Category Archives: Exhibition Topics

Lights, camera, action

We’ve got some great objects on display in our new exhibition – spiders, an Xbox, an anaesthesia machine, and more. These help to bring the stories we’re telling in Pain Less to life.

But pain is personal, and that has driven how we are presenting the stories in our exhibition. The objects we’ve found give a tangible link to our stories, but we want to introduce our visitors to the people behind them.

So we tore ourselves away from our desks, hopped on trains, planes and auto-mobiles, and headed off around the country to film interviews with the scientists and people whose tales we’re telling in Pain Less.

These films make up a key part of the exhibition, and you might have noticed over the last few weeks they have been appearing on the blog, but in case you missed them here they are… Enjoy!

Pain in the brain

Pain killers

Painfully unaware

Virtually painless


Painfully unaware

If you’ve ever had surgery, or simply had a tooth out, then you’ll know popping a couple of Ibuprofen just isn’t going to cut it, you want to be numb, or even better, unconscious… Enter the anaesthetists.

Medics have been using anaesthetic drugs for over 150 years and they have plenty of clinical evidence that they work extremely well. But how does anaesthetic actually work? And how much to we understand about what we experience when we lose consciousness?

During anaesthesia for major surgery, drugs prevent you being aware of painful sensations. Doctors often conduct minor surgery, and other procedures, under local anaesthesia, and use sedative drugs to calm you.

General anaesthetics and sedatives alter your state of consciousness. Anaesthetists commonly give them in combination with powerful painkillers to make sure your surgery is as painless as possible.

Today general anaesthesia often begins with an injected dose of the drug propofol. Researchers know a good deal about how this drug works on a cellular level.

‘Our cell research showed us that propofol influences receptors on certain nerve cells. These nerves normally respond to a chemical messenger called GABA that stops them sending signals. Propofol mimics the effects of GABA and inhibits nerve signals.’ says Jeffery L Barker from the Laboratory of Neurophysiology, part of the NINDS institute in Bethseda, Maryland

Propofol is only one of many different types of anaesthetic drugs. Each type appears to affect different sets of receptors in the brain, but they all make you lose consciousness.

Because some anaesthetic drugs influence different kinds of neuron compared with others, their precise effects on the brain may be very different.

Brain research tools can show which areas of the brain are affected by different anaesthetics. With fMRI (functional magnetic resonance imaging), for example, a scanner shows brain activity in 3D. On the other hand, when an EEG (electroencephalogram) is recorded, non-invasive electrodes are stuck onto your scalp to measure electrical activity on the brain surface.

EEGs and fMRIs can measure brain activity during different levels of consciousness: awake, asleep and even anaesthetised.

So what can today’s brain imaging technologies tell us about how anaesthetics work?

Steven Laureys leads the Coma Science Group at the University of Liège in Belgium. In an experiment he anaesthetised patients and scanned their brains.

‘Even when volunteers were unconscious, small “islands” in the sensory cortex of their brains showed activity in response to external stimuli,’ says Steven. ‘But this activity did not spread through the brain to areas that control behaviour and memory. This means that although your brain responds to sensations while you’re unconscious, memories don’t form as they would normally.’

Most people seem to have to no memories of sensations during surgery. But Jackie Andrade, Professor of Psychology at Plymouth University, has demonstrated that we’re able to form partial, ‘implicit’, memories under anaesthesia.

‘We tested patients by having them listen to certain words during surgery under general anaesthesia. When they came around, we found that the patients responded differently to words we had played while they were “unconscious” than to other words.’

There are two groups of patients with explicit memories of surgery: those who can remember pain and those who can’t. If you remember pain, you are much more likely to develop post-traumatic stress. But Jackie thinks that implicit memories may also affect you.

‘Although you’re not aware of these memories at all, they could affect recovery times after surgery and cause psychological stress.’

‘Implicit memory could be used to benefit patients undergoing surgery. Encouraging and positive comments made in the operating theatre could be used to reassure patients and reduce anxiety, even while they’re unconscious.’

