a patient there inside your brain at that point that's where you're perceiving pain.
Ms. LAURA TIBBITS (Palo Alto): He said, `Here's the pain that you got when you were flexing your muscle, the pain you've been complaining about.'
GORN: Laura Tibbits of Palo Alto has had continual pain for seven years, ever since she was thrown from a horse and hurt her shoulder. At age 31 now, her shoulder has mostly healed but the pain has not really gone away. And so when Dr. Mackey showed her the pain on a brain scan, it was a revelation to her.
Ms. TIBBITS: You know, hearing it's in your head for me was a good thing because he literally was showing me where it was and so I felt a tremendous validation to know that even when--even though my bone is healed, I'm still producing this pain as if it's not.
GORN: And seeing that, Dr. Mackey says, can be a breakthrough for patients.
Dr. MACKEY: The pain is real. It's a neurological process, but ultimately all pain is in our brain. No brain, no pain.
GORN: In the study trial, patients sit in the FMRI scanner, watch the pain in their brain, and when they do meditation or mental imaging during that scan, they might actually watch that pain dissipate, or if doctors want to test how a pain medication or a dose works for an individual, they can actually see the effects of that pain medicine in real time. And those prospects have Dr. Mackey excited.
Dr. MACKEY: There's a tremendous number of opportunities for taking control of the brain, and in doing so, being able to change medical conditions.
Dr. SCOTT FISHMAN (President, American Academy of Pain Medicine): The thing that people need to understand is that we're basically looking into a room through a keyhole right now and we're trying to extrapolate what's in that room.
GORN: Dr. Scott Fishman is president of the American Academy of Pain Medicine. He says the potential uses for this technology are immense, but one of the important words here, he says, is potential.
Dr. FISHMAN: The big question is: Is it applicable? And it's not applicable at the bedside just yet. The issue with real time FMRI is that the technology is still very new and very expensive.
GORN: Expense is always an issue in modern medicine and it will take years of continued studies before this technology could come to the marketplace, but Dr. Fishman adds that this neuro-imaging research could eventually apply to everything pain doctors do. He calls it the Holy Grail of pain treatment. And since these pain doctors are clinicians as well as researchers, they have seen their patients suffer. Dr. Mackey says he lives for the moment when that suffering can be eased. So beyond the potential for a scientific breakthrough, he sees great promise for doing good.
Dr. MACKEY: And that's the most satisfying part of what I do. That's why I got into this field. I couldn't think of another area where I could have such a huge impact on people's lives.
GORN: For NPR News, I'm David Gorn.
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