Tag Archives: pain

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?


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!

Tell me when it hurts

One particularly interesting piece of research we are exploring in Pain Less is all about the power of the mind…

I’m not a morning person, and every now and then when I drag myself out of bed and, bleary-eyed, wander towards the bathroom, I stub my toe on an inconveniently placed step. It has to be the most unreasonably painful experience for first thing in the morning. According to new research, my grumpy morning mood may actually contribute to my pain. Neuroscientist Irene Tracey believes the power of the mind can drastically change the extent of our pain, and that feelings of sadness and anxiety can increase the level of pain we experience.

‘Emotions, how sad or anxious you feel, change the way signals from damaged parts of the body are processed by the brain – the organ that produces the experience of pain – so they directly influence the pain felt by the subject.’

But how does she test this?

‘I look for volunteers to experience pain in controlled laboratory experiments. When the volunteer is anxious or depressed, they feel pain more intensely. During some tests I make the volunteers feel depressed by playing slow sad music and getting them to read negative things about themselves. It may seem harsh but doing this is helps us to understand the impact our mind has on our perception of pain. This means future pain treatments might target both the body and the mind.’

And how does Irene measure people’s response to pain?

One example is this special ‘poking’ equipment, which Irene uses to do what are called Von Frey Filament tests. It ensures her willing victims all experience the same level of pain. Irene has pointed us in the direction of where we can get our hands on our own set of these pain-inflicting sticks for Pain Less – for display purposes only of course!

To get more accurate results Irene also uses some more hi-tech poking devices – lasers. These heat the skin to 50 degrees Celsius, and we hope to get hold of one of these for the exhibition too…

No pain, more game

The Games in London saw some extraordinary feats of human endeavour. This is especially true in the case of athletes who have lost a limb, yet can achieve things many able-bodied people can’t. People who have lost a limb may face a number of difficulties and one of the most bizarre is pain in their missing limb.

The phantom limb…

Phantom limb is the sensation that an amputated or missing limb, or even an organ, is still attached to the body. In some cases people feel as if their missing limb is gesturing, itchy or even trying to pick things up. People have reported sensations such as water trickling down the phantom limb, or a phantom ring becoming too tight for a phantom finger. And in the majority of cases this sensation is painful.

Neuroscientists think the problem could be caused by the brain rewiring itself incorrectly after the loss of the limb. The brain receives lots of sensory messages from the body. Once a set of these sensory inputs is lost, the brain has to rewire itself, and this is where the trouble can start.

Vilayanur Ramachandran is studying how to trick the brain into correcting this wiring problem and therefore relieving the pain. He uses a mirror box to fool the brain into thinking the limb is still there.

However, new technologies may provide a more hi-tech way to trick the brain.

Play your way to less pain…

Games have come a long way since I played Super Mario Bros. on my Game Boy.

Virtual reality research at the University of Manchester may help some patients with phantom limb pain.

Computer scientist Steve Pettifer, from the University of Manchester, has paired up with pain medicine consultant Ilan Lieberman to create an immersive virtual reality that allows people to move virtual limbs, gradually rewiring the mismatch between the mind and body. In the future, people could be able to access this virtual world from the comfort of their living room using an Xbox Kinect.

We have one of these setups for Pain Less.

Are you conscious?

Count down from ten…

Have you ever been put under general anaesthetic before surgery? I have, and when the anaesthetist asked me to count down from ten, I got as far as eight before I was out cold. The next thing I knew, I was waking up in the ward, tonsil free, and looking forward to a two-week diet of painkillers and ice cream. Most of us assume that when the drugs knock us out, that’s it; we feel nothing until the effects of the drugs wear off. But is this really the case?

Andrew Morley is an anaesthetist. He regularly sedates patients for minor surgery. For this, he uses a general anaesthetic drug called propofol at a low, or ‘sedative’, dose. Under these circumstances apparently some patients respond to pain while they’re under.

‘Patients do appear to experience pain from time to time during procedures under sedation – I take their response as a prompt and give them painkillers and top up their sedation. Afterwards they very often have no memory of the pain.’

This suggests that we may experience pain during surgery even when under sedation, but not remember it after. If you can’t remember pain, does it matter?