So how can research improve future anaesthesia?… Do we just need better drugs?

Consultant anaesthetist Andrew Morley from St Thomas’ Hospital in London thinks new drugs are not the top priority.

‘Patients having surgery under anaesthesia in future will benefit more from small changes in all aspects of the process than from a single “miracle” anaesthetic drug,’ says Andrew.

‘Even if we don’t know exactly how they work, today’s general anaesthetics are highly effective. Before surgery, I consider both patient and planned operation in deciding the best combination of drugs and techniques. I aim to provide good operating conditions for the surgeon, minimising side effects and getting the best possible outcome for each patient. It’s a bespoke business.’

Could new technology be the answer?

The fEITER is a portable imaging technology that has successfully recorded 3D images from anaesthetised brains as they lose consciousness.

Brian Pollard, who developed fEITER the University of Manchester, explains:

‘These images gave us confirmation that losing consciousness involves changes in electrical activity deep inside the brain. Finding out about the process of anesthesia and sedation can help us monitor brain function in the operating theatre, and reduce the risk of painful awareness during surgery.’

But are high tech monitors alone enough to improve anaesthesia?

Emery Brown’s work at the Department of Anaesthesia, Massachusetts General Hospital and at the Department of Brain and Cognitive Sciences, MIT spans two disciplines: anaesthesia and neuroscience. He believes electroencephalogram (EEG) recordings allow anaesthetists to see when someone is unconscious and to understand how anaesthetic drugs create altered states.

‘Different drugs produce signatures that are readily interpretable using EEG. I can see signatures which indicate that the brain is unable to process information, which would mean that you are unconscious. In the future, we may be able to identify the brain circuits for consciousness and pain, and treat them directly using targeted drugs delivered to these circuits.’

Emery believes painful awareness can be prevented by training anaesthetists in neuroscience so they can interpret how EEG readings relate to underlying brain states.

‘The true culprit in cases of awareness is anaesthetists not being able to tell when a patient is unconscious. They often rely on brain activity monitors that are grossly simplified.

‘I can understand detailed raw EEG readings. If you came to me and told me you were afraid you were going to be aware during surgery, I would tell you that I can keep it from happening by keeping an eye on your EEG.’

It is clear to see experts are approaching this issue from all sides. But in the end it may all come down to the skilled experts in the operating theatre…

Andrew Morley explains, ‘Preventing painful awareness in surgery is not only about technology and understanding the brain.’ says Andrew Morley. ‘For decades, scientists and clinicians have tried to use the EEG – raw and otherwise – to distinguish conscious from unconscious patients reliably. No-one’s got it quite right yet – awareness still happens.’

‘Improving anaesthesia is also a matter of improving vigilance in the operating theatre and reducing the likelihood of human error. The Royal College of Anaesthetists and Association of Anaesthetists of Great Britain and Ireland are gathering information on real cases of accidental awareness during general anaesthesia. The results may help us progress towards a better practice and healthier patients.’

Virtually painless

Pain helps you minimise damage to your body by warning you when you’re hurt. Acute pain is caused by injuries, illnesses or surgery and tells your brain that something is wrong. Chronic pain, on the other hand, persists long after the cause has gone and your body should have healed. Every year the NHS spends £5 billion to treat chronic back pain alone.

Why is chronic pain so difficult to deal with?

If you take strong medication for a long time, it can become less effective and may cause unpleasant side effects, such as nausea or drowsiness.

Like any other chronic illness, chronic pain persists for a long time. It can be hard to find a cure and patients can endure a lifetime of suffering. Even though the pain seems to come from the body, ultimately it’s the brain that interprets the sensation of pain.

So how does your brain relate to your body when you feel pain?

Just like sight and touch, pain is part of your sensory system. Your senses provide you with vital information about the world around you. If you get your skin stuck in a zip, you’re able to react immediately.

A sensory map in your brain quickly tells you where the pain is. During your lifetime this map grows and changes in relation to your movements, sensations and even your injuries.

