14 June 2020

The New Yorker: “The Neuroscience of Pain”

Without a reliable measure of pain, physicians are unable to standardize treatment, or accurately assess how successful a treatment has been. And, without a means by which to compare and quantify the dimensions of the phenomenon, pain itself has remained mysterious. The problem is circular: when I asked Tracey why pain has remained so resistant to objective description, she explained that its biology is poorly understood. Other basic sensory perceptions—touch, taste, sight, smell, hearing—have been traced to particular areas of the brain. We don’t have that for pain, she said. We still don’t know exactly how the brain constructs this experience that you absolutely, unarguably know hurts.

In 1991, a team at Massachusetts General Hospital, in Boston, showed its first, grainy video of a human visual cortex “lighting up” as the cortex turned impulses from the optic nerve into images. Captivated, Tracey applied for a postdoctoral fellowship at M.G.H., and began working there in 1994, using the MRI whenever she could. When Allen, at that time her boyfriend, visited from England one Valentine’s Day, she cancelled a trip they’d planned to New York to take advantage of an unexpected open slot on the scanner. Allen spent the evening lying inside the machine, bundled up to keep warm, while she gazed into his brain. He told me that he had intended to propose to Tracey that day, but saved the ring for another time.

Nicola Twilley

This last paragraph sounds like a scene straight out of The Big Bang Theory! On a more serious note, it is a fascinating article discovered as I was browsing The New Yorker after saving the other article I talked about previously today. They also fit together thematically, since both explore aspects of our minds and brains that have so far remained poorly understood.

Research into the neural patterns related to pain
Research is illuminating the neural patterns behind pain’s infinite variety. Illustration by Anna Parini

There were many regions with activity levels—the images looked almost as busy as the heat maps—but the blobs were subtly different in shape and location. In my brain, pain was shading into pleasure, and, curiously, many of the same regions were involved, activated in a slightly different pattern. There’s quite a lot still to be understood in terms of the relief side of this equation, Segerdahl said. He hesitated. It’s, like, I’m super interested in it, but I almost don’t want to touch it yet, because it’s the ultimate goal.

Tracey has been looking at pleasure for almost as long as she’s been studying pain. They are two sides of the same coin, she told me. Many signs of their interrelation crop up in her work. Chronic-pain patients typically also suffer from anhedonia—the inability to experience pleasure—and research suggests that their brains’ reward systems are wired slightly differently from those in other brains. Pain is naturally a more urgent research priority, given that most of us find it intolerable, but fully understanding it will require a better understanding of its opposite.

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