Psychologist Jackie Andrade thinks it does:

‘You may be aware during surgery but not completely remember it. Partial or “implicit” memories of these situations might lead to psychological stress and longer recovery times.’

Questions like this, and the incredibly rare cases where patients remember specific events of awareness during major surgery under general anaesthesia, have prompted researchers to come up with new ways to measure consciousness to ensure we really are out for the count, when it counts.
Meet fEITER, a portable scanner that can project a real-time video of the brain’s activity as it slides into unconsciousness. Once anaesthetists understand exactly what this activity means, this new invention might help them to understand more about their patients’ awareness.

Unfortunately, there are only two of these scanners in the world and the scientists couldn’t spare one for a whole year for Pain Less.

But we have managed to get our object-handling gloves on one of these…

This is called a BIS monitor. I’ll leave it to our expert anaesthetist Andrew to explain:

‘This machine continuously records the electrical activity on the surface of the brain. It then analyses these “brain waves” using a mathematical formula to come up with a number that reflects the likelihood of the patient being conscious. Some anaesthetists use the monitor to adjust the dosage of anaesthetic drugs to keep their patient unconscious. Others are sceptical about how effective machines are at monitoring consciousness.’

I’ll be back soon with more stories of success (or disappointment) from the object quest.

Define the topic

Step one to create a new exhibition: define the topic.

Defining the topic is tricky. We started with anaesthesia, pain and consciousness – but that’s a huge area that spans a massive amount of research. It could fill a whole museum! We need to narrow it down, and pick the stories that grab the attention of our visitors and cover the very latest ground-breaking research.

So the first step is to research these topics. We partnered up with Andrew Morley, a consultant anaesthetist from Guy’s and St Thomas’ Hospital who, as part of this project, created a network of experts: scientists and researchers working at the cutting edge of research in pain, consciousness and anaesthesia.

With Andrew’s help we narrowed down this network to just over 60 leading experts. But this is still way too many research stories to fit into one exhibition. How do we select what to keep and what to leave out?

We turn to our two participatory groups: Year 9 students from Langley Academy, and a group of adult chronic pain sufferers. A handful of our leading experts came to meet the groups and to explain their research.

Of the three topics, ‘pain’ stands out as the most interesting for both Langley Academy and our adult group. How mood and emotion affect how we feel pain, the line between pleasure and pain, how we measure pain, and the emotional and psychological aspects of pain were the areas they engaged with most. Consciousness also prompted some lively discussion; do we really feel no pain when we’re unconscious, or do we simply not remember it?

The next step is probably the most challenging – to combine the new with the interesting to feature unforgettable stories that are newsworthy enough to entice our visitors to engage with the exhibition.

The ageing population is a massive issue that isn’t going to go away. Will new drugs be able to offer painless ageing? What are the implications of the mind-boggling, often pricey and potentially dangerous cocktails of drugs people take to overcome pain? Are we in danger of become addicted to pain medication? One in five people suffer with chronic pain. What about global medicine; how do those in developing countries cope without the expensive drugs?

The focus of the exhibition comes out of the following…

In the UK, on average we take 373 painkillers each year. They can be addictive or have side effects, so taking them isn’t great. But will the current research provide an alternative?

Our groups were fascinated with the idea of how personal pain is, how much it is governed by our mood, emotion and psychology, and why we all experience pain differently. How does the link between the brain and body influence the pain you feel? Will this understanding lead to a pain-free future?

Our experts and groups and some amazing individuals will help us to tell stories about this mind–body connection in our Pain Less exhibition.

Suzy’s loss…

A lot of great stories have to be thrown out when we define the topic of the exhibition. I asked Suzy Antoniw, the Head of Content, which was her favourite story that was lost – she had become very attached to some!

‘Did you know chilli can help numb pain? I didn’t until we started to research new pain treatments – apparently it’s very good at numbing painful nerve endings. Unfortunately we haven’t been able to feature it as a main content section because, while the molecule involved is very effective in the body, it has strong side effects in the brain. Our exhibition is all about how understanding the mind–body link is leading to new treatments – but the research in this area hasn’t quite managed to solve this mind/body problem yet. You never know, though, I may try and pop it back in when we write the in-depth content.’

So we now know what stories we want to tell. Hurray! Believe me, that was NOT a painless process (pun definitely intended). Next we need to get our hands on some great objects to bring the stories to life.