Can learning how the brain changes in relation to lasting pain lead to more effective relief?

For the first time, researchers at Northwestern University in Chicago have seen a change in grey matter in chronic pain patients. Scientists hope to understand the mechanisms that cause this change and use the knowledge to develop new therapies for chronic pain.

One particular type of chronic pain has already helped researchers understand more about how the brain changes in relation to serious injury – phantom limb pain.

If you suffer a serious injury such as an amputation, your brain’s sensory map no longer matches what you see or do. This happens because every adult brain has neuroplasticity – the potential to remould. About 60–80% of amputees develop pain in their missing limb. Sometimes the sensations can be as simple and strange as the feeling of a hand brushing their cheek. Other times it is persistent and hard to treat. Using mirrors or more complex virtual-reality games can help some people.

Scientists think the reason why virtual-reality games can reduce chronic pain is because of the adult brain’s ability to change. But could we use these treatments more effectively in future?

‘Our research has shown that virtual reality can reduce pain for hours, but we know little of its long-term effectiveness,’ says Jonathan Cole, a consultant in clinical neurophysiology at Poole Hospital and Bournemouth University. ‘What we really want to do is teach people to do this as soon as they lose their limb. The longer you wait, the more time the brain has had to grow the wrong connections and reinforce the pain.’

‘Because the adult brain is dynamic and changes throughout our life, it’s certainly possible that in future virtual-reality techniques could be extended to treating other common pain problems, such as certain types of back pain. However, virtual reality doesn’t always work for everyone,’ says Ilan Lieberman, a pain consultant at Spire Manchester Hospital.

So is there an overarching solution to chronic pain?

‘Over the past 50 years, people have been looking for a one-size-fits-all treatment for chronic pain,’ says Vania Apkarian, a leading chronic pain researcher at Northwestern University. Vania thinks treatments in the future will be tailored to the individual.

‘With today’s advances in brain imaging, we can see that the brain of every chronic pain patient is structurally and psychologically different. We found that there are different forms of chronic pain, each with their unique brain imprint. You can’t expect to treat them all in the same way.’

In an ideal future, doctors would be able to use medical scans to look into the brain of a patient and see exactly where things have gone wrong.

This level of insight is what Vania’s research team are trying to achieve.

‘We’re entering into unknown territories, testing drugs that may reveal brain areas involved in chronic back pain. I can’t disclose more for now, but if successful, it will provide evidence that understanding brain mechanisms of chronic pain can lead to targeted therapies.’

Pain killers

You might not like it, but you need to feel pain. It’s important. It helps to keep you safe by letting you know when something is wrong. You experience pain through specialised nerve cell endings called nociceptors. You will find these throughout your body, but some areas, such as your skin, have more than others. They alert you to different causes of pain which could harm you, such as extreme temperatures, pressure, damaging chemicals and infection.

So how does a painful sensation tell your brain you’re in trouble?

You accidently put your hand on a hot hob… ouch! Your nociceptors respond to this pain and create an electrical signal using special proteins called sodium channels. These channels are like gates in the membrane that surrounds the nerve cell. When a cause of pain – such as hand on hob – triggers a signal, these gates open and let in a flood of positively charged sodium ions. This changes the electrical charge of the nerve and a signal travels from nerve to nerve, up the spinal cord and into your brain to alert it to the pain.

We have nine different types of sodium channels, but only one is particularly important for pain – Nav 1.7. This channel is essential to transmit pain signals. Each channel has its own gene, which provides the instructions for how the channel should work. The gene for channel Nav 1.7 is called SCN9A. Mutations to this gene effect how you experience pain. Some mutations can make people super-sensitive to pain, while other mutations can cause people to feel no physical pain at all.

A rare mutation to the SCN9A gene, called a non-sense mutation, causes the sodium channel to stop working. This means that pain signals from the body aren’t transmitted to the brain. People with this genetic mutation are unable to feel any physical pain and can’t smell, but are otherwise healthy. Fewer than one in a million people in the UK can’t feel pain because of SCN9A mutations.

