My Pain, My Brain

Cool article over at the NYT Magazine about using fMRI to view the impact of chronic pain on the brain, and using it as biofeedback to control the pain.

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.

The area of the brain that the scanner focuses on is the rostral anterior cingulate cortex (rACC). The rACC (a quarter-size patch in the middle-front of the brain, the cingular cortex) plays a critical role in the awareness of the nastiness of pain: the feeling of dislike for it, a loathing so intense that you are immediately compelled to try to make it stop.

The study involves five 13-minute scanning runs, each consisting of five cycles of a 30-second rest followed by a 1-minute interval in which you try to increase rACC activation and then a 1-minute interval in which you try to decrease rACC activation. 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.

The chronic-pain patients who underwent neuroimaging training reported an average decrease of 64 percent in pain rating by the end of the study. Traditional biofeedback also compared unfavorably; changes in pain ratings of subjects in the experimental group were three times as large as in the biofeedback control group.

One thing that blew me away was her technique for increasing and decreasing the pain:

By the last run, I had the strategies down heretic-martyr: rACC down; heretic-victim: rACC up.

If you read the article she explains more of what she means, but basically in both cases she imagined herself being burned. I thought she might imagine her self on the beach or sitting in an ice cave or something to decrease the pain. Instead, she imagines herself being burned, but as a martyr. To control the pain she doesn't try and get away from it, but rather she gives the pain meaning and by doing so the pain goes away.

It takes Buddhist monks 30 years of sitting on a mountain learning to control their brains through meditation we're trying to jump-start that process.

I wonder if in the future we will be able to all use fMRIs to fine tune the way our brains work. What if monks could use it so instead of it taking 30 years control their brains they could do it in 5? What if we all could use it to improve our tolerance to pain, or improve our concentration or other skills that it takes the monks many many years to perfect?

via New York Times Magazine