Researchers want to recreate the effect of the mutation to treat pain in others. If scientists can isolate a molecule that can block pain signals in the same way they will have a powerful painkiller.

Oddly enough research reveals that molecules in toxic venom from snails, snakes, scorpions and spiders can block human sodium channels. If scientists can find the venom component that only blocks pain channel Nav 1.7 it could mean pain relief without serious side-effects. This is because Nav 1.7 is only responsible for pain and smell, unlike other targets for pain-relief drugs, such as opioid receptors. As well as pain relief your opioid receptors are linked to your emotions, and things you do automatically such as breathing.

A drug which only targets Nav 1.7 would specifically target the experience of pain.

Could venom be the ‘wonder drug’ of the future?

‘Yes!’ says Pierre Escoubas, Founder of Venome Tech.

‘Your nerves have many sodium channels to communicate between the brain and body. Each has a specific function. Blocking a channel other than pain channel Nav 1.7 could have serious effects on the heart, muscles or nervous system. A treatment with too general a target could be fatal.’

‘Venom-derived molecules can be very selective. This makes them the ‘magic bullet’ of potential drugs, as they hit a specific target without undesirable side effects.’

Venom might be the source of a future drug for pain relief. But it’s not as easy as just milking a spider…

‘The big problem is that the peptides (protein parts) we have isolated so far are not selective enough. They strongly block Nav 1.7 but they block other channels as well’ explains Glenn King, Professor of Molecular Bioscience at the University of Queensland.

‘Right now we have found a good candidate which is very effective at blocking Nav 1.7. Unfortunately it also blocks Nav 1.6, which might cause undesired side-effects. So, we’re hoping to tweak the molecular structure a little and get the selectivity required for a perfect painkiller.’

Could this pain killer be too effective?

Pain may not be pleasant but it helps keep you from hurting yourself too. If the drug blocks all pain could it be so good it’s bad?

’I think we would only need to worry about a drug this effective being too good if the effects were permanent’ says Glenn King. ‘The molecules we’re looking at have a limited life in the bloodstream and eventually break down. Patients would probably need regular top-ups.’

Venom has a lot of potential, but it’s not the only possible future for pain relief.

‘Another type of pain transmitter in the body is the transient receptor potential (TRP) channels’ explains Julie Keeble, a pharmaceutical researcher at Kings College London.

‘As part of my research I have been studying the role of TRP channels in painful inflammation, such as the chronic pain associated with arthritis. Some TRP channels are affected by simple kitchen ingredients – like hot chilli peppers and mustard oil, but they can also be activated by chemicals that are produced during pain. Drugs to target these channels are still progressing through clinical trials, but they may offer new hope for chronic pain patients.’

Pain in the brain

You don’t just experience pain physically. The amount of pain you perceive is influenced by environmental factors – for example sound, temperature and your surroundings – and psychological factors, such as your thoughts, beliefs, feelings and attitudes.

You feel pain through specialised nerve cell endings called nociceptors .These send signals through your central nervous system, which your brain will interpret.

So how much can your perceptions really affect your pain?

The placebo effect

Your expectations and emotions are powerful. They can have a significant impact on the success of a treatment. You might experience pain relief, or improved symptoms, from taking fake medication or having a fake procedure. This is known as the placebo effect.

In one experiment led by psychologists at the University of Michigan, participants received a placebo that they were told would help reduce pain from painful stimuli such as heat or an electric shock. Images of their brains while in pain showed less activity in the pain-sensitive areas of their brains when they had the placebo, compared with when they didn’t.

If positive expectations can make pain better, can negative thoughts make it worse?

The nocebo effect

Meet the placebo effect’s evil twin! Researchers have found that expecting negative side effects from drugs can sometimes be enough to cause them, even when the drugs are supposedly harmless. This is called the nocebo effect. In one experiment, a group of patients with back pain were asked to do a test. The half that was told it would make their pain worse reported that they experienced more pain.

So how might this change how medics talk about pain and pain relief?

The placebo and nocebo effects have shown the importance of the way you talk about pain. If doctors give negative suggestions, or tell patients too much information about possible side effects, they could increase the chance of the patient experiencing them.

‘Patients who have unrealistically high or very low expectations from a treatment may affect the efficiency of the drug or surgery they are having’ explains Paul Enck, Professor of Medical Psychology at University Hospital Tübingen.

’Probably the best way to address this in future is to speak to the patient about their expectations from the treatment. Choosing the right terms to use may be as important as avoiding giving the wrong information.’

Now we know that our thoughts and expectations can affect our response to pain treatment, can we actively change our emotions to make drugs more effective? And can understanding the effect of a good mood on your pain improve treatments?

‘If we can understand how being in a happy mood, or having positive expectations, reduces pain signals in the brain, we might be able to provide a radically different way to switch off the pain and provide relief,’ explains Irene Tracey, Director of the Oxford Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB).

But can patients find their own path to pain relief?

‘We have found that even a brief amount of meditation training can make a difference in the experience of pain,’ says Fadel Zeidan from Wake Forest School of Medicine.

‘In one of my experiments healthy volunteers were given a painful stimulus and rated their experience. After four sessions of meditation training, meditating whilst experiencing the painful stimulation reduced pain unpleasantness by 57% and pain intensity by 40%. In contrast, researchers have found that a clinical dose of morphine reduces pain by up to 25%.

‘Clinicians are already using meditation alongside medication to help reduce the amount of drugs patients need to take.’

‘Meditation is not necessarily about reducing the pain sensation, but about changing the perception of pain and relating to it differently,’ says Tim Gard at Massachusetts General Hospital, Harvard Medical School.

‘In one study I used brain imaging to see changes in the brain while meditating and experiencing pain. I found that activity in the brain was different between those who had and had not meditated before. The experience of pain was less unpleasant in those who meditated.

‘I think meditation will play an increasingly important role in chronic pain management, but alongside medicine rather than replacing it completely.’

So the question is; can we really have a drug free future?

‘For something like pain, in particular chronic pain, there is no doubt that a three-way approach – drugs, working with psychologists and physical rehabilitation – is the most successful,’ says Irene Tracey.

‘Pain is both a sensory and emotional experience. A single approach to tackle one element can provide a lot of benefits, but a combined approach really attacks the problem at all the different points at which pain can take hold.’

Future clinicians will need to decide who will benefit most from which combination of approaches. Which approach would you prefer?

A life without pain

Most of us don’t like feeling pain, but we know how important it is. Pain is the warning signal that lets us know when we’re injured or ill.

One of the extraordinary people we came across during our research was Steven. He is ordinary in almost every way, but unlike most of us he has a rare condition that means he can’t feel any pain.

‘When I’m overcome with nausea, exhaustion or aches it may just be a cold, but it could be deadly serious like a burst appendix. My life is full of potentially dangerous situations because I don’t feel pain.’

Clinical geneticist Geoff Woods was among the first to report that some people who don’t feel pain carry a genetic mutation that affects the pain-sensing nerves in their bodies. None of their pain receptors send signals to their brains. Geoff explains:

‘Some painless people have a small mutation in an area of their genetic code that is essential to make a pain channel in their nerves. Without the channel it’s impossible to send pain signals to the brain. By studying people like Steven’s DNA we can eventually understand why he doesn’t feel pain. More importantly, it tells us how the rest of us do.’

Powerful gene sequencers such as this one can read an entire human genome in one day and identify the no-pain genetic mutation. We’ve got our hands on this clever piece of kit for Pain Less.

Natural born painkillers

Researchers are now working to understand exactly how this mutation blocks pain signals to the brain to try and mimic it, and create the ultimate painkiller.

They may have found the answer from a very unusual source – snake and spider venom. Venom is a cocktail of different molecules used to incapacitate prey and deter predators.

Biochemist Glenn King is investigating some molecules in this noxious mix that stop pain in the same way as the no-pain genetic mutation. These molecules block a channel in the body’s nerves to stop pain signals from reaching the brain.

So rather than start from scratch to synthesise these complex molecules, pharmaceutical companies are looking to venomous sea snails, spiders, snakes and scorpions to provide vital ingredients for the next generation of painkillers.

Jasmine’s favourite find

Jasmine Spavieri, one of our Assistant Content Developers, describes how she sourced one of the most striking objects in our exhibition…

‘One exceptional story we found was that of Steve Trim, a former chronic pain patient and a pain researcher. After finding a treatment that worked to cure his pain, Steve was inspired to accept a job working in pain research.

‘He discovered that the use of venom as a potential medication is a growing field of research. He decided to start his own biotech company – or as we like to call it “venom farm” – and is now the director of Venomtech. His laboratory provides an array of “fresh” venoms, from snakes to spiders and scorpions. Steve also gives educational talks to school groups and answered the questions of our young participatory group from Langley Academy.

‘Steve has been kind enough to provide us with what I think is one of our coolest objects, the skin and fangs of a huge tarantula, along with some milking equipment!’

I’m relieved it’s not a snake – they give me the heebie-jeebies.

Playing with pain

Hi, I’m Jasmine. I’m part of the contemporary science team working on Pain Less. When creating a new exhibition our job is to research the topic, interview and work with experts, and write the content for the exhibition.

However, we’re doing things a little differently this time – enlisting help from groups of people who can give us unique perspectives on the topic and shape the content of Pain Less. So my job is a little different too. My main task throughout the creation of Pain Less is to work with one of these groups – Year 9 students from Langley Academy – to ensure their ideas inspire and become part of the exhibition

So what have they done so far?

At the start the students met researchers at the top of their game studying pain, anaesthesia and consciousness.

Out of the three topics, the students decided their favourite was pain, because everyone, well almost everyone, can relate to the experience.

The students got to quiz the experts about everything and anything they could think of that’s to do with pain…

How many different types of pain are there? Why do we all experience pain differently? Why do some people feel more pain than others? Do you feel that current painkillers are good enough? If you could get rid of pain completely, would you?

The questions they asked, along with the very interesting answers, inspired the content of our exhibition. We explored different pain treatments, such as virtual reality and spider venom. The students, especially the girls, were very interested in how our mood can drastically influence our perception of pain. This then became one of the main topics of Pain Less.

As well exploring the stories we tell in Pain Less, we shared the different ways we deliver our content at the Science Museum. We visited some of the Musuem’s other interactive galleries – Atmosphere, Launchpad and Who am I? – and also took the students to explore our team’s interactive gallery, Antenna.

From artwork to films to objects, the students told us what they liked and disliked.

They decided they wanted their contribution to Pain Less to be an interactive video game, as that’s what they enjoyed the most in the galleries they visited. You can have a go at some of these games yourself online.

In the next few sessions, ideas for games were all jotted down on giant tablecloths before being presented to the rest of the group.

The students agreed that the aim of the game should be to stop the pain, and came up with some very painful scenarios for the game character: getting your braces tightened, paper cuts, even broken limbs.

Creativity was not lacking! All we needed was an expert game designer…

So we introduced the group to Thought Den, a video game company from Bristol. Together they talked about point systems, bonuses and power-ups, and how they could be related to the science in the exhibition. One idea was a ‘power-up painkiller’ – the character can take it to defeat attacking pain waves, but must be careful not to use it too often as it will become less effective, reflecting the reality that we can build up a tolerance to painkillers.

As there were so many ideas for the game, we’re all very curious to finally see it in action!

I’ve only given you a taster of all the work we’ve done with Langley Academy, but luckily, back at the start of the project, I began writing a blog (yes another one!) about our sessions, called Ouch!Ouch!Ouch! Check out sketches and ideas from the students, online science games, even a video of a tarantula and a scorpion getting milked… Enjoy!